""Alcoholism is primarily a chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug, alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic.""
:- Joint Committee of the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) and the American Society of Addiction Medicine (ASAM)
Alcoholism is a chronic problem. However, if managed properly, damage to the brain can be stopped and to some extent reversed. In addition to the problem of drinking, the disease is characterized by symptoms including an impaired control over alcohol, compulsive thoughts about alcohol, and distorted thinking. The risk of developing alcoholism depends on many factors, such as environment. Those with a family history of alcoholism are more likely to develop it begs them; however, many individuals have developed alcoholism without a family history of the disease. Since the consumption of alcohol is necessary to develop alcoholism, the availability and attitudes towards alcohol in an individual's environment affect their likelihood of developing the disease.
FIVE MYTHS ABOUT ALCOHOLISM AND ALCOHOL ABUSE:
- Myth #1: I can stop drinking anytime I want to.
- Myth #2: My drinking is my problem. I'm the one it hurts, so no one has the right to question me.
- Myth #3: I don't drink every day, so I am not an alcoholic OR I only drink wine or beer, so I can't be an alcoholic.
- Myth #4: I'm not an alcoholic because I have a job and I'm doing okay.
- Myth #5: Drinking is not a "real" addiction like drug addiction.
Recognised along with immediate effects, such as nausea and vomiting, binge drinking and prolonged heavy drinking can affect you in mentally and physically.
Binge drinking can cause blackouts, memory loss and anxiety. Long-term drinking can result in permanent brain damage, serious mental health problems and alcohol dependence or alcoholism. Young people's brains are particularly vulnerable because the brain is in the developing stage during their teenage years. Alcohol can damage parts of the brain, affecting a person's behaviour and the ability to learn and remember.
Drinking alcohol is the second biggest risk factor for cancers in the mouth and throat (smoking is the biggest). People who develop cirrhosis of the liver is (often caused by too much of alcohol consumption) which can develop liver cancer.
HEART AND CIRCULATION
Alcohol can cause high blood pressure (hypertension), which increases the risk of having a heart attack or stroke. It also weakens heart muscles, which can affect the lungs, liver, brain and other organs, and can also cause heart failure. Binge drinking and drinking heavily over longer periods can cause the heart to beat irregularly (arrhythmia) and has been linked to cases of sudden death.
People who drink a lot of alcohol regularly are more likely to suffer from collapsed lungs and to get pneumonia many other lung related diseases. When a person vomits during the course they are likely to choke.
Drinking too much of Alcohol causes fat to deposit in the liver. With continued excessive drinking, the liver may become inflamed, causing alcoholic hepatitis which can result in liver failure, and death. Excessive alcohol can permanently scar and damage the liver, resulting in liver cirrhosis and which in turn increases the risk of liver cancer. Women are particularly susceptible to the effects of alcohol on the liver.
Drinking above recommended limits can lead to stomach ulcers, internal bleeding and cancer. Alcohol can cause the stomach to become inflamed (gastritis), which can prevent food from being absorbed causing in digestive related diseases and can increase the risk of cancer.
Drinking above recommended limits can lead to stomach ulcers, internal bleeding and cancer. Alcohol can cause the stomach to become inflamed (gastritis), which can prevent food from being absorbed and can increase the risk of cancer.
Heavy drinking may result in ulcers and cancer of the colon. It also affects the body's ability to absorb nutrients and vitamins.
Heavy drinking can increase one's risk of developing high blood pressure - a leading cause of chronic kidney disease.
- In men: Heavy drinking can cause impotence (lowered libido/sex drive) and infertility.
- In women : In women: Heavy drinking can cause infertility. Drinking alcohol when pregnant can seriously damage the development of the fetus.
Alcohol interferes with the body's ability to absorb calcium. As a result, your bones become weak and thin (osteoporosis).
Alcohol is high in calories. Weight for weight, the alcohol in a drink contains almost as many calories as fat. The average bottle of wine contains 600 calories while four pints of average strength large contain 640 calories
Alcohol dehydrates your body and your skin. It also widens blood vessels, causing your skin to look red or blotchy.
