Maxfax

Irma's Kitchen- Jamaican Food

2011-12-12T06:37:00.000-08:00

It was my first visit to the Western Hemisphere. I was to serve for 6 weeks as a volunteer dentist and oral surgeon in Jamaica. I was on an early morning flight from New York to Montego Bay. That morning, I was so hungry I could eat anything…at least until I saw two men kissing on seats across the aisle. The middle aged balding man unabashedly petted and fondled an effeminate youth with a brush moustache. I had never seen two men kissing openly before. The scene was a culture shock that took away my appetite.
It was therefore a rather hungry young man who landed in the small and informal Sangster International Airport in Montego Bay. Mr. George Palmer the local coordinator received me and dropped me off at the house where I would stay for the next few weeks. I then met the formidable Irma who would be my cook, bodyguard, advisor and babysitter. She was referred to generally as Irma the maid. I first shocked her by emerging from my room with a lungi. She would always refer to me as the guy from India who wore a skirt. She had not cooked lunch. How would she know what a brown guy in a skirt would eat!!? We often laughed about it later. In any case I was to eat in a nearby restaurant the first day. My first lunch was in the neighbourhood local restaurant where I ordered what I was told was the ‘national dish’- Ackee and Salt fish. It was a disaster. The ackee is some kind of fruit that tasted like nothing I had eaten before. It came with a steamed, peeled, raw banana which reminded me of something we don’t talk about at a dinner table. The fish was salty as promised but certainly not to my taste. I had a forkful of each in deference to Jamaican sentiments about their national food and went back to the house. Later that evening I was informed by a friendly neighbour that unripe Ackee could be dangerous and one could die if it was not cooked properly. I decided that I would not like to die on a sun kissed Caribbean island 10,000Kms from home with undigested raw Ackee in my system. I would see plenty of it over the next month. Never ate it again.
I sat Irma down the next day to plan my meals. We agreed about avoiding Ackee at all costs. She told me a list of things she liked making. She was not what you would call an imaginative cook. The good news for her was that I had no food restrictions. I knew I would survive. I returned from work the first afternoon to what she called a beef soup. It was the most elaborate soup I have had. There were vegetables, dumplings and various other ingredients, some floating and some sunk to the bottom of a large bowl that could feed a small family and their pet dog. For the next few days it was roast lamb or chicken and rice. It takes some time for South Indians to get used to the idea that rice can be eaten without some kind of gravy. I never thought I would ever crave for Sāmbhar in my life. I meekly mixed my rice everyday with Tabasco sauce.
I met Kishore Gopal about a week into my assignment. He was a dentist from Thirupathi working for the Jamaican Government. We met through a common friend, a nurse who worked in one of the clinics I visited. After introductions we started speaking in English. She insisted that we should feel comfortable and speak in our native language. I spoke English, Malayalam and Tamil. He spoke English and Telugu. Both of us had only a vague familiarity with Hindi. English was our common language. The nurse insisted that we speak in our native tongue. She could not believe that we came from the same country and knew several languages but English was the only common one we could communicate in. Gopal, whose wife was away on vacation, introduced me to the Red Stripe Jamaican beer and Jerky pork. When he first suggested Jerky pork I could not dismiss from my mind the recurring imagery of a convulsing pig jerking in a barbeque pit. I later learnt that Jerky came from the Jamaican use of the word Charqui which means dried meat in the language of the Arawak Indians (The original inhabitants of Jamaica). Jerky Pork or Chicken with the accompanying sauces made from one of the spiciest chili sauces became our standard dinner. This was invariably washed down with six pack cans of Red Stripe beer or Jamaican Rum Punches. The world famous Appleton estate rum was distilled just a few kilometers away from where I stayed. Jerky pork or chicken or beef is actually dried meat marinated in spices and pimento sauces and cooked over a smoking pit of wood charcoal. One could actually stand at the edge of the pit and select portions.
The Jamaicans were a happy people who danced, drank and ate with gay abandon. They happily went about eating their Ackee and salt fish without any major disaster. Nobody else I talked to had heard about an ackee death. However, I later came to know about scientific reports of death caused by severe alkaloid induced hypoglycaemia from the raw ackee (which was brought to Jamaica by the slaves from West Africa). The Jamaicans have a very eclectic cuisine borrowed from various ethnic groups that have settled in the country over the years.
It was on my last evening in Jamaica that I was introduced to the very popular local dish called curried goat. It tasted every bit like a typical south Indian mutton curry, replete with ground coconut and spices. In fact it entered Jamaican cuisine through the relatively small ethnic Indian community who came to Jamaica more than 150 years before as indentured labour. They were sometimes derogatively referred to as ‘coolie’ Indians. I was once called that by an irate driver in a traffic jam. They mostly lived in a county called Westmoreland near Montego Bay. On my last day I was happy to taste a bit of India on the happy dinner table of the joyous people of Jamaica. They truly epitomized the national motto “out of many one people”. Where else would you find traditional Arawak Indian Jerky pork, West African Ackee and Asian Indian Goat Curry at one table?

