Greeting gestures, a language of paying honour, respect, love, adoration, graciousness, empathy towards each other. It is a global custom and has multiple variations. Each country has its own customized version and ritual. The most popular version i.e. hand-shake probably has its roots in Great Britain. Men in the United States will usually shake hands when greeting each other, but it’s not usual for them to kiss when greeting. Americans in addition to handshaking also do a fist bump, wave and hug.

For English people, the handshake is the formal way of greeting when meeting someone new. In informal situations, both men and women use a quick kiss on the cheek, and for women who know each other well. Handshake works universally as a professional way to greet. It is a little firm in Germany, more extended (3-step handshake) in Botswana and for Malays, it extends to touching each other’s fingertip followed by their hearts. Filipinos take a hand of their elders and press it to their foreheads called as ‘Mano’.

One of the major health and environmental challenge we face today is rapid emergence of novel pathogens. The spread of these pathogens, especially of nosocomial origin (hospital based), is often linked to cross-contamination by healthcare workers and ways of greeting gestures while meeting each other. An idea of handshake-free zones in hospitals have encouraged awareness. But also questioned how a doctor will take the physical examination without touching a patient. On the other hand, we cannot ignore the fact that microbes like Acinetobacter calcoaceticus, Enterococcus faecalis, E. faecium, and Shigella dysenteriae type 1 can sustain on hand surface upto one hour while Pseudomonas aeruginosa and Burkholderia cepacia survive up to 30 minutes. Rotavirus might survive for 20 min while the viability of human parainfluenza virus is nearly 60 min.

Studies indicate that a contaminated hand can transfer its viable contamination to seven different subjects or surfaces. One of two common items is a clean paper towel and soap dispenser with average transfer rate ranges between 0.01% to 0.64% and 12.4% to 13.1% respectively. We touch our face nearly 2-5 times a minute i.e., 2000 to 3000 times a day. In fact, whatever contamination we have on our hands is also getting transferred to our face. We may wonder whether our hand soap is capable of killing all the potentially pathogenic microbes. Are we washing our hands correctly and does it really help? We often use hand wash, sanitizers without giving attention to their content and standards. Do they qualify for antimicrobial purpose? Moreover, our greeting gestures further contribute to the spread of the germs.

For healthcare workers, the protected physical contact is a non-avoidable choice. Healthcare workers and doctors should change their gloves while switching from one patient to another. Avoiding greetings which involve physical contacts especially during outbreaks can provide a preventive approach to managing outbreaks. Hospitals need to improve compliance with hand hygiene. Handshake free zone can be one alternative in hospitals. But they aren’t designed to replace hand washing but to complement it. Creating handshake free zone will also bring attention to the hands as vectors for disease. It will also improve compliance with hand hygiene and an easy and inexpensive way to reduce infections.

It is rude to not to shake a hand if a person extends its hand towards you in the name of trust and honour. We can’t be rude to others but why not to adopt ‘Anjali Mudra’, Wai, Namasté, Wave, Bowing or Adaab to greet. This respectable way of greeting with no physical contact should be adopted in the healthcare settings. In India, by adopting our age-old greeting method especially in a healthcare setting can shield us from many invisible microbial infections. We just need to adopt, practice and re-practice these gestures to decrease the spread of infections.

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Last year May 24-26, 2017 was big startup event Latitude 59 in Tallinn,Estonia. I attended the event and got a flavor of the startup scene and healthcare sector discussions were held. I aligned my visit to Estonia along with the visit of my meeting with CBHEALTHACCESS delegates, innovative healthcare companies from Finland, Sweden, Estonia and Latvia.

I could witness many startups and meet some friends. At any point in the premises of the conference there were over 1000 people and all engaged about future trends and opportunities. One way to know future is always by observing what problems best startups are engaged in solving. I could witness many biotech (genetics) based startup trying their hands on personalized medicine and new age diagnostics platform. Also, interesting was the cyber security companies.

One cyber security startup from Switzerland, OneVisage, that attracted my attention was working on 3D face scanning as authentication mechanism and looked promising for applications like online banking with your own face as your password. Estonia in general has made great advances in two areas, one that of e-governance including e-health and the other cyber security. Hence, it was no surprise for me to see both kind of startups flocking in conference and building upon the existing good work happening in that country. The other exciting thing to see was the countries collaborating and there were many international visitors including from India. Japanese and Finnish presence was quite visible.

There was also heavy promotion of e-residency program with some exciting announcements about easier account opening with a Finnish provider. It lured me also to try my hands on registering a company and post conference it took me only few minutes with the help of some local friends to register a company! Although, I am yet to make it fully functional, but that was already something for me.

The highlight for me was the healthcare session on the second day, which had a keynote by Nicky Hekster from IBM Watson. Nicky started by asking everyone in the room to standup and asked first those who have been to a hospital in last six months to sit down or someone in their close family. Next, he asked if they knew someone in friends/relatives who have been to the hospital. To my surprise there were only 2-3 people standing in the room  which had over hundreds of people. This was a master tactic to drive the point home, that healthcare matters to all.

Followed by the keynote was a panel discussion, which comprised of panelists from USA, Finland, Germany, Italy, Netherlands and Estonia. They were healthcare practitioners, investors, incubators, startups and large company representatives. The session was interesting and demonstrated that how international best practices sharing and collaboration is need of the hour cutting across all type of stakeholders. I really enjoyed my two days not just in the conference but also in after parties with loads of intellectual discussions. Look forward being there again next year!

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz 
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw

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