Health

Chronicles of a Choked City

As Delhi suffocates under hazardous air, The Wire talks to people from different parts of the city battling the public health emergency and a disastrous climate crisis.

New Delhi: Fifty-five-year-old Laxman Singh wakes up at 5 am in the morning to get ready for the day. For the rest of it, he rides through the nooks and crannies of Delhi in his auto-rickshaw. He returns home for a short nap in the evening and gets back on the road at 8 pm for a few more trips until he finally returns home for the day at 11. Singh spends roughly 16 hours outside in his auto-rickshaw.

He, along with his family of four, lives in a small room with no ventilation in the Chhuriya Mohalla of Tughlakabad village.

“We can barely afford this room now. But situations were different when we had our own house, until last year, when it was demolished by the ASI authorities. They [governments, authorities, police] listen to the orders of the Supreme Court when they have to demolish thousands of homes but simply ignore the rules imposed by the Supreme Court when it comes to burning firecrackers. Rich people drive their cars, burn firecrackers and blame farmers of Punjab and Haryana for Delhi’s pollution. And us, who have nowhere to go but the streets to earn our daily bread, are left in this dense, polluted air. Neither the central government nor the Delhi government has done anything for us. They don’t even care to distribute masks to the children!” said Laxman, when asked about whether he has received any help or amenities from the authorities to battle the pollution.

Laxman Singh. Tughlakabad village, New Delhi.

“I sometimes think that at least I have a windscreen in my auto… think about the rickshaw pullers, they are exposed to this poisonous air throughout the day without any protection, leading to a slow death. I try to read as much as I can to know better about our surroundings and end up getting more disappointed every day. One day, I’ll start an NGO or something that takes care of the problems of people like us – poor people,” he adds.

Sabeena Ansari (36) lives in a parking lot of an apartment building in Batla House with her husband and two daughters. Her husband, Mahmood Ansari (38), works as a security guard there. Sabeena is a part-time domestic worker who works in the nearby, posh residential areas like New Friends Colony and Sukhdev Vihar.

From 7 am to 6 pm, she covers nearly 8 houses, spending a large chunk of time outside, walking from one house to another. Often, she gets caught up in traffic while returning home in an e-rikshaw.

Sabeena Ansari. New Friends Colony, New Delhi

“There are a lot of high-class houses that don’t allow us [domestic workers] to use the lift so we have to take the stairs. After walking amidst this polluted air, I feel parched and tired. How can one climb five stories in this condition? But we don’t have any other option. If I refuse to do so, they’ll just fire me from my job,” said Sabeena.

When talking about Delhi’s rising pollution and the difficulties people facing everywhere in the city, she says, “I can’t really afford to think about pollution anymore. There’s a lot of dust and smoke everywhere. My younger one suffers from a severe cough, cold, and shortness of breath every winter. But what can we do about it? That’s how Delhi is. Two of my daughters are studying in school, and for them, I have to work to earn. Can’t do that without going outside. I don’t want my children to end up like us.”

“The last time I breathed in fresh air was ages ago, in our village near Kishanganj, Bihar. Yahan to ye logon ko rasta banana nahi aata hai thik se, to hawa se zeher kahan se nikal payega? (Authorities can’t even make proper roads here, how will they take the poison out of the air?)” Sabeena added.

According to several reports, there has been a spike in the number of patients from Delhi NCR suffering from shortness of breath, lung failure, cough, and other respiratory problems since Diwali, when the air quality started worsening. Children and the elderly remain the most affected. Twelve-year-old Saurav is suffering from COPD (chronic obstructive pulmonary disease) and a severe lung infection. His condition worsened after Diwali, and this year, it is taking longer to recover. This was his third visit to Safdarjung Hospital in two weeks.

Saurav, Safdarjung Hospital, New Delhi.

“He suffers from lung issues throughout the year, and every year at this time, it gets worse. One doctor once suggested that I leave Delhi during the winters. But how can we go? I barely earn enough to sustain both of us. Traveling is a far-fetched dream,” said Saurav’s mother, Sumitra Mondal (33). Sumitra works with a construction company as a daily-wage labourer. She has been out of work since all major construction activities were shut down by the Delhi government due to severe air pollution.

Maya Chetri (54), a resident of Darjeeling, is on her first visit to Delhi. “I always wanted to see our capital and its monuments but never had a chance. I knew that the summers are unbearable in Delhi, so I, along with a few other friends, planned this trip now- only to see people gasping for breath. I never realized the amount of trouble this smog could give. In the hills, we see a lot of fog. Although this smog looks very similar to fog, it feels completely different. Ever since we reached Delhi, all of us have had sore throats and breathing problems. Can’t even see the Lal Quila properly.” said Maya.

Maya Chetri. Red Fort, New Delhi

Ayesha (21), a student of Delhi University (DU), stays in a shared, one-room flat in GTB Nagar, near DU North Campus. “It’s not all our fault, you see! Delhi’s climate crisis is a failure of the entire crony capitalist system. Now, both the state and Union governments are playing a blame game. We are not supposed to bear this as citizens. I feel angry, numb, and helpless. I wonder when the capital becomes completely unliveable, what will the rich and powerful do? Some of them will definitely fly abroad, leaving the rest of us here to choke to death?” asks Ayesha and quotes a Native American saying from her phone, “When the last tree has been cut down, the last fish eaten, and the last stream poisoned, you will realise that you cannot eat money”.

Ayesha. GTB Nagar, New Delhi.

All illustrations are by Pariplab Chakraborty.

Does Air Pollution Cause Deaths? Government Says ‘Yes’, Government Says ‘No’

The Union government has constantly said in parliament that there is no conclusive evidence to link air pollution and deaths. However, the latest letter written by Union health secretary to states alludes to an ICMR study that said 17 lakh people died due to air pollution in 2019.

New Delhi: On November 18, the Union health ministry released a letter to reporters. It was written by the health secretary to the chief secretaries of all states and union territories in the country on the same day. The letter asked them to take a series of steps to tackle health issues arising out of rising air pollution levels in Delhi and across India.

On the same day, the Supreme Court came down heavily on the Central Air Quality Management Commission, that consists of officials of Union and state governments, for not doing enough. It also rebuked the Delhi government.

In the letter mentioned above, Union health secretary Punya Salila Srivastava reminded chief secretaries that Atul Goel, director general of health services, who works with the Union health ministry, had written to states on October 19, alerting them about various measures to be taken in the months before the onset of winter – considered to be peak pollution months.

