Sunday, December 23, 2012

Brutal Violence Against Women

While justifiable outrage has occurred to protest against the brutal rape of the medical student in the capital city, the cynical view is that this is just the cycle of anger followed by life as usual. Nothing will change unless we understand that a society based on a collective consciousness of naked pursuit of wealth and power divorced from human values cannot be free from such cycles of violence. While human nature is essentially divine, the creature called man is capable of rising above all to reach divine levels, but is equally capable of sinking to levels of bestiality that can make the most ferocious creature appear tame.

While not alluding to specifics, i wish to recall the episodes of Satyameva Jayate where domestic violence against women on the issue of dowry, the brutalization of children by close relatives, murder of the girl child and violence against elders were highlighted. We lamented the waste of a Sunday morning and criticized The show and called it a publicity stunt. The brutalization of the women in the North-east due to AFSPA (Armed Forces Special Powers Act) has been going on for years but since this is not affecting me, can i be bothered about it? We live in times where the state government which aided and abetted the worst crimes and bestiality against women more than a decade ago gets reelected thrice and shamelessly projects its leader as potential PM. Khap Panchayats order killing of women merely because they dare to love and be faithful to their love. Do we protest then? Do we even care?

Violence starts in our lives in every thought word and deed. Often the negative thought that results from anger and leading to hared, leads to harsh words and violent actions. An unkind word or expression of ill will can hurt more than a tight slap. Our desires to acquire material things at all costs, results in anger and tainted attached actions. The food we eat arouses passions and the consumption of animal flesh, unnatural to our species and nature can lead to violent behavior. Without for even a moment condoning, the violent behavior of the Delhi rapists, I feel the lack of proper exposure to sex education and the culture of patriarchal dominance must be addressed, if we wish to see a solution to this endless cycle of violence against women.

Also, it shames me to see the women coming out in the streets, to protest, while we men go about our "business as usual" attitude. For change each of us must introspect and try to eliminate violence in our thoughts words and deeds and be the change that we want to see in our neighborhood. We must rediscover our divine true consciousness and create a cumulative consciousness, which can foster an era of safety and security for one and all.

Tuesday, December 04, 2012

FDI in Retail

Disclaimer : I am not an economist nor an expert on this matter, but as a citizen of this nation, I have to decide what is best for me and my country.
So where do we begin?? The basic premise is that the development model India is pursuing is probably now nearly completely divorced from the vision of the welfare state that India saw herself as in 1947. This debate is not new and it surfaces every time the monopolies and licence permit raj is dismantled. However, like in all situations extreme positions lead to disastrous situations. The Congress justifiably says that the opposition speaks the language of opposing when out of power, only to enact the same legislation when in power. So where is this debate on FDI in retail different?

The demography of India is slowly changing and an agrarian society based on low scales, massive production losses and lack of technology needs to get a boost. However, the boost cannot be at the cost of loss of bio-diversity, native wisdom and destruction of ecology and a model of unsustainable development which is imported from the West. If India and China reached the same consumption levels as the US of A there would not be any earth left. While I am not a Luddite who wants to take us back to the pre-industrial era, i believe that a food chain model based on organic farming, with active encouragement to the native farmer to protect his seeds and improve them is the way forward. A top class cold chain for storage and a practice of giving best prices to the farmer, while ensuring reasonable cost to the consumer will result in gains for everyone and our country. Do our expert economists and confident industrialists need FDI to ensure the above reforms. While i do believe that there is no need to reinvent the wheel in every case, my common sense says that the provisions of FDI in retail stipulating only 30% of local sourcing, means that the local manufacturer will take a huge hit. Are foreign investors charitable philanthropic organizations coming to emancipate our farmers, or are they coming for the massive profits that the increasing buying power of the Indian consumer can give them?? The answer is obvious.

The last question that comes to my mind is that can we the common man have any say or power in this matter? Does this Government, perceived as the most corrupt Government of post-independence India have the credibility to take such major decisions without a wide ranging consensus?? What the opposition leader said in Parliament about Walmart, Pepsico, Carrefour etc. is nothing new or unknown, what frightens me is the disconnect of the middle class and the nouveau rich with the farmer and the poor vendor who has served them faithfully all these years. It seems that naked self interest of the political classes will stage manage a debate and ram through the reform which they desire collectively. The poor of this land will be the ultimate loser.

Yours sincerely 




  

Thursday, November 22, 2012

Ajmal Kasab

India as a nation in 2012, after 65 years of existence chooses to punish and execute, by due process of law an ignorant, uneducated and indoctrinated terrorist in a clandestine hush hush manner. To top it all, its educated ministers gloat about it and back slap themselves and our home minister leads us to believe that he decided a month back on the date and chose not to inform the PM or the super mom PM about this decision. Executing terrorists was a routine occurrence and part of his daily chores as home minister. If all this does not qualify to be called bizarre and absurd, then the contention that the Government can escape its fate in Parliament on burning issues like FDI in retail etc. takes the cake. Also the eagerness of our government to take on Narendra Modi and beating their breast and proclaiming "I am macho man"  coz. I hanged Ajmal Kasab (a radical animal like man who was unrepentant and thought that he had been conferred his ticket to heaven).

A mature civilization does not use capital punishment routinely and many countries have abolished capital punishment. But India continues to keep this provision, to be used in the rarest of rare crimes, as we believe that such punishment will act as deterrents and prevent acts of terror. While nine terrorists were killed at the time of the crime their presence and death could not conclusively prove the complicity and active participation of Pakistan in this act of terror against India. The sacrifice of constable Tukaram Ombale, who put himself in the line of fire and actually captured Ajmal Kasab helped India show the world the evidence of Pakistan's direct involvement in the 26/11 attack on Mumbai. Is India a soft state and a soft target for acts of terror and will this execution deter any terrorist?? As a people have we learnt our lessons and are we safer today and more capable in preventing terror attacks??  These questions are far more important than weather we have hung Kasab by following correct procedures.

