"What is it Tom? I am here at the OP. What happened?"

"Nothing sir. I want to meet you."

He was there in a minute. He looked tired. In the OR, he was a restless creature full of energy. Anytime I looked at him he was rushing to some place or busy at work. As a scrub nurse he was ready with the scalpel. But he was a little too quick for anybody’s comfort. I had noticed his unsteady and shaky hands at times, but he managed to mask them well with his agility and quickness. It was evident that at the moment he had been busy the whole day. He was not his usual self, though. The smile was not there for one thing and then his restlessness.

"Sir, I need your help. I don’t know how to say it."

"What is it? Go ahead and tell me." The impatience was becoming evident.

"I need money, sir." Then there was a pause. "They are suddenly asking for money. All these days it was fine …and now last moment. You know, I am leaving to Gulf. My visa is ready. It came in yesterday, so I am leaving. They are not paying …they are cutting." It all came out in a rush.

"The hospital is not paying you last month’s stipend?" It took me a while to understand.

 Most, almost all of the nurses, are working for the hospital under a contract. They get to work in the hospital, earn a stipend, stay in a hostel free of cost, have subsidized food. In turn they are educated in nursing. They have all completed their required courses but are still not competent. So they often, for practical on-the-spot exposure, work for less at some big hospital like ours. In return at completion of the two years of bonded work they are released with a certificate stating their work experience. Most of the nurses manage to get certificates of recommendations form the senior consultants with whom they worked. They also spend quite a bit on English courses. Then they apply to work in hospitals abroad. The most preferred places are USA, UK and the middle east countries like Saudi Arabia, UAE and so on.

"I completed my two year bond many months ago. I was applying here and there. I was not sure. Suddenly I got call. Visa is ready. I went to Delhi to collect it. I have to go there. Now the personnel dept. wants money." The words became less distinct. He stood crestfallen. "They are not giving my completion certificate." When he looked up to see my response, I could see tears in his eyes.

"How much money are they asking for, Tom?" I couldn’t take it anymore. "Don’t cry, Tom."

"Sir, all the hard work I did. I worked overtime so many times. I did so many duties. But last moment…." He broke off. "I don’t like asking for money like this. Its very difficult. I thought I could ask only ask Dr Pathak , he is not in his room. Then I thought about you. Please don’t think anything, sir" He was pleading hard.

"Tom!" I was searching for words to say myself. "The world is not fair at all times. Sometimes, we learn the hard way. probably they wanted a month’s notice. But they could have considered your past work. Does the Nursing Supdt. know about this?"

"But she won’t do anything. She said you settle with personnel dept."

"So you need 4000. I don’t have so much in my purse. I have to check in the bank. Come we will go and check in the ATM."

"Sorry sir! I don’t like doing this at all."

"Come on, Tom. Stop sobbing like this." I patted him on his back.

I managed to get 2000 from the ATM. I explained my inability to get the rest. Lets see if I can get it from Sandy or Rajesh. So I left him downstairs and hurried to the Men’s room to see if I could get some more. I knew they would be reluctant. I was wondering if I should put it to them as if I required the money. I decided to tell them the truth.

"Sandy, are you free? I need to ask you something."

"What?" His brows furrowed deep and he shook his head querying.

"Well …Tom is in a spot. You know he’s leaving for Saudi. He’s quitting. He needs money. They are not giving him the completion certificate unless he pays them a fine for leaving without notice. I was wondering if you could spare some money."

"I don’t have money on me, buddy. "He relaxed immediately. "But I will give you a word of advice. By the way how much is he asking you for?"

"4000. I managed some for him but not all of it." I deliberately hid the amount I had managed form the ATM. "I thought I will ask you and Rajesh for something. Can you…"

"I will tell you something. These people cannot be trusted." His tone was grave. "If you are giving him money then don’t expect it back. He will fly away for ever and never return. If at all you want to give him some money, give him a small amount and forget about it. I mean, explain to him nicely!"

"How much can you give?" I was livid and I wanted to be direct. But I didn’t show it. I didn’t come here for advice. I didn’t come to ask whether I should or not. I was in the mood for arguing, but then, Tom was waiting. I decided to give up.

"I don’t have any money on me, boss."

So that’s it. I scrambled down to meet Tom. I wondered if he had managed to find more.

"Sir, I met Dr Pathak. He returned. I explained my situation to him. He asked me to wait here. He said he will get the money for me. So I can return your 2000. I am happy sir. Thanks a lot." He returned my money.

"Ok Tom!" I took the money back. A small pause. I fished out a 500 and thrust it into his pocket. "Here Tom,. keep this. Buy  a new pair of shoes or a pair of trousers."

" No sir. I don’t want it." He was beaming. He had his problem solved. "Sir I won’t forget what you did for me. Give me your number."

That was about two months ago. There was a call yesterday from Tom. He was in Dubai. He was back to his same restless self eager to go to work. It was tough work but he said he was enjoying. We talked for  a while and then he hung up. I felt a warm feeling come over me.

