Category: health

What motivates me to fight for clean air in India

I have practiced clinical medicine and public health in India for over 20 years in a number of roles, including academic researcher, educator, corporate medical director, and patient-centered clinician.  In 2015, after six years of living and working full-time in New Delhi, I thought I had undertaken every precaution to keep my family healthy: pesticide- and hormone-free food, purified water, mosquito protection… you name it, I had probably investigated it and figured it out.

The one thing I completely neglected to protect against was the air pollution. In fact I was oblivious to India’s air pollution until, in our final month in New Delhi, my then 9-year old daughter required emergency room care for sudden-onset asthma attacks. Coincidentally, in that same month, the World Health Organization announced that New Delhi was the most air polluted city in the world.  We had no choice but to move away, not just for an upcoming job transfer, but simply to protect our children.

I was grateful that we were moving to live in clean air, but both professionally and personally, I felt I had left behind a huge problem, affecting everyone I knew and loved there. I could not let it go. I now travel to India every few months, in part to support a non-governmental organization that raises awareness and advocates to mitigate India’s air pollution crisis.

A few days ago, a young New Delhi-based reporter asked me for my “expert opinion” on how air pollution harms children in India. Here is an excerpt of what I wrote:

“Children born in air pollution face shorter life expectancies compared to their counterparts born in cleaner air… Children suffer physical health harms, including diminished lung growth and development, and increased prevalence and severity of pneumonia and asthma… [they] risk functional health harms including suboptimal cognitive development and sports performance. Air pollution is associated with depression, anxiety… and contributes to cancer and lifelong chronic diseases in adulthood including diabetes, cardiovascular disease, and dementia…”

These health facts are easy to summarize, but they do not convey the whole story.  What is more difficult to articulate is the stress and suffering that air pollution has created for millions of Indian people.  Including me.

I hate all the coughing. It starts within three days of my landing in New Delhi. Every friend is coughing or suffering some respiratory symptom. The plane is full of coughing passengers when I depart.

I cannot fully enjoy Diwali anymore.  I dread the futile arguments my friends and family will have with neighbors who insist it is their “right” to set off illegal firecrackers.  I dread the off the charts toxic air my friends and family will breathe in the subsequent weeks. I mourn the loss of elderly neighbors and relatives who have died of respiratory illness in the post-Diwali smog.

I hate that I discouraged my 75-year old father from visiting India for his elementary school reunion last November, because I was worried that the toxic air and ill-equipped health care system would seriously harm him.  

I feel sad for scheduling my children’s India visits only during the monsoon season, when the heavy rain reduces the air pollution. I feel guilty for limiting if and how long my children can play outside for those few weeks, knowing that their friends practice sports in worse air, every day.

Air pollution is not just a health problem harming our bodies. Air pollution compromises our moods, how we celebrate weddings and holidays, and how we live, work, play and travel. It is a crisis, affecting families just like mine, every single day.

Ultimately, for me, the only marker of success in this fight is India achieving clean air, for every person, every day.

I now know many of the experts and activists in India engaged in this fight, and I join forces with them.  We lack a sure path to clean air. Yet, we know that solving this crisis is entirely possible. Other countries have successfully cleaned up their air.  And Indian history has proven the country’s will and capacity to dramatically change.

India can and must overcome its air pollution crisis.  We have to believe it is possible, bring our skills to it, and keep at it. Not just life, but more importantly quality of life, is at stake, and worth fighting for.

by Gita Sinha MD MPH

a year in books

meeting my Goodreads goal of 35 books in a year was one of my most gratifying accomplishments of 2018

1. The Ministry of Utmost Happiness by Arundhati Roy

This book was recommended to me by my mom, and besides her suggestions usually being pretty solid, I was excited to start the year with a book written by an Indian woman. I loved it – it was equal parts personal, political, and historical, and an emotional and informative foray into the world of Delhi’s hijras. It can be emotionally draining/difficult to read at times, so I didn’t devour it the way I’ve devoured books in the past, but I’d definitely recommend this to anyone looking for a good read.

2. Killers of the Flower Moon: The Osage Murders and the Birth of the FBI by David Grann

This was one of the ‘hot’ books of the year, and for good reason. I love David Grann’s writing – he really brings out the “story” in “history” (cheesy, but true). More importantly, however, the book refocuses the lens of an important moment in history on the Osage community in a way that humanizes them and brings to light the brutality and hatred waged against them by the not only the white people in their community, but the US government as a whole. Killers of the Flower Moon focuses on a pretty particular part of our history, but that in an of itself serves as a telling indicator as to how and why indigenous peoples have been unjustly excluded from familiar narratives of American history.

3. A Criminal Defense by William L. Meyers Jr.

Sometimes you pick up a book for the sake of reading something and not wondering or worrying if it’s going to be good or not and this was one of those books – it was ok. Definitely not recommending it to anyone, but wouldn’t deter you from reading it either. Super quick read.

4. Animal Farm by George Orwell

A classic. I don’t know why we never read this in high school and I’ve been thinking about it for a while, but reading it now I feel like I got more out of it than I would’ve at the time. The whole dogma versus propaganda thing that comes out of the story is more relevant than ever.

5. Infinite Jest by David Foster Wallace

I can’t figure out why people like this book. I read way more than I should’ve honestly, and finally picked up the courage to abandon it (I literally never do that with books).

As much as I hated reading this book, there’s a Goodreads review of it that is perhaps the most iconic Goodreads review to ever exist, and the review itself is maybe a 20 minute read, but truly worth every minute. I cannot emphasize how good this review is, although I may be biased because it also validated a lot of what I felt while reading the actual book. Either way, it’s pretty fun to read. Here’s the link – https://bit.ly/2Qrfyeg

6. Exit West by Mohsin Hamid

After watching The Reluctant Fundamentalist (which has become one of my favorite movies of all time) I knew I had to read something by Mohsin Hamid ASAP and ended up ordering a copy of Exit West, mostly because it was most recently written and because I didn’t want to read The Reluctant Fundamentalist since I had just seen the movie (not the same, I know, this is just how my internal process of justification worked out).