India is a flawed democracy and has never in its history punished perpetrators of mass genocide, so to say that our democracy has triumphed thanks to this incident is at best a half truth if not an outright lie. We have different yardsticks for different criminals has been proved endless number of times. The state kills in the name of "development" by displacing and uprooting the poor, by neglecting and allowing to rot the whole health system, by allowing foreign MNC's to get away by killing thousands in the worst industrial accident. Our policies of material acquisitions and greed lead us to destroy and kill thousands including our mother earth.

Mercy is a virtue, reflecting positive human values and however bad we feel about the crime that occurred on   that day, we become criminals ourselves by taking the life of another individual. An uneducated 24 year old man, indoctrinated by radical merchants of hate who commits an act of terror deserves mercy in my opinion as he probably does not know what sin he is committing. You may say that Kasab knew well what he was doing and therefore should not be given mercy. But I put to you that Kasab did no really know, that all men are  creations emanating from the same divine source and he was actually part of the same universal consciousness as his victims. In fact most of us do not know or even if we know we choose not to know the fact of our universal oneness. Let the land of the Vedanta rise above petty hatred and eye for an eye mentality and usher in an era of peace and unity among all of us and our fellow dwellers on earth.

These are my humble views and i would welcome debate and comments on these.

Sincerely
Dr. Vispi Jokhi


Saturday, September 29, 2012

THE GREATER COMMON GOOD


THE GREATER COMMON GOOD

Renunciation, sacrifice, living for others, giving up individual rights for the benefit of society are the different terms used and abused by those in power all over the world. A few days ago the Supreme Court used this phrase in the context of the judicial reference made to it in the 2G spectrum allocation case. The basic question that needs to be answered is that in a welfare democratic state where inequalities exist, should the Government intervene for the welfare of the disadvantaged? If the answer is yes as our leaders with socialistic leanings from the Nehru-Gandhi era thought, then why did the welfare state go horribly wrong? The next question that needs to be answered is can the state allow market forces to rule the roost and believe that such market driven GDP measured growth will benefit the poor by the so called “trickle down theory”? The last question to be asked is that are the present policies favouring corporate India at the cost of welfare economics, the correct way to go forward?

Small is beautiful and self sufficient. An economic model based on small units, local production, local consumption, reduction of needs and desires was the dream of the Father of the Nation. Production by masses rather than mass production was Gandhi’s mantra. Independent India with its aspirations and with Nehru at the helm quickly dismissed these ideas as impractical and ancient. Modern India looked on the large public sector where Government became the provider of all services and individuals who wished to create industries for profit were looked down as enemies of the nation. It was thought that the state was paramount and the repository of all wisdom, and would work for the greater common good. In the guise of the greater common good, small industries, local arts and crafts and forest based tribal cultures were brushed aside in favour of large factories and projects. Large dams, mono-culture fertilizer based farming, acquisition of forest and tribal land led to huge internal migrations and exploitation and misery for the poor. In every field, native wisdom was forgotten and the state became dominant. The result of these policies was a massive flawed inefficient state along with the killing of individual enterprise, creativity and entrepreneurial initiative. The license-permit raj led to a low growth rate and a brain drain where Indians went away from the country and excelled abroad. Taxation and state interference in the name of the “greater common good” made the people evade tax and become cynical and frustrated.

After 1990, in the face of huge external debts and an economic crisis, the state took a U turn and unleashed the Indian enterprise and allowed the private players a free hand. The private players created massive wealth and used all means fair and foul to amass wealth. A country where showing wealth was considered vulgar, the display of wealth became the norm and the role models of society changed overnight. It was believed that the market forces would create demands and jobs and the poor would become rich. Foreign players were given free rein and allowed to come in with some safe guards. All of this is resulting in a gradual abdication by the state of its duties and responsibilities to the poor. The greater common good has been forgotten. Corporate India has cornered and influenced policy by fair and often foul means to create massive wealth for itself without serving the greater common good. Anything for welfare like right to food, loans for the farmer, social security schemes is considered as unjustified expenditure, but cheap land acquisition of industry, soft loans for corporates, rescue of faltering companies by loan waivers and tax concessions is considered good economics. This has resulted in unprecedented massive corruption. The crass materialism and spawning of unbridled desires has resulted in an erosion of values on an unimaginable scale. The ravaging of the natural resources and mother earth has resulted in a complete reversal of the principle of “the greater common good”.

 "I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall the face of the poorest and the weakest man [woman] whom you may have seen, and ask yourself, if the step you contemplate is going to be of any use to him [her]. Will he [she] gain anything by it? Will it restore him [her] to a control over his [her] own life and destiny? In other words, will it lead to swaraj [freedom] for the hungry and spiritually starving millions? Then you will find your doubts and your self melt away." "Earth provides enough to satisfy every man's needs but not even one man's greed". Both these quotes from Gandhi reflected his vision and ability to see and understand the concept of individual growth and the greater common good, long before we have as a nation reached the present state.

