EMPATHY AND PATIENT CARE

 

                                     EMPATHY AND PATIENT CARE

 

 

 

 

 

 

 

Recently,I came across an article in the health section of The New York
Times.It was headed-REFFERAL SYSTEM TURNS PATIENTS INTO COMMODITIES.The
article, candidly written by a cardiologist,takes a critical look at the
inter-referral practices amongst community practitioners and specialists in the
USA.At one point,the article reveals that a New Jersey hospital was
investigated for giving sham salaries to community doctors to increase the
number of referrals in its cardiac surgery programmes.
The above mentioned Referral System is,however,not the subject of discussion here.
.And I mentioned the cardiac surgery programmes for a reason I shall
elaborate later.

 

 

Which direction contemporary health system is heading for?One can notice - the more the advancement in
Medicine in various fields,the broader the gap
between the doctor and the patient.A patient is being looked upon more
and more as a Vehicle for a clinical anomaly.We,health care professionals,are
definitely to be accounted for this to a large extent.Our
focus,predominantly,the sole focus is on the management of the clinical anomaly
itself,as we comfortably tend to forget the fact that the Vehicle is a human
being with a sensitive mind,in a state of apprehension and uncertain
fear.Modern health care is taking this aspect of the patient farther and farther
away.

 

 

A patient with heart disease had come to me for consultation.He was a diagnosed
case of coronary artery disease with heart failure.He had been admitted in a
city hospital with sudden onset acute chest pain,breathlessness,severe
perspiration and vomitting.As I glanced through his case papers,I knew that he
had an acute myocardial infarction.He had been admitted in the ICCU,an
immediate thrombolysis had been done.Following a series of ECGs,a 2D-Echo had
revealed an ejection fraction of 15-20%.The doctors having stabilized the
cardiac failure status,had set him up for a coronary angiography.

The angiography had revealed a 3-vessel block with a 80%lesion in the RCA,and
an atherosclerotic plaque blocking the entire bore of the LAD-100%.Subsequently
a balloon angioplasty had been done with medicated stents in the RCA and the
left circumflex,the doctors having not dabbled with the plaque in the
LAD,presumably finding that the collateral circulation to the left ventricle
was satisfactory at that stage.The patient had been discharged with medications
with an advice for regular follow-ups.

 

I found an uncertain gaze of apprehension in his eyes,almost amounting to
fear.I wondered why he had not followed up with the hospital and chosen to
consult a new cardiologist.I found nothing wrong in the treatment protocol he
had been subjected to,the choice of medicines being exemplary.I asked him as
soothingly as possible about how he was feeling with his present medications.
"I had a heart attack!"he said.I nodded agreeingly,waiting for him to
disclose further.
"I have heart failure..",he blurted out immediately,and I did not
miss the change in his expression as he said that.I had just begun to tell him
that I appreciated the fact that he knew what he was suffering from,when he
interrupted me with a trembling voice,"How long shall I live?" I was
surprised by this question.His face had turned pale,and he was desperately
trying to hold back his tears.
I reached across the table and held his trembling hands,saying,"You
shouldn't be thinking of that at all..if you follow the medications properly
and have regular follow-ups.."-my attempted speech was interrupted by his
completely breaking down.He sobbed inconsolably,his shoulders jerking in
spasms.I waited facing him,puzzled,my mind trying to figure out why this man
was in such a mental state.
I am not going into the details of the dialogue that followed.But after he went
out of the door an hour later,I began to meditate upon What he had gone through
while he was in the hospital.I tried to picturise myself in his position,going
through all the experiences he had gone through and at the end of it,I almost
revolted inside.

 

After his first ECG,he was told by a cardiac resident that he was having a
Heart Attack.He was rushed to the ICCU for an immediate thrombolysis.He was
being monitored closely,being frequently visited by intensivists and nurses who
were doing their job by the book.But all along,the only fact that overpowered
his mind was that he had a Heart Attack-a term that creates in the mind of the
common man.

A 2D-Echo was performed,after which he was told that he was in Heart
Failure.Period.Again nothing was explained to him regarding what "heart
failure"means clinically.Now he knew that he'd had a heart attack and he
was in heart failure.I could well imagine what he must have had in his mind
during that agonising time he spent in the ICCU.
The coronary angiography that followed told him that he had 'severe blocks' in
his heart vessels and a PTCA was needed.He was informed in detail about how the
procedure would be done and what were the risks involved.He was told to sign a
consent form.

