Tuesday, October 20, 2009

Medical Negligence , Searching for root cause

Ramkrishna Paramhans had said that there are three kinds of physicians , one who prescribes drugs and forgets ,has nothing to do as what has happened to the patient . The second category are the ones who hand over the medicines to the patient and lastly the ones who will forcefully make the patient gulp the medicines . In today’s scenario of lack of faith on doctors , last kind of medical practice is better forgotten .
Medicine is a noble profession . Medical negligence literally means neglect of a patient by his physician . By and large no doctor will ever neglect a patient wilfully . A doctor will always try to do his / her best to help a patient . However in present day on and off we come across the news about medical negligence . The root of this dreaded disease is quite deep . The negligence is far more than just forgetting scissors in patients tummy .
Why should a doctor neglect a patient ? Either he is not trained well enough to take care of his patient , or he is well trained but is not able to devote sufficient time due to other responsibilities like family or social or he is over burdened with work . The training starts at the institute from where he has graduated . Let us have look at the medical training institutes.
Hippocrates oath states that a doctor should practice medicine without bias on caste , creed , religion or sex and without fear . But right from admission to medical colleges this oath is corroded at the fundamentals . Admission in medical colleges in graduate and post graduate courses is based on caste and if the wishes of our politicians materialise , then soon we will have religion based admissions.
In all the medical colleges in India , there is no teachers training program like B.Ed. (bachelor of education ) . So the medical students are taught by the teachers who are not trained in teaching at all. Naturally the undergraduate students are often taught by the post graduate students who do not touch the basics of medicine and teach whatever they have learnt from books or their limited experience . The teachers in medical college are supposed to take rounds in wards , see patient in outpatient departments , attend emergency calls , do administrative duties , attend medico-legal cases , guide PG students , up date their knowledge in latest in medicines , and also fulfil the national health programs like leprosy eradication etc . It is hard to believe but a bitter truth is that most of the time of medical teacher is wasted in the corridors of power in preventing transfers or getting promotions . So they have very little time and energy left for teaching the students .
With proliferation of private medical colleges , the teachers from government set up are resigning to join these institutes for better salary and better perks . There is awful shortage of teachers in medical colleges . In order to get sanctions for medical courses from MCI ( medical council of India ) the colleges show the number of teachers by unethical means . These include the government medical colleges who transfer and retransfer the teachers in order to show the adequate number of teachers prior to inspection by medical council.
The curriculum in medical courses are vague . Take an example of curriculum in medicine in M.B.B.S. course , it states cardiovascular system but does not define the limits where the cardiovascular system begins or ends .
The studies in medical colleges are not research oriented. So there is very little research work going on in medical colleges . Thesis written by post graduate students lack depth and often repetition of some work already done earlier .
Because of poor payment structure , the teachers from medical colleges tend to leave colleges and start private practice which gives them both money and stability . So the bitter truth prevails – there is exodus of quality teachers from medical colleges . The lack of good teachers in medical colleges and hence poor training is one of the root causes of medical negligence .
Once a student graduates or post graduates and thinks of starting practice he has already a significant burden on his shoulders . Burden of finances – during admission for basic medical course or post graduate course a medical student has already spent lot of money in studies even when his non medico counter part pursuing other courses have started earning their livelihood . So naturally here is a situation where a doctor is interested in recovering his money even before he has actually started practice .
The establishment cost for doctors is high . The lack of basic infrastructure like constant electricity and water supply interrupts smooth functioning of his practice . Exorbitant cost of instruments topped with high taxes like octroi on the instruments , high interest rates for loans besides the cost of developing infrastructure which includes purchasing power generators in power starved states makes him indebted to financial institutes for ever .
A medical practitioner today is in extreme tension to meet financial challenges . In view of this he has to work more to pay back loan . For a beginner it is difficult to get patients directly so he has to stress on referral from other doctors which feeds milk to the nasty serpent called “cut practice”.
After all these , once the patient has come , he has to be looked after , operated upon and also has to be provided with round the clock supervision in a decent environment . So the doctor needs to employ more staffs . This adds to financial burden .
A doctor also has to look after few non-medical aspects of his practice that includes maintaining his establishment , taking care of environment , paying taxes , paying dues to employees provident fund , paying professional tax , renewing license of hospital with municipality or corporation , getting registered with labour department , attending medico-legal cases etc. Unfortunately all these government offices are located at different places and have different time frames of last dates . All these non-medical aspects are often more important than the practice itself as the neglect on these fronts have serious consequences .
The doctor has to be of good quality , well trained , - so also the juniors assisting him . – it is difficult to get well qualified MBBS doctors as assistants – so doctors untrained in allopathic medicine like BAMS and even BHMS doctors are employed to look after the patients treated by practitioners of allopathic medicine . Hence there is every chance that something might go wrong .
In order to treat medical negligence , there is a need to look in to above problems. I have few suggestions -
a. Reduce cost of medical studies basic courses like MBBS as well as post graduate diploma and degree , reduce fees structure , abolish donations ,
b. Abolish caste and religion based admission to medical courses .
c. Allow the graduates of other pathies to work as assistant to allopathic doctors by including the basic allopathic courses in their curriculum
d. Include teacher’s training program in post graduate level before a doctor is allowed to teach medical students
e. All medical establishments should be provided with uninterrupted electricity and water supply .
f. All government offices should have single common window system so that doctor need not be harassed at various government offices and need not waste time on non-medical issues.
g. Give loans to doctors at cheaper rate and waive off the taxes from life saving medical instruments
h. Recruitment of medical teachers and their promotion should be only on the basis of merit and experience and on no other criteria like caste , creed and religion .
i. Liberal scholarships to economically backward students