Anyway, this is one of my favorite reads from this year. The story starts in Pakistan and slowly travels westward, following the main characters, Nadia and Saeed, as they’re driven out of their homes after war breaks out. At the center of everything is a relationship that reflects the experiences that Nadia and Saeed are forced into, but also goes through the same shit that relationships tend to have to go through even in the contexts we’re familiar with. So much of this story is relatable, and the way things progress and end is bittersweet and real. It’s not too long, and Hamid does a great job of packing just the right punch – never does it feel too contrived, but it never really feels like anything is lacking either – and this book is just so so good.

7. The Inner Courtyard by various Indian women

I liked this one! It’s a little more ‘rustic’ in a sense, and I can imagine that it might be more pleasurable for someone who knows and has grown up in Desi culture. I loved that the authors were chosen from a variety of different time periods and regions within India, and would totally have loved to have read more. Many of the stories were not originally written in English (we get to read translated works from languages like Urdu, Hindi, Bengali, Tamil, Kannada, Malayalam, etc.) and there’s a cultural intimacy there that you don’t get from a lot of modern Indian writers who write in English and therefore inevitably write with some degree of western influence. Highly recommend for anyone who is Desi or part of the diaspora, or for anyone who is interested in reading work by women that doesn’t feel colonized.

8. Creativity by Philippe Petit

White man obsessed with his own mind trying to impart wisdom. I regret picking this book up. Not worth discussing further.

9. The Early Stories of Truman Capote by Truman Capote

I am such a big fan of In Cold Blood, so when I saw this book in a bookstore I decided to pick it up. Honestly it’s quite a light read, but a very solid one too. A lot of the criticism I’ve seen about it is the fact that it feels super “freshman” (which, it was – Capote wrote these in his late teens/early twenties), but I actually love it because it paints a clearer picture of his evolution as a writer. Some of the stories can be a little cliche, but that never really struck me as a bad thing while I was reading it – overall, I enjoyed it.

10. Open City by Teju Cole

I LOVED this book. It’s not so much about a story playing out as it is about the protagonist reflecting on a things as his life happens – it’s like reading the personal journal of someone who’s really good at writing. I especially liked reading the conversations he has with the people he meets – particularly ones that make us think twice about how we assume certain systems of thinking and speaking, especially when it comes to conversations about society and politics, and a lot of times those assumptions ignore and/or forget to account for experiences that are not centered around the US.

A lot of Open City is poetic and slow and reflective, and it’s a great read for when you’re feeling quiet.

11. Educated by Tara Westover

PLEASE READ THIS BOOK. It’s wild to the point that I had to keep reminding myself that it was REAL. I devoured it in a day and I’m so sure you will too.

12. Moth Smoke by Mohsin Hamid

Moth Smoke was Mohsin Hamid’s first novel and reads a lot more like other works of South Asian fiction I’ve read in the past (compared to Exit West), but still stands out because of Hamid’s style of writing, which is always eloquent and beautiful but also still so relatable and never contrived or condescending. The main character is this guy who’s grown up with the elite of Pakistan but as an adult struggles more and more to identify/belong with the people he’s grown up with, which leads to a lot of self-destructive behaviors and decisions. It’s a quick read and can be equally appreciated by both Desis and non-Desis, I think.

If it wasn’t clear, I am 100% a Mohsin Hamid fan at this point.

13. Barracoon by Zora Neale Hurston

An absolute must-read. When I say must-read I mean you really must read it. It’s a first-person account from the last surviving person to have been brought over to America on a slave ship –not only is it a vital piece of history, it’s also shocking how much of this man’s story still resonates today. Especially to my fellow Americans – if there is a single book you read on this list, let it be this one.

14. A Clockwork Orange by Anthony Burgess

I actually did not like this book. I appreciate the story as a whole, but was gritting my teeth the whole way through. Aside from the violence being excessive, the Nadsat slang makes it almost unbearable to read.

15. The Wind Up Bird Chronicle by Haruki Murakami

My first Murakami and it was an EXPERIENCE in the absolute best way possible. Murakami’s writing style is an absolute delight and the story is simultaneously deeply reflective and whimsical (I guess a byproduct of the magical realism). The story itself was so beautiful and there was enough mystery and intrigue that I started, then kept reading till I was finished, then promptly order like four more Murakami books from Amazon.

16. The Curious Incident of the Dog In the Nighttime by Mark Haddon

A fast and fun read, told from the POV of a 15-year-old with autism. I guess I’d describe it as same vibes as ’Tuesdays with Morrie’ but not as sad, but also not really a happy story either. There’s a mystery at the center of the story, but it doesn’t take center stage, and I was okay with that because it was well-written and engaging. Apparently this was the author’s first time writing for an adult audience, and that makes sense to me when I look at the way the book was written. Overall not exceptional, but very enjoyable!

17. American Appetites by Joyce Carol Oates

I’ve been interested in reading something by JCO for a while and came across this book at a bookstore so I scooped it up. It was… ok. Actually, I think it was mostly well-written, but the characters – especially the protagonist – are ridiculously irritating and sometimes act outside the boundaries of reasonable human behavior, but like in the weirdest/most frustrating ways possible. Nevertheless I was interested enough to keep reading to the end… solidly confused re how I feel about this book.

18. Chanakya’s Chant by Ashwin Sanghi

Chanakya’s Chant is all around just a really good story. I’ve seen it described as a political thriller, which it very much is, but half of it, while still being a political thriller, is in the context of ancient Indian history, so it’s clearly a little more than that too. I’ve seen varying comments about whether or not it’s historically accurate, and I don’t know enough about Indian politics to see the parallels to recent politics, but all in all it’s entertaining.

