Moving to Sweden as a doctor: Practical training

In this post, I am documenting my experiences during the mandatory practical training (PT) that you have to undergo for qualifying for the medical license in Sweden.

Before I passed the practical exam, I thought that it would be a good idea to shadow a doctor at a hospital (called praktik in Swedish) so that it helps me build confidence for the exam. It was September 2020, and one was not allowed to do practical training before one passed the practical part of the medical license exam. So, I wrote to the manager (verksamhetschef) of the Vårdcentral near to my home, explaining my situation, and asking if they will be interested in taking me in for a praktik a few days a week. In the same mail, I expressed interest in continuing in the same Vårdcentral (VC) for my PT once I pass the exam. After a week or so, I was called in for an interview at the Vårdcentral. I explained my situation to them, and they were not only interested in allowing me for the praktik, but also were generous to offer me a place for PT. This was the only Vårdcentral that I applied to, and I was lucky to be chosen to work there. I have heard from many students that they have found it hard to find a hospital which would take them in for PT. Here are some tips for those applying for a PT:

1. PT is a relatively new service and many managers do not know about it. When you write a mail to the manager asking for PT, you have to also explain what PT is, and if possible, provide relevant links to the website containing descriptions of PT. The hospitals usually do not have the finances to hire you, so you have to tell them clearly that it is the Region (i.e. VG region in my case) or Arbetsförmedlingen that pays your salary and your supervisor’s compensation. This means that the hospital/VC is essentially getting an extra person to work for them without incurring any cost from their side. They are usually happy due to this prospect. If your manager does not know this part, you are unlikely to find a job.
2. Applying to the VC or hospital near your home versus applying at a faraway place is always beneficial. You can tell in the email to the manager that you live quite close by the VC, and you are open to the possibility of continuing to work for them after the PT is over. There is usually a scarcity of qualified licensed doctors, so smaller hospitals and VCs are interested in keeping you there if you happen to perform well enough during your PT. They know that, if you live near the place of work, chances are that you will stick to it because of easy commuting.
3. You have to tell about your past experience in the email. In my case, I had a PhD. Many of the doctors who come to Sweden are specialists in their home country. If you are a specialist in, say, family medicine in your home country, chances are that you are preferred for the job in VC. Always attach your CV to the email that you are sending to the manager.
4. I have found from others’ experience that you are more likely to get a position if you apply to VCs in areas where a lot of immigrants live. Such VCs usually want doctors who cater for multicultural patients, and your Swedish language skills do not matter so much because most of your patients (and sometimes colleagues) will be foreign-born.
5. Never ever write your email in English. Always write in Swedish, and if possible, get the text of the email verified by a Swedish speaker to avoid embarrassing mistakes.
6. Make your email easy to read and understand. The managers usually get dozens of mails every day, and they are usually very busy. Your email title and content has to grab their attention. Have good amount of text in the body of the email and attach the CV as a pdf (not zip). The manager might skip reading your mail if you have a lot of downloadable material and unclear text in the body.
7. I have heard that some doctors visited the VC or the hospital directly and asked for meeting the manager. Doing this is hard because the manager is usually busy with other things, but this is definitely worth trying. If you haven’t got any reply for your email for a month or so, you can also call them via telephone and ask about the status of your application politely.

Most often, you apply by directly writing an email to the manager. If you are in VG Region, you can get the list of all VCs here. Go to each VCs page, find the email of the verksamhetschef and write an email to them. You can also apply to the VG Region web portal here, but it takes time for them to find a place for you and their process is quite slow. Apply to many VCs and hospital wards at the same time – you never know who will call you for an interview first.

My interview for the PT at the VC was approximately an hour long. I and the manager talked for around 30 minutes. I was mostly asked about the reasons for choosing to go to Sweden, details of my PhD project, future career plans, reason for choosing to apply to this particular VC and what I expect to learn from the job. We spent the rest of the 30 minutes going around the VC, meeting people and getting used to the rooms and facilities there. I was impressed by the way the VC worked so efficiently. Even before I cleared the practicals, the manager told me that I can join there as a PT doctor once I pass my exam.

