AAPI Journal

American Association of of Indian Origin Spring 2018

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1 www.aapiusa.org TABLE OF CONTENTS TOPICS # Editor’s Report - Ravi Jahagirdar, MD 4 President’s Report - Gautam Samadder, MD 5 Chair BOT Message - Ashok Jain, MD 7 President - Elect’s Message - Naresh Parikh, MD 8 Young Leadership Report - Kusum Punjabi, MD 9 Executive Committee 10 Regional Directors 11 Board of Trustees 12 AAPI’s Historic Global Healthcare Summit ,2017- Anjana Samadder, MD 13 Physical Survival in US Healthcare - Joseph Challi, MD 16 Doctors, Its time for us to get off the sidelines - Venugopal Menon, MD 17 Violence in Schools: Time to Be the Change - Dr. Nirupama Madduri 18 Wanterpreneur to Entrepreneur - Kusum Punjabi, MD 21 TB Free - AAPI's Dream - Manoj Jain, MD 22 Increasing Nicotine use in Indian Youth, Impending chronic kidney disease epidemic - Mehul 23 Dixit, MD Kaziranga - Udita Jahagirdar, MD 34 Grasping an elusive diagnosis probing the mystery of undiagnosed groin, lower abdominal and 36 pelvic (UGAP) pain. - Dr. Pramod Wasudev Toxic Chemical exposure of farmers in India: Prevention strategies. AAPI JagtialClinic distributes 37 free protective gear - Jagan Ailinani,MDFACR A Multiple Probiotic Therapy to treat or prevent hospital acquired infections- Malireddy S. Reddy, 38 DVM, MS, Ph.D. What has AMA achieved "On the Hill" for Doctors? - Vidya Kora, MD 39 Integrated The Smart Approach - Pudupakkam K Vedanthan, MD 40 Update on the AAPI activities at the AMA - Vijaya Appareddy, MD 41 Understanding the Human Being An Ayurvedic Perspective - Hari Sharma, MD, DABIHM 42 The Great Journey Pre-med/Medical Students Externship 2018-19 - Veena Gandhi 44 My medical mission trips to India - Venkit S. Iyer, MD 46 AAPI Takes Its Legislative Agenda to Capitol Hill 48

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XXXX_Abbott_SJM Balloon_R1F_out.indd 1 9/22/17 9:29 PM EDITOR’S REPORT PRESIDENT’S MESSAGE The strong support association, we are committed to unify AAPI by We, the AAPI Publication Committee, take pleasure to present this edition of our Journal for this year 2017 - 18. The response has continued to be enthusiastic, as 18 articles and dedication breaking down the barriers of various regions, are offered with two poems and seven reports. The decision to make the submission from an excellent languages, medical education within the process on a continual round the year basis has been welcomed by the writers. executive organization and bringing everyone together as a committee, whole rather than separate fragments. A noticeable shift has been to increased submission of medical topics, and if this particularly Dr. trend continues, future efforts could be directed to making the academic articles peer reviewed. Naresh Parikh In order for AAPI to retain our influence, we must (President Elect) mentor and develop the next generation of doctors A special section this year has been created for the AAPI candidates contesting for and Dr. Ashok Jain in leadership. I want to encourage medical students, various positions at the upcoming AAPI Elections. This service provides a platform for (Chairman, the residents, fellows and all second-generation Indian them to reach out and connect with the electorate, as these Journals are mailed out to Board of Trustees) American physicians to be actively involved in 16,000 Members. Ravi Jahagirdar, MD this year has been both local and national level for building a strong Editor, AAPI Journal Our thanks to the President Dr. Gautam Samadder for his encouragement at all levels, remarkable in so association focusing on leader development and and to each individual member of this Committee for their efforts to help with the Gautam Samadder, MD many ways. strengthening our professional relations. editing and proofreading, to Ms Vijaya Kodali at the AAPI Office for organizing the material, and Ms Arpita Chedda for President, AAPI AAPI’s mission We the physicians of Indian origin are proud of arranging the articles for final publication. has been to have our great achievements and contributions to our Please enjoy the 2018 AAPI Journal - the Spring Edition. our voices be heard by the people making the motherland, India, our adopted land, the US and in a laws. AAPI must succeed in bringing to very significant way to the transformation of the the forefront the many important Indo-US relations. healthcare issues facing the PUBLICATION COMMITTEE community and A new phase in our relationship and raising our voice unitedly AAPI will succeed in collaboration with the American before the US lawmakers. Our bringing to the forefront Medical Association has been the many important health membership is our strength care issues“ facing the initiated. AAPI will succeed in and as the 2nd largest physician community and bringing to the forefront the many medical association behind raising our voice unitedly important health care issues facing the AMA, we cannot stay before the US Congress the physician community and members. silent any longer. raising our voice unitedly before the US Congress members. I want to express my sincere gratitude and appreciation to AAPI The American Association of Physicians Beejadi Mukunda, MD Nirupama Madduri, MD Radhu Agrawal, MD delegates and the Congressmen for of Indian Origin was pleased to support the taking the time out to come and support AAPI’s nomination of Dr. Jerome Adams for agenda at the national level. The powerful voice” Surgeon General, currently serving as Indiana of the leaders and members of the American Health Commissioner with a proven leadership Association of Physicians of Indian Origin (AAPI), record with a steadfast dedication to improve the was heard on Capitol Hill on Thursday, April 12th at lives of the communities around him. the annual Legislative Day. Addressed by dozens of lawmakers from both the Republican and Democrat I was happy to visit numerous AAPI Chapters in my parties, the event was a forum for AAPI to have its efforts to engage the midlevel AAPI Leadership – voices heard on the corridors of power and giving the Regional Directors in bringing them closer to us a voice in shaping the healthcare policies and the mission and vision of AAPI and contributing to programs of the nation. the cohesiveness of this large organization and its Ravi Nathan, MD Tarang Sharma, MD members. As President of AAPI, the nation’s largest ethnic

www.aapiusa.org 04 05 www.aapiusa.org AAPI with the collaboration and cooperation from AAPI Local Chapters was successful in organizing AAPI took the initiative to improve the Health and Healthcare of Overweight and CHAIR BOT MESSAGE Obese Veterans along with other My dear AAPI My dream is development of AAPI leadership organizations including WHEELS Global Colleagues, academy under leadership of the young physicians. Foundation (WGF), Global Association They are our future. of Physicians of Indian Origin (GAPIO) The AAPI 2017/2018 and VETERANS OF FOREIGN WARS year has started with Our BOT has dynamic members. Dr Amit Chakrabarty (VFW) and MOVE! Weight Management flurry of important is engaged in fundraising efforts for AAPI to support Program in developing the “Veteran events and overseas hurricane Harvey rebuild efforts, and support the Obesity Awareness Campaign”. Leaders trip under the able Lymphoma and Leukemia Society by arranging Talat representing each of these groups leadership of Dr Aziz shows in nine cities. signed the official document, pledging Gautam Samadder to work together in the campaign and his young and Dr Hemant Dhingra is working hard on develop a supporting atleast one hundred VA energetic executive new osteopathic medical school in California where facilities throughout the United States. team. AAPI and its members would be active participants, Ashok Jain, MD in addition to start a new primary care residency Recognizing AAPI’s role in supporting BOT Chair, AAPI The South Africa CME program in Fresno, California. a Nine City Musical Tour by Talat Aziz and NJ and contributing to the many rising challenges trip was a success and Musical Gala, which helped raise 100K for victims of of our adopted country, AAPI has been in the very well organized. It was a monumental task with Many thanks to Dr Madhu Agarwal for a successful Hurricanes across USA. forefront, contributing immensely to meet the 250 member and family members joining the trip. year as BOT chair and many accomplishments. She ongoing needs of the larger society. has been mentoring me this year. Continuing with supporting noble causes, AAPI has During Independence Day celebration week, our YPS/ taken on yet another cause to promote through its AAPI’s recent meeting with the Association of MSRP group arrangeda a very informative leadership Dr Samadder is working hard to make GHS in Kolkata active support by officially launching a campaign Physicians of Pakistani Descent of North America retreat at Indian consulate in New York. As always our a big success. He has the full support from all at the against Leukemia and Lymphomas, by donating (APPNA) and the Bangladeshi Medical Association young and dynamic BOT member Dr Kusum Punjabi BOT 100K to the Leukemia & Lymphoma Society of of North America (BMANA) was intended to lay mentored and coordinated the retreat that was a full America on March 10th during the annual AAPI the groundwork to provide South Asian-American house. Thank you Drs. Roshan Shah, Atul Nakhasi and Spring Governing Body meeting in Freemont, physicians a seat at the table in both organized Pooja Kinkhabwala for a job well done. CA and committing to make efforts in educating medicine and mainstream policy discussions. people about the deadly disease around the world. The MOU signed by the groups would seek to establish a coalition of South Asian Physicians in North America (SAPNA) which will collaborate MISSION: on strategic opportunities to address health and AAPI is a forum to facilitate and enable Indian American Physicians to excel in patient care, teaching wellness of South Asians in North America and the and research and to pursue their aspirations in professional and community affairs. South Asian Region. MOTTO: The changing trends and statistics in healthcare, Unity of Purpose both in India and US, we are refocusing our mission Collegiality in Action and vision to make a positive meaningful impact Commitment to Excellence and on the healthcare delivery system both in the US Compassion towards Fellow-being and in India. VISION: The annual convention this year is being organized Promote professional solidarity in the pursuit of excellence in patient care, teaching and research. by AAPI’s Ohio Chapter from July 4th – 8th 2018 Bring American medicine the distinctive contributions from India, and advance the American creed of in Columbus, Ohio. I will like to cordially invite all one nation under God, indivisible with liberty and justice for all. members to register for the convention and enjoy the extravaganza planned for you by our dedicated convention team.