19. The Outsider by Stephen King

Last year I started reading IT and ended up not sleeping two nights in a row and finishing the whole thing in three days, so I had high hopes for this one. It started off really well and I stayed up to finish it, but it just got more and more boring and ended in a way that was dull and anticlimactic.

20. Another Way of Telling by John Berger and Jean Mohr

So I’m not usually the type to read media theory for fun/without looking to get something out of it for creative purposes, but I saw this on sale at a local bookstore and recognized John Berger (shoutout to CAMS 101) and bought it impulsively. It’s honestly one of the best books I’ve ever read and I 100% intend to read it again, maybe in a few months. It’s incredible how principles discussed in the context of photography extend to a lot of the philosophical and sociopolitical questions that loom large today.

21. Girl Sleuth: Nancy Drew and the Women Who Created Her by Melanie Rehak

TBH I don’t even know why I read this book and don’t remember most of it, except that Wellesley is featured somewhat prominently, which is why I must have picked it up int he first place. Moving on….

22. The Bluest Eye by Toni Morrison

The last time I read this book was in high school but TBH the school I went to did such a bad job of teaching it that I wanted to re-read it to see if I would get something different out of it, especially since I also read Beloved for the first time a year prior and was blown away. I don’t know that I got something different out of it necessarily, but my reading of the book did feel more nuanced and richer because I was reading it for myself versus having my perception and reading of the book structured by a curriculum.

23. Square by Mac Barnett

My sister found this picture book at one of those fancy indie toy stores and picked it up as a birthday gift for a friends. She showed it to me before wrapping it up, and I was immediately taken with it – the illustrations are absolutely stunning and the story itself is both funny and philosophical. It’s the kind of children’s book that’s actually written for adults and it pulls off that whole shtick SO WELL.

24. Collected Short Fiction by V.S. Naipaul

Another book I picked up randomly in a bookstore on my quest to read more South Asian writers. It wasn’t until I brought it home and my mom said “oh, you’re reading VS Naipaul?” and I finally did some googling that I found out that he’s actually a really important writer in the Desi diaspora. Then a few weeks into reading the book, Obama announced he was also reading Naipaul so that was cool. Anyway, one of the reasons I love his Miguel Street stories (a series of stories that explore the lives of different people living in the same neighborhood in Trinidad) is their illustration of the inevitabilities of existing as brown/black people in a world that is colonized, without centering the colonizers. Naipaul tells the stories of brown people in the diaspora as it existed in places that are not India or America which was something I wasn’t familiar with.

The book was great and I really liked Naipaul’s writing, but it was hard to read in one sitting. In any case, I actually ended up being glad I split up reading the stories periodically because it was fun to come back to different stories with the same characters – it felt like revisiting an old neighborhood.

25. The Elephant Vanishes by Haruki Murakami

A great collection of short stories by Murakami. I wouldn’t consider this a Murakami primer, because there’s something about reading his novel that was missing from the collection as a whole, but if you like Murakami or you like short stories, I’d definitely recommend.

26. Pachinko by Min Jin Lee

I gobbled this book up, it is SO GOOD. It’s the intergenerational story of a family in Korea and the best description of it that I saw somewhere was that it is both fiction and a true story – though the characters themselves have been concocted, so much of the story was a reality for Koreans at the time. This was the most satisfying book I read this year, and is the kind of thing that everyone/anyone can enjoy reading, no matter what your tastes are. Fair warning though: this book reduced me to tears MULTIPLE times. Just writing about it makes me want to go back and read it again.

27. Half of a Yellow Sun by Chimamanda Ngozi Adichie

I…. shouldn’t have read this coming right off of Pachinko because it truly felt like a double whammy. The whole fiction-but-true-story thing can also be applied to this book, and even though I was emotionally exhausted reading this after Pachinko, it was actually also kind of cool reading them back-to-back because some of the themes are similar, and it was cool seeing that play out in two totally different cultural contexts/histories.

PS – If you read and liked this or Pachinko and want another similar read, I’d highly recommend checking out The Lowlands by Jhumpa Lahiri.

28. Triangle by Mac Barnett

Another book in the same series as Square and equally good.

29. While Mortals Sleep by Kurt Vonnegut

It’s always interesting when we go back and try to asses authors’ unpublished works. I’ve always held that Vonnegut was one of my favorite authors and I think that may have felt more positively about these stories as I otherwise might have? The stories are good, but not spectacular. But again, if you like Vonnegut or you just like short stories, I’d recommend it!

30. The Lost City of the Monkey God by Douglas Preston

If you’re like me and you spent your childhood daydreaming of going on adventures and reading about excavations of archaeological sites and all the legends that accompany them and mentally inserting yourself into Jurassic Park and playing games like Cluefinders (even though the educational part of it was way below your level) because you loved the adventure part of it  – you HAVE to read this book. You know how in adventure books/movies people have to pinch themselves to confirm that what they’re experiencing is real? That’s what reading this book is like.

Even if you are not the kind of crazed person I described above, you will enjoy this book. There is so much that the author covers – the adventure and archaeology of course, but also the science, the technology, the anthropology, the academic drama, the politics, the history, the ethics, even the epidemiology – and even my dad, who basically hates reading anything but books on economics, business, etc. , really liked it.

Such a huge shout-out to Douglas Preston for relaying the facts and his experiences in a way that is always exciting, well-researched, and refreshingly responsible.

31. The Remains of the Day by Kazuo Ishiguro

This book was also…. so good. It’s an innately powerful book that comments on our responsibility to ourselves and our future selves when it comes to making choices about how we live and how ignorant we are willing to be in the name of responsibility and ‘dignity’, and how ‘dignity’ means something essentially different based on our experiences, but also based on where we stand in life and what past, present, and future look like at that point. The whole thing is heartbreaking but also relatable and kind of cautionary and this is yet another book I cannot wait to read again. Also wow Ishiguro is such a skillful writer.