 

Now I could understand why he had not gone back to the hospital for a primary
follow-up.Despite being successfully treated for the myocardial infarction,the
heart failure having been well taken care of,and the angioplasty ensuring a much
improved circulation in the coronary arteries,he had walked out of the hospital
knowing three things about himself-he had a heart attack,he had heart failure
and his heart circulation had severe blocks.
And he continued live in fear till he hesitantly decided to approach another
cardiologist for reassurance.I explained to him,drawing simple pictures on a
sheet of paper,what a heart attack means,that his heart was not really failing
that it would stop pumping suddenly,and showed to him what the blocks meant.
I had a taken a little over an hour.I sensed the relief inside him looking at
his face,his eyes asking a confident question-"Is that
all?".
I told him just that-what he Needed to know-"That's all".

 

Are we really looking upon a patient as a "commodity"?I had mentioned
the New Jersey hospital episode
earlier because it was connected to cardiac surgery programmes.
I have no doubt in the hospital had not looked upon the patient as a
Commodity.Nor do I believe that there is a rat to smell in its cardiac
procedure programmes.But,ironically,I feel worse.

 

No one had tried to empathise with this patient.No one had even tried to feel
what the patient might have feeling when official data were being presented
before him at various stages of his treatment.Nobody had told him what he
Needed to know.He was just a Vehicle for clinical anomalies,and those had been
looked after well..Yet he walked out of the hospital,a frightened human being,with
a deeply traumatized mind.

 

Modern health care has got serious flaws in almost every level.Is the way
medics and paramedics are being taught and trained in their formative years,the
correct way?Able health professionals could not even Feel the mind of a patient,let
alone trying to allay his fears.Is the way treatment protocols are being
executed,the correct way?Despite a near-perfect treatment being given, a
patient went home broken,scarred and frightened to death.Is health care being
guided by the correct moral values?A patient did not recieve any empathy from
health professionals,and his psyche had to surrender in front of the treatment
protocol,to be deeply wounded.

 

 

 
The origin of the word "empathy" dates back to 1883,when Theodore
Lipps,a German psychologist coined the term "ein fuhlung",literally
meaning-"in feeling".He used this term to mean "emotional
appreciation of another's feelings".

Objectively,Empathy has been variously defined,right from "the process of
understanding a person's subjective experience by vicariously sharing that
experience while maintaining an observant stance",to "a balanced
curiosity leading to a deeper understanding of another person's experience
within that person's frame of reference".

Pin-point analysis of a simple word leads to complicated definitions which tend
to put the word in an objective frame of reference.We may Understand the
concept better,but not necessarily Feel the same.And empathy is all about
Feeling.I am specifically putting a stress here because empathy cannot be
taught.Physicians,in the contemporary infra-structure of health care,are
trained in the world of "FIND IT AND FIX IT"medicine,a world where
empathy is a mere afterthought.Empathy has been known to be a bed-side manner
considered innate and impossible to acquire.Either you have it or you don't.
But experiences like those of the patient narrated here,having heart
attack,heart failure and severe heart blocks,and the subsequent train of events
that followed have been perceived by physicians in millions,worldwide,in day
to day practice.And it Can produce remarkable results-within a little over an
hour,a man who was unsuccessfully battling a fear of death,was transformed into
a satisfied man,happily accepting the realities concerning his health,and
confident enough to confront them positively.Only after this stage,his
treatment can be qualified as Successful.

 

 

Empathy does have a role to play in treating a patient.The Approach of the
health-care model has to change.

Students of medicine and paramedicine can be taught the same
volume of information with a different approach,an approach which will instill
the 'feeling of Feeling' in a student's psyche,as he advances towards completion
of studies.Yes,Empathy cannot be taught,but it can be gradually inculcated in a
human mind.The "FIND IT AND FIX IT" can be done away with after
debatable deliberations.

Many experts have begun to agree that empathy and empathetic communication are
"learnable skills".

The PERMANENTE MEDICAL GROUP'S Terry Stein with
Richard Frankel developed a communication model-the "Four Habits
Model"(Invest in the beginning,Elicit the patient's
perspective,Demonstrate Empathy,Invest in the end).

 

The BAYER INSTITUTE FOR HEALTH CARE COMMUNICATION developed the "4 E's"model(Engage,Empathise,Educate,Enlist).

