My two-wheeler diaries - Week 4 - No science, high science and everything in between

Now, before I begin, this one week has not just been on two-wheelers. 50% of the travels this week have been in the close confines of a car. And thank God for that! And this week covered, like the title says - high science with us having to talk to oncologists about therapies and on the other side, we had to talk no science with people in animal health. Yes animal health.

So I'll begin with animals. If last week dealt with companion animals, or pets in other words, this week dealt with man's first best friends - cattle. And while we went to meet several of the healers, that did not preclude our meeting several of the patient species either! So on the roads, in the sheds and some even in the doctors' houses. Tied to posts outside their houses obviously. And what we realized was that of these doctors, several were not, well, doctors. Their treatment credentials were, doctored! But then like one of them told me, in chaste rural Gujarati, how does degree matter when you're able to produce results? Touche Mr vet, is all I could say! And while waiting at one vet's house (well let's continue calling him that), one guy came looking really distraught, saying that his buffalo was ill. The vet asked him, how long the animal had been ill and the guy's response was 6 months. 6 MONTHS???!!!??? Later my colleague told me that typically people feel that the animals are after all, well, animals. Robust, strong as a bull, the expression wouldn't have come up had it not been true, right? So give em anything or nothing at all and the poor things would heal themselves!

Now moving to high science. Oncology is a dicey topic. But the more you see the masked patients in wards, the true impact of mortality hits you hard. Like one person mentioned to me, sometimes one wonders what the whole point is. In some really rare and terrible forms of cancer, mortality is a reality, when is the question. Also the answer to when is even more painful, since long term itself is hardly 2 years. But looking at the way the disease is and how we struggle to find a complete cure, one can clearly see what life would have been like before the discovery of penicillin, when even a flu would perhaps have been as infectious and deadly! Also, people refer to hypertension and diabetes as diseases of the rich, since they typically come about because of the degeneration of lifestyles. But in reality, looking at the financial impact of any form of cancer on a person's life, quality treatment, rather any treatment, honestly cannot be afforded by all! And more often than not, people just give up.

In many ways, a cancer patient's condition is similar to that of the animals I'd seen before. The animals have no clue about what is being stuck into them - antibiotics, placebos or plain water. Likewise, those suffering from cancer know that they are being stuck with something unpleasant, since effects like neutropenia, where a patient's natural defenses are brought to 0, thus increasing susceptibility to all possible infections perhaps leaves the patient feeling completely and totally violated! The animal feels uneasy, but cannot communicate what it feels. The person knows about the suffering but can do little about it. The similarities were stark, and appalling. On the long drive from Baroda back to Ahmedabad, I had enough time to really wonder why the disease even exists. What could possibly have been God's plan in creating such a disorder and more so, what could He possibly have had in mind while inflicting this torture on young children. And I drew a blank.

As far as traveling was concerned, 4 wheels was a dream. Especially since I had an opportunity to cover the National Expressway 1 twice this week. Once between Ahmedabad and Anand and again to Baroda. However, on the day I went to Anand, the expressway was the only smooth part of the trip, since the rest was literally on a dirt track! The real meaning would perhaps come through when I perhaps put up some pictures, but dirt track indeed. And my driver was the kind who honked on the expressway. So you can imagine the condition of my poor spine by the time I got back to terra firma. But bumpy roads, preceded by bullock carts, at times preceded by bulls and buffaloes, and sometimes simply stuck behind a cattle crossing. All these escapades in pictures shall follow soon. But till then a starkly contrasted and deeply introspective week 4.

My two-wheeler diaries - Week 3 - a broad spectrum indeed

Time for the two wheeler diaries this week. Well, this week went from life savers to everyday medicines all the way to pooch care! And while the nuts-and-bolts level of learning was interesting, what I saw in terms of psychology and reality was even more interesting!

So, life savers. Let me be frank here. But observing the need for life savers at public hospitals or public-private places is heart rending. Those people, who throng the hospital in drones need the help. And without the concept of Government health care or Medical insurance, the financial implications are terrible! And this isn't an issue just here in India. The US has this issue of deep-reaching health care too. While the afforders can avail themselves of medical help, the poorer ones end up being on the wrong side of the life expectancy statistic! And earlier this week, when there were furious debates on the whole NDM -1 gene, although the debate was on a topic as frivolous as its nomenclature, one aspect that did come out was the unfettered use of antibiotics. And this is a reality, in the Indian context, given that there is no law to control OTC drug sales. I myself saw a chemist self medicating, and asking for certain prescription drugs and it was up to us to tell him to first see a doctor. But so many people, he said, walked up and bought drugs that had been prescribed earlier by a doctor for certain symptoms, that recurred! Scary? Yes indeed. Mutant strains of malaria are on the rise, which are resistant to antibiotics, and an unbridled use of super strong drugs can have terrible implications for the Indian race in itself!

