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DON'T LET SKILLS GO TO WASTE, ASYLUM SEEKERS ARE TOLD
22nd April 2006 -
http://www.thisishull.co.uk
National Consensus Workshop
on Caesarian Section Under Local Anaesthesia
Click here to view the PDF document (Added15 July
2005)
Saving lives ... at what cost?
Click here to view the article on 'The Hindu'
Kavery Nambisan is a
surgeon and novelist, and has worked extensively in rural India.
E-mail her at:
wallden@sancharnet.in
Milroy Lecture (2003) by Rajan Madhok
Click here to view in Adobe
PDF
Syndromic management of prolonged fever: a
cost-effective approach. An article from Tropical Doctor, by
Subhash Daga.
Click here to view in Adobe
PDF
Source:
Tropical Doctor
Stop the Slaughter
Taken from Washington Post
Online (Registration
Required)
By Bob MacPherson
Sunday, August 8, 2004
A day in Darfur is as close as you'll ever get to walking back
and forth through the looking glass. In Darfur you might, as I
did, witness an eight-pound 3-year-old who will be dead in a few
hours; then the next day you're back in the United States, where
60 percent of the population is overweight.
This is something few can grasp even if they see it. I spent a
troubled period recovering from injuries received in the Vietnam
War. After that I believed I was immune to personal tragedies.
I'm not. Darfur is as close to hell on earth as we can imagine.
Aid workers have seen hungry people before, but even those
directly involved in emergency humanitarian assistance seldom
encounter starvation and virtually never witness the starvation
of tens of thousands of people.
The cruel irony in all of this is that the world has been down
this road before, in both Somalia and Rwanda.
In fact, I thought I'd seen it all before going to Darfur last
month. I'd been to Baidoa, Somalia, in December 1992 and to
Rwanda two years later. In both countries I saw mass starvation
and murder. But what I saw in Darfur is worse. I walked into
camps and saw women and children in every state of human misery.
Too far gone to eat, many would be dead by morning. Just when I
thought it couldn't get any worse, I heard about the systematic
rape of women. It was not two or three women telling me this.
Virtually every woman I met in a camp had a story of brutal
violation. This is what the world faces in Darfur.
The United Nations has given the Sudanese government 30 days to
disarm the mounted militias known as Janjaweed and bring the
war-torn Darfur region under control. That's 30 days too late
for more than 13,000 women and children. More than 440 people a
day are dying from starvation in Darfur. And this does not
include people who will be murdered outright.
In addition, the Sudanese government is in armed conflict with
two forces, the Sudan Liberation Army and the Justice and
Equality Movement, in Darfur. It is also trying to conclude a
critical peace agreement between North and South Sudan. Is it
realistic to expect that government to also disarm a vicious
Janjaweed militia and facilitate international relief?
Although this is the worst humanitarian disaster in the world
right now, the United Nations has received only $158 million of
its $350 million donor appeal for Darfur. While catastrophic
loss of life is occurring, the international community is buying
time. For what, exactly? How many people have to be killed or
starved to death before the world acts? The international
community has the resources to mount a swift response, but thus
far it has lacked the will to stop the slaughter. Rich
governments must respond, both for the immediate crisis and for
the long term.
The Security Council has invoked Chapter 7 of the U.N. Charter
and endorsed deployment of African Union cease-fire monitors and
troops to protect the monitors. To date, a mandate has not been
endorsed to provide protection for the Sudanese population and
the security required for humanitarian assistance. This could be
mobilized under the auspices of the African Union, with support
from the international community.
Since my return, my heart has sunk as arguments intensified
about whether the Darfur situation should be defined as genocide
or ethnic cleansing, and whether sanctions should be applied.
What's happening in Darfur is the wholesale slaughter and rape
of unimaginable numbers of human beings. Sudan is a sovereign
nation. But it has utterly failed in its responsibility to
protect its citizens. Definitions should be left to the
dictionary -- now is the time for action.
The situation in Darfur is not an American issue. It is not a
European issue or an African issue. It is the most fundamental
statement of what we stand for as members of the human race. The
slaughter and rape of hundreds of thousands of people is not
acceptable by any standard of humanity. If there is ever a time
the international community has to come together, and do so in a
decisive fashion, it is now.
The writer is CARE's security director and a retired Marine
colonel.
Barbara Wallace featured in the Savannah
Morning News,
Guest: G-8 members must recommit to fighting HIV/AIDS
Click Here
The following is a publication by Kavery Nambisan. Kavery Nambisan is a surgeon and novelist. E-mail:
wallden@sancharnet.in
HEALTH ISSUES: Doctors of the world, unite
Reaching medicare to those who have little or no access to it is one of
the primary goals of healthcare professionals today. KAVERY NAMBISAN
comments on a medical conference held in Hull recently.
A MEDICAL conference with the theme "East Meets West" was organised from
June 24-26 this year in Hull, a small town in Yorkshire, U.K.