 

The AMERICAN ACADEMY ON PHYSICIAN AND PATIENT has invented the PEARLS
model(Partnership,Empathy,Apology,Respect,Legitimisation,Support).

Having mentioned the novelty and success of these models,it has to be kept in
mind that these models are training programmes which aim to drill the concept
of Empathy in a Trained Physician's mind.And a trained physician might choose
to "not to be drilled"in the first place.So shouldn't the process
begin in the formative years when a trained physician was a student?

Many medical schools have recently developed curricula with a strong focus on
the physician-patient communication and empathy.Delivery of these curricula
begins early in the students' training.This 'Beginning Early' is the most
important(and of course,debatable)aspect.

 

The UNIVERSITY OF COLORADO HEALTH SCIENCES CENTER has taken up a curriculum known as the "Foundations of Doctoring Programme",where the teaching staff consists of senior
physicians and trainees from the CPMG(Colorado Permante Medical Group).
Making practical use of an esoteric concept requires 'division of the concept
into its simplest elements' as Carl Jung said.

But for that a health care professional does not need to be a psychiatrist or a
mental health expert,obviously! Willingness and Spontaneity can more than
suffice.The only requirement is an "awareness"(again a spontaneous
emotion)of oppurtunities for empathy during a consultation of a patient.The clue
Always comes from the patient's emotion,either directly expressed,or
implied.Clues oftenly get hidden in the fabric of discussion of a clinical
anomaly,and physicians very often tend to miss them,the "brain"
sincerely engaged in the biomedical details of management of the disease.The
"mind"should be equally involved.

 

Ideally,when a patient perceives the physician's empathetic attention,he
expresses an agreement or confirmation-"You got it,doc!" In the case
of the patient discussed in this chapter,the confirmation was in his eyes,which
had the question,"Is that it?".But it required merely an hour to
bring in this psychological change.He was openly invited to participate in the
understanding of his own problems and their solution.Simple words re-assuringly
explaining "fearful"concepts,aided by simple diagrams of lines,curves
and circles on a piece of paper did the trick.The mode of explaining may
vary,but the notable fact is the patient did Participate without any
inhibitions,when he sensed empathy.This is the reason Empathy can be an
integral part of user-driven health care,and narrative medicine.And here lies a
vast scope of improvement ahead along with Evolution of Awareness.

A recent informal survey has revealed serious
misgivings and misconceptions about empathetic communication.Physicians have
declared to "not having enough time during consultation",to be
"too busy focusing on the acute medical problem",and some have even found
it "mentally exhausting".Unfortunately,this group of physicians have
mistaken empathy for Sympathy.Unlike sympathy,empathy does not require
emotional "effort"on the part of the physician.An appropriate gesture
of empathy takes less than a second,can go huge distances ahead in building
relationships,enhancing rapport,all of which can only result in the Success of
a treatment protocol.But as I said,Evolution of Consciousness has to be in
process.

 

 

Referrances:
1.M A Stewart-A Study of interactions and outcomes.Soc Sci Med 1984.

2)P J Moore,N E Adler,P A Robertson-Medical Malpractice. West J Med,Oct 2000.

3)A L Suchman,D Roter,M Green-Collaborative Study Group of the American Academy on Physician and Patient. Med Care,Dec1993.

4)R M Frankel,T Stein-the four habits model, Perm J-Fall 1999.

5)P A Barrier,N M Jensen-Mayo Clin Prog,Feb 2003.

ABHIIMANYU

                           ABHIMANYU

----------------------------------------------------------------------------------------------

Yesterday I happened to pick out the Maharbharata out of my dusty
book-shelves while my eyes were lazily gazing across the book-titles as I
sipped on my evening mug of cold coffee.I haven't read the book
actively for ages though it remains to date,one of my most favourite
books of all times.I am not a religious person at all(much to the
chagrin once displayed of my departed mother and now my wife, both of
whom though separated by a generation and a half,seem to condescend on
one point-that it is a disastrous act of blasphemy on my part for not
taking active part in prayers to The Almighty,and not for once,having
shown any interest in organising 'family tours' to sacred places of
worship.)The fact,that I keep the occassional spiritual exercises I
indulge in to myself,is another story,and it will never negate the
potentially ill effects of my acts of blasphemy,in front of the ladies
in my life.

