The Generation X Lady Doctor

Female medical students are putting up a unique case to oppose the scheme that all medical students before being awarded their degrees must serve a year in the states where they are studying, possibly in the rural hinterland. They are saying that because of this requirement, their marriages are going to get stalled that therefore the health minister should go around hunting for life partners for these damsels. Listening to this story, one does not know if one
should laugh or cry. These students are studying in government institutions – Nalanda Medical College is the institution mentioned and the ruckus is because the new requirement would increase the duration of the course to six and a half years from the five and a
half years (including internship) as is the arrangement now.

Now consider this. The students are going to government medical colleges which means that their education is to a very significant extent subsidized by the tax payer. These are not students of snazzy self financing institutions - and even if they were, the agitation
would still be questionable. Secondly, these students are students in one of India's poorest states and if any state in India needs doctors in their rural hinterland to serve, it is probably Bihar and its neighbors. Thirdly, by extending the duration of the course to six and
a half years, the ministry is not stepping beyond any kind of line. The norm in fact for medical colleges in most countries is to have courses of exactly this duration and actually much more before one can actually get down to practicing medicine.

It is a symptom of the consumerist culture these days that has so seeped into our marrow today that the state requiring its citizens to perform a civic duty in lieu of subsidized education is met with opposition using the most ridiculous of reasons. When I read these
sort of articles and the grossly selfish mind set that is perpetuated by these sort of demands, I wonder if for certain kinds of professions at least, meritocracy and the entrance examination driven system that decides who enters the portals of our medical colleges and other such
institutions is a flawed methodology.

Professions like medicine require and demand a certain kind of moral fiber, character and aptitude that determines whether one has the basic service mentality to enter into this kind of a profession. But these things are never assessed in our exam driven system except in a
handful of institutions like the Gandhian college at Wardha and the Christian Medical College, Vellore and the one who gets the nod to get admissions in the government colleges are the ones who head the merit list and in the private colleges, the ones who have some money and
some merit.

In a profession like medicine which is part science and part art, is the merit list the best indicator of who is going to be the best kind of doctor - the most humane, the most caring and the most ethical? hat kind of medical ethics might I expect from some one who even as a
student is so self centered as to only worry about when they can get arried and settle down even before they have done a day's work? If they are on emergency duty in the casualty ward, would these doctors of tomorrow be tracking the well being of their patients or tracking
their watches so that they can go back and attend to their families?

There is nothing wrong with wanting to get married and having a family but these things need to have a perspective. Imagine a soldier in the midst of a conflict wanting to go home to his wife and kids. That they don't is largely why the armed forces survive as an institution and
the country is safe in their hands. A doctor's situation is some what similar. If I were in need of acute and a pretty intense level of medical care I would worry if I knew that the treating physician was some one trained in Nalanda Medical College with one eye on my pulse
and another on the clock because she wanted to fix dinner for her husband. But till we change our methodology of evaluating candidates and look at other intangible factors other than the academic score card, I guess I will have to just keep worrying.

Are We Slow and Unresponsive ?

The Indian Express in its op-ed column of Dec 01 informs that the Prime Minister in a recent speech delivered on November 29^th has lamented that our system doesn’t value time and that it is one weakness that worries him a great deal. The Prime Minister isn’t completely correct. Witness the manner and speed in which the law was passed to fix the age at which the Director of the All India Institute of Medical Sciences retires at 65. Parliament typically doesn’t have time to transact much business and even the current session has already been adjourned several times over Nandigram and other matters. But this particular bill was cleared by the Lok Sabha on November 23^rd, by the Rajya Sabha on November 29^th, received in the President’s Office on the following day and signed with in hours in to law. By sun down Dr. Venugopal the doughty fighter had lost his job and there was a replacement in place. Clearly when it comes to vendetta the system responds lightening fast and the Prime Minister couldn’t be more wrong.

In the old days, if you annoyed the monarch, you had your head lopped off. This happened the world over but at a point of history, when at least in England , some folks thought that even the sovereign had crossed a line, the elite got together to draft the Magna Carta at Runnymede in 1215 to force the king to guarantee certain institutions of State, basic functional freedoms. The Magna Carta is today accepted as the essential building block of democracy around the world with adaptation and modifications as needed.