It was a platform where doctors from different parts of the world could
meet and share ideas, not just technicalities. This was a platform for a
debate on ethics, which affect not only our profession but also the
world we live in. The conference was held at the 1,000-bedded Royal
Infirmary, a hospital with exceptional facilities and staff to cater to
every medical need.
The organiser, a consultant paediatrician in Intensive Care, Dr. Hilary
Klonin was a slightly built, energetic, infectiously outgoing lady with
the habit of speaking in breathless long sentences. She conveyed in 30
minutes the larger purpose of the conference.
We Indians are a strange people: We pride ourselves on our eastern
heritage but follow the western precepts of progress.
In medicine, we have imported technology, built mega-hospitals and
succeeded in catering to the rich. And, of course, we are proud that a
large number of our best doctors have "made it big" in the West. Yet,
only 15 per cent of our population have benefited from our frenetic
advance in medicine, and millions still die of curable diseases.
Many doctors have begun to look at progress with a clearer, if more
suspicious, gaze. And they find that it does not hold up so well in the
light of reason and justice. West is not always the Best. The rift
between the advantaged and the disadvantaged has never been so vast.
At such a time, it is worthwhile for us in India to look at another
picture — of individuals and teams who have tried to bridge the gap.
Jackie Smithson is a consultant physician in Hull. She has been involved
in a teaching programme in Mbrara, Uganda organised by the medical staff
of Hull Infirmary. In Uganda, where the AIDS epidemic has reduced life
expectancy to 43 years and where infant mortality is 11 per cent,
doctors are scarce.
The team from Hull visits Mbrara to train physicians. Given the funds,
it would have been easy for the team to start a medical school based on
the western model. Instead they had the temperance to perceive that
community-based teaching was better than classes in lecture rooms. "The
people on the ground know best," explained Dr. Smithson.
Dr. Nicholas Maurice is a general practitioner in Wiltshire, U.K. where
six generations of his family have practised medicine. In 1982, he set
up a link between the town of Marlborough and a Muslim fishing village
in the small West African nation of Gambia.
It is based on the exchange of people — 700 to date — to bring better
understanding between communities, which would otherwise remain ignorant
of each other. This has led to the setting up of an integrated
development programme in Gambia.
Dr. Maurice who is the Director of UK-One-World Linking Association
works towards spreading this concept of connecting people.
Bringing help to those who suffer.
Wali Wardak has worked to improve the mental health of refugee children
in Afganistan, Iran, Iraq and Pakistan. In a school for refugees in
Peshawar, the children were asked to draw self-portraits of what they
were as a result of war and what they would like to be.
Bush, Blair and, indeed, all our "statesmen" need to hang these
portraits in their office and bedroom, to see how the simple needs of
children have been taken away by the cruelty of war.
Some speakers chose to touch upon issues beyond the scope of
professional work.
Dr. David Southall is the medical director of Child Advocacy
International. He is also a consultant paediatrician in London — a
controversial figure, known for his fearless exposé of child abuse in
the U.K. His talk about "Children and the Arms Trade" was a searing
account of how the arms trade affects the health of the world's
children. Most major conflicts after World War II have taken place in
poor countries; wars which leave them with little or no funds for health
care. The maternal and infant mortality in these countries is an index
of the injustice foisted upon them.
Mozambique suffers from a scarcity of health resources in the rural
areas. Amelia Cumbi described their experiment in training health
professionals for the villages. They are taught simple methods of
treatment including minor emergency surgery and normal deliveries.
Despite the important role played by these health workers they have met
with difficulties. The powerful medical lobby has seen with
dissatisfaction the growth of an alternate team of health providers.
Remy Toko is a smiling, burly paediatrician who now works in South
Africa. Some years ago he left his hometown of Kinshasa in Congo, when
the hospital where he worked started to be targeted by soldiers. He
showed grim pictures of a country savaged by war and described the
plight of ordinary people, especially children.
A senior military official once visited his hospital, accompanied by no
less than 14 security guards. Most of the guards were around that many
years in age.
While the official was busy with his work, some of these child soldiers
ran into the front yard of his house. They put down their AK-47s and
played like normal kids. Killing was part of their job and they "felt
nothing" afterwards. Most are habituated drug users from an early age.
Countless children run away to the jungles to escape being soldiers.
Schools have been closed down.
Dr. Subash Daga, associate professor of paediatrics from Grant Medical
College, Mumbai, lets his work speak for him. He presented a simple and
effective protocol for treating prolonged fevers in children.
Doctors often rely on a host of investigations, which require hospital
stay and cause discomfort to the child. In the end, there is a
substantial bill to cope with. Poor families can ill afford more than a
few rupees.
Over the years, Dr. Daga has evolved a step-by-step treatment, which
involves few tests and uses medicines costing much less than the high
antibiotics routinely used by doctors in their haste to "cure" fevers.
