Friday, December 17, 2010

The Epilogue

I thank all of you for taking the time to read my blog. Those who are reading it for the first time, it would be best if you click on "October" in the Archive section. Then you can read from the beginning to the end.

The journey has come to an end. I had so many questions.

The first question was if I would be comfortable living here in the old Delhi. It can be easily answered with an emphatic up and down Indian nod :) I had a one room accommodation with hot and cold running water and electricity. The room was spacious and the surroundings were really good for long walks. The food was not the best at the local eatery. But there was always Suneeta nearby :)

The second question I had in my mind was if there was any way for me to make a useful contribution to society. That question was answered in the negative. It was not the answer I was hoping for, but it was expected. So I was not all that surprised -- a little disappointed yes.

On the medical front I found that I could not provide a long term meaningful teaching and learning experience for the residents and myself. I had a good time on the medical floor which was staffed by hard working residents. They were lucky to have a very competent of department head teaching them. Other floors and departments were not so lucky. The young men and women were of the highest caliber everywhere. The problem is that the system that does not promote inquisitiveness, leadership and talent.  The emphasis here is on rote learning and passing examinations. Independent thinking, discussions, self-study and group projects are on nowhere in sight.

The medical school has one of the most concentrated areas of highly educated and intelligent people in Delhi. Even here a culture of incompetency, grandiosity  and/or  inferiority complex predominates in the people who are in power.  Without the cooperation of the highest level of the administration of the medical school, there is no use of me going back.

On the social service front, I spent a lot of time with people working on the anti-corruption crusade. They are a bunch of dedicated people. I worked on the legal proposals that they are putting forth to establish an independent body to investigate corruption.  However they already have enough competent and experienced people working on it. I did not feel that I was able to make any difference. The important thing for me was that I tried. All you can do is try. Sometimes you succeed sometimes you fail. The destination is not everything but the journey is.

Red Traffic Light Means Go

Thursday, December 16, 2010

Photos from New Delhi

I have placed some photos from the New Delhi on Pacasa. Please click on the following link to go to the site.

Thanks all for the comments and encouragement.

Satish Steve Gupta

Sunday, December 12, 2010

Last day in Delhi

Yesterday was pretty depressing. Today it is different. I am looking forward to getting home. There is excitement and anticipation, mixed with sadness. I have already packed two suitcases. Tomorrow I will be leaving early in the morning. The flight is at noon.

While walking past the college building I realized how the building looked so nice! Just a month back it looked like such a piece of junk. Human beings are so malleable. The building certainly will be declared uninhabitable by any western municipality. The electric wiring is pathetic. The number of working toilets is far below the minimum required by the building code, the fire exits--the less I say the better. But here in Delhi it is one of the better buildings. After spending six weeks here my perception has changed dramatically and I did not even know it. After another month I will be making statements like the ones made by one of ministers, “Delhi is a world class city!”

Second to last day in Delhi

Today is second to last day here in Delhi. There is certain sadness in leaving this medical school with the knowledge that I will not be coming back any time soon. I was hoping against hope that I will find some “connection” that will bring me back every year. I was hoping that I will be invited back. That is not going to happen. There is no room or field for me to make any positive contribution at this time.

Today is also the day to say goodbye to Dad. This is likely to be last time I will see him. It was good to see that he is such a good physical condition. He can walk pretty good. He can hear everything. He eats really well.  When I first came here I took him out for lunch. He did not like the food. Next time he had food made for me even though I had told him that I will take him out to a different place. I did not want to eat there. Anyway I ended up eating there. Next week the same thing happened. He would say yes when I told him that we were going to go out, but when I got there he would refuse to go. So the next week I picked up “Chole-Bhature” from Haldiram Restaurant and took it with me. Dad really enjoyed the chole-bhature. So I asked him whether I could bring the same next week. He said fine. I was so relieved. The chole-bhature is easy to carry and stayed pretty good for the one hour that it takes for me to pick it up and take it to dad. This week I called and told him I was coming over with chole-bhature, he said, “I cannot have chole-bhature every day! Bring something else!” Now I have to figure out what to take that will taste good after one hour of picking it up from shop. He can be a pain in the back. Well at least dad must be feeling good since he is himself again!

Dad is very sharp on some things but some things he is making up. It happens in old age and the medical term of this is confabulation. When a person cannot remember he makes it up. I know my daughter will say that her dad has done it all her life!

After lunch I said good bye to day. He asked when I was going to see him again. I said when it is the wish of God. He knew it is probably the last time he will see me. He had tears in his eyes as we said good bye.

Friday, December 10, 2010

Last two lectures to the Medical Residents

In the last two days, I gave two lectures to the residents. One was about medical malpractice law and related issues. The other was about my experiences in India. There were about thirty doctors for the medical malpractice talk. It was based upon a hypothetical patient who came to hospital in a very poor condition and later expired. The talk went well, everyone was very attentive and the discussion was good.

The talk about my experiences in India did not go as well. I told them that the most frequent question I had been  asked was,"Is it better to go to USA or stay in India?" I answered that medical doctors would be better off in USA unless they had strong family ties or obligations or if their families were very wealthy.

Then I talked about how the residents kept complaining about the poor facilities and lack of basic equipment. They were right in their descriptions but I told them that they were not doing all that they could do. They could still make things better by their own actions. It was not right to say that you are not going to do the proper thing just because others are not doing it. I think I got a little carried away and it did not go well with the audience:(

Respect -- sometimes welcome sometimes not

When I first saw the security officers at every gate, I was a little worried. They might check every person's ID and I had none that entitled me to get into the hospital and college campus. I had asked the Dean to give a letter of introduction, that he had approved, but it never materialized. However, soon I learned that if I walk confidently and carry a stethoscope, I could go anywhere in the campus. Most of the time the security officers would get up from their chairs and salute me. I liked the respect they showed.

But there were times when the respect was not welcome -- like riding in Metro and the young men getting up to offer me their seats because the seats were reserved for "old and disabled"!

The other time when respect was not welcome was when strangers, sometimes in their forties or fifties, called me “uncle.” With utmost respect they would ask me, “where is the bus stop? Uncle!” Whatever little hope I had of looking like a young man have been dashed forever. Coloring my hair and mustache was not fooling anyone. I guess there is no use coloring my hair anymore. But if I do not color my hair I end up with a same statement in USA. They say it differently but it means the same. In office patients have asked my three or four times, “You are not retiring anytime soon? Are you?” On the golf course other golfers have asked me, “You are retired. Aren’t you?” This has always happened when my hair and mustache were as white as Santa Claus’.

