Tag Archives: India

‘I HAVE NEVER VOTED. MAYBE THIS TIME I WILL, FOR THE NEW GENERATION’

22 Saturday Mar 2014

Posted by in Uncategorized

≈ Leave a comment

Tags

, , ,


Image

My name is Reba. I think I am 37.

The village I was born in, a few hours out of Kolkata, is one of those places nobody knows about. You don’t come to know about it even when you walk through the middle of it. And it’s for that reason that I have no voter card, no ration card, pretty much nothing. So I have never voted.

I have four children. Three daughters and a son. Today was a difficult day. While cutting vegetables at one of the nine houses I work in as a maid, I cut my hand. A nasty gash. I poured water on it and pressed it with a damp cloth until it stopped bleeding. But by the time I reached the third house of the day, the strong phenyl and acid combination I used to mop the floor had infected my wound. I blinked back tears and carried on. After 13 hours of work, with on 15  minutes for lunch, I got home. Instead of collapsing on my bed, I repeated my actions of the day – wash, sweep, clean, dust, cook. This time I was working for my home, my four children, my husband.

Yes, I can see how a lot of you will look at me as soon as I say I have not voted. My daughters — I’ve educated them, one of them is even doing her Bachelor of Arts from Delhi University — look at me the same way. But you don’t understand. You don’t understand that I don’t live in the same world you live in.

You sit in your rooms, debating whether India ought to take a stand against the Naxalites, typing furiously into your laptops about whether or not the price of petrol is inflated. What you don’t understand is that my bicycle and I really don’t care.

I care about feeding my children, I care about helping them escape this torture I’m living through. I care about being able to smile on my deathbed and consider my life determined solely by the quality of life my children live. And nobody actually helps with that. Not one party.

It all sounds very fancy. It all sounds as if they have these grand schemes to help us, but that’s all they are: schemes. I don’t vote because even though I now have an Aadhar Card. Even though my daughters are educated and smart and talk of how important it is to vote, I’m jaded. I’ve been sidelined, ignored, forgotten by the entire political scene. So much so that I don’t ever remember being part of it.

My daughters say I cannot complain about my politicians if I don’t vote. That I can’t talk about a broken system if I don’t do anything to change it. But to me, voting for the politicians here is as useful as voting in Bangladesh – inconsequential. They make big promises, these big men, but I’m no longer affected.

Perhaps my attitude is defeatist, but you tell me this: what child is born with that attitude? We’re all born clean slates. Take something from that. Look at why I am this way. It’s because of a lifetime of disappointment.

The new generation is full of hope. The new generation is full of fire. And maybe this time I will vote. Maybe I will, not so my life gets better, I have given up all hope for that ever happening. But for the new generation. I pray the politicians won’t turn them into fragile, cynical things. I don’t know whom, I don’t know how, but I’m praying for somebody, and this time maybe I’ll do it with a ballot in my hand.

As told to Saba Sodhi in Noida, Uttar Pradesh. Reba, who requested partial anonymity, spoke in Hindi and Bengali. This interview has been translated, condensed, and edited for clarity.

Photo credit: Vishal Darse

TLC from a Monkey

28 Saturday Jul 2012

Posted by in Uncategorized

≈ 1 Comment

Tags

, , ,


First off, my apologies for the long silence. It’s been a busy few weeks, but I have a quick story I have to share.

 

I went off with some old school friends for a few days to Shimla, a small hill station in North India. While there, we went off to see a temple to the god Hanuman who had the form of a monkey. Thus, monkeys were considered sacred to the god, and a large number surrounded the temple.

As we walked up the rather steep and numerous stairs to the main temple, we came across full herds of monkeys who weren’t shy about how they felt. If passers by looked them in the eye or said something to them they were quite unabashed about slapping them across the face. One of my friends got slapped across the face and consequently was a tad skittish around them.

I, of course, kept walking ignoring him and like a good friend making fun of him about his fear of the monkeys. So after touring the temple and seeing the 108 foot statue of the god, which was quite impressive, we walked down.Imagew

After walking down, I stood around waiting with a friend while my other companions went off to see another temple. As we stood there chatting, all of a sudden I felt something hit my head and my glasses disappear. My friend, in splits of laughter told me that I’d just had a monkey creep up behind me, eye my glasses closely, leap towards me snatching my glasses off my face.

I turned and sure enough, he had my glasses perched on an arch about 12 feet high. In vain I stood there trying to figure out how to get my glasses back. He, smart man that he is, walked across to the men who worked there and asked how I should get my glasses back.

These men had stopped me in the beginning of my walk up the temple telling me to take an offering for the monkeys. I, seasoned traveler that I am, ignored them. Then when this seasoned traveler was squinting at the monkey who had my glasses in confusion they offered me a way out.

The man took two packets of some sort of candy- small round sugar balls basically, and walked up the stairs to the monkey. As he rose, he split one open and threw it in all directions. A horde of monkeys descended on it scrabbling and fighting for the candy. Not the thief though- he wasn’t going to be swayed by a communal offering. As soon as the man got close to him, he threw him the other candy packet. The monkey caught that packed in one hand and neatly dropped the glasses- luckily into the vendor’s waiting hands.