I passed the exam in September 2020. It took a week or so for me to get the approval from Socialstyrelsen to continue with PT. I sent the approval documents to the VC, and the VC did the rest of the work for me, including fixing the finances, getting the necessary approvals required for the workplace to employ me. It took almost one and half months for this process to complete. During this period, I worked on a part time project with Creative Commons to create an educational resource for pathology. I also got to work on a research paper about stroke. Being busy with these prior commitments, I could only start PT by December 1, 2020. I signed a contract with a salary of 30,000 SEK per month (much less than my previous salaries, but PT is mandatory, so I had to take the job regardless of the salary). Some say that you can negotiate your salary, but I didn’t do it because I was thankful that I got a PT at the first place. Secondly, I had no experience whatsoever with the healthcare system in Sweden, so I didn’t see why my employer should give me a higher salary for taking in someone who is a beginner. The Region only gives 30,000 SEK per PT, and any extra money going into your salary has to be put in by your employer. Before signing my contract, I did not discuss about vacation, and it so happened to me that I got no vacation days whatsoever. Before you sign your contract, talk with your manager about the terms regarding number of vacation days (usually it is 14 days). You are also qualified for a fitness allowance of around 600 SEK.

The first two weeks of my PT were actually a training period. I had to learn Asynja Visph, the software used for recording journal notes. There are also other portals and software such as Pascal (for Apodos), Melior (for reading notes from the hospital) and Picsara (for adding pictures of skin lesions etc to the journal), but I found them easy to learn. The tough part for me was to get used to the routines that are practiced in the VC and to counsel the patients regarding their disease condition. I found out early on that you cannot satisfy all your patients. There will invariably be patients who ask for unnecessary medication, unwarranted sick leave or advanced diagnostic tests. If you judge that their request is inappropriate, you have to politely refuse it. Learning to say ‘no’ is a big part of your training. Always remember that your main aim is to have disease-free individuals, not happy customers. It is the managers job to keep the customers happy, and your job as a doctor is to do the optimal thing to ensure the long term well-being of the patient as well as the society in general, and to explain to the patient the reasons for your choice of treatment.

I started seeing patients on my own starting from my third week of PT. I would talk with patients and explain the history and examination findings to another doctor, who will then decide the diagnosis and treatment. After two more weeks of doing this, I started taking patients independently, even though I consulted with a senior most of the times in between or after the patient visit. On an average day, I usually took 5-6 patients, made 2-3 follow up phone calls, and renewed one or two prescriptions. This might sound like an easy job for those of you who used to seeing up to 50 patients a day in your home country, but that is not how things work in Sweden. There is a good deal of documentation to do, and you are supposed to spend quality time with your patient. In my case, time just flied between 8 am to 5 pm, and most of the time, I used to forget about fika breaks.

A good part of the job in Sweden is that you can always look up a variety of web resources in medicine. Here is the list of some of them I know.

1. REK list: Most important reference book for everything related to patient management in primary care. For any disease, refer REK list first. You can check other resources only when the description in REK list is inadequate. Available in booklet format also.
2. Äldrekompassen: Guidelines regarding medications for the elderly (available as booklet also).
3. Medibas : Contains commonly encountered diseases and their management. Paid membership, but you can use Institutional access to get full access.
4. Internetmedicin: Contains description and management of diseases both at the primary care level as well as the specialist level. Useful when your patients need to know about what could happen next after being referred to a specialist.
5. UpToDate: Contains newer and updated worldwide guidelines about several diseases.
6. Krav- och kvalitetsbok Vårdval: If you are interested in management and is looking forward to become the manager of a VC, or if you are just curious about the specifics of how a VC works, this book is for you.
7. FASS : Contains information regarding all available medicines in Sweden, including its pharmacokinetics, interactions, dosing and contraindications.
8. Smörjschema: Several patients would need to use cortisone creams, and the scheme for tapering the medicine is quite lengthy. I usually give a print out from this website to ease my job of writing out the instructions in detail.
9. JanusInfo: Lot of good information about medications, including medications for pregnant and lactating individuals.
10. STRAMA: Antibiotic prescription has to strictly follow STRAMA guidelines. No exceptions.
11. 1177: Information about self-medication for minor disease conditions can be found here. I usually encourage my patients to read 1177 for knowing more about their diagnosis and self-help remedies.
12. Läkemedelsverket: Contains details about why some medicines have been phased out, and which medicines can be used in their stead.

