sanjay nagral
@sanjaynagral
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Surgeon, writer. Bio & writings on
Mumbai, India
Joined March 2010
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Nurses & doctors in a dedicated covid icu in a Mumbai hospital after successfully taking a patient of the ventilator. It was the patients wife’s birthday & he spoke to her on a video call within minutes of extubation.
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A covid patient who was ventilated in a mumbai pvt hospital has recovered & been discharged. Great news. Good for him & his family. PS : the bill Rs 12 lakhs paid by his employer.
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I was witness to another act of solidarity & compassion from the Karkare family. Kavita , Hemant Karkare’s wife passed away in 2014 from brain haemorrhage. Her children donated all her organs which were transplanted to give life to many fortunate individuals. True nationalists.
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In case u r wondering why so many Indian students travel all the way to Ukraine (or Russia/ China) for med degrees? 1 Fees r lower than Indian pvt med colleges 2 teaching/training seems better. Several hav worked with us as interns & their edu is more well rounded
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Thanks after u r done with this try another challenge. A few mins from ur house is a municipal covid hospital called Bandra bhabha where pts are pouring in & health workers are struggling for ppes. Help them. Can connect u to the hospitals in charge.
@suchetadalal
I am challenging you back
@YUVSTRONG12
, but this time with a twist!!👀🙅🏻♂️😉
All I can ask everyone to do is take care and stay safe!
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As a doctor in mumbai who closely saw the ravages of covid I was hoping that the political agenda shifts to healthcare. But it seems slaps , competitive lumpenism & faux pride will once again dominate. Cry my beloved city. The joke is on us.
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Dr Omar Akhtar a young surgeon I know was arrested in Srinagar yesterday. I attempt to send him a message through my piece in today’s mirror.
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Proud to be working with Mumbai’s first private hospital
@Jaslok_Hospital
who has admitted a covid patient. Hope more follow suit. Everyone is needed.
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Entrance to pvt ‘charitable’ hospital attached to pvt med college in mumbai. Transparency? Strategy to keep the ‘unaffording’ away?
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Navi Mumbai creek today. What ?social distancing? Not us.
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Breaking! Scientists baffled by unique covid variant in many Indian hospitals! Patients & family members can transmit it to hospital staff & hence need to be swabbed every time for admission or a procedure. But staff cannot transmit it to patients & hence don’t need testing!
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Rare occasion when felt good to be member of
@IMAIndiaOrg
But wary of this being twisted into a false fight bet Ayurveda / Allopathy.
It’s a fight against a charlatan with a business empire & political patronage exploiting the covid pandemic
There r some in allopathy also
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When a problem is glorified as a solution.
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‘Epidemic within a pandemic’ Drug chart. Covid 19 icu. Rationality apart, also ticking time bomb for side effects, drug interactions & medication errors. Cause additional injury & even death.
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We need more ventilators ! But as someone who works in both public & pvt health sector in Mumbai here r some immediate suggestions. 1 inventory of functioning vents in the city. No, type, hosp.
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A UNIQUE DIWALI BAKSHISH.
Had the fortune to participate in a unique Diwali.A family lost their young son to a brain stroke in a Mumbai Hospital.Amidst intense grief they donated his organs.His liver & kidneys were transplanted to 3 lucky individuals whom they didnt know. 1/n
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Icu staff in the mumbai hospital paying their respects to the departed mother who will live on in 4 others.
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Covid must be back. Can see cardiac surgeons on prime time TV.
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It doesn’t stop here. U then buy pg seats at astronomical fees, go abroad at own expense, acquire foreign experience, walk into corporate hospitals as consultants sometimes inheriting a family practice. Of course through this u rant about lack of merit in caste based reservation
28% reservation in MBBS seats for ultra rich as annual tuition fee alone on these seats is over Rs 10 lakh
High fees ensures only 5% Indians can apply
Thus 28% seat quota for 5% population?
Where are merit ke pujari now?
No howls of protest?
Will govt reveal scores of this 28%?
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Yrs ago we attempted a RCT in a mumbai public hospital. First 3 patients we tried consenting said ‘Dr Saab aapko accha lagta hain woh karo’( Sir do what u feel is best) We stopped the study. Every time i read about rct on covid pts in india I wonder what pts say when consented?
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‘Medical emergency ‘ travel by metro? Grow trees in ones own garden? Do they hire fantasy script writers to tweet for them?
T 3290 - Friend of mine had a medical emergency, decided to take METRO instead of his car .. came back very impressed .. said was faster, convenient and most efficient .. 👍
Solution for Pollution ..
