Tuesday, June 21, 2011

Printer's devil

We Indians love ostentation and pageantry. I have written about this on earlier occasions. This love is across the board. Poor people if unable to have the artifacts that make up the show would like to watch the wealthy and powerful decorated in them. One has to only look at the bejeweled Indian bride or Indian army general in his full regalia or a person about to receive a diploma from a university to appreciate what I am saying. The stage set for these ceremonies too reek of vulgar ostentation [vulgar to my eyes, of course].Talking about degrees and diplomas; there are two verities of these. One variety is that the person who is getting them deserves it because he has slogged and worked for it and passed rigorous examinations and has thus earned it. The other is that he has been awarded one. Those who belong to the latter class are interesting persons. They need to have one single qualification. That is they should have the proper connections, preferably political. Most vice chancellors of universities and each state has several universities, are political appointees and are thus amenable to pressure.

Let me give an example. Mr B is a two bit poet. But he thinks that having published few poems in the local daily and having given some lectures on the place of poetry in modern day life, thinks that he deserves to gel a hon. doctorate. He has his classmate, Mr C, who has become the state’s education minister. So he pesters the minister to recommend his name. For The education minister, this probably is the least troublesome request. He gets many more which are very tough to oblige. This one is too easy. So he shoots of a recommendation to the vice chancellor who is beholden to the government. So among the many, Mr B too is given a Hon Doctorate [D’Litt]. On the appointed day, an emotional Mr B accompanied by the admiring family and few friends goes to the venue. He is made to wear a ornamental gown and a head gear and the chancellor makes laudatory remarks on the literary achievements [speech written by an underling], calls him over to receive the scroll. To register the momentous occasion photographs are taken from many angles.

Mr B, then on becomes a firm believer in his literary merits and makes it point to drive home this to all and sundry who cares to visit him. His conversation begins with,’ you know when I was awarded to doctorate---.’ We have a flood of these doctorates. Film stars, politicians, social workers, artists and even professionals have become doctors of literature or Philosophy, and proudly display [prefix and suffix] these ill gotten letters with their names.

Some years back, a well known social worker’s name was recommended for an honorary doctorate. He was an exception to the rule; in the sense he really deserved it. He came to know of this. Instead of being happy he got worried and wrote to the university to please not to honor him. Those close to him told me that he felt that the work he is doing gets downgraded if he accepts this award!

Talking about earned and unearned degrees, we doctors are no exceptions. We know a large section of our clientele get impressed with our qualifications. We also know that hardly any one checks what the letters in front or before the names really mean. Usually, M.B, M.D, M.S D.M, MCh, DNB, PhD are earned qualifications in India. M.B. MRCP. Phd are earned ones from the UK. In the US one’s qualifications are rarely displayed. For them a simple MD will do. But here we can get any number of degrees and diplomas by virtue of being in the profession for some years or by paying a fee. FRCP,FCCP. MCCP etc .etc. Some doctors have a penchant for acquiring these hon. diplomas in addition to their real earned ones.

35 Years ago I was an office bearer of the local medical association and we had a president whom I will call Dr P. This doctor P was a well qualified specialist with both Indian and foreign [earned] degrees. But he like the others also had a string of other diplomas next to the ones earned. These letters occupied the top line of his letter head.

We organized a major conference and I was the organizing secretary. We had to get some stationary printed giving the conference details etc. Those days printing was primitive compare to the present day. Composing was a laborious process and was done by hand. Based on the recommendation of the president who used to get all his work done by a particular printer, I went to see him with my order. Before placing the order I wanted to see samples of his work. He knew I had come with recommendation from Dr P. So he began showing the samples and the first one he showed was Dr P’s recent letter head. It read, Dr P………….M.B.B.S, M.D, M.R.C.P, [UK] F.R.C.P, F.C.C.P. F.U.C.K [UK] F… etc etc, occupying the whole top line. Intrigued, I asked the printer what these letters F.U.C.K meant. He said.’ I don’t know sir, I have been doing work for doctor for many years and don’t know the details, you should ask the learned doctor, he has so many of these.’

After a few days, I had to meet with Dr P in his chambers in connection with the conference work and I asked him about this special qualification of his, that too from UK. Taken aback, he took out his letter head and there it was for all to see, F.U.C.K [UK]. How many years this printer’s devil had gone unnoticed, even the good doctor did not know.

I leave it to your imagination what followed.

Recollecting this brings on a smile even after so many years.

