March 05, 2006
Damned if you, damned if you don't
This appeared in today's Mumbai Mirror
The resident doctors all over Maharashtra have again gone on strike this week and its that déjà vu feeling all over again.
Every three-four years, since the early-80s, there has been a strike by resident doctors. The issues are always the same: more money, better working conditions and better accommodation. This time the flash-point though, is the issue of security, due to the increasing incidence of doctor-bashing violence by patients within the hospitals.
Should the resident doctors strike?
Think about living, four to a 150sq feet room, with bed-bugs, poor ventilation, terrible food, unclean water, a 24-hours a day, seven-day a week schedule and the constant threat of work-related diseases such as tuberculosis, HIV and hepatitis B, and now, the threat of violence. For around Rs. 8000/month (<150$). Now think how you would feel if the resident doctor were you, or your son or your daughter.
So why is there such a big issue created when they go on strike?
Because, when the residents strike, more than 50% of the city's population is suddenly deprived of basic and essential medical services. That’s right. 50%. 7 million people. So do read on.
Let’s now understand who these resident doctors are!
Resident doctors are the ones who are training for their specialty MD and MS degrees, after having finished their basic MBBS and internship, in colleges, usually attached to large public hospitals, usually run by the government, e.g. JJ Hospital or by the Municipality, e.g. KEM, Nair and Sion. These hospitals provide health-care virtually free of cost to anyone and everyone, even to those who are not domiciled in Mumbai.
The residents, in theory, are supposed to be “trainees”, “training” in these hospitals to obtain the theoretical and practical knowledge that they need to eventually become qualified, specialized doctors such as surgeons, cardiologists, radiologists, etc. - in reality, the authorities get cheap labor to run these public hospitals. In KEM Hospital alone, there are 700 resident doctors and 400 staff doctors, which means that if the resident doctors aren’t around, at least 60% of the work should still go on. In reality, only 5-10% of the actual work happens, because despite their “student/training” status, they are completely critical to the functioning of these hospitals. Even the “peripheral” hospitals such as Kasturba (opposite the Arthur Road jail), Rajawadi (in Ghatkopar), Bhagwati (in Borivli), etc, stop functioning, because they too completely depend on residents posted in rotation from the central hospitals.
Are the residents then morally justified in striking?
Do you really think that we have never agonized about this? This is a demon that has always haunted us, all through each strike that we’ve ever participated in. I don’t have an answer despite extensive soul-searching, but most of us eventually rationalize this action by transferring accountability onto the authorities, holding them responsible for the strike having happened in the first place.
These strikes are preventable, simply because the demands can easily be met. If the authorities were proactive and tried to solve the residents' problems in time, things would not come to this. Expecting this to happen however, is obviously a pipe dream. Maybe, the residents could go to court, and file a public interest litigation. But from where will the resident doctors get the time, energy and money, required to fight a court case on a daily basis? And so, the only solution that remains, is to go on strike, for which there is at least some concerted and determined effort, manpower and time, if not money, available, for a short period of time.
You would think then that the authorities would want to negotiate with the doctors to resolve the strike. Think again!
Who are the people affected by the strike? It is those people who cannot afford private doctors and hospitals, those who earn less than sustenance level and those who live in slums or on the roads or wherever.
The authorities do not care, since these poor people affected by the strike don't really matter. It is not like the Municipal Mazdoor Union going on strike and winning their demands in 24-48 hours, because no one can stand their garbage not being collected.
Moreover, the resident doctors are eventually doctors, who after a few years are going to be in the top 10% income bracket in the country – subconsciously, this affects the extent of public and press support – the authorities play with this fact and so they wait and threaten, wearing down the patience and enthusiasm of the resident doctors, who after all are educated, intelligent, white-collar individuals, completely unused to this sort of a method of protest.
At the end of a month or 40 days (the usual length of a residents' strike), the strike ends, the weary residents accepting whatever few sops the authorities are willing to give. And the authorities magnanimously tell the striking doctors that they will not penalize them for not having worked for one month and will allow them to keep terms - one of the worst fears resident doctors have, is of losing a six-month term or losing registration. Threaten them with this loss and half of them start thinking of capitulating.
Why don't the residents learn from the past? Because, every three years, a new crop of residents is in place. And the lessons of the past are forgotten.
The anatomy of the strike, thus remains the same.