Grow more trees .. I did in my garden .. have you ❤️
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Many doctors are outraged by this edit from Lancet one of the worlds respected medical journals. Regular readers know that it has a long tradition of commenting on major global political developments. You could differ with the view but to question its mandate reveals ignorance
Editorial: "PM Narendra Modi vows that his decision to revoke autonomy will bring prosperity to
#Kashmir
. But first, the people of Kashmir need healing from the deep wounds of this decades-old conflict, not subjugation to further violence & alienation."
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May I translate
@TOIMumbai
?
A woman with limited life due to advanced breast cancer needs pain relief nutrition & caring humans around her is in jail. Can she spend her last days in a more humane way ? Will India’s palliative care movement stand up?
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Caution
@Covid
Widely popular immune booster Giloy promoted by
@moayush
marketed by
@PypAyurved
& others causes major liver damage by autoimmunity. Study just published in
@JCEH_Hepatology
peer reviewed international journal
via
@timesofindia
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What was the 'Ayurvedic surgery' brouhaha about? And how what was essentially a turf war between a resurgent ayurveda establishment & an insecure national organisation of allopaths has no relevance to the problems of health care in India. Posting the full pdf. 😉The Hindu
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@kikumbhar
with a deep dive into history of health care in India demolishes some myths & suggests caste as a central reason why policy ignored ordinary people
His thesis is available in full at https:/
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There is a good way to understand the role of resident doctors & nurses in Indian hospitals. They are the ones who work at night so that the senior medical staff (me included) can sleep well.
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Based on 1st wave experience what should we do in mumbai?
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This is unfortunate. We need to stand with
@theliverdr
Bengaluru Civil Court passes ex-parte injunction order to X to suspend the account of Dr Cyriac Abby Philips (
@theliverdr
).
The order was passed in a suit filed by Himalaya Wellness Corporation which alleged that
@theliverdr
made defamatory allegations against the company.
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Is there a chance that the Covid debacle will change Indian healthcare forever? If somewhere in 2022 when we r done with all waves if we r discussing even 10% of the current volume on healthcare there is hope. Twitter please remind us.
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Mumbai 2nd wave
If it’s about saving lives
reduce obsession with total no’s
Merge pvt & public sector beds
Triage, triage, triage
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Useful info ! seems one can use one ventilator for 4 patients at one time by just tweaking connections. If interested in further info pl contact surgeon
@sonalasthana
, Bengaluru or intensivist shruti tandan , mumbai shrutitandan
@gmail
.com who have both done it.
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We performed 3 major emergency operations over last 2 days in a mumbai hosp which was closed weeks ago. What struck me was the matter of fact manner in which ward boys, nurses, anesthetists, resident doctors participated. Coming to terms & getting on with treating non covid pts.
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whilst ur concern about the supreme court order on ‘free’ testing by pvt labs is being debated what wud u say about this?
@kiranshaw
@malini_aisola
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We often see rants from aggrieved med students in India about how their meritorious seats are snatched away by increasing reservation policies. From a narrow individual viewpoint it’s true. However let me share with u the privilege trajectory of some around me for a perspective.
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Whilst we the elite debate the science of Ramdev’s claim
there will be a huge demand for coronil from tomorrow. Ramdev will make a killing in a few days. By the time there is scientific repudiation he will be laughing his way to the bank.
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Thoughtless practice in Indian hospitals.Discharge changed to DAMA (Discharge against medical advice) for patients who request to be sent to another hospital for better care. No records provided for next provider to study. Widely prevalent with silly excuse of ‘medicolegal’ need.
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If anyone thought WhatsApp is fun forwards yesterday night our surgical units communication about a seriously ill patient collapsed. A ct scan couldnt be shared Multiple phone calls just about salvaged the situation. How were patients managed decades ago? Or were they?
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Most of us won’t be lucky to pass away peacefully in our sleep. We will need to engage with healthcare at the end of our lives. My ode to a hospital & idea which cares rather than cures. Nilaya is easy to translate but Sukoon? In todays
@htTweets
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Nominating my esteemed senior colleague for another award ‘ The grovel achievement’. Tough competition though. Stellar lineup of nominees.
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A unique feature of d current civil society response to Covid crisis is to do both ; help people & critique govt policy The 2 r not mutually exclusive. Artificial, deliberate division bet 'social work' & 'activism' suits status quo & has hampered health care reform in India
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Impressive discharge summary ; old patient of mine admitted for covid in state of the art hospital. Long list of drugs & plasma. Bill; 2.2 lakh in ‘economy’ class
ps. Asymptomatic, no hypoxia, no comorbidities
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Few of my hospital colleagues got a call for vaccine today. One of them a ICU respiratory technician. Unknown & unrecognized covid warriors. Took care of ventilators , breathing tubes , oxygen in full ppes in sweltering heat. Infected but carried on.
