Saturday, June 11, 2011

Eternally late

8 pm , 5th June , 2011 .

Howrah railway station .

The platform was overcrowded . Thousands of passengers from Kolkata and nearby have gathered to catch Howrah – Mumbai Mail . The train has not yet been parked at the platform , it shall soon arrive . Sourabh , my nephew has come with his luggage to catch the train to reach Nagpur for some important family event .

Clock struck 8.15 pm , departure time , but the train was no where in sight ! Gradually time ticked away , 1, 2 , 3 hrs , train was not in sight . There was no announcements , the officials said that they do not know about the status of train . Whole night people were stranded in the platform without any proper information about the train . Saurabh , finally got tired , he had a wink of sleep for few minutes . at about 4 am , he was not able to keep himself awake .

At 4.30 am , he opened his eyes , his baggage was no where to be seen . These were stolen . His all belongings , ticket , money and all important documents were all gone . Finally the train arrived in the platform at 4.30 am , and left at 5.30 am without Saurabh , as he did not have ticket and money .

The train was late by over 9 hrs . This was not an isolated event , this is happening day after day , months after months daily since last 8 months . All the trains leaving Howrah station and which pass through so called Naxalite infested areas at night are delayed by over 8 hrs so that the trains pass through these supposedly dangerous terrain only during day time .

We are in a democratic country , where the law of land prevails , an elected government exists . But there is no answer to this situation . The authorities do not declare that the train timings have been changed and the trains will always leave after 8 hrs of the scheduled time of departure .

My daughter aged 11 years asked me , “ Papa , who are naxalites ? How do they look like ? Are they terrible creatures ? ” “ No my dear , they are humans like you and me !” I answered . “ Then who are they papa” , the innocent child asked . “ They are educated but jobless , homeless , poor tribal who create law and order problem .” “ Why is it so , papa ? ” again the simple question .
I looked at the ever inquisitive child .

How can I tell her about land mafia , mining mafias , corruption , government apathy , swiss bank accounts of our beloved leaders whom we have voted to power !

A tale of two friends

Circumstances change our attitude . What may appear obviously wrong today may seem appropriate tomorrow . The same situation or event may appear proper or may appear totally bizarre depending on which side of the fence are we .
Ramu and Raman are two close friends who studied together in primary school in a village . Ramu was son of a farmer who continued his studies to become a an agricultural graduate and devoted his life in village only . Raman , son of a businessman went on to become an engineer , did MBA and settled in Mumbai . He is a top executive now .
So far so good , the stories differ from now on . Ramu remained a middle class person , earning just sufficient enough for his families’ livelihood . He has a small farm and is happy with it . He walks a lot in his farm , grows plenty of vegetables , the people in the village know him closely and come to him often for any reason . He has many friends to talk to , celebrates various festivals with joy and gusto .
Raman on the other hand is a top executive , earns a lot , strives hard for more and more , has lot many responsibilities , has put money on shares , never gets time to walk but tends to travel by Mercedes to save time on travel and also for social reasons . He attends to night parties . He has professional colleagues but no friends . He has a costly cell phone as company . Drinks and smokes are his compulsion if not a choice . He became irritable , gets bodyache , headache and is constantly under tension .
After a decade , Raman developed diabetes and soon hypertension followed . He had to take eight different tablets to keep his blood pressure and diabetes under control .He soon got frustrated with the chain of events . He remembered his childhood friend Ramu and rushed to his village . Both met each other after three decades .
Ramu was very glad to have his friend Raman after such a long time , he gave a bear hug and after a lot of gossip under the banyan tree , both sat for dinner together .
Raman asked Ramu , “How much do you earn ?”
Ramu replied humbly , “ Just enough to keep me and my family going , few thousands , but its enough for us .”
Raman laughed at him , “ Only thousands ! I pay that much of tax every quarter . Well what do you drive ? ”
Ramu replied ,” I have a bullock cart and also a bicycle , but I prefer to walk ”
Raman gave him a sarcastic look , “ I always travel by Mercedes. You know it costs 22 lacs . And you know Ramu , I have a flat in 13th floor from where I can see Arabian sea all around . That flat costs two crores . ” Raman looked around with pride .
“ Bhai sahib , should I give you some more rice ? ” asked Ramu’s wife .
“ Oh no , my blood sugar will shoot up ”.
“ Then will you like to have jhunka bhakar , bhai sahib , and also have some baingan bharta . It tastes delicious if you mix it with nimbu-achar ( lemon-pickle ) ” , she asked again .
“ What are you offering me bhabhi , my blood pressure will go up , already I am on 5 different drugs to control it . And pickle ! My doctor will go mad if he comes to know about nimbu achar . I am on antacids round the clock you know . ” said Raman .
After the dinner , Ramu offered him rus malai . Again the Laxman rekha of diabetes came in the way .
While departing , Raman invited Ramu and family to Mumbai . “ Why don’t you come and settle in Mumbai , Ramu ? I shall help you in starting a business there . There is lot of money in Mumbai , you know . ”
“ Yah , there is , but you get diabetes , hypertension and acidity free with that money . What is the use of such money which prevents one from enjoying jhunka bhakar , nimbu achar , baigan bharta and rus malai ?” said bhabhi innocently .
Raman thought that how foolish these villagers are , while Ramu felt lucky that he did not settle in Mumbai !

