Sunday, November 30, 2014

Earlier "noble" now a "heartless" profession

Fortis Hospital, Bangalore
In the midst of the ongoing controversy over deaths of 13 women in Chhattisgarh after their tubectomy procedure another massive case of professional misconduct by doctors was reported the other day from Delhi. For the common man medical treatment is increasingly becoming dicey, given the proclivity of medical professionals towards illegal gratification sought and taken from the pharmaceutical companies and prescribing medicines that may or may not be necessary but for which one has to pay unscrupulously hiked prices.

The two cases mentioned above show some similarities. The deaths in Chhattisgarh were initially reported to have been caused due to botched up operation by the surgeon who was otherwise a reputed professional. Since the entire blame was being heaped on him he went underground and was eventually arrested. In the meantime, however, autopsies revealed that the deaths were not really caused by the surgical procedure but by the post-operative medicines that were administered to these unfortunate women. They were given locally manufactured brand of ciprofloxacin, a commonly prescribed antibiotic, and ibuprofen, a pain killer. Analysis of the antibiotic revealed that it contained poison that is used to kill rodents. The other relevant fact that was revealed that there was no need to procure the drug locally as the same was available in the hospital stores suggesting some link-up between the local manufacturer and the hospital administration.

The other case that has been reported to the Medical Council of India has put as many as 300 doctors under investigations for prescribing drugs of a particular pharmaceutical company when cheaper alternatives manufactured by better-known companies were available. The doctors were, in exchange, being paid substantial amounts of money and were being gifted cars and flats and were also being offered all-expenses-paid foreign pleasure trips. The investigations have been initiated on the basis of an anonymous complaint from Ahmedabad. All the doctors have been asked to produce copies of their bank accounts and passports and present themselves with their originals.

Of late, the reputation of the medical profession – once upon a time considered noble – has taken a severe hit due to the indiscretion and the dishonest ways of many of its members. Perhaps increasing materialistic culture in the country has enticed even the best of medical professionals to cross the ethical line and forget the Hippocratic Oath. It was not so earlier. Five or six decades ago there were hardly any specialists; most patients used to go for succour to general practitioners – medical graduates or even licentiates. None ever recalls any ethical wrong-doing; the physician may have gone wrong in diagnosis but one never heard of commissions from diagnostic clinics or from drug manufacturers. In most cases, the doctor used to have an attached dispensary that dispensed medicines. The development of specialities and super-specialities, upgrading of investigative tools and surgical methods and equipment have, while promising far better healthcare, mixed a lot of poison in the curative potions. Modern hospitals are generally mammoth organisations full of specialities, super-specialities and their concomitant highly qualified physicians and surgeons. Not only the hospitals are exceedingly large, the salaries paid are also astronomical. In order to, perhaps, even to break even these hospitals, their physicians and surgeons tend to compromise on the ethical content of their profession, breaching the Oath that they were sworn to.

In India today there is a race to become (at least) a rupee billionaire (a crorepati). Half a century ago even a hundred thousand rupees were beyond the reach of many. In the absence of a rat race, the professionals retained and maintained the nobility of their profession. Today, in the highly competitive and acquisitive environment, doctors – physicians and surgeons – are also in that race. Armed with a degree obtained after maybe bribing his way to a medical seat, paying a huge capitation and other fees to go through a medical school, then spending years in graduation, post-graduation followed by studies for a doctoral degree a medical student is ready to enter his profession, mostly, deeply indebted. As practicing in government institutions does not quite meet the requirements to square off his commitments, the private, or even better, the corporatized healthcare institutions are found attractive. It is, inter alia, here that the ethical compromises commence.

Receiving a handsome package, he is asked to generate revenues for the corporate house that runs the establishment. The game starts when a patient is viewed not as a human needing succour but as a revenue generating medium. He is asked to go through several needless investigative procedures, he may be admitted as an in-patient quite needlessly and administered drugs that cost the sky, and occasionally gratuitously put under the knife or on the ventilator. I recall a case of a corporate hospital where a lower middle-class boy was kept on the ventilator even after he had died only with a view to claiming a fat bill. In another case a man was subjected to an angioplasty and a stent was placed at the site of the arterial blockage. However, a year later during an angiogram of the same patient in a public healthcare institution of repute the stent was not visible. Obviously, the stent in question was never implanted though the cost was recovered in full. A corporate hospital in the South was caught over-charging for a stent to be used on a patient whose relative knew exactly how much the hospital had paid for it. Reports have appeared of hospitals charging for hip implants that were obtained free on bargains such as buy-one-get-one-free. The hospitals seldom mention in the discharge certificates the particulars of the implants disabling patients from claiming damages in case the implants cause problems later, which they frequently do. Things have become so bad that even Pappu Yadav, a supposedly shady leader, has called doctors “executioners”.