At the end of the practical training, your supervisor and manager fill up a form, which you can send to Socialstyrelsen along with other relevant documents. I sent my documents to Socialstyrelsen in the second week of June 2021 and received my Swedish medical license via e-mail within one week after application.

Earlier posts in this series:

1. Moving to Sweden as a doctor: PhD admission
2. Moving to Sweden as a doctor: Learning Swedish
3. Moving to Sweden as a doctor: Medical license exam
4. Moving to Sweden as a doctor: Practical exam

Later posts in this series:

1. Moving to Sweden as a doctor: Starting Specialist Training

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Writing about COVID-19 on Wikipedia

Last month was eventful not only in terms of my personal and professional life, but also in terms of my volunteering work. In March-April, I have been regularly writing articles on English Wikipedia about COVID-19, mostly about the medical aspects, issues surrounding the impact of the pandemic and people in leadership in responding to COVID-19.

I am used to doing everything in a structured way on Wikipedia, but COVID-19 changed everything. I usually take days and weeks to think about a new project on Wikipedia, then create a time line and a work plan, and then work systematically on each aspect of the work. But in a crisis situation like a pandemic, this level of structuring is not possible, so I am helping out wherever help is needed. Nowadays, I log in to Wikipedia in the morning, read the updates about the pandemic from there and then go searching for topics that are missing. Given the recentness of the pandemic, there is usually a lot to write about, especially about its socio-economic impact. In addition, the tables about the disease epidemiology need to be updated, new regulations and lockdowns passed in various countries need to be added and the biographies of notable individuals working on COVID-19 need to be created. I work on all these aspects.

I get my references from all kinds of sources, thanks to most journals making their COVID-19 research papers open access. Many magazines and newsletters like The Economist have made their articles related to COVID-19 subscription-free. The WHO, UNPFA, UNICEF, Human Rights Watch, Amnesty International and many other organisations have also created several documents related to COVID-19 and the impact of the pandemic on various spheres of life. I have generously drawn content from all these sources for creating and expanding articles on Wikipedia.

I have mostly been following the World Health Organisation (WHO) for knowing the latest disease updates, so I mostly bring information from the WHO to Wikipedia. As of 9 April 2020, I have written around 25 articles related to COVID-19 on Wikipedia. The most popular one so far is 2020 coronavirus pandemic in Kerala. The article I am most proud of is Gendered Impact of the 2019-20 coronavirus pandemic. The article which I think would be the most useful is List of unproven methods against COVID-19, given the misinformation circulating about the disease. Nearly 700 edits I made on English Wikipedia thus far are on articles related to COVID-19. The articles started by me have been viewed around 35,000 times every day during the last one month.

What am I going to do next? We are still in this pandemic and the situation is rapidly evolving (for better or for worse, we don’t know yet). So, I am going to take everything one day at a time, doing what is important for today, not making any long term plans. I will continue to do what I am doing right now on Wikipedia, until help is no longer needed. As a Wikipedian, doctor and researcher, this is the least I can do to empower people around the world to get open and reliable information about COVID-19.

Stay safe, y’all.

 

How to identify misinformation related to coronavirus?

We live in the era of information overload and misinformation. Ever since coronavirus started being a cause for panic among the public, a lot of misinformation regarding it started circulating in the internet. How to identify if a given information is true or not?

