November 23, 2017

Health Behaviour

By Anu Dev

“Rest when you’re weary. Refresh and renew yourself, your body, your mind, your spirit. Then get back to work.” – Ralph Marston

Back when I was rotating through Family Medicine, we had a lecture on the concepts of “Heath behaviour” and “illness behaviour”, which I believe may be useful to the general reader. Heath behaviour refers to any action a person undertakes to promote, maintain, or protect health. And illness behaviour refers to the actions taken when sick to get better.
It made me remember that, at the beginning of med school, I was struck by how finely balanced all our regulatory systems are, ensuring that all of the processes in our body are in sync. Makes you sympathetic with those who believe there had to be a “master watchmaker”!! And think how elaborate our immune system is, to prevent us from getting sick all of the time. There are an awful lot of bacteria and viruses out there launching attacks on us, but we don’t spend every waking moment sick, warding them off, do we? That’s because our immune system is fighting off the invaders all the time.
And I realised how much we take these things for granted. We eat what we want when we want, not caring about what the nutritional content of the food or our irregular eating times might be doing to our bodies. Or we adopt a sedentary, couch potato lifestyle with nary a thought as to what is happening to our body that evolved over hundreds of thousands of years being quite active. And while we take in the car every 3000 miles for the oil and filter change, we don’t make regular check-ups with our doctor just to check if the systems are OK. Until we get sick, that is. We place more importance on our illness behaviour than our health behaviour.
But being healthy isn’t just about being physically healthy. The WHO thus defines health: “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” And you’d be surprised as to how many “physical” illnesses are cause by “mental” disequilibrium. One medical expert, in the book, “Lives of a cell”, hazarded a guess that it might be as high as 50%!
There might be interminable arguments by philosophers about where the mind might be located, but there’s no question mental health is as important for normal-functioning as any of the other aspects of health. Mental health is defined as “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” (OK…that one’s from the text! But it’s pretty complete.)
What about social health…we are social beings, aren’t we? Well that deals with your lifestyle choices. Do you want to die early from lung cancer? Then by all means keep chain-smoking those cigarettes. But secondary smoking is even deadlier to those around. So just quit! Smoking and drinking excessive amounts of alcohol are all lifestyle choices that you should say no to if you (or those around you) want to stay healthy. Remember: alcohol and domestic violence are highly correlated in our culture.
Other decisions you can make about your lifestyle are about the food you eat. Eat smarter, eat healthier. In Guyana, we’re at high risk for diseases like hypertension and diabetes. These diseases don’t have absolute cures, just ways to manage the illness. So let’s take preventative measures to prevent ourselves from getting these diseases.
Let’s try adjusting our health behaviour, because prevention is always better than cure!


By Anu Dev

Medical tourism can be considered a kind of import: instead of the product coming to the consumer, as it does with cars or sneakers, the consumer is going to the product – James Suroweicki