George Paul
October 1991

Kinky Food!!!

2011-12-12T06:35:00.001-08:00

“Balut! Balut!" cried the hawker, carrying a steaming basket on his shoulder. I had been hearing this cry every evening for several days. I knew it was something people ate, but did not have a clue what it was. I finally asked a Filipino friend.
“Oh! You haven’t eaten a Balut?” he enquired incredulously. He tried explaining the rather unique delicacy. To me it sounded like some form of boiled egg!
“No big deal, we eat plenty of them back home” said I. He thought for a while and said this was different. He told me it was ‘sexy’. Now! I was really curious.
I finally approached the hawker the next day with the trepidation of a teenager buying condoms at a pharmacy. The description of ‘sexy’ was making me curious. The hawker spoke a little English. He whipped aside the steaming cloth that covered a basket full of eggs. He went on to crack the top of one egg to make a little hole. I was getting quite nervous about this whole affair. He proffered the egg to me and asked me to suck the contents out through the hole. He watched while I tentatively put my lips to the hole in the egg. I almost felt like I was doing something clandestine. Seeing me suck up the contents of the egg he heaved the basket onto his shoulders with the ominous promise of “Make you sexy”. The contents went down my throat – a warm, gelatinous mucus like bolus, leaving behind some tasteless crunchy bits in my mouth. I chewed and swallowed that too. I hurried back to my hotel room. I certainly did not want to be overwhelmed by some gross sexual transformation on the main street of the little town of Puerto Princesa. God only knew what it was!? I sat back and waited for the ‘sex elements’ to take effect. After about an hour I realized nothing was happening. Realizing it was safe to venture out, I sauntered out to the hotel bar. Over a bottle of beer (the world famous San Miguel) a Filipino doctor friend told me about the enigmatic Balut. Balut, he explained, was a fertilized egg that is incubated till about 10 to 15 days to allow the chick to form. It is then boiled and the developing chick is eaten by sucking it out through a small hole as I had done. The crunchy bits were the cartilages of the chick’s early skeleton. The rest was obviously half formed foetal tissues which were of course boiled. The locals also called it an ‘abortion’. He told me that he himself preferred it a little more mature- incubated for a few more days. He explained that there would be some downy feathers by then. He offered to introduce me to the more mature feathery version. I politely declined. No! I wasn’t in a mood for the more ‘well done’ version. I then delicately put the question uppermost in my mind. “What about its aphrodisiac properties”. The Filipino doctor burst into laughter. He confirmed what I already suspected. It was a popular myth. “The feathers sometimes tickle your palate” he said. “Nothing else gets tickled….” he said with a mischievous smile!!