The Mahabharata is arguably one of the best commentaries man has ever
written on himself and setting aside its universal fame as a religious
epic does not decrease its value by any means as a classic piece of
literature on sociology,politics in its embryonic stage in human
civilisation and an epic statement on morality of common man in
everyday life.

Everything happens for a reason and it took some time for me later on
to figure out why I proceeded to read the story of Abhimanyu for the
umpteenth time yesterday.

The story of Abhimanyu is classically tragic. Not because the innocent
hero died his death in the battlefield,grossly outnumbered and
unfairly under-armed as veteran warriors dealt their death blows on
the helpless prince.A closer look at and contemplation on the
battle-tactic formulated for the day he died shows that he was left to
fend for himself by his own lot. He was in a way betrayed by his own
bloodline and his sacrifice was almost 'planned' by Krishna to give a
different shape to the Epic Battle when it was not particularly going
in favour of the Pandavas.Krishna was successful for this special plan
of his.

The event-sequences of the Mahabharata keep on repeating themselves
with amazing accuracy in modern day Bharata.And the "legacy" of
Abhimanyu goes on remorselessly.

{Ramapada Chaudhury,the late famed
Bengali author,wrote a novel called 'Abhimanyu' in the late 70s where
the character of the protagonist was based on the real life
physician-scientist (-you know who-) who Should be called the Actual
Father of the Test-tube Baby and who subsequently took his own life
being cheated,defamed and left in the lurch by his own team of
co-researchers.}

We look for Scapegoats everywhere,find them out randomly and kill
them. My subconscious act of reading the story of Abhimanyu does not
originate from my recent knowledge of how a senior politician was
unceremoniously shown the door by his own league because he dared to
exercise his rights on his freedom of thought and expression in our
Great Indian Democracy. My act of perusal has got nothing to do with
politics. But it Is about Heinous Politicking in the holy field of
academics related to my own profession of practising medicine,which
was planned in the holy guardian-tower for medical education in
India,the Medical Council of India(the MCI).

The Respected MCI has never been a subject of Respect by Indian
doctors though. Known for its consistent ability to churn out
formulations of out-the-world guidelines [and policies and acts and
recommendations and amendments and inspections and infra-structures
and unrealistic quotas and sameside goals and irresponsible mishits
and unsuccessful home-runs and dishonest buffooneries and lumpen acts
of corruption -the glorious list is endless- all of which can be
collectively termed as the 40 year old repeatedly-reformed act of the
Medical Circus Institute(MCI again,naturally)],all it has effectively
done is downgrading the quality of medical education all over the
country,and degrading the quality of health care and its
infrastructure to newer depths of a dark abyss over time. The recent
chaotic saga of the MCI related to deeming and undeeming of universities and its
mysterious unwillingness to scrap the system of capitation fees
further highlight the incompetence of the bunch of jokers who occupy
the important chairs(read bunch of pathetic bums warming the
hot-seats)of administration(read gross abuse of power).
 

And what comes out of the MCI as well though-about public quotes and
declarations in the media as information for the community of Indian
doctors or as those dreaded brown envelopes privately reaching the
addresses of doctors' residences,stink of CCVD Syndrome (Cerebral
Constipation and Verbal Diarrhoea).

Ahimanyu lingered on in my subconscious after I came to know of a recent unhighlighted recent shameful,sordid state of
affairs in the MCI because a formal acquaintance of mine-a
senior,experienced health-professional who is an internationally famed
academician of impeccable integrity,a great thinker-philosopher and a
great visionary,a rare breed these days,has been victimised.I have
been personally fortunate enough to come in contact with this much
sought-after luminous source of Guidance a number of times myself at
various stages of my life.

The story : An insignificant gap of just 60 days in a stipulated
period of 5 long years in an academic post in a teaching institution
which formalises a promotion to the next higher post has almost
suddenly put a degrading question-mark regarding the ethical integrity
of the resume of this scholar after years of dedicated and fruitful
service to medical education which has produced distinguished students
now spread out all over the globe.And this deficit of 60 days,a very
minor and insignificant technical 'snag' having nothing to do with the
Ability of the person as a competent,honest academician,was the result
of a communication-lapse on part of the head of the educational
faculty of the scholar's corresponding university and not at all a
conscious act of mal-intent or dishonesty,an aspect which the
victimised scholar has kept at bay through life.
 