It’s November, which means that it’s Tourism Month again. This year, the theme is “Sustainable tourism – A Tool for Development”
I was a bit surprised; however, that medical tourism wasn’t touted at the launch of the Month, since this is one of the most lucrative and growing areas of tourism. A few years back, when I was still at Queen’s, medical tourism was in the air in conjunction with the proposed “Specialty Hospital”. But even if the latter has been shelved, it doesn’t mean the former has to die. Just like other types of tourism, “medical tourism” — as the quote above reminds us — is a special reverse type of import; here, the import (the medical tourist) actually comes to buy the product (medical treatment), and leaves the foreign funds in Guyana, rather than sending it abroad!
And those “foreign funds” are astronomical. According to the World Travel & Tourism Council (WTTC), medical tourism contributed 9 per cent of global GDP (more than US$6 trillion) and accounted for 255 million jobs in 2011. So, while our regular tourist numbers are inching ever upwards, I believe we should keep on in that area; especially since we have several medical schools in Guyana, and another is slated to open next year — which I understand will have an adjunct hospital.
Medical tourism brings in more than twice the spending of foreign tourists; so while we’re not going to be exactly overrun by tourists in downtown Georgetown, you’d be surprised how many relatives, friends and ‘significant others’ of patients will fill up the Marriott, Pegasus, Ramada Princess, and all the other smaller hotels that now dot our – dare I say it – once and future Garden City.
With angioplasties (for instance) going for $100,000 in the United States (and we are talking about US greenbacks here!) versus the $11,000 that India charges — even if we go to $15,000 — there’s still a lot of wriggle room for the surgery to be done in Guyana, and rake in all the side benefits of regular tourism.
And what the studies on the major players in medical medicine – India, Thailand — have shown is that, having come for the medical treatment, the foreign patients do get an opportunity to see the country and its attractions. And why shouldn’t they come to see our dear land of Guyana? We have so many beautiful sights to behold and places to visit. The land itself has done half of the work, all we Guyanese have to do is to market the beauty! And medical tourism can be another arrow in our marketing quiver to do this. Brazil is also a big player in medical tourism.
Another type of medical tourists that we can attract would be our Guyanese diaspora in the United States and Canada, which is fighting socialised medicine tooth and nail. For some reason, not many officials talk about the number of these “foreigners” who return to Guyana to have their dentures replaced. They cost at least ten times less than in the United States. Maybe our Specialty Hospital can also do dental surgery, as for instance Costa Rica does.
In the latter country, dental care can cost as much as 70 per cent less than in the United States. More than 40,000 medical tourists visited Costa Rica in 2011, a third for dental care. Guyana, like Costa Rica, is but a short trip from the United States, and it offers orthopedics, cardiology, spine, cosmetic and bariatric (obesity) surgery.
So let’s think – and act – outside the box and watch our tourism revenues swell! And not so incidentally provide higher paid employment to our swelling number of doctors!

Diabetes: Prevention is always better than cure

“Diabetes taught me discipline.” – Sonia Sotomayor

By Anu Dev

I’m rotating through general surgery again, and I’m seeing a lot of the same types of patients I saw last year, especially patients coming in with “diabetic feet”.
“Diabetic feet” refers to the characteristic changes seen in the feet of people with diabetes. Diabetes affects the blood vessels and nerves of the feet (and everywhere else in the body) and inhibits your body’s innate capacity to heal; which to a large extent depends on blood being supplied to the wound.
Because of the nerve damage, diabetics don’t really detect pain as readily as non-diabetics. So if, for example, they stepped on something sharp and injured their foot, they mightn’t even notice the injury. And because of the reduced blood flow and the consequent reduced ability to heal, there’s a greater risk of the wound staying open and becoming infected.
Diabetes also affects your ability to fight off infections, so the infection might spread to the entire leg, and to the bone. The infection could also spread to the blood, leading to a life-threatening condition called sepsis. Since diabetes affects the blood vessels of the feet, the blood supply to the feet is compromised. And if the tissues aren’t getting enough blood, they’ll eventually die. Some people end up having to have an amputation of a toe, a foot, or even an entire leg.
People with wounds to “diabetic feet” need specialist care from doctors and nurses who are experienced with this condition. When I was in Guyana, I was happy to learn that there is a specialised unit in Guyana to deal with “diabetic feet”, since there has been an upsurge in diabetes worldwide, which I am sure has increased our already historically high rate.
So if you know that you’re diabetic, you should take care of your feet, to prevent injury and infection. You should inspect your feet daily. Check for cuts, blisters, redness, swelling, or if your nails are getting brittle and thicker. Keep your feet clean. Use a moisturizer to keep dry skin from itching or cracking. Try to avoid walking barefooted, even indoors, to avoid stepping on anything that could cause a cut or a bruise.
And one of the most important things is to keep your diabetes under control.
Prevention is always better than cure, so it’s important to take care of your feet, to prevent injury and infection. And if your foot does get injured, or if you notice an ulcer forming, you should see your doctor.
I’ve seen so many patients who come in so late with the infection spread so far that the only solution was amputation.

The significance of Diwali

By Anu Dev

“Diwali – A festival full of sweet memories, sky full of fireworks, mouth full of sweets, house full of diyas, and heart full of enjoyment.”