www.aapiusa.org 06 07 www.aapiusa.org PRESIDENT - ELECT MESSAGE YOUNG LEADERSHIP REPORT As President Elect Dr. Ajay Lodha, Dr. Hemanshu Pandya and Dr. Asha AAPI, the year started Parikh. Weekend in February 2018 in Las Vegas and with an exciting and A strategic and symbolic “Singing of MOU with was an overwhelming success - strengthening adventurous Summer Physician of Pakistani and Bangla Desh origin with and growing our membership base while trip to South Africa AAPI was a historical moment in Feb 2018 In Miami, also creating formal relationships with our followed by a trip Florida. This brings about a non-binding alliance professional colleagues at the South Asian Bar to India, particularly of three south Asian physicians groups that will Association (SABA). Keynote Speakers included Rajkot and Saurashtra, help support strategic and agreed upon programs Dr. Poonam Alaigh (Former VA Undersecretary) where most of the that impact health and wellbeing of South Asians, and Dr. Shaan Patel (Shark Tank, Mark Cuban’s action took place . such as addressing the higher incidence of heart Business Partner), Harvard Leadership Training diseases in South Asians. led by Drs. Jay Bhatt (President of HRET, SVP Naresh Parikh, MD Thalassemia Major is of AHA, and Presidential Scholar), Vipan President-Elect, AAPI a devastating disease, Three key priorities for the year July 2018 to June Nikore, and Kusum Punjabi, as well as Panels Roshan Shah, MD, DABIM prevalent in Southern 2019 on Entrepreneurship, Health Law, Blockchain AAPI YPS President part of Gujarat. India. An NGO, Koticha Foundation is in Healthcare, Health Advocacy, Academia in doing an excellent service for the Community. AAPI 1. Opioid epidemic and awareness. Coordinator Dr. It am privileged to serve you as the 2017 - 2018 Medicine, and much more including our annual has signed Memorandum of Understanding (MOU) Kavita Gupta and Dr. Sanjay Gupta President of the Young Physicians Section (YPS). Research Competition. The conference provided whereby we have made an appeal to Ministry of 2. Lymphoma and Leukemia Research Coordinator I am a board certified internist from Houston, attendees a superb forum to help foster a Health to make mandatory blood screening before Dr. Vinod Shah Texas and currently a physician entrepreneur. In marriage or high school / college admissions. A 3. Silent Epidemic TB in India. A major focus at The strong network that will only advance the YPS addition to my private practice, I co-founded the nominal test costing only Rs. 500 can prevent child Global Health Summit to be held from Dec 28th to and MSRF members to morph into productive India Heritage Group which supports non-profit born with this disease. 30th in . Dr. Ravi Jahagirdar, Dr. Manoj Jain national AAPI members. of CDC and Chief Strategy Adviser , AAPI Mr. Anwar organizations that promote our culture, health, The YPS and MSRF look forward this year to the Kidney stones are also most prevalent in Gujarat due Feroz Siddiqi is Instrumental in Coordinating USAID activism, and impact the broader community at opportunity to take a proactive role, planning to hard water consumption. Dr. Kansangra explained collaboration thru CDC Atlanta GA and with various large. I have served the YPS board as Treasurer, content for the 36th Annual National AAPI how his organization is helping poor resident that agencies in India. Vice President, President Elect, and President Convention in Columbus, Ohio. need dialysis with 500 Rupees per day for dialysis Ongoing and Year round effort to have a over the past four years. session. Dr. Kansangra makes frequent visits to meaningful and convincing conversation with USA On behalf of all current and past YPS and MSRF supervise this program and is a regular participant lawmakers to increase Residency Slots for Physician The YPS and MSRF (Medical Students Residents Executive Committee members who have at AAPI convention to help raise donation for of Indian origin that can help fill up slots and and Fellows) sections of AAPI are the future of worked tirelessly to make the Winter Medical supporting this effort. partner with USA in easing shortage of Physicians, this great organization. We have taken on the Conference such a resounding success, I particularly in underserved areas. This effort is task of establishing the AAPI young physicians’ would like to thank the current National AAPI AAPI is pleased to announce the opening of its 16th being coordinated by Dr. Ajeet Singhvi who is very network through a grassroots movement by leadership for their support - to National AAPI charitable clinic in Panvel, Mumbai, MS known as passionate about this topic. a consensus reached at the annual meeting - President Dr. Gautam Samadder to BOT Chair Tara Clinic and is sponsored by Naresh and Asha Winter Medical Conference (WMC). The WMC Dr. Ashok Jain and the entire Board of Trustees; Parikh Foundation in collaboration with AAPI Please plan ahead to join us for an amazing provides a forum where next generation AAPI and all National Executive Committee Members; Charitable foundation. This clinic is serving residents experience and would like to welcome all of leaders can network, exchange innovative ideas, all AAPI Regional Directors and Local Chapter from the Panvel tribal community which is about 2 you and your friends to the 37th Annual AAPI and brainstorm its strategic planning. In the five Presidents. I would thank other Past AAPI hours from South Mumbai. Convention in Atlanta from July 4th to July 8th, years since its inception, the conference has leaders for the mentoring they have engaged 2019. grown exponentially, expanded AAPI’s brand, in so graciously. Your support and commitment A look ahead at The Year 2018 starting with July: and infused the organization with a base of new to the next generation physicians is invaluable AAPI Summer Family Tour to North Europe and Our Mission and Motto: “Keep AAPI members. to our success, and ultimately to the success of Iceland is scheduled from July21st to 30th. Thriving with Balance, Unity and Pride” AAPI. Thanks to an overwhelming response, we are in an The 5th annual WMC held over President’s Day oversold situation as reported by our coordinators

www.aapiusa.org 08 09 www.aapiusa.org EXECUTIVE COMMITTEE REGIONAL DIRECTORS

Rakesh C. Gupta, MD Harnath Singh, MD Hemant V. Reddy, MD Pacific Region Mountain Region NW Central Region

Gautam Samadder, MD Naresh Parikh, MD President President - Elect

Srini Potluri, MD Bharat Barai, MD Anjana Samadder, MD SW Central Region NE Central-I Region NE Central-II Region

Suresh Reddy, MD Sudhakar Jonnalagadda, MD Anupama Gotimukula, MD Vice President Secretary Treasurer

Tarak Vasavada, MD Sapna Aggarwal, MD Bhavani Srinivasan, MD SE Central Region New England Region Mid Atlantic-I Region

Ajay K. Lodha, MD Roshan Shah, MD Pooja Kinkhabwala, DO Imm Past President YPS President MSRF President Ravindra Kolli, MD Mukesh Nigam, MD Amish Parikh, MD Mid Atlantic-II Region South Atlantic Region South Region

www.aapiusa.org 10 11 www.aapiusa.org AAPI’S HISTORIC BOARD OF TRUSTEES GLOBAL HEALTHCARE SUMMIT ,2017 Pre-Summit: December 31st at the world famous JW Marriott. AAPI delegates had a This momentous occasion included the CEOs memorable visit from Forum, Women’s Forum, the launch of the free December 24-27 to Health Clinic, First Responders Training, CMEs, the city of Dubai and Research Contest, cultural events and tours. the kingdom of Abu Dhabi, where they AAPI Global Health Summit has been strategically were greeted by local engaged in working with the Union and State high ranking officials, Governments of India for the past ten years and who have expressed has collaborated with more than 35 professional Ashok Jain, MD Dharmi Kanuga, MD Ami Shah, MD interest in collaborating medical associations, pharmaceutical and medical Chair Vice-Chair with AAPI affiliates device companies to address the health care Anjana Samadder, MD in the Gulf Region. challenges of a rapidly developing India. It is the A memorandum of understanding was signed passion, willingness and staunch loyalty towards with NMC Healthcare, allowing Indian American the former motherland that draws several AAPI physicians to be able to work in the UAE/Abu Dhabi members to join this effort by working with Hospitals. experts in India. AAPI is able to bring solutions that are India centric which helps in making quality healthcare affordable and accessible to all people of India. Ajeet Kothari, MD Kusum A. Punjabi, MD Sreeni Gangasani, MD The theme chosen for the GHS this year was Healthcare, Career and Commerce, with the focus on Women’s Healthcare, including high priority areas such as Cardiology, Maternal & Child Health, Diabetes, Oncology, Surgery, Mental Health, Allergy& Immunology, Sleep disorders and Gastroenterology.The scientific program of GHS 2017 was developed by leading experts with the contributions of a stellar Scientific Advisory Board and International Scientific Committee, featuring plenary sessions, interactive round-tables, clinical Seema Arora, MD Amit Chakrabarty, MD Hemant Dhingra, MD The delegates, apart from visiting the modern city of practice workshops, and meet the expert sessions. Dubai and its major tourists attractions, had a fruitful In collaboration with the American University visit to the famous NMC Hospital in Abu Dhabi and met with the founder and chairman, Dr. Shetty. The pre-summit tour to Dubai provided AAPI delegates with several unique experiences including: the Christmas Dinner Cruise , the City tour to Palm Island, Khalifa Tower, Burj Hotel, Dubai mall, Dubai Museum, and other festivities.

Global Health Summit: We had a highly successful 11th edition of the Madhu Aggarwal, MD Aaditya Desai, DO Atul Nakhasi, MD annual Global Healthcare Summit in the historic Past Chair, BOT YPS Past President MSRF Past President City of Joy, Kolkata from December 28th through

www.aapiusa.org 12 13 www.aapiusa.org Choreographed and designed by famous fashion . The Summit’s valedictory event was presided by by popular Bollywood singer Usha Uthup, who kept designer, Nachiket Barve, AAPI members walked Vice President of India Honorable Mr Venkaiah the audience spell bound for over two hours with on the ramp showcasing their talents and exquisite Naidu but also attended by Governor of West her melodious singing and live interaction with the taste for the finest clothing and attire,. audience. The year end party on December 31st night was a memorable one for all participants. The Summit’s valedictory event was presided by This is the first ever free health clinic sponsored Vice President of India Honorable Mr Venkaiah by AAPI in the state of West Bengal. A welcome Naidu but also attended by Governor of West reception was organized by the local Rotary Club Bengal, Shri Keshri Nath Tripathi, the Minister for in honor of the physicians who had travelled early Urban Development, West Bengal, Firhad Hakim in the morning on a bus to serve the much needed and several others. patients at the clinic. of Antigua (AUA) College of Medicine, and the The evening galas included performance by popular Choreographed and designed by famous fashion American Heart Association, AAPI was successful Bollywood singers Alka Yagnik and Usha Uthup, designer, Nachiket Barve, AAPI members walked in imparting the much required training to who kept the audience spell bound with their on the ramp showcasing their talents and exquisite First responders by lead trainers of the National melodious singing and live interaction with the taste for the finest clothing and attire,. Association of Emergency Medical Technicians audience. The year end party on December 31st Bengal, Shri Keshri Nath Tripathi, the Minister for (NAEMT). The final session of the three days night at JW Mariott, was a memorable one for all Urban Development, West Bengal, Firhad Hakim and In collaboration with the American University long training program ended on December 28th participants. several others. of Antigua (AUA) College of Medicine, and the with 150 more police/para medics personnel American Heart Association, AAPI was successful representing Kolkata Police, West Bengal Police, Post Summit The theme chosen for the GHS this year was in imparting the much required training to Kolkata Traffic Police, Police Training School and The Post-GHS TOUR to the heavenly Bhutan from Healthcare, Career and Commerce, with the focus First responders by lead trainers of the National Criminal Investigation Department of West Bengal. on Women’s Healthcare, including high priority Association of Emergency Medical Technicians The First responder training program was held at areas such as Cardiology, Maternal & Child Health, (NAEMT). The final session of the three days KPC Medical College and Hospital, Kolkata. Diabetes, Oncology, Surgery, Mental Health, long training program ended on December 28th Allergy &Immunology and Gastroenterology, The with 150 more police/para medics personnel AAPI, in collaboration with the Rotary Club of scientific program of GHS 2017 was developed by representing Kolkata Police, West Bengal Police, Madhyamgram Metropolitan launched a free leading experts with the contributions of a stellar Kolkata Traffic Police, Police Training School and healthcare clinic offering medical care to much Scientific Advisory Board and International Scientific Criminal Investigation Department of West Bengal. needed people of the region at the Prajapati Committee, while the event featuring plenary The First responder training program was held at Bhavan, Basunagar, Madhyamgram in the outskirts sessions, interactive round-tables, clinical practice KPC Medical College and Hospital, Kolkata. of Kolkata on December 29th, 2017. Over 30 AAPI workshops, and meet the expert sessions. members, spearheaded by Dr Madhu Aggrawal, AAPI has been strategically engaged in working attended the free one day healthcare clinic at the The Conference was organized in partnership with the Union and State Governments of India suburban center, and treated over 200 patients with the ministry of overseas Indian affairs and for the past ten years and has collaborated with during the day long clinic.This is the first ever free January 1-4, 2018, took the delegates to the world ministry of health and family welfare, along with more than 35 professional medical associations, health clinic sponsored by AAPI in the state of West renowned and ancient Takshang Monestary, Hike in collaboration with over 15 professional associations pharmaceutical and medical device companies Bengal. A welcome reception was organized by the Tiger's Nest, Buddha Dordenma, National Heritage from all over the world. The GHS 2017 featured some to address the health care challenges of a rapidly local Rotary Club in honor of the physicians who museum and Dochula. of the biggest names in the healthcare industry, developing India. It is the passion, willingness and had travelled early in the morning on a bus to serve especially at the 6th annual CEO leadership forum staunch loyalty towards the former motherland the much needed patients at the clinic. AAPI delegates also visited the beautiful state of with leaders from across the globe. that draws several AAPI members to join this Assam from January 4-8, 2018, touring Kaziranga A special unique to the GHS 2017 was a session effort by working with experts in India. AAPI is A special unique to the GHS 2017 was a session National Park including Rhino Park, Nehru Stadium, on the Impact of Cinema on Public Health and able to bring solutions that are India centric which on the Impact of Cinema on Public Health and Assam Rajyik State Museum, Guwahati Market awareness with a live conversation with Bollywood helps in making quality healthcare affordable and awareness with a live conversation with Bollywood and Kamakhya Temple.The Summit also offered stars and producers, including Dr. Kapasi, Shekar accessible to all people of India. stars and producers, including Shekar Das and everyday guided Tours and evening entertainments das, Dipankar Banerjee, who shared their personal Dipankar Banerjee, who shared their personal to the delegates, and concluded with a special experiences of making movies on social themes that experiences of making movies on social themes that dinner hosted by Government of Assam. AAPI was imparts education on various social topics. imparts education on various social topics. also successful in having MOU signed with the Ministry of Health for Physician exchange program. The events came to a close with a live music concert

