Monday, February 14, 2011

Cricket Crazy

The game of cricket is confined to Britain and its erstwhile colonies. The one legacy the colonies bear cheerfully but have also excelled in. For many decades it was Australia. Australians were virtually unbeatable in playing cricket and in the art of sledging. Sledging is a term referred to acts designed to irritate and do things to get the batsman of the opposing side to lose concentration and throw away his wicket. This is a specialty of close in fielders especially the wicket keeper. Sledging identified, as some wit put it, the hallmark of progeny of erstwhile prisoners who colonized Australia! Words like,’ you want to sleep, there are better places’, when the batsmen went run less, or ‘now you can think’ when the ball thrown at the batsman hits the head [though covered with helmet]can disturb any batsman and sensitive Indians were particularly prone to this some decades back. Now I believe they too have become experts and have taken to saying so in Hindi which the hapless Australians don’t understand and worse likely to misunderstand as it happened between two volatile players, the Australian Symmonds and Harbhajan Singh the Indian. What Harbhajan said to Symmonds in Hindi was ‘Theri Maaki……’ [Your mother’s]. Symmonds heard it as you are a monkey! The two came to blows and the umpires had to intervene. The Sardar [Harbhajan is a Sikh] is not by any means a handsome fellow but Symmonds has some simian features which added color to the misunderstood ‘theri maaki!’ Good it was misunderstood as the Hindi curse has worse connotations. In the enquiry that followed, the venerable and much respected Tendulkar who heard the altercation was hard put to explain the meaning! I believe our own skipper M.S.Dhoni is a sort of expert sledger behind the wickets.

Every three years a cricket extravaganza is held and it goes by the name World cup. Over the years India has taken over as the prime promoter and Indian companies spend mind boggling amount of money on promotion. The centre of cricket and the power is slowly and steadily moving Indiawards. Going by the record crowds that attended the first match yesterday, which was a practice match and therefore does not really count, we are in for a crazy period of six weeks. Incidentally India won! 30.000 cricket fans paid through their nose for the privilege of seeing the two sides fling a ball 600 times at each other! [It is not as simple as that]

When the Britishers left India it was a complete severance. Unlike in other countries where many stayed back, In India and Pakistan none stayed. This is indeed a surprise, so alienated were they from the locals, that they had no options but to leave. The first Englishman who opted for Indian citizen was a defrocked priest called father Vernier [read the famous and well written and researched biography on father Vernier by Ramachandra Guha]. But many of their habits and institutions survived. The game of Cricket is one such. The other is our clubs. In most of urban India there are these bodies where in friends [members] gather mostly to drink in private [not really wholly true]. These clubs have their own archaic rules. Till recently one of these in Bangalore, did not allow women to become members! Even now you cannot enter some clubs in comfortable Kurta and Pajama’s. If you go in a Lungi, it is possible that an elderly member clad in suit will suffer a heart attack.

Cricket caught on like wild fire. It suited us very well. We are an over populated country with a large number of partially or fully unemployed. These found it great to spend time five days watching this game. Those days there were no limited overs cricket which ended in six hours. They could sit back relax, sleep and do nothing in keeping with our national character.
With money and new found affluence this pastime has become a monstrous obsession and addiction and the newly rich cash cows are hell bent on making all of us slaves to this game.

Sadly it includes your truly!

Thursday, February 3, 2011

Drugs Doctors and Patients

How did L. Leela get tablets of Colchicine without prescription? If you are a non Indian reader of my blog you are justified in wondering. If you are a reader from India then you know how and it will be of no surprise to you.

I will tell this sordid story of easy availability of drugs and the damage that this is causing to people with a real life story and follow it up with another later.

Mr C has been my patient for over twenty years, that is, when he is in Bangalore. A senior executive, he is often posted out of Bangalore and seeks attention with other doctors or self medicates. He suffers from high blood pressure and diabetes for which he takes medication and consults doctors when there is trouble. When living in New Delhi he developed pain In his back for which initially he saw an orthopedic surgeon who prescribed him a drug which belongs to a class called NSAIDS [non steroidal anti inflammatory drugs].The commonly prescribed drugs such as diclophenac, Ibuprofen, Indomethacin, paracetamol, aspirin etc belong to this class. He was asked to take one of these for five days when the pain was acute and was asked to report back. He never did go back. Instead whenever he had some back pain he took these drugs and got pain relief. Few months ago he went for his annual medical and he was found to have elevated levels of creatinine in the blood, a sure sign of renal disease. His creatinine levels were near normal when the test was done a year ago. Indiscriminate use of the pain killer had irreversibly damaged his already fragile kidneys [due to high blood pressure and diabetes] and he is now in end stage kidney disease and on three times a week dialysis. This means spending the rest of his life hooked on to a machine for over six hours, three times a week. If the drugs were not available to him and he was forced to go to the doctor this misery, possibly, would not have happened.

How then did Mr C get his Ibuprofen?

n India pharmacies are run by businessmen. The license to run a pharmacy is obtained in the name of a qualified pharmacist who is usually not the owner. Even if he is one, he would be reluctant to let go an easy custom for want of a prescription. Many of them are located near the patient and those who work in the pharmacy are friends of the patient and are unlikely to refuse a request. Old prescriptions are used with impunity and doctors too are to be blamed for indiscriminate prescriptions.

Let me tell you all another ongoing problem a patient of mine is facing. She is a seventy four year old lady who is a severe diabetic with complications and who has chronic urinary tract infection caused by a versatile organism called E.Coli. This one belongs to a class of germs who are called ESBL producing organisms. Meaning there by, that they are clever enough to survive the onslaught of most of the available antibiotics. How did this happen? We doctors to a great extent, and patients to some extent, are responsible. How did she manage to acquire this dreaded multidrug resistant strain? Please go to the website given below and read the article by Dr Chatterjee. How is she being managed? An ongoing struggle for both of us.

On many an occasion the illness especially the one caused by virus is self limiting and no drug is required. Rare is a doctor [of any variety] who says so to the patient. Almost always a drug is prescribed. This is especially so with painkillers and antibiotics. To learn more about the havoc we doctors have caused I draw your attention to an article by Dr Biswaroop Chatterjee [Turmoil over New Delhi Metallo-Beta Lactamase-1: a tale of ersatz patriotism] which has appeared in the recent issue of Indian Journal of Medical Ethics []

Have we, both doctors and patients learnt our lessons? Sadly, the answer is no and the sordid tale is continuing and I shudder to think of the future scene of resistant infections. Probably we will be back into 1930s [pre antibiotic days] very soon.

Scary isn’t it?