Wednesday, December 8, 2010

Last Few Bites in India

Today I found out that I am going to be here in Delhi for only five more days. (My travel agent informed me that my return flight is booked now, before I did not have a definite return reservation.) So I have decided to eat plenty of what is not available in Los Angeles. See how my mind works :) I have decided to live on a balanced diet. I am going to eat plenty of fruits and then balance them with plenty of sweets! I have already described the sweets. Most of the fruits here are plentiful in Los Angeles like mango, watermelons, cantaloupes, apples and papayas. But there are some that are not available back home.

This is my favourite, Gauva. It is of a consistency somewhat firmer than an apple. Normally you eat the skin but I am peeling off the skin, just in case. It is not very sweet, just enough to make it delicious. The grapes are just to give you a perspective.

Cheekoo looks like a big kiwi fruit. But it is nothing like a kiwi. The inside is brown, my favourite color, just like me :) It has one or two large black seeds and the rest is delicious. You have to peel the skin.

Orange looks like an American orange but it peels off like a tangerine and is sweet like an orange. They have American style oranges too, they call them Keenu here. When I was here these were called Mousambi. Who knows when and why the name got changed.

I faintly remember this fruit Sitaful. It has outside appearence like a pineapple. Inside each piece comes off like pieces inside of a pomegrantes. Each piece has a large seed. There is hardly any pulp and the pulp is slimy and very sweet. No wonder I do not remeber this fruit. It is not my favourite.

Tuesday, December 7, 2010

A Night at the Movies

I wanted to see a Bollywood movie while in India, the Indian style. So I had asked Suneeta if she would like to go to movie with me. She had not seen any movie in a theater for over a year, so she was happy to go. Her husband works so late that we left him out. So it was three of us, Suneeta, her teenage son and me. We gave the task of choosing the movie to the teenager.

I want to give a little background for those who do not know my experience with Hindi movies. When I was in High School we used to live in an Army Camp. There was an open air movie theater just for the army families. My dad paid a monthly fee and we all could go as often as we wanted. The theater was about two hundred yards from our house. The theater showed three different movies every week. It would screen a Hindi movie four times a week, an English movie once a week and another regional Indian language movie once a week. I used to write down the title of every movie that I saw there. I still have the list. When the list went to 150, I decided to quit. All the Hindi movies had one story, the same story in all movies. A man falls in love with a woman. The villain comes in between. There is fist fight and the hero gets his woman. (They were supposed to be boys and girls, but the parts were played by over-thirty actors.)

So in the last thirty years I have not been able to sit through many Hindi movies. I think I have seen one, because I was with my brothers and their wives in New Jersey.

So I was expecting another one of those boy meets girl and triumphs over the villain story. It was a pleasant surprise to see this movie about a quadriplegic man who is asking the court to allow him to end his life. There was not much of a story line but it was very well done. It had only a few songs at appropriate times and no fist fights! The movie lasted only two and half hours. Not the usual four hour movie with thirteen songs.

Monday, December 6, 2010

Teaching the Residents

Today I gave a presentation to the ENT PGs (as residents are called here). There about twenty five doctors, about half staff and half PGs. I talked about Allergies of ENT. The talk went very well. The faculty members asked several questions and the PGs none. Then the chief and a few senior faculty left and I talked to the PGs. They were very interested in doing allergy testing and learning more. I had earlier thought that they were not showing any interest because they do not see allergy patients or they are missing the diagnosis. But the PGs told me that they see hundreds of allergy patients every week. But they do not have any way of testing for allergies or giving any allergy shots. In the present situation the allergies take a low priority. Anyway I told them that if they get their Department Chief’s permission and they get some patients together, I will show them allergy testing.

It was nice to see that young doctors are interested in learning. I am finding the same on medical floor. I have been a little more vocal about the medical problems and they appreciate the information.

Sunday, December 5, 2010

An Atheist Who Prays Every Morning and other random observations

ATHEIST: I am an atheist but it does not stop me from praying every morning. In New Delhi, there are Mosques, Temples and Gurudwaras behind my room. They are pretty far but every morning at 5:30 AM, I wake up to the sounds of prayers. So I join them. Here is my prayer:

“Oh God, bless all of them, Hindus, Muslims and Sikhs. They are all fine people. Please, please bless them and tell them not to use loudspeakers since your hearing is not impaired.”

DELHIWALLA: There is certain charm in the hustle-bustle of Delhi. I could live here if I had a good,  meaningful job. There is never a dull moment if you go on the road. There are people walking, riding bicycles, rickshaws, sometimes riding horses or camels, motorcycles, tuk-tuks, small cars, imported luxury Mercedes cars, and screeching past them are the huge buses and trucks. They all used to belch thick heavy smoke trails, the men puffing cigarettes and the machines giving out diesel smoke. Now no one smokes and all buses, tuk-tuks and a lot of the cars run on CNG, so there is no smoke trail.

TERRORIST: I traveled on the Metro yesterday and my train went past a school. It was a spacious school with children playing soccer on a neatly groomed, large playground. It reminded me of the Delhi Public School --  one of the most expensive and prestigious schools in Delhi. The DPS was here when I used to go to a government school in Delhi. My school had few teachers, let alone a playground.

I used to walk past an officer’s club. They had beautiful grounds and even a swimming pool. My father was a private, so we were not allowed in there. I could not understand why the government would spend so much money on them and not on us. They were already getting paid enough. They could afford to pay for their own recreation. Privates' salaries were low so I thought the government should pay for them to belong to a club.

Social injustice was as rampant then as it is now. I could feel it even when I was ten or eleven years old. I remember during Junior High, one of my fervent desires was to have a few nuclear bombs. Then I could detonate them over India. I believed that only after the whole damn place was destroyed could a new India  be born, an India with social justice for all. I am sure with some encouragement and proper, or improper, depending upon your point of view, guidance I could have been groomed into a suicidal terrorist.