www.aapiusa.org 14 15 www.aapiusa.org PHYSICIAN SURVIVAL IN US DOCTORS, IT’S TIME FOR US TO GET OFF THE SIDELINES HEALTHCARE Independent India focused heavily The significant role of us Indians on medical education, creating in enhancing life in America is With Congressional time our overhead and work load have increased several medical colleges to serve indisputable, whether we are in efforts to repeal exponentially. Surviving in these turbulent times the health needs of its people. teaching, keeping technology and replace require not just your clinical skills, but acquiring Consequently, most of us received efficient or computers running, Obamacare in the new business skills like finance, marketing and medical training almost free of small businesses, the sick rear-view mirror— strategic planning. In the turbulence of uncertain cost, the expenses being heavily or saving lives. Hardly a whisper and replaced by Healthcare on the horizon, solo practitioners may subsidized by the state. Many of us of appreciation is heard about President Donald not be able to stay safe for an extended period migrated to America, in search of such huge contributions. The Trump’s vows to sign of time. The US healthcare industry is facing advanced training and stayed on. bigoted don’t know or seem to Prof. Joseph M. Chalil, MD, executive orders tremendous challenges, while at the same time, it is As we filled the shortage of health care; to them we often remain the Chair of AAPI Global Clinical that many fear would experiencing extraordinary growth. care providers here, the irony of ‘undesirables’. severely cripple the Trial Network. Venugopal K. Menon, M.D. our diverting the investment by law—pessimism What can we do? our mother country for selfish We can remain oblivious. The abounds about the future of the U.S. healthcare The mighty United States is purpose often remains ignored. successful in our community are system. The years ahead hold both opportunity and established and acknowledged Some of us also remain guilty of comfortable with an assumption uncertainty as physicians continue to move into as a country of immigrants, a deriding the primitive ways and that we are safe and would remain Healthcare in America is more expensive than in any the world of value-based care and other healthcare melting pot and a flawless medley means of the Third World that we so forever. But it is our ‘Dharma’ other wealthy nation. In 2016, the average American advances. To tackle these challenges better, we of many elements, ingredients. ‘left behind for good’. to protect our kind, and ensure spent $4,571 on their health – a figure five times physicians need to acquire a better business This is the one place on earth that their safety, and that of our future. higher than the average out-of-pocket spending of acumen. To reach that end, one institution - the distinguishes itself as the most Our generation boasts in our Organized establishments like other countries in the Organization for Economic H. Wayne Huizenga College of Business and chosen by humans from all over wisdom of choice and exalt AAPI must leverage our clout and Cooperation and Development (OECD) .. with no Entrepreneurship at Nova Southeastern University to arrive with hope and scope for watching our next generations protect our community, our status, measurable better health. The life expectancy of in Florida has launched a brand new MBA degree, improving their lives and that of excel in their vocations. But our privileges, our future and that the average US citizen is 78.8 years .. just a fraction with a Complex Health Systems concentration. This their future generations. alarmingly, there seems to be of our descendants. The commoner ahead of the Czech Republic, where the spending novel program provides a comprehensive, flexible, a shift, the land of immigrants must be informed about the was $236 last year. transdisciplinary, experiential and team-based Indians originally landed as accusing the ‘inferior’ immigrants substantial contributions of Indian environment that completely focuses on the new indentured laborers in the to be its ‘nemesis’, responsible for professionals in today’s America, Unlike in most other markets, health care lacks business of health. early 1900s but our real exodus the many damages and atrocities to be accepted and appreciated serious price competition (price competition being occurred during the latter part of around. In spite of all the race on the merits of our legitimate one of the ways in which markets reach efficiency). Another key survival skill is to work with each other, the twentieth century. Today, we crimes, mass shootings and roles. We deserve it, but we need For example, hospitals do not list prices as we enter and get involved our Medical Organizations at the are the second largest immigrant blatant prejudicial exhibitions, the to demand it. the door. When was the last time you shopped National, State and Local levels, and take charge of group after Mexicans, being highly ‘elite wasps’ are excluded for their around for the lowest-priced lab test or an x-ray? our destiny. Associations like AAPI has a significant qualified, proficient in English atrocities and related discussions For any machinery to be As a result, the current health care system runs on role to play in helping us design our own future, and contributing as doctors, as if the natives adopted them operational, all of its parts have what’s called asymmetric information— where you instead of the Insurance companies, Hospitals and engineers, computer specialists, as their worthy successors. To to be functional. Individual get services first and find out the cost later — and the politicians or their lobbyists on Capitol Hill research scientists, and excelling the xenophobes, shaded skin accomplishments may satisfy our markets characterized by asymmetric information telling us what is good for Our patients. in a variety of technological fields and turbaned heads remain personal ambitions, but unless are generally inefficient - whilst the cost to increase. and considered to be the “model substandard, out of place and our society is thus recognized, our minority”, and probably the most polluting the purity of the stock, job is not done. It is no more an Physician reimbursement have been significantly socioeconomically successful and being screamed at, ‘go back to option, but a dire, historical need, reduced over the past two decades. At the same minority ethnic group in the USA. your country’. We Indians are not a mandatory duty. as holy as we think.

www.aapiusa.org 16 17 www.aapiusa.org parents. A recent news program mentioned that struck by a bullet. We can put greater restrictions VIOLENCE IN SCHOOLS: TIME TO BE schools are becoming more like prisons, with armed on weapons that are accessible to the public. We guards, metal detectors, and random searches can have laws that limit the ability to purchase of students’ belongings. There was a time when guns by individuals who suffer from mental THE CHANGE schools conducted tornado and fire drills. Now, illness. However, as important and valuable as In 1999, our nation intervene or respond to cries for help, as bullying these have expanded to include active shooter drills. these actions are, they are ultimately band aids. was shocked by has long been considered a normative milestone in Students who experienced the recent events at Our society is plagued by violence. People drive the mass shooting childhood. However, bullying has been described Marjory Stoneman Douglas High School in Parkland, violently, react violently to unexpected news, taking the lives of by expert researchers as a “systemic abuse of power”. Florida, have shared their chilling accounts of fear, review violently on Internet websites when fifteen people and There is a clear pattern of aggression towards a chaos, and despair witnessing their friends and dissatisfied with a restaurant or mechanic, and injuring over twenty seemingly weak individual, which is repetitive. In teachers lose their lives when a shooter entered violence pervades entertainment and media. others. Almost every recent time, 25% of school children report that they the halls and opened fire. Nicholas Cruz, who was Children are exposed to violence in all facets of year since, we have are bullied yearly, and this goes unreported. Many the gunman taking the lives of seventeen people their lives. In the medical community, we take been inundated times, the bullies are considered to be popular, that day, has expressed feelings of hopelessness, an oath to “first, do no harm”. We should be with numerous and this bullying behavior serves as a construct for resentment, and isolation. These qualities are cognizant of warning signs, and we should heed images of girls, boys, achieving social dominance. Sadly, most bullying shared with other gunmen who opened fire in other to cries for help. We serve on the basis of love and Dr. Nirupama Madduri women, and men is unreported, ignored, and unpunished, leaving schools and took lives of children and adults. compassion, and we should be the conduits for whose lives were the victims to feel the burden of social isolation. these powerful forces. It is our duty to, as our Great ended tragically from bullets that was fired on the Schools and parents must accept accountability for We are obligated as a society to address this, and Soul, Mohandas K Gandhi declared, “Be the change campuses of colleges, high schools, and elementary creating standards of citizenship and honoring the take action. As parents, we owe our children a that you wish to see in the world.” schools. In The National Survey on Children’s basic human values of love and nonviolence. world where they can still play in a neighborhood Exposure to Violence, conducted in 2009, responses park and walk to school without the fear of being indicated that in that year alone, 60% of children Schools can also be a venue for abuse, at the had been exposed to violence in various settings, hands of authority figures. Many teachers and with half of these respondents being victims of teachers’ assistants who are ill-equipped and who DR. MOHAN DURVE PRESENTS CME PROGRAMS FOR YEAR 2018 / 2019 violent assault. For children who are present in lack proper resources succumb to demeaning a Prices From a school that becomes a war zone, the long term student in a classroom setting. These students Antarctica Cruise (14 days) Dec 20, 2018 - Jan 2, 2019 or Dec 13 - 27, 2019 $8334 effects can be debilitating, as they witness friends may have learning disorders, mental health issues, Australia - New Zealand (14day) 2018- 6/5, 7/10, 9/10, 10/2, 10/30 $6749 from LAX and teachers being struck by bullets from assault or instability in their family lives. A report by weapons. The children who are watching the Swigonski, et al (2014) described bullying by athletic Canadian Rockies by train (7 day) Weekly departures May to Sept, 2018 $3180 events unfold on their televisions have the images coaches. Many student athletes receive verbal Croatia (5, 7 or 9 days) 2018 5/13, 6/10, 7/8, 8/12, 9/9, 9/23 $1450 recurring in their minds. 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Youth who are bullied have an of that student being labeled as a weak link, leading Switzerland (10 days) Oct 19 - 28, 2018 $3999 elevated incidence of depression, anxiety, somatic to repeated mistreatment expanding to other South America (12days) Sept 9 - 20, 2018 $4999 from Miami complaints, suicidal ideation, and suicide attempts, classmates. *Tran-Siberian Railway (10 days) July 22 - Aug 2, 2018 (Moscow to Ulaanbaatar) $12995 per Holt and Gini (2017). In addition, victims have 5 Stans (Uzbekistan, Kyrgyzstan, Kazakhstan, Tajikistan & Turkmenistan) Sept 6 - 26, 2018 $7995 higher probability of bringing weapons to school. Of late, mass shootings on school campuses have *Oberammergau (12 days) July 20 or Aug 3, 2020 $3999 Sadly, many schools and school officials do not become a somber reality for students and their Call Dr. Mohan Durve at 888-794-1995 or 440-845-7272 e-mail at: [email protected] or website: CMETravels.com