The underline fact is frightfully simple (and well known through the
strong hushed up whispers which frequent the corridors of our medical
academia).The institute fortunate to have the academician-philosopher
in its faculty had refused to cough up a Bribe demanded by the
inspector-pimps during its early days of development requiring
official recognition/identity.

It seems so untrue..unfortunately it is not.It looks like a
resurrected scene from the past when a brilliant Italian
scientist-astronomer from the city of Gallilee had to bow down before a
medievaly blind Catholic Church which refused to see the light of Dawn

heralding the end of the Dark Ages.

I can foresee in thr recent future,the end and burial to total oblivion,of the Medical
Council of India.The nitwits disornamenting the offices of a governing
body,so important for improved medical education and care in India and
yet so miserably ineffective should be hung high in places chosen for their
imminent permanent exile.

It's time we,individual doctors,started the process in a
disciplined,committee way, watchfully and with a Vision.Apart from
Tamiflu tablets and syrups,we need to come out with a permanent cure
for the "CCVD Syndrome".The country needs health care.Not an expensive
Circus.
 

IS THIS A JOKE?

On the 14th.of August,2009,while going through the pages of The Times
Of India in Mumbai,I was dumb-struck when I arrived at page-11(under
the heading:Times City, which presumably reported about events in the
city itself)

A write-up by a certain Joeanna Rebello Fernandes features prominently
in the middle third of the page with the heading: TWINS ARE TWICE THE
TROUBLE FOR DOCS.
The write-up is ornamented with a cartoon featuring a mother grinning
and carrying with a pair of twins who are shown to be crying,one of
them tugging at the thinning hair strands of a doctor,supposedly a
paediatrician,who is thinking,"This is too much!"
The write-up begins with the following sentence:
"The waiting room of a paediatrician's clinic is like a petting zoo
when the animals are getting their shots."
The second sentence ends with"..and the doctor has to remind himself
why he chose this discipline in the first place."

Obviously,Madam Fernandes has attempted to write something humorous
involving howling twins and the plight of the hapless paediatrician at
that point.While unwillingly trying to accept the 'unfortunate fact'
that this Joeanne CLOWN Fernandes must be possessing a sense of humour
of superlative quality,a dry humourless intelligence like that of
yours truly feels that the lady-clown has gone a bit too far with this
one.

Nobody would mind similar digs and jokes in the entertainment section
of the same newspaper,or in popular books of jokes around the medical
profession.Not even poker-faced unattractive medicos like me.But it
becomes difficult to comprehend why responsible journalism would
create an article of such a poor,distorted taste and macabre humour
and why it should find its away to be in printed expression associated
with a cartoon in page-11 of a widely-read,responsible newspaper,where
the unassuming reader is supposed to search for important news-feeds
about the city in which he lives.

Joeanna the Joker proceeds to investigate the cause behind a
'seemingly unwanted,pathological situation'(read recent increase in
the birth-rates of twins) and 'blames' recently developed fertility
programmes and use of drugs like Clomiphene Citrate for this.

I don't know if Frauline Funny Fernandes have got relatives who have
copulated to have given birth to babies,or she herself has
participated in a similar active exercise to produce off-springs and I
seriously doubt that the 'funny products' of copulatory exercises of
Fernandes have ever been taken to a paediatric clinic to be branded as
howling inmates of a zoo.

May her tribe increase,but it remains to be seen in what circus-like
novel manner Mad Madmoiselle Joeanna will react and with what funny
creatures she will compare to,if anybody from the Fernandes tribe
comes up with a pair of twins who will ultimately develop the clinic
of a paediatrician.
Joeanna has made fun of twins as terrible,howling creatures-not for a
moment pausing to think of the mother who might have responded with a
pair of twins to a fertility programme and apparently her black humour
makes her unaware about how invaluable a child is for its mother and
father,whether born singly or with another sibling,or for that matter
two,three or four.

And nothing gives this over-enthusiastic nuthead,the unholy Joeanna,
the right to confidently and publicly ponder over WHAT a doctor of any
stream and speciality thinks while approaching human lives who need
his consultation,irrespective of whether they are a member of a
quadruplet born together or a nonagerian restricted to a bed and a
wheel-chair.At least that doesn't come anywhere near the expression of
a cartooned white-coat in the middle of a news-page following and
preceding sad news of untimely deaths occuring in a panicking country
at the moment,from whose deliberation Jumping Jackflash Joeanna or her
newspaper cannot completely wash their hands off.

