1. Ask all your staff to welcome every body with a Namaste & a smile & genuine one just as they do in the Indian Airlines or Air India flights.

2. Injection free zone:
Put a big board saying your clinic is an injection FREE zone & put it in all the languages & request parents to read it out to their children & scrupulously follow this instruction.

3. Make your clinic a baby friendly clinic a happy clinic. Children are our guest, we should be their friend “ A friend in need is a friend indeed.” Because of the fear of injection children do not want to go to the doctor even when they need a doctor’s help, for them doctor is not a friend but an enemy. We must change this attitude of children by our behaviour. Possibly have a separate vaccination room for children little away from the consulting room.Possibly keep a fully trained nurse to give vaccines. Child must not associate you with the injection.

4. May your clinic be a pleasant place so that the children who come with suffering go relieved. If you welcome them with a smile and snacks and love then they will crave to come to you during illness.

6. Toys:
Keep a discarded stethoscope as a toy in the waiting room. Everywhere children are scared of doctors and they identify doctors with stethoscope. If they play with a stethoscope in the waiting room their scare will go and they will allow you to do more comfortable examination. Toddlers will love to play “doctor doctor” and examine their parents. 7 Instant Clinical Anaemiameter /Haemoglobinometer.

In the clinic put a big mirror behind your chair’s back in which the whole family, child and parents, can watch themselves. Ask them to compare the relative redness or paleness of their faces. This mirror is instant cost free, pain free, clinical anaemia meter or hemoglobinometer. Usually fathers are pinker. They neither get periods, nor do they deliver nor breastfeed babies, so they have no iron losses. But mothers do lose blood in all these ways. So they are often pale. Children are pale because no diet on the earth gives enough iron to growing children. Ask father to ensure that the mother and baby get iron till they match the father’s shade of pinkness. Try this instant hemoglobinometer. In the laboratory how do we estimate hemoglobin , we match colour of the blood sample with that of the standard. If we match the colour of the skin of the child and the mother’s face with that of the father’s face acting as a standard we can compare and show to them that their child and the mother are anaemic. This is instant. The parents appreciate the paleness of their children and the mother. Ask them to give iron for the baby & the mother match the colour of their father. Ask parents to educate their people and use their own home mirror as similar as bio-hemoglobinometer.
8. You should have at least one window to clinic, consulting room which will give bright sunlight/daylight for seeing the blue skin or the paleness of the yellow skin or yellow eyes of jaundice baby.

9. “First touch the feet of a serious baby.If the feet are cold, see if it is due to cold air or whether child is in shock.See if they are blue.

10. Seeing the throat of the baby

Sitting baby is the best baby or the best way to see the throat of the baby is a baby sitting on the lap of their mother. You should sit with your back against the window and the window light is the best light to see the throat of child. Second best light is tube-light: In the white light of the tube light you sit with back towards window or tube light and ask the mother to keep the baby on the lap in such a way that the light of the tube light can enter into the baby’s mouth and put the tongue depressor in the throat and just touch the back of throat and child will have a gag reflex and the child will open the mouth this is the simple best way to see the throat of the baby.

11. Put a ceiling mirror on the examination table. When all the babies above one & half months age, when kept on the table they look at their own image in the mirror & keeping playing & make the examination absolutely comfortable.

12. Seeing X-Rays when there is no view box.
When ever you do not have a view box you see the X-rayfilm, hold a white sheet of paper between the source of light and the X-ray film and then see the film. The white paper provides good uniform white background & it is the best way to see an X-ray.

13. Giving intramuscular vaccine :
Sleeping baby is the best baby to give an intramuscular injection, vaccine or other.. Infants do sleep in daytime and whenever the opportunity arises give vaccine to a sleeping baby.The crying and suffering of the baby, parents and the doctor is minimum. sleeping baby so that the resistant is minimum. So baby who is taking breast feeding, or sleeping on the lap their mother this is also an second best method to give vaccination or any intramuscular injection.