First week - enthusiasm, rallies, hunger strikes, street plays
Second week - some of the less enthusiastic residents go home, some default, some start studying for their exams on the sly
Third week - government threatens loss of term and enthusiasm dips.
Fourth week - most residents want to get back to work.
Fifth week - strike is over
But things don’t end here. Like a tragi-comedy, even after an agreement is finally struck, the authorities do not always fulfill the terms of the agreement. Follow-up by MARD (Maharashtra Association of Medical Doctors), after a strike, is extremely poor due to the fact that the doctors get extremely busy, working, learning and reading for their exams and they are extremely mobile, changing hospitals and rotations all the time. The authorities know this as well and can play around with the terms and conditions any way they want…until the ground is laid for the next strike about three years later. And everything comes full cycle.
Damned if you do, damned if you don't.
Posted by bhavinj at 01:50 AM | Comments (0)
September 11, 2005
Empathy (Or My Lack of It)...Revisited
I wrote about my empathy drying up almost five years ago. Not much seems to have changed.
New Orleans is no more. An entire city…is just gone. When I saw the city under water, on television, I went cold. But as I later told my wife, the reaction did not really have anything to do with New Orleans itself…it was because I immediately thought of a similar scenario in Mumbai and that almost knocked me out. We were unable to handle Terrible Tuesday. Something like this would have killed millions of us, in one stroke!
Uma and Ajit have talked about their reactions and why they haven’t written about New Orleans in as much detail as, for example, Uma wrote about the Mumbai floods. Among other things, I suspect it is a combination of “tragedy fatigue” and distance. Terrible Tuesday hit home, all of us had stories and most of us were affected. New Orleans is on the other side of the globe and unless you’ve been there or know someone (and I have neither been there, nor do I know anyone), at least I find it very difficult to connect.
On Friday, when a few parts of Mumbai were flooded, as normally happens every monsoon, the government agencies and the news media pressed the panic buttons. People at work started getting calls from their parents to leave for home immediately. And as everyone at the same time started driving northwards back home, we got stuck in the mother of all traffic jams beyond Parel. We eventually had to leave our car in KEM Hospital (thank God for these few sanctuaries) and then hoofed it up. When we reached Wadala, we realized that the traffic was actually moving well and we were able to get a cab hone. I finally went back at 11PM and got the car back from KEM.
In the meantime, I was fielding calls from home, from my HRD manager and other employees on what to do! Luckily, being in the arena, and having realized that this was nothing but a panic situation with no real issues, I was able to get some sense into everyone.
In the evening, we took the other car and drove to Matunga Gymkhana for the kids’ karate exams. After dropping Mom to the market, we drove on and landed up in a jam again. I get amazingly claustrophobic in traffic jams and with what we had gone through an hour earlier, I was already on the edge, wondering what “worse-case” scenario had happened.
As the cars moved, we realized what had happened. Some idiots had decided to do a Ganapati visarjan (the only visarjan on that day) and instead of using the by lanes, were merrily blocking the main market road and creating a jam. I just lost it. I got out and let loose some choice expletives at a couple of guys at the end of the procession, especially at one guy who was trying to divert traffic as well!
This is what I seem to connect with. Local issues and personal problems. Maybe it’s a euphemism for selfishness or self-centeredness…I don’t know. What I do know though is that unless the tragedy is close by, images and words from television and newspapers only provide a way for my brain to assimilate the information, but at no point do they really strike a chord.
Damn me!
Posted by bhavinj at 10:51 AM | Comments (2)
August 15, 2005
Patient Empowerment - Definitely not a Good Thing
The Sunday NY Times has a long article on the travails faced by patients in the US, in this modern world.
The article is a must-read for all patients and doctors. It traces the history of the current state of affairs, relating it to the movement for access to information that the baby-boomers demanded in all aspects of their lives, including medicine. As the unquestioning role of the doctor diminished and the patients started feeling empowered in making their own decisions, as the amount of ligitation increased along with the subsequent rise of defensive medicine, it led to a situation where the doctors stopped taking decisions for the patients, started putting choices in front of the patients and asked them to make the call.
That’s like asking a blind man to decide on the path to take at a crossroad, by asking him to read the signboards.
A few years ago, an article in the BMJ (I couldn’t find the link) expounded on this subject as well, saying that eventually the role of a doctor would be that of a travel agent. As patients became more empowered, they would themselves figure out their problems and their choices of treatment and the doctor would only help as a facilitator.
This is all so much bull-shit.
