Surrogate Motherhood in India

Millions of couples all around the world are battling infertility. Assisted Reproductive Techniques (ART) like Surrogacy seem to be the light at the end of the tunnel for such couples. Surrogacy involves employing the services of a surrogate mother to physically bear and give birth to a child at the end of term binding a contract. Although it seems to be a win-win situation for both parties, there are certain delicate legal and ethical issues that come into the picture.

Is Surrogacy Moral?

Throughout the pregnancy, the surrogate mother is physically and emotionally involved with the baby. Pregnancy comes with its own set of hormonal changes and the surrogate mother is bound to get attached to the baby during the process. Giving it up at the end of term and completely detaching herself once the child is born can be very taxing for the surrogate mother, affecting her mental well-being as well.

Ethical issues are also raised on treating a child as a commodity, a commercial object that can be bought off someone else. Surrogacy has the potential to violate human values and dignity as it places the reproductive capacity of a woman in the market place. The Convention on Human Rights and Biomedicine clearly states that “the human body and its parts shall not, as such, give rise to financial gain.” Since surrogacy essentially removes the idea of motherhood by treating women as “objects of reproductive exchange”, this “womb-for-rent” practice devalues the process of childbearing.

There is also a lack of regulation in this field that causes exploitation of surrogates in addition to denying basic human rights of citizenship and identity to the surrogate child. Oftentimes, the surrogate mother comes from a poor third world nation. In the absence of economic alternatives, they are sometimes pushed into international commercial surrogacy by their families for the sake of their livelihood.

Legal Aspects of Surrogacy

Most countries throughout the world do not consider the intended parents as the child’s legal parents. That title goes to the birth mother. India is an exception, with commercial surrogacy being legalised in 2002. This, in addition to the relatively low cost has made India a very sought-after destination for international surrogacy.

The Indian Government has regulated the laws governing surrogacy with the surrogacy contract between the parties involved and the ART guidelines of the clinic. Drafting, reviewing and signing the surrogacy contract at the very beginning is of paramount importance.

The Indian Council of Medical Research (ICMR) along with the Law Commission of India have laid out the following legal guidelines for surrogacy:

·         Prohibition of sex-selective surrogacy

·         Birth certificate of the child to have the names of the intended couple as legal parents

·         Requirement of one of the intended parents to be the donor to promote a healthy biological relationship

·         Surrogacy contract to take care of the surrogate’s life insurance cover

·         Right to privacy of the surrogate

International surrogacy also comes with several legal issues of its own. The surrogacy laws of both countries should be uniform. The citizenship to be granted to the child is also another major legal issue.

The focus of this article is to bring to light the various legal and moral grounds surrounding surrogacy. Although it comes with its own challenging ethical and legal issues, in most cases, it goes smoothly for each party involved as long as there is a solid agreement in place.

Connecting with Nature

The World Environment Day is organized every year in order to encourage worldwide awareness about environmental importance and its protection which is in turn aimed to get a healthy environment for everyone, especially for the coming generations. It is celebrated in more than 100 countries every year with a unique theme. The Theme for the year 2017 is “Connecting with Nature”. World Environment Day is celebrated to promote positive actions for the environment in order to sustain all forms of life in the long run. This year’s theme calls us to be a part of nature by joining any natural environment related activity. It invites us to find fun and exciting ways to create a vital relationship with the environment and to cherish the same. So how can we connect with nature in order to make the World Environment Day 2017 more successful?

How to Connect With Nature on This World Environment Day

You can celebrate the day  by performing both the indoor and outdoor activities and these can be:

Plan Outdoor Trip

Planning an outdoor trip like at beaches or in the valleys on the day will boost your senses as well as your enthusiasm and strengthen your connection with nature.

You can also visit the major parks in your city which are surrounded by the healthy plants, trees, and a variety of pretty flowers. Do not just walk inside the park, take long breaths and also try to touch and hug the trees carefully. This is such an awesome way to come closure to nature and realize the importance of their existence for our own.

Bring Nature Indoors

You can also decorate your home by keeping the jars of fresh flowers at the different places in your house. You can also give a space to the houseplants such as Aloe Vera, Anthurium, Peace Lily, Peperomia, Snake Plant, Christmas Cactus, English Ivy, and Basil etc.

Make Use of All Senses

You can find a peaceful green area where you can perform yoga or meditation as it connects all your senses with nature and gives a peace and relaxation to your body and mind. You can also put off your shoes and can start walking on the grass. This is such an amazing way whereby you can walk wet grass during the morning. Now, enjoy the sensation of the touch, andfeel the fresh air on your skin.

Plantation

Planting in your garden or in your nearest park can be a fascinating experience that directly links up you with nature. This step will seriously encourage the development of a green and healthy environment for you and everyone.

Add Vegetables to Your Diet

Buy some organic vegetables and fruits from the vegetable market. Instead of sending your servant to buy them, go yourself and pick the variety of fruits and vegetable. Now, Eat fruits and cook vegetables at your home with without any assistance. By doing so, you can create a healthy connection with nature. Thus, build a close relationship with nature on the day. The aim of celebrating this day is to become aware of the importance of sustaining the environment for a healthier life for the present and future generations.

The Perils of working in the NGO Sector

The not-for-profit sector in India is driven by visionaries and philanthropists who foresee a better community by solving problems that our society is plagued with. However, it has its own share of challenges; an important one being human resources. An NGO needs a dedicated workforce to manage innumerable tasks, leverage resources and build a friendly relationship with the recipients and donors. It faces various hurdles with the management of the HR function.

People have ingrained belief in working for corporate and government organizations with stable, secure and well-paid jobs. People in non-metro towns do not have enough corporate job options. For them, to choose a career in the social sector itself is a big step. There is a sense of insecurity with the job and salary when working at an NGO. Also, they wonder if they will be in line with society's idiosyncrasy while working with HIV infected people or the disabled. It is difficult to change this mindset.  Our government should pitch in with efforts to educate both, people at the grass-roots level and the leaders behind the NGOs, to adopt practical thought processes.