Later on, we realized those monkeys were likely trained to retrieve people’s valuables in exchange for candy- a supposition our hotel manager confirmed while in splits of laughter at my predicament.

So, that’s the story of how I got some tender loving care from a monkey.

I want a surgery

04 Wednesday Jul 2012

Posted by in Medicine

≈ 2 Comments

Tags

, ,


So a few days ago there was a patient who’d come into the out patient department to see the orthopedist we’d been shadowing. She was a follow up patient, who as soon as she walked in repeated her complaint. Let me give you an idea of how it sounded.

“You should do surgery”

“What surgery?”

“My knee hurts.”

“So should I replace it?”

“Well, I cant walk”

“That doesn’t mean I should do surgery”

“Well, why can’t I walk?”

“Because you’re overweight…. Lose weight…”

That was the gist of the conversation. And then, the patient smiling sheepishly left.

It’s a conversation that I can’t imagine being repeated in a US hospital. It’s a conversation unique for being so blunt and requiring a certain relationship between patient and doctor that is present in India, but harder to find in the hospital.

Is that something you’d prefer to hear? Or do you prefer the system presently in place in the US.

Indian Hospitals: Public and Private

26 Tuesday Jun 2012

Posted by in Uncategorized

≈ 1 Comment

Tags

, , , ,


So, as you all know I’ve been shadowing at an Indian government hospital for the last few weeks. Recently, I ended up going to an uber expensive, uber nice private hospital with my grandparents. Now, a few words on the differences.

 

Firstly, the government hospitals. The doctors there are excellent- well trained (not by the training, as much as the practice of seeing that huge patient load), they function with minimal resources and use novel solutions and approaches. They offer excellent treatment options, try to minimize risks to the patient and generally do what’s right. They don’t sugarcoat a patient’s prognosis, nor do they mince words. I’ve heard them tell patients with regards to a degenerative disease “baal safed hoten hain, na, voh safed hote rahenge- hum dhere kar sakte hain, rok nahi sakte” namely, as your hair gets white when you age, it keeps getting whiter, right? We can’t stop your hair (disease) from getting whiter (worse), but we can slow it down.

The downside to a government hospital- the crowding. Treatment is uber cheap, but due to the sheer patient load, you hit delays after delays and are more likely to die of an infection than of the treatment’s risks. Also, a lot of the patients who come in are being seen after days- precious days which if treatment were instituted earlier could have had a different outcome.

 

Private hospitals on the other hand, have no problem with overcrowding. Doctors have time for you, they’re soft, polite, soothing and charming. They’re understanding of your concerns and are willing to change your treatment based on what your limitations are. The flip side is, from what I’ve heard from physicians on staff, they are quite willing to “order” surgeries for patients who don’t really need it, to make their required bottom lines. The upside is, they’re shining clean, the staff is typically quite nice and fairly competent. Your chances of dying from infection are rather slim, however the general idiotic actions in medicine, are quite common there. One of the things I’ve heard from a patient at one of India’s best private hospitals, is that after a blood sample was taken and analyzed, the remainder of the blood was (with some air) injected back into his veins. As he put it, he sat there waiting for the pulmonary embolus that would kill him. Thankfully, that didn’t happen.

 

If you ask me, where I would go- I’d say I’d go to a government hospital for a surgery or a consult, but not to be admitted- for that I’d choose a private hospital.

30 seconds to Diagnose

21 Thursday Jun 2012

Posted by in Medicine

≈ 2 Comments

Tags

, , ,


Today we observed a day in the Outpatient Department of the Orthopaedic Clinic at the hospital I’ve been observing at. To give you an idea of the day, let’s start with this. 10 or 12 doctors saw over 250 patients in a little over an hour and a half.

Yes, that was 10 doctors and 250 patients. Yeah, that means they saw 25 patients each. In one and a half hours. Which means each doctor saw 16 patients an hour. Each patient got 3.75 minutes. Which seems higher than what we observed.

To paint the scene for you, we were sitting in the doctors office, in two chairs facing a eminent ortho surgeon. He was sitting in one chair, and the chair next to him was for the patient. Patient’s treatment cards were dropped off, and he called them in the order of the cards arrival. (Speaking of the cards, they cap patients at 250 per OutPatient Day- the first 250 get cards and subsequent treatment). So, the doctor would call out a name-  said patient would come in, and they’d sit down, by which time the doctor had asked them what the problem was. As the patient spoke, the doctor would be looking at their X-rays, CT scans, or MRI’s. Then, as they went along, the doctor would do a quick physical exam, without asking the patient to disrobe, scribbling in the card the whole time, tell the patient the treatment or tests required and send them off. Then, the next patient and so on. As time went along, the room got more crowded as patients started waiting within, other doctors would pop in for consults and more patients would be standing around while the patient being seen was being questioned about their ailments.