www.aapiusa.org 18 19 www.aapiusa.org Thakar Financial, LLC is built on principles of strong work ethics, integrity and placing client’s interest first. We strive to WANTERPRENEUR TO ENTREPRENEUR provide exceptional service to our clients and never forget that AAPI YPS/MSRF Winter Medical Conference our success lies in the success of our clients. An arena for education, growth, networking and innovation clinical medicine. There were Other topics discussed were several prominent speakers Blockchain in Healthcare, like Dr. Poonam Alaigh (Under Healthcare Advocacy by We are proud to manage AAPI Board of Trustees and AAPI Charitable Foundation Secretary for Heath at US AMA Leaders, Understanding General and Endowment Accounts. We are also proud to manage assets of many Non- Department of Veteran Affairs) Healthcare Law for Physicians Profit Organizations and High Net-Worth Individuals like you. who talked about the current by South Asian Bar Association state of veterans health care (SABA) President and Academic We look forward to many more years of working together. and its overall impact on the Medicine roles for physicians system. She also talked about interested in working beyond For all your “Financial Health and Wealth” check-ups, please contact us at 412-809-0990 or her journey on how she got clinical medicine. [email protected] to this very prestigious and Kusum Punjabi MD, MBA, responsible job, which was The conference also included FACEP very inspiring for all us present CME lectures, Research Poster AAPI Board of Trustees to hear and learn from. Other competition, leadership Assistant Professor of Emer- speakers included Dr. Shaan training by experts trained at gency Medicine Patel (a medical resident who Harvard University and Rutgers Rutgers University, Robert Wood Johnson Medical School is Founder of PrepExpert and University, singles mixers and featured on the famous TV show several evening events at On February 16-19th 2018, the Shark Tank). He talked about Las Vegas’s premier venues AAPI Young Physicians Section his challenges and success in like Tamba, Omnia, Hyde in (YPS) and Medical Students developing a company and Bellagio and Hakkasan. The Thakar Financial, LLC Residents and Fellow Section now managing it as a busy conference was well planned 2 Robinson Plaza, Suite 320 (MSRF) had their Annual Winter medical resident. He was asked and heavily subsidized thanks Pittsburgh, PA 15205 Medical Conference (WMC) at questions about his day-to- to support from national AAPI Tel: 412-809-0990 the Palazzo Venetian hotel in day lifestyle which he also very Board of Trustees and Executive Fax: 412-809-0995 Las Vegas. This was the 5th year humbly shared and gave great Committee. It truly shows the Left to right: Sonia Chowdhry, MBA, Office Manager Email: [email protected] Girish Thakar, M.S., MBA, AWMA®, President, Registered of the conference and it was insight on the good habits of commitment of the organization www.raymondjames.com/ThakarFinancial Principal-RJFS; Seema Mendon, Bachelor’s in Commerce, extremely successful with more great leaders. Ms. Anita Malik for recruitment and retention of Client Service Manager; the 200 attendees including and Mr. Chintan Desai spoke next generation leaders in AAPI. several field related sponsors, to the conference members non physician professionals like of why they are running for We all have it in us to do well. “Wealth is nothing without Wisdom. lawyers, bankers, prominent the US Congress and shared We all want to do well. But this Wealth and Wisdom is nothing without Health.” healthcare dignitaries and with all the participants their conference helped us get some Congressional candidates. understanding of the current insight of how many of us can go ______healthcare system and were from being wantrepreneurs to The conference this year Securities offered through Raymond James Financial Services, Inc. open to hearing our practice true successful entrepreneurs! Investment Advisory Services offered through focused on growth as a medical challenges and offering Raymond James Financial Services advisors, Inc. leader in spheres outside of solutions to some of the issues. Thakar Financial, LLC is not a registered broker/dealer and is independent of Raymond James Financial Services, Inc. Raymond James is not affiliated with nor does it endorse or sponsor AAPI publication

21 www.aapiusa.org TB FREE INDIA – AAPI’S DREAM

In our day-to-day education and communication, are in place. For example INCREASING NICOTINE USE IN INDIAN YOUTH practice, seeing a case patients get an incentive of Rs 500 per month for of tuberculosis is rare continuing and completing their course of TB. Doctors or in America, even for me health providers get paid Rs. 200 for reporting a case of Impending chronic kidney disease epidemic as an infectious disease TB to the government’s electronic registry, Nikshay. All of doctor. However, such this effort is producing results on high risk areas such a Increasing popularity of smokeless tobacco, hookah cotinine –a stable NIC is not the case in India. slums with more cases being reported than ever before. and E-cigarettes among Indian youth chronic exposure metabolite 2- content In fact, each year almost to nicotine (NIC) is an emerging renal risk. NIC increases of non-smoking 3 million new cases of Here is what AAPI has done. At the 2016 Global Health inflammation in the kidney, which changes renal function, children exposed TB occur in India, and Summit, AAPI convened leaders from USAID, Indian hemodynamics as well as viability of renal tubular and to parental tobacco of these over 1,400 Medical Association, TB Union, and other leading endothelial cells. Hence, long term NIC exposure increases smoke is higher the risk of development and progression of renal diseases. than those that Manoj Jain, MD patients die each day organizations to discuss how to combat TB. Also, from this completely AAPI signed an MOU with TB Union to disseminate In this review we summarize potential renal risk of were not exposed preventable and information, as well as donate towards a local project. smoking/E-cigarette use. 13. These studies treatable disease. For this effort Rotary Club near Memphis donated call attention to the $10,000 to AAPI for TB projects in India. At the 2016 Scope of the problem: dangers of direct and Smoking is a preventable risk factor that affects many indirect smoking in Often we wonder, “What can be done?” A great deal, and AAPI meeting tuberculosis elimination organs including the kidney 1. Renal effect of smoking younghood. We also AAPI has become a leading partner in making true the was a key part of the conversation similar to other AAPI may sound surprising but have to consider that the main determined that NIC dream of TB Free India. initiatives such as traumatic brain injury. component of cigarette smoke is nicotine (NIC), which directly and indirectly is excreted through glomerular filtration and tubular influences oxidative At the international level, the Global Fund has Now for the 2018 Global Health Summit, AAPI is secretion 2. Experimental and human studies showed high status in the kidney: committed billions of dollars along with technical convening key partners such as CDC, USAID, Gates affinity of NIC to the kidney 2. Even though overall rate Mehul Dixit, MD, DM via inducing the pro- assistance from World Health Organization. Both Gates Foundation , Clinton Foundation, TB Union, Indian of smoking declines in South-East Asia 3,4 the increasing (Nephrology) oxidant p66shc gene and the Clinton Foundation have boots on the ground Medical Association and central and state health popularity of E-cigarettes –which are thought to be safe i t facilitates production in India with large grant donations. Additionally, CDC, authorities. The team in collaboration with local alternative to smoking 5 – smokeless tobacco and hookah of reactive oxygen species (ROS) 14 and also suppresses Centers for Disease Control and Prevention, and USAID, authorities will work on crafting a roadmap for TB is on the rise among the Indian youth 3,4. antioxidant responses 12,15. United Stares Agency for International Development, elimination at a city level. AAPI members who want their assist in piloting new ideas for case finding, diagnostics, home city to be part of the plan can join in by contacting Studies established that smoking/chronic NIC exposure The most obvious therapy against smoking/ and adherence strategies. For example, the GeneXpert us. enhances inflammation 6, which is a major risk for most NIC exposure-associated renal impairment is smoking chronic diseases 7 including chronic kidney disease cessation. However, many times this option is not realistic TB machine which has sensitivity and specificity (80% (CKD) 8. Inflammation increases oxidative stress, vascular in long-time smokers for various reasons. Further risk is and 98% respectively) for TB detections on sputum As for me, in an effort to make a personal difference, dysfunction and hypertension 9 that ultimately causes that use of e-cigarettes, hookah or smokeless tobacco smears using PCR technology within 2 hours is now I have embarked on a journey to help eliminate TB in CKD. Chronic inflammation is –at least partly- mediated increases the probability of future smoking 16. Hence, available in every city and every district in India. Also my home city of Indore. Some 7 years ago, we started by the transcription factor STAT3 7 that regulates alternative therapies are needed. Since adverse effects are labeled with blister packets with a call a local collaborative effort called Collaboration for transcription of various inflammatory cytokines such as of NIC is associated with development of inflammation, back number to track TB adherence. Eliminate of TB from India ( CETI) www.tbfree.org . Each IL-1 and IL-6. it is reasonable that anti-inflammatory therapies may year I visit with local partners and keep in touch with fulfill this goal. This may include natural inhibitors of At the national level, the most impressive work has local NGO through skype and whatts app. At each visit UMMC Nicotine Renal Research Laboratory: the STAT3 pathway 17. In addition, applying as well as been done by the Government of India. Prime Minister to India, I realize the imperative to do more. Recently, I We demonstrated that chronic NIC exposure activates STAT3 various antioxidants may suffice. Our studies show that Narendra Modi has made tuberculosis elimination part realized, my driver, our house help and gardener lived in the kidney that mediates cytokine release and fibrosis resveratrol 18, various flavonoids 19, alpha-tocopherol 20 of the dashboard of each of the state’s chief minister. A in a place where 2 of every 1000 people had active TB. in the kidney 10. We also found that chronic NIC exposure or coenzyme Q10 21 attenuates NIC-associated oxidative national priority to make India TB Free by 2025 (much Tuberculosis is not a local problem but an international exacerbates renal toxicity of certain anticancer therapies stress in cultured renal proximal tubule cells. Research in cultured renal proximal tubule cells 11. In addition, we indicates when combined with diabetes and/ or obesity, like the make India clean) is in full swing. My hometown one. established that detrimental effects of NIC on the kidney nicotine use significantly enhances renal damage due to of Indore was ranked number 1 as the cleanest city and is age-dependent in a mouse model: adolescent-age oxidative stress. now I am involved in local projects to make it the first TB So, se must be proud that AAPI is part of the common mice are more vulnerable to adverse effects of NIC than free city in India. vision to make India TB Free just like the successful effort adult mice even in case of passive smoking equivalent Acknowledgements: Prof. Istvan Arany, PhD significantly which has made India polio free. My dream is that cases NIC exposure 12. These findings are in good agreement contributed to this research. Unique approaches beyond the simple IEC, information of TB in India will be as rare as they are in America. with those observation that show that urinary and plasma

www.aapiusa.org 22 23 www.aapiusa.org Please support me for Board of Trustee

Mukesh Nigam, MD [email protected] VISION AS BOARD OF TRUSTEES - Help AAPI pace with changing healthVisioncare and strengthen the voice of organization as Board of Trustees by collaboration with strong national organizations like AMA.MISSION STATEMENT - Help AAPI in my capacity with strong financial stability and to project it at national level as a • Help AAPI pace with changing healthcare and strengthen the voice of robust, unified, scientific and topmost non Caucasiaorganization by collaborating with n physician organizationstrong national organizations like AMA. - Help AAPI to promote our old and young talents to prevail with guidance and assistance. - AAPI to be well recognized by Political figures so as to generate much needed support at • Help AAPI in my capacity with strong financial stability and to project it EDUCATION legislative level for current issues we faceat national level as a robust, unified, scientific and topmost non Caucasian - Unify AAPIphysician using the power of social media to bro organization. aden our message and membership • Help AAPI to promote our young physicians to prevail with guidance and EDUCATION AND PRACTICE assistance. • MBBS, MD Anesthesiology – M G M Medical College, Indore 84 • Residency • – AAPI Medical College of Georgia 98 to be well recognized by Political figures so as to generate much • Cardiac/Transplants Anesth Felneeded support atlowship legislative – Louis Pradel Cardiologic Hospital, France level for current issues we face. • Asst Professor, Anesthesia- VCOM & LCOM Faculties • Unify AAPI using the power of social media to broaden our message and AAPI membership. • Past President and Founder – MP Medical Alumni Association of North America • Entertainment Chair• National – AAPI AAPI Caribbean to Help fund and for-freeEurope Cruises clinics • Member, Alumni and Membership committees run by local chapters • Regional Director, South Atlantic – 2015-16, 2017-18 ORGANIZED MEDICINE • Regional Director and Board Member –Virginia Society of Anesthesiology – 2015 -18 • President – Danville Pittsylvania Academy of Medicine 2006 • Chair, Department of Surgery, DRMC – 2011-12 My family with with 3 sons, 2 are surgery residents, first • Chairman Anesthesiology – DRMC , granddaughter 2008-2017 and little poodle “Oreo “. • Board of Directors – Gateway Health Alliance Group – 2011-13 • Medical Society of Virginia – Member, Nomination Committee COMMUNITY & FAMILY - Board of Trustees (3 terms) – Carlisle School, rated one of Virginia’s top schools - Spouse - AMA Alliance National committee. - Children - In surgical residencies and engaged in international health.