Srivastava’s letter also has the ‘National Programme on Climate Change and Human Health’ (NPCCHH) document enclosed as part of the advisory.

The NPCCHH highlighted a ‘recent’ Indian Council of Medical Research (ICMR) study that has brought out a startling fact – that 17 lakh deaths were ‘attributable’ to ‘air pollution in 2019. This number is significant – a little more than the entire population of Goa. The secretary’s advisory sought to impress upon the state administrators that this was a large number of deaths ‘attributable’ to air pollution every year.

The ICMR and the Public Health Foundation of India (PHFI) conducted the highlighted study in 2019, and its results were released in 2021.

However, the secretary’s letter violates the stand that the Union government has maintained in the parliament and in public statements over the years, wherein it has stated that there is no study which can establish some sort of cause-and-effect relationship between air pollution and deaths.

Although the government has referred to this ICMR study in internal policy documents over the years, it has never mentioned it in public communication.

Sample this answer given by the 2023 Minister of State for Health in parliament on April 6 that year – two years after the ICMR study was published.

“There are several studies conducted by different organisations, using different methodologies, on the impact of air pollution. However, there is no conclusive data available to establish a direct correlation of death/disease/life expectancy exclusively with air pollution. Air pollution is one of the many factors affecting respiratory ailments and associated diseases,” the ministry said.

Many similar replies can be traced to 2023 and the preceding years.

And yet, November 18, 2024, is not the first time that a policy document connected air pollution to deaths.

In fact, the 2022 version of the ‘National Programme on Climate Change and Human Health’, says exactly what the 2024 version says. That, too, went on to detail that chronic obstructive pulmonary disease (COPD), followed by heart disease, stroke and lung cancer attributable to air pollution had led to 17 lakh deaths in 2019.

There was another such ICMR report – a 220-page-long ‘India: Health of the Nation’s States: The India State-Level Disease Burden Initiative’ published with the PHFI in 2017 – which met the same fate.

It said, “Air pollution was the second leading risk factor in India as a whole.”

“Outdoor air pollution caused 6.4% of India’s total Disability Adjusted Life Years (DALYs) in 2016, while household air pollution caused 4.8%. Combined, they make a substantial contribution to India’s burden of cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.”

DALYs are the years lost to hindrance caused by a particular disease. One DALY represents one year.

This report contained congratulatory messages from the then vice-president of India, Venkaiah Naidu, and the then and current health minister of India, J.P. Nadda, for those who prepared the report.

Screengrab from a video of Union health minister J.P. Nadda bursting crackers on Diwali day, October 31, 2024. Photo: JP Nadda’s Facebook page

But the Union health ministry discredited this report in a parliamentary reply on March 23, 2020, saying it was based merely on estimates, without either going into the nuances of the message or its methodology:

“The study report provides the distribution of diseases and risk factors across all states of the country from 1990 to 2016. The five leading risk factors for Disability-Adjusted Life Years (DALYs) in 2016 includes child and maternal malnutrition, air pollution, dietary risks, high systolic blood pressure, and high fasting plasma glucose.

“However, the report is based on estimates as there are no conclusive data available in the country to quantify the extent of mortality/ morbidity, exclusively due to air pollution.”

Nonetheless, the governments before the current National Democratic Alliance government have also shied away from accepting the connection between air pollution and deaths.

In 2007, health minister Anbumani Ramadoss, told the parliament on November 30 that a WHO report claiming that 4.07 lakh premature deaths in India could be linked to air pollution was not sound enough.

He added, “According to a report of Indira Gandhi Institute for Development Research, it is estimated that 4.1 lakh to 5.7 lakh women and young children die prematurely every year due to indoor air pollution caused by burning of biofuels in poorly ventilated homes. However, no conclusive data is available to establish the correlation between mortality and indoor air pollution.”

“No conclusive data” has been the refrain of all governments over at least past two decades.

Lonely battle

Meanwhile, the medical fraternity seems to be fighting a lonely battle alongside the patients. This reporter reached out to a chest physician of a prominent government hospital that caters to thousands of patients everyday on November 18.

When asked as to whether we can link air pollution to death, he replied, exasperated, that everything has been said for the past 10 years has hidden the obvious truth. “The situation is going from bad to worse. Now is the time to ask questions from administrators rather than doctors,” he said.

Dr Arvind Kumar, a prominent chest surgeon and founder of the Lung Care Foundation, has presented a whole range of studies in various meetings organised by the government over the past several years. “I feel saddened and helpless with the response of different policymakers [claiming absence of data], even though they know everything’s there. They act as if they don’t know,” he told The Wire.

Meanwhile, the footfall of patients at healthcare facilities would have gone up as the Air Quality Index clocked at 494 (severe category) on November 18 according to the Central Pollution Control Board bulletin. Many patients who were previously healthy would now need treatment, say doctors.

Also read: Delhi Chokes On A “Severe” AQI of 494; More Restrictions in Place to Curb Pollution

It is not possible for any clinic or hospital to quantify the surge at out-patient respiratory departments accurately because such record-keeping is not done. There are hardly any dedicated air pollution clinics in the city.

“Moreover, the full effect would only be felt in the next two to three days,” Dr Sreedev Narayanan, a resident doctor at the respiratory medicine department of a city-based private hospital said on November 18.

However, recounting his experience of the last five years, Narayanan said that the number of patients who get admitted or even who land in emergency departments go up as the air quality worsens. These are people with pre-existing respiratory problems like asthma or tuberculosis.

“The pollutants can cause bronchus to collapse almost completely in patients who have pre-existing respiratory problems,” Narayanan said.

The load in the in-patient departments where admission takes place doubles or triples during this two or three-week duration every year. This is especially true, again, for patients with pre-existing illnesses. “Their threshold of tolerance is very low,” said Dr Anmol Jindal, a resident doctor associated with the department of internal medicine of a city-based private hospital.

Jindal explains that exposure to pollution may lead to swelling in lungs of patients who are already unhealthy. This may make it difficult for them to exhale carbon dioxide, causing death.

“We have to resort to steroids [for patients], who had been otherwise responding well to prescribed medicines before onset of ‘pollution months’. They would not have needed steroids had the pollutants not aggravated their illness, ” he said.

Besides these bits of empirical evidence, there exists year-wise and cause-wise data that the WHO has maintained for all countries, including India, on air pollution and deaths. According to it, 8.9 lakh deaths took place in India in 2019 alone due to diseases linked with air pollution. This is quite conservative a number as compared with 17 lakh deaths that the ICMR-PHFI study estimated for 2019.