Dr. David Berger, an Australian medical practitioner, writing in the British Medical Journal said that bribes and kickbacks oil every part of India’s healthcare machinery. He had come as a volunteer physician in a small charitable hospital up in the Himalayas. “A model of iniquity”, the healthcare system, he says, is highly privatised extending the facility of latest technological medicine to higher strata at a high price leaving around 800 million people in the hands of inadequately provided and ill-equipped sub-standard government hospitals or, worse, quacks. At 70%, the out-of-pocket expenditure on healthcare in India is higher than even in the US. The editor of the Journal Fiona Godlee had recently urged for stopping corruption in healthcare or else other nations could turn away Indian doctors. A campaign against the evil is being launched starting from India.

Apparently India is not the only country where such unethical practices are rampant. Highly disappointed in the way the healthcare system functioning in the US an Indian-American physician, Dr. Sandeep Jauhar, has, in a candid mia culpa, called it a “heartless profession”. For raising revenues of the corporate hospital doctors now have very little time for patients as they have to check many more than what was actually the practice earlier. He has blown the whistle on American medical practice which he says has “become pitiless, mercenary, money-ripping vocation where doctors treat patients as revenue generators rather than as human beings”. They keep patients in hospitals longer than necessary, order needless tests and cozy up with predatory pharmaceutical companies to sell dangerous drugs. In India it is not much different in the private corporate healthcare establishments. 

 Another Indian-American, Dr. Surya Prakash, has confessed that in the changed environment medical practitioners have increasingly lost that vital much-needed human emotion of “empathy” for their patients. If that is so in the US, perhaps, it is truer in India.

Photo: from the Internet

Friday, November 21, 2014

"The Unity Run" and the later controversies

After Modi’s lionisation of Sardar Patel the Indian National Congress sat up and tried to put the latter back to where he belonged – a high pedestal. In the latest issue of its official organ “Sandesh” it has paid homage to him.

 Modi must have been aware that he would be courting controversy if he gave pride of place to the Late Sardar Vallabhai Patel on the 31st October last. The 30th death anniversary of Indira Gandhi, the Late Prime Minister and the 139th birth anniversary of the Late “Sardar”, the first post-independence Home Minister, coincided on that date. All these years the Centre, marginalising the “Sardar”, had marked 31st October as “Martyrs Day” in commemoration of Mrs. Gandhi’s tragic death at the hands of two of her security guards in 1984. This year, however, Modi decided to celebrate the birth anniversary of the “Sardar” in a big way. Not only was it designated as the “National Unity Day”, a “Unity Run” too was organised in acknowledgement of Patel’s role in unifying India after the British left in 1947, amalgamating 600-odd princely states within the Indian Union. Mrs. Gandhi’s “martyrdom” was reduced to a sort of foot-note to the celebrations.

The inevitable happened and an unseemly controversy raised its ugly head. The Congress accused Modi’s Bharatiya Janta Party (BJP) government of not only marginalising Indira Gandhi but also appropriating a Congress stalwart like Vallabhbhai Patel only to “downplay the traditional Congress heroes Nehru and his daughter, former PM Indira Gandhi”. Congressmen voiced their anger at the lack of plans to adequately venerate the anniversary of assassination of the former PM. Prominent Congressman Shashi Tharoor tweeted “Disgraceful that government is ignoring the martyrdom of our only prime minister who was killed in office in the line of duty.” Officially though, the Congress had no objections to the government’s plans as they too revere Patel. However, a top Congress leader was quoted as saying “no one can overshadow the legacy of anyone.”

The BJP had, in fact, not exactly painted itself in a corner. After all, Narendra Modi, as Chief Minister of Gujarat, had already initiated plans for erection of the tallest statue ever to be erected anywhere in the world only to honour the “Sardar”. He, apparently, has enormous respect for Patel because of the latter’s role in unification of the country. The statue is going to be almost 600 ft tall and will be called “Statue of Unity”. On the latest controversy, however, the BJP says, “There is no question of anyone being pitted against anyone else”. Senior journalist, MJ Akbar, a new entrant in BJP, said on the controversy, “...the row is quite unnecessary. It is not necessary to forget someone to remember another...” He also said that there was a concerted effort to portray Patel as a leader who took anti-Muslim stand. Akbar said that Patel was against Muslim League for demanding partition and not Muslims. It is true, Patel was vehemently against partition but he agreed to partition only after the “Direct Action Day”, also known as the “Great Calcutta Killings”, initiated by the then Bengal chief minister Soharawardi.