Dr. Nicholas Hart is a consultant plastic surgeon in Hull. Once a year,
he visits Pakistan with a small team of volunteers and operates on
children with cleft lip and palate. This was made possible because of
the cooperation between doctors and staff in Pakistan and Hull; and
because of the generosity of people who care about children in another
part of the world. On an average they do 100 cases in a week before
flying back to Hull.
This kind of work is impressive not because it is medically advanced but
because it is compassionate and imaginative. It makes one wonder whether
the linear form of progress, which is to keep improving upon what you
have or what you are, is always the best way.
In medicine, we have been taught to believe that linear progress is
inevitable and essential. But there is another form of progress, which
is concentric. It moves forward but never loses touch with the
beginning, or the past. It is not competitive but quietly dynamic.
There were more such examples: Dr. Deepak Upadhyay who now works in Hull
has helped set up low-cost intensive care units in his country, Nepal;
Dr. Barbara Wallace of the U.S. takes AIDS awareness to disadvantaged
countries; Dr. Louise Miles uses tele-medicine in Winnipeg, Canada, to
reach patients living thousands of miles away.
My own contribution to the conference was a description of the scope of
surgery in rural India.
The Association of Rural Surgeons of India, which was formed 10 years
ago, still has less than 500 members. This, in a country where 70 per
cent of the people live in villages.
In any society doctors are a strong, influential and, often, pampered
minority. Their role extends beyond clinics and hospitals, towards
ensuring that health reaches everyone. At the conference, there was a
good indication of this happening in many places.
Every speaker, in some way, underscored the need for doctors to unite,
especially in protest against atrocities, which lead to suffering. In
these days of hypocritical politics and greed which is fast destroying
the sanity of mankind, what we need is not an eastern or a western
philosophy but a refinement of both; a society which accepts that a life
saved in Mbrara or Dera Ismail Khan or Hudikeri is as important as a
life saved in Miami, Darwin or Hull.
The wasteful use of resources in one part of the world is directly
responsible for the loss of lives in another. In Hull I met doctors
trying to work towards a humaneness that could, one day, bring real help
to those who suffer.
Article from Hindu Online
The following is a publication by Kavery
Nambisan. Kavery Nambisan is a surgeon and novelist.
OUTLOOK-PICADOR INDIA NON-FICTION CONTEST 2003 - RUNNER UP
Dr Sad And The Power Lunch
"I love food but keep things simple," said Dr Sad. "This meal
hasn't cost more than ten rupees." Sad could get away with
serving dinner to a guest and then announcing how cheap it was.
The joint-runner up entry in the third Outlook-Picador
Non-Fiction Contest.
KAVERY NAMBISAN
As a young doctor fleeing from the perpetual anxieties of city
life, I came to Fakirpur to work in a hundred-bed hospital
managed by nuns. Fakirpur was eighty pothole-ridden
dacoit-infested kilometers from Patna. Given the bare
facilities, we did a decent job of treating those who could not
afford city prices.
Antiquated medicines like tincture of belladonna, ipecacuanha,
canninative mixture and plaster of turpentine were in common use
while penicillin was reserved for nasty infections. We were
cheap and reliable. I performed surgery with the naive poise of
a fledging, using a hallowed textbook of surgery as my surrogate
boss, friend and adviser. Over the years, I became isolated from
the progressing world of medicine. And when I made mistakes, I
found out the hard way.
In my fourth year at Fakirpur, a new administrator took over.
Sister Perpetual Succour was a nun who had taken her medical
degree abroad. She was determined to modernise the hospital and
take it to 'new heights of excellence'. Out went the mixtures,
plasters and even penicillin; we prescribed capsules and higher
antibiotics. Suddenly realising that the hospital was really
very backward, the nuns went on a buying spree. Patients watched
bewildered as some equipment or the other was unloaded from a
truck every week: a new ECG machine, a cardiac monitor, a pulse
oximeter. The nuns worked hard to get donations from the local
landowners and merchants. The expenses went up and so also the
bills. The villagers believed that machines and expensive
medicines would somehow provide good health. And they did not
complain.
Sister PS was set on making us efficient.. Work started at 0700
hours and finished at 1800 hours with a 35-minute break for
lunch. She set up committees: waste management committee, drug
purchase committee, food committee. She encouraged us to read
the foreign journals which she subscribed to. Aware of the
deficiencies in my knowledge I made amends by staying longer in
the library. I walked with brisk steps to the hospital, relied
on machines to tell me the diagnosis, did less and felt
triumphant.
Everyone was given a responsibility: I was on the food
committee. Instead of the usual thali meal nerved at the
hospital canteen, we had boiled-egg-and-tomato sandwiches
wrapped in plastic; puris and idlis for breakfast were replaced
by bread and jam. Easier to serve and less messy. For some of
the staff including me, it felt good, almost fashionable to be
munching abacterial, aseptic sandwiches while reading a journal
in the library.
