The case against Abortion

As I have mentioned before, it has always surprised me that my views on abortion are not shared by many of my colleagues and friends. So you will have to bear with me if I keep harking back to the topic, in the forlorn hope of convincing some of them!! But I thought I would sign off September (which has been a difficult month!!) with some links that deal with the basic pro-choice arguments and why they do not hold water. These have been drawn from the few blogs I read regularly. I have found that most of them inevitably link to the same posts!! And moreover, as these have been collected over time, I hope you will excuse the lack of credits.

THE STORY OF LILA ROSE: This is the story of one of the key investigators in the exposure of the lies and racism propagated by some abortion clinics in the US. Did you know that you can pay to have a black baby aborted?!! Lila Rose took up the issue when she was 15 and now (at 22) heads one of the leading non-profit organisations fighting abortion and also edits one of the important pro-life publications. This is an inspiring story......

P.S. Clock up one more point for home-schooling!!!

IS THE UNBORN CHILD HUMAN: This is the basic question that we need to resolve. Scientifically, the unborn child fulfills all the criteria for a living organism - like growth, response to stimuli, metabolism, and so on - from the moment of conception. Pro-choice advocates are generally forced to admit this fact in the face of overwhelming scientific proof. And the rapid development from a single cell into a newborn baby is a further proof that killing the unborn is just the same as killing any human being. If there are still any doubts(!), here is a video by another young advocate on the reasons why the unborn child is human.

IS THE UNBORN CHILD JUST AN EXTENSION OF THE MOTHER: While most pro-choice activists and feminists now accept that the unborn child is actually human, they base their support for abortion on the fallacy that the unborn child is just an extension of the mother's body. Rather like a tooth or an appendix that can be removed with no future consequences. But again logic shows that the unborn child is a totally different human being who is just dependent on the mother for 9 months. The unborn child has a totally different DNA, may be of a different race from the mother and in fact, can be transferred into the mother from outside as in the case of test-tube babies. If that does not make the unborn child a totally different human being from the mother, then what does!! (Sorry, no link for this one!!)

THE RAPE ARGUMENT: This is where the argument for abortion usually begins. This article brings out the absurdity of the argument when carried forth to its logical end. If the unborn child should be killed in order to prevent causing pain to the mother, then why not kill a young boy who mercilessly torments his younger sister. Or kill a boss who causes deep emotional pain to his co-workers by his words and actions. In fact, there are very few societies that even kill the rapist - who is the one that caused all the pain in the first place! So if the unborn child is human, there can be no logic that can condone killing him or her if it is not right to kill even the rapist. This article expounds this concept - the 'trot out the toddler argument'.

OTHER PRO-CHOICE ARGUMENTS THAT ARE FULL OF HOLES: This short article beautifully debunks many of the usual pro-choice arguments. It's just a click away and well worth a read. Another similar article is here.

AND FINALLY: For all those of you interested in learning more about how to argue the case for life, here is a flow chart that incoporates all pro-choice arguments into 3 simple questions and offers an approach to each one. For a video explaining the chart see here. For a video explaining the SLED test (philosophical differences between the unborn and a human - size, level of development, environment and degree of dependency), see here. Click on the chart to enlarge.

The ruptured uterus dilemma

In most parts of civilised India, a ruptured uterus is unheard of. It's something that is to be read about in text books or to be enthralled by as senior professors tell stories of the occasional patient they have seen with this problem. However, in places like Bihar, it is sadly an all too common occurrence. For however far medical and obstetric care have progressed in the rest of the country, here childbirth remains an extremely risky proposition for both the baby and the mother. (For those not associated with the medical profession, a uterus can rupture in pregnancy when there is prolonged labour or the uterus has been weakened by previous Caesarian sections). In the short time I have spent here, the stories of tragedy during the delivery process have been too many to recount. The worst part of every story without fail is that doctors and quacks all around seem to wait till just past the point of no return before referring the patient to us, by which time even our most strenuous and aggressive efforts prove to be in vain. And the icing on the cake of course, is that the blame and the ire of relatives and even mobs falls on us, rather than the various places they had come from, whose improper treatment had led to the problem in the first place.