Sunday, October 18, 2009

My Step Wife

She is a new entrant in my life. Right from the time she came in , she has been by the side of my heart . I feel ashamed but I must admit that she has somehow replaced my legally wedded wife , later stays inside my heart !
I told my sweet wife that its impossible for me to live without this new entrant . My wife was apprehensive , she felt that the new entrant will be more of a nuisance .
She had captured my attention the day I saw her in a mall . She was a point of attraction for everyone around . She was beautiful , slim , attractive , decent and royal . Naturally I fell flat for her . Wherever I moved around , my eyes were always on her . So was of other guys around . More I saw her , more enchanting she looked . I was mesmerised , hypnotised , unaware of the surroundings , just I kept on looking at her , as if the time stood still . I missed my heart beat . As I returned home , I kept on thinking about her . My wife asked why am I looking distracted . I replied that I have fallen for a beauty . She was shocked but thought that I am befooling her .
Next day I brought her home .
Life has been never so nice . She is always with me . Initial few days , it took me time to understand her . She appeared very beautiful but very complex . She had many sharp features . Her qualities were endless . She has a very sharp memory . She can tell me any phone number any moment . She remembers home addresses , office addresses and also keeps appointment record for me .
Morning till night , she is with me . Even at night she is with me . I have become so fond of her that I take her wherever I go . She is with me even in my office .
Occasionally she sings songs in my ear . She is very well behaved and follows my commands as per my wish . If I ask her to keep mum , unlike my legally wedded wife , she follows my dictates and keeps mum till I tell her to chatter again . Whenever she is mum , and still wishes to speak , she transfers her feelings through vibration . Unlike my wife , she does not demand to go to my in-laws house , has no demands for gold , diamond , does not ask for bangles , necklace , or ear rings .
Early morning she wakes me up with a sweet tune . She can remember the faces of people or any scenery and captures these for me . She is talented . She can solve difficult sums . She does divisions , multiplication , addition or substraction in no time . I am weak at calculating percentages . If I ask her to derive a percentage , she does it in no time . She is a wonderful company to keep . My children enjoy her company very much . Strangely enough my wife does not mind a bit .
She is sautan to my legally wedded wife or in other words she is my step - wife . Though she can not cook delicious dishes as my loving wife does , my cell phone is not less than my wife in many ways !