But as the Ramadoss episode demonstrates we may have the veneer of democracy but the vestiges of feudalism and crude demonstration of power die slow. In the olden days, the King’s frown was enough to bring down the sunset on an unlucky victim, today the King needs to do some paper work and win over a bunch of pliable people. And the job is done. Clearly, the spirit of democracy has not sufficiently seeped in to our marrow. For instance, The Lok Sabha instead of engaging in any debate over the treatment to Malkaysians of Indian origin and coming out with a reasoned diplomatic response, chose to do what it is best at – get adjourned after a group of Tamil MPs created a ruckus. Presumably the members did not have the energy to debate and discuss a tricky issue event though a Malaysian minister had issued a stinging rebuke to Karunanidhi walking a diplomatic tight rope.

So is the Prime Minister right, and are we slow and more so slow because we are a democracy and supposedly we have mechanism that tries to ensure that laws made in the country best reflect all shades of public opinion and that consensus building exercise takes time? Wish that were the case. In his speech, the Prime Minister cites the instance of South Korea in the old days when it was a totalitarian regime and the Finance Minister of the day had to make a decision on devaluation of the currency. He needed to make a short phone call to his president to ascertain his views and that would take about half an hour and that he felt was a bit too long a time. Man Mohan Singh goes on to say that decisions in democracies do take a little longer than thirty minutes but laments that in India the pendulum has swung to the other extreme and decision making takes forever.

Perhaps our good Prime Minister should be more specific and also lament our priorities. The trial in the Mumbai bomb blasts took 13 years and more, with mercy petitions on behalf of those sentenced to death pending since 1992, the women’s’ reservation of seats bill in parliament eluding a consensus since it was first introduced in 1996, there is a lot for our law makers to mull over certainly. But whereas these things can wait, what seemingly can’t wait is the passing of a law whose sole purpose is to ensure that a person and that too a person of eminence whatever his frailties is sacked and sacked fast and quick, so that his minister boss can strut. India is 57 year old democracy alright on paper, but in real life, the shadow of the jahanpanah’s wrath still looms long on the lok shahi that we think we have.

Living by Candle Light

Some years ago I made a trip from Ballia in Uttar Pradesh to Patna– an episode I will long remember. The journey we were told would take about five hours we were told but since it was raining we left afternoon giving the trip a little more time than we were told was needed. We crossed the Ganga at Ballia and crossed into Buxar where we entered Bihar. Between the winter sunset and the cloudy sky, it soon turned dark and scary. We wound our way through several trails and village roads as our driver soon realizing that the trip would take more than five or six years began looking for shot cuts.

With not a trace of electricity in any of the villages, the only lights apart from the car headlights were sinister flashes of lightening illuminating a few meters ahead in grotesque flashes and the occasional flickering candle light from a village hut. As the car sped forward, gaggles of women would scatter as the car lights focused on them as they sat for their ablutions by the road side. With a pitch dark sky, a thousand stars but no moon and the brilliant flashes of lightening lighting up what appeared to be abandoned buildings but were simply huts with no electricity or candles. Altogether, the whole scenario looked like a lift out of a set from a Dracula movie with total darkness all around and shadowy figures appearing and disappearing at irregular intervals.

But perhaps the sets from the Dracula movies will become more common and we will learn to live by candle light as most of our ancestors had done. For the facts are clear. India's peak power deficit touched a 10-year high of 14.6 percent between April and October, due to an exceptional spurt in demand and worse-than-expected capacity addition. India's government has further scaled down its expected power capacity addition in the current year to 12,000 megawatts from 17,000 megawatts. Further poor as well as slow planning and decision making processes ensure that even if projects are passed rapidly, it will still be years before the plants begin production. Meanwhile 412 million people live with no electricity and those who do have suffer long power cuts. Power thefts as well as transmission and distribution losses continue unabated all over the country.