I just returned from a visit to Divali Nagar in Trinidad. It was the perfect way to relax after some very stressful Ob/Gyn finals, thank you!!
Divali has always been one of my favourite festivals. And I guess what has always been its most attractive feature has been the air of tranquility that lingers in my memories as I remember my mom and I spending most of the day puttering about the kitchen, cooking up a multitude of dishes — both “sweet and salt”. My personal favourites were the samosas and “aloo balls”.
But before the actual day of Diwali, the house would have been given a thorough cleaning — both inside and out. I haven’t been able to be home for Divali during these last two Divali occasions, but to be honest, I didn’t miss the cleaning part! Most Hindus — and this includes my Mom — literally don’t even leave a stone unturned when cleaning up for Diwali, because we are symbolically welcoming God into our house, and who would want to welcome God into a house that’s less than spic-and-span?
By six o’clock, we would be in our pooja rooms, offering prayers to the deities, Mother Laxmi in particular. Mother Laxmi is the Goddess of Light, so we pray to her on Diwali, which is the darkest night of the year (Amaawas night). Families praying together and singing bhajans to Mother Laxmi is one of the many wonderful ways that Diwali strengthens the family bond.
We would then carefully place a diya in every room of the house — especially the ledges of the verandahs — and then proceed outside, where the passageways, fences and bridges would be outlined with diyas. Because we live so close to the Ocean, the wind is invariably very strong, and it’s always a challenge to keep the diya going. You evolve strategies like placing them where two wicks touch and keep each other lit!
Divali is a harvest festival, and the underlying message – like with most Hindu festivals — is the triumph of light over darkness (good over evil). Poverty is seen as one of the greatest obstacles to living a virtuous life; so, from this perspective, banishing it through a bountiful harvest is a powerful message.
The lighting of the millions of diyas every Diwali is significant; it means we are battling the odds and lighting up the world on the darkest night of the year. Though the moon isn’t out, we’re making our own light. We’re forging our own paths in this life. And that’s important: you can only build up good karma if YOU take action, not if someone else does it for you. And karma is an integral part of Hinduism- we believe that we can only achieve moksha (liberation) based on our actions in life.
Sure, lighting up fireworks and cooking are really, really fun, but the whole essence of Diwali is that every diya that you light you are making a conscious decision to end the darkness. The darkness doesn’t just mean external ‘demons’ like drugs, bad friends, poverty, sickness etc.; it also means tackling your own internal conflicts, like trying to fix that mean aspect of your personality, or cultivating better discipline.
On Diwali, family members across the globe reconnect. Whether they just call or even visit for the holiday is up to them, but the important thing is that the bond is being maintained.
This Divali, I will be shuttling between north and south Trinidad; but I still hope, as I did last year, I will be in the Pooja room with my family, singing our favourite Divali Bhajans – via the magic of Skype!!
So go out there this Diwali, light a diya, keep on burning bright, and keep on shining.

The dangers of consuming alcohol, smoking during pregnancy

By Anu Dev

Think for 2; don’t drink or smoke for 2 (The following was written as the intro to a CAPE project five years ago. Intimations of future career specialisation?)