The majority of people do not know where their liver is, most can’t even pronounce the word “diagnosis” correctly and the majority of information comes from websites that are not peer-reviewed. The only real acceptable sources of information are through peer-reviewed journals, accessed through a portal like Pubmed, where in any case, without subscriptions, access to a lot of information is restricted. Moreover, even peer-reviewed information can be patchy, seemingly contradictory and often focusing on one tiny aspect of a part of the problem, which may not be apparent to the “lay” individual.
The situation is unfortunate. Though people love the concept of feeling empowered, when it comes to deciding between different lines of treatment, they just don’t have the training, the objectivity and the understanding to make a choice. Eventually the choices are often made on emotional reasons, or on the basis of past personal experience, or the advice of gurus and other well-meaning friends and family, all of which are flawed parameters to use. In India, the problem is further compounded by the plethora of alternative modalities available as well, virtually none of which, barring properly practiced ayurveda, have been proved scientifically to work.
One of the reasons the article gives for this situation to have developed, is the demise of the family physician and the bonding relationship between the GP and the patient, due to a variety of reasons, including litigation. I agree entirely. Even if the GP is not entirely up-to-date (and it is almost impossible to keep entirely updated all the time), the presence of that one person who can serve as a guide, who in difficult situations can help make a guided-choice, can make all the difference.
Many young couples and nuclear families are eschewing the GP even in Mumbai. They go directly to consultants, often by asking friends and family. Except probably for problems related to the eyes, when you could directly go to the ophthalmologists, even going directly to a pediatrician can be fraught with problems. Irrespective of the so-called GP-consultant-lab nexuses, etc, there are enough checks and balances in place. No GP can afford to go wrong with his patients, because he will then lose the confidence of his patients and their families, who may never come back to him. No GP today can afford to lose his paying patients and therefore will rarely take the chance of referring his patients to consultants and hospitals who will not be able to deliver the necessary results. GPs have access to a large formal and informal knowledge-base and can speed up the process of getting appointments, arranging tests, helping in defining the further course of treatment, checking out and treating minor complications and reactions, getting hospital admissions and making sure that the hospital also delivers appropriate care. More importantly, they can even accompany the patient during difficult procedures or consultant visits.
Exercising choices in medicine is not the same as with tourist destinations and car purchases. Even if the available information is inadequate, the worst that can happen is that the car may not be upto the mark or the holiday may be a bit inferior to the one expected. A bad choice in medicine may maim or kill.
In short, patients need to have more information, but they must develop the confidence and faith to let their treating doctors make the choices for them. Where a choice probably needs to be exercised, is in choosing the right GP.
Posted by bhavinj at 07:19 AM | Comments (3)
July 08, 2001
Its A Small World
We may have reached the 1 billion mark and we may be the second most populous country in the world, but in some respects, we are still a very small community.
Last night, we went for a small, surprise birthday party that WFM's friend's wife, Pushpa had thrown for her dentist husband, Paresh. Pushpa asked us to be present by nine, which is when she was going to get Paresh to the party-room, in a small hotel in Chembur. We did not know how many people she had invited, but we presumed that we would not really know anyone except Paresh's elder brother who had been in medical college with me. Paresh and WFM had been friends since their years in Ruia college in the early 80s; as is the norm, all the other mutual friends from that time have migrated to the US.
The party-room had no board or valet outside and we opened the door slowly wondering whether that was the correct room. I saw two couples sitting on a sofa at the far end. One of them we knew; Suresh, a dentist and Roma were family friends; Suresh and Paresh had been in dental college together. Brijesh and Parul, the other couple got up for introductions and Brijesh startled me by saying "Hi ___". He remembered me from school, having been one year junior to me. Parul looked at WFM and said "Hi, weren't you in Vachha? Don't you remember me? We were in the same class."
Four more people came in about five minutes later. As we got ready to introduce ourselves, assuming them to be Pushpa's or Paresh's friends, one of them, Vasu, walked up to me and said, "Oh, I know you. Weren't you in college with Mukesh (Paresh's elder brother?)". I couldn't place him, but he told me that he used to study in Khalsa college and would often come over to play cricket, etc. in our college. He even remembered that I used to keep wickets for my college cricket team. A little later when we got talking a little more, he told me he worked in Lintas, which is where a very close friend of mine works. Obviously he knew him; apparently they had also studied advertising together at XIC.
A little later another couple, Meeta and Shravan, good friends of ours from medical college, walked in. Shravan and Paresh had been in school together in Chembur and were very good friends.