How different from the ideal patient encounters we’re taught in medical school. Forming a bond with your patient, open ended questions, exposing an area for a physical exam, vital signs, not to mention washing one’s hands all went out the window. The doctors worked like automatons, seeing patients one after another, sorting, treating, prescribing and diagnosing.

As it went along, we saw things we’d never heard of in the US. Skeletal Fluorosis, and Osteoarthritic Tuberculosis. Patients who had TB in their L3-L4 vertebrae, and patients who’s teeth and fallen out and bones were brittle due to excessive Fluoride. It was astounding, and though the doctor was swept off his feet, in minutes snatched between patients, or while the patient was sitting there we’d learn about these diseases and unique presentations of others.

I saw the benefits of the paternalistic model of physician-patient relationships once again. Patients who’d religiously follow the doctors lifestyle prescriptions. Anything they said, from exercise, to stop eating this, stop doing that, was met with a Ji, Doctor Sa’ab (Yes, doctor). The doctors would say, quite clearly, “This problem you’re having is due to your weight. Lose weight.” and the family would follow their orders to the letter.

Part of me considers that perhaps we should move back to a paternalist model of medicine, where the doctor knows best- you’ll solve the problem of non compliance. But, at the same time, doctors aren’t equipped to make a value judgement based on their patients lives. The only one who can do that is the patient. If I were enough of an idealist, I’d imagine that a perfect blend of the two exists to have neither’s drawbacks and both’s positives. I share no such hope- I just realize that some systems work in certain places and others work well in different places. It’s all about the culture and society you set it up in.

Thoughts?

Of Broken Spines and Missing Metacarpals: Observing at an Indian Hospital

20 Wednesday Jun 2012

Posted by in Medicine

≈ 1 Comment

Tags

, , ,


Over the last few days, I’ve started observing at one of India’s most advanced, most crowded and most over-utilized and understaffed hospitals. I’m starting in the Orthopaedics department, so in the last two days I’ve seen things clinics, outpatient departments and a couple of surgeries- including two spinal fusions (or spondylosyndesis- for the technically minded) as well as the beginning of a surgery involving a severely cut hand which was spurting blood from a severed radial artery branch.

It’s a different world in this hospital- there are patients in all directions, waiting in hallways, on floors, in every situation imaginable. The patients are waiting patiently, waiting for a doctor to come through quietly enduring whatever they’re suffering. As the doctors come through with a bevy of senior and junior residents on rounds they spend barely a minute talking about a patient. They don’t talk to the patient, nor do they attempt to explain anything. They discuss it amongst themselves, reaching a decision on how to treat the patient, with a look at the diagnostic imaging, a glance at the wound, and a few words from the resident who looks after the patient. The first few patient interactions, I was shocked- how could one responsibly be doing this, I wondered? Then, I saw the number of patients. Day one, we rounded on over a hundred patients in a little over an hour. After that, each resident had to run to get to doing all they had to do- be it treating, testing, surgery or whatever. As they do so, they speak to their patients, telling them what decision has been reached, how they will be treated and an estimation of when.

These residents and attendings are treated by patients and patients families with a reverence that is amazing to see. The paternalistic philosophy of medicine is very much alive and well here- the patients are not consulted about their decisions, they are simply told. Decisions are made and communicated to the patients, and for a vast majority of them, they seem to like it. The physicians act and are treated like rockstars, with admiring glances and awe in their wake. It’s a heady combination this, and I can admit to getting swept up in it as I go along. But, for one, I feel like a bit of a fraud in that white coat- I’m a second year med student, not a practicing orthopaedist and I still have a little trouble reading CT scans. So each time a patient comes up to me, with a look on their face that grants me that same level of awe, I feel not yet worthy.

Day two, as we rounded, I saw a woman badly injured, lying on a gurney unconscious. We didn’t speak about her or discuss her, nor did we even acknowledge her presence. But as I walked by and looked her mother and sister in the eye, I felt this sudden urge to speak to them- not for the minimal medical advice I could have given, but to perhaps offer comfort in a difficult time. I understand why it can’t be done in the restrictions one works under in this type of system. Yet it makes me wonder if doing so for years will make one detached and cold to the people one came into medicine to treat.

Each day more patients requiring an OR come in than can be treated by the staff and resources available. So, the backlog grows day by day. The numbers of patients who need closed reduction grows in such leaps and bounds, that they require a day in the hospital but stay a week.

That being said, I’ve seen some of the faculty do amazing work- surgeries with a cleanness and economy of time, energy and resources that speaks of their comfort and competence. At the same time, as you walk the floors of the wards, you see what they’re up against- the sheer numbers that could overwhelm their prodigious skill, and the constant fear in such overwhelmed hospitals- infection. I can only imagine how they must feel, their pride in a perfect spine repair or reduction being reduced to bitterness when their patient dies from an infection acquired due to too many people in too small a space.

I will try to post regularly as I go along, but that’s assuming time permits.