It is said we are what we eat. When it comes to a pregnant woman, her child is not only what she eats but whatever enters her bloodstream by whatever route. During pregnancy, all nine months of it, it therefore behoves the mother to always remember that whatever she eats, her baby eats and whatever she drinks, her baby drinks. In the same way most mothers would not contemplate putting alcohol in their baby’s milk, they should not even consider drinking alcohol or using drugs while pregnant because the effects on the developing foetus are just as toxic.
The baby may not be conscious of the effects while in the womb, but after birth, and years after, the baby will continue to suffer from the effects of its mother’s folly. Alcohol passes easily through the placental barrier and the foetus is less equipped to eliminate alcohol than its mother. Furthermore, the babies are affected more by the exposure to alcohol than the mothers, since the developing foetus cannot break down the alcohol as the mother and consequently, the foetus receives a higher concentration of alcohol. Babies born to mothers who used alcohol are likely to be born with low birth weight, small head circumference, developmental delays, organ dysfunction, facial abnormalities, epilepsy, and poor coordination.
Nerve and brain disorders are especially prominent if the alcohol is imbibed during the second and third trimesters of pregnancy, since it is during this timeframe that complex brain development occurs. Such exposed babies are born with poor motor skills and poor learning abilities. Physical deformation of the brain itself may also occur, with small head size and other abnormalities such as cerebellar hypoplasia. If alcohol is consumed during the first trimester, it interferes with the migration and organisation of brain cells, causing structural deformities. During the third trimester, damage can be caused to the hippocampus, affecting memory, emotion and the encoding of auditory and visual information. Babies who suffer from growth deficiency, the three facial deformities, central nervous system damage and prenatal alcohol exposure are said to suffer from Foetal Alcohol Syndrome.
Drinking alcohol is not the only bad habit a pregnant woman should endeavour to break: smoking is another one that is just as deadly.
Cigarette smoke contains over 4000 chemicals, with lead and cyanide being just two of the 60+ carcinogenic chemicals. The nicotine from cigarette smoke narrows blood vessels in the umbilical cord[1]; effectively decreasing the amount of oxygen available to the baby. Additionally, the carbon monoxide present combines with the haemoglobin of the red blood cells carrying the oxygen thereby decreasing the oxygen capacity of those cells.
Babies born to women who smoke are usually underweight due to their underdeveloped bodies. Their lungs may not even be able to work on their own due to delayed lung development caused by nicotine. These babies are also especially vulnerable to asthma and other respiratory ailments. Furthermore, babies whose mothers smoked during the first trimester of pregnancy are more likely to suffer from heart defects at birth. Nicotine also retards brain development: the developing brain being particularly sensitive to low oxygen levels, especially affecting the areas of the brain that control breathing. Additionally, nicotine is poisonous to the areas of the brain directly involved with heart and breathing functions.
Passive smoking – inhalation of second-hand smoke – also affects the baby and may lead to underweight babies being delivered. The smoke that burns off the end of a cigarette and escapes into the air actually contains more harmful substances (tar, carbon monoxide, nicotine) than the smoke inhaled by the smoker.
So pregnant mothers-to-be, stay on the straight and narrow. At least for the nine months.

Look for early signs of breast cancer

By Anu Dev

“I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity” – Angelina Jolie (on getting a double mastectomy)

October is “Breast Cancer Awareness Month”, and although many women are aware of the existence and possibly of the prevalence of breast cancer, I don’t think that there is enough awareness of the things they should be doing for early detection, or about factors that put them at a greater risk of having breast cancer; so I believe this article bears repetition.
In the Caribbean, the WHO announced in 2013 that rates are rising because of our change in lifestyle in imitation of the developed countries. In my first clinical rotation (surgery), we saw a lot of cases of breast cancer, which illustrated the stark statistic. In fact, during my month at the San Fernando General Hospital, the unit I was on had a separate clinic dedicated just to breast complaints. Many of the cases of breast cancer that we saw were unfortunately rather advanced forms of the cancer, and required quite radical surgeries. It was a sobering experience.
By being aware of the things in our life that might put us at risk of breast cancer, we can try to avoid those things — like smoking; cigarette smoking increases your risk of contracting breast cancer and a whole host of other diseases; but that’s a lecture for another time, I suppose.
Since the risk of breast cancer increases with age, if females are socialized from young adulthood to check themselves for early signs of breast cancer, then — statistics have shown — in more than 90% of those cases, with early prognosis, the women can go on to have cancer-free lives. This is an amazing statistic, and is the rationale behind Breast Cancer Awareness Month; and we should all talk openly about it.
A monthly breast self-examination results in the detection of almost 40% of breast cancer; and the steps are very easy to learn, since they consist of varying methods of observing and checking for lumps or thickening of the tissue of the breast or underarm. Sometimes there are changes in the appearance of the breasts or nipple, and even discharge; all these should receive professional scrutiny. The examination can be undertaken during several activities – in the shower, in front of a mirror, or lying down. The goal is to detect any lumps that might have formed since the last examination.
Not all lumps are cancerous, and at a visit to the doctor, a clinical breast examination can be performed by a trained health worker. Obviously, this would increase the chances of early detection.
The most conclusive test is done by a mammogram. A mammogram is an x-ray that allows a qualified specialist to examine the breast tissue for any suspicious area. The breast is exposed to a small dose of iodizing radiation that produces an image of the breast tissue.
Mammograms can be performed at a clinic or hospital, and are the most extensive method of detecting breast cancer today. It is recommended that all women over 40, or those in a high-risk category, should have a mammogram every one or two years.
I, for one, am tired of seeing the devastating effects that cancer has on so many, many people. With breast cancer, we have a chance to make a difference, especially if we intervene early. So let’s fight back, and let’s educate ourselves about this disease. And we can start by examining our breasts for lumps and bumps the next time we step into the shower. And yes, even though more rarely, men can develop breast cancers also.
Detection of cancer doesn’t any longer have to be a kiss of death.