Wednesday, June 15, 2011

Female feticide

Readers of my blog are aware of my irritation whenever a mention is made of my country is progressive and is going to be a super power in the years to come. I have often written the reasons for this. One more addition to this disgust.

Couple of days back the newspaper carried an item of finding ten dead female fetuses. Imagine this scene where a mother agrees to kill/abandon her own baby just because the baby is female. Ten mothers must have done this at one time and apparently it must have been from an institution based facility. This attitude is not confined to economically and socially poorer section of the society but is spread across the board. The rich and well off resort of feticide in utero by getting the sex of the child determined by sonography. The law does not permit determination of sex this way. But who cares for the law in this country?

Why is it so? The reasons are mainly economic. The girl child is a burden as she is not going to be economically or educationally empowered. She will remain illiterate or semiliterate and will await her marriage [ultimate doom or salvation].The rich too feel the female child a burden because of the same reasons. They spend enormous amounts of money in getting the girl married and often even educated girls are victims to this malady.

What is the solution? Economic empowerment and a movement to boycott ostentation in performing marriages is required. Women should learn to say no and should not consider marriage as an end all of life.

The best example of social empowerment of women is seen in Kerala. Matriarchal society, women’s education and employment have resulted in their social and economic emancipation and there is no reported case of female infanticide in Kerala.

There is already a skewed sex ratio in the BEMARU states. If you take the census of younger people it must be worse. There may come a time when like Draupadi [one of the main characters of Mahabharata] a woman may have to manage many husbands. Worse still is the scene where like water wars, women wars may be fought amongst men. Will the status of women get better then?

I wonder.

Monday, June 6, 2011


It is nice to write about nice things and events that happened in your past. But it is not so when you write about unpleasant events. Also one has to be dispassionate which is difficult if have witnessed them and also suffered the consequences of such events. Most of the years between 1966 and 85 have been years of suffering for us Indians. When I say Indians I mean law abiding, taxpaying ones. The one person who is most responsible for this suffering was Indira Gandhi.

I have vivid memories of many of her misdeeds. The outstanding one was not her declaration of emergency but of my old mother standing in the long queue for daily necessities such as soap and tooth paste in front of the so called fair price shops. She coined many catch words which she used liberally to hood wink all of us. One of her favourite one was called garibi hatao. Garibi hatao is a Hindi sentence for removing poverty. Who wants to be poor? So when she said that all the poor persons, and their numbers were much more than it is now, felt here comes a savior who is going to get them out of their misery. They even went to the extent of calling her Indira Amma [mother]. But what this amma succeeded in doing was to spread the poverty and not remove it.

She considered that ends are important and not the means. This led to wide spread corruption and probably she was responsible for institutionalizing corruption and what we see today as the greatest danger to our lives began during her regime. Another scene that haunts me is the hordes of slogan shouting hired persons [hooligans] ferried to where ever she was speaking. The going price then was ten to fifteen rupees. Now I believe it is two hundred! This paid crowd gave an impression of her immense popularity. Our entrepreneurs, businessmen soon realized that only way to survive and prosper is to tow the line which strengthened the license and permit raj and a pliant corrupt beurocracy helped her do what she wanted in the name of socialistic progress. A fledging business house which knew the ropes managed to import an entire factory as scrap metal and get away with it. Many who had no scruples prospered at the cost of those who could not or would not do this. Many of the big names in Indian business today owe to the policies of the then Government of Madame Gandhi for their success. The beurocrat and the politician ruled the roost at the cost of common man. Poverty was visible everywhere. It was common to see nearly naked people going about [less common now].Nutrition status was worse than it is now [even now it far from satisfactory]

Was there no one who protested? There were and the frustration of the people took the shape of Sarvodaya movement under an old Gandhian and erstwhile friend of her father called Jayaprakash Narayan, It succeeded in ending her rule but her rule had so emaciated the opposition that no sooner they came to power they forgot their objective of good governance and began fighting with each other. Can one imagine, the JP experiment lasted two years and the people chose Indira Gandhi once again to head the nation? We were back in square one.

Indians have been good sycophants. This was so under the Hindu Rajas, Turkish Sultans, Mogul Nawabs, and the British. It is easy for us to say yes than no. When we say yes it may mean no as later events prove. We also are very prone to bribery both in giving and taking. This has deep roots in Indian Psyche. It was common in the past to go with a gift when you went to see a dignitary. The raja then reciprocated with some reward. It may a gold coin, a necklace, a bangle or a piece of land. This gift giving and taking has continued over centuries and got institutionalized even when the gift taker is being paid handsomely by the government. It reached its zenith under Indira Gandhi [some who are keen observers of present day politics may say it is worse now]

The name congress I is not to be confused with Indian national congress. It actually stands for congress Indira! The old Indian national congress was killed by madam and her supporters in a very undemocratic coup and the present generation of congressmen are not bothered about history and behave as though they are the inheritors of Indian national congress.