Everyday drugs. Now, a scary trend here is that of people not completing prescriptions. The ailments can be simple. And if a dosage has been prescribed, more often than not, people stop the medicines once they find an ounce of relief! And they perhaps don't quite get the perils of such behavior at all! And knowledge of medicines amongst the rural illiterate population is a matter of worry. Since, one, they don't know anything about the science of medicines. And second, the supply through uncontrolled chemist shops stokes their ignorant behavior to a point of unabashed misuse!

And finally animal health. But more on animal health after I am done with all of it this week.

Meantime, a moment to talk about traveling. Some time back, there was a hue and cry on Shashi Tharoor calling the economy class on flights cattle class. Well, now I realize why they raised hue and cry. Because they felt that Dr. Tharoor was being very pro-upper echelons of society by disregarding the real cattle class. And I mean that the real sorry state of affairs exists in the common man's mode of road transport - the bus. Especially the inter-city ones. These buses are old, they rattle even on a super smooth expressway. They toss you high into the air on the other arterial roads that are not as good as the expressway. But God bless the Expressway, for keeping distances down and speeds up. As if the rattling were insufficient, these buses run packed. People undertake 2 hour long journeys standing up in the aisles. And there are some other fun aspects too. Like if the bus happens to stop at a large depot at a town on the way, where some people typically get down, expectant faces peep in through the window and throw bags, handkerchiefs and what not on the imminently emptying seats! Not just one bag, but a whole handful is sometimes tossed in! But squeezed into such a rumbling, rolling vehicle, you realize that one one hand, you have the Ferraris and Jaguars zooming into India, while a greater majority still travels as a foursome on a scooter.

So the learning was immense and the expectations are still higher for the week to come.

My two-wheeler diaries - week 2 : Health care and inclusive development a thought on 15th August

For my Two-Wheeler diaries - second week, it seems quite opportune that the Sunday for the post falls on Independence Day!

We've been away from the days of the Raj for all of 63 years now. A long time indeed. We do have a lot to feel proud of. from groveling in poverty, without enough to feed our own burgeoning population, we've become a food grain exporter. We've managed to curb population explosion without draconian laws like a one child policy and so on. We've managed to build our expertise in the service industry, such that the term IT Services is now synonymous with India. We've held on to our core competence of having a large English speaking population and with bills like the Right to Education coming through, we seem to be on the right track when it comes to legislation and policies.

But what I've seen over this past one week, and as promised, here are true blue insights - that in the real world, the story is not so rosy. On the macro level, we are extremely powerful. We're doing the right things, saying the right things at the global forums. But like we say, the India story is unprecedented. We cannot be judged only at the macro level. India is all about micro and grass roots. So, take the example of health care provision. The least that is needed is to ensure that all our people have access to good health care. And the key word is ALL. Granted, India is the hub of a multi million dollar medical tourism industry. We treat and give a new lease of life to struggling patients from Afghanistan, Scandinavian countries, and even provide affordable super specialty treatments to people from the West. I myself saw several African patients at the kidney research hospital, that goes on to prove my point!

But what about our own people? Why does treating malaria become so tough? Why do so many people still die of Malaria in India? Come monsoons, the water logging, and the resulting stagnant water becomes a malarial parasite breeding ground. And let's face it. Quality health care in India is not affordable to everyone. Over the past week, I have been appalled at sights of poor families crowding around the bed sides of patients, having to eat their meager meals, right next to the patient hooked on to a tube of IV fluid. Post surgical patients have to languish in the tropical heat with just a swiveling fan overhead, and that too shared by 2 beds! The floors are unclean and the walls are cracked. Civil hospitals are a worse sight. The cleanliness of the building premises is appalling. Granted, these hospitals have all possible departments - from a general ward to oncology and even kidney and liver transplantation. This clearly shows that the medical proficiency is very good, perhaps excellent. But the upkeep is downright terrible! Even this is minor, given that the pathogens are in check in these hospitals and the patients are in extremely proficient medical hands. But what about post-op treatment? Or ongoing treatment for chronic cases?