The Circle of life

By Anu Dev

“From the day we arrive on the planet And blinking, step into the sun There’s more to see than can ever be seen More to do than can ever be done.” -Tim Rice, Lion King

I’m currently halfway through my year 5 Obstetrics and Gynaecology rotation, which builds on what we’d done in year 4. I’d always had a greater interest in this area than several others that come to mind, and was looking forward to the repeat. I’m definitely more knowledgeable than I was back then. There’s less of me going, “A speculum? What?” But, of course, there are still those moments where I stare back blankly on rounds when a consultant asks me about something I’d never even heard of before. But, overall, I’m not in the constant state of befuddlement that I’d grown accustomed to last year.
This year, instead of just observing deliveries, we have to actually perform the deliveries under the guidance of a midwife. My first delivery definitely wasn’t as miraculous and profound as I was (naively) expecting. And it all seemed to happen so quickly! The baby’s head was crowning, the mom was pushing, the midwife was quickly telling me where to put my hands, how to grasp the baby, and suddenly there I was, holding this newborn baby in my (thankfully, gloved) hands.
I then quickly had to clamp and cut the umbilical cord, show the mom her baby, wipe the baby down, and attach the baby’s name tags around his ankle. It certainly wasn’t a Simba moment, and it was not because there was no Pride Rock for me to triumphantly present the newborn to the world!!
Even though I’d observed deliveries back in 4th year, I was still surprised by how involved the whole process was. In the back of my mind, I guess I sort of felt like I’d be standing by with a catcher’s mitt and the baby would drop into my waiting hands. So, as you can imagine, I was more than a bit thrown when, there I was, actively pulling this little human into the world.
And the process doesn’t end with the delivery of the baby — that’s only the second stage of labour. The next stage is the delivery of the placenta (the afterbirth). And as part of the “Active management of the third stage of labour”, I had to gently use controlled traction on the umbilical cord to deliver the placenta after I saw the signs that it had separated from the wall of the womb.
After examining the mom to make sure she didn’t have any injuries to the birth canal, and after tidying her up, it was time to inspect the placenta with the midwife. I don’t know, but after getting up close and personal with several placentas now, I really don’t understand the trend of women eating their placentas, claiming the nutrients are helpful. To each her own, I guess!
For my next couple of deliveries, as I grew more accustomed to the process, I could understand and appreciate everything a whole lot more. The sight of a mother holding her baby with so much tenderness and love after the excruciating pain she endured is a sight to behold.
These deliveries of babies have definitely been one of the high points of medical school so far. After my first couple of deliveries, I felt a little bit like running up to random people and telling them, “I just delivered a baby! My hands brought new life into the world!” Thankfully for everyone around, I was able to exercise some restraint. Maybe I’ll still have my Pride Rock moment!

