A Day Like Today

 Remember Bryan Adams?

Today has been a day like the one in his song where I never want to see the sun go down.

An altogether perfect day- did some writing for the Rural Primary Care group, had some intense discussions on the same, did my taxes (at last!), took a nap, and after I woke up, I found the syllabus for a virology course that my buddy Dr.Chitra asked me to teach.

And this discovery is what has thrilled me to bits- the virology course is exciting! I'm reading Pranay Lal's book "The Invisible Empire" and all sorts of ideas are rattling around inside.  

Have decided that I will read 10 pages of the book every day and blog about the same. This way, the book will serve as my primary source material for the course and I'll become more familiar with my own field. This also means that I should be done with the first reading of the book in about a month, give or take a few days. 

RK and I usually take stock of our year and make plans for the next one around this time every year.  I usually categorise my plans into smaller bundles like "travel" or "scholarship" or "grant-related" or "how to make more money in a happy way". Last year, I realised that my scholarship output  for 2020 had been rather dismal and so this year, I really worked hard, got a publication out, got one more submitted, got my team to submit 5 abstracts at conferences (of which 4 have been accepted for oral presentations! And the 5th could win the video presentation category, with God's grace!) and gave multiple presentations at local, national and international forums. So I feel like having that discussion last year and making that plan for this year was really helpful in pushing me to achieve things. 

So for the next year, my scholarship plans will include my teaching this course, blogging about the learning I've gleaned from this book and others that I study for the course, getting my team to write two papers (with them taking the initiative, and me as the mentor), and me taking the initiative on two papers myself. Plus, I know that our larger group itself has a couple of papers planned so I'll get to be on those as well. 

So really, this course is something that is new and I'm looking forward to it. Maybe next year, I'll pick another course to teach so I constantly keep learning things that are useful to me. 

A message from the universe?

 Just finished an application for the Goldman Sach's 10000 Women Program at NSRCEL, IIMB.

Then got an email from Niti Aayog saying that there is a Women Transforming India award under the Women Entrepreneurship Program and that the last date is day after tomorrow. So checked that out and decided to apply.

Then got a call from my friend Dr. Prasoon reminding me that I had agreed to speak at NIT Rourkela and that he specifically wanted me to speak about being a woman entrepreneur.

Talk about coincidences... 

I think what the universe may be trying to tell me is that it's time I put my mind to actualizing a plan for what I say I intend to do: transform primary care and public health diagnostics. With each of these applications or events being more detailed than the previous, I will need to think hard about how I intend this to happen more than just mention that I will do it.

So...  I will choose to see this as yet another way by which my faith in the universe makes what I want happen. 

Bolero and the Brain

 Whenever there are discussions on babies and their development (With the various lockdowns that we have had, is it any surprise that so many people around us are now having babies? 4 couples currently that I know of had babies within weeks of each other), the question of music and babies invariably pops up. 

Unfortunately, there is not a lot of published scientific work on the long term effects of classical Indian (or really, any non-Western classical) music on brain development, even though there are plenty of anecdotal reports of how listening to Hindustani or Carnatic instrumental or vocal music influence enhances overall brain development, builds nascent musical talent etc. Recently, there was an entire issue devoted to "Music in the Lives of Young Children" in the journal Early Child Development and Care. One of the articles in this issue was on the effect of Carnatic music on the mathematical abilities of young children aged 5 and 8 (listening to Carnatic music significantly improved mathematical ability).

We all read about how listening to Mozart is supposed to make babies brainier and programs like Little Einstein try to introduce short fragments of Western classical music to toddlers. When I was pregnant with Ani, Lori, my labmate in the Pittsburgh Retrovirology Lab, at Pitt, had shared a CD (those days, we still had CDs!) that was a compilation of well known symphonies. It had the usual suspects- Eine Kleine Nachtmusik, Beethoven's 5th and 9th symphonies, The Blue Danube etc. Then, right at the end, as though giving a small nod to a more modern time, the CD included Ravel's Bolero. Have you heard this? Depending on your mood, it could either be haunting or utterly annoying. That tune, once you have heard it, never gets out of your head.