The WHO figures were based on the secondary data sources while the researchers for the ICMR-PHFI study collected first-hand information. They adopted a robust methodology by using aerosol optical depth data from multiple satellite sources combined with a chemical transport model. This data was calibrated with data from ground-level monitoring station locations in India

From 2010-2018, 3-8 lakh deaths took place each year because of this annual killer, according to the WHO. The year-wise data sets can be found below:

In nutshell, air pollution paves the way for all these five major life-threatening diseases, invisibly causing a slow death. However, the government has been rejecting this data as inconclusive.

Besides causing these big five diseases mentioned in the WHO database, air pollution has been linked with skin problems, ophthalmological issues, mental health disorders, dementia, stillbirths, anaemia, decreased fertility rates, and host of other illnesses affecting the nearly whole body.

Children, meanwhile, are the worst sufferers. A foetus gets exposed to air pollution through its mother. Kumar, quoted above, says, that given the situation in Delhi now, within the first hour of birth, a child is born with lungs that are the equivalent of them having smoked a few cigarettes.

Exposure to pollution can lead to brain inflammation of mild levels in children. This can make them hyperactive. They may cause an attention deficit. Their lung development may be hit at a tender age. Their IQ development is impacted. The arteries and pancreas get affected too – Kumar goes on.

“Some of these can really have long term impacts, even beyond teenage. Nowadays I am not surprised to see black spots in the lungs of teenagers who are non-smokers,” he adds.

Meanwhile, the ban on crackers continues to be flouted in many parts of Delhi, even now. Dr Parth Sharma, a community health physician and a public health researcher, says ongoing studies in Delhi have shown a higher degree of presence of heavy metals in the blood of people, two days post-Diwali as compared to the pre-Diwali days.

Heavy metals like copper, arsenic, zinc, cadmium and selenium are found in crackers. Exposure to these heavy metals, over years, can cause endocrine (hormone) disorders and cancer.

Both Kumar and Sharma highlight that not only do morbidity and mortality increase due to air pollution, but so does the financial burden.

“The average cost of one asthma pump is Rs 300-400. In government hospitals, it is mostly out of stock – how are poor people going to afford it?” Sharma wonders. Kumar says he has seen exponential increase in sales of nebulisers for children, along with cough syrups and inhalers.

The sale of air-purifiers also shoots north. But the doctors caution that they may not work as well as imagined by people. Every air purifier has a handling capacity, and it has to be installed according to the volume of the room. A small purifier in a big room is of no advantage – besides being the least affordable alternative.

Insofar as masks are concerned, cloth or surgical or any other types of masks do not work outdoors to filter PM 2.5 (particulate matter Smaller than 2.5 microns; one micron being one millionth of a metre). The government advisory, as doctors also say, notes that only N95 or N99 masks can work. These are currently being sold at several times their original cost.

Neither the Union nor the Delhi state government have taken any steps to provide these masks at subsidised prices or to try to curb the abnormal price rise. No government has shown any urgency in creating awareness about masks either. These are small but effective initiatives. Yet they have, so far, not figured in plans of any government to mitigate the effects of pollution on health.

10 Newborns Die in Blaze at Overcrowded Uttar Pradesh Govt-Run Hospital

Dozens of children were rescued as seven fire tenders got to work, reports say.

New Delhi: A fire at a Uttar Pradesh government-run hospital’s neonatal intensive care unit led to the deaths of ten newborn babies on the night of November 15.

The incident took place at the Maharani Laxmi Bai Medical College in Jhansi.

Dozens of children were rescued as seven fire tenders got to work, say reports. The fire led to a rush and a stampede-like situation.

Indian Express has reported that the neonatal intensive care unit (NICU) has two sections – the outer unit for babies who were in a stable condition and the inner unit for those in a critical condition. The fire is suspected to have originated in the inner unit and was possibly caused by a short circuit.

At the time of the incident, the NICU was overcrowded, housing 49 infants despite having a capacity for just 18, reported the Indian Express. The fire reportedly broke out around 10:20 PM, forcing staff to break window panes to rescue the babies.

Deputy chief minister Brajesh Pathak announced a thorough investigation, assuring strict action against those found responsible.. The incident is being probed at multiple levels by the health department, police, district administration and through a magisterial inquiry.

India Today has reported that expired fire extinguishers were found at the NICU, and the safety alarms did not go off, delaying evacuation.

The NICU has been sealed and police personnel have been deployed outside. Established in 1968, Maharani Laxmi Bai Medical College is Bundelkhand’s largest hospital.

The Prime Minister’s Office has announced an ex-gratia of Rs 2 lakh from the PMNRF for the next of kin of each deceased child. The injured will be given Rs. 50,000.

This copy was updated at 12:57 hours on November 17 to reflect new developments.

Gujarat Patients’ Death Over Unnecessary Surgeries: Why Ayushman Bharat Is to Blame

A newspaper has reported that an inquiry has found that the percentages of blockage in arteries shown in the medical reports of the hospital were higher than what the footage of the procedures revealed.

New Delhi: In what appears to be the latest in a series of incidents in which patients are taken in for unnecessary surgeries so that healthcare providers can pocket health insurance money, two Ahmedabad patients died this week due to botched angioplasty at a Gujarat hospital. Investigations have revealed that the surgeries had been planned when the blockage in their arteries was insufficient and did not warrant insertion of stents.

According to The Indian Express, the Gujarat police has lodged a first information report against two doctors of the hospital and its CEO, along with two others associated with it.

Khyati Multispeciality Hospital, where these surgeries were performed, will now be de-empaneled from the Pradhan Mantri Jan Arogya Yojana’s Ayushman Bharat Scheme. Under this scheme, the money for surgery is paid by a private health insurance company. The premium for health insurance is paid by the Union and state governments. Both patients had been beneficiaries of the Ayushman Bharat scheme.

The newspaper has reported that an inquiry has found that the percentages of blockage in arteries shown in the medical reports of the hospital were higher than what the footage of the procedures revealed.

For example, one of the deceased patients, was reported by the hospital as having had a 90% blockage while the footage revealed it was only 30-40%. Another artery had no blockage at all, as against the hospital report’s claims of 80% blockage.

In case of the other patient, the FIR states percentage of blockage differed in the different portions of left anterior descending artery (LAD). The LAD is the largest artery.