From these respects, the story I recount today has a happy ending. It occurred on a day when all my other colleagues were on leave and at about 11 pm at night (the time when patients who have been referred from other places usually reach here), 3 patients came at the same time to the Emergency. As doctors often do when busy, I mentally classified them based on their diagnosis - snake bite, OP poisoning and oh no! Ruptured uterus! The patient was a lady who had not yet reached term but had had two previous Caesarians with one baby dying shortly after birth. She had been in labour for a day and had been undergoing treatment at a local clinic where the doctor had been attempting a normal delivery. However, she suddenly started to pour out blood and had been immediately transferred to our hospital.

The moment I saw her, white as a sheet and lying in a pool of blood on the stretcher, I knew there was very little time. As the sisters (who are an outstanding yet unsung group of people in our hospitals) readied her for the operation, I took the consent and sent the relatives off to try and get some blood. We were in the operation theatre in about 10 minutes (again an outstanding feat given that the OT staff need to come from their homes!) and the baby was out shortly after. To my surprise and delight, he was alive although rather sick and needing to be sent to the neonatal ICU. The reason for the bleeding was soon clear. The uterus had been adherant to the bladder and had ruptured it as well. After closing up the uterus and bladder, I was about to begin the ligation of the Fallopian tubes to prevent future pregnancies and ruptures, when my floor nurse told me the relatives had refused the tubectomy. They wanted another baby!! After 2 Caesarians and a rupture!! I went out to try and convince the relatives, telling them clearly that another baby may kill the mother. But as I have found so many times, a woman's life is not considered important enough to make plans based on her welfare. Risking her life for the sake of another baby made perfect sense in the eyes of the family. I knew that in her heart of hearts, my patient herself was keen for the tubectomy, but she flatly refused to go against the wishes of her family, once she knew they were not agreeable.

And so, for me, the joy of saving the child and the mother was dampened a little. I felt sad that the woman's life had so little value for her own family. I felt angry that crucial decisions about her own body could be made by others and she did not even have a say. I even felt a little guilty that I did not have the courage to go ahead with the tubectomy on medical grounds against the express wishes of the family. It is a situation I find myself in ever so often nowadays. Perched on the horns of an ethical dilemma, not knowing what to do. And always fearing that I have finally made the wrong decision!!

The price of womanhood

The stories are piling up and there's so little time to tell them!! The composition of a good blog post is an art form, but art takes time, unfortunately! So do bear with the brevity and the lack of analyses. The stories are so stark that it sometimes seems abrupt and jolting to leave them without comment. But then, maybe commenting and rationalising will make them more understandable, more acceptable. And that cannot be allowed. In this great country of India, where dwell some of the richest people in the world, where advanced medical care draws people from all over the world to access it, where our scientists are making giant strides at the cutting edge of research and our people are accessing lifestyles that are at par with any developed country in the world, there are still places where the realities of life are far removed from choosing which mall to go to or which movie to see or which joint to dine in. Every day, I am shocked and moved by the stories. Stories that I could not have even imagined possible just a few short months ago.