#CoronaVaccine
#CovidVaccine
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‘India has not reached the stage where it is a moral or economic necessity to have universal social security’
Mr Nageswaran I am no economist but I invite u to join me for a day when I see patients across hospitals.
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Every WhatsApp group of doctors I am part of is abuzz with self congratulatory hyperbolic messages on reduced sentence for medical negligence. For perspective Healthcare in India is one of the least regulated & has one of lowest litigation & conviction rates in the world.
Bharatiya Nyaya Sanhita prescribes lesser punishment for doctors for causing death by medical negligence.
While causing death by negligence is punishable by up to 5 years imprisonment, if it is done by a doctor, the punishment is up to 2 years. It may be noted that the present
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In organ donation & transplantation the real heroes work in the background unsung & even unrecognised. As they do in many aspects of our lives.
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When will u give up a hospital bed for someone sicker than u? if assured that when u need it u will get it. This needs 'collective' trust in the system. When 'triage' is not just a sterile academic word
In an oped in todays Hindu I also say (thread)
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Humans of the world unite! Three young working men in kochi greet us in solidarity with a clenched fist salute! Their hands, transplanted after donation from three other young people whose courageous families donated them after their death.
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@DesirajuKeshav
our coeditor passed on today. Got to know him when putting this together. Erudite, humble , courageous. Opposed corruption by those who milked gravy train of medical education. The slow but steady change in India’s mental health scenario owes lot to him
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Covid! Who says that the pvt health sector in India is not transparent in charging? Minor problem; they r transparently charging exorbitantly. Who says the govt has not intervened? Minor problem; the intervention is on paper.
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In a letter to
@AskDrShashank
who spoke with
@PMOIndia
on Mann ki Baat I explain why his comments disturbed me & why as doctors we shud avoid narratives like ‘we r the best’ ‘better than Europe & Us’ & ‘high recovery rate’
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Many ward boys,ayahs,nurses,transplant coordinators junior & senior doctors spent time away from their families on Diwali eve & Diwali day to make this happen. To participate in this unique Diwali Bakshish. As a family grieves 3 families will celebrate a special Diwali gift 2/n
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What we will discuss ; stress, genetics, fitness, checkups, angiograms
What we could do; train bystanders to feel pulse & start CPR, install AED’s at public places, start rx in ambulances, get people to hospital in an hour
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Yesterday while speaking to young med students there was constant ref to how practicing medicine in India is no longer ‘worth it’ as a career. Not true. If one considers the immense social capital. And the potential to help people in distress. Btw there is no unemployed doctor
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This is rare amongst Indias medical profession but need more of this. Rational doctors publicly calling out a senior celebrity colleague who spouts unscientific advice. And has a clear conflict of interest.
AIIMS cardiologists Dr. Ganesan Karthikeyan & Dr. Balram Bhargava have done a huge public health service by calling out Dr. Devi Shetty for urging even very fit ppl to undergo a CT Angio
CT Angio is a diagnostic tool NOT a screening tool
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I tell patients they have a right to seek care from any stream of medicine though I’m skeptical but wait this is official reco from GOI! Peddling info without evidence ! Dangerous because citizens may lap it up as truth! Make us a laughing stock in Int science.
@fayedsouza
Advisory for
#CoronaVirus
Homoeopathy for Prevention of Corona virus Infections
Unani Medicines useful in the symptomatic management of Corona Virus infection
Details here:
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In 1992 as a resident doctor at KEM hospital I joined
@amarjesani
, Sunil Pandya (HOD neurosurgery) & others to start a 8 page ‘Issues in Med Ethics’ Today a globally recognized journal
@IndJMedEthics
which didnt miss an issue for 30 years & survived without ads & pharma funds
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No he did not. Dr Baruah’s act 25 years ago was a reckless experiment on a poor unsuspecting Indian. This is misplaced national pride & nostalgia.
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Ideas like this. One reason to have humanities in medical colleges.
One major advantage of medical colleges is we don’t have humanities departments. Everyone does their own job, and no one gets offended or oppressed on behalf of others. And (gasp!) many students actually focus on academics.
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Disappointed with cliche of a response
@theliverdr
& shallow comparisons. People don’t visit plumbers ,electricians for illness. Moreover option of govt dr is nonstarter for many.Don’t offer ‘concessions’ if u don’t wish to but such banal views don’t fit into ur other sharp takes
Will you ask for discount at the same petrol station or to the same lawyer or your same plumber, coconut climber, electrician, painter, car service person, or at a restaurant or street food vendor or while ordering multiple times from Swiggy and Zomato also?