Friday, September 25, 2009

Ganesha drinks milk again

The God has done it again . Last time in 1996 , Lord Ganesha was kind enough to drink milk in different places all over India and this time his parents Lord Shiva and Goddess Parvati did so. Never mind , this is all in the family !

Since time immemorial we know that the God has special liking for milk and milk products . In so many temples the paintings and sculpture show lord Krishna drinking milk , curd and stealing butter .

But the question is whether the idols really drank milk ? The students of physics have easy explanation . The so called drinking of the milk by idols is actually the phenomenon of capillary action whereby the liquid tend to move up into a capillary . If you dip a biscuit in to a cup of tea , tea not only wets the part dipped but it wets the part of the biscuit above the level of tea .

Whether the God drank milk or not , but the news – starved television channels were delighted . The mobile companies too had a field day as they minted money through SMS . ( e.g. whether the idol would drink one ounce of milk or 1 gallon , send a SMS !!! )

Offering food to God is symbolic in nature . This is in fact thanking the supreme being for giving us food .The food offered to the idols are not really eaten by the God but by the people who worship Him . In fact the Creator Himself does not need any food , water or milk . These materials have been created by Him for the living beings in the world .

Over centuries , the idol worship has led to many misgivings . In almost all temples , milk , curd and ghee are poured on the idols as a ritual . Those who do so should think about thousands of mothers and children in the country who go to bed without food . These poor people can only dream about milk . Many children do not know how butter looks like . These costly and high protein nutritious substances go down the drain in every temple daily .

During snake festival Nagpanchami , milk is offered to the snakes with the hope of getting blessings . But milk is definitely not the natural food for snakes . In fact milk is harmful for snakes .

In south India , statue of Mahabali is bathed with tons of milk , curd and ghee . In the name of worship people do havan or yagnya in which wood , ghee , food and vegetables etc are put into fire . The same philosophy is stretched to the extreme limit in the sacrifice of animals and even humans in the name of pleasing gods.

People offer not only milk but gold ornaments , diamonds etc. In fact daily collection in one of the south Indian temples cross a crore . There is nothing wrong in faith and beliefs provided the fruits are utilized for some good cause .

Rabindranath Tagore had penned “Tomar poojar chhaley , Tomay bhuleyi thaki” which means that in the process of following rituals , I forget Your true self .
( I forget that you are much beyond the stone idols, you are omnipresent and omnipotent .)

The idol worship was practiced mainly for meditation purpose so that the wandering mind can be controlled and focused . But over a period of time people started identifying the idol with real God which led to many ill conceived practices including animal and human sacrifice .

History tells us that the Somnath temple was destroyed by muslim invaders 17 times. This temple was a very rich temple those days . Temple property was looted and taken out of India . The temple had a Shiva-Lingam which people believed that it possessed many powers . They thought that the moment the enemies touch the Lingam , it would burn the enemies in to ashes . But it did not happen . The invaders virtually looted everything without any resistance from the devotees . Hindus looked helplessly with a hope that some miracle will save the deity but in vain . They forgot that the god is far beyond the stone idols , in fact He is in our heart and mind .

God is not to be found in temples or palaces , He would be found by the side of the road breaking stone or in the fields growing grains , It is worth searching Him amongst the downtrodden hapless poor people .If at all you wish to feed him milk , feed the poor , it shall reach Him automatically .

I remember a hymn learnt long back during my school days . It said --

“When I was hungry you gave me to eat
When I was thirsty you gave me to drink
Now enter into the home of my Father
For whatsoever you do for the good of your brothers
That you do unto me”

Friday, August 21, 2009

Bulls of Barcelona

It was a bone chilling experience .
I was witnessing a sport in Spain which has been going on since time immemorial. It was a bull fight . With the display of the colourful band , fierce bull rushed inside the ring arena . It found a man inside and rushed to crush him under its mighty hoofs. The man was expecting this attack so he jumped over the boundary to clear off the attacking bull. The mighty bull then started thumping its hoofs on the ground . And there entered a warrior with a flag mounted on a sharp arsenal . The angry bull now attacked him but before it could pierce the man with its sharp horns , the man had pierced the sharp arsenal on the back of the ferocious bull . The crowd became ecstatic . There was appreciation all around and the man jumped the boundary wall like a hero .