Any time the CD reached Bolero, I would lunge towards the player and stop the track and breathe a sigh of relief if I managed it before the first strains of that tune started. However, many times, regardless of whether or not I managed to either shut down the system or skip the track, the tune would have already started inside my head, relentlessly marching forth in that unmistakable whiny tone set to the backdrop of that military beat.

Today, after nearly a decade of Bolero-freedom, I sought it willingly because I had forgotten how infuriating it is. And I also learned a little more about Marcel Ravel. 

Ravel apparently started un-Raveling (haha!) right about the time that he wrote Bolero. This near constant obsession with the same tune came around the same time that he started showing early signs of a mental disorder called that progressively affected his language and motor ability. People think now that he suffered from a condition called PPA and CBD. In this paper from last year, a group of scientists described  the obsession of another artist with Bolero. This artist (and former scientist), Anne Adams, painted the elements of Bolero with great attention to detail. Coincidentally, this phase corresponded to an early phase of subclinical PPA in her as well.  As her dementia and aphasia progressed, her paintings became increasingly photographic representations of what she saw around her. 

Below are the paintings and information about them as well as her clinical status as per the paper “Unravelling Boléro: progressive aphasia, transmodal creativity and the right posterior neocortex” in the journal Brain in 2020.

 Painting done by Anne Adams in 1991, 9 years before clinical symptoms of PPA 

Unraveling Bolero; done in 1994, 6 years before PPA symptoms 

Representation of pi, 1998, 2 years before her clinical symptoms

ABC Book of Invertebrates, done in 2000, the year her symptoms were apparent and she was diagnosed with PPA

Arbutus Leaves, painted 2 years after diagnosis in 2002

Amsterdam, painted in 2004, 4 years after diagnosis. By this time, she was unable to communicate through spoken language. 

Here is a CT scan of her brain against the phases after diagnosis

Finally, the authors say 

 , "AA was enchanted by Ravel's ‘Boléro’, composed by a man with the same syndrome, PPA, and possibly the same underlying histopathology, CBD (Baeck, 1996; Amaducci et al., 2002). AA's interest in ‘Boléro’ arose before she developed overt PPA symptoms or learned of Ravel's illness. Furthermore, AA painted ‘Unravelling Bolero’ at nearly the same age and disease stage that characterized Ravel when he wrote ‘Bolero’, suggesting that some patients with early PPA may be drawn to themes of repetition, texture and symmetry, perhaps because their thriving posterior cortices are increasingly tuned to these stimulus qualities. Whatever its basis, the relationship between AA and Ravel sheds new light on how neural systems interact to enhance the creative process"

So while Bolero might still make me lunge to turn it off and yet stay in my head forever, now I will have this additional amazing story to think about. Repetitions, symmetry etc are attractive to people with certain neural traits. While the link between art and mental disease is well known (you can see this by Googling schizophrenia and art), to me, these case studies and research work also highlight the importance of art in people with mental disorders: that such amazing works of art were made by Anne Adams even as her disease progressed to me indicates that perhaps creativity and art might even slow down mental disorders... I suppose that is a separate story altogether.

Ongoing Lessons in Faith

 Working on it...getting better.... reading books that help me with it, like those by Napoleon Hill and Wayne Dyer. 

There are still occasions of fear but for the most part, been replaced by steely resolution that I WILL NOT fail and I WILL ask for help and have faith that the HELP WILL COME.

And in addition to all this, have decided that the best way to embrace faith is to see everyone in my journey as an ally... not in a naive, rose tinted glasses kind of way, but in an open, honest way that accepts and acknowledges conflicts of interest, conflicting or opposing priorities and yes, competition too. 

Freaking Out

After much effort, for the majority of time these days, I am fairly stable mentally. I remain cool and collected, positive and optimistic. 

On the bad days, life tells me that this is a mere house of cards and everything comes tumbling down and I can barely catch my breath because I'm panicking and everything seems overwhelming.

On those days, picking myself up and putting myself together again is a battle against the demons in my mind which replace all the good, strong thoughts with thoughts of fear and failure. 