Besides there is political opposition to whatever mode of electricity you try to generate. The opposition to the Indo- US nuclear deal has become common knowledge but what has become hidden in the fine print is the fact that most of India’s nuclear power plants are operating at levels of peak capacity due to a chronic shortage of uranium pending the finalization of the deal. So on one hand we are increasing demand and not adding commensurate capacity and on the other hand, the existing capacity is lying underutilized. Opponents of the nuclear power are also those who fear Chernobyl style disasters or slow effects of leaking radio activity leading to environmental and public health impacts among other things.

Similarly thermal power plants have their detractors. Down to Earth, the leading environment magazine lists that coal based thermal power plants in particular are high in air pollution, water consumption waste and carbon dioxide emission and others are not far behind. So it does not advocate the functioning any more of thermal power plants. Next on the list of are hydel power plants of which India is a huge reservoir, but wait a minute –while Hydel power plants are the least polluting of them all but seem to cause the largest amount of human displacement and suffering. The agitations surrounding the environmental and human displacement caused by the Narmada and the Tehri Dam have carried on for years and there have been others like the project in Kerala adjacent to the Silent Valley that have never taken off. In India where all kinds of lobbies are active and vocal and their paths often cross, we have never been able to determine the balance between addressing human and environmental concerns with the concerns of economic advancement without balancing one apple cart or the other. And even as we learn to do that, we might also learn in the meanwhile to live by candle light as they do in the villages of Bihar.

Do Our Languages Need a Life ?

A recent issue of India's Outlook magazine covered the valiant efforts being made by some languages to survive and the threats looming over them. According to the report, this silent killer which does not attract so much attention takes away one language every fifteen days some where in the world. In India, the Mysore based Central Institute of Indian Languages (CIIL) is at the vanguard of efforts to salvage Indian languages from extinction. Among the languages on death row are languages like Great Andamenese (7 speakers), Onge (100 speakers) and Ahom (150 speakers). The urgency for these languages is obviously great and efforts are being made to salvage the language and the culture associated with them for posterity even if the tribes which speak these languages seem doomed.

A couple of issues later a debate began regarding the need for these languages to survive and for CIIL to do the work it is attempting to do. An anthropologist argued that it made little sense tracking grammar and diction of a language that would soon be history. Wasn’t there any thing better to do? What after all would be the value of preserving a language if there was no one around to speak it? Another reader argued that this was not extinction but rather evolution. The big ticket languages like Hindi, Bengali and Telegu for instance would certainly swallow up a lot of the smaller languages but the languages themselves would survive in some form – albeit in a different avatar – much like Sanskrit or Latin surviving not so much in terms of the numbers of people speaking them but in they having contributed a large chunk of the vocabulary of the languages that live and that people speak. A third reader went on to say that even the major regional languages – the vernaculars as we used to call them are becoming irrelevant and with the gradual creep of English, even the so languages that millions speak are no longer the same – watch for example the gradual emergence and promotion of hinglish from a semi pariah bastardized conglomerate of words to the preferred form of communication of most. This reader went on to include that the death and demise of any language and culture that did not serve commercial and business interests was inevitable and that eventually regional languages would be reduced to being the vehicles of ritualistic communication and nothing more – much like Latin chants or Sanskrit mantras. So are institutions like CIIL fighting a fool’s battle? Do languages have a right to live and thrive and a right to protection against extinction? Ever since Christopher Columbus first set foot on the white sands of Guanahani island in 1492 to "take possession" of the land for the king and queen of Spain, his legacy of erasing the language, culture and customs of the conquered has been derided a lot, but has nevertheless had no shortage of disciples to carry on with his ideology. And so main landers displace islanders and highlanders, the neo colonizer conquers lands politically as well as economically and displaces the defeated and all of those victorious stamp their cultural footprint on the dust of the defeated.Each extinction of a language means that a fascinating way of putting words together is no longer alive and that an intangible part of our human heritage is gone forever. I remember the outrage of the world when the Bamian Buddhas were blasted out of existence by the Taliban. They had stood for two thousand years and more and were a symbol of our existence and our history. And yet as pointed out in the beginning of this article, every fifteen days a language that may be older than even the Bamian Buddhas dies out unlamented. And yet sadly our eyes shed few tears at this slow and silent extinction that is happening before our eyes.