32. Circe by Madeline Miller

Loved this book – a super quick read and it gave me the same pleasure I used to get reading YA books (but this book is definitely not YA). If you like Greek mythology, you’ll definitely enjoy it.

33. Hey Ladies! by Michelle Markowitz and Caroline Moss

A year in the life of a gal group in NYC, as told through their emails and texts. It’s funny and light-hearted and easy to get through. I liked it a lot a the beginning and definitely felt called out at points and laughed at many others, but as it approached the end, the characters got a little too exaggerated which just made them annoying and got more boring to read it. I will not be recommending this book to anyone but I also wouldn’t deter anyone from reading it either.

34. Black Swans by Eve Babitz

In all honesty, I got this book because the cover looked cool. It was interesting because having done a little research on Eve Babitz before reading it, I found her as a person and her existence to be interesting. That said, I’m still trying to process how I feel about this book. I initially didn’t like it because a lot of it felt contrived and also ignorant and also super white (actually, super wealthy white which… you know). I don’t think my opinion on her writing itself has changed much, but I do find myself thinking of the stories often so I guess some part of it succeeded. It might also be because I work in entertainment and that whole world from a both a professional and non-professional perspective is so fascinating to me. Again, still trying to digest this one.

35. The Good Society by John Kenneth Galbraith

This was a small book but it took me months to finish. Not sure why because I really liked what I read when I read it, it was just that, for whatever reason, I could only manage to read two sentences at a time. JKG is good at taking concepts that are kind of common sense and reasoning them out and giving them more support and depth, which is what a lot of this book is. I’m not going to be touting it around everywhere, but if you’re interested in socioeconomics and making the world a better place, there’s a good chance you’d like this book.

by Lucky Bommireddy

Navaratri

It is the morning after several nights in a row. Nine nights, to be precise. The gods are carefully divested of their crowns and garlands, their long black tresses tied back with wispy cotton threads, packed into recycled plastic bags and put away in the big black trunk that holds the history of inter-continental crossings and multiple house-movings.

The living room reclaims its position as marginal to the life of the household- so maybe it is more correctly named the “(with)drawing room” (we don’t really live there, do we?)- after having served these ten days as a site of communing with friends and family from a variety of circles, many of whom we see only once or twice a year. But there’s a temporary void beneath the window where the steps stood, making space for the descent of the gods from the storage area off our terrace to the level of our everyday. It will take a couple of days before the mundane reasserts itself and the memory of green and blue-tinged bodies, and their other-wordly aura, fades. “The room seems so empty now,” my mother in law remarks after we’ve cleared the last of the festival paraphernalia.

Navaratri, like almost every other festival, brings up all kinds of ambivalent feelings in me. There is nostalgia, of course, for uncomplicated times and the innocence of childhood, where the only protests had to do with getting up early or having to take an oil bath or going around with the invitational kumkum bharani, exposing oneself to the curiosity of the neighborhood aunties who would comment on the length of one’s hair or the inadequate number of bangles on one’s wrist. But that was always made up for by the innumerable varieties of sundal and sweets that one was offered by those very same aunties. And I was also one of the fortunate few who was never asked to sing for my sundal, having deftly sidestepped those obligatory Carnatic music classes that most of my contemporaries in the Tam-Bram circle were privileged to attend. Much to my parents’ regret, I suspect (and truth be told, to my own as well).

Now that I’m an auntie myself (as my children often remind me when I show embarrassing signs of forgetting), and I am the one offering the sundal and sweets, not to speak of being the one who has to spend that extra time in the kitchen cooking it all up, the ten-day festival (even though it is technically nava-ratri or nine nights) represents not just the opportunity for silk and music but also… work. And that work, and everything it represents, is implicated in all sorts of politics that my academic self cannot ignore.

My friends who are more deeply rooted in the progressive academic discourse would have much more to say about this discomfort and its relationship to modernity but for now, I’d just like to lay out some of the contradictions that I am constantly trying to reconcile (and why one even needs to reconcile them is another question, for another time).

–how does one deal with the notion of the oppressive Brahminical without discarding everything that is beautiful and good in tradition?
–how does one hold on to the aesthetic aspects of culture while also refashioning the meanings held within the form(s)?
–in other words, how does one appropriate the form while discarding all that this very form may have represented in the past?
–how does one learn to take pleasure in the social and cultural opportunities that such festivals offer in a truly secular–and egalitarian–way?

Each year, I try to deal with these questions, sometimes subconsciously, as I put the bomma golutogether and make my list of people to invite and balance my time between the demands of work and the extended kitchen time. Many of the dolls that we display have a special meaning for my family; the main pieces were made by my mother in law over forty years ago, lovingly and painstakingly, and each time we bring them out is a chance for her to recall her younger, more agile self and take pleasure once again in the sense of crafting something. Each year, as we prepare the display, we listen to stories of the making of the dolls, the years the family spent in Shillong, the many people who came and saw and what they said. This invariably leads to conversations about other navaratris in other places, and my children (if they happen to be here) and I are treated to glimpses of the past which tend to stay buried the rest of the year as we go about our regular business. We remember people who have turned into faded faces in our photo albums, and get a sense of what life was like before modern telecommunications.

So clearly, the sense of ambivalence also derives from another sort of nostalgia, for the loss of neighborhood, of the ease of getting around, of dispersed families, of a calendar that respected the personal and the familial and recognized the need for a periodic slowing down of the professional. The days leading up to the festival, I’m anxious and nervous about managing things, and I allow a resentment to build up, telling myself that I am only meeting expectations, that I am doing things that are not part of my modern-liberal psyche. But that’s only partly true. I am myself loath to give up the practice, because it is tied up with so much that I value and respect, with so much that–when I allow myself–I truly take pleasure in.

