Category: Long Form

Long Form Indian writing Digest 003

The phenomenal Mary Kom—five-times world champion and mother of two is profiled in Intelligent Life

India’s Gold hope in the upcoming Olympics is interviewed by Rahul Bhattacharya

But next to Mary, these other girls were ponderous. Their feet were sluggish, their positioning not so clever. She could fight with her guard down, testing her reflexes by offering them her bare chin as a target, and counter-attacking in angles unfamiliar to boxers who take the orthodox stance.

All around the gym the girls furtively watched her. They covet her low-gravity wound-up springiness, her pure petite explosiveness. They would love to lunge so wide and fast, and never need to wrestle or go to the ropes. Aggression is her hallmark, and it makes her exhilarating to watch.

“Yeh leh Mary,” Mr Bhaskar Bhatt goads her, “take this. And this.” This too is the play of boxing.

“He tries to make me angry,” she says later, “but I have to be cool.” Her grimace is hidden by her white gumshield. You can feel her burn; it’s been 80 minutes now.

Whatever Has Happened to Civil Society?

Neera Chandhoke, who teaches political science at the University of Delhi, and is director of the Developing Countries Research Centre, University of Delhi, takes a detailed look at the rise and fall of Civil society in India. She traces its history, political challenges, failures and success.

One of the most creative of Marxist theorists, Antonio Gramsci (1891-1937), had warned us that liberal democratic states possess formidable capacities to harness civil society to their projects of domination. Civil society, according to Gramsci, is the space, where the state and the dominant classes produce and reproduce projects of hegemony. And this is exactly what has happened in India. The rush of political theory that acclaimed civil society in the aftermath of the Velvet Revolutions of 1989 eagerly claimed that it is only the third sphere that can take on the state and the market. The participants in the debate had forgotten Gramsci. And they paid a heavy price for this, because liberal democratic states – and India is one of the most sophisticated of this genre of states – quickly moved to neutralise civil society by laying down the boundaries of what is politically permissible and what is not.

 

Fixing the healthcare mess; Satyameva Jayate or showmanship?

Dear fellow Doctor; from your Facebook posts, emails to me and tweets, it is obvious to me that the Satyamev Jayate episode on corruption in healthcare worried you deeply. some of you were happy that such an exposé happened, but most of you were worried that there was over-dramatization and untruth in the presentation, and that this would lead to doctors loosing respect in the sights of their patients. As it is, India is known for its violence towards healthcare personnel, it is only fair that you feel that people would use this show as an excuse to attack more doctors.

I too, felt that many of the things Mr. Amir Khan said were unbelievable, some of them were clearly exaggerations and one-sided and I wondered about the truth behind the cases he presented.

But before we jump into another analysis of how Amir Khan got his medicine wrong, let’s look at a few other things.

Here is a list of some of the recent healthcare related scams and exposes that happened independent of Mr. Khan
  1. Senior Professors of prestigious institutions caught following orders from Pharma companies about drug safety reports to the DCGCI.
  2. AMRI, Kolkata hospital fire – revealed bad infrastructure, collusion of top doctors in hushing up things, lack of training and preparation in dealing with emergencies.
  3. Female infanticide – Millions of female babies are being aborted. A phenomenon Involving parents, Radiologists, Gynecologists.
  4. IMA protesting against nurses strike even as they support doctor’s strikes. This, in-spite of the horrendous working conditions and pay of nurses.
  5. MCI’s dissolution – It was so corrupt, that even a corrupt government had to agree.
  6. Surrogate mother industry – poor women being exploited, paid, but not as much as promised, not following international norms in number of pregnancies.
  7. Harvesting of ova- recent report shows how this is probably harming young girls without their knowledge.
  8. NRHM scam for which 22 doctors were suspended – INR6000 Crores is thought to have been stolen.
  9. Hysterectomy epidemic. – Need I explain?
  10. Illegal clinical trials and deaths from them.
  11. Reports of patients being affected from drug trials and not being compensated.
  12. The AYUSH report – No standardization, AYUSH doctors prescribing non AYUSH medication.

There are more, of course.

Let’s now look at the main points raised by Amir Khan in his program; not specific cases, because he is not a doctor and is not qualified to make judgment calls on treatments given to patients. Let us just look at the basic complaints patients had.