The hospital claimed that there was 90% blockage in the LAD, while the footage revealed it was 50-80% in two different segments. The right coronary artery had no blockage but the hospital report claimed it had 90% blockage.

An angioplasty (a procedure involving insertion of stents) is preceded by angiography (investigation performed to know how much blockage has happened). On request of patients, a hospital can provide a compact disc of the angiography as well. This footage is usually referred to in post-operative enquiry for medical or other purposes.

Also read: Treatment for the Dead, Discharge Before Surgery and the Many Problems of Ayushman Bharat

Apart from these two patients, five others belonging to the same village, according to the police, had undergone angioplasty. They have been shifted to another hospital of the city for post-op care. All of them had been identified by the hospital during a health check-up camp organised in their village.

The Gujarat police has recommended that the Gujarat State Medical Council suspend the licence of the doctors. It is only after the medical council’s action that the doctors concerned could be barred from treating patients.

A similar scam took place in Bihar in 2012 when 703 women lost their uterii to unnecessary surgeries done by hospitals which had been empanelled under the then Rashtriya Swasthya Bima Yojana, another health insurance scheme for which the premium was paid by the Union and state governments.

The FIRs were lodged by district magistrates of the concerned districts. However, even four years after the registration of FIRs, the Bihar State Medical Council has failed to take action even against one accused doctor.

Less Than a Third of People Suffering from Diabetes Get Treatment in India, World’s Diabetes Capital

As per a Lancet study, only 27.8% and 29.3% of the entire cohort of women and men suffering from the disease in India have any treatment coverage.

New Delhi: The diabetes rates among men and women in India has gone up by 10-12 percentage points in 2022 as compared to its prevalence in 1980, a new study by Lancet released on November 13 says.

Currently, 21.4% of men and 23.7% of women of India suffer from diabetes. India has historically been the diabetes capital of the world. The latest study pegs the total number of diabetes cases in India at 212 million. This accounts for 26% of total diabetes cases in the world – the highest proportion contributed by any country.

But what is more worrying is that a majority of diabetes patients are not receiving any treatment in India.

As per this study, only 27.8% of the entire cohort of women suffering from the disease have any treatment coverage. Similarly, only 29.3% of men receive treatment.

Treatment coverage has only minimally improved in the last 44 years, despite India now having a dedicated treatment and prevention plan for diabetes incidence. The treatment coverage for women and men in 1980 were 21.6% and 25.3% respectively.

India contributes to 30% of the world’s untreated diabetes cases – the highest, again. This amounts to 133 million people.

China has 78 million untreated cases – the second highest. The difference between the country contributing the highest and the second highest number of such cases is more than 50%.

Pakistan and Indonesia have 24 million and 18 million diabetes cases that are not under any sort of treatment coverage.

“We also found that the current variations in treatment were largely related to the extent of diabetes under diagnosis, which means that improving case detection is a prerequisite to increasing treatment coverage,” the study’s authors say.

The Lancet assessment also points out that countries in South Asia are not doing enough to prevent the early onset of diabetes. It said:

“In countries with universal health insurance and good access to primary care, people at a high risk of diabetes might also be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset. This approach is less widely used in low-resourced health systems with limited attention to, or resources for, diabetes screening.”

Genetic and phenotypic (environmental factors) differences also contribute to a country’s having a higher diabetes population than other countries. But this becomes all the more relevant in countries in South Asia, where these factors are also accompanied by weight gain due to childhood nutrition choices and foetal development.

India accounts for the second-highest proportion of obese children in the world after China, a paper published in 2022 had noted.

The report also pitches for increasing the financial accessibility of people towards buying healthy food like fruits and vegetables. This is important for countries like India, because the last ‘State of Food Security and Nutrition in the World’ report said that as many as half of Indians (55%) are not able to afford a healthy diet.

“Improving affordability and accessibility of healthy foods and sports is particularly important for poorer families and marginalised communities, and requires measures such as targeted cash transfers, subsidies or vouchers for healthy foods,” the authors say.

The report advocates that countries must levy a higher rate of taxes on foods containing refined carbohydrates that lead to weight gain.

“In addition to obesity, the consumption of specific foods might influence the risk of diabetes. For example, yoghourt and possibly some other forms of dairy, whole grains, and green leafy vegetables reduce the risk of diabetes, whereas refined carbohydrates, including in sugar-sweetened beverages, increase this risk,” the study notes.

Why UP’s Dengue Cases Have Been Rising

India’s most populous state Uttar Pradesh is grappling with higher dengue cases as changing climate creates ideal conditions for mosquito breeding.

Lucknow: Transmission windows of dengue, a mosquito-borne viral illness, have been expanding due to changing climate, and the number of cases has been increasing, an IndiaSpend analysis of prevalence data in Uttar Pradesh, particularly its capital Lucknow, has shown.

Between October 31 and November 1, Lucknow reported 91 new cases of dengue, as per the data accessed from the chief medical officer. In the week to November 1, more than 400 cases were confirmed. There hasn’t been a single day in October this year without the detection of new cases. Overall, more than 2,100 dengue cases have been reported in the city so far this year.

Across India, cases have risen from 157,315 in 2019, before the Covid-19 pandemic, up to 289,235 last year. The disease, transmitted by the Aedes aegypti mosquito, causes a wide range of symptoms, from mild fever to severe, life-threatening illness.

There is no known cure for dengue, and cases can be treated at home with regular oral hydration and fever management, as IndiaSpend reported in September 2022. However there is danger of bleeding, in which case the patient would need to be hospitalised and need blood transfusions, a 2017 study found. During an outbreak this causes shortage of blood platelets, says the study.

Risk of dengue increases with increasing temperatures and increasing rain in India, found a study published in 2019.

Innocuous infections can quickly turn deadly

Girish Chandra Dubey, a 56-year-old resident of Aliganj in Lucknow, had a fever that persisted for several days. Soon after, he began experiencing severe pain in his limbs. His family rushed him to King George Medical University (KGMU), where tests confirmed he had contracted dengue. His platelet count had dropped to 20,000. After two days of treatment at KGMU, the hospital was unable to provide the necessary platelets, and Dubey was transferred to a private facility.

In a healthy individual, the normal platelet count ranges from 150,000 to 400,000 per microlitre of blood. However, when platelet levels fall below 20,000, the risk of developing dengue shock syndrome (DSS) becomes imminent, N.B. Singh, chief medical superintendent at Balrampur Hospital explained.