Binge drinking makes you lose your inhibitions and affects your judgment. This may make you less likely to use a condom, which increases your risk of getting a sexually transmitted infection such as Chlamydia, HIV. It can also lead to an unplanned pregnancy
People may think that alcohol helps them cope with difficult situations and emotions, and that it reduces stress or relieves anxiety, but alcohol is in fact associated with a range of mental health problems including depression, anxiety, risk-taking behaviour, personality disorders and schizophrenia
Alcohol has also been linked to suicide. The Mental Health Foundation reports that:
- 65% of suicides have been linked to excessive drinking
- 70% of men who take their own life drinks Alcohol before doing so;
- Almost one third of suicides among young people take place while the person is intoxicated.
Excessive drinking can disrupt normal sleeping patterns, resulting in insomnia and a lack of restful sleep, which can contribute to stress and anxiety
ALCOHOLISM AS A FAMILY ILLNESS
Living with an alcoholic is a family affair. As it subjects all members of a household to constant stress and fears of various kinds, it has often been referred to as a "family illness." To one degree or another, all members of the family are affected. However, not all alcoholic families, nor all members of the same family, are affected in the similar manner. Alcoholics may have young, teenage, or grown-up children; they have wives or husbands; they have brothers or sisters; they have parents or other relatives. An alcoholic can totally disrupt family life and cause harmful psychological effects that can last a lifetime.
Each member of the family may be affected by alcohol differently. Parental alcoholism has severe effects on normal children of alcoholics. Many of these children have common symptoms such as low self-esteem, loneliness, guilt, feelings of helplessness, fears of abandonment, and chronic depression. Alcoholism also has negative effects on the spouse of an alcoholic. The spouse may have feelings of hatred, self-pity, avoidance of social contacts; they may suffer from exhaustion and become physically or mentally ill. Very often the spouse has to perform the roles of both the parents.
After 10 years of study of alcoholic families, we can say that (and know that) family problems and marital problems often start because of Alcoholism, and the spouses and children may contribute to the drinker's habit making it worse. Some of the families allow heavy drinking to continue rather than deal with serious family problems, and condone the habit to keep the family together.
There is also another chief aspect, probably debatable, that is, most probably alcoholism happens as a result of confrontations with one's family, especially altercations with the partner. Yes, the better half. Alcohol induced problems are common among couples. Alcohol abuse affects couples' relationships in a variety of negative ways, including communication problems, increased conflict, nagging, poor sexual relations, and domestic violence. Loss of libido can be one of the major issues contributing to altercations between couples, and it is directly linked to Alcoholism. Men's sexual behaviors can be affected dramatically by alcohol.
In fact, our studies show that men who are dependent on alcohol have a 60 to 70 percent chance of suffering from sexual problems. The most common of these are erectile dysfunction, premature ejaculation, and loss of sexual desire.
ALCOHOLISM AND LOW SELF-ESTEEM
Two prominent results of alcoholism is the apparent low self-esteem and the persistence of ineffective, self-destructive behavior in the face of undeniable negative consequences, which makes our model a particularly promising one for understanding and formulating treatment for alcoholism. A primary question to be answered then is whether, in fact, alcoholics suffer from low self-esteem. Clinical observation indicates that they do, but dependable research on the subject is lacking. Low self esteem is often directly related to poor sexual potency or libido. Loss of libido may influence the self esteem of the individual and this can create serious psychological conflicts.
People in the southern state of Kerala are the heaviest drinkers in India, and sales of alcohol are quickly rising day by day.
""Drinking is a disease in Kerala. A drunkard will lose his kin, respect and all their money chasing alcohol. But everyone encourages you to have it - your friends, the government". Kerala has the highest per capita consumption of alcohol - more than 1.76 gallons per person a year - in the nation, overtaking traditionally hard-drinking states like Punjab and Haryana. Shockingly, more than 40% of revenues for Kerala's annual budget come from booze.
A state-run monopoly sells alcohol. Kerala State Beverages Corporation (KSBC) runs 337 liquor shops, all open seven days a week. Each shop caters on average to an astonishing 80,000 clients. Not surprisingly, revenues from alcohol to the state's exchequer have registered a 100% rise over the past four years. There are more than 5,000 shops selling toddy (palm wine), the local brew. There is also a thriving black market liquor trade.
Despite a growing number of people who demand a ban on the sale and consumption of alcohol, there is an equally spirited group of hard-core drinkers who lobby for cheaper and wider distribution of liquor.