  • There is lack of communication between doctors and patients. They don’t feel like they are part of the decision-making process about their own disease.
  • There is a lot of bad handling of deaths, accidental deaths etc. News not being shared, defensiveness, etc.
  • Actions of many or some doctors is leading to a wide-spread distrust or doctors, more so because if you go to 2-3 doctors for the same problem, they often suggest different treatments
  • Issues with improper consent taking and explaining of need for surgeries and other procedures.
  • Lack of information about what a hospital is licensed to do, what training doctors have, and the fear that people without sufficient training are treating them.
  • Referral fees, cuts and other forms of bribes paid to doctors affecting medical judgment.
  • Money being a major deciding factor in issuing medical college licenses and other kinds of licensees.
  • Bad policing by medical bodies leading to un-checked unethical and bad medical practices.
  • Too much power held by private players who don’t care about medicine, just profit.
  • For the government, healthcare spending seems to be low priority.
  • Poor get differential treatment.

Is any of this fabricated or unreal?

They are real; you and I know this.

We are poor communicators, busy as hell, running between wards and OPD or from one clinic to other, often we just cannot find the time to sit down and explain things to each patient. There is also the problem that what we think is communication might not be what the patient wants, and our training does not really help or prepare us to communicate better.

All of you have heard stories, of patients being admitted into the ICU for what turned out to be gastritis, and probably seen patients who have had two cholecystectomies and appendixes removed from both sides of the body. This happens, a lot, and it is a frustration we all share.

How can we reconcile with the fact that an unknown, but very large part of healthcare practice in India has a less than ideal or even acceptable level of quality and that the system is designed not for the patient, but for the professional?

While we mull on that, here are some things he got wrong, in brief.

  1. Using branded expensive drugs and not cheap generics – Not all drugs have generics, not all generics are tested, and in many instances there is significant difference in quality. There is also the patient’s expectation to use standard medicines. Much as I hate them, I can trust the quality of medicine made by a large pharma company, how do I trust a generic?
  2. Healthcare as a business is not necessarily evil, and the solutions that were put forward, including making everything government run is simply out of touch with reality. Your neighborhood green grocer is a businessman; this does not mean he will sell you poisoned vegetables if it gives him better profits. Businesses can be run ethically, and markets have great power of self-regulation.
  3. Doctors have a right to livelihood. Just because we are doctors, to expect sacrificial living is ridiculous. If indeed, as Amir Khan suggests, we are the smartest of the lot, then we deserve proportionate incomes.
  4. Doctors control only a part of the healthcare system; costs of drugs are for most parts out of our control, as are institutional costs. Blaming doctors for high cost of drugs comes from not understanding the basics.
  5. Doctors have an exalted position, but this kind of a mess could not have been created without collusion and involvement of regulators, businesses, government, other members of the medical team, and the market. Blaming just us is myopic.
  6. “Most doctors in India need to get their licenses revoked” is an unforgivably careless and unsubstantiated claim. While I don’t want an apology from him, Mr. Khan should know that it only displays his ignorance.
  7. “Will not see a doctor in India” What about Devi Shetty? Again, a very careless thing to say, but hey, it’s his choice. There are people who don’t want to vaccinate their kids, some people even say this on TV, but that is their choice, their life.

Back to the show.

Most of the reactions against the show hinged on one of the cases discussed in which there was ambiguity about the process. In this clamor to prove that Amir Khan got his medicine wrong, we forgot and ignored the other stuff, the stuff that I listed above.

Dr. R Srivatsan, Senior Fellow at Anveshi Research Centre for Women’s Studies wrote this in an email when this episode came out:

I think when a critique is mounted against you, it is important to look close and hard at yourself and the community you belong to. Where there is smoke, there is bound to be a fire you don’t want!  Most often people don’t have the time to bother to criticize you — except when you cause a great deal of pain.  Criticism is an opportunity, a possible door to transform a process — it has to be nurtured, not snuffed out with hurt defensiveness.

Could we benefit from such a show? Can we use this time to weed out or at least distance ourselves from those whose practices all of us find distasteful?

Doctors are at a particular advantage here; it doesn’t matter how famous Amir khan is, it doesn’t matter how widely his message reaches, people still need doctors. Maybe we can use this as an opportunity to make things better.