Today I tell the story of Guddi Devi (name changed). I never knew her. I never even met her. But the poignancy of her story breaks my heart. Her only crime - being a woman in a society where womanhood is a curse. A society where spending money on a woman's health is an unnaceeptable economic burden. I never met Guddi Devi since she never made it to the hospital. But her baby did. He was brought by her relatives, hale and hearty and completely unaware of the deadly drama playing out around him. His mother had been bitten by a snake - an uncomfortably common occurrence in these parts. (The other day we had a krait in our house, but that's a story for another day). The family had taken her to the local witch doctor, who commenced his mantras and spells (or as they are locally called - jaddi putti or jhar poke). While he was doing the necessary charms to remover the poison magically from her body, her baby started crying and she fed him, as any good mother would. And soon after, even before the magician had finished his spell, the dreaded symptoms began. As her eyes began to close and her breathing became more laboured and as the witch doctors incantations increased in volume and fervour, her relatives did the first thing which occurred to them - they rushed the baby to the hospital. After all, this precious boy had suckled at the breast of poor poisoned Guddi and God forbid anything should happen to him if some of the poison had somehow managed to enter him through her milk. As for Guddi, she died quietly, not even a footnote in history, while her little boy played happily in the arms of the relatives whose deep concern for the boy was so terribly countered by their absolute apathy for her fate.

For what it is worth, I honour Guddi Devi and the millions of women like her, who live and die quietly, destined to be second class citizens solely because of the absence of the all-important Y-chromosome. May God have mercy on their souls......

The cost of saving a life - going to jail

This morning a lady came into the hospital. She had delivered a baby 2 days ago and had been bleeding ever since. She was white like a sheet and her blood pressure was barely recordable. Her Haemoglobin was 3 gm. When I worked in Jharkhand 15 years ago, our management would have been simple. Find someone with her blood group, bleed them and transfuse. But things are different now. As in all aspects of medicine, there are strict regulations and guidelines governing blood transfusions and without a recognised blood bank, it is not allowed. A few years ago, two staff members of a rural hospital spent some months in jail for transfusing blood to save a patient without a blood bank licence. So now, even if a patient is dying, we cannot transfuse them blood to save their life without running the risk of going to jail.

A lot of things are like this in our country today. With more and more regulations being brought in by powerful lobbies and highly placed doctors from the large corporates in cities like Delhi, those of us who practice medicine in very different circumstances find ourselves battling with life and death questions like this every day. It is no wonder that doctors don't want to work in rural areas or smaller hospitals. On the one hand, since the majority of our patients are poor, we are never going to get enough money to procure all the expensive gadgets, doctors and facilities that are mandated by the law to practice even basic medicine. On the other hand, we are faced with situations like this where a simple intervention that has very little risk is guaranteed to be life-saving, but cannot be done without breaking the law.

The husband of the patient was sent to the local blood bank and came back with the news that there was no blood. But he had been told of some private clinic where blood was available. I don't know if it a profitable side business of someone from the government blood bank or it is a private clinic who have bribed the powers that be to turn a blind eye. Since bribing is not an option for us, we will always be at a disadvantage if we ever stray even a millimeter from the law. Anyway, we sent off the patient, feeling relieved that our ethical dilemma had been solved by someone else. But the big question remains - will I risk going to jail in order to save a life? I do not know the answer to that question........

Madhepura!

I got married in good old arranged marriage fashion. One of the tools I used in the whole meet-and-greet process was to tell the prospective bride that I could possibly end up working in a small village in Bihar. Well, I now realise you have to watch out what you wish for, since many years down the line, here we are!! Our caboodle has relocated to a small hospital in Madhepura town, North Bihar after bidding a tearful farewell to our dear friends in Bilga and Ludhiana. The sorrow of the parting still hangs heavy on our hearts although it is a sweet sorrow, since we moved in response to the pull on our heartstrings. And having been here for some time now, it is clear to us that this is where we are meant to be for this season of our lives.

Madhepura is a dusty little town in the basin of the river Koshi. This is its biggest claim to fame as the river floods at regular intervals wreaking destruction throughout the area. Its other claim to fame is being the bastion of the Yadav political dynasties - Lalloo and Pappu Yadav on the one side and Sharad Yadav on the other. Demographically and economically it is in the poorest cluster of districts along with neighbouring Saharsa, Araria and Purnea (1). The literacy rate is 53.7% and the sex ratio is an appalling 914 females for every 1000 males (2). There are a number of Dalit and Mahadalit communities surrounding the hospital with the Moosahars (lit. rat-eaters) being the group among which we do the maximum work. The small hospital where we work is on the outskirts of the town and has many challenges. As many of our patients cannot afford to go to larger cities like Purnea, Patna or Siliguri for treatment, we often are faced with the situation of taking care of rather sick patients without too many facilities. However, we often find that necessity is the mother of invention and things go better than we expect which is very encouraging.