Looking at that school brought back those memories from forty five years ago. I guess there may be a “sleeper terrorist” some place inside me! But that person is happily in deep, deep sleep :)

Retirement Home for Cows

Today I visited a “Retirement Home for Cows”. It is about 25 miles from Delhi. There are several of these around Delhi. They are run by Non-Profit Organizations. People respect cows and donate money to take care of them until they die of old age. Most of these cows were abandoned by their owners when they were no longer useful. As you might know, cows cannot be killed in India. They are considered holy. My cousin Amar Nath donates money to this place so we went there to donate the money and take a look.

Amar Nath Giving Money

The Retirement Home

The home has about 1420 cows. Only about 12 of them produce milk -- the others are non-productive. Cows live about 20 to 25 years. They give milk for about nine months after delivering a baby calf. One of the keepers told me these facts. He said a cow may get “married” about 10 to 15 times during her life and after giving birth to calf can give milk for nine months each time. Unlike American farmers, they do not use any hormones to keep the cows lactating. Most milk in India is produced not by cows but by water buffaloes. The milk of a water buffalo is higher in fat and the milk output per water buffalo is much higher than from an Indian cow.

They can go inside the shed or wander around
 The volunteer managers and their 22 employees take good care of the cows. Both the facilities and most of the cows are washed twice a day. There is plenty of space for them to roam around. There is a big farm in the back to grow cow feed. The workers are all from Bihar. The whole of Delhi and neighboring area depends on migrant workers from Bihar to keep going. The Biharis are to Delhi what illegal Mexicans are to USA.

This very holy blind cow has an OHM on his back

Progeny of the very holy blind cow

These four were posing for me, like saying please take our photo

Friday, December 3, 2010

Teaching the Medical Residents

I have given up on teaching the medical students. They told me that their main interest is to pass their examination. After passing the M.B.,B.S. (as MD is called in India), they become interns and then they have to study even harder to get good grades in their Pre-Entrance Examinations for post-graduate slots. All the examinations are based on your ability to memorize and regurgitate. There are no meaningful clinical examinations. So unless the method of entrance to post-graduate courses change, there is not going to be any interest to learn something that is not going to be on the exam. They are absolutely right. Until and unless medical ethics and law become part of the examination they are not going to show any interest in it.

So I have decided to go ahead and concentrate on the post-graduate doctors, as they are called here. In USA we call them interns and residents. I gave a ten minute talk on Monday and one on Thursday. The Monday talk was on the importance of getting patient consent and how to get it. The Thursday talk was about the need to keep proper medical records and I added a five minute lecture on the need to follow the rules and regulations, like wearing white coats and carrying medical diagnostic equipment with them. The second part did not go over very well with some of them. Next day I got an earful of how bad the working conditions are and here I was insisting on them wearing white coats!

I am thinking of giving a talk on communication next week! Kristina will say, “and what do you know about it?” The basic things that we take for granted in USA are missing here. So I do not have to be an expert. All I have to do is talk about some very basic needs of a hospital. We will see how it goes.

Fine for Loitering

Sign in the Hospital
I am glad no guard fined me for committing offense number six!

Suneeta and Mahesh

The phone is glued to his head
Suneeta is the daughter of my late sister Kanta. Suneeta lives about a mile from my place in Delhi. I walk to her home from time to time. At other times I take a rickshaw. Suneeta calls me every day about seven o’clock in the evening to invite me for dinner. She does not take no for an answer! Her cooking is adding to my waistline. Her household consists of her husband and her son. Her daughter is in Dallas studying computer science. Her husband, Mahesh, is a charming man who keeps the conversation going. Both of them have a great sense of humor and I feel completely at home there.

Mahesh has a degree in auto engineering. He is working as an independent claims adjustor. He is very busy working almost seven days a week. Suneeta runs a pre-school for kids for four hours every morning. Their son has finished high school and is applying for admission and hopefully a scholarship some place in the USA.

They live in not too far from the Red Fort of Delhi. This area was first inhabited at least a thousand years ago. It has been in continuous use since then. The streets are not wide enough for autos. Mahesh has to park his car about half a mile away.

My sister had a sad and tragic life and died of cancer at the  very young age of about 55. When she was born there was some problem. I am not sure what happened but it caused her to have borderline mental retardation. She could not walk until she was three years old. Then she could not read and write no matter how hard she tried. At the age of eighteen she was married. Naturally she could not fulfill her duties competently. She was expected to cook, clean, take care of her in-laws, husband and children. Here she could hardly take care of herself. It was very tragic for her husband too. There was no divorce in India at that time. Kanta had four daughters and one son. They are all married and are well settled. Her grandchildren are going to graduate and post-graduate schools. Kanta would have been so proud and happy.

Sweet sweets :)

I love Indian desserts. After spicy food, a sweet dessert dish is the perfect way to end the meal. I found this place called Haldiram. They have dozens of varieties of desserts. I have tried about 15 different ones, so far. They are all good, some better than others. Between the desserts and Suneeta’s cooking, I have put on ten pounds! My pants do not need a belt to stay on me, any longer!

Wednesday, December 1, 2010

The Barber Shop

While on a quasi-purposive walk today I saw a saloon in Connaught Place. So I decided to have a hair cut and some highlighting of my hair. The barber looked like a kid. He was moving fast thru my hair with his scissors making a lot of noise. It went on and on. I am not usually in the habit of watching myself in the mirror. I usually close my eyes and relax. After a while I got a little worried. Was he cutting one hair at a time? Even that would not take very long since Keane has told me that my hair count consist of only two digits. Well he was being very careful. I think he would cut one hair, one tenth of an inch and then later on cut it again! Then he trimmed my mustache. This was the first time in my life someone other then me, had trimmed my mustache!

He made some horrible smelling stuff and covered my head and mustache area. I looked awful, like someone in between Groucho Marx and Adolf Hitler. After fifteen long minutes he washed it off. He washed my mustache and his fingers rubbed my lips. I did not like it. A man touching my lips. I must be homophobic or something like that. He was just doing his job. Now came the bill for Rs. 460/- I told him that Rs. 460/- was for a full head of hair. I asked for 50% discount since only 50% of my head was covered with hair. The result of all that hair chopping and slopping came out really good. I was very pleased so I left him a big tip ($2.00) !!