Writing helps. Because it forces my brain to slow down and pick out individual thoughts from the roaring quagmire and put that thought into words. 

So. Varsha. Replace the two F words, fear and failure, with a third F word: Faith. 

From the Bhagwad Gita to the latest self-help book, everything that seeks to empower tells you to have faith, either in yourself, or in the greater universe or in whatever God there is. In the millenia that have come before me, there must have been people frantic, fearful, and fighting. And so there will be in the millenia that come after me. Their issues must have seemed insurmountable to them then, but would have seemed minor either to someone not them or to them after some point of time. Similarly, my problems seem insurmountable and overwhelming to me now, but I need to remember that at some point of time in the (near?) future, they will seem insignificant. 

If I have faith that things will work out somehow, things usually will. 

So, Varsh. Calm down. Show some gratitude to what you have and cultivate some faith. 

The kids will be fine.

Your life will be fine.

The world will be fine.

A Weekend of Milestones

Milestones:

a) Leaving RK and kids without a thought about how they will manage at home.  Apparently, 11 year old Ani cooked dinner on night 1 and they all Swiggy-ed food on night 2. Really proud of my kiddos for being unfazed about cooking or keeping house! Maybe RK has the right attitude towards this after all: expect that kids (and people) will figure out how to take care of themselves, and they will! 

b) Going for a sporting event with PCMH-MSCH junta: We have a lot in common, but it's usually not sports. So, I feel like I discovered a new facet to my friends and colleagues. We discuss health and fitness so much and it's nice to be able to practice what we preach. And we did it together, as we have done so many other difficult things together.

c) Cycling (almost) 40km: 21k from Kishkinda to Vittala, 4k inside Vittala temple complex, 9-10k on the way back, and about 5k to return the cycles. All in 1 day. If I could hug my legs and butt and tell them how proud I am of them, I would! Perhaps there is a yoga asana for this 😄 

Mr. Nagaraj, who biked down to Hampi from Belgaum in pouring rain at midnight, so he could be there at 4:30am to cheer and support the runners and cyclists. He took this pic

Prathamesh and I cycled, bird watched, explored the ruins of Vittala temple and encouraged each other.

Others in the group did amazingly well too- some walked 10k and climbed the steep hill on Anjanadri (575 steps!)

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Not easy doing Anjeneyasana on a hard rock, but Poorva, Praneeth and Swaathi make it look effortless

Ushnaa, the youngest (and clearly the fittest) of our group cycled 47km and ran 2km just for the heck of it. She's also the resident photographer extraordinaire:

d) Actively choosing to trust: leaping off a 15ft cliff into the Tungabhadra makes me realize how important it is to let go of control, and place trust in something or someone else. If Ani had not done the 20ft jump into the Kaveri a few months ago, when at BR Hills with Dr. Sudarshan, would I have had the courage to trust in my mentors, Mr. Kiran Betageri and Mr.Ravi, to do this? 

What I am beginning to learn is that choosing to trust is a powerful act that enables greatness. I am so, so glad that I chose to jump and by doing so, shattered some mental beliefs of myself and created some new ones. 

e) Gratitude for my body: I have such gratitude and pride for this outer covering that does so much for me. I have felt like this after breastfeeding my babies, probably hands-down the hardest thing I have ever done or will ever do. 

Our religious texts and our society tells us not to take pride in our bodies, the latter from a sense of morality and shame, and the former from a viewpoint that the soul and the state of the soul takes precedence.  In the Bhagvad Gita, the body is considered just the outer garment for the soul, something to be used and discarded in the soul's journey. This idea has given me intense comfort after the passing of my parents. It is the same I use when comforting those who have experienced the deaths of loved ones. 

                                                     

Yet, I treasure this outer garment and am grateful for the chance to strengthen it.

Update after discussion with RK:
The motto of the All India Institute of Medical Sciences (AIIMS) is "Sharīramādyam khalu dharmasādhanam" The body is the instrument of performing Dharma (doing the right thing). So, if you do not take care of your body, then how can you do anything else that is worth doing?