Meanwhile drinking is killing a lot of people and exacting a heavy social cost, say doctors and activists. Rising numbers of divorces in Kerala are linked to alcohol abuse. The figure is as high as 80%. And the majority of road traffic deaths in the state - nearly 4,000 during 2008 - 2009 - are due to drink driving. Hospitals and rehab centers are packed with patients suffering from alcohol-related diseases. The situation is so grim that the KSBC (Kerala State Beverages Corporation) itself is running hospitals specializing in treating alcohol-related problems. It also runs a campaign to combat alcohol abuse.
Most activists believe that prohibition is not the solution, as it just drives buyers and sellers underground. The solution possibly lies in introducing drinks with mild alcohol content. And since drinking is not only a cultural problem, it will lead to a fatal disease, Alcoholism, it needs to be addressed urgently. But even though we are proud of our high literacy rate, the truth is that, most of the population in Kerala are not aware this fact. So, proper advocacy about the true nature and consequences of Alcohol consumption - which may lead to alcoholism, a deadly disease - needed to be initiated urgently. People must be made aware of the havoc that alcohol can create in their lives.
It is this mission that Punarjani Charitable Trust for De-addiction and Rehabilitation has been embarked on through its limited resources, since the last 10 years.
Dr Johns K. Mangalam, is the Managing Trustee of the organization, "Punarjani Charitable Trust for De-addiction and Rehabilitation".
He retired as the HOD of Philosophy from, Sree Kerala Varma College, Thrissur. Dr Johns himself was an addict, who after many trials and failures, came back to life from the boozy world of liquors. "Punarjani" is a Trust registered under the Indian Trusts Act 1882 (Act II of 1982) and its Registered Office is situated now at Killanoor Village, Poomala P. O., Thrissur, in Kerala. The main objective of our Trust is to establish and run institutions for de-addiction treatment and institutions that are rehabilitation-oriented. Other objectives include awareness campaigns through all media, to render financial and other sorts of assistance to persons who are victims of alcohol and other toxic substances and to make them de-addicted persons through awareness programs and through motivation and personal assistance, and also the physical, mental and spiritual development of socially backward persons.
Dr Johns is the son of a teacher, who was a drunkard until his death. At the age of 56, he died and handed over the legacy of Alcoholism to his elder son Dr. Johns. He was born at Poomala in the year 1962. In his childhood, he was not good at studies. It was his father's drinking habit that stood as an obstacle for his studies. He failed twice in his pre-degree examinations, and did many jobs including head-loading worker to rice-mill operator. But after a small period, he himself recognized the fact that if he continues with such petty jobs at the most it will lead him to the job of a plumber and noting more. This self realization, supported by his cousin's motivation, compelled him to try again and finally he passed his pre-degree examinations in the third chance. Then he joined at Sree Kerala Varma College, for B.A. in Philosophy. But surprisingly, he got first rank in his U.G., and P.G. Courses. Subsequently, he got U.G.C. Fellowship for PhD and after five years of research, Dr. Johns became a Doctor of Philosophy in the topic "Gandhji's Views on Socialism", but he is not a Doctor of Medicine.
All through his academic life, he was accustomed to drinking. He began his career as a lecturer in the department of Philosophy, at Sree Kerala Varma College, Thrissur. As a lecturer, he tried to change the ways of his life and with that intention he got married. Her name is Raji, she was a teacher at a High School at Kottakkal, and they wished to start a new life together. But unfortunately they both met with an accident after 2 weeks of their marriage and she lost one of her kidney, spleen, and a portion of the liver and suffered many other internal and external injuries. The same was the condition of Dr. Johns, who was admitted at Medical Trust Hospital, Ernakulam due to head injuries. They were compelled to undergo treatment for more than 6 months. But soon he lost his job which was a temporary one and likely to be made permanent. That was not expected. The reason was that, the person on leave - a research scholar who wished to pursue research abroad, and who relinquished that project for personal reasons - cancelled the long leave and rejoined for duty.
The method of non-formal counseling and group therapy, communal living etc. applied in 'Punarjani' is totally different from conventional treatments. Punarjani is striving hard to recover the alcoholic patients in the same way as Dr Johns recovered from the evil world of an Alcoholic. He wanted to impart his happiness to other people who were suffering from addiction to drinking, which is nothing but a disease.