The stadium was jam packed . I reached the stadium before-time lest I should be denied a ticket . My daughters accompanied me but were not allowed inside as they were below sixteen . As I stood in the queue , horse mounted police force took up position to ward off any kind of disruption by animal lovers who had assembled to protest against the cruelty to the animals . They were people from different walks of life who assembled in front of the stadium carrying placards depicting the photographs of poor animals being injured by almighty humans . Something inside me cried aloud and I was about to return back from the venue but then my curiosity won and I purchased the tickets .

It appeared to me right from the beginning that the bulls were intoxicated possibly with opium or alcoholic drinks . Their ability to judge and then attack was missing . After the sharpened arsenal pierced the bulls , there entered warriors ‘picadores’, mounted on horse's back and armed with a sort of lance. The horses were huge , muscular and tall . The horses were covered with protective coverings . Their eyes too were covered with clothes to prevent them from seeing the attacker . The ferocious bull attacked the horses . The warrior sitting atop the horse attacked the bull with the arrow and pierced its chest wall . A gush of blood came out of the wounded chest . The bull lost a lot of blood following this attack. It had become weak and also confused . It was unable to understand as to why he should be a target of such inhuman attacks by human being .

And then the real hero ‘torero’ descended on the scene . He walked up to the centre of the arena , waived his hand carrying a sharp sword muleta, in one hand and a small red rag in the other . He waived the red rag at the bull . Bull rushed at him but could attack the cloth only as the warrior had moved to a side . This game continued for quite a while , the warrior would enrage the bull with red cloth , bull would attack towards the red cloth but the man behind would just move a bit to a side to score off the attack , the bull would get enraged further to attack with renewed vigor . But the bleeding bull was getting weaker every moment due to continuous blood loss from the inflicted wounds . Soon it was damn tired and was unable to move quickly . The hero then attacked the bull with his sharp sword to pierce its heart . The bull fell on the ground , convulsed a little , vomited blood and soon became motionless . There was excitement all around . The crowd started shouting with joy .

This was followed by a play of band and second bull was deployed for the game . The same routine followed , this bull too was intoxicated , repeated assault by the warriors well dressed and decorated , and final assault by a hero who fought with a tired and weak bull who was at the verge of death any way due to incessant rapid loss of blood . To my utter dismay , there was cheers all around , viewers were ecstatic with joy as their hero triumphantly killed the animal . This show was repeated many times but I could tolerate no more , my heart was pounding as if it would come out of my throat . I was saddened by the fate of poor hapless animal . I came out halfway from this terrible show of inhumanity and pseudo-triumph.

Wednesday, April 8, 2009

.................Thus justice is done

“You are fined Rs. 500/-”, said honorable judge.
“Saheb, I am not guilty “, replied Ramdeen.
“Thousand rupees”, judge ruled .
“Saheb, please, I am a poor man”.
“Thousand five hundred or fifteen days imprisonment”, judge closed the file and took up another case.
Ramdeen could not pay any fine hence was jailed for two weeks. I knew Ramdeen since last four years . He has been visiting me for health checkup of his second child who is suffering from kidney ailment. This time he came after an unusual long gap. “How is it that you came after such a long time, Ramdeen? “I asked.
“Saheb , its all game of stars”, he replied . Later he narrated the chain of events that led him ‘behind bars’.

Ramdeen used to sell cloth bags at one of the busiest traffic points in the city . This was his only source of income . He was blessed with a daughter . At a very tender age of two, she had developed redness of eyes and gradually lost her vision. Ramdeen took her to government hospital but did not get any benefit. His second child, a son, was healthy but had developed nephrotic syndrome, a kidney ailment, for which he used to visit me frequently. I was moved by the tragedy of his children. I took opinion of my ophthalmologist colleagues . The girl’s blindness was caused due to Vitamin A deficiency. But by the time she was seen by my colleagues, her blindness had become irreversible.
Whenever her father and brother would visit me, she would accompany them holding hand of her brother . My heart would bleed for the poor child .