 Patel and Mrs. Gandhi defy comparison. Both were, undeniably, great patriots but they lived and worked in different eras and circumstances. While Patel was an important figure in the national struggle for freedom, Indira Gandhi had very little to do with it. The simple reason was that she was much too young to participate in it.  However, the legacies left behind by each could be a basis of evaluating their respective contributions.

It will not be way off the mark if one says that if we are one big nation today it is largely because of Sardar Patel. Had it not been for him India would have not even been like the “moth-eaten” Pakistan that Mohammed Ali Jinnah cribbed about after the Partition. Patel went about meticulously and tenaciously persuading 600-odd princes soon after independence to join the Indian Union. On India’s independence with the lapse of suzerainty over them of the British Crown they had become free to decide either to remain independent or to join one of the two newly-emerged countries. Besides, had it not been for him we would have lost Kashmir as it was he who forced an indecisive Nehru to send troops to defend the state from Pakistani-supported marauders after its accession to India. Likewise, it was he who forced a vacillating Nehru for the so called “Police Action” against the Nizam of Hyderabad and his “razakars” led by Qasim Rizvi. Earlier, Patel had ensured assimilation of the princely state of Junagadh after its Nawab and Divan fled to Pakistan. With determination, tact and sometimes brute force Patel created a unified, monolithic India which exists until this day. But for him this would not have been possible. It was a gift of great significance to his beloved people who cherish it to this day as his most constructive, valued and abiding legacy.

Indira Gandhi’s legacy stands quite a distance away, at the other end of the spectrum. The foremost element of her rule that comes to one’s mind is corruption and its institutionalisation under her rule. Earlier too, there used to be corrupt politicians but those who happened to be corrupt then were milk-sucking kids when compared to her. Daughter of a well-regarded father, she took measures the fallout of which was copious corruption in public life. For instance, she banned as early as in 1969 corporate contributions to political parties. It opened the flood gates of political corruption. Over the years, corruption has got deeply embedded in India’s political and administrative psyche. Loot and plunder of national resources have become the norm regardless of the party in power. The “license-permit” “Raj” that she ran was a source of ill-gotten gains, as, indeed, foreign defence and other contracts. Every opportunity of making money was used to further her political clout.

The other significant legacy of hers is subversion of well-established institutions that ensured smooth functioning of our democracy. Ruthlessly ambitious as she was, she wanted to rule without any irritants like courts or the press or any public institution that happened to be independent of the government. The Emergency declared by her was an example of her relentless pursuit of power. She just bulldozed her way through subverting the parliamentary democracy with its cabinet system, putting the entire Opposition under arrest, amending laws with a brute majority to bend the courts and other institutions of the government to toe her line. Her party men lost all voice and were herded around like cattle. They even acquiesced to her dynastic ambitions and after she was gone sucked up even to her sons and daughter in-law. The political dynasts that later became prolific took the cue from her.

On an objective assessment, therefore, Patel’s legacy stands out as beneficent, while that of Indira Gandhi as baleful.

Photo: From the Internet

Thursday, November 20, 2014

Thirty thousand and counting

Crowd at the Boat Club last Sunday
Last reports said that on the 9th edition of “Rahagiri” in Bhopal last Sunday the kilometre and a half stretch of the Lake View Road was busting with “rahagirs”. As many as thirty thousand and more had collected there and there was hardly any space to move. People, obviously, couldn’t walk, cycle, skate or play any games for want of space. The road seems to have been overwhelmed by “rahagirs” and this after the authorities opened the roads along the RCVP Narhona Academy of Administration and the Campion School on the banks of Shahpura Lake were also thrown open to them where around 15000 collected to enjoy the vehicles-free roads.

Doesn’t all this prove something? Well, it does. It proves how people are fed up with vehicles clogging the roads leaving hardly any space for pedestrians and cyclists. We have too many motorised vehicles while the roads are few and generally inadequate. It takes time and needles money on avoidable detours to cover short distances. Only this afternoon my auto driver (I don’t
At Shapura infront of eponymous Lake
drive in the crowded Old City area) had to take a long detour as there was a big jam near the GAD Square flyover. It was a great nuisance. I couldn’t but pity the students sitting in those yellow buses taking in in copious quantities the noxious diesel fumes. If this is the fate of people in a developing economy I would rather not have this kind of development. I wouldn’t mind going back sixty years when we used to walk or cycle to the schools and colleges. Perhaps, all those who collect for those six hours on every Sunday are harking back to those good old carefree days when life was simpler and less complicated – the roads were free of these miserable automobiles.