Trust! I could not help feeling right about having trusted Tom.

Tags: Trust, orthodoc

The Tamil Nadu election results was coming out on the TV. B was aligned with the DMK and a few others were aligned with ADMk. Our Consultant was also back in the scene. He was equally curious to know who would get the majority this time around.

As we switched between Tamil to English channels, I was suddenly reminded about Rajdeep Sardesai’s hosting a talk show in the Anna University campus with some prominent figures from Chennai, both political and non-political. Among them was N Ram, the editor of The Hindu.

The boys grappled with the results that were pouring in when there was some comment on how the politicians had thrown in populistic measures to draw people onto their sides. In response to this I brought up a remark N Ram made in the talk show – Not all populist measures were necessarily bad for the people. The best example of this was the mid-day meal scheme.

In this light it was not necessarily bad that the DMK had promised 2kg of rice for the common man. 2 acres of land was too much of a promise to match, though. There was sudden opposition to the idea. How can populist measures be good for the people?? Everyone seemed to agree that mid-day meal schemes have done well but no one seemed to agree that it was a populist measure to start with. There is no doubt that the fight in Tamil Nadu was focussed on the enticements, read populism, that the two major factions had to offer. Whether the winning party, that is the DMK, lives upto its promises and whether it will be beneficial to the people of Tamil Nadu …only time will tell.

I ended doing some searching on the web about the mid-day meal scheme. I had read about it in detail during the Community Medicine classes in med school. Everything seemed to have slipped out of memory.

My visit to Wikipedia revealed a reasonable write-up on the mid-day meal scheme and how it originated.

One of the pioneers of the scheme is the Madras corporation that started providing cooked meals to children in corporation schools in the Madras city in 1923. The programme was introduced in a large scale in 1960s under the Chief Ministership of Kamaraj. But the first major thrust came in 1982 when the then Chief Minister of Tamil Nadu, Mr. M. G. Ramachandran, decided to universalise the scheme for all children in government schools in primary classes. Later the programme was expanded to cover all children up to class 10. Tamil Nadu’s mid-day meal programme is among the best known in the country.

There was more on it which with respect to populism.

Although the programme in Tamil Nadu was initially termed as an act of “Populism“, the success of the scheme made the project hugely popular. The success was so spectacular that in 1995, the then Indian Finance minister Manmohan Singh hailed the success of the project and suggested that the scheme be implemented all over the country, and thus began the “National Programme for Nutrition Support to Primary Education”.

At the website of – Right to Food Campaign – there were more articles on this issue. Find a list of them by clicking here. One of them that I picked up had a lot to say about the history of the mid-day meal scheme in particular – Rajivan, Anuradha (2003) Nutrition Schemes in Tamil Nadu

Some interesting facts that I picked up from the article

• Providing food for children outside the home is not a new idea in TN. In some form or another this has been in operation from way back in 1956.
• School mid-day meals scheme became operational in the state of Madras in 1956. Initially it was started with purely voluntary contributions from the local people. Within a year the government stepped in.
• In 1967 the system was radically modified to operate through Central Kitchens.
• On July 1st 1982, TN saw one of the largest expansions of mid-day feeding through the Noon Meals Program (NMP) of the former Chief Minister, MGR.
• The noon meal feeds a population of over 7.7 millions nearly every day, not through dry rations or precooked items like biscuits, but serving a hot rice meals cooked on the spot for all. (Today it must be even more!!).

Presently the scheme has been expanded to all parts of India, especially after a directive from the Supreme Court in 2001. There is a similiar scheme operating also in UK, known as the Free School Meal.

I wish I was armed with all this ammo in the morning when I was alone in the men’s room defending N Ram!!

:: :: ::

Times have changed. There was talk this time in the men’s room about how a recent Tamil movie potrayed Indian docs. Thriupathi starring Ajith is currently running in the theatres in Chennai. Most of our friends felt like walking away halfway through the movie. So disgusting was the potrayal of doctors. The anger was largely directed against the Director. How could be so unfair and unjust!?

Being a citizen of a democratic country, the director had all the rights to express his opinion about a section of the society. He may have made errors in his potrayal. Democracy gives equal rights to the opposing party to express his or her opinion about the movie. Everyone was surprised how the medical council or the Indian Medical Associtation (IMA) had not protested about it.

There could be several reasons:

1. Doctors are busy making money. They do not have time to watch movies or register protests against them.
2. The several medical bodies, that exist, do not realise the importance of registering protests against the biased representation of the medical fraternity in popular media like movies. Numerous movies depict erroneous basic procedures in hospital or clinical setting. They are let to pass by and reach the public. Popular media is a powerful medium of communication and can be exploited to educate or inform the public.
3. There cannot be smoke without fire. The Indian medical system does not support or encourage self-criticism. There are rotten apples in the basket, so to speak, and if we do not make efforts to identify them, and either rusticate their licences or improve them through further training, the risk of the medical community’s image being tarnished is very high. It is natural to have poor performers. It happens in all other professions and medicine is no exception.
4. Profit is the driving force for many or almost all private hospitals. Morality and ethics have gone for a toss and discussions, if any, are limited to the few classses of Forensic Medicine in medical school. Public or charitable hospitals are on the verge of ruin. This is becoming more and more apparent to the public in general. They are forming a poor impression of doctors. If this is not countered at an early stage, it may become difficult to reverse the whole process.