“Platelets are necessary for blood clotting. A deficiency can put the patient’s life at risk,” said Tulika Chandra, head of blood and transfusion medicine at KGMU.

DSS is a severe complication that occurs in the later stages of the disease. Symptoms include persistent fever, body aches, and the development of rashes and red spots on the skin. As the condition worsens, the patient may experience a slowing pulse and their lips may begin to turn blue–a sign of circulatory collapse. In some cases, internal bleeding can occur, and if left untreated, dengue can be fatal.

On October 19, an 84-year-old woman died of dengue at Balrampur Hospital, the only such fatality this year in Lucknow, according to data from the CMO’s office. Singh noted that “her immunity was already very weak”, which made her more susceptible to the complications of dengue.

Cases have shown an uptick, as we said. In September 2024, there were 388 confirmed dengue cases in Lucknow. By October, this number rose to over 2,100.

In the pandemic year of 2021, the city had reported 1,104 cases up until November 4, with 95% recorded between September and November. In 2022, Lucknow recorded 1,677 dengue cases and in 2023, there were 2,700 dengue cases in the city.

How the vector has adapted

Singh and other medical professionals agree that the Aedes aegypti mosquito thrives in areas with stagnant water. Changing weather, with heavy rainfall followed by heat, creates the perfect breeding ground for these mosquitoes.

Warmer temperatures accelerate mosquito breeding, enabling the mosquitoes to bite more frequently, further increasing the chances of spreading the virus, research shows. High humidity, which supports the survival of mosquitoes, and the accumulation of floodwater from heavy rainfall also contribute to the growth of mosquito populations, creating additional breeding sites. As a result, areas that were once considered low-risk are now seeing outbreaks of the disease.

Experts also point out that the change in human habitations has helped mosquito populations spread faster, as IndiaSpend reported in September 2022. India’s population density in 1961 was 155 people per sq km, which in 2021 increased to 469 people. The Aedes Aegypti mosquito breeds in natural containers such as tree holes and bromeliads, but nowadays it has adapted to urban habitats and breeds mostly in man-made containers, including buckets, mud pots, discarded containers, used tyres, storm water drains etc., making dengue an “insidious disease in densely populated urban centres”, according to this World Health Organization article.

Dengue symptoms typically begin with fever, severe headaches, joint and muscle pain, nausea, vomiting, pain behind the eyes, and skin rashes. In the most severe cases, the virus causes internal bleeding and can lead to death if not treated promptly. While the majority of people experience only mild symptoms, the potential for severe complications makes dengue a serious public health threat.

“There are a lot of overlaps of symptoms between malaria and dengue, and other tropical diseases, and viral fever. In the early phases even swine flu and leptospirosis [have similar symptoms],” which could lead to incorrect diagnosis or reporting of malaria and dengue cases, said Bharat Agarwal, internal medicine specialist at Apollo Hospital in Navi Mumbai, had told us in September 2022.

Sanjay Kumar, the district medical chief of Bahraich, told IndiaSpend that the rise in dengue cases is indeed related to the shifting weather patterns. “This time the winter is late and the warm temperature combined with water logging has become a perfect ground for the breeding of mosquitoes. The preventive measures by the government have been scaled up but it needs more attention,” he said.

India’s malaria and dengue data are collected mainly by the Health Management Information System and the Vital Registration System and Medical Certiﬁcation of Cause of Death. But not all malaria and dengue cases are diagnosed, leading to undercounting, as IndiaSpend reported in September 2022. And India doesn’t register about 3 million deaths and does not certify the cause of death of about 8 million people, IndiaSpend reported in August 2021. No certification could mean that some dengue deaths are also not certified, and thus undercounted.

Rising platelet consumption

At Balrampur Hospital, 36 beds are specifically allocated for dengue patients. Till November 1, 2024, a total of 28 patients were receiving treatment for the viral infection. Ajay Tripathi from Lokbandhu Hospital shared similar figures: Of the 20 beds available, 13 were occupied by dengue patients.

Of the 150 fever cases presented at both hospitals daily, around 15-20 are diagnosed with dengue. With platelet counts in many patients plummeting rapidly, recovery times are lengthening, sometimes taking more than a week for patients to stabilise.

Major hospitals said they are maintaining adequate stock of platelets. However, a growing strain on the city’s blood banks is evident. Private and government hospitals have reported that their platelet consumption, which was about 200 units per day just three weeks ago, has now surged to over 400 units daily.

Despite these challenges, Manoj Agarwal, the CMO of Lucknow, said there is no shortage of beds or platelets in hospitals. “The increase in cases this month is less than last year. We have enough resources to handle the current situation,” he said, calling for hygiene and usage of mosquito nets as preventive measures.

Agarwal points out that the city’s increased efforts in testing and raising awareness have helped in detecting more cases early. “The number of cases in October increased by about 5% compared to last year, but the total number recorded this year remains significantly lower,” he explained. He attributed this to heightened surveillance and 135 testing centres across the city–up from 83 last year.

“The higher number of cases this month is primarily due to increased testing,” Agarwal added. “Overall, we are managing the situation better than in previous years.”

Rajesh Srivastava, CMO at Dr Shyama Prasad Mukherjee Civil Hospital in Lucknow, told IndiaSpend that the condition of dengue patients in the district is improving by the day. Special precautions are being taken for dengue patients at the Civil Hospital, such as the provision of mosquito nets and special attention to cleanliness.

However, the in-charge of a community health centre in rural Lucknow, on condition of anonymity, stated that if proper testing is done, the number of cases could rise even further. “When the report comes back positive at our centre, the patient either doesn’t come to the hospital for treatment at all or goes to a private hospital,” they said. “In such cases, they are not even counted. Patients go home and start treating themselves.”

IndiaSpend reached out to the principal secretary for health in Uttar Pradesh for comment. We will update this story when we receive a response.

Changing climate and its impact on dengue

Gaurav Kumar, physician at a private hospital, explained how temperature plays a crucial role in mosquito breeding. “Studies show that in September, October, and November, temperatures between 20°C and 35°C are ideal for the rapid growth of Aedes aegypti mosquito larvae,” he said. “The recent climate changes, including rains in October, have created favourable conditions for the mosquitoes. As temperatures begin to drop, mosquito populations will likely decrease.”