One has to admire the spirit of these men and women, boys and girls and of course the children that they, on the weekly day of rest, pull themselves out of their beds travel over long distances to be at the Boat Club or the Shahpura Lake. Had I been younger, perhaps, I too would have joined them – after all I am not immune to the herd mentality. But that is now not possible. Nonetheless, sitting at home I ruminate over what is happening to the Lake with such a huge pressure of people, given the sheer incompetence apart from lethargy of its custodian which is none other than the Bhopal Municipal Corporation. Reports had earlier indicated that trash in large volumes had collected after every session of “rahagiri” and hawkers of food are still around to cause littering. Indians somehow can’t resist eating whatever is available when they are on an outing.

 One can only hope the new Municipal Commissioner, who has actively encouraged “rahagiti”, will take care of this aspect of the movement which seems to be on a roll. The Lake is in his charge and he must take care of it. In my opinion, it is now time cap the numbers of “rahgirs”.

Photos: From the Internet

Wednesday, November 12, 2014


I am writing this only to convey to you the anguish of a large number of people and that of mine at the insensitiveness of your government. How could a responsible administration with hordes of bright bureaucrats could not think twice before conducting an hour-long session of fireworks from various sites around the Upper Lake the other day for which an unseemly crowd of a lakh or so had been asked to collect on the VIP Road? As if the Lake is not polluted enough; as if all the drains discharging pollutants into it have been plugged; as if the motorised boats plying on it have not been polluting it already; as if thousands who collect for the so-called “Raahgiri” days heaping litter on to the Lake were not enough that you had to go and shower enormous amounts of carbon on its waters. The Diwali fireworks this year had been prolonged and the government need not have indulged in another spell of fireworks in this ‘grand’ scale so soon spending massive amounts of public money, unless it was meant for mere self-promotion.

It was a kind of height of irony. Your own government had engaged CEPT in 2011 for recommending measures for conservation of the Upper Lake, the report of which has not been (deliberately?) worked upon yet. And, here was the same government going about polluting the Lake by its own indiscreet action. For God’s, sake, don’t you know that we use its waters for drinking purposes? With the heavy metals released from the immersed effigies of gods and goddesses, the waters are not what one could call potable, the Corporation’s treatment being hardly effective. And instead of improving the quality of water you take steps to needlessly pollute it more with loads of carbon.

You must have blown a crore of rupees, if not more, on the fireworks. Last year, as much as 5 crores were spent on “Jheel Mahotsav” but not a pie was spent for its conservation. The government refrain before the National Green Tribunal has been that for want of money its directions could not be acted upon. The heavily silted Lake bed needs to be de-silted but the government has no money for either buying or hiring a dredger. But there is enough to be blown up on activities harmful for the Lake. It is being exploited to the hilt only to degrade it every day by the thoughtless actions of your government. The Sports Authority of India and the Sair Sapata have already forced the birds to quit their traditional roosting place and damage the Lake’s ecosystem. Now your government is ensuring unmitigated harm to its waters.

 We, who feel for the Lake, agree with the three university researchers who had said last year that by the end of this century the Lake wouldn’t exist as we know it because of the way it is being degraded and allowed to decay. We, however, now feel that this may happen much sooner than that because, given the way your government is hell-bent in destroying it, the Lake will remain a couple of decades from now only as a shrunk and shrivelled small spread of filthy water, unfit for human consumption. A millennium old inheritance is going to be lost to posterity, thanks to your government’s uncaring and mindless actions.

Lastly, a city which is starving for basic civic amenities, where roads are in a shambles, where sewer and water pipelines constantly leak or overflow, where garbage piles up without being cleared and where the landfill in Khanti is burning polluting the environs rendering several people sick your government, according to us, had no business in staging this expensive show. These are only opiates it is trying to administer to the people to make them forget their otherwise miserable quality of life. Remember, people are not fools. They can and will see through these ploys.

DISAPPEARING FREEDOM OF EXPRESSION Rama Chandra Guha, free-thinker, author and historian Ram Chandra Guha, a free-thinker, author and...