Off and on, police constables would pester Ramdeen for putting up the shop at traffic point . Everyday, police constable would take bribe from him and let him do his business . But one evening , he could not bribe the constable on duty and hence he was arrested, produced before the court and fined . He was told to pay a fine of Rs. 500. When Ramdeen tried to explain it to the judge, his penalty was doubled and then tripled. As he was unable to pay penalty, he was put behind the bars.
“ I have stopped selling cloth bags , sahib”, said Ramdeen. “ I am working as an attendant in a shop now ” , he replied.
“But why have you given up your business of selling bags?” I enquired.
“Saheb , in my life , I have never been humiliated so much. I had never seen the prison before . I always thought prison is for thugs . For initial two days even my wife did not know my whereabouts. She was shocked to learn that I was jailed. My neighbours look down at me and my family. Even the children from the neighbourhood have stopped playing with my kids.” His eyes turned moist. “ I shall never sell bags again, it has robbed me of my pride.”
I could understand that Ramdeen has lost confidence in himself. The judgment delivered by the judge changed his life. There stood the man humiliated and shattered, father of two ailing kids, one of them being blind forever . I looked at the far window to hide tears in my eyes .
After a few days I happened to pass by the same traffic point where Ramdeen sold his bags. There still were a few bag- sellers selling cloth bags. A police constable was standing nearby sharing some tobacco with them , but Ramdeen was not to be seen . I have not seen him since long now.

Thursday, March 26, 2009

Hysterical Hindustan

(This article was written before Ashwarya Ray and Abhishek Bacchhan got married)

Don’t worry , be happy Hindustan , this is Hindustan news channel bringing you head lines - Ash and Abhishek have got engaged . Its time to celebrate Hindustan !

What did you say ? Farmers committing suicide ….. Oh , it is routine affair . It occurs very frequently , in fact its happening over three years now , it will go on happening as the authorities continue to be in deep slumber . How can it be the prime news ? Forget it , now elevate your moods , wipe the tears , it’s the time to celebrate , Ash and Abhishek are getting married .

Oh no , not again . Why are you in blue mood over load shedding ? You do not get electricity for 4 hours in your town and for 12 hours in your village . Don’t you worry . When our favorite starlets get married , you shall see and enjoy what electricity look like . The best lighting of the century shall be displayed in their wedding . The world will remember for ever the great show ! So worry you not , Hindustan , forget load shedding , its time to celebrate , Ash and Abhishek are getting married .

What if the Uttar Pradesh Chief Minister Mulayam Singh did not visit Noida where hapless children and innocent girls were tortured , their body dismembered and bones thrown in to garbage , but don’t you realize that Mulayam is the only Chief Minister to express his overwhelming happiness over marriage of Ash and Abhishek . In fact he has deputed his lieutenant Amar Singh for Herculean task of making arrangements for wedding of the starlet duo . After all , such ‘small’ incidents of murder do happen on and off . You should not be anguished for such insignificant incidences , elevate your mood , see , Ash and Abhishek are getting married .

Water scarcity ! What is that ? Every one knows that during summer you shall be without water and electricity . Why do you worry about such routine things ? The authorities will dig the wells once water scarcity starts . The health care facilities ? Don’t you ever say that ! We have severe resource crunch for these basic things of life . Now we bring you a news flash – Ash will be wearing anmol Benarashi lehanga worth Rs two lakhs for wedding . This is only lehanga , don’t ask about georgette and bandej saris in varied hues including pink , scarlet , mustard , royal blue and magenta with exquisite pearl and stone work , ornaments , Italian chappals for Ash , best designer outfits and German shoes for Abhishek , Swiss diamond studded wrist watch for both and a party to be held in an exclusive yacht over pacific ocean where a chartered flight shall ferry the guests . The wedding itself will take place in some palace of Jaipur . Oh , how exciting !
Never mind if the amount spent can feed and rehabilitate the starving hundreds of Melghat for ever .