1. Check the source of the information. If the information you found comes from a website, check the URL to find out if it is a reliable organization. Some of the sources that you can rely on are the governments of your countries, World Health Organization and established newspapers. Even Wikipedia has reliable information related to coronavirus pandemic. This is made possible by thousands of volunteers, including experts, monitoring  pages related to coronavirus and updating the pages for accurate information. There is a Wikipedia page for Misinformation related to the 2019-20 coronavirus pandemic. Several instances of misinformation have been recorded here.
   If the information you got is via a social media platform such as Whatsapp, you should be careful about its authenticity. Always ask the sender for the origin of the message if you are unsure if it is true. Encourage everyone to share trusted information only.
2. Extraordinary claims need extraordinary evidence : If you find a post that says that the the cure for coronavirus disease is found, or makes similar tall claims, it is likely that they are wrong. If a vaccine or medicine for coronavirus gets indeed made, it will be all over the place, not just in that single forwarded message.
3. If you find something like “The truth behind coronavirus pandemic” or such that has the word ‘truth’ in it, it is likely that they are sharing an unpopular opinion, and therefore, it is likely to be false. Those saying the truth don’t need to affirm that they are indeed saying the truth, but liars need to do it from time to time to make sure their lies are spreading.
4. If the coronavirus-related post deals with supporting an ideology or a religion, it may be false. In the zeal of projecting one’s ideology or religion first, people tend to create and spread all kinds of news, including fake ones. Neither capitalism or communism has figured out how to control coronavirus spread. Neither Hinduism nor Islam has solutions for preventing disease transmission.
5. Take extra care when you SHARE information. Only share the posts that you know are true. Don’t be a part of the fake news chain.

Moving to Sweden as a doctor: Medical license exam

This blog post is about my experiences in appearing for the theory part of the medical license exam in Sweden.

Once you have learnt Swedish upto around SFI-D (between B1 and B2 levels, if you are following CEFR), I would suggest that you start going through the past years’ questions of the theory part of the medical license exam (kunskapsprov för läkare utanför EU). Details about learning Swedish has been explained in detail in my previous post. You can find the past questions here. It is likely that you don’t understand many terms, but you might be able to understand something at least. Medical vocabulary in Swedish is quite similar to that of English, so if you have understanding of Swedish grammar, learning medical terminology in Swedish would not take so much time.

To start with, you can translate the past questions to English in order to understand how tough it is. You can upload the pdf document to Google translate to get an English translation. My experience was that the theory exam in Sweden was easier than the post-graduate admission exam (NEET) in India. It is also less intensive in terms of having to memorize concepts. The medical license exam in Sweden focuses more on the basic concepts and practical applications of fundamental principles. This means that a good number of questions are case discussions, where you are asked to choose the most correct option about the diagnosis or management of a particular patient. Most often, the cases have typical signs and symptoms. Sometimes, the question only gives you hints about the patient’s symptoms, and ask you to choose a suitable treatment. In that case, it is upto you to work out the diagnosis first, consider the situation (if you are in primary care or tertiary care) given in the question and choose a diagnosis that is most appropriate for the situation. For example, the question might be about managing a patient who came with hemiparesis and slurred speech in primary care. First, you need to work out the diagnosis as stroke. Then, you need to consider that you are in primary care, and it is therefore not possible to manage the case in your hospital. The right answer would be to send the patient in an ambulance to the tertiary care hospital immediately. On the other hand, if the questions says that you are in a tertiary care, the option of doing thrombolysis might be the correct answer. In order to confuse you, both the options will be given to you. The key to cracking the exam is to visualize the situation in your mind, and then choose the option that sounds the most reasonable for you. Apply your common sense generously.

The theory exam consists of approximately 180 questions divided into three parts : a general part, a clinical part and interpreting a research article. The weightage of subjects can be found in this document. You can see in the document that medicine is the most important subject with 10% of the questions devoted to it. You will need to study pre-clinical subjects as well. I studied First Aid for the USMLE (Step 1) book for the pre-clinical part. This book is very condensed, so whenever I could not understand some concepts, I would look up my old textbooks to read elaborately about that topic. To some extent, Kaplan lecture notes for microbiology and pathology also helped, but I did not read them completely due to lack of time.