And in the doing of things, in the ritual of setting up the display, the resentment fades. While those questions and contradictions remain, I set them aside for another time, another space, another context.

by Usha Raman

“Cancer? Yes, obesity causes cancer!”

“Being overweight is not good for you, you can get diabetes or have heart disease”. This is something we all hear frequently and know for a fact. What we don’t hear and many of us don’t know is that being overweight and obese also causes cancer! Yes, that disease that we all fear CANCER. In fact, it can cause up to thirteen different types of cancer. This includes cancers with some of the worst outcomes like oesophageal and pancreatic and those linked to reproductive organs like womb and ovarian.  This is in addition to the risk from diabetes and heart disease that we are all familiar with. With obesity levels rising globally it is currently the second biggest cause of preventable cancers after tobacco use and we must do more to reduce rates. 

The way that obesity and extra weight can cause cancer can be considered complex but as the diagram shows very simply, the extra fat cells are active and lead to an excess production of hormones and growth factors.  These in turn stimulate key cells to divide increasing the risk of mutation and cancer cells being produced.  It is the mutation through cell division that leads to a cancer cell in the body that rapidly divides to form a tumor.

There are many factors that contribute to obesity but we know that the best way to reduce your weight to a healthy body mass index (Height cm/Weight kg; 18.5-24.9) is to eat healthily and reduce the amount of foods that are high in fats sugars and salt (HFSS).

Currently the evidence shows the link between obesity and cancer in adults BUT we do know that if a child is overweight and obese, they are 5 times more than likely to become an overweight adult with an increased cancer risk, in addition to the risk of diabetes and heart disease.  All have high associated health costs. Knowing this it is vital that we do more to support children to eat healthy.

There are many things around us that constantly tempt and encourage us all but especially children, to see, want and buy these HFSS foods – from marketing to price promotions.  Research from Cancer Research UK has shown that for every extra broadcast advert a child watches a week they are likely to consume an extra 350 calories/week!!

Obesity rates are rising globally and if we don’t do anything it will overtake smoking as the leading cause of cancer.  It has a large health risk associated with it financially, physically and mentally and we must do more to prevent it.  Raising our awareness of the health risk posed from obesity is a start and combined with doing more to reduce the increasingly “obesogenic” (obesity friendly) environment we are living in, we can start to hopefully turn this epidemic around.

References:

Brown KF, Rumgay H, Dunlop C, et al. Thefraction of cancer attributable to modifiable risk factors in England, Wales,Scotland, Northern Ireland, and the United Kingdom in 2015. British Journal ofCancer 2018; 118(8): 1130-41.

https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/obesity-weight-and-cancer/does-obesity-cause-cancer#Obesity0

“Under Pressure: New evidence on youngpeople’s broadcast marketing exposure in the UK”. 2018. Christopher Thomas,Lucie Hooper, Gillian Rosenberg, Fiona Thomas, Jyotsna Vohra. https://www.cancerresearchuk.org/sites/default/files/under_pressure.pdf

by Jyotsna Vohra PhD

Children and Media- Young Children

From interactions with my patients and their families, I am increasingly concerned about the impact of digital media on our children who are growing up in environments saturated with technology. I had the mother of a two-year-old patient insist he was getting his “own” tablet as a present, and she became very upset when I cautioned her about the impact of unsupervised use of media. She insisted that she only used educational programs and that her child would be “left behind” if she did not buy him a device. The American Academy of Pediatrics (AAP), the American Psychological Association, (APA), Common Sense Media and many other experts and organizations have expressed concern about this issue as well. This is true in the United States and also in developing countries, like India. Child psychologist Dr. Malavika Kapur states: “Based on field and clinical experience, psychodynamic and behavioral theories and most of all from a developmental perspective,…indiscriminate viewing of visual media, especially with violent content, interferes with normal development.” The people who sell us this technology are themselves concerned and are limiting or banning their own children from using these devices. Concerned parents in Silicon Valley even have their nannies sign contracts so their children are not exposed to “screens.”

So what do we do? The following is a summary of the expert recommendations with my own comments and opinions as a pediatrician who has worked in general practice and in the academic world and as a parent. I use the word “media” to include all kinds including digital (computers, tablets, smartphones, educational computer toys), as well as TV and videos.

Young children are particularly vulnerable to exposure to media and devices as this is a crucial period of brain development. I had a parent proudly tell me that their child’s first word was “Alexa”, but I’d really prefer Mama or Dada to be that first word. Children two and younger need to explore with their hands and interact with trusted adults (parents, babysitters, daycare providers) to develop language, physical, social, emotional and other skills. Any use of media should be with parents who watch with them, reteach and reinforce its messages with them. They simply do not have the ability to learn from digital media as opposed to human interactions. An exception might be made for using video chat (Skype, Facetime, WhatsApp) to talk to family in other states and countries.  These programs are wonderful for grandparents and so long as parents are there to help interpret what’s going on, this is okay although it’s not a substitute for a real-life grandparent.

For children who are between the ages of 3-5 years, it’s tempting to use media to get a break from all that energy and maybe get some laundry done. When my children were little, they watched Sesame Street, Mr. Rogers, and Thomas the Tank Engine. They later moved on to dinosaurs and nature-related shows and documentaries. I think it’s important to recognize that while this is “down time” for both the kids and parents, try to be “present” during this time so you can chat about the content. Parents often try to pick educational programs, and some programs like Sesame Street are known to have some beneficial outcomes. I think it’s important to recognize that as parents, we are allowed to take breaks; however, many apps and shows that are supposed to be “educational” are really focused on rote academic skills. At these ages, parent-child interaction and unstructured social play are still critical to developing important thinking and social skills which toddlers lack, including impulse control, emotional regulation, creativity, and task persistence. Excessive TV watching at this age has been associated with cognitive, social, emotional and language delays. Additionally, excessive media use during preschool years is associated with increased risk for obesity possibly related to food-related ads, decreased physical activity and watching TV while eating/ snacking, which, as we all know, makes for “mindless overeating.” Excessive media use has been associated with decreased sleep even in infants, maybe from the screens’ “blue light” and the content watched.