I used to blog avidly many years ago and hope I will be able to get back to some regularity. The main reason I am restarting this blog is to tell some of the stories of our patients. These stories tell the real plight of the people we work with and I hope they will reach the parts of India that I am used to - where things are very different and some of the situations we come across would be unthinkable. Do let me know what you think in the comments or by email. So hope I can keep writing and you all will enjoy reading! God bless!!

(A picture from the blog of a friend of mine which shows the front of the hospital... and a horse, something that is not as unheard of as we would think!!   http://jeevankuruvilla.blogspot.in/2012/11/madhepura-christian-hospital.html)

Reference

1. http://brlp.in/documents/11369/125465/Poverty+and+Social+Assessment+-+A++districtwise+study+of+Bihar.pdf/8a3c0c07-7021-45c8-8dbb-cb5d6190a9e3

2. https://www.udyogmitrabihar.in/docs/dp/madhepura.pdf

The Community Physician's Prayer

Amy wrote this prayer while working on one of her assignments for her MA course with our amazing coach Dr. Stan Nussbaum. I was really moved when I read it and thought I would share it with all of you. The photograph is by Dr. Rajesh Isaac.

Easter celebration

This Easter, the fellowship department of CMC organised a celebration of the life of Christ through music and dance. Here are two songs from the musical. It takes ages to upload so the rest will come slowly. Due to the poor quality of my handicam, you may need to watch these in HD.

Merry Christmas (and some news)!

This has been a wonderful year for us! We had two new additions to the family - a dog in January and a baby in November! Our cup of joy runneth over and we are grateful to God for all His goodness to us. The arrival of the baby made this year a most blessed one and though there were a number of ups and downs, 2014 has been a landmark year for sure. The highlights of the year for Amy were completion of her data collection for her thesis and the whole pregnancy period and the delivery of the baby. We were grateful to both our mothers who could be here with us during that time. Arpit enjoyed his involvement in the Sunday School and with the students both academically and musically, the highlights being a concert of instrumental music and the musical 'Shrek'. We thank all of you who have journeyed with us in thought, word and prayer and wish you all a Christ-centred Christmas season and a blessed New Year. We look forward to 2015, knowing there may be many new beginnings and value your prayer for all of us in the New Year.

A new addition to the family

There has been some big news in our small family in the last year. After a long time of zero growth, there has finally been some activity! It all began on January 14^th when I called my one and only first cousin to wish him for his birthday. (The fact that I have only one reaches significance only with the added information that Amy has 39!!). In the course of the conversation he asked me we were planning to get a dog. I said, no way! We had enough going on without the additional responsibility and given that we are such frequent travellers, keeping a dog would be well nigh impossible. I had already explored this with some of the dog-owners of the campus and after listening to them, had decided that this was too much for us at this point. Maybe, when we were settled down permanently (will that ever happen?!) somewhere, sometime in the distant future…We then moved on to other topics.

That same evening Amy and I stopped at a departmental store to get some groceries and supplies for a meal we were hosting for friends that evening. Right opposite the store where we parked our car was a pet shop. Outside the shop was a cage with 2 tiny Labrador (or Labradog, as it is known in these parts!) pups. Amy and me, both ardent animal fans, went over to look at them and make the usual accompanying noises – Awww, so cute and such like. Unlike usual, we stayed a little longer than we probably should have, making silly noises at the unsuspecting pups, who, of course, reciprocated as all pups in cages would do – with wagging and whines and a general dispensation of ultra-cuteness.