His knowledge about the minds of alcoholics, his personal experiences as an alcoholic, and his knowledge about the basic psychological principles, psychological problems, and its solutions etc. contributed in the experiments conducted by him to form a practically-effective and different approach for the recovery of alcoholics from their disease.
Many psychological methods are used at "Punarjani". But no medicine is used. It may become the model for a new generation of De-Addiction Center in Kerala. The concept of "Wounded Healer" which Dr Johns practiced in the "Punarjani" and the tapering method of lessening the quantity of drinking day by day, to overcome the withdrawal problems, the different method of Counseling Without Limit of Time and Space, the de-sensitization programs, follow-up techniques etc. are unique to "Punarjani". The dedication of his co workers and the beautiful location of the center at the bank of a small Dam reservoir also contribute to the high rate of recovery through "Punarjani".
One of the specialties of "Punarjani" from other de-addiction centers is its approach. Both group and individual psychotherapy is being used. It is done without the help of an expert supervision because a personal experience of each Alcoholic is more effective in making changes in the minds of fellow Alcoholics. Because each and every one of them wishes to recover from this habit, but the fact is that, they are helpless to escape from the clutches of the Disease all by themselves. The patient should be educated about the risks of continuing alcohol use. Here at "Punarjani" we are utilizing the depths of psychotherapy. The effectiveness of the application of this approach is the main reason for the success of this organization. And these ways and methods will definitely be a Nobel model for other de-addiction centers.
Counseling is an important method of treatment used in "Punarjani". Unlike many other counselors, Dr. Johns K. Mangalam, with his humorously colloquial language, is creating a new style of counseling which may be a unique model that helps to create a rapport. Dr. Johns with his own experience as an Alcoholic could read the mind of other Alcoholics. His style and use of colloquial language definitely touches the heart of other Alcoholics. The counseling sessions are the main reasons for the conversion of the minds of Alcoholics.
Sharing as a method of treatment technique is used in "Punarjani". By sharing, the patient can ventilate their depressed feelings and emotions. The feelings of helplessness, worthlessness, rejection, marginalization, etc. will be reduced and even can be eliminated from the minds of patients through these. By the same process of open and voluntary sharing of thoughts, experiences, and hopes, among the inmates of "Punarjani", we impart future hopes and expectations, energy and confidence, and the will to overcome the obstacles to fight against the disease of Alcoholism.
SPECIALTY OF PUNARJANI FROM OTHER DE-ADDICTION CENTERS
Alcoholics usually resist undergoing any sort of treatment due to two reasons: the formally accepted method of treatment which restricts the total freedom of an Alcoholic by imprisoning him in a De-Addiction center for a long period of time, and the application of heavy doses of Medicine that are not acceptable to them. The salient features and factors, which differentiate the approach of Punarjani, is the total freedom of the patient and the non-use of any sort of Medicine for the recovery the patient from his disease.
Freedom from unnecessary bondages is very important for an Alcoholic. An Alcoholic is a person who lavishly enjoyed and misused freedom by virtue of his disease or as a symptom of his disease. So Punarjani believes that, whenever he is compelled to restrict his freedom, he will not co-operate with the means and methods or attempts of recovery from Alcoholism. Restriction of his freedom by imprisonment will generate a rebellious attitude in the minds of Alcoholics and thus their mind will not listen to what they may hear about their disease and its method and means of recovery. An intellectual conviction about the true nature of this disease, its symptoms, its reason, its remedy, the means and the methods of recovery, all these are very essential for an Alcoholic for recovery. Unfortunately, while the patient is under the state of imprisonment, he is not able to and will not co- operate with those who wish to assist him, for his recovery. So, "Punarjani" has no gates for its de-addiction center.
All we have here is a communal living together, which enable the patients to learn from the life experiences, losses, hopes, achievements, and expectations of other Alcoholics, which will give a proper insight about the bad effects of Alcoholism. Among the Alcoholics, there will not be many sort of difference due to religion, wealth, and education. They will interact with all the family members of other patients. Thus a new friendship and relationship will begin at "Punarjani".
