Hello everyone. Today I'm going to have an Opentalk with Dr. A.S. Soin about the current Delhi Air Emergency. Dr. Soin is a surgeon and pioneer in the field of liver transplantation. Currently he is the chairman of the Institute of Liver Transplantation and Regenerative Medicine at Medanta. In 2010, he was awarded the Padma Shri, fourth highest civilian award by the president of India for starting liver transplantation in India. It's my pleasure to have an Opentalk with you today. My first question to you is how are you doing and my reason of asking this question is two-fold. The first reason is you being doctor you ask all your patients about their health, but rarely we ask doctors how are they doing and the reason we are doing well is because you are working very hard to ensure that we stay healthy, so thanks for taking care of us. Thank you Sumit, for asking. I'm actually doing well, but I could do better, you're right, because of again two reasons: one is that my own personal existence would be much healthier, I would breathe much fresher air if the Delhi air was less polluted. Yeah. And the other reason is of course that I see a lot of patients who are having long and short-term problems because of air pollution. Right. So I'm trying my best but I could be better if the pollution situation in Delhi was better. Right and you are based out of Gurugram, right? Which is probably the worst part of Delhi NCR in terms of air quality. Yes, I live in Gurugram and I work at Medanta Hospital which is a large multi-specialty hospital in Gurugram. As far as the area which is the worst in Delhi, I think that all of them are pretty polluted if you look at any meter, which is online, there are several apps also, which give you these figures. I mean at different times of the day different areas in Delhi NCR are polluted so I don't think we should be in a race to Who's more polluted, who's less. We are all in the end, living in an extremely polluted atmosphere unfortunately. Yeah. So how does the situation look today and what is the impact you are seeing on health and especially the liver? So the situation is pretty grim. Having said that, generally every year around the time of Diwali, you know end of October-beginning November, the air gets more polluted and that's because of several reasons: one reason is that you know, the stubble burning, the crop burning happens at this sort of time. The second reason is the air starts to become a little cooler than the rest of the year and the cool air settles down and war air rises and forms like a cap over the cold air; and cold air , therefore traps all the impurities and particles and toxic gases etc. So it is in this kind of changing season that we feel the effects of pollution more clearly, you know at the level at which we are, like about 10 feet above the ground. So, every year it happens at this time and of course crackers at Diwali also contribute smoke and crackers at Diwali also contribute, people are becoming more aware with the passage of time and in fact, the good news is that in 2019, the good air days preceding the bad air days were more in number and greener compared to let's say 2018 and 17, but we are still way above the safety limit. So we need to get better on this front and another reason that the air is polluted in Delhi NCR is because of the regular traffic. We have way too many vehicles on the road and if the public transport was a little more efficient, the facilities were better, then perhaps there wouldn't be so much vehicular congestion and pollution from that. Correct. As far as the influence of air pollution or the effect of air pollution on liver is concerned, everybody understands that there are several toxic substances in the polluted air like carbon monoxide, ozone, sulfur dioxide, nitrogen dioxide and of course PM 2.5 which basically means small particles of 2.5 millimetres, which basically get into our lungs and harm them. A lot of people and this includes some pollen and allergic substances as well. So a lot of people get asthmatic and bronchitic symptoms in this season, but that's not my area of specialty. What very few people realize is that after passing through the lungs, these toxic substances and small particles actually will travel via the blood to the liver; because liver is the organ that detoxifies our body. So all the toxic substances that get into our body are handled by the liver and in the process a lot of this or these toxic substances will get deposited in the liver and harm it. So it's been shown by studies, scientific studies that hepatitis - which is liver inflammation, fibrosis, cirrhosis, even liver cancer, the incidence of these diseases and even fatty liver disease is much higher in Delhi NCR and it is actually reaching alarming rates. So air pollution harms, not just the lungs, but it actually harms a lot of the organs including the liver. That's very serious and you talk about the 5 Cs, right? Which are the reason for... Yes, I talk about the 5 Cs. It's not picked up from anywhere. I just put together 5 Cs, looking at what causes the pollution. So the 5 Cs, include Congestion i.e. congestion, that means vehicular congestion, population congestion and congested localities with structural shops, residential areas, all clustered together and then Combustion which means emission of toxic substances from the vehicles from factories from any kind of smoke and then Construction where you have dust coming at you and then Crackers of course and Crop-burning. Crop-burning is again little particles in the air that carry across from mainly Haryana and Punjab by coastal winds that move northwards and then what happens is that when these winds hit the Himalayas, they obviously can't cross them, so they get trapped in the Northern Plains and not just Delhi, but all the surrounding areas bear the brunt of this pollution. Right. So what do you think, as a citizen or as a resident of Delhi, somebody should take precautions and if you can talk about precautions as per the age