Once the critical limit was passed, the same thought began to form in both of our minds. As we looked at each other, I did not need to hear her words to know what she was going to say – Shall we get one? Having already been befuddled by the dashed pups, how could I then handle the deep pools that were my dear wife’s eyes?!! 20 minutes later we were the proud owners of a tiny pup, a bag-load of accessories that we were told were completely essential and a ton of advice on the various methods of making sure the pup did not die.

I am not used to making on-the-spot decisions. Usually, every decision is accompanied by many hours of research, dithering, pulling of hair and gnashing of teeth. But after January 14^th, I think that maybe, being a man-of-the- moment may not necessarily be the worst thing in the world. For bringing home that puppy was one of the best decisions that I have ever made, though it went against all the advice I had been given and my ‘researched’ plans! And so ‘Awesome’ (as I named him over all Amy’s vehement protests!) Mathew came home to spend what would turn out to be a tumultuous day at No.8 Gateway Terrace!!

(to be continued)

CMC chapel choir sings Vande Mataram medley - Happy Independence Day!

Happy Independence Day! As we honour our great leaders who won our freedom for us at great personal cost, I feel happy and proud to be a member of this great nation with its rich and varied heritage. As we worshipped in the church this morning, I was wondering at the magnanimity and openness of our leaders who enshrined the precepts of secularism in our constitution. How easy it would have been for this country with its huge majority of Hindus to declare itself a Hindu state and follow the path of so many of our neighbours into religious fanaticism and destruction. How easy it would have been for our leaders to have won the votes and hearts of the majority of our population with a narrow-minded agenda. How easy it would have been for them to declare - Hindustan for Hindus. But it is a sign of their greatness that we live in this land of freedom in all forms, including religious. Where I am proud to call myself an Indian although I come from a minority community. Where I can follow my own life and path without fear of prosecution or retribution. Where I can join with my fellow Indians to sing together 'Maa Tujhe Salaam - Vande Mataram'

Christmas cantata

This last year has been a really bad one for this poor blog!! Let's hope that the next one will be better!! There are many reasons for the slump, which I think are best left unsaid!! But just to let you know that all is not dead creatively (!!), here are two songs from the short Christmas cantata that Amy and I composed for our institutional Christmas programme performed by the faculty choir conducted by Dr. Jacob Koshy (the wonderful soloists are Christine Joshua and Preethi Paul). Wish you all a very Merry Christmas and a blessed Year ahead.

P.S. There are a few more videos of the Christmas choir and also the Easter musical on the same youtube page - thanks Rev. Stanley.

Single incision laparoscopy in a mission hospital

Recently, I was talking to a friend who was concerned he may have to go to a mission hospital to work for a short time. He said, that it was a dead-end and he would lose out a lot professionally. I have often come across people who are worried about working in a mission hospital for a variety of reasons and a long time ago, (when I was blogging regularly!!), I had started a post on why I loved working in a mission hospital. However, it got rather too long and personal and so it never saw the light of day. So this time, I thought that instead of putting down all the benefits of life and work in a mission hospital in one long, wearisome post, I would address the fears people have one by one in different posts (if and when I get the time and mental space to write them!). I hope you will forgive me for using my own experiences most of the time. Please do add on your own experiences in the comments and other reasons which I can touch upon in later posts.

One of the biggest worries I discern from bright young doctors who are thinking of working in a mission hospital is what my friend shared with me - that professionally there is nothing stimulating about mission hospital work and everyone ends up doing primary health care and treating coughs and colds. Now of course, that is also important, especially if we are trying to see every patient as the image of God, but it is not completely true. In fact, mission hospitals provide a great opportunity for the committed and innovative doctor to improve greatly rather than decay professionally.