A model of individualized local development, with technology assisting human growth and development rather than exploiting masses to create wealth for few should not be beyond the capabilities of human beings. Today, I do not think that the state is capable, willing or trustworthy enough to create such a model. While listing examples of wrong intent on the part of the state will make this blog too voluminous, I would only like to take the burning issues to make my point. 2G spectrum allocation in the name of creating widespread cheap telephony was used to amass wealth by the ruling class. The trading of ministries as a bargaining chip for supporting minority government obviously points to wrong doing. Coal gate is another example of such doings. Diesel price hike has hit the poor while creating a situation where 90% of the luxury passenger vehicles produced is running on subsidized diesel. SUV’s are sold cheap so rich take example of this subsidy while the poor and made to pay extra for their LPG cylinders. Does this policy seem correct??
FDI in retail, why?? Can we not strengthen our farmers by creating the infrastructure, cold chains and storage facilities in our own country instead of inviting foreigners? Why kill our local shopkeepers who can provide variety and individualized services for large monsters catering to material desires and creating wealth for corporate. Does India need a rise in the number billionaires on Forbes lists or a rise in human development indices?

Can we trust the state to do its duties and serve the greater common good in the real sense different from the Nehru model and the liberalization model? I think it is time for persons with vision to take up this task in earnest and work to make a sustainable model to truly serve the greater common good. The answer will come by going back to the grass roots and connecting with native wisdom.
Sincerely
Vispi Jokhi 



Wednesday, September 05, 2012

A Tale of two verdicts


It is a quirk of fate or a sign from the celestial that India saw two judgements pronounced on the same day, supreme court giving the verdict on the Pakistani terrorist Ajmal Kasab and the Gujarat courts giving a verdict on Dr Maya Kodnani and Babu Bajrangi. Both courts found the accused guilty and deserving the maximum punishment there are many similarities and differences between both actions.

Both crimes were committed in the name of religion, but both crimes could never be considered as religious acts, by even the wildest stretch of imagination. Both of them represented their masters, who conspired to get their foot soldiers to kill indiscriminately and brutally persons of a particular religion who were defenceless and innocent bystanders. While Kasab claimed that the crimes committed in Gujarat gave him enough reason to do what he did, the Gujarat accused claim that act of burning Kar sewaks in Godhra prompted them to do what they did. Fundamentalist attitudes feed on each other and unscrupulous elements in the name of religion indoctrinate vulnerable gullible persons to commit such heinous crimes.

While Kasab used modern weapons to indiscriminately gun down any person who came in front of him, the lady doctor and her pack of goons hounded and hunted down innocent persons who were Muslims with crude medieval weapons and liberal use of petrol as a retribution and revenge for acts committed by their co-religionists. While Kasab is a poor uneducated, foot soldier, vulnerable to get influenced by persons who spread hatred and venom in name of religion, Dr Maya is a gynecologist, educated professional trained in helping create and propagate life. While both were backed by persons in power Kasab was from foreign land acting against persons who his country considered as enemy, Dr Maya and Babu Bajrangi acted against their own countrymen and while not actually using a weapon of mass destruction, distributed and directly exhorted frenzied mobs to commit violent acts defying all civilized norms. Kasab probably knew that he would be caught or killed and was prepared for both eventualities, he is showing no remorse for his acts. Dr. Maya and Bajrangi were almost sure that they would never get caught and had it not been for the Herculean efforts of the human right activists and unprecedented actions of the Supreme Court reopening cases which the state had closed to protect its favored few, both of them would have been enjoying power and rewards from their political masters.

We are all very ready to hang Kasab, but our muted reaction to the other verdict betrays a mind set ready to condone brutal acts against persons considered as them as opposed to us.
In my view capital punishment is wrong and no civilized society can have it on its statute books, state complicity in acts of violence against its own people cannot be forgiven. In the history of modern India mob violence and killing in the name of religion has been endemic and our short memories and NIMBY (not in my backyard) attitude has resulted in allowing the perpetrators of such violence to escape punishment and in fact become more powerful. Can two or more wrongs add up and make a right? Can ignoble means justify noble ends?

In conclusion I leave it to your judgment to decide your reaction to these acts and judgments. Those who forget history are condemned to repeat it. However Kasab and Kodnani are two sides of the same coin and their masters fall in same category too. 

Saturday, July 28, 2012

Dr Jamshed C. Taraporvala


I have just returned from the funeral of our beloved teacher Dr. Jamshed Taraporvala. He appeared a pale fragile figure a shadow of the ever smiling, young "buddha" that we fondly called him in our JJ days. 

I have known him and learnt from him from my undergraduate  days where his anecdotal description of conditions like frozen shoulder remained etched in our memories. Then when fate destined that I specialize in Orthopedics, my colleague chose unit II over unit I in JJ enabling me to work under JCT directly. Grand rounds were an event lasting 4 hours on Wednesdays, with every patients problems discussed threadbare, the levels of academic discussion reaching high academic levels meant for exam going students and also catering to fresh housemen like me. The importance of treating patients ethically and giving the correct management without succumbing to the temptation of operating just to learn was firmly imparted to young knife happy youngsters. Conservative treatment in the days when operations were not entirely safe was emphasized. However, progress and change was allowed only if it benefited the patient. Sir backed his residents at all times and fought tooth and nail with authorities in case of any conflict. He would admonish us and point out our faults, but made sure that he never pulled up a senior before a junior. He exerted authority but in a manner that never made his subordinates feel bad.  I can cite numerous examples where JCT as teacher towered above his peers. For instance, when a few elective cases  had unexplained infection, he chose to systematically go to the root of the problem and stopped surgeries till the problem was identified. The importance given to documentation and follow-up  was reflected in his unfailing presence in every follow-up OPD. His surgeries were neat meticulous and every step in the book was neatly demonstrated to all of us. The marathon Saturday PG clinics which he held before the exams with special cases which came from his private case collection, showed a rare and dedicated commitment to teaching, seldom seen in PG teachers.