Quasi-Purposive Walking

I love walking around. It is usually with some faint or unimportant reason. But to me it looks like I have a purpose. I call it quasi-purposive walking! I was once asked what is quasi-purposive? I was in my third year of medical school. I used to read before going to classes. I knew we were studying neurology so I read the chapter after the one the teacher had talked about the day before. The chapter was on Sydenham's chorea. When I entered the room in the hospital, I was very late. All students were sitting down and Lecturer Patla Srivastava was teaching. We had two Srivastavas. One we called Patla (thin) Srivastava and the other we called Mota (Fat) Srivastava. There was a patient next to him. The patient's hands and legs were moving here and there. Srivastava asked me to describe what I was seeing. I told him it was Sydenham's chorea! Srivastava's jaw dropped. A third year student diagnosing an extremely rare disorder. Fortunately for me that was the only abnormal movement disorder I knew. He asked me to describe the movements. I had just read the book. So I repeated the text, “Sir, the patient has involuntary quasi-purposive movements.” Then he asked me what was the meaning of quasi-purposive? I had no idea!

Now I know what is quasi-purposive! Around Connaught Place I walk around as if I am shopping. Rarely I buy a thing or two. I must look lost today because a very fine gentleman told me that I was walking too slowly while crossing the road. He told me that the cars will not slow down for me. I thanked him for the information. Then he told me where I was and asked me where I was going. I had to tell him that I knew my way around. I just did not know where I was going:)

A day full of promise

The day started out full of promise. I had two interesting appointments. I was so see the working of a Consumer Court at 10:00 AM and later at noon I had an appointment with an official of the Max Hospital chain.

My contact for the Consumer Court had sent me an email listing the address of the court as Room 4 Floor 8, Oil Bhawan (Name of building) on JanPath Road. So I took a cab and headed for JanPath. The traffic was horrendous. It should be a five minute drive. It took twenty minutes. Once on JanPath, we started asking people for the Oil Bhawan. No one seemed to know the building. After three tries, I called my host. He said he was late and was driving so he could not talk much. He said it was not in Oil Bhawan but in  “Janpath Bhawan” on JanPath next to the courts. Now we headed to the courts, which were easy to find but once again we had to ask for directions to the right building. After we found it, there was no sign as to how to get inside.  So after another two inquiries I got inside the building and got in the elevator. The elevator had signs only for seven floors. So more inquiries followed. I had to get off at the fifth floor, cross to the other side of the building through a maze of corridors and then take a second elevator to the seventh floor! This time another fellow accompanied me thru another set of corridors to stairs and I climbed one more floor to reach my destination.

In the USA, I am going to miss all this human interaction! I talked to fifteen people today to find my way to the Highest Consumer Court of the land.

Inside the court room there were two commissioners. They did not have to be judges, but one of them was. All the people doing the talking were attorneys for the people. Here I was under the impression that Consumer Courts were made so that people could argue their cases without attorneys!

The commissioners were all business. They seemed to know the cases and the law very well. The arguments and outcome was more like a regular court! The same problem too! All three cases I sat through, ended up being continued. My host's case was filed in a local court seven years back :( His opponent carried out the same old trick, he sent a junior attorney who pleaded ignorance of the case and asked to postpone the case. It was postponed for three months.  It was getting late for my next appointment so I left at 11:15 AM.

It was noon when I got to my next stop  at the offices of the Max Hospital chain. This chain has several very posh hospitals in India, and is aggressively promoting medical tourism in USA and Europe. This official was interested in starting an allergy specialty department in the hospital.  Once inside the office building, it was like I was in some big law office in Century City. All leather sofas and an ornate waiting room. The guard showed me to the waiting room and informed my host. I was glad to be there on time. The problem was that only the building was western not the people working inside. The staff was Indian and they were on Indian Time! After waiting for 25 minutes I left. On my way home the official called to apologize. She blamed it on her assistant and miscommunication among them.

Banerjee's Head on the Chopping Block

Banerjee carries the title of Medical Superintendent (CEO) of this hospital but a better title would be the Hospital Firefighter. He runs around with a fire extinguisher tied to his back, dousing the flames here while another fire starts elsewhere.

The latest disaster to strike the hospital is the news report in the photo. A poor patient was injured in an auto-accident. He was taken to a nearby hospital but the hospital refused to admit the patient claiming they had no ICU beds available. He was rushed to another hospital which was  supposed to be a trauma center. They refused to admit him saying that they did not have an ultrasound machine and the patient needed an ultrasound. They probably have developed a sophisticated system of refusing all the poor patients with one reason or the other. The patient was then brought to this hospital where the newspaper says he was refused admission because he did not have the correct papers. The patient died in the parking lot.

The chief minister of Delhi has promised a full inquiry and punishment for all of the people responsible for the poor care given to the patient. So I am sure Banerjee is going to have to see the chief minister and make a statement to the press, to douse the flames.

I do not know what happened in the Casualty of this hospital. The initial newspaper reports are frequently misleading in India because the reporters are so untrained. They do not even try to get the  facts from both sides. They just print what one party claims. It is possible that the patient died in the parking lot of this hospital before anyone had time to see him.

But on the other hand, the training of the doctors in the Casualty is pathetic. They only have MD degrees and one year of internship as the required qualification. The internship in India is more like externship of medical students of USA. So essentially a Casualty Medical Officer may have no emergency training at all. There is no advanced training programs in Emergency Medicine in India. When I was in Casualty I saw some real sub-standard care by the doctors. They also appear so unconcerned with the pain and suffering of the patients. I guess prolonged exposure to extreme conditions desensitizes you otherwise you will not last.

Anyway Banerjee's head has been on chopping block several times. One of these times the axe may not miss!

Chair chairs everywhere,... even for beggars

Here was this beggar in Connaught Place sitting on this chair and begging!
His chair appeared better then the one I was sitting on in the hospital!

Tuesday, November 30, 2010

More observations on the Medical Floor

I have been going to the medical floor regularly. Yesterday was the emergency admission day. Most patients were brought in half-dead. They have about a 10 to 15% mortality rate on the medical floor. A few days back I attended the mortality conference of the pediatric department. Practically all the deaths were in the first 48 hours of admission, most within 24 hours. So I guess the half-dead patients somehow survive and are discharged. Those who are admitted three-quarters dead do not survive.