One example is the technique that we developed in Shillong of doing single incision laparoscopic surgery (SILS). This simply means doing laparoscopic surgery through a single incision rather than the 3 or 4 that are usually used. The main advantage of the procedure is the lack of a visible scar if well done. The procedure is not very commonly done in India even in the larger centres. However, with the large volumes of laparoscopic cholecystectomies that we had there in Shillong, it seemed a natural progression to try the technique. The problem was that the equipment required was rather expensive and we could not justify using disposable instruments and ports that costed many thousands of rupees. Over the course of the next two years, the surgical team at Shillong developed a technique that did not involve any additional cost over a conventional laparoscopic cholecystectomy or appendicectomy. With more or less similar results as you can see from this picture taken immediately after the operation.

So when I heard my friend say that he feared professional suicide by going to work in the mission hospital, I had to differ with him. The number of techniques that have been developed by physicians and surgeons in mission hospitals that I have witnessed myself, are too many to be listed here. Of course, very often they do not become well known, as they remain within the confines of the hospital. But for someone who is interested in academic and professional development, a mission hospital is sometimes better than an established set-up where anything new requires a lot of time, persuasion and approval of seniors. So if you are considering your future, do not be fooled into thinking that a mission hospital is a place for those who could not make it in the outside world. I can truly say that my time in Shillong (and earlier in Jharkhand as well) were times of extreme professional growth and satisfaction. The SILS techniques was just one of the exciting things that happened!

CMC Ludhiana Senior Choir

CMC had its Christmas programme yesterday and today. Here is one of the songs that the senior choir  performed (as seen and heard through a little camcorder). We also had a 60-strong (and phenomenal) junior choir comprising of students from all the colleges and a Christmas play. Videos of those later perhaps. It was great to welcome the Christmas season with this enjoyable evening. The lady with the golden voice is Dr. Preeti Paul and her husband Dr. Vineeth Jaison is on the rap.

Quo Vadis, Doctor, Quo Vadis?

The young lady was brought to the small hospital in Jharkhand gasping for breath 2 hours after she had been bitten by a snake. She was quickly intubated and given the life-saving Anti-snake venom antitoxin. For the next 2 days, the junior doctor manually ventilated her round the clock as she slowly recovered. Her hand that had received the bite developed fasciitis and required a debridement. But after a week, she was ready to go home. Her bill, after heavy discounting came to Rs. 1500, mainly for the medicines that needed to be replaced. After a day, the husband brought in the money to pay the bill. Out of interest, the doctor asked him how he found the money. He said he had taken a loan from the moneylender. And the interest – Rs.10 for every Rs.100, every month. 120% annual interest. The young doctor was horrified – that was a life sentence. With the enthusiasm and altruism of youth, he offered to pay the money which could be returned to him if and when possible. But the farmer was resolute. He said it was actually a good bargain. He would never be able to repay the loan, but he would be able to work on the moneylender’s farm for the rest of his life and be sure of at least a meal a day. And when his young son was little older, he too could work and this way, his family would be secure…… For the sake of a medical bill he signed away his family into a lifetime of bonded labour.

This is a true story. It is no one-off event. It is repeated nearly every day in the villages of our country, where decades of suppression and government apathy have created a feudal system that would be unthinkable in a modern, educated society. A system that has bled the poor to feed the rich. A system that has sparked the rise of a violent movement that, according to our home minister, is the greatest threat to our national integrity. A system that is due, at least in some degree, to the corruption and avarice of those whose vocation it is to serve – our doctors.

A survey by Transparency International found that after the police, healthcare was the most corrupt service sector in India with a quarter of the respondents having paid bribes to access health services. The key culprits were, not surprisingly, the doctors (77%). We have all read in great detail of the unbelievable corruption that has claimed (for the time being, at least), the head of the chief regulatory body of Indian doctors. But then, he was arrested for corruption in 2001 and came back, winning the MCI election again. The astronomical amounts that buy undergraduate and post-graduate seats in the medical colleges of our country only rise every year. India is the world’s biggest bazaar for human organs. And every new government initiative in health care is quickly and confidently hijacked by our doctors to work for their monetary benefit. In short, our health system has fine-tuned itself to greatly benefit one group of people – the doctors.