Let’s agree to this:

  1. People who were on the show are real people; I think it is safe to assume that they were speaking their truth. Even if one of them was not, there were others who were. They don’t need to speak untruth because there is no lack of bad diagnoses being handed out. We need to live with the fact that there are unscrupulous doctors, and we all know people who fit the bill.  Protesting this fact is only helping them.
  2. Amir Khan is an actor.  He runs a reality TV show. He is not a scientist, has no background in public administration, and the show is not a journal nor a scientific exposition. There will be things wrong with the show. He will get facts wrong. Have you met people who spend their Sunday morning reading out the Journal of Industrial Biochemistry to their families? Didn’t think so. Facts are often boring, Mr. Khan will try to make them attractive and sometimes, the real face will get buried under the make-up.
  3. No silly excuses. Some of you made what is possibly the silliest of excuses, ever. “Everybody is doing it, why target Doctors?” SILLY. I’m going to let you figure out why.

We work long hours, the pay isn’t amazing, the system is corrupt, without cutbacks and the pharma parties, life would be tough. We want that to change, we want to practice great medicine and have a life.  We want pays that are proportionate to our effort and attainment, we would like to be respected and acknowledged for the good work we do.

How is cursing Amir Khan helping us achieve any of that? What will help? I think we know some of the answers, not all of them. What are they? Lets talk.

Long-form Indian writing- Digest 002

I’ve been trying to find bloggers who write longer posts, and am happy to feature a few today.

My child’s spirit is just as important as her physical health.

Karina Varma (BziB on twitter) and her daughter had a not-uncommon horrific experience in a hospital. If you are a healthcare provider or a parent, this post if of great importance to you.

I have never forgiven myself for those forty five minutes when I let someone tell me that being a mother made me inadequate for a particular situation. But it was an excellent lesson, one that now makes me rabid about every single detail of my child’s care. I no longer accept everything her doctor says. I question everything now. When we went in for a follow up, the first thing we asked him was, if the need ever arose again would he consider us taking her to another hospital. He agreed. He even helped us with names of doctors in other hospitals whom we could meet with and decide on. See why we like him?

Notes from a script lab – Which side of the river do you want to be on?

So what happens in a script lab? Does it really help? If so, in what way? – These are few questions that i have been asked many times since i attended the NFDC-Locarno script lab. Have been thinking about writing a post for a long time but never managed to do so. And so here’s Vikas Chandra‘s post about his experience at Mahindra-Sundance script lab. His script Toothache was one of the eight scripts selected for the lab this year.

Vikas Chandra (@vikSchandra) describes his experiences in a script lab, this is great advice for not just movie makers, but anyone who wants to craft a story.


Ignobel Indians

We might not be winning any Nobel prizes but there is no drought of Ignobel winners from India, from formulas to calculate elephant body surface areas to the physics of hoola hooping. Priyanka Pulla in Open magazine.

Leaving love out in the cold

The playground is indeed the best place to get a glimpse of who your kids are going to be when they grow up. It is also a place to reexamine your filters, clean out the cupboard of your prejudices and open up your world to the lacy fan of possibility. On one such evening, as I watched them, I saw a bunch of kids ranging from 4.5 years to nearly 13 snicker, look goofily uncomfortable and exchange looks with each other when my little girl said “I love you, don’t go” to one of the kids.

Is your child comfortable in identifying what and who she loves? Sandhya Menon tells us about her princess.

Long-form Indian writing- Digest 001

In my last post I outlined that Longform writing on the web has found a new life thanks to apps like Readability, Instapaper and Longreads. My interest lies in finding indian writings that are long from and bring to focus my immediate surrounding. Every week I will present that weeks finds, and hopefully this list will grow as time passes.

Mumbai: Cities within

Sanjay Sipahimalani (SanSip on twitter) hosts a book-review carnival with around 10 recent books that are written about Mumbai.

It’s a chemical romance that begins and ends with the word “Bombay”, where all manner of depravity arising out of addiction is on parade. When the novel moves on from the Seventies in tracing the decline in the characters’ lives, you find an elegy for an earlier time: “Already now there were times when he could feel it slipping away, a way of life vanishing as he watched, the pipes, the oil lamps layered with years of black residue, the conversations that a man would begin and lose interest in, all the rituals that he revered and obeyed, all disappearing.”