One would rarely find an exclusive HR department in an NGO. Neither does the founding committee allocate enough funds nor do they put in the required efforts on developing a HR team. The other employees lack organizational efficiency. Hiring is a time consuming process. It requires patience to sort applications and interview candidates. Also, young people join in to get NGO experience and leave with certificates. Some non-profits themselves term it as a good time to fill the gap in their summer leave. They must hire full time candidates. They have more time to imbibe the culture, adapt to the requirements and work productively. It would be wise to retain interns and those working on a project basis.

NGOs at grass-roots level are unable to manage funds and cash flow. They constantly need money and resources by funding which need to be utilized appropriately. Wages ought to be paid on time. They often have long working hours including outstation travel and stay. Employees work on different domains and across departments. NGOs must hire people who are self-motivated and willing to work out of their comfort zone; people who are able to strive for a goodwill cause.

Most NGOs lack proper facilities which make it more difficult to attract quality talent and volunteers. Scarcity of water, fluctuating electricity and unkempt surroundings make a bad work environment. There should be regulations on facilities and support for employees. It is crucial for NGOs to maintain hygiene and keep their employees motivated by ensuring access to these basic needs.

Non-profit trusts and organizations tend to give too much attention to raising funds instead of solving problems. There is a lack of communication to the lowest grade staff in the organizational structure, making them feel left out and lose trust. NGOs must keep everyone aligned to their vision and mission. Keeping governance systems in check would ensure everyone is on the same page and work in unison.

The Legacy of Jawaharlal Nehru

Jawaharlal Nehru, one of the greatest Leader India has seen so far, was the first Prime Minister of India. He was at the forefront of Indian politics and Independence movement along with Mahatma Gandhi. The people of India loved him a lot, and he remained as the Prime Minister for a long duration of 17 years! He is considered to be the architect of the modern India. Jawaharlal Nehru was born on 14^th November 1889 as the son of Motilal Nehru and Swaroop Rani. He was a graduate of Trinity College, Cambridge, and the Inner Temple, where he trained to be a barrister. He became a rising figure in Indian politics by the year 1910. The Non-Cooperation Movement was a significant phase of the Indian independence movement from British rule. Mahatma Gandhi led it after the Jallianwala Bagh Massacre. It led to thousands of common citizens to participate in Indian Independence movement. Nehru was an active leader of this movement, and he got arrested for the first time for activities against the British rule.

In 1929, Nehru became the president of the Indian National Congress. It was his first leadership role in politics. On 8^th August 1942, the members of Congress passed the Quit India resolution demanding complete political freedom from Britain in exchange for support in the World War II. The following day, the British government arrested all Congress leaders, including Nehru and Gandhi. He spent a total of nine years of his life in jail. Pandit Nehru wrote ‘The Discovery of India’ in 1942–46 at Ahmednagar fort in Maharashtra, where he was in imprisonment. The book is considered one of the finest modern works on Indian history. He wrote several other books later.

Once elected, Nehru headed an interim government, weakened by outbreaks of communal violence and political disorder. After failed attempt to form coalitions, Nehru reluctantly supported the partition of India. He took office as the Prime Minister of India on 15 August 1947. He was a visionary leader and started to lead India to accomplish his vision of India. The Constitution of India was enacted in 1950, after which he started working on an ambitious program of economic, social and political reforms. He led India's transition from a colony to a republic, while nurturing a multi-party democracy. He took a keen interest in developing Indian foreign policy.

Under Nehru's leadership, the Congress emerged as the largest party all over India and won consecutive elections 1951, 1957, and 1962. He remained popular with the people of India in spite of some political troubles and the 1962 Sino-Indian War. Throughout his 17-year leadership, he advocated democratic socialism and secularism. In 1951, he published the first five-year development plan and encouraged India’s Industrialization movement & improvement in the agricultural production.

Nehru had the vision of investing in Space Science & Nuclear technology and also had the skills to convince his colleagues about it. He brought exceptionally great intellects like Dr. Bhabha & Dr. Sarabhai to lead these programs & also managed to get help from other countries like the US, Canada, France and Germany in the early stages of these programs. He instituted various social reforms such as free public education and meals for Indian children. He approved the legal rights for women including the ability to inherit property and divorce their husbands. He appealed the conventionally opposed categories of low caste and high caste, Hindu and Muslim and North Indian and South Indian.

The Indian democracy is in the steady state today because of the foundations laid by Nehru. If India has become a large economy in the World, it is because of the multi-purpose projects, the public sector undertakings and institutions established by Nehru as well as the systematic planning process initiated by him.

India will always remember Jawaharlal Nehru as a great leader of Congress, the single largest political party in India that time & the first Prime Minister of India. During his leadership, India became independent, the Constitution of India was signed, and India made considerable progress as an Independent Nation. He developed a great relationship with multiple nations and led India on a progressive path. He was the greatest political leader India had seen so far.

Helping Our Aging Parents

Do you have aging parents? Then consider yourself blessed. It means that you are in the prime of your life, and have already accomplished a lot of what you had been dreaming since your childhood. On top, you still have your loving parents whom you have known since you were born.

But never take this blessing for granted. Many are not as lucky as you. Many may not be having any parents alive, and a few may have only one of the parents alive. As time goes on, your blessings may run out. I have known many who always had this regret, "I wish I had done this ..." for their parent. However, one would only say that this is not their fault. Everyone thinks their parents will live forever; at least as long they themselves are alive. The fact is, we have seen our parents ever since we have been alive. The thought that they can leave us, never enters our mind. Let the truth be told, however harsh and heart-breaking it may be for you. Unless you yourself meet an untimely end; your parents will depart from this world before your eyes!

If you have realized this and taken it bravely, then NOW is the time to do something for them. Never postpone your solemn duty of caring for them; because you may never get the opportunity again. So, what can we do for our aging parents? Below is a brief list that may serve as a reminder, an agenda and a To-Do list.

 1. Give Them Your Time

Aged parents feel neglected and unwanted. As senior citizens, they feel as if they are like products which have passed their expiry dates. This terrible feeling is more reinforced, when they find that many of their friends and peers have passed away. The feeling of loneliness can be killing. Find TIME for them. It is the most precious gift that you can give them every day. Remember the times when they send so much time on you. You were their indulgence. They gave up many of their life's enjoyment so that they can spend more time with you. You own needs were very visible, and you would not have been what you are today, if they have not given you their time, often sacrificed their sleep, rest and comfort. Sit with them, eat with them, talk to them, and take them around; is the minimum caring you can do. Often aged parents, after retirement from jobs, are restricted to their rooms. It is just like putting them in a prison cell. Caring for them means making they feel ‘at home’ and that they are still an integral part of your family.