ANJANA SAMADDER, MD CANDIDATE FOR AAPI - BOT ELECTION AAPI TREASURER 2018 2018 Spend Your VOTE Wisely, Leadership With VISION for AAPI’s Mission VOTE ERSH RESPONSIBLE FUNDRAISING

Founding Member, Bappi Lahari Concert, raised $42,000 for Autistic Children, 2014 Core Member, Sunidhi Chauhan Concert, raised $167,000 for AAPI- CO Breast Cancer Research, 2015 Core Member, Shreya Goshal Fundraiser Concert AAPI National Tour, 2012 Founding Member, Every Child Counts Fight Against Child Trafficking, August, 2017 Core Member, APPI Hurricane Harvey Relief Fund (Talat Aziz Concert, 2017)

SAJANI SHAH M.D.

LEADERSHIP EXPERIENCE CHIEF OF BARIATRIC SURGERY National Coordinator, AAPI Convention 2018 National Coordinator, AAPI Veterans Obesity Awareness Campaign 2018 Regional Director, AAPI Northeast Central II 2016 – 2018 TUFTS UNIVERSITY MEDICAL CENTER, BOSTON, MA Governing Body Member, AAPI 2014, 2015, 2016, 2017, 2018 National Coordinator, AAPI Global Health Summit, Kolkata 2017 PRESIDENT -IMA NEW ENGLAND 2015 Bylaws Committee Member, AAPI 2016, 2017 President, AAPI-CO 2013 – 2015 MEMBER OF THE AAPI GOVERNING BODY – 2015 AND 2016 Executive Committee Member, Women’s Forum, AAPI 2015 Founding Member, AAPI Gastroenterology Alumni Member, Asian Indian Alliance AAPI –REGIONAL DIRECTOR FOR NEW ENGLAND – 2016

PATRON TRUSTEE AAPI CHARITABLE TRUST ACADEMIC CAREER Assistant Professor, The Ohio State University College of Medicine CO-CHAIR- AAPI ACADEMIC COMMITTEE 2015-2016 Gastroenterologist, Mid-Ohio Digestive Disease Medical Director, Mid Ohio Surgery Center Gastroenterology Fellowship, The Ohio State University Hospital, Columbus Ohio MEDICAL COVERAGE AAPI CHARITABLE FOUNDATION CLINIC Internal Medicine Residency, Hahnemann University Hospital, Philadelphia Pennsylvania MANDI Merit Ranking Finalist, Alumni of Medical College Calcutta, India Sub-Investigator, Columbus Clinical Research Inc., Columbus, Ohio MEDICAL OFFICER AAPI HEALTH CAMP MANDI

ENROLLEE, MIT-SLOANS SCHOOL OF BUSINESS EMBA HONORS AND AWARDS National Merit Scholarship, Medical College of Calcutta India GENEROUSLY FUNDED MEDICAL RELIEF PROGRAMS National Leadership Award Honorary Co-Chairman, Physicians Advisory Board Honored Professional in the National Registers CME LECTURE CIRCUIT PARTICIPANT Ohio Asian Leaders, Leader Honoree, 2012 Hospital, Columbus Ohio Internal Medicine Residency, Hahnemann University Hospital, Philadelphia Pennsylvania Merit Ranking Finalist, Alumni of Medical College Calcutta, India Sub-Investigator, Columbus Clinical Research Inc., Columbus, Ohio

DR. BHAVANI SRINIVASAN REGIONAL DIRECTOR MID-ATLANTIC REGION PRESIDENT GRANT MEDICAL COLLEGE ALUMNI ASSOCIATION

CANDIDATE FOR AAPI BOARD OF TRUSTEES 2018/2019

Pediatrics, Public Health, Acupuncture Past President AAPIQLI, Past President Suffolk Pediatric Society. Alumni Chair AAPI Atlantic City Convention 2017. Member Alumni Committee Ohio Convention 2018. Participated and promoted all activities of AAPIQLI, Membership, and sponsored CMEs, for the last 22 years. Served on AAPI Committees, Ethics and Grievance, Women’s Forum during the last 15 years. Received numerous Community and County Awards in Long Island New York.

PLEASE VOTE FOR ME, FOR AAPI BOARD OF TRUSTEES 2018/2019 VOTE for a Sincere Worker RAGHU LOLABHATTU, MD 478-998-9088 Support me for AAPI Board of trustees

Presently serving as President of Georgia chapter, GAPI AAPI Contributions: Convener and core committee member AAPI Fundrasing programs and AAPI CONVENTION 2019

Thank you for your support DR. BHUSHAN PANDYA Manoj Shah, MD – Candidate for Board of Trustees, AAPI FOR AAPI TREASURER 2018 Associate Professor and Chief, Pediatric Gastroenterology & Nutrition Loma Linda University School of Medicine Leadership. Experience. Dedication. 11175 Campus Street, Coleman Pavilion, Loma Linda, CA 92354 (909-558-4773) Unparalleled Experience in Organized Medicine Vote for Manoj Shah as 1 of 3 BOT members

to change status quo in AAPI • AMA – IMG Governing Council, Chair 2016-2018 Goals If Elected as Member of Board of Trustees: Awards or Special Recognition: • Medical Society of Virginia, President •Increase involvement of academic, “grassroots” and young •Special Recognition for long-term service, India 2016-2017 physicians in AAPI Association of Inland Empire, August 2009 • State Board of Health, Virginia, Vice- •Continue to provide research and volunteer opportunities for •Diamond Jubilee World Conference, Baroda Chair 2004-2012 undergraduate students, medical students and foreign medical Medical College Alumni Association Special • AAPI, Regional Director and many graduates at Loma Linda University Recognition as Faculty/Speaker at CME •Increase AAPI’s political and legislative influence by joining program, December 2009 other contributions hands with other national ethnic associations (Indian — •Special Congressional Recognition (United • Maulana Azad Medical College Alumni dentists, pharmacists, AAHOA, TiE — and non-Indian — States Congress, House of Representatives), Achievements in Leadership Association of North America, Past Network of Ethnic Physician Organizations) August 2010 (India Association of IE) and President, Current Treasurer November 2011 (IMASC) Service to AAPI: •City of Riverside, Neighborhood Leadership • Licensure Parity between IMGs and AMGs, changed •Patron/life member for more than 20 years Academy program, November 2010 the law in Virginia which A Fresh and New Change for •Pacific Region Director, June 2013–June 2015 •Special Award for Contribution to AACIO – sets an example for other AAPI •Member, Governing Body, 2011 and 2013–present American Association Cardiologists of Indian states •Founding President, Inland Southern California Organization Origin, March 2015 • Lead Physicians through of Physicians of Indian origin (ISCOPI – Local Chapter), 2013– Opioid Crisis in Virginia I commit to serve AAPI with present Involvement in Organized Medicine: • Conducted Symposium for integrity, honesty, strength and •President, Indian Medical Association of Southern California •Fellow, American Academy of Pediatrics Residency Applicants (IMASC – Local Chapter)- 2011 Past Member, Government Affairs • hold myself to the highest ethical o Advocating for Indian •Member, Childhood Obesity Awareness Campaign (presented Committee, Section of GI & Nutrition Physicians on H1B Visa standards. My experience will obesity related information and arranged 1-Mile Walk at •North American Society for Pediatric • Facilitated ECFMG help transform our AAPI to a multiple schools in Southern California), 2013–present Gastroenterology, Hepatology & Nutrition Credential Verification for •Member, Veterans Obesity Awareness Campaign, 2017– (NASPGHAN) MAMC Graduates abroad mainstream physician present Past Member, Endoscopy Committee • Conducted multiple organization that serves its o •Speaker, CME at 8th Global Health Summit, , Endoscopy Camps in India oPast Member, International Committee members, our adopted country India, January 2014 • • Organized Veterans Health Loma Linda University Medical Center & and Obesity Awareness and our country of origin. •Co-coordinator (with other leaders from Southern California), Children’s Hospital Shankar Ehsaan Loy Concert, Los Angeles, June 2013 Campaign in Danville, VA. oChief, Pediatric Gastroenterology & • And Much More….. •Mentor and provide research opportunities in Pediatric GI at Nutrition (1994–present) Loma Linda University for medical students and foreign Director, Endoscopy Lab, Children’s o medical graduates (2000–present) Hospital (1994–present) I humbly ask for your vote and an opportunity to serve AAPI Kaziranga by Udita Jahagirdar, MD

Caravan of healers from a distant nation, Surveying the terrain with keen concentration ….in KAZIRANGA

Shimmering shapes move in the morning mist- Is it a rhino, an elephant, or… some mythical beast?

Parade of pachyderms slowly emerge into view, Stomping and swinging their trunks, as if on cue.

Baby rhino munches happily on tall elephant grass Cautious mama unicornis lets the humans pass.

Wild water buffalo swims lazily across the “jheel”, Retinue of white egrets above, pecking with their bills.

Iridescent blue morpho darts and flits ahead, Nature’s chandeliers – the orchids, sway overhead.

The swamp deer barks its stern warning call Hushh….shall we see the royal tiger after all..?

The wild boar snorts, and breaks into a run, A somnolent gharial basks in the warming sun.

A kingfisher swoops into the clear blue water, Still stands the ibis and the “snake-bird” darter.

A golden langur swings from the “bael” tree, Pair of hawk eagle soars ever proud and free.

Rose ringed green parakeets color the blue firmament, Musical “koyals” create a land of enchantment.

Ignorance, prejudice, disease and death- May you repel a poacher’s every vile threat.

