Tuesday, September 26, 2006

Rural Service for Doctors.

Out of Blue, doctors who are going to complete their internship this year, are asked to work for a year in Primary Health Centre in Rural Area. They have signed a Bond when they took admission in Medical College, but for last 4 years this bond was not enforced.Now our enthusiastic Health Minister in Delhi want to enforce the Rural Service clause in entire country, so in next 5 yrs not a single village in India will be without the services of trained MBBS doctor. Predictably Doctors who have faced this farce off and on for last 30-40 years have not taken kindly to this dictate from govt. In Maharastra about 50% have paid the Bond amount of Rs. 1 lac and will not do this Rural service. State is richer by Crore or so and has found out new avenue to fill up state's treasury. Next they will increase the Bond amount so that they can get more money.

But it is more pertinent to try and find out why Doctors are not opting for Rural stint.Usual perception is that these citybred doctors don't want to serve Rural poor inspite of getting expensive Medical Education -paid for by the state. This impression is reinforced by media ,especially Print media. Reporter dont finds it necessary to talk to those who have done Rural Service and find out ground realities. This year those graduates who were preparing for Post Grad.CET for a year would not like to go to Rural area for a year and then appear for CET. Its better to give CET when you have just passed MBBS and have prepared for CET. But others are refusing job that will pay them about Rs. 17000 P.M. There must be reason for that.Past experience shows that many Rural Posting don't have adequate basic facilities to stay. The food is another problem. One can imagine plight of a Lady Doctor in Rural PHC. There is pressure from the local politicians. Many Govt. M.O. dont want them to interfere in the local set up they have established. Sometimes they are asked to do work they are not trained for -like performing Post Mortems. Unavailability of Medicines, Pathological Lab, X Ray and Sonography and other items is another big problem. Just posting a Doctor in PHC doesn't always solve the health problems of rural areas.

Solution to this should be provided by preparing a Model Action plan. This can be done as project by IIM's. Doctors are available and if given just basic facilities they are willing to work in Rural areas.Govt. has no clue about how to carry out project to provide medical help in rural areas and may be they don't have necessary funds to do so.As in past ,for 2-3 years Doctors will be forced to go to Rural areas and then govt. will discontinue the scheme, which will result in great mess for Post Graduate admissions as happened just 4 years ago.

Wednesday, August 30, 2006

Party time in the Morning- F.M.Radio

For last two months or so, I am using FM radio as Wake up alarm. Since most of the FM stations have limited stock of songs and they play the same songs almost at the same time everyday, I change the FM station everyday. I keep the Radio on while I go about my morning chores-read Newspaper, my Cuppa of Tea or get ready for work. As Radio is playing in my bedroom, I recognize the song by tune. Most of the songs being played are remix version and one thing is common in all these songs, their rhythm. There is only one Rhythm-THIG..THIG…THIG.. THIG….. There is no variation, no change, nothing. For the entire period of about 2 hrs or so, one feels as if one is in Disco or pub. The different beats, sounds used in original song is completely lost. Sure these songs-remix version are good for party or in disco, but why should it dominate our music so completely? With these songs there is no difference in style and sound used by different music directors. There are songs with very special beats or sounds which has elevated them to classics. In these remix version they sound like any other mediocre composition. Its necessary for FM stations to play original version of the songs in their morning programme as well and not to relegate them in programme after 9 pm.

Sunday, July 02, 2006

'Que' mannars

We were visiting Hoover Dam, It was hot afternoon and we decided to have some soda and Ice Cream at the cafetaria. It was a small place and there were only 2 people behind the counter. There was a long Que of some 15-20 people and person taking order was not particularly quick.We had to wait for some 30 mts. before we were at the counter.she took some time to get what we wanted and more to calculate the charge and change to be paid to us .But during this entire period, people after us in the Que were waiting calmly,talking among themselves,joking. There was no murmur of protest, nothing.

We had gone to Naaz 8 to see 'Chup Chup Ke'. It was weekend and 'Krrish' was just released. There was a long Que, as tickets for Krrish were sold out for all the shows that day, line was of people who wanted to pick up their tickets booked by phone or on net. But there were few who wanted to see other movies running there and their showtime was fast approaching. Only one ticket counter was open but there was no protest and everyone waited for their turn at ticket window. when we entered the moviehall,we had missed the begining.