2.  Taking Care of Their Finances

Senior citizens no longer continue to earn or get paid employment after retirement. Your parents may not be earning anything now, yet the cost of living continues unabated. In fact, they may be on the higher side, if cost of healthcare, health food supplements and medicines are added. It would be good if they have a house of their own. You have to see that they do not face any financial hardship. The house can be put on mortgage, if fund position is tight. It will give them the required liquidity to manage their affairs. Your siblings can chip in, if they are good children. Sharing costs would reduce the financial burden. Do whatever you can, but never let your parents face any financial hardship at this age. Remember the times when they did whatever they could, so that you can have what you wanted or needed badly.

3. Caring For Their Health Issues

As they advance in age, your parents will be facing an increasing number of health issues. It can be anything from arthritis or cataract to Alzheimer’s or Parkinson’s disease. Senior citizens may not have anyone else in this world to turn to. Some retirement plans and pension schemes include life-long medical care which includes the spouse. Check for any such policies. More than anything else, during their illness, your mere presence with your parents will give them great comfort. Do your best to ease their sufferings in these sunset years of their life.

4. Give Them Your Emotional Support

It might come as a surprise to you, that the ones who supported you emotionally when you were young; will actually need emotional support themselves. But it is true. As senior citizens your parents may feel helpless and frustrated with their illnesses; and lonely because they may have lost their entire elder or peer near relatives and friends. As their very own blood, your emotional support will be a lifeline to them. It will fill the void they feel in their life. Do not miss this chance to repay your blood debt.

5. Old Age Home or Paid Health Caring

In India, it is customary to have the parents in the family. However, times are changing. Many old age parents have their children working abroad. There is no one to take care of them. This situation can be disastrous, when any of them falls sick or becomes a victim of a mishap or accident. NGO’s or paid care givers have to be employed to take care of them. With the risks of theft and mugging of senior citizens on the rise, the children living overseas find it safer and more convenient to put the parents in old age homes.

These are just the most important points to be taken care of, and only illustrative. There are as many ways to take care of old age parents as they thoughtfully did for their children decades ago.  It is not just a noble humane responsibility, but also an experience that is very warm, satisfying and fulfilling. You will remember this for long and feel thankful when your parents are no longer with you. Someday in not very distant future, when your own time comes, you will also be in their shoes.

New Pension Scheme - Retire Well

There was a man living in his late 50s, he had a daughter to get married, a son in his graduation and a wife and he is the only earning member in the family. He had to plan for so many things lined up and most of them are cost heavy. Now there can be two possibilities- the man had done initial investments (stocks, real estate, mutual fund etc) and he sells them and take returns to satisfy the needs along with his savings from the salary. The other situation is that he has planned everything systematically and opted for NPS. He knew how much he would need in future for big expenses like child education, marriage etc. Finally, the man retires- son and daughter both married and living outside India happily. The man now has no earnings in case 1 as he had sold his investments. But in case 2 even though he sold his properties at the time of need, he will get monthly income due to NPS. He still can earn his living without tension and the man along with his wife enjoy their senior citizen life.

The purpose of life is to live a healthy living, eat meal two times a day, keep your family happy, satisfy their needs and earn- how much? The nature says that we are never satisfied with what we get and on how much we wish to earn. But we have options till we have a job, business men are exceptions in this situation. Imagine you are working in a small shop or any unorganised sector and you turn 60. What next? No job, no earnings, what will happen to your family. Here is an illustration to this.

Nothing bad will happen because here is scheme which will provide regular (monthly) income to your family once you retire. This scheme is NPS-New Pension Scheme. It has been introduced by Government of India for providing pension benefits to the common man specifically to those who are self-employed like barbers, shopkeepers, etc. and to those who work in unorganized sector. Under this scheme, individual has to regularly invest some amount and he will get some fixed amount at the time of retirement as income. There are various benefits and what better than this would serve your purpose. It is like you get a reward of your job for the hard work and your contribution to the company.

It is open for every citizen of India and you can opt for this scheme easily and conveniently. It is very flexible and regulated by PFRDA (Pension Fund Regulatory and Development Authority) which is a transparent regulatory body. Hence, you are secured and keeps a monitor check on the happenings and proceeds. Thus, it is highly genuine and trust worthy. Any person from the age 18 to 60 can opt for this scheme. But when there is an undischarged solvent, unsound mind person or might be a pre-existing account holder of NPS, he/she is not eligible for NPS.

Next section is about opening of NPS account. It is simple indeed. Two types of account can be opened under NPS Scheme i.e. Tier 1 and Tier 2.Tier 1 says that the amount can be withdrawn by the NPS account holder up to the age of retirement i.e. 60 years and Tier 2 account subscribers are free to withdraw their savings as per their requirements.

Everything basic thing is discussed but major question striking your mind would be how much amount to be contributed. So, there is a minimum limit of Rs 500 per month or Rs 6000 per year. The minimum contribution has to be of 1 year. There is one flexibility out here in case of withdrawal. There is an option to withdraw early i.e. before the age of 60. It might be due to some urgency because of severe illness, big expense coming your way, sudden death or mishap. And the other is of course to withdraw when you retire normally at the age of 60. In a country like India, where social security schemes are practically non existent for those in the unorganized sector

Bonded Labour in India – A Form of Modern Day Slavery

        

India is a labour-surplus economy – with an unlimited number of workers willing to work at a subsistence wage – a paradoxical feature of the labour market is the rising incidence of scarcity or shortages amid a situation of potential plenty.  Labour law reform has been in debate since several decades but this has come onto the political agenda in India by the results of the 16^th General Election. it is commonly being argued that the reform is intended to address the problem of labour market rigidities and ensure a smooth economic investment growth by removing the unnecessary obstacles.

Bonded labour is the most prevalent form of modern slavery in India today, despite being outlawed. Individuals and families, including children, are exploited in slave-like conditions to pay off debt. The lender, often a landowner or factory boss, uses numerous tactics to exploit this slave labour. The borrower is often forced to work at paltry wage levels to repay the debt. Exorbitant interest rates are charged (from 10% to more than 20% per month), and money lent for future medicine, clothes, or basic subsistence is added to the debt.