Systematic desensitization is a new approach to recovery from Alcoholism by which the patient is undergoing the recovery program along with his family, with special attention to the psychological aspects of an Alcoholic's life. The advantage of this method of treatment is that, once the patient has become physically, mentally, and socially competent to live without the assistance of alcohol, he can stop drinking till death by taking a decision that Today I will not drink. If this is possible to practice any Alcoholic, then he can live lifelong without drinking, by repeating that same decision, day by day.
Live Show is a psychological technique applied in "Punarjani" to make the Alcoholics to understand themselves. It is a self realization for each Alcoholic. It is an effective method used here at "Punarjani" to show the bad impact of Alcohol upon the patient and his family. After allowing the new patient to consume Alcohol, from the hands of old patients who are undergoing the recovery course, all patients will get the chance to observe the absurdities performed by the new patient. That will be a shocking experience to them. The suffering of their family members also will act as an eye opener. The pathetic condition of an addict and his aggrieved family could be realized by the addict himself through this method.
TYPICAL LANGUAGE FOR COMMUNICATION
There is a typical colloquial language for communication used between Alcoholics and recovering alcoholics. The language of sophisticated counselors is mostly alien and not acceptable to Alcoholics. Therefore, a lesson or message expressed by an Alcoholic in his own language could reach the understanding faculty of other Alcoholics better, than that of an academically educated, trained counselor.
At "Punarjani" everybody is free to choose his own Deity as he himself conceives it. Because "Punarjani" believes that in order to fight and defeat the disease of Alcoholism, we need the help of a power that will be stronger than that of alcohol, which has already defeated us. The belief and prayers offered by an Alcoholic and his suffering family will reap its fruits, through his recovery and future prosperity, through the unexpected interventions of God. It is not a scientifically proven fact on paper but what we experience as a fact for which we may not have adequate and reasonable explanations.
COUPLES THERAPY/ COUNSELING
Evidence indicates that involvement of a nonalcoholic spouse in a treatment program can improve patient participation rates and increase the likelihood, that the patient will alter drinking behavior after the treatment ends. There are various approaches to marital family therapy. Behavioral-marital therapy combines a focus on drinking, with efforts to strengthen the marital relationship, through shared activities and the teaching of communication and conflict evaluation skills.
Many persons with alcohol-related problems receive, counseling from primary care physicians or nursing staff in the context of five or fewer standard office visits. Such treatment, known as brief intervention, generally consists of straightforward information on the negative consequences of alcohol consumption along with practical advice on strategies and community resources to achieve moderation or abstinence. But this is not sufficient. The life partner must know the true nature of the disease, Alcoholism, and must be equipped to adjust and understand the problems to be faced by a recovered patient and must be equipped for the same. We, through Punarjani, make them capable of doing so, through continuous follow- ups.
FOLLOW-UP THROUGH NETWORK
The network of the family members of Alcoholics, who happened to get a chance to stay at "Punarjani" for a period of 21 days, will act as the supporting group for every newly recovered Alcoholic. The intimacy and affection expressed among the similarly aggrieved and suffering patients will have strength stronger than that of any other group. Thus, in fact each and every person who undergoes this recovery process at "Punarjani" will become a healer of other Alcoholics. Thus we can feel the wonder created by the intervention of the "wounded healer" upon the patients at "Punarjani".
After realizing about the disease Alcoholism in the various aspects, the patients who return to his family will meet with many challenges from his colleagues and former partners of drinking. They will try to bring him back to their company and will compel him to start drinking by different means and methods. At that time he may start consuming Alcohol again. In order to prevent this, we will teach them how to tackle this problem. The recovered patients who visit frequently as part of follow ups will be the best teachers having the same experiences and who were able to overcome such persuasions and inducements. So the chance of relapses will be very little for those, who undergo Punarjani's course for recovery from Alcoholism, for a period of 21 days.
Dr. Johns K Mangalam, as an Ex-alcoholic patient, is trying to convey the message "Alcoholism is a Disease" and "Alcoholism is a Family Disease", through the activities of Punarjani Charitable Trust.