Imagine situation at Andheri station ticket window. There are 3 ticket windows,the line has some 10-12 people. Ticket clark sitting in poorly lit and poorly vantilated room where temp. is around 38-40 C (110+) has to give ticket for stations between Andheri and Churchgate and Dahanu Rd. on W.R.. Andheri and C.S.T. by main line and Harbour line,Andheri and Karjat,Khapoli,Kasara and Belapur-Panvel.One way or return for all different lines. He has to exactlly know the location of the station,its fare, calculate 'orally' the amount to be collected and change to be paid.He issues the ticket and gives the change. This takes about 15-20 secs. This is what actually happens every day.

But what's the reaction of people in the Que?

" Abe, Haath jaldi chala."
" Saala, soya hua hai kya"
" Chal Fatafat,deri ho rahela hai"

And it goes on.Ticket clark ignores all these barbs and continues to issue ticket nonchalantly.

Saturday, July 01, 2006

Cinema Theatres in US

While taking part in discussion on Movei expirience in Single screen and Multiplexes in India, I felt strong urge to pen my expirience-as a visitor from India- about Movie expirience in USA. During my stay in LA and San Jose I saw six movies-4 Bollywood movies and 2 produced in Hollywood and realesed in US.

Hollywood movies were realesed with lots of pre realese advt./actors being invited to talk shows of Jay Leno & co. Trailors on almost all news channels giving some detail of the storyline.Jokes about the storyline by stand up comics etc.I did not come across any "critical" reveiews of the movie in any newspaper or on News channel, may be I missed it. Only thing I could know was 1st week's collection and it's standing in just realesed movies- at present 'Click' starring Adam Sandlar is in 1st position. Theatres are usually in big malls and have multiple screens. They are nice with jazzy lights and very good ambience.Unlike our multiplexes inMumbai, only basic snacks are available. Tickits are checked at the entrance and there are no assigned seats no. or screen no. is printed, so theoratically one can see any movie screened there and as often as one wants to.Sound is good so is picture quality. Its enjoyable expirience.But this account is incomplete as I was persuaded not to go to Theatre in UV Village near USC,as crowd there is not good(?).

For Bollywood movies there is only one theatre-Naaz 8. I saw movie in Naaz8 of Artesia and in Fremont. Its really difficult to differentiate the two though they are some 400 miles apart. Its collection of 8 single screen theatres!Naaz8 reminded of Chandan and Chitra and Naaz(remember it?) in Mumbai. Dimly lit(Subdude lighting!) entrance and corridors with very poor ambience. Walls had posters of forthcoming movies mounted in old wooden frames, clenliness was not high on the list and Naaz in Fremont had such small Mens Restroom with just 2 urinals!!Men! was it dirty? Though sound and picture quality was ok,it was not great expirience. Unfortunatelly 'Desis'-well behaved everywhere- were transported to India. Popcorns littered the floor,Children were running around and shouting,few laughed so loudly and for so long that it would drown Paresh Rawal's comedy. In the interval the Indian Chai and Samosas were as bad as it used to be some 10 yrs back in India.I almost felt that I was watching movie in single screen theatre in India.Same callous attitude of theatre owners toward their customer. Same run down, poorly lit,dingy and dirty theatre.If i had encountered a rat or two, the expirience would have been complete. My host said that this is better than nothing,so we have to tolerate it. This is the only place we can see Indian movie so....

Should it be like this? Will Indian producers like yashRaj films,Karan Johar and Rakesh Roshan insist on Hindi movies to be exhibited in good theatres-mainstream theatres? May be a show or two daily or on weekends.Naaz8 charges are not less than other theatres, its just making more profit by exploiting Indian viewers.Indians in US can and will pay more to watch Hindi movie in good theatres.Who knows they will make more money as Hindi movies will be realeased in more theatres and for more shows.

Thursday, June 29, 2006

" Solution " to Reservation in Higher Education

Sunil Joshi, guest contributor to Gaurav's Vantage Point has interesting, market oriented solution for Reservation in Education. Simply put. he advocates liberlising the education sector so that anyone can provide any type of education, at a fee that market can bear.Dr. Devi Prasad Shetty advocates the same thing while talking to Shekhar Gupta in" Walk the Talk".