Flourish and thrive for a future generation, A veritable paradise - a jewel of our nation! ….. My KAZIRANGA

www.aapiusa.org 34 GRASPING AN ELUSIVE DIAGNOSIS PROBING THE MYSTERY OF TOXIC CHEMICAL EXPOSURE OF FARMERS IN INDIA: PREVENTION UNDIAGNOSED GROIN, LOWER ABDOMINAL AND PELVIC (UGAP) PAIN. STRATEGIES. Though “Undiagnosed is elusive. Chronic pain causes emotional problems, sleep AAPI JagtialClinic distributes free protective gear groin, lower abdominal disturbances, low self-esteem, and even depression. and pelvic” (UGAP) pain is a common condition, it The first step to approach this condition is appropriate India even today 39% used bare hands to mix the chemicals, nearly half of has received insufficient diagnosis. In the majority of these patients, diagnosis is a predominantly them used the emptied containers to store other items clinical attention. The is strongly suspected just by clinical examination; few agrarian country, in the house. Only 28% used some kind of protective volume of patients, as patients need expensive diagnostic work. Thorough local with a majority of the gear. well as the condition’s exam of the lower abdomen, groin, and pelvis is helpful. I population dependent AAPI preventive health clinic of Jagtial conducted a economic impact is have come up with the following innovative signs, which on agriculture for Rythu Rakshana ( Farmer’s welfare)camp in the village of staggering. In the US have been helpful during my 30 years of practice. Final livelihood. Small Mothe in Telangana state on December 8 2017. It was to alone millions of patients confirmation is conducted by administering a series of farmers, who make up educate the farmers in the hazards of these chemicals are reported as having steroid injections and observing the patient’s response. 70% of the cultivators, and proper techniques for protection. They were also UGAP pain. Nearly 15 have little education, provided with personal protective gear kits containing million women have In females: Wasu triad signs Pramod Wasudev, MD and limited resources. sturdy gloves, facemask, goggles and apron. 200 kits chronic pelvic pain (CPP)2, • Rectus flexion sign—examiner’s hand is placed on the Jagan Ailinani,MDFACR and in this subset 46% insertion of the rectus muscle over the pubic bone, and The start of the green were distributed. have dyspareunia. The annual medical cost of diagnosis if the patient experiences severe pain on flexion of the revolution in the 1960’s and treatment is almost $1.2 billion. And the cost of lost rectus muscle when attempting to sit up it is considered brought synthetic fertilizers and chemical pesticides to It will take a coordinated and cooperative effort between productivity is an estimated $15 billion per year. Interstitial positive sign. (Figure 1). the farmers. Their use has skyrocketed in the last few government and NGO’s to raise awareness of this easily cystitis affects half a million to one million people in the • Adductor resistance sign1— It is considered positive decades. India now is a leading manufacturer of agro- preventable problem, educate the farmers, and provide US, causing CPP4. Sportsman’s hernia affects 0.5–6.2% if patient experiences pain when the examiner places a chemicals. These are potentially toxins, which require subsidized or free protective gear kits. AAPI with its of all professional athletes.3 Also, nearly 17% of patients finger over the insertion of the adductor longus tendon careful handling and proper protection to avoid harm mission and liaison with Indian authorities can play an suffer from late groin pain following repair of groin and asks the patient to adduct the bent knee against the from inhalation and absorption from skin and mucous influential role in saving lives from needless tragedies hernias. assistance hand. membranes. Across the globe more than 300,000 like the one in Maharashtra last year • Vaginal hook sign—If patient experiences pain on UGAP mimics several different conditions. In females vaginal exam and hooking fingers anteriorly over the people die from acute toxic effects of exposure to these it can present as vulvodynia, interstitial cystitis, and pubic bones then this is considered positive sign. chemicals. CPP, including dyspareunia. In males, it may present as radiating pain to the testis, abacterial prostatitis, and Pesticides are categorized as hazardous materials, but sportsman’s hernia. In both males and females, it can safety precautions are nonexistent. Government officials present as acute or chronic lower abdominal and/or groin are required to train the farmers in the proper use but in pain, mimicking appendicitis, diverticulitis, and groin practice it is the dealer who may give some instructions. hernias. Several patients have reported rectal symptoms There is little or no monitoring to check if any of the of spasms and irritable bowel syndrome. Also, some have safety guidelines are being followed. The small farmer anal, lower back, gluteal, perineal, coccygeal, and/or hip with little education cannot read the instructions, which pain. These unfortunate patients, are shuttled from one specialist to another and undergo expensive diagnostic Figure 1. Rectus flexion sign and Vaginal hook sign are mostly in English. Safety gear gloves, facemasks, tests (e.g., CT scans, MRIs, bone scans, ultrasounds). goggles and apron are not provided. In case of injury the Endoscopies, laparoscopies, and sometimes unnecessary In males: Wasu triad plus signs local primary health care centers lack basic medications surgeries (e.g., exploratory laparotomy, hysterectomy, • Rectus flexion sign like atropine to treat exposure of eyes to the chemicals.. inguinal herniorrhaphy) are performed. Countless • Adductor resistance sign A toxic combination of lack of regulation, indifference of healthcare dollars are spent on unnecessary diagnostic • Spermatic cord traction sign—patient is examined in a the government and the poor farmer’s desperate desire Reference. : Chemical use in farming and its health and studies and unnecessary interventions. Patients and standing position on traction of the spermatic cord and to maximize yield with limited expense create a deadly environmental imlications. physicians are equally frustrated because the diagnosis experiences pain over the pubic bone; however, on lying situation. In 2017 in the state of Maharashtra 1800 down there is no tenderness over the spermatic hundred cotton farmers were hospitalized and nearly 50 Rakesh PS et all, Journal. Of Environmental Science, cord. This is considered positive sign died from toxic exposure to the pesticides Profenax and Toxicology and Food Technology.5: 2319-22402: 2013 • Paraprostatic sign—on digital rectal exam, most of the time there is mild or no pain over the prostate Cypermethrin.. These were preventable deaths if only the gland. However, on examination lateral to the farmers were trained in proper handling of these Acknowledgement:I would like to thank Dr.Maqbool Haq prostate gland, if there is tenderness, this suggests for editing this article the patient has CPP, also known as abacterial chemicals and wearing of protective gear . prostatitis A 2013 report in the journal of Environmental science, toxicology and food technology in India reported that Figure 2. Spermatic cord traction sign and Paraprostatic rectal sign nearly 20% of the farmers stored the chemicals at home,

www.aapiusa.org 36 37 www.aapiusa.org A MULTIPLE PROBIOTIC THERAPY TO TREAT OR PREVENT HOSPITAL ACQUIRED INFECTIONS WHAT HAS AMA ACHIEVED "ON THE HILL" FOR DOCTORS? Every year the to MIPS adjustments. The hospital acquired or nosocomial infections are American Medical D) IPAB (Independent Payment Advisory Board) due to multiple antibiotic resistant bacteria such as Association was one of the components of the Affordable Care Clostridium difficile (C. diff) and Methicillin Resistant convenes the Act which organized medicine, including AMA, had Staphylococcus Aureus (MRSA) etc. A patient is National Advocacy opposed, has been repealed. hospitalized for a specific disease and unfortunately Conference in he or she will end up with an unrelated bacterial Washington DC in E) The bipartisan Budget Act also eliminates a mandate disease, which is prevalent in the hospital setting. February. Influential that EHR standards become more stringent over time. Officially over six million cases are reported per lawmakers from annum with over 100,000 deaths. both sides of the F) The bipartisan Budget Act also provided funding for aisle and thought four years for CHIP. The obvious question is why are these bacteria leaders on health more prevalent in hospitals? Apparently it is the Malireddy S. Reddy, care and pundits G) The Budget Act reauthorized funding for community place where the patients are exposed due to cross DVM, MS, Ph.D. share their views health centers, National Health Service Corps and contamination from other sick patients, garments, Vidya Kora, MD upcoming health teaching health center GME programs for two years. health providing professionals, the equipment and care legislation. surroundings. According to CDC they are spreading Nano meters), coupled with the smallest diameter (0.5 to 1.0 milli micron spherical cells) and smallest H) The Budget Act avoided the physician payment cut now from healthcare to community settings, with as AMA’s ADVOCACY WINS FOR THIS YEAR: by removing the misvalued code as an offset. high as 50% mortality rate. If the antibiotic therapy is width and length (0.5 and 2 milli micron rod shape cells) Probiotic bacterial cell concentrates, with single 1. Blocked Anthem/Cigna and Aetna/Humana mergers, not working, what is the next alternative? In the case effectively protecting over 500 million dollars in annual In addition to the provisions mentioned above, the of C. diff infection, out of desperation, physicians are cell morphology format (as opposed to be in chains), seems to be the principle factors (when administered physician payments. other positive elements of the new spending bill treating the patients (unsuccessfully with recurrence) 2. Preserved health insurance coverage and patient include 6 billion dollar state grants for opioid epidemic using Fecal Microbiota Therapy, at an annual cost of orally) to treat the C. diff infection successfully. This is accomplished mainly through Probiotic induced protections and blocked steep Medicaid cuts for initiatives, a 2 billion dollar increase in NHI funding, a 5 billion dollars. providers. QPP/MACRA transition. AMA’s advocacy 4.8 billion dollars in emergency Medicaid funding for immunomodulation by production of lgA, IL-10, efforts reduced reporting burdens, made favorable Puerto Rico and U.S. Virgin Islands and a 4 billion dollar and T-reg cells to establish the immune tolerance Why is it so difficult to treat the C. diff infection? adjustments for small practices and raised low volume allocation to rebuild VA hospitals and clinics. by pacifying the inflammation, followed by direct The answer is C. diff resists several antibiotics. C. exemption - and as a result, unto 97% of physicians will inhibition of C. diff by Probiotics. diff infects patients who have dysbiosis or impaired avoid penalties in 2020. To add …. last week AMA scored yet another victory gastrointestinal microbiota. The C. diff organisms 3. Passage of AMA model bill on prior authorizations. by working with Anthem and having Anthem It has also been reported that Down syndrome, induce immune stimulation with inflammation 4. Progress on opioid epidemic objectives. rescind a proposed policy relating to physician use Autism, and Fibromyalgia are partly linked to the through activation of T-cells, TH-1, TH-2, TH-17, and 5. Bipartisan Budget Act of 2018. of payment Modifier 25 that was slated to take effect dysbiosis and immune deficiency and thus this subsequent production of inflammation provoking on March 1, 2018, across the company’s commercial therapy can also be used to treat several autoimmune interleukins IL-4, 1L-6, IL-12 etc. In addition, C. diff A) In the new budget spending bill passed earlier this health insurance businesses. This provision would entero toxins destroy the intestinal epithelial cells diseases. Why are these diseases more prevalent month, there was a provision to cut Medicare payments have decreased the fee for E/M Service appended with leading to intestinal perforation and systemic and increasing rapidly in the developed nations, as based on a two-year misvalued code policy. As a result Modifier 25 along with minor surgical procedure by 25 infection. The recently published discovery of Dr. opposed to underdeveloped nations? This can be of AMA’s action alert on February 5, more than 3,000 to 50 percent. This 25 to 50 percent cut has now been M.S. Reddy's Multiple Mixed Strain Probiotic Therapy partially answered through "Hygiene Hypothesis". emails were sent to Congress in less than 24 hours. On rescinded and Anthem has decided not to proceed seems to be the best answer to successfully treat or It is a hypothesis that states that a lack of early February 9, Congress passed a spending bill including a with this policy after extensive discussion with the prevent these nosocomial infections (Int J Pharma childhood exposure to infectious agents, symbiotic number of key important elements advocated by AMA. AMA’s leadership. Sci Nanotech. 2018. Volume II (issue I): 3937-3949). microorganisms (such as gut flora or Probiotics) This therapy includes Multiple Mixed Strain (naturally and parasites, increase susceptibility to diseases by B) Amendments to MACRA which provide flexibility to I urge our physician colleagues to become members antibiotic resistant) Probiotics belonging to different suppressing the natural development of the immune CMS to set cost weight at 10% for the next three years of the AMA and be part of our struggle, and support genera and species along with their Nano growth system, which results in auto immune diseases and and to set performance threshold for the next three the advocacy efforts of AMA, to amplify our voice. end products. The prior growth end products of these nosocomial infections. years. multiple Probiotics i.e. immunomodulins, specific bacteriocins, and Nano inhibitory compounds (<100 C) It also clarifies that Part D drug costs are not subjected

www.aapiusa.org 38 39 www.aapiusa.org INTEGRATED MEDICINE The Smart Approach UPDATE ON THE AAPI ACTIVITIES AT THE AMA