If I consistently underestimate the strength of my body, what else do I underestimate about myself and others, I wonder? 

Here is a video of Kranthi, another chronic under-estimator of her own strength, who jumped 25ft without a life jacket, just because she knew she could and because she felt like it! 

I'll end this post with a few pics of the amazing landscapes at Hampi. Until this trip, I had never appreciated it very much- always felt it was hot and crowded. But after this, it's become embedded into my mind and heart. After all, I have cycled its roads, I know its birds, I have discovered its hidden ponds behind hard rocks and I have seen its sunset and sunrise! Looking forward to returning with the man and kids... maybe we too will climb, cycle and dive together!

Sunrise at Sonapur Lake 

Sunset by the Virupaksha temple on the Tungabhadra. Just check out those sunrays... *feeling blessed*

Our hotel rooms- cute or what? We are hobbitses!

View from Anjanadri- the birthplace of Hanuman

This lot had an unending thirst for looking at old stone buildings. Thank God I was not with them!

Banofee pie          

Crispiest falafels ever had in India!

Post lunch somnolence

And finally, here's a (not comprehensive) list of birds and beasts seen:
a) Our ubiquitous bee-eater friend the little green bee-eater. I think we also saw blue-tailed (based on the length of the tail, not the color, since I didn't have my binos at the time)

Blue tailed bee-eater. Pic from eBird

Little green bee-eater. Pic from Wikimedia

See how similar looking they are?

b) White breasted kingfisher: found EVERYwhere, any little patch of water, be it in a paddy field or a pond, this little dude is sitting there waiting to catch his snack. 

c) Southern grey shrikes, peacocks, egrets

d) Wire tailed swallows

These are the ones that do acrobatic flights, very commonly seen in evenings and early mornings. Check out the long wires at the tail that give it its name. Pic from Wikimedia.

e) White browed fantail: found in or near water bodies, happily catching insects. A friendly fellow, he shows off his plumage quite happily

pic from https://ebird.org/species/whbfan2

Also looks like this... much blacker than the one above. Pic from https://ebird.org/species/whbfan2

f) Lots of water birds:
- Painted storks (adults and juvvies),
- Cormorants
- Purple moorhens (in non-breeding plumage)

Adult and juvenile purple moorhen- we saw both at the pond near Sugriva's cave. Pic from http://www.oiseaux-birds.com/card-purple-swamphen.html

- Grey herons

Grey heron. Pic from https://www.flickr.com/photos/krishnacolor/50738727583

Grey heron in flight at sunset. Photo credit: Poorva Huilgol.

- Pond herons
- White ibis

- River terns (we saw one guy valiantly trying to catch fish at Sonapur Lake during our sunrise trip... he made multiple sallies, caught one, only to lose it a few seconds later as the fish slithered out of his grasp. Undaunted, he tried and tried again! Sonapur had LOTS of fish that kept leaping out and jumping ahead of the coracles, so hopefully he was successful!)

From https://ebird.org/species/rivter1 
Distinguishing features: the black head, orange beak, forked tail and the boomerang shaped wings

g) Many bulbuls, including white browed, red vented and red whiskered

h) Hoopoe

On the way to Sugriva's cave 

From https://ebird.org/species/hoopoe

h) Many butterflies: I'm still very much a novice when it comes to lepidoptery and find them way harder to identify than birds. But here are some of the ones we saw:
Blue tiger:

Tirumala limniace. Pic from Wiki media commons

Lesser grass blue

Pic from https://www.ifoundbutterflies.org/sp/829/Zizina-otis

Common grass yellow

 

Pic from Wiki media commons

And finally, some monkeys:

The usual bonnet macaques seen everywhere and most excitingly, the grey langur (also called Hanuman langur)

Pic from Wiki media commons

Finally, a shout-out to Kiran sir's Isuzu- is there anything more fun than clinging to the back of a pickup truck as it races over a highway at over a 100kph? At night? With the stars gleaming at you? Very little can top that experience in terms of sheer thrills, not even jumping down a 15ft cliff!