I can only imagine the conditions at the government hospitals outside of Delhi. They send their sickest patients to this hospital. I have seen all kinds of mismanagement of patients before they arrive at the Casualty here. One patient had epilepsy. Prior treatment had been Valium, etc and smelling salt. I am sure it made her worse. Another patient was brought in today. She had C. Section followed by acute kidney failure. It looks like they gave her the wrong blood and she had a transfusion reaction. Another patient had AIDS diagnosed at another peripheral hospital three months back. He was not prescribed any anti-AIDS medicines.

Enough sad stories. Now the good news. I had applied to get my medical licence renewed in Delhi. I had a valid licence to practice medicine here in 1972-1973. Today after about three weeks of applying I received my Delhi licence. Now I can officially treat patients in state of Delhi. So now I can open a long distance allergy clinic here in Delhi and see patients on Skype, sitting in La Canada. Just a thought :)

Monday, November 29, 2010

Chairs chairs everywhere.....

This is the chair I sat on for about an hour and a half. Now I am not going to complain if some chair in the USA is not so comfortable!

This is the chair that the Professor and Head of the Department of Medicine sits on! So I guess my chair was not that bad, considering that I am nobody here :)

Sunday, November 28, 2010

A chair in the Cyber Cafe

You have to admire the ingenuity that went into making this a soft padded, reinforced chair.

Editorial in Indian Newspaper

This is the editorial by The Pundit in the daily newspaper The Hindustan Times. It is one of the largest newspapers in India. Since it is hard to read, I have downloaded the text from its web site. Here is the text.

She's Dubya's double
Geography and politics are not Sarah Palin's strength
This could be a boon for nations like N Korea & Pakistan

"The geographically-challenged Sarah Palin is always good for a few laughs. But when she mixes up a nuclear-armed rogue North Korea with America's ally South Korea, people should be afraid, very afraid. In the recent trouble between the Koreas, our Sarah made no bones about how the US should stand with its North Korean allies. When corrected, she amended it to, "And we're also bound by prudence to stand by our South Korean allies, yes."

 Not just the Americans, but the North Koreans must be terrified of Sarah becoming the main woman in the US and mistaking their beloved leader Kim Jong-Il for Kim Cattrall of Sex and the City. Anything is possible with a woman who could call feminists a cackle of rads and who called upon peaceful Muslims to "refudiate".

But we must be thankful that she has taken up where Dubya left off. We wonder why she did not get the Korean issue right by making notes on her palm as she has done before big speeches in the past. We can only assume that the breadth of her vision could be comfortably encapsulated in that space. In fact, to justify her palm propensities, she quotes God as justifying this in a passage in the Bible. Imagine if she were to drop by here when and if she become prez. She might well ask why we are not wearing feathers in our hair and brandishing tomahawks.

Her celebration of ignorance might prove a boon to countries like North Korea and Pakistan. "Asif, who are these people with strange, ticking steel devices strapped to themselves?" Old Zardari would answer, "Oh, they are part of our meteorological team out to record the ambient air quality." To which Sarah might respond that this is a skill sorely lacking in America. Meanwhile, let us hope that Sarah with her telescope vision is looking beyond Russia which she can see clearly from her window in Alaska and keeping an eye on North Korea, sorry South Korea, oh, okay, someplace out there."

Things we take for granted

The other day, early morning, the water stopped. I almost went into a panic. I had to go number two. How was I going to wash my hands! Fortunately the water flow was restored after a few minutes. I remember the old days when the water would stop for hours at a time, almost on a daily basis. We used to have buckets of water stored, as soon as water was available, in case the water stopped. Now we are so spoiled by running water that we take it for granted.

My laptop crashed really badly. I reinstalled Windows 7. It took me a whole day. It crashed again. Then I realized how we take computers for granted when they are working fine. I called the tech support and reinstalled Windows again. I am being very careful with the laptop. I am using it more or less as a desktop. There is some problem with the USB-internet modem and the laptop going into hibernation. The USB modem does not like it.

Saturday, November 27, 2010

A couple

During my time in Medical School, if there was a couple walking or talking, everybody would stare at them.
 I guess staring must have worked!! 
Now there are couples everywhere!!!

Corruption in India

The extent of corruption in India has to be seen to be believed. The cabinet level people take such open and outlandish bribes that they would put President Noriega of Nicaragua and President Marcos of the Phillipines to shame. I always beleived that once you have a billion dollars or so, why would you want more since you cannot spend it no matter how hard you try. I was so wrong. These people have billions of dollars and they still want more.

I saw the documents containing the "smoking gun" with my own eyes and now I believe that the current top most Indian leaders are the most corrupt in India's history.

The smoking gun I saw relates to the ambulances you see in the photo above. They were purchased by the Delhi Government (DG) for the Commonwealth Games, that were held in Delhi in October 2010. The amblulances have advanced life support equipment including Automatic External Defibrillators (AED). DG invited tenders for the AEDs. I saw the tender notice and the requirements to be considered an "approved vendor." Several companies applied. DG rejected some of the most well known companies including Phillips Electronics as not meeting the "approved vendor" requirements. Phillips Electronics sent letter after letter showing that they had met all of the qualifications. Then the tender from an unknown vendor was accepted to supply the AEDs for Rs. 310,000. There was another company that protested in writing that they have a long history and better reputation then the company whose tender was accepted. This company had bid Rs 125,000 for each AED! Their bid was rejected.

These ambulances were ordered in a hurry because a lot of money was to be made by the officers of DG. They had no plan for the ambulances after the Commonwealth Games. So these ambulances are sitting in a parking place with nothing to do. Even if they are pressed into service by DG, what are they going to do? They can take the patient to a hospital but the hosptial has no equipement for advanced life support!

I have been working with Arvind Kejriwal, who along with some others, has been fighting the corruption. I spent several days working on draft of a model law to appoint an anti-corruption agency that would be free of political appointees. I think I have done what I can do, there is not much else for me to do.

Friday, November 26, 2010

The Mobile Phone

This is a MOBILE PHONE! This guy can pedal his phones to any place and offer passers-by a way to make inexpensive local and long distance calls. He was pretty busy when I saw him in front of the hospital. He had three desktop looking phones on his counter. The charge posted was Rs 2/- per call, i.e. 5 cents.