Integration is a willing to seek such articles with an integrated In the fall journal I alternate terminologies. The reference committee decided very ‘meaningful’ outlook and scientific methodology. had summarized the to refer the resolution to the AMA Board of Trustees (BOT) for and ‘powerful’ activities of the AAPI further study and recommendations. A report will be sent to word. It means Western medicine (Allopathy) intervenes to cure at the AMA since 2005. the AMA HOD in June 2018. Dr Subhash Chandra served as joint, blended, or resolve or control the source of disease to AMA House of Delegates alternate delegate from AAPI to the AMA. (HOD) is the policy combined, promote healing; Eastern medicine (Ayurveda, making body of the AAPI medical student member Nina Appareddy authored a mutually Traditional Chinese Medicine) focuses on ‘health AMA. The members of resolution introduced by the AMA Medical Student section dependent, and healing of the person’. Integrated medicine the HOD are comprised titled “Disaggregating of data concerning the status of Asian cohesive approach. approaches the combination of the Eastern of Delegates from all the Americans". The resolution was cosponsored by AAPI, and Such a coordinated and Western methods, and the results can be State Medical Societies, adopted by the AMA HOD as AMA policy with an amendment. approach to any ‘astounding’ and ‘beneficial’ to the community Specialty Societies, various sections of the As AAPI delegate I testified in various reference committees Pudupakkam K issue will bring out as well as the individual. AMA and representatives on issues important to physicians and patients we serve. I meaningful and Vedanthan, MD Vijaya L Appareddy, M.D. from other Mainstream also attended the AMA IMG section meeting and the Women mutually beneficial The major achievement by the Government of Medical Organizations Physician section meetings. results to the parties concerned. Combining India, under the AYUSH ministry has been the including AAPI. different parts together to make it a ‘whole’ or establishment in 2005 of ‘Traditional Knowledge I serve on the education committee of AMA Organized Medical ‘holistic’ approach is the key. In the practice of Digital Library’ (TKDL) (www.tkdl.res.in). TKDL The AMA interim meeting was held at Honolulu, HI from Staff Section (OMSS) as a rep from my hospital system. The November 9th thru 12th. I authored and presented a Resolution committee organizes Webinars and Seminars during the Integrated Medicine, approach to care places is an enormous resource available in several on “Physician Burnout and Wellness” on behalf of AAPI. The AMA meetings concerning Physician and Patient issues. I the patient at the centre. The patient and languages (English, French, German, Spanish, resolution was also co-sponsored by the AMA International also participated as a Panelist on Health equity on a online practitioner are partners in the healing process. Japanese) comprising of 200,000 fomulations. Medical Graduates (IMG) section. discussion organized by AMA IMG section. My interest in this approach was actually It is a major attempt to prevent ‘Bio piracy’ ignited when my elder sister was admitted to and protect the healthcare needs of millions Before any resolution is introduced in the HOD it will be AAPI continues to be well represented at the AMA. Please Integrated Medicine Course (a 5 year degree of patients (70% of the population), as well as, discussed in the reference committee. Over 40 AMA members forward any resolution ideas to [email protected] provided enthusiastic testimony in the reference committee and I encourage all AAPI members to get involved in many course) in University back in the 60s. India’s wide traditional medicinal knowledge. and how to prevent and combat Physician Burnout. Members opportunities available to serve at the AMA. Our family, including our father, consisted Integrated medical approach is truly were divided on using the term burnout and suggested of 4 allopathic doctors graduating from the personalized practice of medicine and should Government Medical College, Mysore. My sister be encouraged. with her integrated medicine background and EXCEL CAPITAL MANAGEMENT CORP. training blossomed into one of the most sought “It is much more important to know what sort EGISTERED NVESTMENT DVISOR after Infertility specialists. Her approach was of a patient has a disease than what sort of R I A basically a ‘human’ approach and patients just disease a patient has” Sir William Osler. adored her and vice versa. • Over 25 years of Investment Experience References: • In depth knowledge of Stocks, ETFs, Mutual Funds, Bonds, Options I had the privilege of working with several 1. Clinical study of yoga techniques in university ‘alternate medicine’ specialists, well trained students with asthma: a controlled study," by P.K. • Serving the needs of high net worth clients yoga masters and teachers as well as the Vedanthan, L.N. Kesavalu et al, in Allergy Asthma • A Single Source for 6400 Mutual Funds Yoga University. We conducted several Proceedings, January 1998. • Reputation through Excellence, Integrity and Sound Advice clinical research projects which have been 2. Sherman KJ et al. 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Senses – Bring information from the external part of the human being) helps fulfill the desires UNDERSTANDING THE HUMAN BEING environment through sound, touch, sight, taste, and intentions of the mental level. An Ayurvedic Perspective and smell. This information is metabolized in the physiology. As a comparison, when food is eaten, Harmony in these three levels of life creates peace, it is metabolized and has an effect on the body, happiness, and good health in the human being. either positive or negative, depending on what was Disharmony between the unmanifest level of Ayurveda translates and differences. At an underlying level, bosons eaten. Similarly, information taken in through the Pure consciousness and the mental level creates as “Science of and fermions are the basic building blocks of five senses produces its own unique effects. For disorders and diseases on the physical and mental Life” and is a nature. These spin types correlate with the five example, seeing something beautiful or hearing levels. Ayurveda has modalities for prevention and comprehensive, mahabhutas. something pleasant will have positive effects, treatment that address all levels of life to create and natural system of whereas negative input will have detrimental maintain a healthy, blissful existence. More details healthcare that The five elements, or mahabhutas, have energies effects. on this subject are available in the book Dynamic originated in the with the qualities of space, air, fire, water, and DNA: Activating Your Inner Energy for Better Health, ancient Vedic earth. Matter is precipitated energy. The space Mind – Processes sensory information on the by Hari Sharma MD and James G. Meade, PhD. times of India. element is represented by empty areas in the mental level; has the characteristic of duality, or It emphasizes body. The air element is represented by air pairs of opposites, e.g. likes and dislikes, happiness prevention and breathed in and exchange of gases in the lungs. Figure 1. Human Being and sadness; has desires and intentions; because of is also effective The fire element is represented by digestion, • Manifest aspect duality, conflicts and disharmony are created. Hari Sharma, MD, DABIHM in managing metabolic activities, and endocrine functions in Intellect – Decides, discriminates, and judges; due • Objective part chronic disorders. the body. The water element is represented by to a lack of correct perspective, can make mistakes • Physical body Ayurveda addresses every level of the human being fluids in the body, e.g. plasma and lymph. The and has tendency to blame others. in a holistic approach to achieving and maintaining earth element is represented by solid material in • Five elements: Space, air, health and wellness. Following is a brief description the body. The proportion of these five elements fire, water, earth Chitta – Storehouse of memories; impressions of of the human being from the Ayurvedic perspective differs in different individuals. All creation – actions are embedded here. • Energy body (see Figure 1). humans, animals, plants, minerals, etc. – are made of these five elements in various proportions. For Ego – The “I”; gives the impression of “doer” and • Energy channels (nadis) “experiencer”. Human beings have two aspects – manifest and example, the Sun manifests the fire element and • Energy centers (chakras) unmanifest. The manifest aspect originates from the Jupiter manifests the air element. • Access points (marma) The unmanifest aspect of the human being is the unmanifest, and consists of two parts – objective deep inner Self. It is Witness, Truth, Pure awareness, • Subjective part and subjective. The objective part consists of the The energy body consists of a dynamic matrix Pure intelligence, Pure consciousness. It is non-dual • Senses physical body and energy body. The subjective part of energy throughout the body, connecting in nature and is indivisible unity. It is peace and consists of the five senses, mind, intellect, chitta the physical body with the subjective part of • Mind bliss and the home of all the laws of nature. The (storehouse of memories), and ego. The unmanifest life. Energy channels known as nadis are spread • Intellect manifest aspect of the human being (objective and aspect is one’s deep inner Self and consists of Pure throughout the body and carry the vital energy subjective) originates from the unmanifest aspect. • Chitta awareness, or Pure consciousness. that sustains life. There are energy centers located along the spinal cord that are known as chakras. This unmanifest aspect can be compared to DNA in • Ego the physiology, which expresses the whole manifest The physical body is made up of five mahabhutas, These swirling masses of energy are junction • Unmanifest aspect – Deep inner Self body and contains all the knowledge for the body’s or elements, with energies that have the qualities points for the energy that flows through the • Pure awareness, Pure creation and maintenance. of space, air, fire, water, and earth. These energies nadis. There are points on the surface of the consciousness correspond to the five spin types of quantum body where the nadis can be accessed, known as The human being has three levels of life: physics. In quantum physics spin is an intrinsic marma points. Manipulating these points can have 1. The unmanifest level is the Witness, deep inner property of the two classes of elementary particles, profound effects on the body, such as reducing Self, Pure consciousness, Pure knowledge, and area known as bosons and fermions. These differ in high blood pressure, increasing energy, and of peace and bliss that gives rise to the mental level. spin. Bosons have an integer spin, i.e., 0, 1, etc. reducing stress. 2. The mental level (correlates with the subjective Fermions have a half integer spin, i.e., 1/2, 3/2, etc. part of the human being) is the working This difference in spin type results in fundamental The subjective part of the human being consists of consciousness, which maintains and governs the differences in behavior. Bosons create coherent the five senses, mind, intellect, chitta (storehouse physical level. states, whereas fermions do not. Both are necessary of memories), and ego. They have the following 3. The physical level (correlates with the objective in the structure of the universe, to create uniformity functions:

www.aapiusa.org 42 43 www.aapiusa.org THE GREAT JOURNEY He enjoys the gym, reading, the out- Search 1 (US) doors, football, dining out, going out with Pre-med/Medical Students Externship 2018-19 Men (35 - 45) friends, as well as rewinding at home or with family. It was a joy beyond the words to express, Pre-med/ I, as an organizer always kept in mind that this program He finds intelligence alluring, and be- lieves mutual respect is an integral part of med externship, with the students and volunteers, should not only be a stimulus for global medical a fulfilling relationship. held at Ranchi Institute of Medical Science (RIMS) from knowledge but also physically, mentally, intellectually December 25th 2017 to January 6th 2018. This was and spiritually enriching. I am very thankful to that Search 3 (US) our third year and it was very evident that the previous higher energy for the blessings that this program has Men (46 - 58) experiences of two years added tremendously for fulfilled its ambition of taking the best medicine of the ease of management and expectations from the the East and connecting students from the West to medical faculty. the East. I feel that this allows our youth to be broad- minded and aware of different medical issues and practices in India.

Search 2 (US, Canada & UK) Experienced physicians from USA are the Women (25 - 33) mentors for these students. Students stay in a great hotel, eat healthy food, drink bottled water and take all safety precautions for not falling sick. This way all I can say that this is an excellent opportunity for pre-medical and 1st year medical students.