Wednesday, March 9, 2011

Protect your kidneys, Save your heart

Recent researches show that kidney disease somehow speeds up heart disease well before it has damaged the kidneys badly . Vice versa heart disease can trigger kidney damage . So now it is prudent that heart experts must check for kidney ailments while the kidney specialists should be watchful for existing heart disease in a patient .
Chronic kidney disease, or CKD, is a quiet epidemic: In America , around 19 million Americans estimated to have it don't know they do. The kidneys lose their ability to filter waste out of the bloodstream so slowly that symptoms aren't obvious until the organs are badly damaged. End-stage kidney failure is rising fast, with 400,000 people requiring dialysis or a transplant to survive, a toll that has doubled in each of the last two decades.
And while CKD patients often are terrified of having to go on dialysis, the hard truth is that most will die of heart disease even before their stage of dialysis is reached .

High blood pressure and diabetes are chief risk factors for both chronic kidney disease and heart attacks. But the link goes beyond those risk factors . Once the kidneys begin to fail, something in turn accelerates heart disease, not just in the obviously sick or very old, but even in younger age .

There are three markers of kidney function . Firstly , the rate at which kidneys filter blood, called the GFR or glomerular filtration rate . Second , levels of the protein or albumin in the urine and lastly anemia . As the kidney markers worsen , there are more chances of having heart disease.

What about the heart's effect on the kidneys? People diagnosed with heart disease has twice the risk of declining kidney function in the next nine years. Heart disease narrows arteries all over the body, kidneys included. Also, some heart imaging tests use compounds ( radio- contrasts ) that harm kidneys.
It is thought that both the heart and kidneys send various signals to the bone marrow, which produces a type of stem cell that keeps those organs in good repair. When either starts to fail, this key repair mechanism falters.

What patients can do ?

Any one with heart disease should check for presence of kidney disease as well and vice versa . The tests for kidney disease are inexpensive – just get your urine examined for protein , check your blood pressure and hemoglobin . Presence of protein in urine accompanied by hypertension and anemia indicate advanced kidney problem and need further evaluation .

Remember that presence of protein in urine in any age group is pathological .
Keep the blood pressure below 130 systolic Smoking and tobacco chewing cause narrowing of blood vessels and rise in blood pressure , thus damaging both heart and kidneys . Diabetics must keep their blood sugar under control with diet , exercise and medicines .
Fat content in blood especially low density lipoproteins should be below 70 .
A relatively non-expensive drug called as ACE – inhibitor protects kidneys and delays onset of dialysis .

Saturday, April 17, 2010

Medical Negligence - - - Searching for the 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 . Professional negligence or medical negligence may be defined as want of reasonable degree of care or skill or willful negligence on the part of the medical practitioner in the treatment of a patient with whom a relationship of professional attendant is established, so as to lead to bodily injury or to loss of life.

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 . Negligence means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance, which is required to be maintained by or under any law for the time being in force .

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 practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. 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 .

Treating Medical Negligence ! !

Medical negligence has become a matter of concern . Let the meritorious students opt for a noble profession like medicine . Give them all the support from social and government level. Let the doctors concentrate on seeing patients and not waste time on standing in a que for getting clearances from government agencies .
There is a need to look in to the problem of medical negligence . 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, April 4, 2010

King for a few moments !

By default , I was a king for a few moments .

It was a flight from Nagpur to Mumbai by our ‘ international’ domestic carrier . As I entered into the air craft , I handed over the boarding pass to the air hostess .Interestingly and to my surprise , after seeing the boarding pass , she bowed down and respectfully ushered me to a seat . She asked me with respect with a divine smile on her face , ‘ How do you do , Sir ? ‘. She was an edifice of humility .

Soon followed another hostess , she presented me with ice cold towel to clean my face with . After a grueling day at Nagpur , it was refreshing indeed . As I finished , another beauty followed with a tray , ‘ What you will like to have , Sir , fresh lemon juice or water melon juice , sir ?’ I obliged her and asked for water melon juice .

By now I grew suspicious , am I dreaming ! Am I in a real world or in a wonderland or did I rub a magical lantern like Aladdin ?

I have flown to Mumbai on innumerable occasions but never did I have such a grand welcome . I looked around . The seats were broad , spacious , very comfortable , a separate tray holder with each seat , had extra leg space . The seat cushion was more than comfortable . Oh , at last our national carrier has changed its style of functioning - could be due to tough competition from other airlines . Competitions are really beneficial to passengers - so I thought .
As I was getting adjusted to new kind of unusual VIP treatment , I was further pampered by another air hostess , ‘ Sir , which magazine will you like to read please ! ’ said she in a melodious voice . She had brought 15 chronicles to choose from . ‘ Wow , great . The airline has definitely changed for good !! ’ , I thought .

Now time was ripe for the air craft to leave Nagpur .

An officer from the ground staff came to check the number of passengers in the air craft .Soon he was dialing to the air port check in counter , “ Sir , you said 2 executive class passengers , I find three here . ”

Now the things became crystal clear to me . I was offered a wrong seat , in place of usual cattle class , I mean business class , I was ushered on to executive class seat by mistake and hence all the pampering .

Soon I was back to my original seat in poor cattle class with congested seats , neglectful ‘ care you not ‘ air hostesses , torn outdated news papers in the cabin , passengers sitting next to me had dry parched throats , no one offering water even after asking , forget about fruit juices , ice cold towels and up to date chronicles .

I sighed a sense of relief when passengers of both the classes reached same destination i.e.
‘ aamchi Mumbai .’

Tuesday, October 20, 2009