For the clinical part, I studied PLABABLE, the mobile app for preparing for the medical license exam in UK. As I was working full time while preparing for the exam, it was good to have the study material in mobile app format for me to study while I am traveling to work. I took longer to read Swedish text than English text, so PLABABLE was good for me since it was in English. In that way, I could grasp the concepts fast. I also subscribed to Hypocampus, but it had detailed descriptions for every disease, so I could not read much of it. There are differences in the ways by which diseases are managed in India and Sweden. In order to be mindful of these differences, I looked up the website internetmedicin to know the current Swedish guidelines. There is also a book and a mobile app called Läkemedelsboken that you can refer for the latest management protocols for common diseases in Sweden. These two resources are huge, so use them only as references. I also discovered two books from the library : Akut medicin and Akut kirurgi. These two books have condensed descriptions of commonly seen cases in Sweden. I used these two books for learning Swedish terms as well as for quick reference. There are similar ‘Akut’ books for orthopedics, radiology, psychiatry etc., but since these subjects were not as important for the exam as medicine and surgery, I did not read them. Sometimes, it was tiresome for me to study during the evening after a full day’s work, in which case I watched Osmosis videos passively while lying on the sofa.

I did not need to study for the research article part of the exam because my day job as a researcher helped me there. The most important parts of the research article are its aim and results (including tables). Make it a practice to read the questions first, and then read the relevant parts of the research article to find out the answer. If you instead read the article in full first, it is likely that you will not have sufficient time for answering the questions.

I think that the key to cracking the exam is to work out as many previously asked questions as possible. There is a lot of material out to study, and you can’t memorize all of them. You will need to prioritize some topics over the other, and you need to be familiar with past questions in order to know which topics are important. The previously asked questions do not repeat, but some subject areas are more frequently asked than others, so make a note of that by solving past question papers. All past questions can be found here. If you have time, solve past TULE and AT questions too. MCQs from Lund University are also in the same pattern as kunskapsprov, so practice them too. Whenever I solved past question papers, I looked up the concepts that I did not know and noted them in a notebook. I made it a practice to revise the contents of the notebook every three days or so.

Some people who were successful in the exam have watched videos on UmUplay (available on your moodle), participated in study-circles (find out if there is a study circle in your city) and attended the completion program for doctors educated outside of EU. I have not done any of these, and I studied alone. I studied only for two months or so, that too while working full time as a PhD candidate. But I had the habit of reading medical textbooks, popular science books and watching medicine related videos. Although I did this for fun, this habit helped me to keep my knowledge updated. Therefore, I did not need to study much for the exam. But even then, my first reaction after the exam day was that I would definitely fail. Fortunately for me, I passed the exam at the first attempt in May 2019. My score was 65.2%.

Earlier posts in this series:

1. Moving to Sweden as a doctor: PhD admission
2. Moving to Sweden as a doctor: Learning Swedish

Later posts in this series: 

1. Moving to Sweden as a doctor: Practical exam
2. Moving to Sweden as a doctor: Practical training
3. Moving to Sweden as a doctor: Starting Specialist Training

Moving to Sweden as a doctor : Learning Swedish

This is the continuation of the post Moving to Sweden as a doctor : PhD admission. In this post, I will discuss my experiences in studying Swedish language.

All people who have a personal number in Sweden have the right to learn Swedish language. If you are a temporary or permanent resident in Sweden, you get a personal number, and that enables you to learn Swedish language free of cost. You can choose to go either to Folksuniversitiet or to SFI for learning Swedish (some courses in Folksuniversitiet are paid courses). Both these institutions teach Swedish, but in different ways. Folksuniversitiet follows the Common European Framework of Reference for Languages and has courses starting from A1 to C2 level. At Folksuniversitiet, you need to have cleared the exam for C1 level to be able to practice as a doctor in Sweden. If you go the SFI route, you do SFI-C and SFI-D courses. SFI-C is roughly equivalent to 5th standard level of Swedish and SFI-D is equivalent to 7th standard. People without secondary education start at SFI-A, but you as a doctor has got University education, and you are therefore eligible to start at SFI-C directly.