 

Pics not otherwise credited belong either to me or one of the following: Praneeth Pillala, Swaathi B. Ushnaa Kuri or Poorva Huilgol.

First Forays into One Health

 I've been reading about One Health for years now. One Health as a term has been in the news for the past 10-15 years. Basically it means that human health, animal health, and environmental health are interlinked and affect each other. So, there is a "One-ness" about the planet, its creatures, their activities and their health.

With Covid, One Health is really on the forefront. And I think most people appreciate just how closely interlinked we are like never before.

Another looming public health crisis, a bit slower to peak than Covid but likely to be even more catastrophic, is antimicrobial resistance (AMR). AMR is a classic example of a One Health problem: it intricately tangles humans, animals, soil, water and overall planetary health in a tight Gordian knot. For years we have been talking about the emergence of "super-bugs" which are not stopped by any antibiotics. Given the overall ubiquitous presence of antibiotics in our lives, it's not surprising that Nature does its thing and bugs become resistant to the drugs.

In some parts of the world (such as Sweden, Denmark, Holland etc), antibiotics are banned from the animal husbandry industry and agriculture and are very sparingly used in hospitals. In India, I've been wondering how to look at antibiotics, bacteria and AMR in humans, soil, water etc. for a while now, but couldn't figure out how to do so.

I got introduced to Vishwanath Srikantaiah and Biome Trust recently. They are looking at water conservation and wastewater reuse. Among wastewater reuse, they are specifically looking at the use of treated and untreated wastewater in agriculture. Hence I tagged along to one of their field visits and collected samples. The two young scientists accompanying me were Rakshita , an economist who is passionate about water conservation and studies the impact of Million Wells campaign and lake rejuvenation and Nikita, an architect who is looking urban and rural water usage and is also very involved in lake rejuvenation. Ramya from my group also was with me that day, as she is from that same Vijayapura-Shidlaghatta area and has farmland belonging to her family and was curious about water usage in farms there.

First we went to Vijaypura to Mr. Muniraju's farm. Mr.M grows mulberry leaves, roses and corn. He has been using untreated waste for 25 years. 

25 years ago, Mr. Muniraju was in desperate straits: he had land, but no water. He had started building a house but ran out of money. The house had walls but no roof. He had no money to pay for his kids' school. Vijayapura is in a rain-shadow region with less than 650mm of rainfall annually. He had spent a lot of money digging borewells but to no effect. In a last ditch attempt, he started using water from the nearby open drains which typically get a combination of "grey" water (feces-free) and "black" water (with fecal matter). It seemed to work. He was able to irrigate his crops. Over time, he has also bought another 5 acres of land. This second piece of land is mostly irrigated by grey water. He has been able to build his house, send his kids to college as well. Here is a video about him, taken by the BBC some years ago.

The collection well storing grey water from the neighborhood: water from small cottage silk farms, hotels, bus stands, houses etc flows through open drains which have been tapped to fill this well. Water from the drains move into the well through gravity. 

Water from the collection well is pumped into the field

This is the open drain abutting the field

Muniraju helps me collect the water from this drain. 

Mulberry field. Rakshita of Biome helps me collect soil from the middle of the field.

Look at the long stretch of mulberry! On the left are teak trees bordering the farm.

I decided to collect water, soil and mulberry leaves for plating on bacterial plates. I collected these from the water source (near the open drains), at the water inlet to the farm, middle of the field and towards the far end from the water inlet.   I used small sterile urine collection bottles (they cost Rs. 5 apiece) for the job. After collection of water and soil, the bottles need to be thoroughly wiped. I kept samples from different fields in different ziplocks. What would help is a backpack with multiple compartments to keep tubes, ziplocks, tissue papers, markers etc within easy reach. 

This is the fecal sludge containing wastewater collected in Muniraju's first farm. Once a year or so they have to clean it out to remove the sludge.  Muniraju's farm hands wear gum-boots while they water the farm and walk around in it. 