Take drug availability. In the absence of IPR protection, several large international firms were reluctant to set up a base in India. And now, with a strong patent regime in place, these research based firms are warming up to the idea of helping India heal. But then again, they have large inherent costs in drug discovery which makes their life saving drugs not easily accessible to all. But that does not preclude the socialist government from neglecting those who can't afford good health care drugs. Like the government is a lender of last resort, in a socialist setting, it is the government's responsibility to protect her people. It would be anti-socialist to let the poorer people fall by the wayside, just because they cannot afford the treatment that they need. A capitalist hospital can perhaps adopt methods of differential pricing to its patients, by segregating the payers from the poor, and it can also adopt cost cutting measures and procure the cheapest alternatives. But the government, which perhaps has the deepest pockets thanks to taxation is responsible for helping out those who can't help themselves! Restricting the high figure of life expectancy to only the affording class is a mockery of a country's population and a failure of the state at some level.

Clearly, all inclusive growth is missing. Clearly, we seem to be in a state where we want to follow the winning stories, for they look rosier and we want to wish away the morbid poverty that is unfortunately the truth for a greater part of the Indian populace. And if we don't act fast enough, the years would keep rolling by, the 63 can become 630 and yet we will have a divided billion Indians.

My two-wheeler diaries - week 1

Long years ago Che Guevarra embarked upon a journey to rediscover himself. And also to learn more about his own land - Latin America. From this year long journey sprang the Motorcycle Diaries'. I am sure most of us are acquainted with the book or the movie. But for the uninitiated, it is a chronicle of Earnesto Guevarra's travails through Latin America on a motorbike which first began as an exercise to practise medicine and ended up instilling a sense of revulsion towards the way life was for those in LatAm. So much so that he ended up becoming the world famous revolutionary, feted by communists and youngsters all over the world to date.

Now my chronicles are not so heroic. I cannot practise medicine (thankfully, did I hear you say?). But the likeness between Che's travels and mine, kinda hit me. Let's face it. If I began the post with 'On a hot sunny afternoon, we visited...' I'd have lost a reader! Rather, here, by opening with Che, I can be assured that you'll read this! Besides, Che went to practise medicine, and I am on a journey to rediscover healthcare in India. Che rode a motorbike. I rode on one!

So, my two-wheeler diaries are a thoroughbred CITYzen's look at an India on the roads. And I must say, Mumbai is definitely not India. And Ahmedabad definitely is not India. But for all practical purposes, Mumbai is an exception to the rule. Again, just like a very wise individual a year ago remarked to me that he used to ensure he got out of ISB every once in a while, just to get in touch with reality, since ISB was not Hyderabad, and certainly not reality, for me, a stint outside Mumbai opens up an all new India! Ahmedabad has an ethos about itself and a life of its own. A tier II city, nonetheless, but for me, any place not containing the hustle and bustle of Maximum City warrants an awestruck look!

So week one - keeping work related discussions aside - I noticed that the number of cows and bulls on the roads of AMD far outnumber the pedestrians! And when you travel pillion with someone, the sight of a bovine crossing is enough to make you freeze in terror. More so, what if the creatures look at you and you realize that you're wearing a red kurta! Furthermore, what if the creature has exquisite horns, much like the bisons of South Africa? Imagine you zooming across on a motor bike behind a big bus. You try to overtake the bus (don't say d-uh. All two-wheeler drivers here overtake buses. I wouldn't dream of overtaking a bus while sitting in the secured confines of a four-wheeler back in Mumbai, but nonetheless), and you shoot through their left or their right (thank God not the top, Chiranjeevi style). And moooooooooooooooo stands a bunch of bovine creatures! Screeeeech the bike goes. Mooooo the animal goes. Jeeeeeeeeeeeeeeeeeez my head screams. One animal is still ok, but more often than not, happy family get togethers happen on the middle of C G road, or Ashram Road or any and every other arterial road! Whew! Or rather Mhoooo!

Second. When you are a pillion rider, you have a knight in shining armor right with you! Yes, on your head, your protector, gleaming in the sun, glistening in the rains, the visor protects your face in the rain and prevents you from looking like a Chinki, if you were ever photographed riding pillion, squinting in the rain. And each time the bike swerves, the knight calms you, saying hushhhh, it's ok. When a bus makes a precarious turn at a crossing, just as the bike zips ahead, and you almost think that this is it. You feel that the bus will certainly at least knock your knee and you'll be on the ground, and the knight says, 'don't worry, I'll protect your squash even if you come under the bus. Max damage will be restricted to the breakage of 205 bones, since the skull will be left intact.' Thank Knight for small mercies...

So much for week 1. Next time - true blue insights. And my take on what I saw as an India apart from Mumbai.