Goddesses and violence against females

By Anu Dev

“There is no need to request You, Oh Durga,
To protect and save us.
For does the mother on whom children solely depend,
Ever need such a request?
And so our salutations to You;
So pray the Gods to You.”
Nau Raat began Wednesday. Nau Raat is the time Hindus specifically dedicate (twice annually) to worshipping God as “female”. As a Hindu young woman who has chosen to worship God as female — in my case specifically Mother Saraswati — I’ve sometimes wondered how some Hindu men, who also worship the Divine in her various female forms and incarnations, can inflict violence on females. But, of course, violence against women isn’t confined to Guyana, and certainly not only to Hindus.
It’s just that since we Hindus were enlightened enough to have elevated women to the ultimate Divinity, I was kind of hoping that our menfolk would’ve seen us in a bit kinder light than those men from other religions who insist that God is exclusively male.
In Hinduism, by contrast, while God is ultimately beyond categories — including sex or gender — the conceived female aspects are actually endowed with the Shakti, or animating power. In other words, the male manifestations are posited as completely inert (Prakriti) without the female. They can’t do a thing! So we have, for instance, the Creator, Vishnu, with his female counterpart, Lakshmi. She’s the power behind whatever “creation” — or “projection”, as we Hindus prefer — that’s going on. One-third of Hindus are “Shaktas” – those whose major object of worship is the Mother in her various manifestations. In Guyana, most Shaktas originated in South India, and are lumped together as “Madrassis”, since they left India from the port of Madras.
While Vishnu has incarnated first as fish, tortoise, boar and half-man/half lion, in all his human incarnations — whether as Ram or Krishna — Vishnu is accompanied by his Shakti. As Ram, for instance, his double is Sita. Bringing matters to the human level then, supposedly to provide a model for us to imitate, when one marries, the women is said to be “the Lakshmi of the house”. In offering prayers to the Divine, the male householder is incomplete, and the offerings aren’t accepted if he’s not accompanied by his “Lakshmi”.
So what goes with all this wife beating and violence against females in our society? Why hasn’t our elevation of women among Hindus as Goddesses increased respect for women? Well, for one, in the “modern” world, we have all accepted that “religion” is just one aspect of “life”. Religion, as “Dharma”, a seamless, integral way of life as posited by Hinduism, is “old fashioned” and “backward. Traditional Hinduism, we are convinced, can’t be “modern”. So our menfolk worship the Mother of the temple in the temple, and then knock around the Mother of the house in the house.
The view that the man is the owner of all he surveys — in reflection of the man with the grey beard, who’s floating in the sky above, looking down at us — undergirds what is called “patriarchy”. In modern Hindu homes, unlike the original model of society in which the female was the boss in her own domain, boys and men are still socialized to see females as “their own”. And in a capitalist society, this becomes translated as their “property”. And more to the point, “sexual property”, which he “jealously” guards.
If we’re ever going to get rid of this mind-numbing violence that’s inflicted daily on females, this structural power imbalance between males and females — which starts in the home, ironically by mothers — must be eliminated.
What was it they said about “the hands that rock the cradle”? It can help to make “ruling the world” a bit more fair. All hail the Devi!

Values for life

By Anu Dev

“Education without values, as useful as it is, seems rather to make man a more clever devil.”–C. S. Lewis

I’ve been in school for 17 of the 21 years of my life, and would like to believe I have a fair idea of what different types of teachers could be like. Some go about their jobs like they truly love what they’re doing, others seem to go through the day like teaching is an obligation; and then there are those who clearly see it as an imposition.
But no matter what their personal teaching attitudes or stances are, we inevitably learn a lot from our teachers, even in the breach. Teachers teach more than just Science and Math and all the other “subjects” on the curriculum; they teach ethics as well. In addition to, say, the weekly one hour of “Pastoral Care”, they do this generally through the most powerful medium – not through words, but by their actions. Their behaviour impacts their students strongly. And, of course, since it’s always best to lead by example, we’re most likely to do as our teachers do, rather than as they say.
So, if the Education Ministry says it wants to produce “more rounded students”, then it would have to start producing more rounded teachers. Quite a bit of my personal values and sense of ethics, as to what might be the way to act in the public sphere, are a product of the influence of my school teachers. Of course, the major chunk of core values were directly instilled into me by my parents, who still remain my most influential “teachers” in the real meaning of the term. But at some level, we’ve all been influenced by our teachers in the formal public educational institutions.
My current value system, therefore, is a melange of what I’ve been taught at home and whatever modifications my experiences have forced me to make — with me spending such huge chunks of my time every day in school.
And I’ve realised how damaging it could’ve been if I had teachers whose values and ethical standards were not that solid – especially in the early formative years. What if I had teachers who threw things and screamed at their students, calling them names or belittling them? If a student doesn’t have a strong personal value system or positive role models, that student could easily accept that sort of behaviour as being okay, or acceptable. And that student might carry over that type of behaviour into adulthood, in their professional and personal life. The horror! The horror!
Our teachers, as a consequence, have great power in forming the “Guyanese nation” we all aspire to, as articulated in our national motto. More emphasis should probably be placed, when training teachers, on their role in moulding the values of their students. Implicit values like work ethics are undermined when young students see their teachers “hold back” materials which are taught only in their “lessons”.
Explicit values like the importance of confidentiality and the importance of privacy could be emphasized by the teachers, so that when the students leave the school system, they’ll be able to function like adults that are capable of respecting the autonomy of persons they interact with.
Other values, like the importance of accountability and punctuality, should all be established as being important from a young age. Teachers that violate these tenets in their classes do damage beyond the details of the “subject” not being covered.
Our teachers, then, hold great sway over how we might turn out at the end of our tenure at school; they could be the difference between whether we become successful professionals or whether we go about our jobs in a very slipshod manner. We need a solid foundation in professionalism, and our teachers can give us that, hopefully by their actions, and not just their words.