And this is no secret. Every patient who goes to a doctor goes with mixed emotions. There is always hope – that the doctor will find the cause of the problem and treat it. But there is also fear – of the possibly unnecessary investigations, procedures and medicines that the doctor will order, knowing that every stroke of his or her pen is directly translated to some personal perk or benefit. The rich have no problem with this system. As with every form of corruption, it is the poor who suffer. Official statistics indicate that about 20,000 farmers have committed suicide since 1997 with poverty being the root cause in most cases. And the World Bank has estimated that one-fourth of all patients admitted to a hospital in India are pushed into poverty by this ‘catastrophic’ medical event. Studies done in random villages of Rajasthan, Gujarat and Andhra Pradesh found health-care expenditure being the cause for falling into poverty in 55%, 85% and 77% of respondents respectively. Health care for the poor in India has become a double-edged sword. Not having it is a denial of one’s rights, but having it is detrimental to the well-being of the household – the ‘medical poverty trap’. And often, health costs are driven steadily upwards by the constant search of health care professionals for higher profits and a better life, a situation that is easily exploited by health care companies and pharmaceuticals. The Hippocratic Oath often becomes a big hypocrisy.

Hippocrates refusing gifts of Artaxerxes the king

In today’s world, there are 2 forces that drive our doctors. The more common one is the monetary drive, where decisions of health practice are driven by the higher salary, cut or perk. The more acceptable one is the drive for excellence, be it professional or academic. But there is a third drive – that is often forgotten. In our dedication to either monetary gain or professional advancement (or both), we often subdue the drive that should be given primary importance by anyone who has sworn the Hippocratic Oath – the drive of service. But service is often pushed to the back of our mind during our medical education and practice. The number of doctors even from Christian medical colleges who serve in ‘areas of need’ are so few and far between.

When Nero was burning the Jews at stake in full view of the whole population, including the distinguished leaders of all the conquered kingdoms, when Hitler was exterminating the Jews with implicit knowledge of the Christian church and the educated population of Germany, it was the silence of those who knew better that allowed them to perpetuate these abominations against humanity. And today, many of us doctors participate in a system that is designed to make us richer and the poor, poorer. When Peter was running away from probable crucifixion in Rome at the height of Nero’s persecution, an apocryphal story tells that just outside the city, he met Jesus walking back to Rome to take Peter’s place. And the question he was asked is the one we are asked today – Quo Vadis, Petros, Quo Vadis? Whither goest thou, Peter?

Quo Vadis, doctor? Our country desperately needs more health professionals who will respond to the need and heed the cry of the millions of Indians who suffer under the yoke that the medical system places on them. Men and women of character, who have the courage of conviction to stand against the tide and make a difference like Dr. AK Tharien, Drs. Raj and Mabel Arole, Drs. Abhay and Rani Bang and so many others. The issues are not always so simplistic, but we need to make a start somewhere. Individual decisions need to be made until, over time, we reach the ‘tipping point’ when the flow of health care service will turn from being doctor-centric to patient-centric. It sounds impossible given the present situation, but that day will surely come. And it could start with you and me.

A young doctor stood at the bedside of a patient. This man had survived a major emergency operation in spite of a host of complications. He and his young daughter were extremely grateful to the doctor, but were pleading for a reduction in his bill. The young man took the plea to his boss, but was refused. The next day, the patient was gone, bill paid. Nine months later, the doctor saw his patient again. He had come for the birth of his daughter’s first child. The doctor was confused, remembering the beautiful young girl who had begged for a bill reduction. ‘But I thought she was unmarried,’ he said. ‘She is,’ replied the man, with a bowed head. ‘I sold her virginity to pay my bill.’

This is a true story. Quo Vadis, doctor? Quo Vadis?