Once you finish SFI-D, you can start ‘Svenska som ändraspråk (SAS)’ course. While SFI consists of basic level courses, SAS enables you to learn Swedish as a second language. SAS has various levels : SAS-G, SAS-1, SAS-2 and SAS-3. SAS-G consists of four sub-levels. If you performed well in the final exam of SFI-D, you can go directly to the third or the fourth level, so it is important to prepare well for SFI-D if you would like to finish studying Swedish fast. SAS-3 is equivalent to having learnt Swedish at 12th standard level. To work as a doctor in Sweden, you need to complete SAS-3. Clearing SAS-3 would also mean that you are eligible to take University level courses in Swedish language. When you start practicing as a doctor, you might want to  study short University courses as a part of continued education. Nearly all courses are in Swedish, so it is good for you to clear SAS-3 rather than to clear C1 from Folksuniversitiet. In addition, the completion course for doctors from outside Sweden only accepts SAS-3, and not C1. So, even if SAS-3 seems to take longer time than C1, I would say it is worth the effort. It is likely that you have waiting times between passing one SAS course and joining another. My recommendation is to study Swedish during the waiting time and appear for the SAS exam directly if possible. Most kommuns allow you to appear for the SAS exam without having to go to the course. If you are in Göteborg, you can apply for the SAS exam directly here against a fee of 500 SEK.

It takes around 2 years to learn Swedish if you learn intensively. I studied part time, so it took longer. Starting SAS-1, you have the possibility to do distance course. This was helpful for me because I could now study and do the assignments during weekends. You need to show the proof for Swedish proficiency only when you apply for the medical license, so you are allowed to take the medical license exam (kunskapsprov för läkare utanför EU/EEA) before you have finished studying Swedish. I passed the theory part of the medical license exam while I was still doing SAS-G course, so my advice is to start preparing for the medical license exam as soon as you finish SFI-D. I will write about preparing for the medical license exam in the next post.

Earlier posts in this series:

1. Moving to Sweden as a doctor: PhD admission

Later posts in this series:

1. Moving to Sweden as a doctor: Medical license exam
2. Moving to Sweden as a doctor: Practical exam
3. Moving to Sweden as a doctor: Practical training
4. Moving to Sweden as a doctor: Starting Specialist Training

Free Medical Images Collection

These days I am illustrating Wikipedia articles with images related to medicine. Sometimes, the existing image(s) on an article are too old, so I would want to add a newer, higher resolution image by replacing the old one. Some articles do not have images at all. A major problem for me was in finding the right image for the given article. Wikipedia accepts images/media that are CC-BY-SA or lower, so I had to go through the existing image repositories to find out those with the right license for Wikipedia. I decided to tabulate some of the image repositories that have medical content, along with the license they are shared under. I hope this would be useful not only for me, but for everyone else who are looking for free images related to medicine. Please note that this is not a comprehensive list, I have only included the repositories that I know of.