14. putting intra venous lines:
whenever possible sedated the child by giving syrup pedicloryl or Trichloroplhos.(0.3. ml/kg/dose. If the baby is violent the parent suffer & the doctor suffer & if baby is sedated the baby is comfortable , parents are comfortable & the doctor is comfortable. Ask the tallest parent to keep the baby in his arms or on his shoulders , let the baby ‘s hang free. After you sedated the baby you wrap the baby so that both the hands & legs are covered & they remain warm when we lift he hand the Venous pressure in the peripheral vein is negative and the veins collapse the matter is worse if the baby is dehydrated or in shock. If the baby is put on the parents shoulder & the hands are hanging down the peripheral veins become large they get encourage the venous pressure this is equal to the venous pressure and the vein in centimeters of water equal to the height, length of that vein from the heart is equal to the length of the arm or the leg. The venous pressure in the vein is equal to centimeters of water is equal to the distance in centimeters of the point where you are putting I/V and the heart the vertical distance so the veins become prominent & you can easily get them you prick the vein collect the sample and out the I/V line. This you can do at the bedsides, on the road or in the passage anywhere round you do not require a treatment or emergency room for that.

15. Mother’s milk is the best vehicle to dissolve kid tablets.
to sweeten medicine & to enhance the taste& flavour of wearing foods mother’s milk is the ticket which opens the gate mouth of the child. The smell & taste of mother’s milk is the ticket that opens the mouth of the child for wearing food and medicine.

16. Go Multilingual Iindia has 102 Crore & more of people out of this 33% people understand Hindi. this is the first language. 10 crore people understand marathi & Telegu, this second language and. third language mainly understood by people are ie around six lacks people speak Malayalam, Telegu, Tamil, Bengali, Gujarathi. And only four crore people speak English some people do understand English but may most people do not understand all the English some people understand some English but most people do not understand most English and the route for heart is not a English So if you want to make a heart to heart connection with all the people go multilingual. You talk to children in their language listen to their words & you will soon pick up their required words for eg. Breast milk is called Mola pal in Malayalam, Mar gheer in Bengali , Dhawan in Gujrathi, Aai Cha dhooh in Marathi, Mother’s milk in English, lal Eshak in french. If you ask your staff you will have multilingual staff ask all your patients to write whatever you Want to tell them in all the language and put it outside. you just write your name in their language & see how people love it.

17. Prescribe medicines in multi languages that will eliminate the error that occur in medication because of our effort now hundreds of companies put name in Hindi. You ask for the name of medicine in your own mother tongue. One rupee has one rupee written in fifteen languages in one thumb area so all medicines can be written in fifteen Indian languages in one thumb area in all the strips and bottles. Only we pediatrician must bring out this change largest number of children on the earth did daily in this country and this can be prevented by giving proper information about drugs in their own language for this the name of the medicines should come in the people language and you must work for bringing it in your own mother tongue. It is said that any four language will survive and all other language will die and all of who do not exit for the betterment of our language are responsible for the death of our language.

18. Make sticker for every massage .
most of us give lot of information in files but many people do not read file many people read file & many people do not. If you make a sticker and ask them to paste it on the wall it will make criteria on the wall and not only the patient but even friends, relatives read the massages and society improve stickers also caries your name & it also help you in your practice.

19. Talk before you touch . Often doctors are the poor communicators that leads to quarrels, fights, & consumer protection Act letigation. Ask all your staff also to talk before they touch the child or do anything children cry when you take their temperature because they feel you are going to hurt them with thermometer if the staff tells that I am not going to do anything. Let the child feel the thermometer and then put it on him then it will be pleasant impression.

20. Before giving any injection & medicine talk to the parent and the child & tell them what you are doing then do it. Then the complain improves & happiness improves. Talking while you work especially in emergency suppose for eg. As patient get anaphylactic shock then you ask for oxygen all the staff run for oxygen then when you say injection adrenaline all the staff runs for adrenaline instead one staff go for adrenaline & she should say I am getting adrenaline the another staff getting oxygen should say that she is getting oxygen then there is no confusion & duplication of work. This I learnt from airplane. In the pilot cabin there are two pilot each one says what he is doing to that there is no confusion & never one pilot taking aeroplane up other pilot never puts the lever down to there is no confusion . learn form the aeroplane

21. Always keep the parents with the children.
Often parents are driven out from the procedure room & fear of unknown is the worst fear so tell the parents what you are doing and do it in their presence unless you are not sure. Even if a baby dies, if they see you sweating & even the baby dies they will not blame you for the death.