Sein Myint : The Man With No Name

I met Sein Myint in a refugee camp, the only home he has ever known. He doesn’t remember much of his childhood except that he was born in a remote village in Burma. When he was still a small child, the soldiers came to his village and burnt the place down. They needed the land as the village stood in the way of a gas pipeline that was going all the way to India.

When the soldiers had finished, they had lost all their belongings. With just the clothes on their back, the family fled into neighboring Thailand since when he has been living a tenuous existence as in the eyes of the world, without any papers or documents, he does not legally exist. His Burmese birth certificate was burnt by the soldiers and though Thailand allowed him and many others like him to live in enclosed refugee camps, they did not issue him any papers or identity card.

Sein Myint’s loss of identity and lack of papers is more than symbolic. When he entered Thailand, he was a small boy and was enrolled in a minimalist school in the refugee camp that provided education until the 10^th grade. With little access to books and other tuition, Sein Myint nevertheless passed his examinations. But he does not have a pass certificate as the certificate requires a name and place of birth to be entered and the refugees do not have papers to prove that their names are what they say they are and where they born. They can not prove that they are Burmese citizens and they obviously are not Thai subjects. Without a high school certificate, there are no hopes of any further education if he could at all get out of the camps legally which he cant. Which means that after all this education, he can do stray menial jobs or clerical work at the camps.

The situation of the women is more awkward. Presumably to avoid any claims to citizenship at a later date, pregnant women who are migrants of this nature are promptly deported to Burma. Any one who escapes detection and some how gives birth to a child in Thailand is in an awkward situation as the baby is deemed an illegal migrant at birth ands is liable to be arrested. Attempts to go back to Burma aren’t very helpful either as the Burmese too deny the minimal facilities available to the women if they do not have the requisite identity documents.

The question of identity is always an important one but perhaps no where more so than in the case of people who are stateless – those who are in desperate need of papers of some kind to prove who they are, what there name is and where they belong to – the most elemental of all. It is an eye opener to sit and meet with people like Sein Myint- flesh and blood humans like you and me and realize that in the systems and databases of this world they simply do not exist – they have never been born, never went to school, never worked and in short did none of the things that define the life and existence of almost all of us.

Their birth place has been obliterated under the pounding of jackboots and when their time is up, there is little room to speculate that their deaths will be recorded any better. The whole life of a stateless person may begin and end without any record of their ever having lived except in the memories of their loved ones. That is a frightening and a very, very sad thought at the same time. The ubiquitous birth certificate, high school certificates and other papers I routinely take from granted have suddenly become very important for it is a shuddering thought to think of what it might mean for me to live life without them.

Philanthropists Wanted

As some one associated with the NGO sector, chasing funds is one of my responsibilities. It is not a pleasant job; at times one can feel a kindred spirit with a beggar though of course here one is not soliciting funds for one self but for a larger and nobler cause. Although most NGOs can trace their roots to small community initiatives, often usually religious ones, the scope and size of the work today means that the voluntary sector is no longer truly voluntary in nature.

Over many decades, the sector has become highly professionalized and needs sector specialists in all areas to deliver results and be effective. Also it means that the small resources that a typical voluntary agency would normally be able to raise are no longer sufficient to do the job. Voluntary Agencies have evolved into Non Governmental Agencies which are in turn part of an amorphous entity titled “civil society”

In the process of going around looking for funds from the “for profit” sector so that they can be transferred to the “not for profit” sector, the discovery that I have made is that we in India are short of folks like Bill Gates or Bill Clinton who actually earn money the hard way and they donate it all or most of it so that society, indeed humanity at large can benefit. Some like Warren Buffet have even chosen not to set up trusts named after themselves but rather contributed to existing set ups so that they could then save the start up money and the recurring administrative costs that they would otherwise incur. Because they do that ,charities around the world including those in India can take up pressing projects that might other wise never find takers.

Many projects NGOs take up would never find commercial viability. Initiatives like the Gates Foundation funding that has gone in to develop vaccines for diseases like malaria and AIDS survive largely because of these contributions given generously. Malaria is for instance largely a disease of the poor and the pharmaceutical giants invest next to nothing in researching malaria, tuberculosis and other diseases of the poor because they can never hope to recover the costs involved in such work.