Ashoka Pillar and Headache Conference

I made another visit to the "Magnificant Discovery". The ticket booth was not yet open and the guard was not there either. I wanted to see the Ashoka Pillar up close. It is surrounded by a tough looking fence. I circled all round and could see some garbage inside the enclosure so I knew people had been inside recently. I tried to force open the locks, but had no success. After another circle I found that one of the rods in the fence was missing. There was enough room for me to squeeze in. I went all the way to the base of the pillar. It has plaster all over it except the bottom ten feet. The plaster had fine writing covering the pillar. There must be over a thousand lines of text. I was looking at the oldest written law of the land. King Ashoka had written his teachings, which were basically the law of the land. I read that there were graffiti on the column too. One graffiti was an inscription about the local king winning a battle in 1213!

On the way back I could not find the entrance/exit door. Here I was lost inside of the ruins. I found out that it is no fun if you are forced to stay in a place, even if it is a beautiful place. After another long walk to the pillar, I retraced my steps and got out.

When I returned, there was all this commotion in front of the medical school. So I made my way over and found out that they were hosting a headache conference! The whole place was beautifully made up! Once you were inside of that place, it was like you could forget all the realities outside of the medical school. The whole thing is being paid for by the drug companies.

 There were more drug representatives then the doctors attending the meeting.

I went to the registration booth and asked to be registered so I could eat at their lunch buffet. The food arrangement, as you can see, looked superb. The registration clerk took out the brochure and said the registration fee was Rs 4000/- (about $100). I was in no mood to pay $100, after having saved 12.5 cents on the entrance to the magnificant monument. I picked up one of the registration kits of some other doctor who had not shown up and told the clerk that I will use that, and if the doctor shows up, to call me and I will return his registration. She was not buying it. I gave up and moved on. Maybe I could just show up there at lunch time?

Thursday, November 25, 2010

Amit Banerjee

I have been wanting to write about Banerjee. But he is reading my blog so I have been hesitant to write about him. He is one of my classmates from medical school. In medical school, he was well known to all of us, not always in the best light. His most memorable feat was publishing a year book. It was a beautiful book, full of photos and writings. However, the rumor was that he went way over budget and the editors were not able to publish any year books for the next two years because the school was still paying for our year book!

Another Banerjee coup: One of our professors used to give a lecture from 12 Noon to 1:00 PM. We would get hungry by 1:00 PM and this professor would go on and on in his monotone voice, way past 1:00 PM. He was the most boring professor. One day at exactly 1:00 PM a loud alarm clock went off in the back of the room. The professor left the lecture hall in a hurry and after that never stayed past 1:00 PM. I thanked Banerjee for that. Anyway that was forty years ago.

Today he is the Medical Superintendent of Irwin Hospital. That would be like the CEO of USC-County Medical Center. He was head of Cardio-thoracic surgery before this. He told me that he took the job because it was such a challenge. His family was already used to an absent dad, so the new job with long hours would not make any change for them.

I have talked to several people and have seen him at work. It is a hard and thankless job. But there is so much possiblity of doing good for a large number of people. He works ten to twelve hours a day. This is in sharp contrast to most Professors who regularly work five to six hours a day in government hospitals.

There is one or the other crisis every week here in Delhi. A few weeks ago, two foreign tourists were shot by terrorists. The tourists were brought in to Irwin Hospital. Banerjee had to here day and night, with all the media and the political leaders coming in.

During the past week it was something else. A seven story illegally and poorly built building collapsed killing 50 to 100 people, and injuring several dozens. About forty bodies were brought to Irwin Hospital. About a dozen seriously injured patients were also brought in. This was front page news in all the Indian newspapers for three to four days. Naturally all the politicians would come to Irwin Hospital to show their "concern". Their main concern was that they would miss the media attention if they did not come! Banerjee had to be there to meet them and show them the excellent care that the injured were getting. He did make sure that everyone got the best possible care. This was after all front page news.

Then he had to do the very sad and difficult job of dealing with the bodies. Every body had to be identified. This was no easy task, since most Indians do not have photo ID. Some bodies had no claimants since these were migrant workers from Bihar and Bengal. Some were Moslems and others were Hindus. The bodies have to be treated differently. The railway ministry offered to transport the bodies to Bihar and Bengal in special refrigerated coaches. But the heat was not going to make it easy for them. The bodies might decompose. So the bodies had to be embalmed. Not an easy task in Delhi where only two mortuaries have the ability to embalm.

Then came the greedy ones. The relatives and neighbours realized the value of the bodies. The government was going to give compensation of seven hundred thousand rupees to each of the families of the deceased. Now several bodies had several claimants each. Some families did not speak Hindi. Several families were from Bengal and spoke Bengali. Now Banerjee was himself talking in Bengali to the families, trying to identify who were legit and who were not. By the time the whole task was done it was over a week and Banerjee had been in hospital twelve hours a day everyday!

I do have a complain against him. He has not invited me for lunch, let alone a dinner. One day while walking we stopped at Medical School Cafeteria and Banerjee ordered a tomato sandwich. I shared that with him. The bill was Rs 12/-. I think he did it so he can say that we have "broken bread" together!

I have nothing but high praise for the man. If we had more of him, India would take its rightful place in this world.

Silver Lining in the Clouds

I was talking politics with the auto-rickshawalla, on my way to my favorite place for lunch -- "Haldiram" in Connaught Place. There were elections in the state of Bihar and the results were declared yesterday. Bihar is one of the poorest of the Indian states and it has the second highest population. It was ruled by the party of Laloo Prasad for about 15 years. He was very arrogant and incompetent. The auto-rickshawalla told me that Laloo's slogan was:

"So long as Samosas have Aloo
Bihar State will have Laloo!"

Five years ago the people booted him out but his followers kept a good chunk of legislative seats. The new Chief Minister was Nitish Kumar. The newspapers could not say enough good things about him. How hard working and incorruptible he was. He worked twelwe hours a day and made good on his promises. So now the people have voted for his party and associated parties. They have 84% of the seats in the legislature!

I guess Laloo will have to make his own samosas now, without Aloo!