Idea is good,but can it be implemented successfully? our past expirience is not encouraging. Today all the educational institutes have to take permission from Govt. Dept. of Higher Edu.,Proffessional bodies and various other authorities including UGC. Still IIPM and Amity flourish. When Jharkhand Govt. liberalised education, many institutes of Higher(!) education opened in that state with 2-3 room campuses. Finally Supreme Court had to intervene in the matter and banned them. Maharastra and Karnataka have highest number of institutes for higher education , and when there is inspection after public outcry,it's reported that many dont have basic facilities,faculty or staff and equippments/Labs.Medical colleges dont have clinical material(Patients).I know many Doctors with MD/MS who cant perform simple operations independentlly.Many have not seen routine operations during theirMedical edu..These days almost all commerce colleges in Mumbai offer Diploma/Degree in management, are these worth anything?Many of them get job offer with salary of 1-1.5 Lac/PA.

Now imagine the state of affairs if we liberalise the educational field completelly. Yes if stringent conditions are applied than we will get a good institution, but buisnessman is not interested in that. He will get it sanctioned by providing minimum of facility,paying low salary to teachers, and bribing or bringing political,communal or castist pressure. How will a parent or student will evaluate these institution or their fees, their programme & courses offered(Whats that in indian Context?). You must have seen advt. for computer classes-NIIT,APTECH etc- how many student understand what is offered and whether fees are appropriate?.

To liberalise education completelly, we require dedicated educationists,philanthropists who will donate huge sums to start good institutes and vigilant govt. and knowledgeble public. Unfortunatelly we have none and wont see them in forseeable future.

Tuesday, March 21, 2006

Home Again

After almost almost a month, I could manage to get my internet service.In February end my contract with BSES ended and my net closed down. To compound the matter, my apartment required repainting and it was not possible to work on desktop or even use laptop.I had applied for MTNL triband but they couldn't supply router as they were out of stock!! There was waiting period of 2 months.Even as I write this the Versova Tel Exchange has cleared workorders of 16 January and there are more than 1000 pending applications!!.
I have been unable to understand this. We are talking about increasing net connectivity for almost 3 years. Mr. Maran had announced his plans for Triband as soon as he became Minister at Centre.Is it difficult to manufacture Triband router in India?If they are easily available in all computer stores then why should it not be available with MTNL? Or is there something fishy here? Most of us would not like to wait indefinitely for net connection ,so we would buy it from the open market.Is there kickback to mandarins in Communication ministry or to Ministers party ? Do people in Singapore or Kuala Lumpur, Seoul, Tokyo face same problem? what about US/UK?
Anyway after a month I can now log on to blogs and renew friendship's realized how much I missed reading blogs.It was like being cut off from your friends and didn't know what was happening in their lives.Like serials on TV one gets attached/addicted to Blogs and Bloggers.Has Gaurav got new Job? What Amit is doing after returning from Pakistan? Is he writing on England series? Is Vikrum in India? or has he returned to his home? Missed very interesting scientific essays of Sunil.Has Umas's indian writing or Sonia has added new colour ? So many things to read and ponder about.After a month I feel that I have returned home and it's time to relax and read interesting stuff.

Saturday, February 04, 2006

STD/ISD Booths.

Last month I attended Conference tour of Egypt organized by our Association.Tour was conducted by reputed tour organizer from Mumbai.Ours was of group of some 110 or so Medical Consultants from Mumbai,and many are owner of small Nursing Homes in Mumbai.Few of us had Mobile Roaming facility, rest depended on Phone service in Egypt. Now Egypt has good Telecom facility.With so many visitors from Europe,UK,USA and different parts of world, this is not surprising. We purchased Calling Cards from shop in our Hotel in Cairo.But things are not as simple as it appears. With so many companies operating in Cairo,its difficult to find Kiosk having phone whose card you posses. Ofcourse most of the public places have phone kiosk but during tour or while visiting a monument you don't have enough time to search for a particular phone.Since you don't know the pulse rate and charges,suddenly in middle of conversation you are cut off.. At that odd hour its almost impossible to find store selling phonecard. Few had purchased calling cards of Airtel from Mumbai airport,they had to purchase phone card of Egyptian company to call local number, then punch in card number and then punch in home telephone number..You need someone to prompt the 16 digit number or you are going to miss out or punch a wrong number and have to start all over again.Sometimes it was frustrating.
My experience in Bangkok, Kuala Lumpur,Singapore or US /UK is no different.Then one realises the ease with which a visitor can make Local/STD/ISD call in India.Thanks to innovative scheme of MTNL/BSNL, we have STD/ISD booths all over India.Any small town or even district place will have number of booths and one can choose and select from which booth to call.With advent of cheap mobile and STD calls,big cities and towns are witnessing decline in these booths.But in smaller towns and District places they are doing roaring business.We instruct our maidservant to call us from her native place-Rajapur in Konkan-before she boards ST bus for Mumbai.Its so simple,transparent and hassle free. Its easy to punch in number,and one can check whether correct number is dialed can talk as long as one wants to,keeping watchful eye on charges!.The booths are open for more than 18hrs a day, so calling is almost 24x7.Besides it gives employment or additional income to large number of people,thus serving a social cause in this country.Really one of the really innovative idea !