October 2024 saw the highest average night temperatures since 1901 in all regions except east and northeast India. Meteorologists attribute this anomaly to delayed monsoon withdrawal and the formation of low-pressure areas. Atul Kumar Singh, a senior scientist at the India Meteorological Centre in Lucknow, explained, “The lack of neutral El Niño conditions and the presence of active western disturbances have caused the temperatures to remain higher than usual.”

Last month, Lucknow’s minimum temperature was 3°C higher than usual while the days were, on average, 1.2°C warmer, he said. This abnormal heat has contributed to mosquito breeding cycles and, by extension, the rise in dengue cases.

Vijay Nath, former medical superintendent at Sir SunderLal Hospital at Banaras Hindu University (BHU) and professor at BHU, said climate change is a key factor contributing to the global rise in Aedes mosquitoes. “As temperatures rise and rainfall patterns shift, we could see a significant change in the geographical distribution of these mosquitoes,” he explained. “This could lead to their spread in regions like Europe and parts of Asia, along with Northern Hemisphere where they were once uncommon.”

About half the world’s population is now at risk of dengue, with an estimated 100-400 million infections every year, according to the WHO. Countries in Southeast Asia, including Indonesia, Bangladesh, Nepal, and Thailand, have seen an increase in cases and deaths this year, compared to the same period in 2023.

As temperatures rise, the range of mosquitoes expands, pushing them into previously cooler regions. For example, regions like northern Himachal Pradesh and Jammu and Kashmir, which traditionally had cooler climates, are now experiencing an uptick in dengue cases.

Increasing temperatures may further exacerbate this situation by enabling greater spread and transmission in low-risk or currently dengue-free parts of Asia, Europe, North America and Australia, according to research published in Nature Microbiology in June 2019, which derived estimates based on climate, population and socioeconomic projections.

With inputs from Azeem Mirza in Bahraich.

This article originally appeared on IndiaSpend, a data-driven, public-interest journalism non-profit.

Several Posts Lying Vacant in Commission That Regulates Medical Education, Practice

An RTI reply given in October to an activist said that the appointments to various posts at the National Medical Commission were under process.

New Delhi: Many key posts are lying vacant in the National Medical Commission (NMC) – the regulator of medical education and medical practice in India.

The New Indian Express, quoting a Right to Information reply, has reported that 10 out of 19 posts are not occupied. Two of them are in the Postgraduate Medical Education Board. This Board regulates PG medical courses and super-speciality courses for medical colleges. Similarly, three positions have not been occupied for the board regulation undergraduate medical courses

The Medical Assessment and Rating Board (MARB), a Board under the NMC, evaluates medical colleges – both private and public – on various parameters pertaining quality of education and the human resources. It carries out inspections to do the same; also grants permission to new medical colleges for becoming functional. Four positions at the MARB are also vacant.

Another key board at the NMC is the Ethics and Medical Registration Board (EMRB). The EMRB looks into cases of professional misconduct of the doctors. They also have to register at the EMRB to obtain a licence to practice – through various state medical councils. Three out of the five positions remain unoccupied. Even the post of the president of the board has been vacant for quite some time.

The RTI reply given in October, given by the Union health ministry, said that the appointments to various posts at the NMC were under process. The NMC comes under the health ministry.

The Union government replaced the Medical Commission of India with NMC in 2020 with an aim of streamlining medical education and getting rid of problems within the MCI. However, the NMC has also been under the radar for various reasons in the past, including internal conflicts within its various boards, hesitance to release inspection reports of medical colleges in public domains and changing the official logo by introducing Dhanvantri – a Hindu deity – in it, in a move that many doctors questioned.

Reclaiming the Basics: A Policy Hamster Dilemma

Southern countries risk becoming “jargon consumers,” taking on concepts designed to solve problems that may not even exist in their local context.

In the development world, jargon has become more than a language – it’s practically an industry. Over the years, we’ve seen concepts evolve from “tropical medicine” to “planetary health,” with each term vying for a place in the lexicon of what’s considered “progressive” policy. Such terms rarely emerge from within the Global South, nor do they respond to its most pressing needs.

Instead, these phrases often originate in the think tanks and policy labs of the Global North, in societies that have largely met their basic needs and are now pursuing “high-hanging fruits” like AI in health literacy or antioxidants for wellness. However, while these sophisticated ideals might be feasible in donor countries, they often overlook the day-to-day priorities of the South, where malnutrition, food adulteration, and childhood stunting remain urgent.

The powerful donor agencies in the Global North, who drive development funding, collaborate closely with their domestic universities and think tanks to formulate these high-concept policy initiatives. Driven by a dual purpose of altruism and an implicit belief in the universal applicability of their home-grown frameworks, Northern policy experts often repackage their findings into “international development assistance.”

This doesn’t just translate into money – it means exporting terminology and concepts. Terms such as “resilience” and “sustainable livelihoods” arrive in the Global South as neatly branded packages from aid ministries and soon filter through UN systems, turning the jargon of the moment into policy mandates that land on policymakers’ desks in Southern countries.

This creates what might be called the “policy hamster wheel” of the Global South: local officials tasked with addressing urgent societal needs find themselves running in place, continuously catching up with the latest fads in global development lingo. The consequences are profound. Instead of focusing on foundational services like nutrition, sanitation, and vaccination, the policy and communication elites in the South are often preoccupied with weaving the latest trendy terminologies into local strategies, generating a lot of visible “action” but making limited real-world progress.

In effect, ministries in the Global South have become staging grounds for capacity-building exercises around the “buzzword of the season.” This means spending precious hours and resources on endless workshops, new conceptual frameworks, and capacity-building seminars while ignoring the basics that could significantly improve people’s lives.

Young, ambitious professionals within these ministries, understandably drawn to the allure of international exposure and grants, often prefer to engage in these donor-led programs over “mundane” but critical tasks like improving sanitation or extending healthcare coverage.

Notably, a handful of countries in the South have managed to resist these distractions. Rwanda, for instance, has declined to embrace every jargon-laden trend in global health. Instead, it has prioritised basic community health needs and practical solutions like maternal care and preventive services.

Singapore’s policies remain rooted in what works – effective healthcare and education for its citizens –regardless of fashionable global terms like “planetary health.” Thailand’s Universal Health Coverage (UHC) and Vietnam’s sustained focus on agricultural productivity, primary healthcare, and poverty alleviation highlight a different path: one that leverages global cooperation but remains unswervingly focused on local priorities.

India’s vast and complex bureaucracy faces continuous pressure from multilateral agencies to adopt these trends, yet it has devised an innovative safeguard. By regulating access to its senior officials and restricting interaction with international donors, India protects its policy agenda from being overly influenced by external actors.