In most cases of bonded labour, up to half or more of the day’s wage is deducted for debt repayment, and further deductions are often made as penalties for breaking rules or poor work performance. The labourer uses what little income remains to buy food and supplies from the lender, at heavily inflated prices. They rarely have enough money to live on, so they are forced to borrow more money to survive. Any illness or injury, often due to the appalling conditions in which they work, spells disaster. More money must be borrowed not only for medicine but also because the injured individuals cannot work, meaning the family is not earning enough to survive.

Sometimes the debts last a few years, and sometimes (especially in agriculture) the debts are passed on to future generations. For those who do manage to pay off the debt, often their situation means that they need to borrow more money so they are perpetually in debt, albeit for a series of loans.

Jobs and Careers : Explore the New

At one point I remember studying and appearing for my medical entrance examinations (this was of course years ago), largely because my father wanted to become a doctor. Unfortunately, his father could not afford to pay his fees, though back then, it easier to get in and competition was limited and so my father went off and joined government service determined that whenever he had a child, that child would be what he could not be.  I wanted to be a journalist or a radio broadcaster and had even auditioned for the youth channel of All India Radio – yuva vani   and had taken a few baby steps in broadcasting, when my dreams were shattered and I was told in no uncertain terms that I needed to study to be a doctor. Competition then was already tough, though it might not have been so nail biting as it is today.

Today of course competition is a lot tougher, but then job opportunities are more diverse and options more easily accessible than was the case previously. And even then, parents still want their kids to go down the beaten track of going to IIT and then IIM and then then land a so called secure job or become a doctor. Humanities students can choose the other option – clear the UPSC exam and become a Class a government officer. The less intelligent can opt for the Armed Forces (yes, they no longer attract the cream) or join a PSU Bank or company or the Railways. That is the end of the comfort zone for most middle class families.

So it was quite refreshing to see Startups have changed the rules of the game and even more so than call centers which were “in” a decade or two ago.  When we hear of Startups, we nearly always hear the stories of the founders and their rags to riches story and that cannot be the script of everyone. So it was encouraging to read how the taxi aggregators like Ola and Uber have created transformational stories – not just for those who were always taxi drivers but also many corporate executives , engineers and management staff from there, who are giving up their rat race jobs and taking up driving for Uber or Ola; realizing that there is still scope to earn enough of a decent living doing so and more ever enjoying the luxury of working at their own pace and desire without the need to worry of leave , late coming, attendance registers.

Of course, it is not all about driving taxis. The point is that the world has changed a lot in the last decade even and continues to change. There are many career options available today that weren’t there when today’s parents were setting up their own lives. So let us explore these options and not be intimidated by cut off percentages, entrance exams and interviews which are all gatekeepers to the conventional jobs and courses. 

NEET: How do you test ethics?

As a trained medical doctor, I feel that I must say something about the recently passed legislation called National Eligibility cum Entrance Test (NEET) which will henceforth guide admission in Indian medical colleges.

It replaces the multiple tests conducted by multiple institutions and State governments with widely differing syllabi. Prima facie, this is a great thing as students don't have to study multiple syllabi and appear for multiple exams back to back and some even happening on the same day.  However, there are disadvantages too, as I have discovered by virtue of being associated with the governance of one of the Christian Medical Colleges in the country. The issue with NEET or for that matter the JEE for the IITs is that they test for pure academic merit and nothing else. Academic merit can be accumulated by enrolling in cram centers like Kota whose sole reason for existence is to produce students who can enter those hallowed gates.

However, coming to the Christian Medical Colleges, till the time they were allowed to conduct their own exams they did not only look at academic merit. In keeping with their ethos, they looked for (not always successfully of course) those who had the aptitude to go and serve in rural India, the purpose for which these medical colleges were set up in the first place. There is also another Gandhian philosophy based medical college, which similarly looked for ethics and values in their students and not just marks.

A recent NDTV sting operation brought out the horrendous fact that in Punjab many medical colleges function with the help of hired 'ghost' faculty, private practitioners hired for 2-3 days simply to help get the college its license. Now imagine being treated by doctors who are not qualified, because they went to a college that operated with this kind of faculty. After all, when we seek out a doctor for treatment, we do not typically ask which college and university they passed out from.

In professions like medicine and many others, it is simply not enough to grade a student by how many marks he or she scored. There is such a thing in medicine as the Hippocratic Oath (and equivalent honour codes in other professions).  If we only evaluate students for their academic merit without any look at their motivation, character and ethics, which we subsequently expect them to abide by, then something is surely amiss.

Dementia - When the mind fades away

As per the estimates of the World Health Organization, the number of aging population is increasing in countries like India and dementia is going to become an epidemic among the elderly in the coming decades. Although so far, I have not known anyone personally who is or has suffered from dementia, I am aware of people in my circle of friends who have. Since dementia is generally speaking, largely seen among senior citizens and there are in my immediate and extended family (and I myself am crawling in that direction too), I though to educating myself on the subject a bit and recently did an online course on dementia.

The course with videos of patients and care givers themselves describing their slow and steady downward sided into the disease with some of those videoed showing fairly advanced symptoms and the care givers describing the stress and strain of providing care in a context that can last for several years left me quite disturbed. Looking up the recent statistics, I find that over four million Indians above 60 have the condition, which is around 3.7 percent of that population. Approximately, one out of every 16 households with an elder has someone with dementia. Yet as I look around and ask around dementia remains a neglected area in healthcare, and many families do not seek or get suitable diagnosis or treatment for dementia symptoms. Poor awareness about dementia means that elders who experience problems like forgetfulness, confusion, or difficulty doing tasks do not consult doctors. 

India also struggles with cultural obstacles to improving care for those suffering from dementia. Institutional treatment is considered a taboo in India, as children do not want to be seen as abandoning their aging parents. Many even want to conceal the fact that their parents are suffering from dementia, at times preventing the patients — and the families — from getting the care they need. Myths, superstitions and misconceptions thrive and abound and erect further barriers in addition to the ones already existing due to inadequate public health infrastructure and largely unaffordable private mechanisms of care. The course that I did left me disturbed for one particular reason. The course was designed in the UK where through the NHS and existing support groups, there exists a reasonable structure of care and even there the care givers as they gave their interviews appeared fatigued and worn out and at least one spoke of having to give up their career because the full care giving routine, would not allow for a regular job. I do not what it is like for Indian care givers with far less support and a lot of stigma and what they go through. Clearly Dementia is a condition which is probably more a social problem as much as a medical one and needs attention from that lens.