Thursday, January 12, 2006

Our group had gathered at friend's house to usher in 2005.'Group" consists of friends who had met for the first time when they were students in 5th std. in Bharda High school opp. V.T. A common passion for cricket had brought us together though we were not in the same class in subsequent years.After S.S.C. all of us joined Science stream in KC. college and after passing out Inter Science, I joined medicine in Mumbai,others went for engineering used to meet during vacations,go for cricket matches, evening walks on Marine Drive, party together-Prohibition was just removed from Mumbai- go for Christmas and New Year eve parties, go out on picnic together and over the years, group became cohesive.We were close friends. Luckily for us, all of us got married in'74-'76 period,shifted to suburb Juhu-Andheri at the same time,had first child -all daughters-in '76-77' and second child -sons-in '81-'82 period.Because of these happy coincidences we could remain together as group.
Now we were partying with families, go on vacation tours together, and though the children had their set of friends, the unwritten rule was that they had to be present in group's parties and tours arranged during vacations. Years flew by. Here we were ushering in 2005. we,friends and spouses were present. Children had moved to US for studies. Girls had graduated and were holding good jobs, all of them except A..... were married and Boys were doing their Masters in US. There was sense of satisfaction and happiness in the air. As if our life's goals, mission had been achieved. What more could one ask from life?
All the friends had good prosperous lifestyle, could give good education to children, daughters was married, and sons were planning to settle in US( They will manage, wont they?). Now we were free to plan and live life as we wanted to. Do things or pursue hobbies which we had put off for years.
Anchors on the TV show had started countdown and 2005 had arrived. We hugged and wished eachother and then as if on cue, children phoned in from US wishing us Happy New Year, all of them had to wish all the uncles and aunties !!. Everyone was in high spirit but H... was not well, she had upset stomach, so she wouldn't join for dinner.In the euphoria of the celebrations no one noticed.
Next day afternoon she phoned me.She was passing blood in stools. I immediately fixed up her appointment with the surgeon friend. He phoned me in the evening.There was a Large Colorectal Polyp. she was posted for Colonoscopy next day. There was large Polyp in colon.we took biopsy and now had to wait to find out whether it was cancerous or not. we spent anxious 5 days and then the verdict was out-it's benign tumour.Second opinion was taken and CT scan done. Same finding. Non cancerous Polyp. Gastroenterologist was confident that he would be able to remove it by Colonoscopy. As it has broad base he may need 2-3 sittings.H... had undergone 2 c-sections and was not willing for surgery. Besides she feared that colostomy will be done and she was not prepared for that.No amount of arguing could convince her, so we decided to go for colonoscopy. But 2 session of Colonoscopy removal convinced us that surgery would be the best option. By then it was time for her daughter to come to India to purchase her wedding dress and jewelry. Then there wasn't sufficient time between Surgery and her US visa interview date. (There was 4 months wait for Visa interview!). They got their Visitor's Visa and now there wasn't sufficient time to recuperate from surgery before she was to fly to LA. So she went for her daughter's marriage, friends from the group went to US to attend the wedding. She returned to India and we took appointment for Colonoscopy.News was bad ,Polyp had grown in size and CT Scan had suspicious area. She was posted for surgery in Lilavati Hospital. I accompanied my friend and we waited in the big lobby on the 1st floor.After long wait-operation lasted for 5 hours- surgeon came out.we hurried to meet him.
He just said " She will need Chemotherapy".This almost shattered us but I recovered,
You could get clear margin and remove the tumour?
Nodes involved?
Liver metastasis?
Local metastasis?
Ya, in Paracolic gutters and P.O.D.
He walked away. So much for breaking the news gently.!! Such are vagaries of life. This Slow growing Cancer did not spread to the surface of Polyp, instead it chose to spread towards the base, through the wall of the colon to the area outside. Not a single Biopsy showed even a suspicious or pre cancerous cell.!! Here we were faced with Stage III cancer.This is the reason why people believe in Luck,Destiny and stars!
That one sentence had shaken my friend.Now onwards life is going to be different. Ours is generation which made transition from Joint family to Nuclear family. We grew up in large families -what you see in 'Saas Bhi Kabhi...Grand-parents,parents,uncles,aunts,cousins and even guests from native place lived under one roof.There was solid extended family support for everything.The strength was in number and families could take illness,financial disasters, scandals,deaths in it's stride without flinching.But we had moved out from this big comfortable shelter, and were living independently with wife and children.the extended family was there, but it was scattered. After 25 yrs it was not possible for the family to be together as cohesive force.Ones brothers and sisters and cousins were just a phone call away,but they had limited time for you and years of separation had weakened the bonds.They will phone ,come and meet but for an hour or two.Then they have their life,children,and other problems to take care of. One realizes comfort and strength of joint family during such phases in life. We had added disadvantage. Children were far away from us.They would phone everyday but it was not possible for them to come and be with us. With this cancer ,its treatment and possibility of complications, it will be difficult to manage work and look after his wife.He had to go out of town often on business trips.Now it would be difficult to leave H... alone. But the group became the extended joint family.After being together for almost a lifetime we were one family. Circumstances had conspired to force us to be together,to join forces to face the adversary. We were there to give support,to comfort each other,to allay fear of unknown future, and to let everyone know that he/she is not alone.H... has completed Chemotherapy. She did not loose her hair( Her biggest worry) rather she tolerated chemo. very well and had no adverse reaction.She is 'CURED' at present.
We have gathered to usher in 2006. Mood is sober.Events of 2005 has not dampened our spirit. This year children have come home to celebrate Christmas and New Year.There is hope in the air,K.... will be leaving for US in Jan to be with her daughter who has on 28th delivered a healthy baby boy ! The first of the Grandchildren. Life is beautiful once again.We have something to look forward to. God willing 2006 will be year of Grandchildren and group will visit U.S. to bless them. Anchor has started reverse countdown.... but mentally we are already in 2006.