Similarly, Malawi has designated a single day each month for its officials to meet with international donors, allowing them to devote the rest of their time to local matters. These policies represent a subtle but effective assertion of national sovereignty over development priorities.

Ironically, in this race to keep up with donor-driven fads, Southern countries risk becoming “jargon consumers,” taking on concepts designed to solve problems that may not even exist in their local context. For example, while “resilience” is frequently deployed in discussions on development, tangible measures like social safety nets or flood barriers are often sidelined in favour of “innovative” projects with more appeal to donors.

Similarly, “social capital” is promoted abstractly rather than through actionable steps to strengthen local governance or community networks. This may sound progressive on paper, but it leaves ground realities unchanged.

Development jargon is like clutter – each term may have a purpose, but in aggregate, it’s overwhelming. A “back to basics” approach, like Marie Kondo’s tidying philosophy, could be transformative for policy in the Global South. Just as Kondo urges us to keep only what “sparks joy,” policymakers in the South should hold onto frameworks that spark real, context-specific value, decluttering their agendas from terms that do little but create distraction.

The cases of Rwanda, Singapore, Thailand, Vietnam, India, and Malawi are potent reminders that the Global South can carve out an agenda that meets local needs first. Focusing on core issues like healthcare access, sanitation, and education demonstrates that meaningful progress doesn’t require buying into every new policy fashion or development fad that surfaces in the Global North. It’s a reminder that Southern countries don’t need to run on a policy hamster wheel just to be considered “progressive” by Northern funders.

This isn’t about closing the door on international collaboration; it’s about opening it to partnerships that serve real priorities over donor optics. By championing a blend of local focus and global cooperation, policymakers in the Global South can ensure that limited resources drive lasting outcomes – not just new labels in development reports.

Southern leaders can steer a steady course toward progress if they assert their agendas with clarity and purpose. Without this resolve, however, the development journey risks drifting aimlessly buoyed by each passing jargon, yet never genuinely advancing toward meaningful change.

Sunoor Verma is the President of The Himalayan Dialogues and an international expert in Leadership-Strategic Communication and Global Health Diplomacy. More on www.sunoor.net

Yediyurappa Govt’s PPE Procurement ‘Tainted With Fraud’, Alleges Panel Led by Retired HC Judge

The John Michael D’Cunha Commission report has found that records were ‘built up to show that post facto approval of the Chief Minister was obtained.’

New Delhi: A panel led by a retired Karnataka high court judge has found that the Yediyurappa government of the Bharatiya Janata Party in the state procured three lakh PPE kits from two Chinese firms in a manner that was “non-transparent, arbitrary and tainted with fraud”.

In its interim report, reported on by The Hindu, the panel has also recommended prosecution of the former chief minister and other health department officials who issued orders for the purchases of PPE kits during the time when COVID-19 cases were surging.

The John Michael D’Cunha Commission report has found that records were “built up to show that post facto approval of the Chief Minister was obtained.”

The News Minute has reported that the 1,722-page interim report, submitted on August 30 to current chief minister Siddaramaiah, pointed out that around Rs 1,000 crore was syphoned off in the alleged dubious deals.

The Hindu has quoted the report as saying that the order for the PPE kits were placed without placing an official global tender despite the principal secretary and personal assistant to the chief minister and additional chief secretary recommending the same.

The newspaper said, quoting another official note sheet as referred to in the panel report, that the tender was avoided keeping in mind the urgency of the situation. As such, DHB Global Hong Kong (China) was asked to supply 1 lakh PPE kits, via an order issued on April 2, 2020. One PPE kit was purchased at a price of Rs 2117.53.

Another order for PPE kits was placed on April 10 to DHB Global Hong Hong and Big Pharmaceuticals. The former supplied it at a cost of Rs 2104.53 per unit and the latter at 2049.84 per unit.

On the other hand, the price fixation committee of the state, a month prior, had quoted the estimated cost of one kit at Rs 211.3 – approximately 10 times lesser than what the kits were finally purchased for from the two foreign companies.

The basis for this estimation were the quotes received from three firms other than the DHB Global Hong Kong and Big Pharmaceuticals, from which ultimately the kits were bought by the Yediyurappa government, without inviting any other firm through a government tender.

The Hindu quoted from the report that orders were placed with two local suppliers before and after the April order to the China-based firms. When it became known that one of the local suppliers sold the kits for Rs 330.40 per unit in March, the price was revised to Rs Rs 725 per unit for local suppliers – several times less than the price at which the two foreign suppliers sold.

“Misappropriation, mishandling and malpractice worth hundreds of crores has taken place (as per the report). Many files that are said to be missing were not submitted to him (Justice D’Cunha) despite attempts to track the files,” The News Minute quoted state’s current law minister, H.K. Patil, as having said. The current government established the commission in August last year.

Former health minister of the state and current BJP MP K. Sudhakar rejected the report as ‘politically motivated’.

Severe Irritability in Children and Teens: A New Understanding

Kids with disruptive mood dysregulation disorder have explosive outbursts well past toddler age. Scientists are trying to work out the causes and what treatments help.

It wasn’t until her daughter entered preschool that Holly Provan, a nurse in Los Angeles, began to worry. Compared to other kids, including her younger sister, Anna had a harder time coping when something wasn’t going her way. When told to stop coloring or to leave the playground, she’d respond with explosive tantrums.

Between ages 5 and 9, Anna (her name has been changed) would have meltdowns several times a week, screaming, raging and crying for an hour at a time. A few times in elementary school, she ended up hitting other kids. The outbursts weren’t premeditated; Anna just couldn’t control her temper. “Seeing how bad your kid feels after they’ve come back to themselves — it’s heartbreaking,” Provan says.

At age 7, after several doctors’ visits, Anna was diagnosed with disruptive mood dysregulation disorder (DMDD), a condition in children and adolescents, typically diagnosed between ages 6 and 10, that is characterized by chronic irritability and temper outbursts. But Provan couldn’t find much information on how to help Anna. “My husband and I at the time were just like, ‘I don’t know if she’ll ever be able to live away from home or to function normally,’” Provan recalls.

Irritability — a proneness to frustration or anger — is familiar to many of us. But in children with severe irritability, a hair-trigger temper can get in the way of making friends, getting along with siblings and doing well at school. Parents often express the feeling of walking on eggshells and often refrain from asking their children to do things they don’t like in order to avoid an outburst. In the 11,000-strong Facebook support group for parents of DMDD kids that Provan helps to administrate, some parents are physically afraid of their kids.