Why does a doctor
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Have joined several doctor colleagues in signing this letter. Because it was necessary for some to say this openly
@MalathyIyerTOI
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Family members of covid patients not allowed inside ward/icu is understandable but not being allowed inside hospital nor talk to patient on the phone! overworked hcw’s not able to communicate regularly! Fertile ground for suspicion, anger, litigation & even violence!
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When I ask 10 mumbai doctors the planetary significance of 21st June & all say yoga day instead of summer solstice u know who is winning
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2 repair those lying unused in hospitals (u will be surprised at the no)
3 establish a central command with info on venti availability on a real time basis
4 provide ventis to those with preexisting ecosystems to manage pts.
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Be selfish. Demand better healthcare for everyone. Because sooner or later that everyone includes you.
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Am I alone in feeling better to see Diwali slowly coming to a close to be relieved of the strain & peer pressure to wish, gift, dress, behave in a certain manner? And to no longer witness the herd mentality that drives our societal behavior & political correctness?
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There is a scary vicious circle in mumbai (perhaps other cities)
Covid patients are getting admitted to hospital worried that they may not get a bed when needed. This is leading to not getting a bed when needed.
This can be broken only with strict triaging.
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#LataMangeshkar
Like many I grew up on her songs
As a doctor treating sick icu patients I wonder. Did they set aside the archaic, rules of our icus & play songs to her? Will our icus allow headphones? Will there be music with people in their last hours & not beeps of monitors?
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This is an hour long discussion worth a watch
But for those who wish to know what I tried to say in its entirety here is a summary
1 There is a method to Babas madness
2 His attack on modern medicine is a strategic ploy to get attention of his supporters & sell coronil
Doctors Assaulted, Underpaid And Insulted
@sanjaynagral
says, "My suggestion to IMA is we need to learn to ignore Ramdev. He will come back again after 2-3 months because he wants to promote his products, just like other companies"
Watch the discussion
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Meet the kale sisters. Vegetable vendors in a by lane in central mumbai. After shutting shop feed around 50 stray dogs & cats everyday for years. Set aside part of daily earning for buying the food. ‘Makes us feel happy’ they said as they posed with pride when asked for a pic.
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Sad. My guess is that he was non MBBS dr serving 108 ambulance. Unlikely to happen to allopath dr as they have more clout. Atleast 4 other non mbbs drs have died due to covid. They work on frontlines & r paid less for the same job. Good old hierarchy. Cud someone highlight this?
Shameful!
Dr Shaukat Ali who was posted in Ambulance service at Malad railway station died of
#COVID19
. Despite being a frontline worker, His family ran from pillar to post to get him admitted in either a Pvt/Govt 🏥 to no avail.
Report of
@SamiullahKhan__
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Mumbai just crossed 1000 covid deaths.
Whilst we continue our fight we must recognize that a significant no were from delayed or inadequate treatment, inclu patients moving from hosp to hosp looking for a bed
It’s still not late to change this.
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Welcome bcos not many Ayurved drs openly speak out on need for science. When Ramdev went berserk in covid & some of us called him out none from Ayurved countered him. This allowed Baba to paint us as anti Ayurved modern med drs We all need to shun false loyalty to our own Pathy.
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Any ‘merit’ in this ‘reservation’?
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Indian Drs migrating to foreign countries have every right to do so. But blaming it on overwork, less pay, Ayush, reservation is a very old rationalization trick. Worse is pontificating from abroad. Even worse powerful proscience fighters wading simplisticaly into social science
Why leave India for better opportunities in medical practice?
via Dr. Manik Madaan
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Healthcare policy in India ; Off the cuff nuggets from social media can be more insightful than voluminous scholarship.
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Healthcare in Mumbai seems like normal now .
A patient needing emergency hospitalization was asked to pay a deposit of Rs 1.8 lakhs at 2 am before he could undergo life saving urgent surgery.
I am almost nostalgic for covid & the price capping.
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What can we learn?
A portable AED was available on a football field
It was charged & working
Doctor & players were trained to use it
Was used effectively in mins
Emergency care is not always about ambulances & hospitals
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#COVID19
MUMBAI SOS. Its bad. 4 family members & at least 20 doctor colleagues +ve today. Need bold triaging to avoid chaos. Maybe just test & isolate high risk groups. The rest just mask. After all its about avoiding death & collateral damage due to an overwhelmed health system.