Was there nothing right with Indira Gandhi? Of course there was some. Like her father she was non communal and very brave. She also took some historic decisions with far reaching consequences. One such was sending troops to liberate East Pakistan [now Bangladesh].This she did despite the threat from the US not to do so. The other was nationalization of Banks. Today if you see banks at every nook and corner of the country, the credit should go to her. That certain degree of inefficiency too came in with nationalization is another matter.

The most unethical of all actions was probably was abolishing the privileges [privy purses] of the erstwhile princes. A solemn promise made by the constituent assembly was undone by an act of a puppet parliament. That they any way were an anachronism in a modern society and would have vanished in the course of time is a different matter. But the act was unethical to say the least. To her what mattered was the end and means really did not matter.

What we are witnessing today in the political scenario where the powers are afraid of enacting a law to get hoarded money back to the country is the direct result of those policies of license Raj. The beneficiaries who have stashed away their ill gotten wealth have direct links with this generation of businessmen, beurocrats and politicians and therefore the reluctance.

Saturday, June 4, 2011

Master check up/Annual medical/general physical and such other frauds

Screening for disease is big business. When one needs screening? Does one go and screen the general population? And if so what ailments you screen them for?
These are important questions not only from the point of people’s health but also from the larger issue of economics of health.

Let me illustrate this by a case story which motivated me to write this piece.
He was a 34 year old man whom I will call Mr S, who came to see me two days ago.
Mr S said without any preamble. ‘Your friend, Mr Y asked me to see you,’ he said. This friend of mine is an unavoidable evil [wrong metaphor to use, matter of fact he is very good human being]. He continued without interruption,’ I have liver disease and also high fat in my blood and doctor wants to put a tube down my throat’

I could see he was very agitated and very anxious. Just to put him at ease I asked him who is the doctor who has said so and asked him for some details.

‘Sir, I went Hospital M for my annual medical examination and they found out I have these problems. And they want to admit me. I know Mr Y, your friend and he asked me to see you before getting admitted’.

I went through the annual medical examination reports.

The following tests were conducted. The reports were all in an eye catching folder with all the details of the hospital’s virtues prominently displayed on the envelope.
Complete blood study, ESR, CRP, Chest X-Ray, Abdominal ultrasound scan, Urine analysis, Liver function tests, Blood urea and Creatinine, Blood lipids, Sugar both fasting and after food, EKG, Echo cardiogram, Lung function tests, Audiometry, Eye examination, A physician’s sport and a dieticians consult.

The liver function test showed a marginal rise in blood bilirubin [1.6 instead of 1.4] and his cholesterol levels were marginally high. I found no need for him to undergo and endoscopic procedure, neither a need to take any cholesterol reducing medication as advised by the physician. What he need was a regulated diet with an hour’s exercise and a redo of liver function after 4 to six weeks. Most of the tests that were done on him were unnecessary to say the least. What was the hospital’s screening programme was trying to do?

The answer is very simple.

It was designed to create patients and also is easy pickings. The patient had spent a packet on these tests.

Then was there nothing wrong with the patient? There was something wrong. He had bilateral Hydrocele [collection of fluid around his testicles].This might need surgery at a later date. How was it that it was missed in all this gamut of tests?
Again the answer is simple. None bothered to pull his trousers down to check his genitals!

So what is the lesson to be learnt? Is screening for disease absolutely unnecessary? I would not say so. It is unnecessary in the sense it is not cost effective and detects very few treatable illnesses. Instead there should be what is called selective screening. Let me elaborate. Cancer breast has a strong hereditary bias. If there is a strong family history then the screening for breast cancer in the siblings is worth the effort. Doing mammography for all women is astronomically expensive. Other examples are Heart disease and diabetes. If there is a positive family history then the children should be screened periodically. Probably the most cost effective tests are a blood pressure check and a blood check for diabetes. All others are waste of good money. A normal lipid profile [blood fat study], liver, kidney, lung, eye, ear function will remain so for many years. Then what is the rationale of doing all this, year after year?

The answer is again simple. Keep this farce of a programme gong and create patients whenever it is possible.

What is the final line?

Screen for disease in the susceptible and leave the rest alone. They will be better off without our interfering.