Content is so important. I have had patients who were “expelled” from daycare for hitting and hurting other children. While some children are more “physical” than others, I often find that many of these children have been watching inappropriate or violent content. A patient of mine would sit on her parent’s lap while the parent played “Call of Duty”. She regularly hit children and was asked not to return to daycare. I think it’s preferable to watch media with your child but unquestionably something gentler.

There are times when parents use media to soothe a child, for example, during a plane flight or a doctor’s office visit. That’s not unreasonable and is sometimes necessary, but it is also important for children to learn how to regulate their emotions and soothe themselves. Boredom is not a bad thing and is known to stimulate creativity.

It’s not just the kids. Parent media use also decreases parent-child interactions. And parents who use devices heavily have kids who do.

The AAP recommends “…time limitations on digital media use for children 2 to 5 years to no more than 1 hour per day to allow children ample time to engage in other activities important to their health and development and to establish media viewing habits associated with lower risk of obesity later in life. In addition, encouraging parents to change to educational and prosocial content and engage with their children around technology will allow children to reap the most benefit from what they view.”

In summary (Adapted from AAP)

  • For children younger than 18 months, limit media use other than video-chatting.
  • Do not feel pressured to introduce technology early; children will figure them out quickly once they need to.
  • For parents of children 18 to 24 months of age who want to introduce digital media- choose high-quality programming/apps and use them together (co-view) with children, because this is how toddlers learn best. Letting children use media by themselves should be avoided. Use only quality products (eg, Common Sense Media, PBS Kids, Sesame Workshop).
  • In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Co-view to promote enhanced learning, greater interaction, and limit setting. Help children understand what they are seeing, and help them apply what they learn to the world around them.
  • Avoid fast-paced programs (young children do not understand them as well), apps with lots of distracting content, and any violent content.
  • Turn off televisions and other devices when not in use.
  • Monitor children’s media content and what apps are used or downloaded. Test apps before the child uses them, play together and ask the child what he or she thinks about the app.
  • Keep bedrooms, mealtimes, and parent-child playtimes screen free for children and parents. Parents can set a “do not disturb” option on their own phones during these times.
  • No screens 1 hour before bedtime, and remove devices from bedrooms before bed.
  • Try not to use media as a calming device unless absolutely necessary (we have all been there with a screaming child); work on setting limits, finding alternate activities, and other ways to calm children. See references below for ideas on how to implement these.

Resources and References

  1. AAP Statement- Media and Young Minds- Council on Communications and Media: Http://pediatrics.aappublications.org/content/138/5/e20162591
  2. For parent resources on finding appropriate content, ideas and how parents can limit their own media use: https://tinyurl.com/nrcwvdv
  3. Developing a Family Media Use Plan: https://tinyurl.com/hv3bh48
  4. https://www.commonsensemedia.org
  5. https://www.apa.org/topics/kids-media/
  6. A Dark Consensus About Screens and Kids Begins to Emerge in Silicon Valley https://tinyurl.com/y49jm6zj
  7. Let Children Get Bored Again by Pamela Paul: https://www.google.com/amp/s/www.nytimes.com/2019/02/02/opinion/sunday/children-bored.amp.html
  8. What’s the Hurry? Let Children be Children by Malavika Kapur: https://tinyurl.com/yy76bovh
  9. Silicon Valley Nannies Are Phone Police for Kids https://tinyurl.com/ybure8an
-Svapna Sabnis

Aircraft or the body?

When you take up a big task or a project which is going to take up your mental and physical time, you should be discreet about how you use your energy. Viveka means to be aware and take steps to wisely use the resources. But what are the resources and where are they located? They are the mind, body, the physical space around you, the breath and sleep. These are all connected. How are these connected?


If you are sleep deprived, how will be the state of the situation?
How is your mind when the food you eat is either less or more?
How is breath connected with energy? One question leads to another and you see there is a pattern to this connection.


Let’s look at each of the resources individually and as we do that let’s use the analogy of an aircraft to represent the physical body. There are all kinds of aircraft and different levels of care that is required for each of them. The level of care and caution that is given to a two seater, a passenger aircraft and a fighter plane is different based of the use they have. Whatever be the type and need of the machine, we give it the fuel that it needs in the right quantity and right quality.

You don’t substitute diesel for petrol or you don’t put extra fuel in a two seater because you fancy it moving faster- you cannot do that. Similarly, we give our body the right quantity and quality of food. Not too much not too less.

Taste has types, tamasic, rajasic or sattvic.

Rajasic taste is when you eat for taste alone and hence don’t know when to stop. Sattvic taste satiates the mind and body. The food nourishes the body and makes it available for optimum use. Sattvic food keeps the body free from disease and dullness, the less the digestive system has to process the better it is for the physical body which will be available for a variety of endeavors. Food then is one of the resource.

Sleeping recharges our cells and calms the nervous system. With too much sleep and with too little sleep we are not giving our best. An over used aircraft and an aircraft rotting in the hanger, both are not of any use.

There is no fixed standard measure of time that one must sleep. Each body is different and has different sleep requirements. We need to strike our own balance.

Breath, is addressed last with a definite purpose. It is the link between the body and mind; memory and intellect. It’s like a kite and a thread, the kite is controlled by the string and we use our breath to navigate our mind. Keeping the connection with the body to the mind, via the breath is what keeps a balance. Moving away from the roots or disconnecting due to the changes in the breath, causes immense pain in body and mind and reduces our capacity to give our best.