Soon food came to preoccupy me in another way.
An international medical conference was to be held in Mathura
which PS kindly recommended that I attend: a two-day jaunt to
the land of Sri Krishna, a chance to meet experts, hospitality
and entertainment thrown in. I was happy.
The main symposium during the conference was on Nutrition. Why,
when there was all of medical science? A little thought and I
realised that many lives were cut short because of the food
people ate or did not eat.
The conference was two months away. Being alert to the
possibility of impressing people at an international conference,
I decided to present a paper: The importance of Food in
Post-operative Care. I read journals and research papers,
prepared slides and realised that it was too dull a subject to
impress people with. So I wrote another: Rare Surgical Cases.
It was a showy piece with spectacular, lurid details about some
of the operations I had done that were in someway connected with
eating. I wrote about the chunk of just-eaten meat I had found
in the gut of an undefiled brahmin; the gravel, two pounds of
it, that I had evacuated via the rectum in a eight-year-old; the
roundworms wriggling inside the belly of a man whose gut was cut
to pieces from a gunshot; and about the congealed ball of toffee
wrappers blocking the intestines of a young boy Very clever. I
could see myself on the podium; and later, the doctors milling
around me, eager to listen to more heroics.
I sent in both the papers and waited. Two weeks later came the
reply that the papers had been rejected. We have too many
submissions, they said, which was a polite way of telling me
that mine were inconsequential.
Humbled, I went to the conference, taking the overnight tram to
Mathura. I was to stay with Dr Sadashiv, a friend of a friend in
Fakirpur and who was originally from the same area. The doctor
was slightly built and fortyish, with paan-stained teeth and the
pinched look of one who thinks too much. He looked so pensive, I
labelled him Dr Sad. He wore terylene bush shirts and scuffed
sandals, spoke good English with a Hindi accent and rode a
fourth-hand Bajaj that sounded like the ratted breath of am old
woman.
Dr Sad's wife was a coarse-tongued rustic and they had four
children. I shared a cramped little room with one of his
school-going daughters. His clinic was an extension of his
house. Outside it, a once-white board screamed in red letters
that he was MBBS, FR -- Foreign-Returned. Judging from the
number of times he was being called to the clinic on a Sunday
evening, I reckoned that Dr Sad had a flourishing practice.
We had a simple dinner of deal, chapatti and egg bhujiya. "I
love food but keep things simple," said Dr Sad. "This meal
hasn't cost more than ten rupees." Sad could get away with
serving dinner to a guest and then announcing how cheap it was.
Later, over elaichi tea, we talked.
He had started m the '60s as a compounder, worked his way into
Patna Medical College and then gone to England for a while. He
came back after eight months because they objected to his
chewing paan.
It was not an irony that the money he made was inversely
proportional to the quality of his work. Sad belonged to that
rare breed of doctors who believe that their work should be
superior to what they earn. I was nonplussed and slightly
annoyed by his simplicity and told him in elaborate detail about
the changes in our hospital in Fakirpur, about the monitors and
scanners that had made work efficient. He was unimpressed.
"Sounds like a too-quick transition from a bullock-cart to a
bulldozer," he remarked. "The patients will be paying more but
are they getting better health?"
He said -- without arrogance -- that he was a good doctor
because he made illness more interesting to the patient. Food
had great power over the psyche. "Every prescription of mine
comes with a diet," he said. "One spoon of oil a day, no
chicken; a glass of beetroot juice in the morning for a week,
carrot juice the second week and cucumber the third. Patients
are happy that their doctor is so caring." He saw the puzzled
look on my face. "It's a carefully thought-out strategy. Have
you ever wondered about the money patients have to spend on
medicines? We know that the drug companies make huge profits on
everything they market. A patient can buy half a kilo of carrot
or beetroot or cucumber for the price of a vitamin capsule." He
looked intently at me. "You service the same type of community
as me. I'll give you a bit of advice. Don't prescribe more than
one or two medicines. But prescribe a diet, always. What does it
cost you? it is one way of ensuring that poor people spend their
precious money on some decent nourishment."
I listened with mild contempt. He was making too much of a fuss
about the food people ate. And what could I do about drug
companies making profits? As if that was a doctor's business.
Pondering over it later that night, I decided that he was an
old-fashioned stick-in-the-mud whom I had to suffer for a couple
of days.
Imagine my astonishment when Sad told me that he was to speak at
the conference. Could he have written a paper so imposing and
scholarly that it pipped mine to eligibility? He was secretive,
and would not talk about it.