All these qualities were combined with wit and humor,  good natured sarcasm and a smiling demeanor, which made us all love and idolize the great man and teacher.  Every six months Sir with his gracious wife hosted us residents for a term ending party and served us rare cock-tails made by himself. While there were issues where he had problems in JJ due to ungrateful subordinates and officialdom, he remained committed to teaching and molded many a student. He had a great second innings as PG teacher in Bombay Hospital after retiring from JJH. As an examiner in PG exams he tested knowledge with common sense and I remember his words about his responsibility as an examiner. "My duty as an examiner is to not loose upon an unsuspecting population a man who is  dangerous to the community and patients in general." I think every examiner must learn from his example. 

In 1989, when Sir was President of IOA, an honor he richly deserved, he graciously accepted my invitation to inaugurate my Nursing Home in Baroda. That day was truly a red letter day in my life and I will be eternally grateful  to Sir for giving me more than I deserve.

Life moves on and the old must give way to the new, but for me I can say that Sir was responsible for laying a sound foundation on which I built my career and life as an Orthopod.  I regret not having been in touch with him, due to our busy life and schedules. I feel it is my duty and the duty of the many Orthpods he taught to honor his memory and continue his legacy of importing knowledge to one and all. In these times of materialistic greed and crass commercialism, I can say with conviction that  teachers and persons like JCT are not going to be seen, at least in our lifetime.  JCT sir we salute you and we will miss you.

Sincerely,
Dr. Vispi Jokhi

Wednesday, July 18, 2012

Rajesh Khanna Unexplainable yet Explained!!!

All cliche ridden superlatives can fit the man who passed away and while he was there he was fondly remembered by  the generation which grew up seeing him, but in his death the magnitude of media coverage has left many youngsters dumb struck. Recently we have lost quite a few actors, but their death got the usual stories and a few movies, but i think the way Rajesh Khanna is being relived on screen is certainly more than our wildest imagination. By today's requirements, Kaka was a mis fit. He had no great physique, height or dancing ability, but he had expression and emoting capability which none of the contemporary  Khans, Kapoors or Roshans or Hashmis have. His style, mannerisms and looks spawned a generation which lived and died with each nuance and expression he immortalized on screen. While many thought that he had limited acting ability and a stereo typed acting style, i beg to differ cause his range of movies covered the masala romantic magic along with really meaningful cinema. While all have their eternal favorites, for me one unsung movie which stood out for its value systems and lessons in life was Bawarchi, where a simple cook held a mirror to society. Kati Patang, on widow remarriage, Khamoshi about mental illness, Amar Prem about prostitution, Anand about conquering death, Dushman about jail reform were all meaningful movies which redefined movies from run of the mill roles to sublime cinema.

The man was human, fallible and unable to keep a level head in the midst of adulation. His weakness for alcohol, slowly but surely spelled his fall from grace. He became known for his big ego and his career started going down hill. His inability to digest  his  success ruined his career and his family life. However, he was unable to make a transition from hero to character roles and i feel that was good since for our generation we were spared from a image of kaka which we had never seen.

The man is no more, but we are in for a feast for the next month as i am sure we can sit back and watch a few of his great movies and repeat the famous lines which have been etched into our memories like deep lines etched on our consciousness. Rajesh Khanna will continue to live for generations to come.
Sincerely.
Dr. Vispi Jokhi

Sunday, July 08, 2012

Greatest Indian After Gandhi

Well this attempt by CNN-IBN to select/elect the greatest Indian after Gandhi has been on my mind for a while. A tacit acknowledgement that Gandhi was the greatest Indian, itself has been a bone of contention for some in this country. Since a bench mark has been set we are obliged to  compare the contenders with the standards set by the Mahatma. For me the greatness of the Mahatma was in the complete harmony in thought word and deed. The steadfast adherence to the values of truth and non-violence along with the basic principle of giving more importance to the means adopted to reach the goals over the goals itself. Coupled with all this, he was a shrewd tactician and a street smart politician who out witted seasoned opponents. He had the humility to listen to his bitterest critics and accommodate their views and even admit his own mistakes. And in the context of our times, Gandhi's concept of wealth accumulation for the cause and holding it as trustee is extremely important to me. Since we are defining the greatest Indian, we need to define the greatness in terms of impact on Indians and the legacy left behind by their life and body of work.

After shortlisting 50 Indians chosen by a selected jury and putting them to vote the last 10 have been decided.. Analyzing each one and the reasons for agreement or disagreement with the choices will be my brief in the next few paragraphs.

APJ Abdul Kalam, was a great scientist but certainly not the greatest in the post independence era. His team at ISRO made a major contribution to his achievements. However as a people's President with a hand on proactive approach and his ability to connect to the youth make him a popular choice. His support for nuclear energy and legacy of Pokharan are certainly issues which make me more than uncomfortable with his choice among the top 10.

Atal Bihari Vajpayee for me fails on the test of harmony in thought word and deed. His inability to seize the moment and listen to his conscience at the time of the Gujarat genocide, for me negates most of what he did before. If people say he was a right man in the wrong party, I disagree with that too, for he was a mask used by the communal elements to get power. And Vajpayee allowed himself to be used as such. Flowery speech and oratorical skills, not backed by action when required to my mind disqualifies Atal Bihari Vajpayee.