The rapes , day time robbery and murders , rising prices , corruption , suicide of jawans at the frontiers , battering of cricket team in South Africa , closure of factories and small scale industries ….. ….. these can no longer be the head lines , oh , Hindustan , these happen day in and day out . Don’t worry and be happy , see , Ash and Abhishek are getting married . In the mean time we assure you that we shall bring you the latest details from time to time about premarital gossips , shopping , wedding , honey moon , pregnancy …………,......., .........

Saturday, February 21, 2009

Divine Sticks from Mahabaleshwar

Mahabaleshwar is a holy place . It is situated in the Sahyadri range of mountains along western coast of India . Besides natural beauty , temples and serpentine rivulets , this place is also famous for beautifully carved walking-sticks . It is believed that prayers made here always come true . I have a feeling that the sticks from Mahabaleshwar are as effective as prayers . I have a reason to believe so.
During my childhood , we used to stay in railway quarters . We six brothers and two sisters with parents lived in a quarter admeasuring about 600 square feet - courtesy South Eastern Railways . I was the seventh child of my parents . Our home was shabby for more than one reason . There was always more luggage in our home than needed - some useful , many useless , mostly such items which were never to be used but could not be thrown out either . As if the number of children were not enough , we also had two pet dogs . Not surprising then that in spite of all efforts of my overworked mother , the home remained shabby .

My Mejda ( second eldest brother ) had brought two walking sticks from Mahabaleshwar . These were well carved with beautifully decorated handles . The grips of the handles were designed like the head of Chinese dragon . Mejda brought these sticks for two reasons , one - to decorate the walls of our otherwise shabby home and the other that they would prove handy in father’s old age. Well , the second logic did not amuse my father !

My father was always worried about the future of his sons and daughters . “Alas ! I wonder if my children will ever become manush ”, he often said . ‘Manush’ in Bengali means good human being and amanush meant a spoilt child . I , his seventh child , was far from being a manush , in fact I was more of amanush.

There was a mango grove next to our school where I studied . During the school periods , instead of concentrating on what the teacher taught , my thoughts would hover around the branches of the mango trees . In the recess , we all friends would play hide and seek game in the mango grove . I used to rush to these trees and hide among the branches , while my classmates would search for me frantically .

Once I spread itch – powder on the benches and desks in the class room and later when powder showed its effect , all the kids started scratching their body and I had a hearty laugh till I got a good thrashing from the head teacher . In short I was a naughty and lazy student .

I never lost any opportunity to gossip . In fact I loved to listen to other people gossiping , especially the elders , as that seemed to be the only available entertainment for them in our small town. Needless to say most of my time was wasted like this. Once , just a month prior to exams , a family acquaintance visited our home . He started telling stories about some Bengali hit movie he had seen in Calcutta . I was glued to the spot voraciously gulping his make belief .

My Mejda was an army man ,a strict disciplinarian . He disapproved of all this especially wasting time before exams . He was home for his annual leave and was watching all that was going on for sometime , silent but disapproving . When suddenly….

Dham ..dhoom … dham ..dhoom …. crack , the stick broke on my back . It happened even before I realized what hit me. Unable to tolerate my wasting time Mejda had silently brought down one stick and then ……. This had two immediate effects . Firstly , from that day , I stopped wasting my time in gossiping . Secondly , my father was apparently very happy . Sticks no longer reminded him of his old age .

Many years have passed since then . My father is no more . I do not know whether I have fulfilled my father’s dream of my becoming a manush . I often tell my Mejda , “ Brother , your one stick has made me a kidney specialist , you should have broken both the sticks on my back , then possibly , I would have become a manush in the real sense .”

After all , the sticks were no ordinary sticks , these were divine sticks from Mahabaleshwar !