The practice of yogasanas and meditation brings in the balance. Using the aircraft well and giving them a rest in the hangar make for a long lasting and productive machine. Living wisely leads to high productivity, you don’t fall ill often. You don’t feel sluggish when you are expected to be giving your best.

With a little effort in maintaining the breath, to bring the mind to the NOW, to come back to the source is meditation

by Meena Waghray

Children and Media -Screens in Teens

At first, it was insidious. I would be at a restaurant with my family and I would see another family dining nearby. The children were using some kind of device, maybe a GameBoy to occupy them before their meal arrived. I noticed that the adults were able to have a real conversation. It was tempting to consider getting such devices for my kids as well as we dealt with children who interrupted our talk and demanded our attention- like normal children would. Growing up, I was a voracious reader, and I remember my mom making me put my books away and insisting I join the conversation at dinner. So I persisted with the rule for my children- no books or screens at the dining table.

I never had any absolute rules on computers and video games. Things were negotiable if a reasonable argument could be made. My older son made it easier on me by preferring being outdoors to video games. Luckily for me, he set a precedent and my younger son didn’t realize he could have asked us for a game system.

Now it seems like the devices at dinner time are ubiquitous, and it’s not just the children anymore. Everyone is checking their social media, texting their friends, catching up on the news and seemingly going out of their way to avoid human connection and conversation. I’ve seen kids connect by looking at each other’s social media accounts and comments they receive. That’s the entire conversation! They are often sitting in the same room texting each other instead of talking or playing, or maybe texting someone else because they don’t care to spend time with the person they are with. I find that incredibly rude, and yet  I catch myself fishing my phone out to check something non-urgent when I’m with friends. I avoided social media for a long time, but I recently succumbed to Instagram, mostly to keep up with my talented artist friends. I love seeing what they are up to and sharing my own amateur watercolors. I discovered that my niece who lives in another state is an incredible artist. Although I really signed up to see what others were creating, I suddenly find myself checking on whether people are commenting on my posts.

Don’t get me wrong, I love being able to look things up whenever I need to, read my newspapers, do my crosswords, play words with friends, check my email. I can even put in prescriptions for my patients on my phone.

My 16-year-old uses his phone to keep in contact with his friends, play games, browse some social media but also to do school-related activities. The lines are blurred between work and fun. I bought him a flip phone in sixth grade and a smartphone in eighth grade. With the smartphone came new rules (responsible use, parent access to his phone and any social media). Phones can be used to play games that are fun, entertaining, educational or destructive. I have preteen patients develop sleep problems because they won’t (or cannot) stop using the phone or playing video games. I’ve read that kids have shadow social media accounts that their parents follow, and real accounts that their parents don’t know about.  I’ve read that one can hide porn behind the seemingly innocent Calculator app. Kids have always known how to fool their parents. At some point, you have to throw your hands up and hope that you taught them well. But every child’s maturity level is different. Smartphones can be dangerous in the hands of an immature, impulsive child. It can be used to bully, threaten, intimidate, access porn, post inappropriate selfies or pictures of others, destroy a reputation, or ruin a young life. I had patients (really all girls) who shared nude pictures of themselves with boys which were then forwarded to the boyfriend’s friends. The girls were traumatized, grades plummeted, and they became anxious and depressed.

Smartphones are incredibly convenient and frighteningly addictive. And we put them in the hands of young people who have not yet learned to moderate their impulses. We wouldn’t give them unrestricted access to alcohol, drugs or cigarettes, would we?

Pandora’s box has been opened! We can use our phones for good and for evil. As adults let’s put our own oxygen masks on first, examine our own use of media, and then help our kids have better balance. Let’s get them back in the yard with their friends, balance the screen time with outdoor time. Maybe some star gazing, a hike, have real adventures.

For American Academy of Pediatrics guidelines on Children and Media https://tinyurl.com/y95q9w4c

And if you really want to learn about the importance of play in children’s lives I recommend Malavika Kapur’s book “What’s the Hurry? Let Children be Children”. Disclaimer- she is my mom. https://tinyurl.com/ycx97ke3

http://Other interesting articles https://www.nytimes.com/2018/10/26/style/phones-children-silicon-valley.html https://www.nytimes.com/2018/10/26/style/digital-divide-screens-schools.html https://www.nytimes.com/2018/09/20/business/media/google-youtube-children-data.html

https://www.theatlantic.com/magazine/archive/2018/11/raised-by-youtube/570838/

https://www.theatlantic.com/magazine/archive/2018/07/the-dangers-of-distracted-parenting/561752/

https://www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013

by Svapna Sabnis

One round of sadhana or practice

You start your day on a beautiful note, you are already happy because this is your time and not anyone else’s. Everyone can wait because it is 4.30 in the morning and the whole world around you is asleep. Nobody is likely to wake up, you know that for sure. For a yogi, it is very important that you are on your own, just for some time, so that you can enjoy the time with everyone around you later. You don’t want to be alone all the time!

So what do we do and how does it start? You take the yoga mat and get ready. You stand on the mat and you are thinking, what do I do? Do I do the Surya Namaskar today or a full stretch or do I do my own personal sequence? That confusion is going on in the mind and you are debating and enjoying the debate and finally you decide. And as you are doing it, you are moving your body, you are doing your warm up. Once the warm up is over, the body is naturally flowing into a comfortable rhythm of stretches. The hands automatically go up, the shoulders go up, the feet are firm on the ground and your attention is on your breath, eyes are closed and you decide- today you decide that the plan is to stay in the asanas- so you start with the Surya Namaskar.