Jawaharlal Nehru was an architect of modern India and a true democrat. His nurturing of scientific temper and creation of institutes of excellence in education and public sector enterprises, were required in his time and no one can deny Nehru's immense contribution to India. However, as a leader he negated most of Gandhi's vision. While I grant that his intentions were always good, he outlived his utility and left behind a legacy which has harmed the nation more than benefited it. Dynastic rule has become the bane of Indian politics, the green revolution effect of poisoning our land and water bodies and his inability to stamp out corruption when it started and his mishandling of Kashmir and war against China make him to my mind not a contender for the greatest after Gandhi. Still he deserves a place in the top 10.

Lata Mangeshkar for sheer longevity and the joy she has given to Indians with her voice and inspiration makes her a very good choice. While she has her flaws in terms of  not nurturing talent and crushing her opponents by means fair and foul, her impact is undisputed. Her record of lending her voice to social causes and fund raising efforts has been excellent and she certainly deserves a place in the top 10.

Sachin Tendulkar is certainly a great, an achiever, with immense talent and ability coupled with determination and single minded pursuit of excellence. While many say that cricket is not a global sport as compared to football or even hockey, I do not think that this fact disqualifies Sachin from being called the greatest Indian. His conduct on and off the field has been above average but not without blemish (the Ferrari episode and slowing before landmarks are what immediately come to mind). He has lent himself to social causes and silently contributed beyond his sport. He has given unparallelled joy to millions of Indians in a game which is a national obsession. However, real greatness is defined by rising to the occasion when all around you is falling apart. In this respect Sachin's record in finals and on the big occasion has been found wanting. While success and failure in a game is often a matter of luck the greatest show more consistency than Sachin. He deserves a place in top 10 but not my choice for greatest.

Mother Teresa's impact and social reach in this country and internationally is immense and her legacy is truly inspiring. While accusations of conversion have arisen from time to time I feel she has answered this accusation well. They have just used prayer and religion to ease the pain and trauma of death. She cared for the destitute and inspired her Missionaries of Charity to live in poverty and render selfless service. Sometimes she has received funds from dubious sources, but to use that excuse to detract from her greatness would amount to nit picking. I think she deserves to be in the top 10 and even be considered as a contender for the top slot in my humble opinion.

Dr. Babasaheb Ambedkar certainly deserves to be on the list of top 10 Indians. However his contribution in framing our constitution has been exaggerated to some extent. His empowerment of Dalits have made Dalits deify him and his deification has been so excessive that many have felt suffocated by the phenomenon. However, these issues cannot take anything away from his greatness. For me the real blemish on his record comes from his willingness to compromise on the issue of India's independence to gain rights for his bretheren. His inability to trust and work with Mahatma Gandhi too was something I am uncomfortable with. He is therefor not my choice for the greatest Indian.

Sardar Vallabhai Patel has to be an automatic choice for greatest Indian after Gandhi. A man who was wedded to Gandhian principle and ideology and whose transformation from a brown sahib to a homespun mass leader, who could independently command a following of his own, even during Gandhi's lifetime has to be in the top 10. He was essentially a worker willing to put his ego and self interest below the greater common good. His contribution in saving and nurturing the nation in its infancy has not been adequately acknowledged. All the princely states to this day have been integrated seamlessly into India except Kashmir, where he was not allowed a free hand. His integration of the Civil services making it serve the nation gives India a backbone even today. Sardar Patel's only blemish was acceptance of Partition where he for the first time fell apart from his mentor. However, he is a contender for the top slot without any doubt.

JRD Tata's achievements and legacy make him a certain top 10 contender. He was a giant achiever in more fields than one. Leader of an industrial house, his strength was his integrity and value systems bequeathed to his subordinates. His ability to delegate responsibility to others and trust them was his strength. Even when some of his judgements proved wrong he was able to take strong corrective measures and control the damage. He is the father of Indian aviation and Air-India was a model of efficiency till he managed it. His vision and ability to see that government regulations were stifling India's growth story made him a visionary ahead of his times. It is a failure of Nehru and Indira to listen to his advise which was responsible for India's dismal growth rates in the first four decades of India's independence. His policies of worker welfare, respect for all his subordinates and holding wealth as a trustee for the greater common good makes him a contender for the top slot in my humble opinion.

Indira Gandhi making it to the top 10 is certainly a mistake and her selection reflects the present disgust with weak political leadership provided by our present political class. Her rise to the top is by accident of birth, and her achievement is in staying on top by hook or by crook and more often crook. Her strong leadership coupled with a disciplined armed forces resulted in the victory over Pakistan in 1971. However, she can be be credited with the decay and destruction of all that Nehru and Patel left behind. Her selfish pursuit of power and inability to reign in her spoilt son were unpardonable flaws. The bureaucracy, judiciary and armed forces largely retained their integrity not because of her but in spite of her. I do not think she deserves a place in the top 10.

So finally, which are the omissions which I feel are glaring. Three names come to my mind, Vinoba Bhave , C. Rajgopalachari and Vishwanathan Anand. Vinoba tried to usher in a revolution of land reform, which if had been taken to its logical conclusion had the potential to transform India. Rajaji an original thinker and India's first reformist wedded to ideas of free enterprise was pushed into oblivion by banishing him to TN. However he deserves to be contender for the top slot. Vishwanath Anand achievements in a taxing sport and sheer consistency puts him above any other sporting icon.

In conclusion, my choice for the top slot will first narrow down to Mother Teresa, Sardar Patel, JRD Tata, Vinoba Bhave and Rajaji and my final vote goes to Sardar Patel.

These are my honest views, will appreciate comments on the same.