The Auto-Rickshawalla

 The Auto-Rickshawallas are one step above Rickshawallas. They work half as hard, and make three times as much money. But there is nothing wrong with that, since Ann has been telling me that about my job! This fellow's name is Pawan Kumar. He is forty-eight years old. Unlike a lot of other labourers he is not from Bihar. He had a small shop in a government owned building. The building was converted into some other offices and he lost his shop. So for the past two years he has been driving an auto-rickshaw. He rents the vehicle for Rs. 400/- a day and has to pay about Rs. 80-100/- a day for gas. He works twelve hours a day seven days a week and takes home about Rs. 15,000/- a month. He has one daughter and two sons. His foremost desire in his life is to educate his children so they can get some decent job. His daughter has just finished her B.A. and his sons are in high school. His daughter is looking for a job. His biggest complaint with the world is that he has to face so much corruption. He cannot buy an autorickshaw because of the inflated price and corruption in the licence department. He says his daughter can not find a job because he does not have any relative in a high position and he can not afford to pay a bribe needed to get her a government job.

The auto-rickshaws are everywhere. In Thialand they are called Tuk-Tuk, a very appropriate name, considering the sound they make. 

Outside of Delhi these are used as passenger vans. I saw this one and counted tweleve people in there.

A little further up I saw this one buldging with people on both sides. 

So I asked my car driver to pull up close to the auto-ricksaw and counted twenty people in there.

Tuesday, November 23, 2010

The Ragpickers

The charity group IFA has given me the task of keeping in contact with Pramod Kumar, who is helping the ragpickers. I am supposed to talk to him every month, to encourage him to keep on going and to get an idea of how he is working. First I took the Metro to a place very far from the center of the city. There Pramod came to the Metro station and gave me a ride on his motorbike. After about half a mile, we drove next to this open canal. It was stinking so much, like someone poking needles in your nose. The bank of the stinking canal was littered with garbage. It went on for about three miles. By now I could not smell anything! We arrived at their slum. It was pretty far from the canal. It almost smelled good. I think the smell is a matter of relativity. Their slums were not smelling as bad as the canal.

These people are from Bihar just like the Rickshawallas. There have no marketable skills. They go thru the garbage and pick out anything that can be sold to recycle companies. They pick rags, plastic bottles, plastic bags, styrofoam pieces, human hair, metals and even discarded wrappers. They bundle everything and sell their finds to people who process these things. In the photo above you see their living place. They work and live in the same place.

They even pick women's hair from discarded household waste and sell it. The photo on the right shows piles of hair they have painstakingly separated from the other waste. I was told that human hair is very good for business since they sell it for good money. (Note to Kristina: Next time you use your comb and get some hair, save it, we will give it to them for recycling!)

These rags were just brought in. They will be separated by color and fabric and will be rebundled and sold. There was another room where they burn styrofoam waste. It produces a horrendous toxic smoke. The styrofoam then turns into black gooey stuff which they also sell. They collect polythene and other used bags and burn them for heat in the winter.
They use the same, all year round to cook on. I gave them a long talk about the dangers of burning polythene. Pramod Kumar knew it was detrimental to the environment but he was taken aback by my description of it. I said that burning polythene produces dioxin and that one drop of dioxin on your skin for one minute can kill you! It is kind of true. Dioxin is the name for a group of chemicals. Burning polythene does produce dioxin. The nerve gas, US Army has, is a kind of Dioxin and one drop of it on your skin will kill you in one minute. You do not even have to inhale or ingest it! Anyway Pramod is going to talk to some people in Delhi government to see if they can find some place to dispose of the plastic bags and find some alternative fuel for the ragpickers to cook on.

A Magnificent Discovery

Well that title could be "the discovery of a magnificent fort" right next to my medical school. I have been looking for a good place to take a long morning walk. So I tried going south, west and north of my place here in Delhi. However the problem was that I could not go in any of the three directions for three-four blocks without the bad smell. I could not go east because the door on east side was always locked in the mornings. Yesterday I found that there is another door on the east side just a little north of the locked one. So I went east today. There is a very wide road next to the medical school. It is about four lanes wide in each direction. On the other side there were always some ruins about a hundred yards from the road. I went in the direction of the ruins.

The ruins were guarded by a policeman, who wanted me to buy a ticket for Rs 5. That is why the place was empty! It needs a ticket to get in! I was happy to spend the 12.5 cents that was the price of the ticket. But the ticket window was closed, since it was too early. So I bullied the guard on my way in, without paying the 12.5 cents!

I went in and what magnificent ruins these were. I was seeing them for the first time! This fort was built by Kotla, one of earliest Islamic Kings of India. This would have been about year 1315 AD. The fort goes on and on towards the east. From the ruins you could imagine what it would have been during its glory days. It is pretty large, about twice the size of Rose Bowl with all the parking area included. The walls are about three feet thick with a lot of narrow slits for the archers. There are ruins of a lot of rooms inside. The fort also has an Ashoka Pillar. This was a total surprise for me. I had read during the Grand Gupta Tour of India that there was an Ashoka Pillar in Delhi. But I had no idea it was within walking distance from my medical school where I had spent six years.

The Ashoka pillars have a grand history. They were erected by King Ashoka about 300 B.C. This one was brought from a distant city and erected by Kotla when he constructed the fort. Ashoka ruled from Pakistan to Thailand. He has come to be regarded as one of the most exemplary rulers in world history. He erected numerous such pillars all around his empire. His teachings are inscribed on the pillars. There are only about seven left now. I think I am going to go there every day for a morning walk, preferably before the ticket window opens!

Saturday, November 20, 2010

Be ready for what is coming next!

An old medical school classmate invited CM Goel and me to lunch at his home today. He and his wife both have M.D. degrees with specializations in different medical fields. There was a poster of an old man in the dining area and so I asked who the person was. The wife replied that it was Lord Brahma. I have seen several depictions of Lord Brahma but had never seen him shown as an ordinary old man. She explained to me that she and her husband belong to the Brahma Kumaris Spiritual University. She described in great detail how we are in the tail end of a period called the Kalayuga (It is called Iron Age by BKSU, a more appropriate translation would be age of darkness, it has nothing to do with the Iron Age, Bronze Age etc.).

This age will end one hundred years from now and then the Golden Age will dawn. But only 900,000 souls will enter the Golden Age. There are a total of 6,000,000,000 human souls in the universe. (Goel wanted to know about the souls in the dogs! They explained that animals have different souls. Only human souls are reborn in human form again and again.) So the extra human souls will be in a kind of limbo for the next 12,500 years. Then the Silver Age will begin. Only through meditation and learning to respect your soul, can you assure that your soul will be one of the 900,000 chosen to go on to the Golden Age.