Wednesday, January 11, 2006

Million Missing Girls

The recent article in Lancet has again focussed on Female Foetecide that is practiced in some parts of India.There will be edits in Newspapers-TOI- has it as lead edit today.There will be seminars and discussions, but at the end of the day whats the solution? how do we tackle this problem?
As this study has shown, all the 'established' causes have fallen on the wayside.
Its not poor but Middle class and rich are major offenders.
Dowry is not the cause for aborting girl child.
It's not illiterate mother, rather well educated mother prefers to have male child. It also absolves husbands who were accused of forcing their wives to get Sex determination done.
Our society is supposed to be agrarian so extra pair of hands(Son) was preferable. But now statistics show that even in rural economy females contribute more economically, so its not an issue.
As obstetrician I feel really helpless.As technology advances, with 3-D Ultrasonography, better resolution on good machine,it's very easy to know sex of the child. It is now possible that on 3D USG machines even mothers will be able to know sex of the child when USG scan is in progress.
With newer technique even Abortion is easy to perform.Few tablets and female foetus is dead.It will abort on its own or Doctor will have to do to protect mother from severe infection.
In ART methods , its possible to Pre select sex of the foetus before Embryo Transfer.
So where do we go from here? You cant educate well educated mother. All that we have done so far is to show danda of PNDT act to doctors.But there will be black sheep in every field and there will be greedy doctors who will be willing to carry out USG scan.With these newer machines he wont have to even say anything.Mothers will recognise sex of the foetus.
I sincerely hope that we will be able to find out some ways to reduce this.I believe that there is steady decline in demand for sex determination tests.May be after few years ratio will correct itself. But till than I will keep my fingers crossed.---PK