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A refreshingly reflective panel with some very straightforward & expert colleagues. No contrived political correctness. Thank you
@fayedsouza
India Crosses 1 Million Covid-19 Cases
@sanjaynagral
says "This is a situation where we can't put the whole onus on the state, people have to understand they have a big responsibility, be it wearing a mask or social distancing"
Watch the full discussion
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80 to 90% of the hospital staff in cities like Mumbai travel by suburban trains. The train stoppage will affect them severely. Can transport be organized for them? Only doctors can’t run hospitals
@CMOMaharashtra
@mybmc
@mybmcHealthDept
@writemeenal
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Ambani supports Milind Deora as he understands ‘South Mumbai’s ecosystem’. As a lifelong mumbaikar I offer a translation in case u r confused ‘He will protect interests of our exclusive elite gated community who cross the rest of mumbai only on their way to the airport.’
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Some of this is known but the sheer depth & sweep of privilege & power in the success of a doctor in India needs recognition when discussing seat loss for the meritorious. No consolation to those who suffer but reminder for others who jump on merit bandwagon to broaden the gaze.
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One more thoughtful & courageous analysis from an Ayush insider
Let me add that the thousands of Ayush graduates being churned out essentially end up as cheap labour in modern hospitals. They do lots of hard work including in covid
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‘Oxygen beds’ ‘icu beds’ dont treat patients. Besides doctors, nurses, ward boys, ayahs & cleaners, family members play big role in care giving in hospitals. They aren’t allowed in covid wards.
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That rare occasion when an Indian cardiologist is not playing to the camera or selling wares & offers sober views on heart attacks
What he misses is that a lot of ‘tv studio’ advice is clever marketing masquerading as information
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As covid retreats in India there will be much reflection on healthcare. In mumbai we were fleetingly exposed to an idea.That u cud call a phone no & be guaranteed a hospital bed. Covid’s gone Sadly also the idea. The elite will always get beds, poor will run around. Normalcy.
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5 cap/ subsidize/ fund costs in pvt icus. ( current daily bills of a ventilated pts around 20 to 40 000 Rs) . Use Ayush Bharat funds if necessary
6 ensure uninterrupted oxygen supply for the vents
7 keep a few portable vents for transport
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8 train non icu medical staff for managing venti patients
9 establish std criteria for those who need vents & those who can be taken off(easily available)
10 provide blood gas machines & monitors where they are short.
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Given resident doctors ongoing problems (which r genuine)there's lots of discussion about how its not worth pursuing a medical career in India. I assure young aspiring doctor that this isnt true. It continues to be hugely gratifying for immense gratitude of patients.That matters.
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@NarayanRangaraj
Indian students have to take exam FMGE after which they r eligible to continue studies & practice in India Alternatively they can pursue higher studies in other countries by taking local exam. Russia Ukraine China r tapping Indian med students market at less fee& better training
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A journo asked for message to patients on Doctors day. When I wrote this she wants something more +ve
The trust & tolerance shown by ordinary Indians in us & what passes for as healthcare is both humbling & worrying.Constructive critic from patients is the best driver of change
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In a pandemic an astounding , humbling act of giving! When ur wife has succumbed in childbirth. A newborn whose mother will live in 4 others.
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If u wish to know hierarchy in Indian healthcare here it is. It’s not just what he is saying but he actually represents the thoughts of a large number of his colleagues.
In Maharashtra Staff nurses, Brothers and even class 4 Mama call Junior doctors (SR also) by their names 😡
They don't give respect to doctors ! ( Expect when their patients get admitted under them)
Intern doctors are very badly treated.. It's very annoying to hear it 😢
What's
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Someone high up is being amazingly courageous, resolute & maybe scared. After all Mumbai’s ganesha industry is political power & a revenue stream. Will
@MamataOfficial
take a cue for Durga pooja?
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For those responding with the ‘negativity’ trope
@suchetadalal
has organized maybe the largest network for supplying free ppes to health care workers in mumbai. With zero publicity. Shud know a bit more than us as she singlehandedly exposed harshad Mehta scam in 90’s.
Good morning. Think about this. Most countries have begun to open up carefully!China is importing steel. Italy with 40K deaths is not shut like us. We are dragging our feet because bureaucrats &netas enjoy power of lockdown! Damn the economy or poverty! Back to pre1990 privilege
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On budding gynecologist Payal Tadvi's shocking suicide, I write about a less discussed aspect which I call 'Medicines own caste system' in todays Mumbai Mirror.
Medicine’s own caste system via
@mumbaimirror
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Amongst hundreds of TV & media covid experts who do we believe? As I said during 2nd wave watch out for those who atleast sometimes say ‘don’t know’ or ‘can’t be sure’ Uncertainty is a good sign in a scientist. Beware of cocksure ones who have no self doubt & have all answers
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