From 2004 to 2015, he covered almost around 2500 programmers and conveys this message to thousands of people from all over Kerala, especially in Thrissur district. And around 8000 persons have recovered from this fatal disease, through "Punarjani", and are now living happily with their family, without using alcohol. Our intention is to eradicate the miseries suffered by innocent and ignorant persons due to adverse effects of Alcohol. Dr. Johns wishes to spread out new ideas about the new methods of recovery from this disease, and returning to life. His awareness generation can change the mindset of people towards alcoholics, and advocate them that alcoholics deserve proper treatment and humanitarian attitude.
Punarjani now focuses on the adolescent youths, and young adults irrespective of gender, as they have more chance to get addicted to alcohol and drugs. His advocacy against alcohol and drugs is insightful to their family members, as they become more vigilant to protect the young from alcohol and other drugs. Because alcoholism is a family disease. It causes suffering for many, irrespective of religion, wealth, and education.
The books written by Dr. Johns, "Kudiyante Kumbasaram" (The Confessions of an Alcoholic) and "Madhyapararinju Kudi Nirtham"(Stop Drinking with the Alcoholic's Awareness) have been published by D.C. Books. Now, Punarjani is trying to start a monthly magazine, "Madhysakthante Punarajani" (Re-Birth of an Alcoholic).
We accept patients or Alcohol addicted persons, who wish to recover from their habit of drinking, and only those who voluntarily approach us along with their wife, mother, sister or any other close relatives, as our guest. Such persons and their family undergo a course for a period of twenty one days. During this period, he will get chances to see and observe more than twenty persons having the same problems with Alcohol, and the impact of it upon him and the members of his family, and become aware of the fact that there is a Disease called Alcoholism and its symptoms, and the impacts and consequences of drinking upon himself and his family. This self realization will lead him to take a decision about future. Instead of taking a decision that "He will not drink till death", we advise them to take the decision that "He will not drink today". If he does the same, day by day, he can avoid drinking till his death. The support of his family members, who also become aware of the fact that, their beloved person was a patient and prey of a fatal Disease, and were not a wretched creature, and will give him emotional, financial support without any condition, then, any patient can recover from this Disease. The support of the society also will strengthen their motive to live a new life without Alcohol. The course will provide him ample energy to overcome the problems faced by every Alcoholic. And a defense mechanism will also be learned from the recovered persons, who frequently visit Punarjani without any compulsion for follow ups because they consider it as their own home.
Punarjani is a charitable trust. We do not treat anybody in the medical and technical sense of the term- 'Treatment'. We do not use any sort of medicine here, for or as part of the alleged treatment. We don't use the service of doctors or nurses here, for the recovery of any person from the disease of alcoholism. We convert persons by making them aware of the basic nature and symptoms of alcoholism, and the patients themselves decide to stop the habit of drinking. We are creating an aversion, in the minds of patients, towards alcohol. After the completion of a 21 day course, at Punarjani, they realize their problems themselves and a total change happens in their mental, spiritual, and physical spheres of the patient. After the completion of 1 week, such patients are capable and become willing to nurse, to teach and to motivate the newcomer alcoholic. Thus, we are applying the principle of the "wounded healer". In fact, even we don't know the chemistry of the conversion that happened to Alcoholics with in this short period.
As per your letter referred above, if it is necessary to obtain any sort of license or recognition from the government to run the activities of the trust mentioned above, we are ready & willing to do the necessary, to obtain the said, from the government. But unfortunately we are not aware of the procedure to get the said license of recognition, from the part of Government, for the service done by our Trust. If this institution is compelled to shut down by the order of the Government or any other competent agents, it will cause irreparable damages to the future of many families having alcoholics.
We most humbly request you to visit our institution and verify the facts stated above. This is a new method in the field of alcoholism for recovery of alcoholics through awareness only. The family and the society also must know the fact that alcoholism is a family disease. The success rate of our institution is higher than the success rate of any other de-addiction center in Kerala. We are not supported by any agency or the central or state Government. The payment received from the family of the alcoholics is too meager to provide them food and accommodation for 21 days at Punarjani. It is not functioning with a profit motive. The humanitarian considerations are the only reason for the services rendered through Punarjani.
We expect your valuable suggestions and advices in about our programe. We also wish to get some sort of recognition and license for the services rendered through Punarjani Charitable Trust, which will lead to a new Idea about De-Addiction of alcoholics and as a working model to be accepted by the new generations which will make wonders in the lives of alcoholics and their families.
Dr.Johns K Mangalam,