Not long ago we used to laugh at how poorly lawyers or the police were potrayed in the films. Now it is our turn to be laughed and scorned at! In the end maybe it will jolt the fraternity and help wake up the slumbering associations.

::  ::  ::

There was a casual remark by one of our Senior Consultants in response to the protests by medical students in Delhi, Bangalore and Behrampur about how bad some students are in some parts of the country. I don’t remember who made the remarks in between but I started by saying that English was a barrier to education in India. I thought I lit up a spark but it soon turned into a blaze!

Background:

India’s position is very special. It is home to several languages and numerous dialects (See ethnologue.org for a list). Our nation, soon after its birth was divided on the basis of languages into States. Our Govt. proposed and soon thereafter implemented the three-language formula. Our own mother-tongue (native language) was to be the first language and English the second-language, and the third would be another Indian language. This was done in response to the southern states refusing to accept Hindi as the universal language. So all the schools were literally ordered to carry out the three-language formula. It made sense to read and write in your native tongue because that was the tongue in which you conversed. However a unique problem cropped up. And that was Higher education.

Higher Education:

All forms of higher education at University level continued to be in English whether it was Medicine, Engineering, Science, Humanities or Commerce. So you had to be atleast literate if not well conversed in English to continue your university education. A degree inevitably was linked to a better job, a better financial position and a better social standing. So it was natural that parents desired that their child study in a school with English as the medium of instruction as this promised their wards access to Higher education. In response to this English medium schools cropped up all over the country.

However, this phenomenon was predominant in the cities and to an extent apparent in the small towns. In the villages education continued in native tongues because this developmental process had not touched them. In the cities too, schools that really implemented an all-out English curriculum were the Private schools. Govt schools that catered to the sections of lower socio-economic status had more often than not English has the medium of instruction. This created a schism in the society with people of higher socio-economic status having access to English medium schools and those of the lower classes continuing to pursue their studies in native languages. It has created a rift so wide that it seems impossible at the moment to bridge the gap in any way today.

My Arguments:

• English is foreign to us
• We start thinking and talking in a language but go on to read and write in English. This makes it difficult for all of us as we have to now start thinking and talking in a language alien to us. Why the extra effort??
• English is not de-facto language for majority of Indians. Hence a large group of our society is barred from becoming doctors or engineers. Of course there are large numbers who did their schooling in their native tongues but managed to end up in a medical or engineering college. All these people are the hard-working students who had to struggle. They would have shone brighter in their fields if they would have continued their higher studies in a language they were already familiar with. These are the exceptions rather than the rule.
• Practicing medicine requires a student to fluently converse in a language familiar to the patient. Since most of our patients converse in their native tongues, it becomes even more difficult for a student who has studied his entire course in English to switch over to the native language.
• Even in the clinical setup the number of physicians who use English as a medium of communication border on the minority. Many of them vocalise in their own native tongues. Students form other states, if diligent enough, quickly and easily pick up the native tongues. But the switching in and out of English is what makes life more difficult.
• Writing informed consent has become so important these days. Law requires us to explain to the patient in a language he or she understands and that often is not English. But the form is in English in most of the hospitals and the Junior Doctor or Intern is familiar with English terminology and translation becomes a nightmare. Most of the lower courts use the local language making the knowledge of English redundant.

Counter Punch

I was cornered. The comments flowed from all over. Agitated. Unbelievable. Atrocious. Take your point, but… The gist of what they had to say about the whole thing.

• India has hundreds of dialects in additiion to the score of languages. implementing medical education has been so difficult with English alone. Do you think it would be easy with all these languages?
• Students have the freedom of moving around all over the country because English provides them the common ground to do so. Will they not find it difficult to shift from one place to another and learn one language after another??
• English has been a uniting force. It has enabled communication between the people of various states. It has helped us keep up with the rest of the world. Most of the advances has taken place in the English speaking countries and we have kept pace with new developments due to our proficiency in English. We have managed to beat countries like China in this respect. Emphasising
• Translation of huge books in English into Indian languages is going to be a humongous task! We do not have the necessary tools or resources to enable such a task successfully.
• We are already a fractured society and further division of our communities on the basis of language will only deepen our differences.
• People who need to access higher education will do so depending on their motivation and not their language preferences.
• We have hardly any software in the Indian languages. We don’t have the technological backup to carry out such a task. In the present scenario such a step would be impractical.

So there it was. We went for some time snapping at each other. After a while when things cooled down and we busied ourselves we went our ways. One of the onlookers adjusting his tie, gently put forward his question. So who won??

I often wonder if English has been a barrier to learning of the masses, and development of the country in general.

Whats your opinion?

::  ::  ::