References

[1] Sanjay Kumar. ‘Healthcare is among the most corrupt services in India.’ BMJ 2003; 326 : 10 doi: 10.1136/bmj.326.7379.10/c (Published 4 January 2003)

[2] Peters , DH, Yazbeck , AS , Sharma, RR, Ramana, GNV, Pritchett, LH and Wagstaff, A (2002), 'Better Health Systems for India 's Poor. Findings, Analysis and Options', Washington DC, The World Bank

[3] Krishna , A (2003a), 'Falling into Poverty: Other Side of Poverty Reduction', Economic and Political Weekly , February

[4] Krishna, A, Kapila, M, Porwal, M, and Singh, V (2003b), 'Falling into Poverty in a High-Growth State: Escaping Poverty and Becoming Poor in Gujarat Villages',Economic and Political Weekly , December 6, pp 5171-5179

[5] Krishna , A, Kapila, M, Pathak, S, Porwal, M, Singh, K, and Singh, V (2004), 'Falling into Poverty in Villages of Andhra Pradesh: Why Poverty Avoidance Policies are Needed', Economic and Political Weekly , July 17, pp 3249-3256

[6] Whitehead , M, Dahlgren, G, and Evans T (2001), 'Equity and Health Sector Reforms: Can Low-income Countries Escape the Medical Poverty Trap?', The Lancet , Vol 358, September, 833-36

[7] Malcolm Gladwell. ‘The Tipping Point’. Abacus, 2000.

(The edited version of this article was published in Current Medical Issues (hence the references!), the journal of the Continuing Medical Education department at CME, Vellore this month - my mother's farewell issue. She has done a wonderful job of revamping and editing the journal since 2003 and has begun the process to get it indexed)

Is India rich or poor?

UN HUMAN DEVELOPMENT REPORT 2010: The UNHDR 2010 was released on the 4th of November. Where does India stand? On the Human Development Index, we occupy the 119th spot (out of 169). There has been an improvement of one solitary position (!!) over the last 5 years. We rank below our neighbours, Pakistan and Bangladesh in education (average time spent in school is 4.4 years compared to Pakistan - 4.9) and health (life expectancy 64 versus 67 in Pakistan and Bangladesh). But India has secured the 10th position in the area of improvement of the income index!! In a nation where there are 421 poor people in just eight states, more than the 26 poorest African nations combined - 410 million. We also score 122nd among 138 countries in gender inequality. Generally not a good report card......

2 HINDUSTANS: So how can our income, GDP and economy be going up when there are so many poor people? The mystery man of Indian politics, Rahul Gandhi (or as Lalloo and Sharad Yadav call him - baccha/babua!!), made an interesting observation in an impromptu speech to the AICC meet. 'There are two Hindustans -- one is growing very fast and the other is for the poor (which is in crisis).... We have to connect and unite the two.' He has been doing some interesting things over the last few years, like riding a local train in Mumbai, regularly breaking his security cordon to meet poor people, secretly riding a second-class compartment from Gorakhpur to Maharashtra (with a visit to the unreserved compartment on the way) and meeting students in colleges over the country encouraging them to join politics. It seems he has done some research before making this observation.

WHERE THE MONEY IS GOING: The 2008 Swiss Bank Association report had an interesting finding. The country which has 1/3rd of the global poor also has the maximum amount of money stashed in Swiss bank accounts!! Nearly 2 trillion dollars of it! A large percentage of which must be black...The top 5 stashers are

India ---- $1891 billion

Russia----- $610 billion

China ----- $213 billion

UK ----- $210 billion

Ukraine---- $140 billion

Rest of the world ----$300 billion

(HT:India broadband)

AND WHAT'S LEFT GOES TO...: Certainly not the poor!! It seems that a lot of money goes to the world's superpower - Obamaland!! India is now the second fastest growing investor in the United States after the United Arab Emirates!! As for the 42% of Indians below the international poverty line, let's just forget about them for the moment, shall we......