Dear Joeanna,the responsibility of being a senior journalist and a
social activist necessitates a little amount of dignity,while sharing
a good laugh and while reporting about children of a god which is
perhaps lesser than yours.

CULPABLE HOMICIDE?

It was shocking to learn about the death of Reeda Shaikh,the 14yr.old
girl from St.Anne's High School,Pune, who succumbed to the H1N1 virus
2 days back.

Long after a worldwide red alert has been sounded up about the
potentially lethal Swine Flu(caused by the H1N1 virus)and hundreds of
cases being diagnosed in India,it is disgusting to see how the health
authorities of Pune responded to the ailment Reeda had presented
with.It shows serious lapses of communication between different health
authorities,total incompetence to arrive at a timely diagnosis,and a
shockingly irresponsible and lackadaisical approach by the health
authorities even when Reeda had started to deteriorate.

Reportedly,Reeda had developed symptoms of 'cough and cold' on
21st.July itself.One should particularly note here the temporal
backdrop when Reeda first showed signs and symptoms of a respiratory
tract infection.By 21st.July,a lot of cases had been diagnosed and
quarantined in the city of Pune,and the adjacent Panchgani-Lonavla
area less than 30 kms. away.
It is suprising to note that in this backdrop,the physician to whom
Reeda had reported first,did not keep the differential diagnosis of
Swine Flu in mind,while treating the case.Reeda's treatment was on for
3 consecutive days till 24.th July without any success and even then
the physician hadn't contemplated a possibility of a H1N1
infection.This exposes the general quality of community health care
in a rapidly modernizing city like Pune,with all its recently acquired
glamorous(read upstart) status of the tech-savvy 'trendy
information-technology hub' centre.
When Reeda had not responded to the treatment on the 4th.day,her
relatives took her to Jehangir Hospital,a popularly dependable
hospital for some time.Here too the shocking saga continued.

From 25th. to 29th.July,the hapless adolescent was under 'responsible
treatment' with all sorts of antibiotic combinations and repeated
chest X-Rays,but not even the senior doctors fell upon the possible
differential diagnosis for once,and Reeda continued to deteriorate.A
throat swab was sent to Ruby Hall Clinic on the morning of 29th.July
for the first time,after 8 days of infection.And this first sample was
diagnosed as negative by Ruby Hall Clinic.Reeda's condition continued
to worsen and she was put on a mechanical ventilator the same
afternoon,when a second batch of throat swab samples were sent
again,this time to the National Institute of Virology.It was at this
point of Reeda's treatment that the aetiology of her infection was
formally diagnosed,but it proved to be too late.

I'm not going into the details of what happened afterwards,as it is
not my intention to sensationalize the untimely death of a young girl
which could have been prevented.But on this note,I strongly opine that
the print media should be lambasted black and blue for the way it is
putting the pandemic of Swine Flu over the last 3 weeks.While it has
taken no responsible steps to inform the general public about the
simple do's and dont's to prevent affliction by the H1N1 virus,it has
proceeded to sensationalize the 'new deadly epidemic' which has
created unprecedented panic amongst the population which has made the
methodical medical screening for H1N1 virus virtually impossible for
health care authorities.After the unfortunate death of Reeda,the panic
has touched frenzied heights with a shade of impending violence which
has even forced doctors to redirect cases to other screening centres
as the they have been left short-staffed.And this has potentially
worsened the situation.

Coming back to the treatment meted out to Reeda,we find a physician
who had first treated her for 3 days without success.
The treatment continued in a well-known and popular health
institute(reportedly having Specialists in all Specialists)where the
treatment went on for 5 days.In these 8 days,despite Reeda's
no-response to ongoing treatment,not a single clinician associated
with the treatment seem to have thought of an obvious possibility.This
is shockingly deplorable particularly when confirmed reports of cases
with throat swabs testing positive for H1N1 had alerted the medical
fraternity for over a month.
On the 8th.day,a throat swab was sent to Ruby Hall Clinic(again a
seemingly dependable health institute)which gave a negative
report.Astonishingly,the same afternoon,the 2nd.batch of throat swabs
was reported positive by The National Institute of Virology.The H1N1
test is based on genomics(simply speaking- molecular diagnostics)which
is carried out using real time Polymerase Chain
Reaction(PCR)System.Each test cycle lasts for 4 hours and the margin
of error is practically nil(statistically 0.0000000001% ).It is beyond
human cognition to figure out how an infected sample can turn out to
be a 'false negative',just as near impossible to rationalize the
missing out on a strongly positive differential diagnosis(infection by
H1N1 virus) over a period of 8 consecutive,long days and nights all
along the patient was symptomatic and had not responded to treatment
regime(s).

