Though people have children all the time, when I went through it it was still astonishing. Even in the merely supporting/cheerleading role of the father, I can’t remember ever experiencing anything quite as frightening and, in the end, exhilarating. The everyday can still be mindblowing, when it happens to you: giving birth to a child is still difficult, painful (even with local anesthesia), and dangerous. So many things could go wrong, and yet somehow they don’t, most of the time. And at the end of the day you have in your hands the most uncanny result of all: new life.

In a way I was lucky that S. went into labor last Friday, before I came across the latest issue of the New Yorker, with a typically excellent Atul Gawande piece on the evolution of obstetric medicine. In effect, the story Gawande tells isn’t really an alarming one, though it still might have filled my mind with thoughts better avoided. Childbirth in the U.S. has become fairly safe over the years (though the threat of infant mortality and maternal mortality is still real). But what is a bit disturbing is that until fairly recently so many women (1 in 100) and newborns (1 in 30) died going through this. Interestingly, it was a woman doctor named Virginia Apgar who formulated a rating system (the Apgar scale) which gave doctors a set of criteria by which to evaluate newborns who seemed a bit iffey immediately after delivery. According to Gawande, the Apgar scale has dramatically reduced the infant mortality rate and revolutionized neo-natal care. The procedure that has made the difference with maternal mortality is the modern Caesarian section:

In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred) —- and a hundred and twenty thousand newborns (instead of one-sixth that number). (link)

It’s worth noting that there are disparities along racial and ethnic lines; infant mortality rates for African Americans and Native Americans are appreciably higher than for other groups. The statistics in India aren’t quite as good, though they have also improved dramatically in recent years. Continue reading →

In recent weeks, what is fast looking like an epidemic of dengue fever has been spreading in different parts of India. Delhi is over 600 reported cases, with 16 fatalities; Kerala has over 700 cases; Gujarat, 200; West Bengal, 300. At India’s top hospital, the All India Institute of Medical Sciences (AIIMS), one medical student has died and 20 nurses are infected. In today’s news, it appears that two of the grandsons of Prime Minister Manmohan Singh have also contracted the disease and have been admitted to the hospital.

Dengue fever, you ask?

Here’s the scoop. It’s transmitted by mosquitoes: not the Anopheles, which carries malaria, but the Aedes — especially the Aedes aegypti, which the Centers for Disease Control (CDC) describe as a “domestic, day-biting mosquito that prefers to feed on humans.” There are two strains of dengue. Regular dengue fever (DF) produces fever, headache, back ache, joint pains, nausea, eye pain and rash. Dengue hemorragic fever (DHF) is nastier and potentially deadly:

Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected.

There is no vaccine and no specific medication for dengue. Cases of DHF in particular require rapid hospitalization and fluid replacement therapy for the patient to pull through. This requires, obviously, a medical infrastructure that permits rapid hospitalization, not to mention hygienic hospital conditions, never a given anywhere in the world.

Mosquitoes are the only vector of the disease, meaning that anyone who contracts it in a hospital environment likely did so from mosquitoes hanging out there. The best way to prevent dengue, therefore, is to reduce mosquito breeding opportunities and infestation settings like standing water. In the immediate, the authorities in Delhi (and presumably other places as well) are carrying out a fumigation campagn with pesticides. At the same time, it seems that the country was also insufficiently prepared to deal with a disease that has been endemic for a long time.

The spread of dengue — as well as chikungunya, which has now killed 71 people in Kerala — comes at a time when health experts are revising their longtime opposition to DDT. The WHO has lifted its ban on DDT, and the US government also supports wider use of the once-dreaded chemical. This is controversial, obviously; this article, for example, makes the opposing case.

Dengue has been spreading worldwide as the Aedes mosquito makes itself at home in more and more places. Here is a map that shows the reinfestation of Aedes in the Americas since 1970. As a side note, there is also a hip band out of Los Angeles called Dengue Fever. They play a blend of psychedelic rock and Cambodian pop. Continue reading →

There’s a big article in the New York Times today about diabetes in India (thanks, Gitanjali and Builder). It’s impressive partly because of some surprising statistics given about the spread of both obesity and diabetes in India, and because of some touching individual interviews that illustrate some of the particular difficulties faced by Indians dealing with the disease.