22 .Transparent buckets from prince or other companies are available from the capacity to 5 lities to 15 lities they cost less than 100 Rs. & they make nice disposable , non breakable , oxygen hoods otherwise oxygen hoods cost Rs/- 2000/-. Use stethoscope as “y” connection for oxygen these is always situation when there are less regulators and more children needing oxygen in such a state you can use a stethoscope as a “y” connection and divide the oxygen from one cylinder to two baby putting more stethoscope on line you can have move connection from single resource.

23. While doing endotracheal incubation.
We would have the correct size of connector that is the connector may be bigger than the endotracheal tube in such case you remove the later tube of the I/V set each I/V set has a later rubber tube at the patient level remove that tube mounted it in the endotracheal tube and this can take the connector of any size & the problem solved.

24 Painless I/V set
the size demands that injection ampicilin or ceftaxione should be diluted to 50mg / ml to strength and if you have to give half of ampicilin or cefteaxione it must be given in 10u syringe and in 1 gm in 20 ml of flired that all most no one does it this concentrated drugs cause thromeboflibities, pain to patient and suffering and you have to frequently change the I/V connections. To create painless I/V set put a rubber tube above the air chamber so that you can put medicine by inserting the needle in the rubber tubing & push the drug into the air chamber so that this I/V set has 20 ml to 15ml fluid whatever medicine you put in the chamber get diluted in this 15 ml fluid or the fluid continues drips in to that chamber so every medicine inserted in that drip get diluted in 15 ml to 30 ml fluid & it goes slowly & the thromebofelibilies & the pain is eliminated. Children cry on seeing nurses because they give painful injections. So the injection is given to the I/V set & not to child. the pain disappears the life of I/V cannula increases and child recovers with minimum pain so we should have rubber tubing over the air chamber we have used such I/V sets for few years we had locally manufactured & used for last few years.

25. Newspapers are the best dryers. They soak the blood, water, discharges & put them on the table before keeping the baby & use one newspaper for one child. Subscriber newspaper for each indoor patient and use the same paper for that patient. Use always new paper every time.

26. Empower your staff
you are as good as your staff & let them learn continuously for eg. There are plenty of medical literature available in the language of people for there are 1100 books on medicine in marathi we also are buying out one Arogya Dyaneshwari annual every year and are making our health encyclopoedia on health in marathi called Arogya Dyaneshwari.

27. Give SHEERA to all.
Sheera is best weaning food. India has it is culturally accepted known to people from hame to town it is taken as prashada so make Sheera every morning & give to mother * children.

28. Our services go bad because staff don’t know how to use the instruments properly .One reason is all the instrument information book are in English, so ask for your staff language book on all the instrument. Sony & many multinational companies can provide books about their instrument in 14 language then why can,t our people do. The reason is we do not ask for it so ask all the labels of the warmed Hindi & in your language. The customer is the key you ask for it they will do it ask for how to use warmer booklet in 16 Indian language let us ask for it they will do it.

29. Empty blood collection bags are marketed in alluminium foil plastic . bags they are alluminium plastic bags they have multiple layers these are good insulators to transport new born baby from place to another. In India 30% children are born small for dead baby they become cold so these are good for these babies. Learn ABC and teach to your staff that ABC in jaundice.

30. use mythology.

31. Vaccine children on their date of birth ask them to came on that date of birth for 3 yrs. & then every quarterly. This has to benefit 1} it is easy for them to remember and come & it is easy & your practice gets to spread over 30 days so it does not happen that your own work increases on vaccination day.& under work in another day so you & your staff are taxed on day & lazy on another days and patients have to remember the date of birth and celebrate their birthday & we offer them Sheera.

32. Enhance people : knowledge educate, educate people , use mythology , use vaccination ladder.

33. Use discarded feeding bottle for keeping spirit. If baby who is burnt & crying of pain sprinkle xylocaine 2% the pain disappears & baby becomes comfortable add to xylocaine to injection ceflexione & add sphylospaidens all sphylospaidens must be added xylocaine all make it painless.

34. Why do not you dispense?
The lab albendazole cost Rs.15 to our patient in the market the same tablet is given at the cost of 85 % by big drug company to Tamilnadu & Maharashtra to State government. To you they give you at Rs,2 if you give to the patient.