Of course India has its foundations and charities. Some like the Tata Charities are over a century old and some of the other ones like the ones connected to the IT Majors are new. But the general culture seems to be that if you have got it, then flaunt it. So we have stories of Mukesh Ambani giving his wife an airplane for her birthday, a pan masala baron giving his daughter a Bentley or is it a BMW on hers or Lakshmi Mittal hiring a palace to celebrate his daughter’s wedding. And following behind in the ranks are hordes of other people on our Page 3 Lists who want one day to be able to buy planes and cars for their wives and daughters. The passion for philanthropy is missing.

As Pratap Bhanu Mehta of the Centre of Policy Research writes in the Indian Express, today, much of what passes as philanthropy is really setting up your own institutions, whose purposes you direct and control. He contrasts it with of the striking features of Indian philanthropy before independence was that it was genuinely philanthropic and some where that of the striking features of Indian philanthropy before Independence was that it was genuinely philanthropic. A lot of it was directed at creating public institutions that the donors did not control. That culture now seems to have passed away from the India scene. Even as we read about Indian industrialists getting wealthier and wealthier, and also read in the same vein about William Buffet giving away 85 percent of his fortune, the topmost question on my mind is whether we can expect to have in our amidst a man of the generosity of Buffet any time soon.

The Ghost of National Security

The news that Imran Khan’s cancer hospital has been sealed in Pakistan is unfortunate. It seems from the newspaper reports that after Imran Khan decided to go into hiding expecting to be arrested, the Shaukat Khanum Memorial Hospital was cordoned off and effectively shut. The hospital is perhaps one of Pakistan’s best cancer hospitals and provides free treatment to 75 per cent of patients with the remaining 25 per cent paying fees. All funding is raised through donations, zakat (Islamic tax) and selling of hospital services. The hospital is a registered charity in Pakistan, UK, USA and UAE, and is connected to specialist cancer hospitals in the UK and USA.

The fact that the government put power politics before the welfare of the people is a sad thing. I am not going into the merits of arresting Imran Khan or even any of the other politicians but the thought that Imran Khan, in the eyes of the authorities, posed such a grave danger that they thought nothing of closing down a hospital doing yeoman service in a country that surely needs more and not less of these charitable initiatives. This brings me to the question of what is the responsibility of a state and its government. Is it simply to perpetuate itself and hold on to power or is it to look after the welfare of its people and if so, what can be the justification of shutting down a hospital just because its promoter or patron has run foul of the law and that too not on any criminal grounds but rather on political considerations?

I would have thought that in a situation where the government is by itself not able to provide for the welfare of its people, the last it can do is to provide a conducive environment for charity to flourish and philanthropists to do their bit, as Imran is trying to do. I guess the same thing is applicable in a business context. Would the Pakistan government also be shutting down businesses if they happen to be owned by folks on the wrong side of the political divide? Who then will invest there then?

But let me not talk of Pakistan alone. We can talk reams about India too. For years, the army was occupying school and hospital buildings and other civilian structures in Kashmir. After occupying them for close to two decades to fight militancy, the army has only recently vacated them and even this happened after a lot of reluctance and after the personal intervention of the defence minister, AK Antony.

I wonder if any one has done any research as to the damage to the educational opportunities of Kashmiri children because some soldiers with guns were using their school building as a hold out to safeguard national security and how many people, whose lives could have been prolonged had they been given access to timely healthcare, died because the army was occupying hospitals as free housing. And it is possible that many of the same things are happening in other disturbed areas of India like Chattisgarh and parts of the North East. Information of this nature will never be readily available for we have two, no three phrases under which the state can always find shelter: ‘National Security’, ‘Public Interest’ and ‘Official Secret’. Under these three phrases, one can hide anything and typically forever.

Well if some security analysts read this, perhaps they might have a different opinion, whether here in India or in Pakistan, but the way I see it as a common man is that national security and holding on to power or territory for its own sake is making a mockery of nationhood and sovereignty, if governance, the raison d’etreof a government to be established isn’t happening in small or large measure.