I would recommend people go read the article, but here’s a summary of some of the stats I found notable:

• There are probably about 35 million people in India with Type 2 Diabetes (adult Diabetes) now. In a few years, there could be as many as 75 million. The current rate is 6 percent of adults have the disease, but that number is higher in Indian cities (in Chennai, Kleinfield reports, 16 percent of adults have Diabetes).
  
• Even middle-class Indians tend to remain uninsured, so Diabetes can be a financially crippling disease.
  
• Indians are genetically predisposed to contract Type 2 Diabetes, and they tend to get it 10 years before people in other parts of the world get it. (Which means, the danger is also high for NRIs; apparently this has already been observed with the earlier generation of immigrants)
  
• One of the biggest dangers in India in particular is that Diabetes, which leads to loss of sensation in the legs, often results in infections that can end in leg amputations. Since so many people go barefoot in India (even occasionally: as in, when visiting temples), the risk of foot and leg infections is much higher than in the west.
  
• In the world as a whole, there are now more people who are overweight than undernourished.
  

Any thoughts on this article, or recommendations for other things to read that will educate people on the danger of diabetes in the Indian subcontinent? I did find the tone a little irritating at some moments (“Diabetes — the dark side of India’s success”), but the research and the personal interviews were very informative. Continue reading →

The FDA has recently approved two drugs that will have a huge impact to the desi woman community; a) earlier this summer, the approval of the cervical cancer vaccine (or known as the HPV vaccine) and b) last week the approval of Plan B, the emergency contraceptive, as an over the counter drug for anyone over the age of 18. I think that both of these are huge landmark moments for the advancement of reproductive justice in our community.

According to a policy brief distributed by the National Asian Pacific Women’s Forum (NAPAWF)…

The vaccine, Gardasil, is 100% effective in preventing the infection of human papillomavirus (HPV) which causes 70% of all cervical cancer cases worldwide. The FDA approved the vaccine for safe use among girls and women ages 9-26. Asian Pacific Islander (API) women will greatly benefit from this new HPV vaccine, given their high rates of cervical cancer, particularly among Vietnamese and Korean women.

In fact, in the U.S. cervical cancer is relatively rare. For many API women, however, lack of health insurance, lack of knowledge about Pap smears and preventive care, and lack of culturally and linguistically appropriate services prevent them from equally accessing the health care system, contributing to their higher rates of cervical cancer.

Although abstinence or faithful lifelong monogamy are the only real full-proof ways to protect against HPV infection, these may not be realistic. Regular Pap smears are perhaps one of the most effective measures to protect oneself against developing cervical cancer. Because HPV is sexually transmitted, experts argue that the vaccine should be administered before adolescents have their first sexual encounter.

To me, it feels like an enormous injustice to know that a disproportionate amount of women in my community will have a higher chance of getting a preventable cancer because of the social stigmas attached to sex in our society, especially as a South Asian American female. When I ecstatically announced the FDAs approval to my mother and declared the need to get all the girls in our extended family here vaccinated, I was met with a, “Isn’t HPV sexually contracted? Why would we need to vaccinate then?” I didn’t really know how to respond to her. Social stigma of sexuality in our community as a form of birth control and cancer prevention will only take us so far.

Continue reading →

Last week Toronto played host to the 16th International AIDS conference, a biennial summit that brings together HIV professionals, philanthropists, politicians, artists, writers and victims from all walks of life. It was a week of solidarity, hope and action through future thought for the 30, 000 participants representing the close to 40 million living with the infection/disease today and those 25 million who have died as a result of it. The theme for AIDS 06 was “Time to Deliver”, they should have added a “Now” at the end of that…

Two news items relating to the twin weapons of prevention and cure require mention here while at least two G-8 governments require a duo of tight slaps.

First up, courtesy of a great post on Pass the Roti (Thanks, Ennis!) we have details of a Bangladeshi group ‘Durjoy Nari Shangha’ having to close down sex-worker aid and education centers in Dhaka in order to keep in accord with US funding conditions:

The sex workers collective — its name translates roughly as “organization of women who are hard to repress” — had 20 drop-in centers before December, offering sex and literacy education as well as moral support, toilets and a place to wash and rest for up to 5,000 women. It closed them after signing what aid groups call the “prostitution loyalty oath” that requires groups receiving USAID funding to have a policy opposing prostitution and sex trafficking. The group now has just four centers, geared to children and children’s rights. Bagum said that before the centers closed, the group sold 73,000 condoms a month. That has fallen to 30,000, even though health experts agree that condoms are the best way of stopping the spread of AIDS.[Link]

Continue reading →