I was then introduced to another couple; Priya, a dermatologist and her husband Krishnan, a computer and web-related entrepreneur. Somehow I didn't get to talk to Priya, but I am sure we would have found a whole bunch of common dermatologist or other medical friends. Krishnan and I chatted for some time and it was interesting to talk to an unfamiliar person who had nothing to do with medicine or dentistry. A while later he asked me quietly, "Were you in Ruia? You seem very familiar." I said yes and we found that we had been in Ruia during the same years, but in different divisions. Two of my batchmates in medical school had been in the same division as he. He had lived in Matunga for most of his life and we used to frequent the same circulating library, Abbas.
All in all, there were about 20 people at the party and we found that we knew or had connections with everyone except five or six of them. The only ones we didn't know were Pushpa's cousins and sister, the other couple that had come with Vasu and his wife and a couple of Pushpa's friends.
This is not the first time such a thing has happened. Each time we attend a party of peers, we land up meeting people who we either know, but didn't expect to see at that particular party or people with whom there are connections related to school, junior college or medical college either directly or through mutual friends. I have stopped being surprised and I have definitely stopped using the cliché "it's a small world."
Six years ago, in the US we met Sangeeta, a doctor from Mumbai who had married an Indian-origin doctor, Haresh, born and brought up in the US. When we got talking, we realized we had a whole bunch of common friends and by the time we had finished dissecting our school, junior college and medical college connections, Haresh started feeling so lonely and left out, we had to stop just to get him back into the conversation. He had no clue what was happening. Worse, during the same US trip, we went to meet WFM's cousin in Illinois who had a guest, a prospective bridegroom from Ohio, staying the night over. Though the guest had been brought up in the US, when we got talking, WFM realized that she knew all his cousins who lived in Sion and Matunga and they spent about 45 minutes gossiping. WFM's cousin hadn't particularly seen husband material in him and this incident got her even more irritated. Obviously they did not get married.
I am sure many of you have had similar experiences. This probably has to do with the fact that compared to the country's population, the number of people populating a particular set of schools, colleges and higher-learning institutes is minute. In the end you always find connections.
It is not just a small world; it is an unsurprisingly closed, interconnected and almost incestuous world.
Posted by bhavinj at 09:51 AM | Comments (0)
August 05, 2000
It Happens Only in Mumbai...Of Deluges, Treks, Leptospirosis and Wet Mobiles
Currently I am about to finish a week's prophylactic course of an antibiotic called doxycycline, for a disease called leptospirosis. This is an infectious disease, spread through rat droppings and typically seen in sewage workers. If not picked up early, it becomes deadly and people die because of multiple organ hemorrhaging.
I am sure you know that I am not a sewage worker. So what does this have to do with me?
Last year I had read about two men who drove for half a day to find the only existing PacBell phone booth in the middle of the Mojave dessert in California. All they wanted to do was to go there and make a call, which they did. Why? Just! Ever since, I have had this "keeda" (Hindi for itch, urge, whatever...) to do something crazy!
On July 12, the day of the big deluge, I was at work, but stuck without a car. Around 4.00PM, when I finally decided to go home, I realized that my only options were to stay back the night in office or to try and catch a taxi through Pedder Road, Worli and Dadar with a walk to Matunga or to walk the whole way from Girgaum to Matunga, a distance of approximately 11 km. I had never experienced the last option before and on an impulse decided to try it out, thinking that there would be no better opportunity to do this again. I left my laptop in my office, put my wallet and Palm V in two plastic bags which I placed between my chest and my shirt, put my mobile in my shirt pocket, rolled up my pants a la Raj Kapoor and set out, armed with an umbrella as my only protection against the rain.
At Lamington Road, I suddenly found myself in hip-deep water. People told me that this state would continue only for another 100-200 meters and so I forged ahead. The 100 meters eventually became 4 km, all the way upto Jacob Circle (Saat Rasta). I thought of turning back, but having already walked a kilometer before realizing what I had gotten into, it didn't make sense to turn back. After half a kilometer, my thighs were aching, my shoes were biting and I was feeling miserable. I was wet from a fall I had at the beginning when I thought it would be a smart idea to walk on the divider in the middle of the road, not realizing that at places the divider stones are often absent. Within minutes of starting the trek, I fell into a gap between two stones, lost my balance, bruised and scraped my legs and fell into the water, wet upto my shirt pocket. I soon became an expert though and realized that the best place to walk was a foot away from the divider.