Mathura had donned a festive look, with banners screaming
Welcome. Distinguished delegates arrived, and were put up in
posh hotels. The two days were as hectic, mismanaged, chaotic,
opulent, superficial and meaningful as any conference I had
attended in the past. I listened to lectures and wandered around
the drug stalls put up to entice us. I learnt all there was to
learn about the harmful effects of cholesterol, fatty acids,
sugars, food additives and alcohol; heard that the millions who
starved in Africa and Bangladesh were being rescued by foreign
aid; then headed for lunch, tea or whatever repast was
appropriate for the time of day. I ate paranthas with mughlai
chicken, ghee rice with lamb curry and finished with Agra pedas;
carrying my cup of coffee I staggered back to the conference
hall to listen to the Swedish expert talk about the
micronutrients essential to health, and to the Danish dietician
advocate a daily dose of twelve vitamin tablets and two
cholesterol-lowering capsules.
At tea, I sat in the foyer trying to clear my fogged brain.
Delegates zipped about carrying their complimentary travel bags
that came filled with high-protein breakfast bars. Stalls
displayed slimming tablets, easy-to-eat lunches, low calorie
biscuits, no-calorie biscuits and health drinks. Sad stood a
little away near the water cooler pulling at his Charminar. His
eyes were busy, thinking. He pointed out to me that the infant
food package being sold at one of the stalls was unbeatable
value. "For every thirty tins of the infant formula purchased
you got two free packets of multipurpose protein powder to give
poor patients." A long queue had begun to form at the infant
food stall. "It's always nice to help someone while helping
yourself" Was he being sarcastic? In any case, I had no interest
in infant foods and passed up the opportunity to do charity. I
asked if listening to the eminent speakers had put him in a
panic. A rare smile scissored his face but he wouldn't tell me
about his paper.
The first evening passed pleasantly, with light entertainment,
drinks, scrumptious food and a special appearance by a TV
celebrity. She made a touching speech about how doctors were the
cream of society. Replete with food, I listened.
The second day began with an American surgeon speaking about the
treatment of obesity. "Calories are the scourge of society," he
said, his trim, sun-tanned body taut with the sincerity of his
belief. "Fight calories with the same fervour with which you
fight any vice. Teach it to the kids: Calories are evil!"
Besides a surfeit of pills to restrain hunger, there was the
wiring of jaws to prevent any solid food being eaten; as there
were operations that helped melt away fat. His own time-tested
method was to cut off a portion of the gut and thus limit the
absorption of food. If ten out of the twenty-two feet of
intestine were knocked off, the food speeding through the
shortened gut would have less contact time with the intestine.
It would pass out without absorption of the malevolent calories.
No calorie build-up, no fat accumulation. Result: you eat and
get thin. Among the hundreds of cases he had done, there were a
mere eight deaths and one of them was from a non-surgical cause.
The lady had fallen off the stretcher while being wheeled to the
operating theatre and broken her neck. This surgeon who made
calorie-fighting his mission had started a helpline for the
obese in the town where he lived. One had simply to call the
number to find someone with whom to chat, over cake and coffee.
On the last day after tea were the free papers. I was feeling a
bit sorry for Sad by then. He had requested that he be the last
speaker. With the grand finale of the closing ceremony and the
banquet afterwards, he did not have much chance of being
listened to. He had no slides, no photographs, no text to be
flashed on the screen. He asked that the main lights be switched
on and in their glare he looked ludicrous, standing there on the
dais in his ill fitting trousers and bush-shirt.
He had titled his talk 'The Nutritive Value of the Sky'. I
shifted uncomfortably in my seat. "I have studied the food
habits of people for eighteen years," he began. "In the rural
town I come from, people eat chapattis, daal, raw onion and
green chilli and chew a raw radish or carrot afterwards. Some
families buy a metre-length of sugarcane at the market as a
Sunday special. Roasted wheat, groundnuts or cucumber with salt
serve as snacks. Tea is drunk once a day in summer, twice in
winter. For many of the poor, the staple food is sattu -- a mix
of channa daal and a little salt, powdered fine and carried in a
twist of cloth or a tin. Mixed with water, it is an excellent
meal. Sattu does not spoil and so it is never wasted.
"The mushahars are a rat-eating community in our area. They live
on large field rats and eat house mice for festive occasions. I
have an excellent recipe for rat fry, If anyone is interested.
Whether it is sattu, rat meat or chapattis, the caloric value of
their diet is 1500 calories a day, plus or minus 200. They put
in eight hours work in the fields on this diet and return home
to cope with housework: drawing water from the well, feeding the
cows and collecting dung.
"I learnt in medical college that an average healthy diet for a
working man is 3000 calories, for a woman 2500. Who are they
talking about?
"At dinner last night, it occurred to me that there are three
categories of eaters: Those who can afford to choose what they
eat; those who have just enough and no choice; and the third,
who have nothing. The last group lives on any food that comes
their way. They live on pavements and in the slums, make our
cities ugly and spread disease. We, who belong to the first
group, would like them to disappear. But we're good people, we
don't go about killing others. Instead we quietly let them
starve while we refine our food habits and expand our choices."