Source	License	Notes
Creative Commons search	CC-varied	Datasets from these collections are found on CC-search.
All Free Photos	–	Free photos of all kinds
Burst Images	Public Domain	Free photos of all kinds
Medpix	All Rights Reserved	Medpix is a repository of medical cases run by the NIH, USA. The images are free for personal use, but need permission from the authors for any use other than personal. Contact the authors directly for permission.
Radiopedia	CC-BY-NC-SA	Collection of radiology images. Copyright rests with the author of the image.
Flickr Commons	CC varied	Media from Flickr Commons also shows up on CC search.
British Library	–	Images from British Library, UK
ASH Image bank	Fair Use	A collection of hematology images. Login needed, free account creation.
Centre for Disease Control and Prevention	Mostly Public Domain	Images related to healthcare, diseases, health promotion etc.
Brain Biodiversity Bank	All rights reserved	Altas of human brain. Radiology images and 3D movies available. Free re-use permitted, contact the authors for re-use permissions.
US National Library of Medicine	Fair Use	Contain images related to. medicine. Obtain permission from the website for re-use. Permission shall be granted on a case-by-case basis. Some images are CC.
National Eye Institute	CC varied	Some images are CC-BY. Results can be found from CC-search.
Duke University Digital Repository	CC-BY-NC-SA	Contains advertisements and handouts of medical products
Visible Body	All Rights Reserved	Some content is available without subscription. Contains 3D anatomy resources.
3D Embryo Atlas	CC-BY-NC-ND	Media related to embryology
Bio Atlas	Use with attribution	Contains high resolution histology and histopathology images of humans and animals
CAOM	–	Histopathology slides, pages are slow to load. From Poznan
Brain-Maps	–	Histo- and gross images of brains of humans and animals
Cancer Digital Archive	–	Image repository of oncopathology
Aurora M-scope	Most images in Public Domain	Contains histopathology slides. Needs a special software for opening the files in high resolution.
Heidelberg University	All Rights Reserved	Contains educational images related to pathology
Pathobin	–	A platform for uploading pathology slides. Copyright lies with the uploader.
National Institute of Health, USA	Public Domain	Images are on Flickr, hence available using CC-search.
Europeana	CC varied	Contains media related to history of medicine and natural history
Fossil Forum	–	Collection of fossils. Individual uploaders hold the copyright. Fair use permitted.
Medillsb	Varied	Website of the association of medical illustrators. Contact individual authors for re-use.
Medical Graphics DE	CC-BY-ND	Illustrations related to medicine.
LifeScienceDB	CC-BY-SA	Create your own photos and videos of human anatomy
Neuroanatomy	CC-BY-SA-NC	Neuroanatomy media. From University of British Columbia. Contains 360 degree views of the brain, MRIs etc.
Dollar Street	CC-BY-SA	Collection of everyday objects, people, families showing socioeconomic status of people around the world.
Cell Image Library	CC-varied	Mostly public domain images of cells.
Heal Collection	CC varied	Images for medical education.
Stanford Medical Library	CC varied	Images related to medicine from Stanford.
National Cancer Institute	CC-varied	Contains media related to cancer.
Histology Atlas	CC-BY-NC-ND	Histology images
Audilab	CC-BY-NC-SA	3D images related to anatomy
Sketchfab	CC-BY-NC-SA	Illustrations related to human body
Open Access Biomedical Search Engine	–	Can perform advanced search by License type
Science Images of Australia	CC-BY	Natural history, medicine images
Library of Congress collection	Varied	History of medicine
The noun project	CC-BY	Contains icons for general use and those related to medicine
Somersault Images	CC-BY-SA-NC	Illustrations related to medicine
Smart Servier	CC-BY	Illustrations related to medicine
Ghorayeb Images	CC-BY-NC=ND	Collection of images from ENT
Ecure Me	All Rights Reserved	Illustrations and photos of diseases
University of California	All Rights Reserved	Images of clinical signs and symptoms
University of Iowa	All Rights Reserved	Images of dermatological conditions
Internet Pathology Laboratory	All Rights Reserved	Images related to pathology
Atlas of endoscopy	All Rights Reserved	Images related to endoscopy/gastroenerology

Gandhian Philosophy and neurorehabilitation

This is the essay and poster on Gandhian Philosophy in Neurorehabilitation prepared for the 10th World Congress in Neurorehabilitation, Mumbai, India.

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Neurorehabilitation is a complex process that involves minimization of neural damage and compensation of limitation of functions arising from neural disorders. New insights on neurorehabilitation can be gathered when observed from a Gandhian point of view. The perspectives, ideals, and vision of Gandhi are relevant today that one can find many parallels of principles from his life that are now used in medical practice worldwide.

Simplicity is prominently reflected in Gandhi’s ideas and way of living. His affinity to simplicity was evident even during his early days in England, when he cut down all unwanted expenses and chose to live in a modest setting. Gandhi firmly believed that happiness and prosperity are not bound to materialistic things but are derived from internal peace and satisfaction. He was against over-consumption and affinity to material possessions. The Gandhian virtue of simplicity has an important role in neurorehabilitation where the focus is on patient’s personal satisfaction and fulfilment. Oftentimes, the simplest of all interventions might be the most therapeutic to the patient. Some of the most complex life decisions of the patient can be changed simply by offering new perspectives. In neurorehabilitation, some of the most effective interventions such as mirror therapy and physical exercise are cheap, simple and inexpensive.