Security Guards : Exploited Labour in the National Capital

A few weeks ago, I was staying in a nearly empty guest house with just a security guard (also doubling up as a part time housekeeper) for company. For the two or three days that I was there, he took care of me well. As I was about to leave and my taxi was at the gate, he asked if he could have a few minutes with me. He asked me if I was a doctor as he had heard. When I affirmed that I was, he rolled up his trousers, exposing an angry, swollen and very obviously infected wound below his right knee, he asked if I would prescribe him something. He told me that he was applying some ointment locally but it wasn’t working. The condition of the wound was such that it was very clearly not going to heal through application of any local ointment.

Antibiotics and possibly strong ones at that were needed, if not some minor surgical intervention to drain the pus. Not wanting to prescribe anything in a hurry, I asked him to visit a doctor knowing that the Delhi government had recently opened Mohalla clinics which were said to be functioning well. He told me that wasn’t going to be possible. On probing further, he informed me to my horror that he received a monthly salary of Rs 6,000 with no leave for a 12 hour shift , 365 days a year and if he took any leave at all due to dire necessity, he would lose a day’s wages and with his pay being what it was, he couldn’t afford that. All I could do with my taxi honking impatiently was to give him my phone number and ask him to call me the next day so that I could take a little more in depth history, if I needed to prescribe anything. He never called back, I have never returned to the guest house since and I often wonder how he is faring.

The security business in Delhi has been operating under the Delhi Private Security Agencies (Regulation) Rules, 2009. Under this Act, a security agency takes a licence for its operations, which remains valid for five years. Most of these companies have been flagrantly violating the rules and regulations of the PSARA guidelines. Week offs, insurance, perks are a far-fetched dream for these guards hired on contractual basis. Many of these guards are not even acquainted with the rights and duties made for them under the above mentioned guidelines. They have been working for the sake of getting employment which is still a dream for many, thus, encouraging agencies to hire people on wages less than the stipulated amount.

Delhi is now being governed by a government that is of and for the “Aam Aadmi” and it is time the government took note of the pathetic conditions under which security guards work. Just as ministers are busy inspecting schools and hospitals and penalizing them if they are not meeting their obligations to the poor, it is time that some one picked up the cause of these exploited security guards.

Tuberculosis : An Under reported killer

Many years ago, while visiting a village called Arogyavaram in Chitoor district of Andhra Pradesh which hosts a Christian Mission Hospital, I was shown a cottage where Kamala Nehru, the wife of Jaaharlal Nehru had once stayed decades ago. At that time, Arogyavaram a place with a salubrious climate was a TB sanatorium and Kamala Nehru a patient hoping to recover her health there.  In those days, (we are talking of the period around 1930), TB had no cure and the only treatment prescribed was a longish stay in a TB Sanatorium where it was hoped that a benevolent climate and good nutrition would aid recovery. That didn’t happen to Kamala Nehru however and she moved from sanatorium to sanatorium eventually dying in one in Lausanne in Switzerland in 1936. Exactly a decade later, Streptomycin, the first drug to be effective against TB was discovered.

Tuberculosis has been with since antiquity and has always carried with it a lot of baggage and stigma. India has its share of the disease burden with about 3 million people suffering from it at any given time and is the country’s largest public health challenge. It was a challenge in itself and then in the 1990s and beyond with the spread of HIV & AIDS, and the close association with TB in immune compromised people, it became a bigger challenge.

A bigger challenge though, which multiple advances in medicine since the discovery of Streptomycin, all those decades ago, is the fact that the duration of treatment is long( six months onwards) and many of the patients drop of the treatment radar along the way. This incomplete treatment regime has given rise to strains of multi drug resistant TB. India again has the dubious distinction of having the second largest number of drug resistant TB cases after China. The problem is not going away anytime soon.

A larger question, is the data that I have cited even correct?  According to a report published in the prestigious journal ” Lancet”, more than a million tuberculosis (TB) cases may be missing from official statistics in India as many cases go unreported and the data only captures the numbers of people reporting to health care facilities in the organized sector. But because of factors that are both economic as well as social, many patients seeking treatment for TB turn to unregulated private doctors who often do not report cases. It is also difficult to track as to how many of such people actually complete the course of treatment. Again, one has to fall back on estimates and they seem to indicate that Out of the 2.7 million individuals with tuberculosis (TB) in India in 2013, estimates show that only about 1.05 million or 39 per cent completed therapy through the government TB programme and survived for one year after treatment without experiencing a relapse, according to a report published in the Indian Express. In today’s infrastructure driven age, public health does not attract too many eyeballs. Yet TB, where India hosts the largest number of patients, has an under noticed and under reported problem on its hands. 

Medical Missions in today's time and age ...........

                                                                  

A couple of decades ago , a debate on the essence of medical missions today would not have been necessary. Medical missions meant mission hospitals which were mini townships, often in the middle of the wilderness, sometimes standing with a school and almost always a church. Medical missions has a history in India going back to the Colonial era because it is one of the earliest and most visible manifestation of missions that was visible and still is visible to the common man. It was widely promoted by the then government and can be understood in my view as one of the earliest manifestations of public private partnership. The state often leased out land to the Mission and provided facilities so that drugs and equipment could be brought into the country and in return the missionaries provided medical care with personnel that they brought in. the arrangement worked well at a time when government provided medical care did not extend  beyond  the big cities and hospitals were usually attached to medical colleges or cantonments and in the princely states was dependent on the benevolence of the Nawabs or Rajas in place.  Three developments challenged this cozy arrangement.