Around Nair Hospital, I saw two BEST buses successfully plowing their way through the water. During school and junior-college days, I used to be an expert at catching running buses and I tried to do that again. I am out of practice, thirty-five years old and the bus raised a big wave as it came towards me, pushing me backwards. I fell and completely drenched myself.
Frustrated, wanting some sympathy, I tried to call home on my mobile. It was then that I realized that the mobile had been drowning in water for some time and when I tried to turn it on, it obviously didn't work.
I walked on and reached Jacob Circle. From there on, past Arthur Rd Jail, Chinchpokli Bridge, Lalbaug, KEM Hospital, Naigaum and Wadala, things were much better, since the water was at best, a thin film on the road. I tried in vain to get lifts from stray cars passing by; the only one I could manage was a 1km ride in a police jeep from Lalbaug to Naigaum, via KEM Hospital.
Two and a half hours later, wet and dirty with cuts on my legs and forearms, I reached the safe sanctuary of my home...only to find that there was no electricity and the hot bath that I had been dreaming of was to remain just that.
Last week, I heard of a person dying of leptospirosis outside the KEM casualty. The same day, the Times of India reported that there might be an epidemic of leptospirosis, linking it to the July 12 deluge by tracking the incubation period of the germ backwards. According to experts, on that day, sewage water had mixed with rain-water in all the flooded areas and prolonged contact of wounds, cuts and bruises with this kind of water is known to give rise to this infection. Within an hour, I felt feverish and I immediately called a physician friend who laughed at me, but then anyway advised me to start a course of doxycycline to be on the safe side. I am fine at present and probably past the incubation period...but let's touch wood anyway!
Just to end this on a happy note. I had presumed that my mobile was a gonner, despite having opened it up completely on a friend's advice and dried it using a hair-dryer. I finally gave it for repairs...and guess what...I actually got it back in working condition, in two days. Last week, it conked off again and when I again gave it for repairs, they changed the battery and ever since it has been working fine. My Palm V and credit cards had remained dry anyway, thanks to the double plastic covering.
So, at the end of it all...no leptospirosis, a working mobile and an adventure to write about. Not bad, huh!
Posted by bhavinj at 04:48 AM | Comments (1)
August 27, 1999
Has My Empathy Dried Up?
I am scared....
Disasters on a big scale just don't seem to affect me anymore. I couldn't care less about Kosovo, Kargil, Afghanistan or Turkey. Seeing pictures of devastated people and destroyed places on television or in the Times of India or in Time magazine, reading about the decimation of entire populations....nothing seems to really get me. I read the stuff, drink my tea and leave for work, unfazed, my mind having filed the information in some compartment in the same manner as the news of Kajol's marriage to Ajay Devgan. Or at night, the moment some real-life tragedy comes on screen, I just can't wait to change channels to see Dharma & Greg or Ally McBeal. I dump all email discussions regarding these tragedies that concerned friends send me into the "Delete" box, without even bothering to read them, except maybe for the first two sentences.
So what do I care about? I'll give you an example. Some weeks ago, Sharad Pawar had a big meeting at Shivaji Park for his new party called the Nationalist Congress Party. Truck-loads of people were ferried to Shivaji Park, some willingly, some forcibly. This led to huge traffic jams, people getting stuck between Lalbaug and King's Circle for over two hours. And even after the meeting, flag-bearing jeeps and trucks were merrily breaking all traffic lights and creating traffic snarls. This got me mad!! Sharad Pawar and his c.hor.s...(sorry cohorts) can do whatever they want with the Congress and the country, but they just don't have the f...... right to mess up traffic and delay my ride home. When would Kargil have really affected me? Probably only if Mumbai had got bombed or if we had had electricity outages or if I hadn't been able to watch my favourite sitcoms at night.
A car breaking a traffic light or cutting in front of me gets me worked up, but NATO bombing Belgrade doesn't make any difference. People not saying "thank you" when I hold the door open for them troubles me, but the fate of the Indian government doesn't. Am I the only one feeling this way or is this part of a deeper malaise affecting society? Or is this just a symptom of news fatigue and information overload? Or am I becoming so insular that everyday petty situations are just so much more important to me than end of the world questions? Or has all my empathy and interest just dried up with all the shit happening the world over!!
Or is it only me.......
Posted by bhavinj at 09:56 AM | Comments (0)