Sincerely
Dr. Vispi Jokhi



Wednesday, May 30, 2012

In Defence of Aamir Khan

Aamir Khan's last episode of Satyameva Jayate dealing with unethical medical practice has raised the hackles of many of my medical friends, especially the younger generation. However, much against the tide, I will rise to Aamir's defense. While using celebrity status for social reform is in itself a debatable issue, I endorse it and found most of my friends doing the same when they perceived the issue to be clear cut good vs evil as in the case of the issues of female foeticide, child abuse and dowry. The pattern of the show is very structured and reflects the method actor image that Aamir possesses. He first defines the issue, which he carefully did and gave the clear distinction between negligence and unethical practice and focused solely on the latter. He usually starts by shocking the audience with near unbelievable and extreme examples of atrocities. Then he tries to give facts and figures hitherto unknown and which prove the seriousness of the problem. He follows that with a near court like indictment of the authorities and regulators who fail to stem the rot. This is followed by stories of hope and solutions, of which one of them is direct action focused to a limited task. And the show is summed up by a poignantly composed song which helps recapitulate the issue.

There is no doubt that we are living in times where the decay and rot of all systems have reached levels which are really shocking and seemingly unrepairable. All of us are surrounded by massive corruption and unethical persons. And none of us can remain completely clean like the metaphorical lotus leaf. Each one of us on all the above issues drew a line for oneself and decided that we should not adopt any foul means beyond a point to achieve our goals. So the same holds true for medical practice. It is a reflection of changed times that career choices are not made on the romantic fantasies noble profession and altruistic motives, but are based on the life style, material comfort and profit by any means. In the name of socialism and service oriented profession, doctors are exploited by charities, who actually profit from the doctors largesse. Also, the cost of education in private institutions, and underhand dealings have created a nexus between the regulator and the regulated, resulting in a precipitous decline in the quality and quantity of medical education. Medical research has become a tool for the pharmaceutical companies to manipulate and push expensive branded products in the market.Along with these, have come the new expensive technologies of investigation and treatment, which while helpful has made the medical fraternity dependent and created a bunch of unskilled practitioners. A decline in teaching standards has created a vacuum where commercial pharma and instrument and implant companies have rushed in with biased motivated teaching and training aimed at subtly and often times crudely enhancing their profit margins. The rampant practice of cross referencing and receiving commissions for the same have created a monster, who has destroyed the moral fiber of many a well intentioned person. When a trained medical practitioner comes out in the field of clinical practice, he or she are ill equipped to deal with these entrenched forces and the lack of work and peer pressures. In addition, the need to make up for lost time since it takes longer for a doctor to end his education than any other profession along with the peer pressure to earn well and fulfill ones desires for material comforts beyond ones needs create the soil and the bed for a harvest of unethical practices.

All of us know this and knew these facts when we joined this profession and weighed the pros and cons before making our career in this field. Some of us saw no harm in adopting foul means as we deluded ourselves into the feeling that our noble ends justify the adoption of ignoble means. If there are corrupt politicians selling medical education, they are only there because they cater to a demand from us for the same. While I do concede that the there is a nexus between government and private health care to dilute public health care to the extent that there is no alternative left, i feel that here too we are responsible since we feel that only glamorous private hospitals can give quality care. We have as a medical body have failed to stop us being used by the politicians for their commercial gains. The commercial drug companies and implant manufacturers have successfully made us partners in their criminal intent and further compromised our credibility. Trading in medical education completed the rot and enhanced it by diluting the quality of teachers and creating a scarcity of role models which medical students can look upto and emulate. Amidst all these very few remained ethical and became role models. Aamir showed us a few of these and saluted the efforts of ethical doctors. He showed us how health insurance and policy change at the highest levels can bring affordable health care to the poor and give doctors enough earnings to live comfortably and maintain great life styles. He showed us how, we as a body have failed to self regulate and opened ourselves to criticism and outright ridicule.

So where has Aamir Khan gone wrong? I do not think anywhere, for he has publicly articulated modern health cares worst kept secrets. He has made patients, aware of the decay and the rot which have reduced a noble altruistic profession to a crass commercial no holds barred race for profit and loss. To those of my colleagues, who criticize Aamir, I want to ask only one question?? Can any problem justify unethical acts, playing with the lives of the very persons we are pledged to preserve and protect??? The answer is a resounding "NO". A TV show can examine an issue and its ramifications upto a point and not beyond that, and i think that this show by its very format has  done its bit. It has clearly defined the problem, touched on its causes, asked the stake holders to answer the uncomfortable questions. He has shown the examples of heroic doctors who have swam against the tide and achieved success. and tried to give relief to the commoner by specifically trying to reduce the cost of medicines.

Every show of his has forced us to look inward and introspect and it is high time we did so, rather than criticize and fight his efforts.


Dr. Vispi H. Jokhi MS(Orthopedics)
Assoc.Prof. ESICPGIMSR, Mahatma Gandhi Hosp, Parel, Mumbai
91 9323351529

Thursday, April 12, 2012

HAS CLINICAL MEDICINE BEEN TAKEN OVER BY HIGH TECHNOLGY INVESTIGATIVE MEDICINE?



Yes and I state that high tech. investigative medicine has in many cases taken over clinical medicine and in some cases caused irreversible damage to both the medical practitioner and the patient.
The topic of this debate is actually most appropriate and relevant to my present status as a teacher in a new budding post graduate training institute. All these years I have worked in mgm hospital. Working in this hospital is like working with one hand and foot tied. We have been told to deliver 21st century patient care using vintage equipment and facilities. Despite that most of us have made a success of our work thanks to our clinical skills. What we lacked in equipment we made up by keen observation, thorough examination, compassion and care for patient and experience. Our work in MGM has enabled many of us to become better physicians in outside hospitals where we work.