Gandhi had a holistic approach to his development as a complete social being. He did not divide his personal and private life into watertight compartments and mixed social, political and religious work harmoniously. He also believed that all life goals should be defined in such a way that it should make progress not only to one’s lifestyle, but also to one’s family, nation and the world. This philosophy of holism is one of the pillars of modern neurorehabilitation. A neurorehabilitation professional not only caters for the physical and psychological aspects of the patient, but also for the social and cultural dimensions of his/her personality. Neurorehabilitation involves working with not only the patients, but also their families. It also draws no boundaries between personal needs and social needs. Neurorehabilitation deals with several aspects of the patient’s life including nutrition, mobility, cognition etc. Thus, quality rehabilitation can be administered only by considering the patient as a whole, and not as a sum of organs.

Inclusivity and diversity were Gandhi’s core values. The ‘Hind Swaraj’ of his vision was the one where people thrived and cooperated despite differences in caste, creed, gender or religion. The same vision is applicable to neurorehabilitation in which all medical practitioners, caregivers, the family, and community have to work together with the patient to bring him/her to the fullest possible potential. There cannot be any hierarchy in terms of work division and everyone’s role is crucial in rehabilitating the patient. Gandhi emphasized that one’s action should be directed at the well-being of the poorest and weakest man (woman). This principle is of great importance in neurorehabilitation where the healthcare professional has to deliver the most care to the neediest and weakest patient.

Gandhi warned his followers that ‘healing should be its own reward’. In the present day world, medical care is commercialized and monetary reward is the primary reason for those involved in the healthcare industry. Gandhi had foreseen this problem as early as in 1925 when medical science was in its infancy. In neurorehabilitation where often debilitated patients might need lifelong treatment, it is inhumane to be acutely business-minded. Gandhi had also noted that science without humanity is the root of violence. In neurorehabilitation, the focus of the researcher and practitioner is on being compassionate, empathetic and tolerant. These humane values are emphasized more in neurorehabilitation than in other branches of medicine.

Gandhi had a life-long commitment to his ideals. His lifelong dedication to ahimsa and satyagraha are well-known and are praised by scholars and disciples alike. Similarly, in neurorehabilitation, the patients often need life-long care. Hence, neurorehabilitation becomes an integral part of the lifestyle of the patient. The patient and the healthcare professionals should work hand-in-hand, often throughout the lifetime of the patient to meet the goals of the therapy. Gandhian value of satyagraha encompasses the same philosophy: being patient, working consistently, and not stopping until the goal is reached.

The ideal community as envisioned by Gandhi is a reformed one where each individual works harmoniously to produce a self-sustaining economy. This aspect of community involvement is well-established in neurorehabilitation. The ‘social safety net’ provided by the state, and the ‘social cushion’ provided by the community are very important for patients needing neurorehabilitation. Community support and social awareness regarding neurorehabilitation are essential for enforcing policy change for accessible public spaces, pension plans and return-to-work policies.

It is evident that Gandhian philosophy is closely in alignment with the core principles of rehabilitation. Gandhi’s ideas and practices should continue to inspire healthcare professionals to seek provisions for applying ahimsa in various facets of their work in neurorehabilitation. In current times of intense competition, we, the healthcare professionals, must embrace Gandhi’s integrity and avoid the temptation to forego morality and empathy.

Travel Quiz Questions

This is the slide deck I prepared for Reverberates Online Quiz (external link to Facebook). They are a bit hard to crack, but if Google is your friend, you might be able to get one clue after the other from the question statements, which you can google separately. Image search may also sometimes lead to the answers.

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Photos from Wikimedia Commons, Flickr CC-BY-SA or CC-BY-NC, 2.0/3.0. All logos and photos taken from copyrighted sources used in the slideshow are low resolution and are for illustrative and educational purposes only (Read more about fair Use here). For the pdf/pptx version of this quiz set, please contact me directly. 

General Quiz Questions (Part 3)

This is the quiz set I created for a school quiz in Thamarassery in 2014. Looking back, some of the questions appear interesting to me, especially the one with spiderman’s arm.

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Photos from Wikimedia Commons, Flickr CC-BY-SA or CC-BY-NC, 2.0/3.0. All logos and photos taken from copyrighted sources used in the slideshow are low resolution and are for illustrative and educational purposes only (Read more about Fair Use here). For the pdf/pptx version of this quiz set, please contact me directly.