Sad paused to catch his breath "Last night a doctor I know well
ate and drank enough to please the drug company which hosted the
dinner. And them vomited it all out in the garden at the back of
this hall. While he was thus lightening himself, a few feet away
at the garbage bin where the food we wasted was being dumped, I
saw two children and a woman. They picked out half-eaten rotis,
chicken bones and crumbs of laddu and stuffed it in a plastic
bag. For them too, it was a festive meal.
"I have learnt a great deal about food, from the experts here. I
wonder: how do some people -- several millions in fact --
survive on a diet that you or I or my patients would starve on?
Is there a nutritive value in the sky that looks down on their
labours, in the air they breathe, in the sunlight that falls on
them as they work, to supplement their power lunches? May we
have a long and mindful discussion about the true meaning of
malnourishment and its causes? In college I learnt about
first-degree, second-degree and third-degree malnutrition.
Seeing those children pick at wasted food last night, I thought
instead of first, second and third-degree murder. Who is
guilty?"
I sat in my seat in the fifth row drinking in the scene. The
Americium surgeon, the Danish dietician, the Swedish
micro-nutritionist and our own specialists and super-specialists
were seated in the out rows: clones of clones sweating manfully
in sober suits, their faces stony, impassive. Here was a doctor
with his sorrowful, paan-stained smile and his sandpaper voice
slipping in the barbs that none of them could counter. Compared
to him, they looked second-rate.
There was silence followed by polite applause. Any questions,
asked the expert who had chaired the session. Someone cleared
his throat, of embarrassment. No questions We filed quietly out
of the trail to have tea and samosas and then wait for the
closing ceremony. Dr Sad stood near the water cooler, drinking
glass after glass of water. He looked crestfallen. "There was no
response," he said. "Absolutely none. I thought that at least a
few might appreciate what I was trying to say..."
A doctor by profession, Kavery Nambisan is also the author of
The Truth (almost) About Bharat, The Scent of Pepper,
Mango-coloured Fish and On Wings of Butterflies.
The following is a publication by Kavery
Nambisan. Kavery Nambisan is a surgeon and novelist.
SOCIETY: The baby doom
As the incidence of female foeticide rises and the number of girls
drops, KAVERY NAMBISAN looks at how doctors contribute to the skewed
gender ratio.
Walking alone into a society with an increasing gender imbalance.
Bihar, 1997:
Ward Rounds in a hospital in the small town of Mokama. I am examining a
young woman who delivered her second baby the previous night. I tell the
mother that her baby is healthy and beautiful. She turns away, sullen
and silent. "It's a girl," says the nurse. "That's why."
Kodagu, 2003:
The couple sitting opposite me in the clinic are young and wealthy. She
is three months into her third pregnancy and wants to know the sex of
the unborn baby. Their two bright-eyed daughters aged four and two are
playing outside. I explain. It is against the law; the number of girls
in our country is dwindling; all-girl families are often high achievers.
The husband's patience begins to wear thin. They leave my clinic with
the frown of those who will not come back to me. I find out later that
the woman "miscarried" in Bangalore. Yet again, a doctor careless of the
law, and one more added to the list of unborn girls, now numbering
millions.
THE world's largest minority is an endangered species, thanks to one of
the most privileged and influential groups: the doctors. The medical
profession has been co-opted in a crime against girls and it is not
complaining. "I cannot refuse when a colleague sends a patient with a
request," says one doctor. He makes it clear that he is taking a risk by
defying the law and then extracts a large sum of money for the favour.
Nature has tuned the boy-girl ratio to be more or less equal. At birth,
the girl is at a slightly greater risk of serious congenital
abnormalities and so the normal ratio of girls being born is 95 for
every 100 boys. This discrepancy at birth is evened out later on, as the
girl child has better instincts of survival. In India, where female
foeticide has increased steadily in the last 25 years, we have a
decreasing ratio. Punjab, Haryana, Delhi and Gujarat have 79-87 girls
per 100 boys. Amartya Sen in his article "Missing Women — revisited" in
The British Medical Journal of March 2004 has highlighted this aspect:
the number of "missing women" for the world as a whole is now 101
million. About 93 million of this number is shared between India and
China. The boy-girl ratio in the age group 0-6 in India has fallen from
a healthy 972 girls per 1000 boys in 1901 to an alarming 927 in 2001.
Education, modernity and affluence have failed to favour the girl child.
Studies show that the ratio is better among most tribal communities, and
worse in the cities. The profusion of ultrasound diagnostic centres and
clinics performing illegal abortions makes it as easy as going for a
facial.
The simplicity of the whole process makes it treacherously complex. Sex
determination and abortion are easy to perform. Most doctors say that
misuse occurs because of unregistered mobile scan machines used by
quacks. The law requires every ultrasound scanner to be registered but
this only acts as a legal cover and does not stop misuse: the doctor who
does the scan will signal the parents with a nod for a boy and a shake
of the head or a grimace for a girl. He will pocket his thousands while
the parents leave the clinic knowing if they must abort the foetus or
keep it.