With the advent of medical students since last year, I along with my senior colleagues have become painfully aware of the deficiencies in the trained doctors who have joined as residents. This trend is a worldwide trend has lead to an editorial in the Texas Heart Institute Journal by Herbert L. Fred who has defined such specimens as Hyposkilliacs.  I quote "I call this malady hyposkillia—deficiency of clinical skills. By definition, those afflicted are ill-equipped to render good patient care. Yet, residency training programs across the country are graduating a growing number of these “hyposkilliacs”—physicians who cannot take an adequate medical history, cannot perform a reliable physical examination, cannot critically assess the information they gather, cannot create a sound management plan, have little reasoning power, and communicate poorly. Moreover, they rarely spend enough time to know their patients “through and through.” And because they are quick to treat everybody, they learn nothing about the natural history of disease." These sound harsh words indeed but if we reflect on them they are indeed true. Before the seniors start gloating, I must quickly add that we too should share the blame. In a book by Groopman titled How Doctors think? the author while observing clinical rounds was shocked by both the lack of depth of his students questions and equally by the fact that rarely did attending physicians explain the mental steps that lead them to decisions.

However, some may say that this situation is there not because of the high tech modern medical facilities but has come about because of the particular individual, who has reacted to the system. I beg to differ because it is human to take the easy way out and in this materialistic acquisitive world, where time is money both students and teachers are becoming increasingly mentally lazy. Hyposkilliacs become proficient in ordering tests, interpreting numbers, analyzing images and calculating drug doses. The barrage of information is so huge and the analysis so complex that in fitting the whole jigsaw puzzle the patient is forgotten. How many times residents refer to patients by the result of tests or cot no or subject, the term made famous by Bollywood's Munnabhai MBBS. He held a mirror for our profession when he protested his seniors calling the patient a subject. Rounds are taken by no touch techniques and even the simplest of ailments which may be cured by simple remedies are treated after a barrage of tests. While this is not the subject of the debate today, I can state with authority that a large number of these tests are unnecessary, of dubious use and their results lead to faulty treatment which often harms the patient rather than does him good. Besides they have the not so insignificant side effects  of burning a huge hole in the pockets of patients and bloating the profits of the modern medical high tech. industry.

Let no one conclude that this old man wants to live in the past and does not recognize the value of modern high technology medical facilities. I believe that in a country whose media created  image is of a super power but which is at the bottom of the Human Development Indices, it our responsibility to utilize scarce resources responsibly. We owe it to ourselves and our patients to train ourselves and use what I would like to call critical thinking. Medical treatment and bedside medicine has traditionally been based on systematic steps, beginning with patient listening to "His story" or history taking, which serves the purpose of creating a bond of caring between doctor and patient and helps development the important component of critical thinking. The next step is a thorough examination and recording of findings. Our seniors always said "what the mind does not think the eyes can never see" and their experienced eyes noticed things we never saw. All this leads to a working diagnosis and an plan of treatment. Pertinent investigations which enables one to diagnose and plan the treatment must be ordered. Communication with the patient and with our juniors explaining the rationale of our thinking and the methods by which we arrive at our conclusions are of critical importance. And if we want to restore modern medical care from a mere science to an art form which it was then we need to construct every storey of the building from its foundation upwards and any step missed along the way will lead to disastrous consequences and an assembly line of hyposkilliacs. Critical thinking is the seed from which innovations and discoveries sprout. Today, I wish to pay homage to one such thinker Dr. BB Joshi who was a giant nurtured in the soil of this institute. A kind word, smile, compassionate touch and genuine concern for the patient and reassurance of proper care cost nothing but are far more critical to a patients well being than all the tests and gadgetry and the attendant anxiety created by their use in patient care.

In conclusion, I wish to thank and pay homage to all my teachers and gurus, from whom I have learnt and who have instilled in me the values of ethical compassionate medical practices, good bedside manners and judicious use of modern high technology medicine harnessed to the service of the IP who is really the VIP of modern medicine. I also wish to apologize to my fellow colleagues and students for harsh words. However, a teacher of mine said the words NEENDAKANCHE GHAR SHEJAR ASAVE. Our critics must be our neighbors and it is in this spirit that I request to take these words.

Tuesday, April 10, 2012

Thailand Travelogue


My family and me went to Thailand on March 29 to April 8, 2012. Some musings and observations.

While we all thought our Mumbai airport privatized is world class we were relegated to gate 1A terminal 2 from which some low profile air flights depart. There were mosquitoes galore, and we did not know what to mind our boarding passes or our bodies. The opening of the BKK airways plane with mosquito repellant spray could not quite repel the resilient pests from Mumbai who were determined to take a free ride to Bangkok.

Why do airways serve dinner at 2am?? Just to feed us and mark as fed. Why does hindu veg meal always have paneer? Vegans of the world must start a petition to serve us vegan meals every flight.

All over the world immigration officers are glum stern and slow. Security in Thailand is very tight too.

We went to Phuket, pronounced Pooket and not Fuket to avoid any double entendre. Tourist destinations all over the world are same, full of touts like our own Goa, They tried to sell tours, cheap only one day offer and a time share offered a free ride to hotel plus one tour thrown in for free(conditions apply) listen to their ragas and buy a time share. Luckily we realized there is no free ride.

While Thailand has great roads and tourist infrastructure, it remains an Asian country dressed up to please tourists with plastic smiles and dolled up girls.

Andakira Hotel in Patong bay area, great hotel though not on beach, top notch facilities, recommended. Staff courteous and good but language always an issue.

Thai boxing a rage, night clubs on Bangla road etc. we saw young girls dolled up. Thai women seem to be very hard working; we saw street food made by them, one woman show, cooking, and waiter cleaner cashier all by herself working from 6 pm to 6 am. Amazing by all standards.