This episode of little Reeda has torpedoed a large gaping hole in the
seemingly secure cover which the health care systems,both private and
state-run,promise to hold out for the population of a rapidly
developing neopolis advanced of information & technology.One squirms
to comprehend the possible quality of existing health care in rural
India,and lesser developed cities.
India recently became member of the elite nations to have indigenously
programmed a space mission to reach the moon.While an Indian can
continue to afford to be proud of this achievement,he cannot bypass a
big pointer of a question - if the country can afford embark upon
specialised space missions,why does the archaic voice cry LACK OF
FUNDS,whenever quality of health care comes under special,transparent
scrutiny?

The Indian citizen demands answers and appropriate action to be
taken.Why was Reeda left undiagnosed for 8 days? Why was her first
throat swab reported negative? Despite a wholesome mass coverage by
the print and tele-media,why does the panic of an epidemic originate
and continue to exist?

Lastly,why does not India have a Pandemic Law?The only relevant legal
clause is the Epidemic Diseases Act,formulated in 1897,a time when
Swine Flu,Bird Flu and AIDS did not even exist! Our country surely
does 'moon' over its tech-savvy present.Should we use our hands to
clap to the rhythm of the Indian 'moonwalk',or use them to change a
thing or too,amongst them age old ideas and a biased conscience
feeding on stepping stones of failure?

GANDHI AND TOMORROW'S CHILD

There was a lot of hope and dreams of a happy,content and peaceful future in our eyes 60 yrs back when India became independant.The same leaders(well,most of them) which had led the final,decisive phase of India's freedom movement,had formed the first government of our maiden republic and were an intrinsic part of it.They had the entire country's faith(a situation which is nearly impossible to re-create today),when they sat down to formulate democratic principles and strategies to lead India forward.They failed us miserably.

I might be sounding audaciously brash and ungrateful if I associate our 'heroes' of the freedom movement with abject failure in their post-independance governance.But that seems to be the unfortunate truth.Not taking away a grain of the respect that they command(and deservedly so) for the valiance they overtook in leading India to independance,it would not be imprudent to observe that as administrators they failed miserably.

In fact,they failed in the final run of the pre-independance political process,when India got divided.Perhaps,in their eagerness to achieve the status of freedom,they thought they would deal with the consequences of The Partition somehow.But apparently they took into account potential future situations which were practically the short term consequences.As visionaries they failed miserably,being unable to comprehend the circumstantial ramifications in the distant future-the long term consequences-a situation which India faces today,right now.

One man could see it all.And he fought tooth and nail,in principle,the political process of The Partition.The true visionary he was,M K Gandhi almost went into political recluse when freedom was 'granted' at the cost of his dear country being chopped into two.It would be wrong to assume that he was a dejected man,deeply pained to watch helplessly millions of people leaving their own homes,their intrinsic roots to walk across the border and being bloodied by the senseless violence which had its seeds in the very act of Partition.He foresaw what would happen after decades.And he lost all hope,sensing the frailty of our independance.

It is sad that the country's patriarchs could not empathise with his dejection,and the palpable nonchalance that had engulfed him.
For him,independant India would never be the secular country that undivided India was.He could see the inevitable pseudo-secularism and minority appeasement which would poison the very roots of independant India's socio-political principles.His followers,the glorious founders of the Indian Republic,could never identify with his foresight.And the results form the reality of our present.
 

Honesty is a farcical,utopian concept in today's politics.And our leaders become shamelessly proactive when they need the people's mandate to form governments.And our country has slipped into a self-induced stupor of hypocrisy.Our conscience has changed.We seem to be happy and proud with little steps of progress,barely trying to keep pace with the rest of the developed world.We conveniently overlook what could have happened,had our glorious leaders guided the country in the right direction with foresight and commitment.

Perhaps the child who sleeps in its mother's womb today,will wake up tomorrow with a new vision,a neoconsciousness which will rediscover the glory which lies latent in India's moral foundation which has survived the test of time through the last five thousand years.