Another Train Journey

2011-09-28T20:33:00.000-07:00

It was another one of those long train journeys taking me home after a conference. I did the usual things to while away the morning- reading, dreaming and scheming. North bound trains, I am convinced, have the worst food. Fortunately, choosing a meal was easy. I had the simple choice between vegetable biriyani and egg biriyani. I favoured the vegetable biriyani , simply because I believed it was less toxic. I don’t particularly like the terrible experience of salmonella poisoning (with rotten eggs). Certainly not in our railway toilets. I tucked reluctantly into the half cooked, suspiciously coloured rice with a fragile plastic fork which distinctly looked used. There was only a faint suggestion of vegetables in the meal-a sliver of carrot and a slice of green chilli. The only hope of anything palatable lay inside a plastic pickle packet that was clearly not meant to be opened without a dental struggle. I tried vainly to open it with my teeth and tasted success when it spilt unceremoniously on my moustache and lips. The IRCTC sure does make you work for a meal.
I then settled in for a planned afternoon nap. Over the years I learnt the hard way that it was not easy to take a siesta in a train. There would be the loud conversations between passengers, ringing of mobiles and the intermittent hawker who walked down the aisles shouting “Waterrrrr” or “Tomater soup” or whatever. The few who wished to take a nap invariably snored- and they always fell asleep before I did. These days I go equipped with ear plugs which are quite effective in keeping out most of the noises. I woke up at 4.00 PM ( an hour before my scheduled arrival) surprised at the silence around me. There were three other fellow passengers in my coupe. They talked and laughed animatedly but noiselessly. I removed my ear plugs and was surprised that there was still no sound. I would have panicked about my eardrums but for the fact that I could still hear the clatter of the train.
I watched amazed as the three of them spoke with their lips, hands and a wide array of facial expressions. I soon realized that they were all deaf and dumb. It made me wonder at the remarkable nature of their interactions. There was never a moment in their conversations when one of them could take their eyes of the faces of the others. There was something intense in the communication which we ‘normal’ people ignore. We can talk, narrate, curse or ridicule someone while looking away from them. It is our way of emotionally distancing ourselves when we lie, deceive or have something unpleasant to say. If these special people dared to take their eyes away from the other, there would be no conversation. It would be like putting an ear plug in. Looking into the eyes of others, brings to human interaction a sublime level of intensity and sincerity. I wondered if it would be possible for these three persons to lie or deceive while looking into the face of the other. During a lull in the conversation, the oldest of the three, seeing me watching them, indicated with his hands that the teenager sitting beside him was his daughter. He put a cupped right hand, palm facing downwards and the left hand vertically below, palm facing upwards to indicate a child. I smiled. What else could I do? I was the handicapped one in the crowd. The gentleman then indicated the young handsome man sitting across him and indicated that his daughter and the young man were going to play badminton. He indicated badminton with a telling unmistakable swing of his hands. With my limited dumb charade vocabulary I asked him where they were going. All three immediately turned their attention to me and the older man pulled out a document for me to read. They were on their way from Trivandrum to Lucknow for the national Badminton trials for the deaf and dumb. If they did get selected they could go to South Korea for the world meet. I smiled and indicated a flying airplane by with my hands. They nodded indulgently. I was learning. The older man then revealed through a complex series of actions and lip synchs that he had another daughter and that all four including his wife were deaf and mute. With some difficulty (for me) they managed to ask what I did? I pointed to my mouth and acted out a tooth extraction and they went into paroxysms of appreciative laughter- the only sounds that came out of them. I really was learning. I was just thinking that they must be lucky to not have to use a mobile phone, when the younger man whipped out a Nokia handset. He wanted my number. I wrote it down for him. He indicated that he would message me by gesturing and acting out the process on his mobile keypads. Just as I realized I was catching on the train began to slow down. I was reaching my destination. As the train came to a halt, the sounds of the station came in through the open door of the coach. A cacophony of languages, footfalls and yelling interspersed with those of the hawkers hoarsely vending their tea, coffee and Vadai. Welcome back to the real world. We said our goodbyes with handshakes and I gave the silent universal thumbs up to the two young players. Driving home from the station, I resolved that I will learn the hand language. It would be a great way to spend my old age- gesticulating silently to my wife and breaking out into peals of laughter!!!

