Why This Kolaveri Di

 

Why This Kolaveri Di ?

Yen indha kolaveri?

Long post alert !

This morning I gave a talk to the medical residents at Deenanath Mangeshkar Hospital. About 70 residents from various faculties like internal medicine, gynecology, urology, anesthesia, general surgery, oncology surgery, cardiology attended. Their program director Dr Asmita Bhave and a few other attendings also were present for the lecture.

 It would be hard to make overworked residents attend a talk at 8 am on a subject as boring as preventive medicine. An idea popped in my mind, let’s make this interesting and fun.

Why This Kolaveri Di ?

What do lifestyle disorders have to do with this?

That was the topic I made up. Much to my relief Dr Bhave approved it with no reservations or doubts. 

I had just half a dozen slides ready and most of it was a casual talk prompting interaction from the young attendees, though majority were too shy to answer or speak up.

Everyone raised their hands when I asked if they were familiar with the song. I had expected that. First released in November 2011, written and sung by the actor Dhanush, this song became viral in no time. It became an icon of pop culture, broke cultural norms and influenced global citizens to create parodies. You Tube reported over 250 million views in the next decade and over 2 million youngsters had downloaded the song on their phones. Dhanush received an invitation from the Prime Minister India at the time and earned lucrative contracts for endorsements of products from leading brands. 

The song was destined to face not just unprecedented popularity but also fair amount of criticism. The controversy surrounding it was multi factorial, including the senselessness of its lyrics, degradation of language, such degradation becoming a norm, suggestion of stalking and misogyny, crude portrayal of unrequited love, hint of resorting to alcohol when spurned by the lover. Legitimate concerns if you look at them. Yet did they really prove consequential? 

It is inevitable to ponder upon the reasons for the song’s colossal popularity notwithstanding the controversy. The audience today cited catchy tune. Definitely that’s one of the main reasons. But that’s not all. The lyrics are simple, though senseless. 

Why this Kolaveri Di means why this killer rage? Kolaveri can also imply chaos or commotion. 

It is easy to catch on to both, the lyrics and the tune and sing it, whether alone or in company. The lyrics are whimsical and make you laugh even though it is about heartbreak. It’s a song that calls for no thinking. You put aside your brain and just move along, forget all worries even as you sing about the protagonist’s woes. That’s the paradox!

There is a certain authenticity in the song despite the compromise of the purity of language. The stamp of approval from lay people came because that’s how many youngsters speak in certain parts of Tamil Nadu. The song resonated with them. 

One other contributing factor for its heightened popularity was the marketing. People loved watching Dhanush and the movie’s team during the recording of the song. This video was released a few months before the film and it was already a hit. 

I broke down the issues surrounding the song into four broad categories. 

Making sense

Popularity 

Controversy 

Consequences 

And now attempt to draw parallels with lifestyle and lifestyle disorders.

The audience consisted of budding doctors. I asked them a series of questions.

Does their lifestyle make sense?

Do they have an orderly lifestyle? 

What is an orderly lifestyle?

At bare minimum , one that pays attention to diet, activity, sleep?

How many of these young doctors gave consideration to what they eat or when they eat? The nutritional content of their meals? 

How many tend to exercise at least a few times a week?

How many catch up on good sleep when they can?

How many smoke and drink or know a fellow doctor who smokes or drinks? 

Will there be consequences to such thoughtless lifestyle?

What are the examples of such consequences?

Obesity. Diabetes. Hypertension. Hyperlipidemia. Heart disease. Cancers.

Yes, cancers are also consequences of poor lifestyles.

None of the residents could give the answers to how many cancers are linked to smoking? Or to alcohol? Or to obesity. 

The answers are 16, 7 and 13 respectively.

None of them knew that alcohol is linked to breast cancer. 

Nobody knew the staggering numbers of breast cancer in India. Over 2.5 million new cases of breast cancer in a year in 2020. Over 4 lac deaths per year from this cancer.

One woman diagnosed newly with breast cancer every 4 minutes 

One woman dying from breast cancer every 15 minutes.

The reality of breast cancer in India is that majority of cases present to the doctor in stages 3 or 4. In the USA, in contrast, they present in stages 1 or 2. Why?

Not because American women love mammograms.

But because screening is heavily promoted. The doctors urge them to do so. 

Survival is tightly connected to the stage at presentation. So it is no surprise that Indian women with breast cancers don’t stand as good of a chance at survival 5 years from diagnosis. Survival is 95% at stage 1 and drops to 21% in stage 4.

Why is the picture so bad here?

What’s missing here?

The residents answered this accurately.

Awareness.

Who is responsible for spreading awareness? It can’t always be the government! 

Every doctor is responsible for spreading awareness of preventable illnesses. 

Are they doing it?

How can they if they are not aware themselves?

Preventive and social medicine was taught in second year of MBBS ( medical school). Aim and trend of most students is to clear the exam and then forget about it. It is not going to be needed! Each student gears to clinical medicine as they move forward. 

Four- five-six years later it is time to wake them up from the slumber and remind them of the long forgotten subject.

Why?

Because lifestyle errors can prove costly down the road. Now is the time to start investing in better living and health so each individual, including the doctors themselves, can reap the dividends after a few decades. Now is the time to be aware of proven screening measures that can save lives for themselves, their loved ones and their patients. Now is the time to dissuade them from forming habits of smoking and/or drinking. 

What is popular is not always good. 

A senseless, thoughtless song may not have serious consequences. 

But thoughtless living can have serious repercussions.

It is my observation how much more prevalent smoking and drinking have become in young women in India. These trends have not improved in the men either. It is scary. No one bothers to address this.

A sense of social responsibility must be kept alive in every doctor right from the time they are initiated into the profession. The importance of being a role model must be driven home. The primary role as an educator for our patients as well as our loved ones needs to be emphasized. 

If the trajectory of lifestyle related illnesses in India and globally has to change every young doctor needs to be aware of the magnitude of these problems and how their little efforts can add up to do a whole lot of good.

Even if you cannot persuade a friend to quit smoking or alcohol, if you refrain from these substances it is good enough.

If you can’t spend time on every eligible patient to know about the importance of a mammogram but keep a goal to persuade one woman each day to get her mammogram that’s good enough.

Even if you give a thought to your diet and exercise goals on few days each week, that’s a good start. 

The marketing of various foods, majority of which are not conducive for health, as well as marketing for tobacco products and alcohol, often through popular figures from the entertainment or sports industry is a formidable challenge for health care professionals who strive for good of their patients. Those industries seem to be winning at every step because we doctors have been sleeping for most part. The day doctors wake up to their full potential and duties the picture of diseases will begin to change. The narrow mindset must change for that. 

And therefore, the question must be kept alive in the mind:

Why this chaos in life? 

Why so much illness and suffering?

What are we doing wrong?

Why this? Why this, Kolaveri Kolaveri Kolaveri di?

Take home message:

 Moderation

Awareness 

Thoughtfulness, not thoughtlessness or overthinking 

Social responsibility 

Being role models

Taking work seriously but not yourself