A Buddhist nation predominantly, but ironically pork and beef eating, they do not even know vegetarianism. However slim and trim people, reasons I guess hard work, no wheat lots of greens, rice noodles eaters, but they digest any meat and sea food of any kind too.

Natural beauty abounds, superb white sand beaches, scenic locales, from  and James Bond movies, we really enjoyed the long tailed boat cruise. We also saw Buddhist monkey cave temple. Very good Buddha reclining statues and lots of monkeys in serene green sylvan surroundings. We saw a muslim fishing village, signs of islamization of buddhist country. Religion declines due to the followers all over the world and vacuum taken over by islam. Rock stalactites stalagmites seen by canoe a thrill. Pristine mangroves, a treat to see.

Thailand Phuket especially really international destination, we saw French, English, American, Australian, Chinese, Japanese and Bangladeshis. All kinds, we vote for French as most friendly and nice easy going jovial guys.

Krabi island less crowded than Phi Phi island but our tour guides not up to mark, though not lacking in effort. One French guy got hurt on coral but first aid kit inadequate, no gloves and deep cut, we had to dress and send guy to hospital. So ortho surgeon useful on trip. An Iranian girl had a shoulder contusion treated with cuff and collar and NSAIDS too. Also saw a local thai girl on trip to Krabi with a right side birth brachial  plexus injury, erb’s palsy. Wrist fused, ulnar claw. Told her to send xrays etc by mail, maybe we can give her some function.

Traveling with my daughter Delna is slow and we have to be careful as she can get lost. So we went to a small Elephant island safari, complete waste of time and rip off. Elephants made to perform like circus animals, unnatural and the ranibaug like elephant ride quite useless. Orchid garden and fresh fruit were few flowers half dead and two bananas each. Please do not waste ur money or go there.

Then we went to Felixresort Kanchanaburi, historical town made famous by the fictional movie based on true story Bridge on River Kwaii. The war memorial cemetery, JEATH museum(acronym for death represented by nations Japanese conquerors and oppressors, Englishmen POWS and victims, Americans and Australian troops who were allies in war and Thai the conquered nation. They were all against norms made to construct the death railway with many bridges and tunnels to connect Thailand to Burma and then to conquer India. The troops POW’s and indentured labor suffered and gave up their lives in large numbers and finally destroyed the bridge and delayed the Japanese invasion so that we survive. Saw a natural Buddhist cave with seven rooms, limestone caves but I think monks live life of luxury, hardly any asceticism, smoking and beef and pork eating monks, were told they no not drink. Small mercy indeed. Inside statues of Hindu Gods too. Ganesha.

We visited Tiger temple Buddhist temple to walk with tigers. Despite internet reports by animal right activists to boycott the place since there were accusations of animal trading, our curiosity and desire to see and touch the majestic animal got the better of us. While initially the site of the majestic animals walking around excited us, we soon realized that the majestic cats were only looking majestic but were tame pussies in front of the monks and trainers. We wondered if they were drugged. On asking a monk, later he told us that majority of the 102 tigers in the temple were born in the temple. The cubs were separated from mothers and nurtured by monks and were given a collar and leash early in life. So they felt that the humans were almost their mothers. They were fed and exercised but never made to hunt for food. In short the nurture got the better of nature and the animals became a means of commercial exploitation and show pieces like circus creatures. Maybe no cruelty, but what can be crueler than programming an animal to perform for life, out of his natural habitat. This is not tiger conservation according to me.

Thai roads great, traffic in Bangkok probably as bad as Mumbai, not much lane discipline but no honking. We need to learn. Streets very clean on main roads but a garbage producing society, no awareness of plastic bag recycling, bottled water galore. Toyata commuter running on LPG or CNG very smooth and excellent tourist vehicle.

Bangkok appears to be a great shopping destination. But the Buddhist temple and four pagodas worth seeing. Golden Buddha temple real gold, Reclining Buddha huge statue but Gold colored. Typical Buddhist thai designs porcelain kind of work on pagodas representing powers of the Kings of the Rama dynasty from our very own Ramayana. Present King 84 years old with grand palace. Victory monument, parliament building democracy monument all grand structures, but nothing to write about. We decided to concentrate on retail therapy and give floating markets a slip. Women’s clothes really good, cheap and vfm.

Malls all over the world are the same except bigger or smaller. They cater to the human greed and need to get more for less, without realizing that all we get for more or less has to be left behind for free. The cost of clothes maybe lesser than in our motherland but the carbon footprint of stuff made one place, stitched another, sold and going to another land makes all this costly for all of us. Point to be pondered upon.

Like the sky train monorail experience was very nice. Smooth swift small trains. Ac comfort hope mumbai has the same too.

On Saturday we went to Chatuchak the weekend market to strike more deals get more for less. Daisy my wife very satisfied with her buys. We finally went to the hotel to leave for amchi mumbai smug with satisfaction carrying memories of Thailand and stuff to boast about.

Suvarnabhumi airport huge with a big relief of Amrutmanthan. Thailand has lots of hindu symbols but is far removed from indian culture. Two words we learnt Sawadee for welcome or swagatam and kop kun ka for thank u.

We reached mumbai and sat in a meru cab tata indigo xl cab. more spacious than all the toyotas. home is great but we need to really improve in infrastructure and our people need to learn discipline and civic sense. We will get there but we have miles to go.

While the whole trip was very good cannot pinpoint a highlight or defining moment. Thailand a great tourist destination, has its plus and minus points, not spectacular but certainly value for money.