He goes on to review Tajmahal Foxtrot, The Extras, Behind The Beautiful Forevers and more books.

A few God Doctors

Dilip D’Souza (DeathEndsFun on twitter)  takes us to the Ganiyari in rural Chattisgarh to a unique hospital. Here, around the year for close to a decade passionate Doctors from AIIMS and other top medical colleges work. The hospital is owned and run by a collective of locals, not by the activists who began the hospital. Some of my mentors and personal heroes work or have worked in this hospital, and so it was a delight to find a lovely long article on it.

As they work, the doctors keep up their steady discussion about what to do next, what drugs to give her. I know the two senior men especially, have years of training and experience to call upon. Even so, the impression they give is of addressing the situation not with jaded formulae from medical school, but with fresh minds, thinking on their feet. While their calm professionalism is impressive and reassuring. I cannot help a quick thought about the difficulty JSS has in attracting talent.

Conditions in Ganiyari are hard, the pressure is relentless. Nearly every day throws up fresh crises that interfere with plans for meetings, training programmes, or documentation. The pressures of their work often travel home with them, and there are the usual issues to think about; of the kids’ schooling, and indeed of life itself in this dusty backwater of India. These doctors gave up the chance of high-profile urban careers to come here, to work like this. And when they respond to this poisoning emergency, you can see why.
Hard work it might be, but it is greatly fulfilling too, working among the people who need their care the most.

 

Some you choose, some life chooses

Shubhra Gupta invites us into her home and tells us about her son who is autistic and what autism means to them. Reality is grim and gritty, and yet, humans find reasons to rejoice. She wrote this in the context of the World Autism Day.

We coast on little joys. He is a powerful swimmer, a fish in the water. We put him on a horse in the nearby stables a few years ago. A few weeks ago, I saw him trot, minus the stable lad, who has always had to accompany him till now; he sat upright, smiling widely, having a blast.

He has learnt to be very clear about his needs: not a silly burger, a pizza, okay? And he is on the whole, despite the now occasional meltdowns, a sunny, cheerful child. When he says a new word, it is celebration time. When he turns around and says good night, without having to be prompted. Or when he waves bye, and races off for his evening out. Little things, but for us, huge steps.

In our sobering moments, we are forced to introspect—what has all this meant for us as people, as professionals, as a couple. There is, of course, the cumulative wear and tear of bad-hair days. Sometimes just a few horrible seconds can be enough to wipe off the strength to face a working day.

Introspective confession of a silently fiddling worker ant

Dr.Swarna Rajagopalan (swarraj on twitter)about her journey as a worker ant in the world of politics and policy

And then at some point, something changed. The world became grey. Daily news became miniscule data points on longer-term perspectives. Outrage faded into observation. Opinion was replaced by study. I guess one way to look at it is that I became an academic. I do have strongly held values, but they became somewhat meta-political. What I am trying to say is they held in a place that was above the daily world of petitions and polemics.
….
The grey universe of the worker ant is strangely similar to that of Nero, who fiddled while Rome burnt.

The Language of High Art

Deepanjana Pal (dpanjana on twitter) discovers a new app that decodes the mystifying gobbledygook that comprises most curatorial notes in our biggest art exhibitions.

The Wall Text:

Art for Bose is a site of contest between context, subtext and pretext. Rather than passively see Banana: Braque, Warhol and Beyond, the viewer is encouraged to encounter the works and engage in the dialectics that inform Bose’s praxis. Bose’s work is part of numerous prestigious, international collections and thanks are extended to the following for their generosity….

Translated for the Critic:

Has thesaurus and isn’t afraid to use it. Photographs, paintings, sculpture and installation. Either the artist has studied abroad or has hired a postgraduate student to write wall text. Can use phrases from wall text if writing a review. Postmodern wanker.

Also featuring translations for Artist, Critic, Gallerist, Aficionado, Collector and Random visitor.

……

I hope you munch on these over the weekend.

Mail me at uberschizo at gmail with your favorite long-form writing from an indian author or tag me in your tweets on twitter. I am uberschizo on twitter.