Everyday you can decide to do something. You can do a lot of asanas one day or you decide to focus on the breath or you only move the body slowly. You will decide sometimes that to go deep into the posture or sometimes you may not be well, and have a pain or a catch somewhere and you decide to focus on that for a few minutes, dwell on that and see where it goes. Each day is a new decision on the yoga mat. The unfolding of the mat is a new story and what the body does, the mind helps out- it is far from a rote mechanism.

You start breathing, you start listening to the silent sounds around you. Actually, there are no sounds at this time in the morning, apart from one or two stray vehicles moving on the road. Your practice is going on and it’s almost like 10-15 minutes of asanas, stretches with deepening them and enjoying on the mat.

From far away, you start hearing a familiar sound which says it is that time. It is almost a quarter to five now because the birds wake up at this time. This is your company every morning, these are all familiar people to you, you are aware of these sounds. You are aware of your breath, aware of your body. You take deep breaths and continue into your asanas, continue into the movement. Something makes you continue in the asanas, you recall how you saw this person do this complicated stretch and say let me give it a try. Let me get into this complicated version of the pigeon pose and you try to get into it, you get it right on the right side of the body and not on the left side of the body- it is okay to do that. It probably needs a little more practice- it will happen eventually.

With that in mind, some happiness is swelling over within you already, some peace is turning within you and you are enjoying that. You are enjoying that your breath is becoming easier, body is becoming lighter. Now you want to sit and do the pranayam, the breathing excercises. You sit, absorb the effect of the asanas and allow the body to meditate for a few minutes, maybe 4-5 minutes then start the pranayams. You get into vajrasana, and do the first stage of pranayam with the awareness of the Ujjayi breath, slow and sure. You remind yourself that you will be doing the pranayams like a warrior. The pranayams, one by one, make you more calm and soft in the mind. Now you are done with the pranayam, you do the Sudarshan Kriya. You take a decision that you will do the Kriya like it is the first time you are doing it.

You become aware of the sohums, the in-breaths and the out-breaths. The patterns, the counts and you are lost in them and then you have reached the last round and you close your eyes and just sit. So many thoughts would have been going on all the time, so much planning going on all the time in the mind since the moment you started to climb on the mat. Now it has all vanished, it is just silent. You are aware of the birds chirping but something in the mind is silent. Very silent and calm. You don’t know how much time you spent sitting after the Kriya and meditation, but you know for sure there is no rush, nothing to rush about. There is plenty of time. Everything will be rushed during the day but this cannot be rushed. Slowly you get up, you open your eyes. A chant is forming on the lips- what is that? You say the chants, and again for a minute or two, you absorb the sounds of the chants and feel a burst of energy inside you. As if you can conquer anything, the assurance that nothing is impossible. And that calm is going to see you through the day, is going to see you through many days to come. And that is nothing but the high energy that the pranayam brings, the warm up and yoga brings. You feel the energy- it is a strange feeling but people who do this everyday, feel this. You feel new again. And this is the one round of sadhana or practice.

by Meena Waghray


food rules

We all love to change the traditional ways of making food but what we don’t expect is that we are introducing new elements in the game of food. Food is chemistry and what we do to it has repercussions to the end product and to our health. However, it is fun to experiment and to explore creative foods and ideas. The problem is that traditional recipes come to us with rules and restrictions and we need to know when and why to make changes to them. Or not. Like cooking spinach with a fat and an acid to make sure the iron is absorbed in the body- something that I did on a regular basis. So this changed when I put spinach in a smoothie with a banana and yogurt. There was no fat or acid added. Spinach, a green micro-nutrient was a total loss to my system and to the process of setting up a new routine.

And consider dal or lentils.

A nutritionist I follow on instagram gave me some details on lentils. She posted about the lentil cheela with lots of vegetables and that got me thinking to how when my father suffered with kidney and liver problems and the doctor suggested eating less toor dal or any dal (lentil). He was a mid-life teetotaler, so alcohol was not the reason. The nutritionist said this about the dal intake- “…Ayurveda has already prescribed ways to prevent the ill effects of lentils. Think about our dal ka tadka with asfoetida, garlic, cumin and chillies or sambar that is made with tamarind and a tadka or the various fermented lentil preparations. The oxalates and purines in lentils are associated with oxalate type stones in kidney but if lentils are cooked according to Ayurveda prescribed ways and one consumes enough water, there is no need to worry.”

Thank you Sangeetha Khanna for this, and I would suggest you follow her blog and posts for more interesting information on food and nutrition guidance.

memory and nostalgia

Memory, nostalgia are a part of food.

One of the socio-psychological infrastructure of a community is it’s food practices and rituals. The rituals, mores related to it, have a binding quality. At the same time these are the reason for oppression in many ways. But how are they oppressive? Lets break it down in a way where one can dissect and examine it.

Food is an integral part of a life as it provides the nutrition needed but also a social fact wherein it is consumed in an environment that has the companions, significant others that participate in the process. If the food is bought, it has a easy albeit a monetary value but is also a matter of affordability and can be seen in two ways. If you can afford to buy optimal, nutritious and good food, then you belong to the high income economic bracket. If you are unable to buy it but instead buy sub-optimal, low on nutrition, cheap food then you belong to the low income category. There are variations to this which can be explained but that is another write-up.

Food interrupts lives on a daily basis and this interruption is something of an ongoing challenge. It is in a sense oppressive as one is always having to think of food for the self, for the offspring and maybe a partner if that is available. First it is in this sense about tastes, likes and dislikes of all the people mentioned second it is about tradition that may or may not be healthy and third, it is about preparation- which is all work with a set agenda. This is an interruption because it keeps one away from engaging in otherwise useful pursuits. (And yes, there is an argument to be made for making this interruption a useful pursuit in and of itself).

Some of the tropes that come to mind, growing are stories around food, festivals, rituals, ways of life that are still the binding factor for families and communities.

Food is about the nostalgia and at the same time a battleground for oppression.