By Anu Dev

‘Being a professional is doing the things you love to do, on the days you don’t feel like doing them.”
– “Dr J” – (Julius Erving – basketball legend)

Now that I’m approaching the end of the road in Med School, and am soon to enter the “real world”, I’ve decided to revisit a piece on being a “professional,” which I wrote some time ago, when I was still a callow youth! We’ve all had those experiences: going to the doctor’s office, shopping in some store, or visiting a travel agency, where we probably went through the worst ordeal of our lives because of the way we were treated.
It’s really the pits to go somewhere on a chore and you end up being treated like some lesser being. Call me melodramatic, but after some jarring encounters with sales clerks, I started paraphrasing Shylock’s speech from Merchant of Venice to myself: “Hath not an Anu eyes? Hath not Anu fed with the same food, hurt with the same weapons, subject to the same diseases?” As I rise up in righteous indignation, vowing never to return to that store (at least not until next week!).
It can really leave a bad taste in your mouth, and makes you wonder if that offensive person had an overabundance of bile – or, more likely, absolutely no training. But the thing I don’t understand is it’s not like they’re doing you a favour; you’re paying them for the service. If it’s a doctor, it’s not like he/she is diagnosing you for free. You’ve already had to wait an hour in the waiting room, inhaling everybody else’s germs, and now the doctor is treating you like you’re an errant 3-year-old? What? That’s not being a professional, and I hope I don’t succumb to that hauteur!
And professionalism goes beyond treating your patrons like they’re actual human beings. It includes things like punctuality, accountability, and being able to carry out your tasks efficiently. We really need to break the mould of things always starting ½ hour late in Guyana (and the rest of the Third World). Sure, it’s a running joke that always manages to get a few laughs, but, in reality, it’s a sad reflection of how we’ve accepted our tardiness, and aren’t prepared to do anything to change.
In whatever profession we choose, we must always also have accountability. And not just being able to account for finances – we should be able to account for our actions. We’re not living in our own personal vacuums. Our actions and decisions affect the people around us, sometimes more than we could ever imagine. Nothing has disproved Aristotle’s dictum that we’re social beings. (Incorrectly interpreted nowadays as “political beings”)
But it can be difficult; sometimes you’re just having an “off day”. Some days you can’t be all bright-eyed and bushy-tailed. But in some professions, that’s exactly what’s expected of you as a professional.
To be a true professional, you have to be professional in the way you dress, the way you carry yourself, the way you relate to the people around you. It could’ve been that little girl in the Bank who came in with her mom might’ve gotten inspired by the way you carried yourself, and now she wants to work in a Bank when she grows up, to be just like you.
As professionals, you’re representing your profession. You’re the ones who either inspire us to want to do what you do, or who make us swear never to touch, for instance, “the law” with a ten-foot pole.
And in some professions, you only ever meet some of your patrons for once in your life. Do you really want to be remembered as the impolite, scruffy sales clerk? Or, like Dr J, who can still soar and dunk the ball in his sixties?