Capital Punishment- State Sponsored Murder

2011-09-04T06:15:00.000-07:00

It was black irony on 14th august 2004 when Dhananjoy Chaterjee was executed at the Alipore Correctional facility. It was sad that India’s ‘correctional principles’ involved the termination of life. Seven years later we are preparing for another correction. This time it will be Murugan, China Santhan and Perarivalan, the men who were allegedly involved in the assassination of our former Prime Minister Rajiv Gandhi.
This is not a defense for Dhananjoy Chaterjee or the three young men being prepared for the gallows. It is a candid, soul searching look ,at the rights of a civilized society to take away life- any life. Baying for revenge is a natural emotive reaction to a terrible deed.
It took twenty years of deliberation and prevarication to say that these men must be punished with death. Perarivalan whose crime was obtaining two nine volt batteries that detonated the bomb that killed Rajiv Gandhi must have been less than twenty years old at the time of his crime. The criminal justice system had enough time to think and deliberate with detached pragmatism. At the end it was irrational hate and revenge that prevailed. The men must have already died a thousand deaths- waiting for the state to decide.
In analyzing the rationale for legitimate governments to kill legally we must try to answer a fundamental question.
What do you do with criminals?
Criminologists, social scientists, human rights activists and judicial experts are more or less agreed that reformation should be the ultimate aim. It explains the use of the term ‘correctional’. The other two aims of punishment are deterrence and isolation from society. Deterrence certainly has its place in criminal reformation. However death as a form of deterrence has never really worked. The Sri Lankans and the Pakistanis and the Sikh separatists had their own agenda- and they were willing to die for it. How can a death sentence be a deterrent? It is only inviting the Indian Republic to be like a primeval society and take revenge? Is that what the father of our Nation would have wanted? Study after study from around the world has conclusively proved that death penalty has and never will be a deterrent even for the habitual criminal. It is hard for us to believe this because it appears like common sense that the promise of a strong punishment will frighten the criminal. In fact many well-conducted studies have shown that the certainty rather than the severity of punishment, serves as a deterrent. Canada, which abolished death penalty in 1976, has had a decrease in capital crimes by 40% from 1976 to 2002. In America, the southern states with the largest number of people on death row, continues to have a much larger incidence of capital crimes like murder and rape compared to the northern states. Many States in the USA have actually seen a decrease in crime rates after abolishment of the death penalty and the introduction of life imprisonment without hope of a parole. Justice should not only be certain but also speedy. These statistics have been reproduced in numerous countries, which adopted abolishment of the death penalty. Today almost all the countries, including the European Union, South America and many states in the USA have abolished death penalty or do not have it as a government policy. The countries, which chose to retain the death penalty, have abysmal human rights records. The countries which do not have respect for human rights, like Saudi Arabia, have laws that are hardly worth emulating. India needs to decide what kind of example it must adopt as its social and judicial example. The choice is between that of Europe with its high standard of fairness and Saudi Arabia, Yemen, Iraq, Pakistan and the republic of Congo where even juveniles are punished with death penalty.
The answer to the dangers of allowing hardcore criminals into society may lie in the laws of commutation. It needs to be restructured to ensure that an incorrigible criminal will never go back to society. A life sentence for murder must be ‘for life’. Many ask why the taxpayer’s money should be used to keep them alive. The criminal will have to be accepted by society as a deviant mind, which is the product of his genetic disposition or the ill effects of the socio-political environment. We cannot eliminate them just as we do not eliminate mentally and physically deranged patients or non-productive senior citizens. The welfare state has to take some responsibilities. The only reason for supporting ‘death for the killer’ is a revengeful and barbaric emotion that cannot be a state policy- at least not in our country which has pledged itself as a welfare democracy gprinciples of ‘ahimsa’ propounded by the father of our nation- Mahatma Gandhi.