The Pre-Natal Diagnostic Techniques Act (PNDT) came into being in 1994.
It stipulates that ultrasound and other techniques be used only to
detect foetal abnormalities. In the hands of the right people it has
made childbirth safer. But the Act has not achieved what it proposed to.
Doctors simply put up a notice that sex determination is banned and then
continue to do it.
Doctors are a protected species. Committed journalists teaming up with
activists have exposed erring doctors, only to find that the police are
not permitted to take action. A government-appointed medical team deals
with the offence. In most cases the scandal is covered up. Some doctors
misuse science; others protect those who do.
In the last few years, there have been several decoy operations
conducted by journalists and activist groups to expose the crime. It is
written about in the papers and the doctors' names mentioned. In terms
of fighting female foeticide, this still remains the most significant
step.
Consider the effect of 10,000 ultrasound machines all over the country
each doing one sex determination per week. (This conservative estimate
is based on the assumption that a large number of ultrasonologists are
incorruptible.) If half the parents decide to do away with the baby
because it is a girl, you have 25,000 girls disappearing before birth
every year.
There is also the worrying fact that population control worsens the
situation. Couples determined to have only two children will see that
they get their "share" of boys. Doctors oblige. China is waking up to
the reality of a society dangerously short of women. The other danger is
that as gene selection and cloning become more refined, it will be
possible to decide the sex of a baby before it is conceived. A
high-profile husband-and-wife team were booked a few months ago in
Bombay for claiming to help parents "plan" the sex of their babies. The
husband, until then, used to write a regular column for a magazine on —
of all things — medical ethics.
Committed health professionals, activists, and journalists are working
hard to educate the public in the dangers of a society with a
diminishing number of girls. It would help if the leaders in every
religion spoke out against customs that are loaded against the girl
child. People respect their words. Some soul-searching will reveal that
while we decry the evil influences of western consumerism, female
foeticide is prevalent almost exclusively in the Indian subcontinent and
in China. Our regressive, patriarchal mindset, which encourages the
practice of dowry and male inheritance, is largely to blame. Affluent
families burdened with a large inheritance are reluctant to let a girl
child take it away to another family. It is the "educated" rich who
increasingly resort to sex-determined abortions.
The crisis is as urgent as it is enormous. As the number of girls
declines, atrocities against them will increase multi-fold. Girls will
be afraid to leave their homes even to go to school or college. Women
will be shackled at home. In the end, it is the doctors who have a lot
to answer for. Will we, as a select and privileged group speak out
against the threat to the world's largest minority? Or will we merely
clear our throats of indecision and go on as before, happy with our
day-to-day hospital work? Do we rewrite the medical curriculum, get
guilty doctors booked, rethink our strategy of population control, and
ban the scan?
The privilege of being trusted with the lives of others brings with it
the larger responsibility of fighting social evils. We could still
redress the harm being done by the misuse of technology. Medical Ethics
and Humanities could be made part of the medical curriculum so we don't
produce doctors who are technologically sound and morally corrupt. If we
do not act now, instead of being saviours, we will be the perpetrators
of the world's worst holocaust.
Article from Hindu Online
The following is a publication by Kavery Nambisan. Kavery Nambisan
is a surgeon and novelist.
REFLECTIONS: Small is strong
"Minority" implies a group that is victimised. This need not be so. A
dynamic minority has the potential to influence events, writes KAVERY
NAMBISAN.
To be in the minority does not always translate into being victims.
AT a public gathering in my district a year ago, I heard the guest
speaker praise the virtues of one religion and excoriate the others as
fanatic or foolish. He ranted while the "elite" audience listened, rapt.
My disquiet turned to distress and then anger when I realised that among
the audience were 400 children in white school uniforms. I decided that
I would protest when the speaker finished. An hour later, he concluded
to a standing ovation, and I quietly walked out of the hall.
The recollection of my passivity still troubles me. In an effort to
compensate for my spinelessness, I got hold of the speaker's address and
wrote him an angry letter. There was no answer. By failing to protest at
the right moment, I missed the chance of being heard. My words might
have nudged a few to look at the dangers of religious chauvinism. Or I
might have been ridiculed and shouted down. I had lost my nerve, knowing
I was up against a majority — an elite majority — that is so sure of its
beliefs.
The strength of numbers dictates the law; the fate of the weak depends
on the humane and democratic values of the powerful. "Minority" implies
a group that is victimised. But this need not be so. The shifting
dynamics of place, time and context affords each of us the possibility
of being among the few. A dynamic minority has the potential to
influence events.
"The way in which a man of genius rules," wrote the jurist and legal
historian James Fitzjames Stephen in an essay that was strangely,
against democracy, "is by persuading an efficient minority to coerce an
indifferent and self-indulgent majority." The actions of that minority
must be founded on just principles or else we end up with a polity like
Nazi Germany's or the contemporary United States.