The first was the advent of independence and the foundation of the welfare state where the State assumed the responsibility of providing health care (among other facilities) to its citizens as part of the Nehruvian vision. This meant the inauguration of the Primary Health care infrastructure throughout the length and breadth of the country. How effective this vast mechanism was is another question, but for the first time, outside the big towns and cities, a systemic alternative to mission hospitals became available and mission hospitals lost their monopoly. The quality of care at the PHC and associated district hospitals might or might not be great, depending on who manned them but an option to Mission Hospitals had emerged. Also post-independence, the involvement of missions decreased over time as the symbiotic relationship with the Colonial government and a natural chemistry was missing with the new post-independence government.  More on this later

The second big challenge happened in 1983 when Apollo Hospitals opened up in the county and began corporatizing health care with the clear aim of providing clinical services with an eye on the bottom line and increasing shareholder value.  The latter did not necessarily make health care cheaper by default, but it did spark of innovations in health care at the business model level and not just at the clinical level. Till this time, health care in the private sector was at least notionally nonprofit. Health care in the private sector was not usually cheap, but the “profits” were usually ploughed back into the facility, to facilitate research, improve infrastructure and so on. For the first time, a hospital was opening whose sole reason to exist was to earn profits for its owners. Although there were nay sayers, even in the pre-1991 pre liberalization era, the hospital came to be and eventually spawned a whole range of corporate hospitals – big and small.  Now before the advent of the corporate hospitals, there were the mission hospitals and there were a few large nonprofits. Mission Hospitals would treat rich and poor alike and the rich had few options at the time. Along the way, the rich would cross subsidize the poor patients in the Mission hospitals but with the coming of Apollo and others accompanied by aggressive marketing, the rich had more options to choose from.

The third was the entry into India of medical insurance. Although less than 15 percent of India is insured, the entry of health insurance rewrote all or many of the ways in which health care had been practiced hitherto. To rationalize and reduce payments against premiums, treatment protocols began to be rationalized, hospitals began to be graded and tie ups between insurance companies and hospitals began to happen.  As more and more insurance companies set up shop, they brought in practices and norms that one had to adhere to or be outside the mainstream medical system over time.  A limited few medical hospitals adapted and thrived , a lot many simply stayed put and gradually began to get obsolete. It is then that the debate on revisiting medical missions perhaps really started – when mission  hospitals began to be financially less and less viable and the question became very real – how else could medical professionals live out the gospel if the only model in which it had been practiced had become something that could not anymore be practiced ?  

to be continued.........

Why do men drink so much ?

Recently while on a visit to our program in the slums of Chennai, i noticed that all our programs were structured around women. The program was a very successful one and the team had worked hard with the slum community as well as the local slum clearance board to make thinngs happen and very visibly, the impact was there for all to see. But no men. Of course it was day time and men might be at work; but still I asked. Any programs with men ? No. why ? Some whispers and murmurs, but no answers forthcoming. But curious , i keep probing. In a way, i know what the answer will be, over the years, I have worked with many slum communities and the work is always or almost always with women. So the answer , when it does come, does not surprise me. We do not have any program with the men in the slums because they are either at work or if not , they are drunk.

so why do men drink, I ask ? Well, another round of familiar answers follow. Men go to work and get tired and need a drink for recreation. Oh, they have lots of worries and tensions and alcohol helps them forget their worries and tensions for that period of time when they are drunk. And so they drink. I probe further – what do women do and why don't they drink ? Well, women don't go to work and are not involved in manual labor , so they do not have the compulsions that men have. But they do have their worries and fears don't they ? Oh, yes, I am told- the women have their own fears and worries. So what do they do ? .... well they throw the household utensils around and then go to the neighbour's house to gossip. So in the evening , all the slum women are huddled around gossiping , while the men are slumbering, dead drunk. Neat. Very neat.

For years, i have been observing programs planned with men almost always fail, despite the same dedicated staff, the same meticulous planning and the same effort put in. programs with women succeed; programs with men fail; and usually because nothing consistent can be planned with the menl because of this alcoholism problem among men in the slums. This is case with us in Oasis, it is often the case else where too. Alcohol seems to be the almost universal sopoforic of recreation in the slums and almost the only one it would seem. So can any thing be done for men or are all developmental programs in the slums destined to succeed with women ?

some thing about Oasis's programs among young men gives me a ray of hope. I don't know where we will ever be able to break the scourge of alcohol and its hold among rhe older men, although I should not be pessimistic. But our program with the young men form the slums and others on the verge of dropping out of society which focuses on sports as a tool might be the answer, at least for the younger people. Using football as a glue, Oasis is able to bring together young men who might all have gone their own separate and destructive ways. These young men learn the value and worth of discipline, sportsmanship, fairness and respect for rules and perhaps most importantly make lasting friendships and bondings that may, if they are lucky , last a life time.

The Oasis progam is only a few years old and it could be said that in many ways, it is in its infancy. There is very certainly a long way to ago, and it will be a long time , before we can draw any definitive conclusions. Perhaps , I am being a fool to anticipate so much , expect so much to happen from a program that is so new , so nascent. But even so..I dream that way. I dream that one day it will be possible to walk into a slum and ask the question – not “ why do men drink so much ?” but on the contrary “ why do men play so much ? ”. it will be the day when the brawls caused by drink wll be replaced by the laughter and the banter of sport. That would be change. That would be transformation. That would indeed be life.

Bored meetings or Board Meetings

My organization's Board meeting took place on Saturday. Though the meeting was planned as a whole day event, all business had been conducted by lunch time. There were several eminent people present, all spoke and shared their views articulately and freely. Yet it was still possible to have a vibrant discussion and still all the transactions could be completed earlier than what was anticipated. Every one found time to listen to each other and although by the end of the meeting, a lot of decisions had been, they had been made so collaboratively that it would be very difficult for any one person to have claimed credit for the decision.

The free afternoon time left with lots of time to think of other Board meetings where I have participated, usually as a member, but sometimes as a participant. I remembered meetings of different hues; but the most common memory is that of dull, listless meetings dominated by one person, usually a man, while others sat around with a bored look, wondering what they were really doing there. Some basic, legal requirements were hurriedly gone through monotonously and then the crowd quickly dispersed. They would gather together in a similar fashion in another 6 months or a year for a repetition of this mindless ritual.