Fecal sludge/ slurry is highly in demand in farms. Thus, trucks called "honeysuckers" go around Bangalore city (to apartments, corporate offices, hospitals, hotels etc) or to smaller cities which do not have UGD (underground drainage) and suck up all the fecal matter and dump it on various farms for a small sum. After Muniraju's successes with waste-irrigated agriculture, other farms too have begun using them in Vijayapura. Now, they have a system in place where they take turns in getting the slurry to their farms.

I did not feel up to collecting any water from any of the collection wells... I need better equipment for this. Ideally like a fish line with a little bottle on the end that gets thrown and then drawn back. Bottle would have to be heavy enough to sink... maybe will need to tie a stone to the neck of the bottle. 

Most other farms in Vijaypura supplement the use of wastewater with the borewell water, if they are able to successfully dig deep enough to tap into a deep aquifer. We met one of M's neighbors/ friends who uses wastewater solely for growing cattle fodder and borewell water for vegetables. He said though that it was wastewater that helped him get his two sons through engineering college! 

This is what Mr. M and his friend said about their use of wastewater in agriculture:
a) The amount of fertilizer they need to use is drastically lower as compared to fields with borewell water
b) The "health" of the crops is higher with wastewater than borewell
c) However, the number of weeds with wastewater is also higher

Neither of them feels that using wastewater impacted their health or their families'.

A new bird seen in these farms that I learned about from Nikita: Cinereous tit 

 
From Wiki

After Vijayapura, we headed to Devanahalli, a success story in terms of lake rejuvenation using treated sewage water. 

This is what Devanahalli Sihi Neer Kere (Sweet Water Lake) looked like a few years ago:

 (from Wikimedia)

 (from Wikimedia)

In the backdrop is Devanahalli Fort. Sihi Neer Kere is so called because the waters here were not hard or metallic. This lake had dried up many years ago.

Devanahalli Lake today. This is after rejuvenation of the lake with treated sewage water from Bangalore.

What is thrilling (thanks to explanations by Rakshita and Nikita from Biome Trust) is the fact that many of the wells surrounding the lakes are also getting replenished. Many abandoned wells are now showing visible water levels. Here is a beautiful old well:

This is what the well looks like from the outside. 

Water!! 

The temperature inside the well is a good 5-7 degrees lower than the surroundings. I would have loved to go all the way down, but the stone steps looked dicey and there are supposed to be snakes in that area.

In Devanahalli village, we went to another farmer's house where pudina (mint) is grown using untreated wastewater. Here we are going to into the guy's backyard after crossing the drainage canal

Look at that lovely pudina! Pudina, spinach, coriander and most other greens grow beautifully in wastewater. Most cities in India are supplied with green and vegetables grown in wastewater.

After Devanahalli, we returned to the city. We went to Chikkajalla to Lake Palanahalli. Lake Palanahalli is an urban lake supplied entirely by untreated wastewater. Lake Palanahalli is part wetland part lake. Wetlands have a lot of vegetation growing in them: water hyacinchs, water cabbages, lotuses, cats tail, zandus, and others. All these plants are very good at extracting nutrients and pollutants from wastewater and naturally filtering and cleaning the water. To me, this lake underscored the old belief: Mother Nature knows best. The BBMP security guard said that near the inlet, the lake is stinky. But as you go further and further away, there are fish, birds and the water sparkles.  And none of this happens due to (much) human intervention! The plants come up by themselves, they clean the water, the fish come by themselves and the birds come by themselves. How humbling and reassuring it is to see Nature in action!  

The white bordered bund on the top left of the pic is where the sewage enters the lake. As the water flows through the greenery, it gets cleaned and becomes habitable to water fowl. We saw purple moorhen, egrets and cormorants. 

This is Jakkur lake, rejuvenated entirely by treated wastewater. A lot of the credit goes to one lady, Dr. Annapurna Kamath. Jakkur lake is a haven for water fowl: in winter, the place is crowded not just with humans but pelicans, painted storks, cormorants and others. I'll go into more detail into this lake in another post.

Tomorrow I will plate all my samples on various agar plates. This will be the first time I'm doing hardcore microbiology. I am quite excited about learning about bacterial identification. Will post about my learnings soon.