There are few specific treatments, says clinical psychologist Melissa Brotman of the National Institute of Mental Health, who coauthored a review on the topic in the Annual Review of Clinical Psychology. But now, after years of severe irritability in children being mistaken for other mental health conditions, scientists are studying it as a condition in its own right. “We’re starting to try and understand the problem from a brain-based mechanistic perspective,” Brotman says.

Inside the irritable mind

Starting in the 1990s, many experts saw severe irritability in children — often accompanied by energetic behavior and an inability to focus — as an early manifestation of the mania experienced by adults with bipolar disorder. Bipolar diagnoses, as well as prescriptions for mood-stabilizing and antipsychotic medications, skyrocketed among adolescents and children.

But by tracking children with severe irritability over many years, Brotman found that they didn’t transition to bipolar disorder as adults; instead, they tended to develop depression and anxiety. Perhaps, then, Brotman hypothesizes, severe childhood irritability is an early manifestation of depression and anxiety-like disorders in adulthood.

As scientists furthered their understanding of irritability in children, the Diagnostic and Statistical Manual (DSM) for Mental Health Disorders created a new diagnostic category, DMDD, in its fifth iteration, in 2013. Children with DMDD often also have other conditions like attention-deficit hyperactivity disorder (ADHD) or anxiety, or have experienced bouts of depression. Severely irritable children may have more difficulty than usual coping with negative emotions like frustration, or managing when things don’t go as they expect. They may have a harder time dealing with uncertainty and changes to their routines, says clinical child psychologist Spencer Evans, who directs the University of Miami’s Child Affect and Behavior Lab.

Functional magnetic resonance imaging (fMRI) studies, which use scans to observe brain activity, have affirmed the notion that children with severe irritability respond differently to frustration. One 2019 study compared 134 children between 8 and 18 who had irritability and a diagnosis of DMDD, anxiety disorder or ADHD, with 61 non-irritable volunteers. As they lay in the MRI scanner, the children played a game, earning up to 50 cents for every target they hit — until the researchers intentionally frustrated them by deducting winnings, explains coauthor Wan-Ling Tseng, a developmental neuroscientist at Yale School of Medicine.

Though irritable and non-irritable kids reported similar levels of frustration, the brains of irritable children responded differently: They showed heightened activity in the striatum, a brain region important for processing rewards, as well as in the prefrontal cortex, key to regulating emotions and executing tasks. Some other studies have also hinted at unusual activity in the emotion-processing amygdala in frustrated kids, though Tseng’s study didn’t observe this.

To Tseng, the prefrontal cortex findings suggest that in irritable kids, prefrontal cortices need to work harder to focus. “It’s more effortful for them,” she says. (After the game, the children were given $25 to take home, in addition to their compensation for participating, so that they left with a positive experience.)

It’s unclear how children’s brains end up this way. Research suggests that many kids are genetically predisposed to developing severe irritability, says neuroscientist and child and adolescent psychiatrist Argyris Stringaris of University College London. Adverse environments that involve family conflict or violence are associated with irritability, as are patterns of acquiescence by parents when their child has tantrums, which might reinforce the behaviors. But “we don’t know whether the cause is the parent, the child that elicits the parental response, or both, or some genetic component,” Stringaris says.

New clues for therapies and treatments

DMDD diagnoses are rising, but there’s little concrete treatment guidance. A 2022 analysis of health records found that in the United States, DMDD patients between 10 and 18 were prescribed antipsychotics more often than people with bipolar disorder, and were more likely to get multiple medications. “These drugs have not been FDA-approved specifically for treating irritability or aggression among children in general,” Evans says. Antipsychotics in particular should be used cautiously in children due to their side effects (though there are two antipsychotics approved for irritability in autistic children.)

Yet the increasingly evident links between irritability, depressive episodes, anxiety and ADHD point to different kinds of medications. Stimulants like methylphenidate (Ritalin) can help to reduce irritability and anger in youth with ADHD, while the anxiety and depression medication citalopram (Celexa) in combination with Ritalin can reduce irritability in youth where stimulants alone aren’t effective.

For Anna, Ritalin had little effect, and an antidepressant caused her to hallucinate. A popular yet untested DMDD treatment protocol includes anticonvulsants, and one variety, the mood stabilizer divalproex sodium, seemed to give Anna an extra split second to think through the possible consequences before exploding into a tantrum, her mother says.

As researchers learn more about the underlying brain processes, they hope to develop better and more effective treatments. Some, meanwhile, are looking into non-pharmaceutical therapies.

Recently, Brotman adapted an established treatment for anxiety disorders that progressively exposes patients to things they fear, within the safety of a therapist’s office. Adjusting the therapy for kids with DMDD, clinicians identified the triggers of 40 children ages 8 to 17 with DMDD-type symptoms. Then they simulated anger-provoking situations — such as asking the kids to stop a video game or to do their homework, and talked the children through how to constructively cope with their frustrations.

“I was very tentative at first, because it had never been done before, and we didn’t know if it would make them more angry,” Brotman says.

The clinicians also trained parents to ignore tantrums at home and reward constructive coping behaviors — an approach called “parent management training” that tackles reinforcing cycles within families. Remarkably, irritability symptoms decreased significantly in 65 percent of the children over the 12 weeks of the study.

Most parents, including Provan, eventually settle on a combination of talk therapy and medications. While no parent wants to drug their child, Provan says medications can help make them more receptive to therapy, in Anna’s case with a psychologist. And whether it was the treatment or Anna’s growing maturity, the tantrums disappeared. Now 13, Anna is no more irritable than a regular teenager, though she is still managing anxiety and depression. Indeed, studies tracking DMDD kids suggest that irritability symptoms can taper off by late adolescence or young adulthood, while depression and anxiety can continue.

Provan says that kids with DMDD need better medical treatment options and better mental health services — as well as more awareness in general. Because Anna was judged so much for her hair-trigger temper, Provan wrote a short book — Poppy and the Overactive Amygdala — to build understanding and empathy.

Before she had Anna, she recalls, “I was that parent that was, ‘Oh, screaming toddler — can’t they control their child on an airplane?’

“So, I guess, just be nice to your fellow humans.”

This article originally appeared in Knowable Magazine, a nonprofit publication dedicated to making scientific knowledge accessible to all.