For every Hitler, Bush or bin Laden there has been a Socrates, a Chomsky
or an Anna Hazare; and hopefully, for every Togadia, a Teesta Setalvad.
The true hero ensures that even the adversary is not harmed. He or she
would have reflected deeply before making a choice. The first enemy to
defeat is one's own doubts; after that is accomplished, she becomes a
majority of one.
In a crisis if the majority has been knocked unconscious and inert the
individual or a small group often comes up with an innovative answer.
This could be truly original, like Satyagraha or the Chipko Movement.
Such action requires a certain courage, a readiness to face ridicule and
danger. In the mid-19th Century when all of the U.S. was cheering the
frenzied pace of industrialisation, Henry David Thoreau chose to defy
the system. For two years he lived in a one-room cabin he built in the
woods. He was disregarded as an eccentric. Fifty years later, Gandhiji
read the works of Thoreau and was deeply inspired. My Experiments with
Truth resembles Walden in its clarity and in the reasoning that human
goodness and the pursuit of a simple life are the answers to much that
is wrong with the world.
In a majority, it is comfortable to let one's opinion fall softly and be
buried in the cushion of numbers: as has long been the practice of
thousands of young men in India who partake guiltlessly in the dowry
system, ignoring the fact that they are being sold to the highest
bidder. Marry the girl whose family waves the largest number of
banknotes. Can she, who bought her husband for money, really have any
respect or love for him? When I asked a young doctor in Bihar why he
allowed himself to be purchased, he said, "Sab gharon mein aisa hi hota
hai" — it is thus in all homes. Follow the herd and be happy.
When the film "Water" was damned by Hindu militants in Varanasi, a
friend of mine supported them with this logic: "Will Muslims or
Christians allow a film to be made criticising their holy men? What
happened to Rushdie?" There you are. The ban is justified because other
religions would have done no less. She did not question the fact that
the film was intended to portray a truth about sanctimonious priests
posing as the saviours of a religious heritage. Her argument was, why
show the truth if others don't show it? Let us all belong to one equal
level of untruth. Let us be brothers and sisters in hypocrisy.
To be in the minority does not always translate into being victims.
Doctors, engineers, journalists and Test cricketers belong to small,
privileged groups. Professionals who excel in their field but become
edentulous when they come up against a social evil. As a doctor I have
often thought about my advantages. The degree comes with perks: No
doctor can deny the delights of sporting the Red Cross symbol on her
vehicle, or flashing an identity card to get ahead in a queue. Doctors,
like teachers and lawyers, sometimes go on strike for more pay. Nothing
wrong with that, I suppose, but have we ever banded together in a cause
other than our own?
Okay, we're too busy saving lives. But then, we are five-and-a-half-lakh-strong
in this country and have done little to ensure that every citizen has
access to us. The five-star medical attention being heaped upon the rich
is a condiment we can ill afford. The dazzle of technology benefits
doctors more than it does patients. As for working cohesively, we have
that questionable body called the Indian Medical Association with
branches all over the country. Doctors meet every month and, over drinks
and dinner, make pretentious speeches about a brotherhood that does not
exist.
Half a million of us and unable to root out tuberculosis and the other
communicable diseases which kill millions every year. Proud of our
refined techniques in heart, kidney and brain surgery but uninterested
in the hazards of unclean water or malnutrition.
There are many, both in cities and in the villages who are noble
exceptions. Their number is still small but they will make things
happen, that is, if they remember that when small groups become big
groups, one has to watch every step.
Celebrities are high on the list of privileged minorities. Advertising
agencies buy their names to sell products. Our heroes hail biscuits,
soft drinks, beauty soaps and motorcycles as invaluable adjuncts to the
Good Life. Do the stars who wave these coloured poisons really believe
they're harmless? One sportsperson, badminton champion Gopichand,
refused a lucrative commercial deal because he did not believe the soft
drink was good for health. A financial suicide for him, but noble.
These stars actively strive to avoid doing good. If, during the early
days of the riots in Gujarat, someone like Sachin Tendulkar or Amitabh
Bachchan had made a public appeal, a tragedy could have been averted.
But all of them, and most of our politicians, and even our then Prime
Minister, kept silent. In the loudness of their silence, the brutality
went on and on.
A stagnant society disregards minorities and trivialises the self. In
their midst, the underprivileged are denied a decent livelihood and
denied the chance to change it. Only small, committed groups and
individuals with courage will bring about change. "I cannot and will not
cut my conscience to fit this year's fashions," wrote playwright Lillian
Hellman to the U.S. Congress during the infamous witch-hunt of the
McCarthy era. The U.S. is urgently in need of more Lillian Hellmans as
we are in need of Teesta Setalvads.
Article from Hindu Online
The East West group continues to meet and
minutes of last meeting can be obtained on e-mail from
Faith Chinganga.
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