group largely the child and the adults and probably the senior citizens, what do you think they can do to avoid the effects or bring down the damage? So, you know first of all especially children who have known to be having a tax of asthma or bronchitis in general, they should not be taken out as far as possible, especially during the day; because the pollution levels are much higher during the day than in the evening, than at 10:00 at night. Usually after 8 p.m. the pollution levels start to fall, but of course that's not a time for children to go out. Anyway, so generally children should be kept indoors. That's why you find that the Delhi Administration and in fact Gurgaon & Noida have all asked for the schools to shut down during the days as the pollution levels are very high. So that's one part. In general, everybody should stay indoors as far as possible and they should they should plant money plants, not just for money, but also because it gives fresh air and neutralizes some of the carbon monoxide. They should plant, they should have lots of olive seeds in their homes. So, there are some plants which actually negate the effects of pollution. So these kind of plants should be there at home, people should stay at home. They can use simple filters which are available for anywhere between five and ten thousand rupees, sometimes more expensive for bigger rooms. These work but these will typically reduce the loads of let's say AQI from let's say 400-500 to about 100-150. Even 150 is above the safety limit, but then it's better than sitting in 400 and 500 which is what you have in the open air with your step out. So stay at home as far as possible. I know it's not possible to always stay at home, but as far as possible, try to avoid going out. Then when you do step out, if you're going in dusty areas, polluted areas, smoky areas, or if you are, you know already a person who gets these allergic reactions and especially with pollen or has asthma, then wear a mask and the best kind of mask to wear is a N-95, right? Then the other thing is that don't contribute to the pollution. So please try and use public transport. Please try and use carpools and not have too many vehicles on the road. So that's how we can contribute. I mean we have to take responsibility for what we do, right? And then of course once you try and Diwali is just a few days of Celebration, three-four days, but at that time also a contribution to pollution should be looked at, so obviously there's no question of creating smoke and lighting crackers and those sort of things, because they will obviously add to the pollution and not in your own home, but generally in the atmosphere so stay away from those. During Diwali, there are other healthier ways of celebrating Diwali. Correct. I think this is a hard time but as humans, right we go through a hard time and these hard times give us learning And as you said it's more of a lifestyle choice we should take now and not just about it's not a matter of survival, but it's a matter of choosing the right way of living and more of a conscious living what you're talking about. I totally agree with you, Sumit. I totally agree with you and I think that you know, it's clear that obviously some Governmental effort is needed, some effort on the part of society is needed, but you know rather than play the blame game, let's all contribute to bringing down the pollution, you know, we should, those of us who have the wherewithal and influence should try and influence the authorities also to bring down the problem of crop burning and stubble burning, you know, because you and I can't directly do anything about that, but we should do things that we can do to help bring down pollution. Correct. So I come from Bangalore and in Bangalore you are aware that there is a problem of traffic and when somebody says that Bangalore has a traffic problem, I always say that traffic is not the problem, you are the traffic. Absolutely, I totally agree with that, I totally agree with that. And then you be empathetic, you be conscious and you be responsible, I think yeah, the chain starts from you & the chain starts from yourself, right? Yes, absolutely. Walk where you can walk. Yeah. Use a cycle where you can and use public transport and car pools where you can. So, you know, we can we can do a lot to bring down the vehicular pollution. Right, right. So my last question to you is, are you seeing a rise in terms of patients getting admitted due to the current situation? So, you know what happens is that in hospitals, we definitely see a rise in upper respiratory infections, asthmatic attacks, bronchitis attacks. Those are not directly areas of my expertise, but I have seen an incidence of rising liver disease due to fatty liver, liver inflammation and increasing number of liver cancer cases over the last five or seven years and some part of that is contributed to by the air pollution in which we live. So I think you are in the right city, solving the problem where the problem is probably the acutest. It's a matter of opinion whether I'm in the right city or the wrong city, probably in the wrong city to live in but I think the right city to try and help people. Yeah, the problem, the person like you is acquired at the place where the problem is the largest. Yeah, that is true. Well, I'm like I said, I'm happy to help, I'm happy to advise but you know, it's a collective effort. No one person or institution can actually make a difference but we all hope that the awareness for this problem rises in the Delhi NCR and wherever else there is pollution and might I suggest that there should be like a national program for eradication of pollution and other environmental menaces. So, you know, this has to be taken up on priority by the government, both the concerned state governments and the central government. Right. Thanks a lot Doctor A.S. Soin for having an Opentalk and sharing your views with us. It was a pleasure talking to you Thank you very much, Sumit, for having me on this Opentalk.