Sadly, governance in India is not taken that seriously; at least not in the nonprofit sector where I have spent a lot of my life. It is assumed that because the organizations involved in charity work, are supposedly there with highly altruistic motives, everything is just fine with the way they are run and with the way they are governed. And so Boards and such, by whatever name called, are considered a necessary evil, thrust upon us by the nasty arm of the law. Governance thus is something that is considered an intrusion demanded and required by the law and not something to be pursued for its own intrinsic merit. And so a lot of boards and governing bodies are filled by sycophants and toadies- hangers on with nothing of worth to contribute. The worst case scenario – and yet not uncommon either, are boards staffed by family members and relatives of the founder or the CEO.

This of course is a pity. My own board meeting has impressed upon me the value of having caring, involved people of integrity on the Board. They perform all the necessary statutory duties of course; but go far beyond that limited statutory duty. By virtue of the eminence they have in different fields of occupation, they become helpful sources of information, guidance and most importantly – of advice. They do not intrude in the day to day running of the organization – an activity for which they are too busy any way; but remain available to advise, guide and provide valuable insights – something that only the foolish would overlook.

Although it would see that governance can fall by the way side even in the corporate sector as evidenced by the experience of Satyam, it is an unfortunate fact that in the NGO sector, we do not know enough to educate our board members on what their individual roles and responsibilities are and what they can and cannot do. The sad result is that often NGO boards are either complete rubber stamps nodding assent to everything that the Chief Executive does or at the other extreme, an over bearing, micro managing body, stifling every initiative.

Perhaps , the trick is in having the right composition for your Board. In choosing people, who are eminent in their profession and are also adequately informed about the work of the organization. Individuals, who are committed without being too interfering or intimidating. When a bunch of such people gathers, animated conversation crystallizes into sagely counsel and wise decisions. And Board meetings are no longer bored meetings.

Stop chasing those numbers

A lot of this month seems to have been occupied by numbers – we were writing a proposal for one of donors and if the project were approved, it would mean that we could continue to do the good work that we do. The exercise involved a lot of wrestling with numbers. Numbers to be filled in the budget column ; numbers to be filled in explaining how many people would benefit from the grant and how to make sure that enough number of people had access to the program without us spreading ourselves so thin, that quality itself would be compromised.

Having worked for a funder before, I can understand their compulsions. Funders have to calculate hard data like cost per beneficiary and if that is too high, then the manner in which the program has been designed may not be feasible to run and fund; no matter how good the rationale, the bottom line is always economics – the final question before any funder will sign off – does it make economic sense to fund this program – will enough numbers of people benefit from the grant or a tiny number of them will? If the answer is not satisfactory enough, the application will not be accepted. Working for a donor, I used to examine those numbers and determine whether they were consistent with financial prudence. Today as someone who works for Oasis, an implementing agency, I have to supply those numbers and apply the same parameters.

But just how much should an organization be driven by numbers, is a question I still have not been able to resolve. Numbers are important I know. It costs a lot of effort to raise money and if it is not used in the most efficient and cost effective way, the donor is very likely to feel short changed. Yet as someone dealing with people and their suffering, just to what extent can this be quantified? and even if it can be , to what extent is it fair or right to measure the efficacy and success of our efforts through numbers alone.

At Oasis, a large part of our work is with victims off trafficking. Often they have suffered immensely and in a manner that we can hardly imagine or understand. They have been exploited, abused and brutalized in the most unimaginable ways possible. At Oasis, we try and restore to them some of the lost years of their lives, through a host of interventions. Those interventions are costly. That intervention s is intense. Those interventions take time to work. If at all they work. And sometimes, they don’t because some hurts and experiences human beings cannot deal with, no matter how proficient their methods and how professional their staff. Only God can heal every one, we at Oasis can only try and does our little bit as His agents and instruments.

So is it fair to always ask that question” How many”? How many women did you rescue from the brothels? And how many children? Why so many women? Why so few children? Why did only so many women enrol for your livelihoods program? Why did so few get successfully counselled and come to terms with their past? Why? Why? Why?

As a donor, I used to know how to ask the right questions, and I still do; but today I know how easy it is to ask questions than it is to provide the answers to some unfathomable mysteries. But one thing too I know, that numbers are one piece of the puzzle. Yes money is important, cost benefit ratios are important, effectiveness is important, professionalism is important. All of those things are important. But infinitely more important than all those numbers is the human spirit which we try to heal.

Why Prakash Jha should make another movie

I went to see Rajneeti over the weekend with my daughter. After all the press coverage about how the movie was largely based on the life of Sonia Gandhi and all that, one expected a lot of that, but unless the censors have completely distorted the film by cutting of big chunks of the film, one can hardly see evidence of that. Katrina Kaif for some moments in the film does play a widow and her mannerisms do like one of the Gandhis – could be Sonia or he daughter, the similarity about ends there. The movie is not anything about the Gandhis – Sonia or Priyanka. Rather the movie is about the lumpenization of Indian politics.

We have all grown up with the notion that politics is bad and politicians are the baddies. If one had somehow missed out this bit of a middle class Indian’s education, Prakash Jha can fill the gap. His depiction of Indian politicians – not the underground Maoist types; but the types that fight elections is such that one would come out of the theatre shuddering with horror at our plight as we think about how we are ruled and by whom. And that raises a question.

That politics and politicians are corrupt, inept and amoral has been taught to us from the time we learnt to listen to stories in our mother’s lap. It began with stories of wicked kings and as we grew older, began to be replaced with other people we recognized or knew. Eventually the media created bigger ogres of our ruler and politicians. But coming back to the question that arose after watching the film, I fail to understand one thing – if all our politicians are like the ones portrayed in “Rajneeti”, how are we surviving as a nation?

Rajneeeti’s political figures are barely human. Ranbir Kapoor is supposedly cast in the role analogous to Arjun (the film has shades of the Mahabharata in it), but could well have played the Biblical Satan with ease. Though there is a whole lot of dark side to the so-called democratic Indian political system, but murdering someone from the rival side at the broad daylight in front of masses as shown in the film is like a little too far stretched.

Of course, bad and even villainous politicians live and thrive; we all know that. But what about the good ones, they too exist, don’t they? they may not be saints, and possibly don’t even claim to be one, but they are the ones who ensure that anarchy doesn’t run amuck, and that there is at least some attempt at governance and the rule of law.