For more information please visit any of the following websites. www.hfriusa.org *Please visit the “Activities” section to enjoy This program of 12 days during the college Winter and learn more about past student’s reflections. Break, is extremely well thought of not only for the www.ekal.org exposure to the fundamentals of medicine but also the www.aapiusa.org Indian medical system, tropical diseases, community and preventive healthcare, governmental programs, private nursing home visits (privately owned hospitals), private partnership facilities, exposure to Ayrurveda, daily yoga practice with the explanation of its effect on medical diseases and the mind, trips to remote and tribal villages, attending village and medical camps, visiting Ekal Vidyalaya Schools and enjoying the sightseeing trips to nearby well-known places. All of these programs made the externship extremely enriching for the students. With the best wishes, At the completion of the program all the students Veena S. Gandhi M.D. were in “Awe” with their experiences, which were later Chairperson HFRI & Coordinator of PMME Program expressed during the concluding ceremony.

www.aapiusa.org 44 their church and local VIPs, with connections After three years of different medical mission works MY MEDICAL MISSION TRIPS TO INDIA in USA through their family and friends. Local in India, I wish to share some thoughts. Personally VENKIT S. IYER, MD, FACS advertisements were made, and 400 patients signed they were enriching experiences, making me up for evaluation. Only uncomplicated easy to feel good about myself having done something After retirement as a vascular surgeon, I had earlier repair inguinal hernia cases were chosen, and 40 worthwhile during my idle retired life. I was able to joined the Peace Corps in Africa. I had written about hernia repairs were done in 5 days with full safety share my knowledge and experience with younger that experience in the AAPI journal at that time. I precautions were observed. Patients received spinal surgeons and medical students and show technical reflected I would similarly serve my motherland, anesthesia, minimum set of instruments were used. details of surgical procedures. I treated many poor paying back to the country that gave me a free Postoperatively they were observed for several people, saved some lives too. education, and have been there thrice since 2014. hours, and sent home after voiding and ambulating. Local volunteer support was critical and available. A However these are very minor accomplishments The Christian Fellowship Hospital is a 300-bed few of them stayed for overnight stay.Wounds were when one looks at the big picture of poverty, charitable inspected after 48 hrs, and after 7 days, using help ignorance, lack of infrastructure, and amenities in missionary from local physicians. rural areas and third world countries. These are big hospital, economic issues that only their governments can caring for The Baptist Hospital on the hand is a solve. Teaching is better than doing a short-term a large Prayer is an important thread, where all hospital modern tertiary care corporate hospital in the heart service for a week or two, for sustainable long-term population staff and families are encouraged to go.Work of the city. Dr. Rebekah Naylor a general surgeon of low- starts only after the chapel service at 8:00AM at from Texas started this as a small one room shed income every nursing station or work station and in the about 40 years ago and spent most of her life people in operating room just before induction of anesthesia, working at this hospital. She was recognized at and before every meal is served, and before every the American College of Surgeons annual clinical official meeting - this emphasis on prayer helps Congress with a Humanitarian service award last in improving the morale and humane attitude, year. Once again, I was welcomed as a member of Oddanchatram in state. It serves as in reducing the stress and placing the burden on department the hospital of choice for about 50 miles radius of destiny instead of taking personal blame. of surgery, impoverished neighborhoods. Mr. Tharien started participating CF hospital in a small cowshed about 65 years ago. About 1000 patients are seen at low cost at the in all of their The concept was for doctors to live and work in the various activities. same campus for low salary with charitable service outpatient effects. The dedicated work done by individuals as the motto. It has since grown to a campus of over clinics and The hospital from Western countries over their entire life taking 30 acres of land and multiple buildings, with 150 30 surgical charges care of poor people in third world countries, doctors in many specialties. The doctor’s salary is procedures fees for deserves more about one tenth of those in private practice in big done daily. services, with different rates according to the appreciation. towns, but accommodation and board is subsidized. Maternity, amenities a patient can afford - like private rooms The doctors network and socialize on campus as an obstetrics and A/C. The actual medical care is the same. Medical missions extended family- and are available for patient care and Patients are accepted for admission from other will only work around the clock. gynecology is a big department. Post graduate hospitals and doctor’s clinics. Most of the doctors with active The hospital has students work as junior physicians in various and nurses stay inside the campus or in adjacent local support an attached school departments. Complex patients are referred areas. As a volunteer physician. I carried out similar from hospitals, of nursing that to or . I was part of the responsibilities classroom lectures to medical village chiefs, graduates over 50 department of surgery, serve a useful and students and residents, and lectures to the medical administrators qualified nurses meaningful role as a senior consultant. in all the staff on vascular surgery topics. The hospital and local annually with aspects of patient care, education and teaching, also has out reach centers that admit and treat physicians. Much three year degree. addressing cases they had not done before, and communicable diseases such as HIV, leprosy and of the work is done behind the scenes, and one If they sign up to I felt well appreciated. In 2015, I participated in a tuberculosis and provide end stage palliative care. must know preparations and logistics ahead of time, serve the hospital hernia camp in a small town called Mallappally either through mission agencies or hospitals. for five years after graduation, they are given free in a small 25 bed hospital, with one operating tuition on campus. room, which is rarely used, and organized through

www.aapiusa.org 46 47 www.aapiusa.org will have on the South Asian American community. AAPI TAKES ITS LEGISLATIVE AGENDA TO Extolling AAPI members for their incredible Congresswoman Tulsi Gabbard of Hawaii, the work ethic and strong family values Democratic CAPITOL HILL first Hindu lawmaker to serve on Capitol Hill and Congressman Joaquin Castro, who had supporting current Democratic co-chair of the House India pro-immigration bill H.R. 392 (Fairness for High- The powerful voice of the leaders and members the cardiovascular health care of South Asian Caucus, pointed to how the relationship between Skilled Immigrants Act of 2017), further outlined of the American Association of Physicians of Americans. the two countries have progressed and grown. She that in his home district in California there were only Indian Origin (AAPI), the largest ethnic medical acknowledged that “the H-1B visa issue is one of 0.95 physicians for every 1,000 people, underscoring organization in the United States, was heard on Pramila Jayapal, the first ever Indian-American the biggest challenges facing the community” and the need for a medical school in the San Joaquin Capitol Hill on Thursday, April 12th at AAPI’s Annual woman elected to the US House of Representatives, lamented that a lot of people don’t understand the Valley as part of the University of California system. Legislative Day 2018. Addressed by numerous who had introduced ‘The South Asian Heart Health consequences of the backlog and continued effort lawmakers representing both political parties of the Awareness and Research Act of 2017′ with her to limit H-1B visas. “In Hawaii, we have a drastic Medicare and Medicaid Reimbursements United States of America, the event was a forum Republican colleague Joe Wilson of South Carolina, shortage of physicians and it’s always difficult to These programs have not kept up with the cost of for AAPI to have its voice heard in the corridors of stressed that the community has incredibly high get and retain doctors who can provide that care”, care and the growing populations utilizing them. power, and contribute to shaping the healthcare incidents of heart disease, therefore, being able to Gabbard told the AAPI delegates. “Your presence It is critical that Congress review reimbursement policies and programs of the nation. use a few resources from the federal government to and your advocacy is very helpful as we try to schedules; otherwise, patients may not be able to emphasize and target the South Asian community is construct substantive very important. policy that best serves the American people”, Lowering the cost of prescription she said. drugs The exorbitant cost of prescription Democratic drugs is a critical health care issue, Congressman Frank as some life-saving drugs are too Pallone, Jr., of New expensive for many patients. As Jersey, co-founder physicians, we want to ensure that of the House India the medicines their patients need Caucus, denounced are affordable and will be taken, the anti-immigrant to ensure a high quality of life, fervor emanating from reduction of chronic ailments, and the White House find a physician in their community who accepts effective treatment today to prevent Medicare and/or Medicaid patients. increased health care costs in the Increased residency slots In his welcome address, Dr. Gautam Samadder, future. The U.S. is facing a chronic physician shortage, Tort Reform President of AAPI, expressed his sincere gratitude which will only be exacerbated in the years ahead In order to reduce the practice of defensive and appreciation to AAPI delegates and the Regarding soaring pharmaceutical costs, Republican as more baby boomers retire. Congress can act by medicine, bring down the overall cost of health Congressmen for taking the time out to come and Congresswoman Barbara Comstock of Virginia passing legislation adding 15,000 more residency care, and limit the number of meritless lawsuits, support AAPI’s agenda at the national level. mentioned that she is part of a bipartisan group in slots, which will help to train up to 45,000 more tort reform will bring fairness into the court system the House called the Problem Solvers Caucus which, doctors in the next two decades. and better serve both the doctor and patient AAPI’s agenda for its Annual Legislative Day 2018 among other issues, is focused on bringing down communities. was detailed and covered several aspects of drug prices. Democratic Congressman Joe Crowley of New healthcare in United States pertinent to every one, York reassured a packed room of Indian-origin Repeal of the Individual Mandate as well as those that are unique to international Immigration reform physicians in the Rayburn Building that he continues As Congress has now passed a repeal of this part of medical graduates and workforce in USA – H-1 and J-1 visas are used by many South Asian to work to increase the number of slots here in the the Affordable Care Act, which takes place in 2019, American physicians, playing an important role in United States” and spoke of the GME (Graduate what does this mean for the average physician H.R. 3592 “The South Asian Heart Health providing critical health care across the country. Medical Education) Expansion Legislation which practice if patients drop their health care coverage Awareness and Research Act of 2017” Combined with the Green Card backlog consisting he introduced with Republican Congressman Ryan and how will this impact premiums? This bill, introduced in August 2017 would help of more than 4 million people, we are very Costello of Pennsylvania, in 2017. The bill calls for in providing for research and grants to improve concerned about the impact immigration reform an additional 3,000 residency positions for five Democratic Congressman Frank Pallone, Jr., of consecutive years.

www.aapiusa.org 48 49 www.aapiusa.org New Jersey, co-founder of the House India Caucus for political office. Referring to an adage he often referred to a bill he introduced with two other repeats, ‘If you don’t have a seat on the table, you’re House Democrats, which would prevent the on the menu’, Krishnamoorthi added, “We will not ACA from being sabotaged by President Trump be on the menu if we do the needful” by being and Republicans in Congress. He explained that engaged in public policy.

Congressman Peter Roskam of Illinois, former Republican co- chair of the House India Caucus, encouraged AAPI members to provide feedback from a medical point-of-view about the obstacles they face in caring for their patients.

Among other attendees the legislation eliminates the cap on subsidies, at the AAPI event were Republican Congressman increases the amount that is available to help Phil Roe of Tennessee, one of few physicians serving people pay their premiums, and seeks to stabilize on Capitol Hill, Republican Congressman Mike Kelly the market by having a reinsurance component to of Pennsylvania, Republican Congressman Andy get more insurers and create more competition to Barr of Kentucky, Maryland Delegate Aruna Miller lower prices. He was hopeful the bill would pass (Democrat) who is currently running for Congress if Democrats win the House and Senate in the in the state’s sixth Congressional District, Jason 2018-midterm elections. Marino, Senior Assistant Director of Congressional Affairs at the American Medical Association, Dr. Others who addressed the delegates were Naseem Shekhani, president-elect, Association of Chairman of the House Foreign Affairs Committee, Physicians of Pakistani Descent of North America Ed Royce as well as Congressman Joe Wilson. (APPNA), and Nuala Moore, Associate Director of Congressman Wilson lauded the contributions Government Relations at the American Thoracic of Indian-Americans, in particular Dino Teppara Society. who has served as his chief-of-staff. Teppara, now a public affairs officer in the US Navy Reserve, has Dr. Vinod Shah, AAPI’s Legislative Committee been working closely with AAPI leaders for the very Chairman, Co-chair Dr. Sampat Shivangi, and successful Legislative Day on Capitol Hill. President-Elect Dr. Naresh Parikh emphasized the need for ongoing dialogue between ethnic Congressman Ro Khanna mentioned the tireless organizations and Congress to shape the healthcare works of Dr. Shivangi, Dr. Ramesh Kapur, Dr. Shah, of the future in USA. Dr. Bharat Barai, as among those who knocked the halls of Congress years ago, long before Indian- The day began on Capitol Hill, and culminated at Americans came to be recognized as a force to be the Indian Embassy with a dinner with an address reckoned with. by the Indian Ambassador to the United States. For more details on AAPI and its legislative initiatives Congressman Raja Krishnamoorthi made a strong please visit www.aapiusa.org pitch for Indian-Americans to become even more engaged – to vote, volunteer on campaigns, run

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