Indian Swastika
This is the Indian Swastika. It depicts the four periods, each lasting 12,500 years. The top vertical arm shows time going to the Golden Age. The upper right hand square is the area of the Golden Age. It describes the deterioration of human beings as they lose their virtues. As you go clockwise you will see that  human souls are losing the virtues. We are almost at the transition. The green area is all the time left between now and the apocalypse that will signal the start of the Golden Age.

This is the depiction of the three worlds. On the bottom is the physical world, consisting of our solar system with us in it. On the top is the soul world. The Supreme Soul is on the top and below Him are the souls of all others. Human and animal souls are all there. The souls go through the subtle world to come to the physical world. Here you are born again and again till you merge with the Supreme Soul.

Friday, November 19, 2010

Indian Head Nod

Ann has told me from time to time that sometimes I do the Indian Head Nod. I thought she was crazy, there is no such thing as Indian Head Nod.    I hate to admit it, but I was wrong. 

Different cultures have different ways of saying yes or no, with their heads. 
Americans nod up and down for yes and side to side for no. 
Indian are more complicated. They say yes and no both by side to side movement. Straight side to side means no. But side to side with a little tilt means okay, all right or yes. Watch me and see if you can do it!

Wednesday, November 17, 2010

World Diabetes Day

Today is World Diabetes Day. All the monuments are lit in blue light. There are posters here and there. Diabetes has increased a lot in India. I saw several patients with diabetes in the Medical OPD.

I wonder why diabetes has increased so much. One reason is that some Indians are eating too much!! That is too much for an Indian person. Still a lot less then a Texan .

The second reason in that the “SINK TEST’ has been replaced by an easy mechanical blood strip test. This needs some explanation. When I was an intern here in this hospital, we used a special test called a sink test to see if a patient was diabetic or not. We would collect the patient’s urine and take it to the lab. There we would throw the urine in a sink and look at the splatter pattern. Based upon the splatter, we would write down that there was no glucose in the urine. And lord behold, everyone was negative for diabetes! Therefore, the incidence of diabetes in India was low at that time!

Before you get on your high horse and condemn me and my fellow interns you should know the reasons for the sink test. (By the way we employed the sink test for other tests too, like blood test for anemia. More on that later.) To test the urine for glucose we had to heat the urine in a test tube until it came to a boil. Then we added a chemical called ferrous sulphate. After five minutes of boiling, if the color changed from blue to orange the test was considered positive. We could do only one test tube at a time. Try doing that on fifteen patients. At ten minutes per patient, it would take a person two and half hours. Then we were supposed to test for protein and specific gravity of urine and then do some blood tests. Did I mention that we had to see patients, take and record histories, order treatment, draw blood, and start I/Vs?

One day during rounds, a professor examined my patient. He looked in the eyes of the patient. The patient was pale in color and was obviously anemic. The professor asked me what the patient's hemoglobin was. I said very confidently that the hemoglobin was 8.5 gm% (Normal being 14-16, the lower the number the more anemic you are). The professor said, “To me it looks like it is 7 gm%.”  I said, “Professor I used the same test as you did, and the result came out a little different!”

Monday, November 15, 2010

Anti-Corruption Rally

Arvind was organizing an anti-corruption rally and march. He got a call from this religious guru offering his support. His name is Baba Ramdev. He teaches yoga and meditation on his own TV channel. He has a huge following. He had started a crusade against corruption about six weeks back and now wants to join forces with Arvind.

I took an auto-rickshaw to the Jantar-Mantar, an area near Connaught Place, the main drag of Delhi. When I was about to get out, the rickshaw driver asked me if I was going to the rally of Baba Ramdev! I knew it was going to be big if the rickshawalla knows about it.

There was a sea of people. I estimated the crowd to be about 15,000. They had come to see and hear Babaji. The rally was good. It was quite an experience to see people in bright colors, waving placards and shouting slogans.

There were about seven or eight speakers. All of the speakers were good. They had the Head of the Islam Society as well as the Bishop of Delhi. It was first time the Bishop had come out in any political rally. The Muslim (Moslem) leader was a firebrand speaker. He got the most applause. Babaji was a very good speaker as well.

Looks like the anti-corruption crusade is moving forward. The corruption in the Common Wealth Games (CWG) was so rampant that I think it is possible that some effective anti-corruption legislation might get passed.

Saturday, November 13, 2010

Public Causes Research Foundation

PCRF is a foundation started by Arvind Kejriwal. The purpose of the organization is to do research in all matters that help the public. At the present time, the emphasis is on implementation of the Right to Information Act. I had the opportunity to visit the PCRF office and talk to a few of the young men and women working there. I am writing about them to give you an idea of what kind of people are working there, and why. Not everyone is included here. My apologies to those that I did not have time to talk to with.

Neeraj Kumar

Neeraj is the veteran and has worked with Arvind for about nine years. He has M.Com degree from Benaras Hindu University. He came to Delhi to take an examination for some job but met Arvind and began studying the Public Distribution System. He knew he had to do something about that. You can find out about RTI and its use in improving the Public Distribution System by googling it. He recently got married. I asked him what his plans are for the future now that he is married. How is he going to support a family on the meager salaries being handed out at PCRF? He said he had not given it much thought.

Debjani Basu

Debjani finished her post graduate in political science from JN University and started working at PCRF about four months back. She is currently involved in the analysis of CIC decisions. She says she has great job satisfaction here and is not working for money. Her monthly salary is Rs 10,000.

Ramlal Rai

Ramlal obtained a Master of Philosephy degree from JN University and started working for the Punjab Government at Rs. 23,000 a month. He came to PCRF and started working here about one month back. He does not know what his salary is going to be as he has not discussed the salary yet. He can read Kannada since he is originally from Karnatka. He is analyzing the decisions of SCI of Karnatka. These decisions are in Kannada. Ramlal analyzes them and translates some of them into English. He said he loves working here because no one can do what he does.
Firoz Khan

Firoz is a graduate of Delhi University with a B. Com. He worked in a private bank and got fed up with corruption in the private banking system. He started working for PCRF about two years back. He was a volunteer for Parivartan for about six years.