Take for example our freedom fighters- people whose birthdays we love to celebrate and whose statues and portraits adorn all public squares and several calendars all over the country. Bhagat Singh, Mahatma Gandhi, Veer Savarkar , Sardar Patel, Nehru... and many , many others. Weren’t they politicians of one hue or another, whose beliefs differed widely, usually vary widely, but because of that they wouldn’t kill each other and cause mayhem. They did give each other that space.

Even today such people exist; politicians who are quietly and silently burning the mid night oil so that they can serve the country as best as they can. They may not make it to the newspaper headlines because they are not looting the exchequer and amassing assets; neither are they plotting intrigue and communal violence in the dead of the night. Such people exist; and it is because of such politicians that the nation still runs and that we are not yet a failed state. Their story too deserves to be told. Prakash Jha ought to write the script of another movie. He has exposed the gory side of Indian politics. Now he ought to project its golden side.

Whores and Prostitutes : the baggage that words carry

One of my colleagues was orienting some newly inducted staff about our work among the prostitutes of Mumbai, when an indignant hand shot up to protest. “prostitute” was not a word to be used – especially by our kind of people who were involved in the development sector who ought to know better. After a sheepish apology, the session continued and eventually we proceeded to enumerate the number of "beneficiaries" whom we had rescued from the "flesh trade".

Soon other hands had shot up. The word “ beneficiary” was too patronizing – who did we think we were any way.... and “flesh trade” .... well wasn't the word so coarse and harsh and how could we even think of using such a word, didn't we have any sensitivity at all or what ? I began to have deep sympathies for our communications manager , who presumably has to learn to walk around with a lot of dictionaries and thesauruses to avoid tripping over a charge about the wrong use of words. I was thrilled that I didn't have her role.

Later that day, I was leaving to board a flight. The weather was wet and it had been raining heavily causing traffic jams all the way from my home to the airport. The humidity and the rain had ensured that all all my clothes were soaked to the bone. As the taxi entered the crowded and disorderly airport terminal, i spotted a relatively empty gate meant for “ persons with special needs”. I immediately cataloged all my special needs – I was occasionally breathless, more often than not short tempered and hot headed,m terribly impatient too. Some minor medical ailments were accompaniments too. But the CISF jawan at the gate wouldn't let me in.stripping aside jargon, he told me that the gate was meant for “apang log”, the disabled”. Special needs was an euphemism for disability.

Since then i have been wondering a lot about the words we use. A lot of them have become so much a part of common usage that we use them without thinking and without intending any harm. Yet words carry a lot of weight, can be stigmatizing and devastating for the self esteem. But we seldom know, because we live and breathe in a different world. As a child , I was taught , never , ever to use the word” leper” because it had a certain connotation of exclusion, isolation and neglect. On street corners and traffic signals , I have seen plenty of people who would qualify for the use of the word in its classical sense, but so ingrained is the lesson, that perhaps this is one word that I am most unlikely to use.

Some of course can of course can so completely swing the other way, that they are more concerned about the correctness of their jargon than sensitivity to the person. Indeed it is possible that the people most busy in serving those in need have the least time to update their vocabulary , while those who are right in their nuances of speech are the most indifferent when it comes to doing things that really matter.

So which way does one turn ? While it is perhaps correct to say that one should not be unduly obsessed with words and phrases and that the motive of the heart is far more important than the utterances of the tongue, we should never forget though that words carry a lot of weight and a stray word spoken out of turn and without the slightest ill will intended, can cause paralyzing harm and trauma which we may neither see nor recognize. So let us weigh our words wisely and choose our phrases carefully , in as much as we are able. There is enough hurt in the world, without we needing to add unwittingly, an extra ton.

Volunteers : The silent worker bee

Volunteers are one of the most valuable resources and a voluntary organization can have, especially today when a lot or most voluntary organizations are largely staffed by paid professionals who work for a salary. While the changing nature of the sector and the increasing demands and scrutiny made by government, donors and funders and even the general public may mean that this shift is largely inevitable, volunteers still help to remind us of our roots.

At Oasis, we have been fortunate in being blessed by many volunteers – short term and long term. Some of them have been around for years and while having cost the organization next to nothing, have enriched Oasis in ways that might be difficult to quantify. The other day, we were trying to calculate in monetary terms what the worth of a few specific volunteers with their particular skills and experience might be. I do not know what figure was finally arrived at, but we agreed that if we had to hire all those people and pay them the salaries that they could command, it could hit the organisational balance sheet quite badly.

But money and salaries are one thing. Often volunteers bring with them skills and experiences that are not readily available in the market place. It is not a matter of being able to pay the salaries, often the right people with a suitable combination of commitment and skill are just not around.

When volunteers come from another culture or country, they also enrich local staff in providing them a platform to work in a multi ethnic and multi cultural environment. They usually bring perspectives on a particular situation or a way of doing things that are fresh and new and can help challenge existing notions of how business has always been conducted. More importantly, by their very presence and the dedication they display, they may end up challenging or changing local work culture and practice.

It is worth considering why volunteerism, even for a short spell is not at all entrenched in India. The concept of the ‘gap year’ is not prevalent in India at all unfortunately. It is one straight and long ride from school to college and university and then onto your first job. In most situations, a gap in the resume that does not follow this beaten track would raise eye brows in most interview situation. The concept of taking some time off now and then and follow the call of the heart is not too well understood or accepted in India.

Of course there is also an economic dimension to this that must not be missed. Volunteerism costs. It may not cost the receiving organisation like Oasis directly, but some one obviously is paying the bills that the volunteer worker is incurring in the country- their housing, their grocery bills, utility bills and others. Depending on organisational policy, possibly the office may absorb some bills, but that still leaves a substantial chunk that the volunteer ultimately is responsible for.

We at the receiving end of a volunteer's untainted service are often unaware of what it takes to raise that sort of money that would pay your bills, no matter how frugally you ultimately choose to live. Occasionally mid career professionals have worked long enough and saved enough to manage their own finances, but ever so often we get younger people who are not likely to have reached that stage and need to reach out to friends and family to raise the necessary resources to come.

Volunteers are the silent worker bees that often quietly and unobtrusively keep the bee hive of activity running. More importantly perhaps they keep a much needed notion alive; that in a materialistic society where every one seemingly works for money- not every one really is.
Volunteers represent the incarnational model that often enough it is more blessed to give than to receive and enough people still exist who believe that and live by that.