The Australian Council Against Death Penalty (ACADP) says this about capital punishment:
The most premeditated of all murders.
The only thing it accomplishes is death.
There is no justice or redemption for the criminal.
There is no restitution for the family of the victim.
There is only a dead body.-Another dead body and another group of innocent victims.

To understand the premeditated process of killing, one needs to examine the protocols that are followed. The prisoner knows the date and time and spends it in isolation, while his lawyers make last ditch efforts. There is a death watch to make sure that the prisoner does not kill himself (and thus deprive the state of the privilege). He is asked what he wants to dine on. Dhananjoy’s last meal was two extra pieces of fish, some curd and sweets. It was a small luxury- a few hours before he was to be hanged. Contrary to popular belief most people don’t get anything more than a cheese burger, fries and a soft drink (in the USA). The prison manual in India allows a vegetarian meal (unlimited I am told). Doctors examine and weigh them to make sure they are healthy. In India they are weighed to make sure the rope will hold. If the rope breaks, the prisoner might break his legs, you see. In the USA they are given diapers lest they void and embarrass themselves in the course of dying. They even swab the skin with a disinfectant before administering lethal injection. There is something sick and eerie about the methodical process of planned killing. No wonder the majority of countries with a conscience have done away with capital punishment.
In India there is yet another dimension. Race and religion. Many Tamils do not want the Sri Lankans killed. Many Muslims do not want Afzal Guru killed. Many Sikhs do not want Bhullar killed. To me there are men and women who have been involved in heinous crimes. I cannot differentiate one from the other. If Ajmal Kasab had killed randomly in Mumbai or Afzal Guru had played a role in threatening the Parliament then Murugan and others have killed a former Prime minister and numerous others. To me these are as heinous as the hundreds of murders that have gone with lighter punishment including the murder of Graeme Staines and his children!! Why is there a double standard in political circles? The Hindi belt is unconcerned about the Sri Lankans. The Hindu fundamentalists are baying for the death of only the Muslim terrorists. Many Sikhs are interested only in the pardon of Bhullar. It is high time that India reconciled itself to the fact that it must stand with the civilized world on the matter of state sponsored murder and have an equal stand on capital punishment. No more killings by the state! Lock away the criminals and throw away the keys if you must. No more Killings!

George Paul.

Diluting Medical Care

2010-10-01T23:37:00.000-07:00

In July 2010 the Madras High Court, in a landmark judgment, ruled that doctors qualified in Ayurveda, Siddha and Unani systems of medicine can practice ‘modern scientific medicine’ along with their respective systems. This Judgment was further buttressed by a Government Order (GO) issued by the Department of Health, Government of Tamilnadu, permitting practitioners of traditional systems of medicine to prescribe allopathic drugs and perform a range of surgical procedures including orthopedics, gynaecology, ENT, Ophthalmology etc. To understand the grave dangers posed by this unfortunate decision, one must understand the evolution of traditional and ‘modern’ medicine.

Conventional medicine that is practiced around the world is often referred to as modern medicine in India. About two hundred years ago western medicine was poorly developed and many of the practices like bloodletting caused more harm than good. It was in this setting that Samuel Hahnemann introduced the philosophy of Homeopathy in 1796 . Homeopathy became popular not because it was highly effective but because it was perceived as not being as dangerous as the conventional medical system of the time. In fact it was Samuel Hahnemann who referred to ‘the other treatment’ as Allopathy.

It was only in the last two hundred years with the discovery of microbes, antibiotics, anaesthesia, immunization, modern pharmacology and other aspects of medicine that conventional medical care in the West overtook the traditional practices all over the world. Unfortunately many traditional systems in India and China did not evolve with the times and remained rooted in ancient practices. Today Ayurveda, Siddha and Unani do have limited patronage in India. Their adherents are usually those who are wary of modern systems and perceive them as being unnatural and therefore dangerous. In fact these traditional medical systems have capitalized on the very same sentiments to promote themselves as an alternate system of medicine. For others, traditional systems carry a heritage charm of being ancient and therefore exotic - in fact, esoteric.

Unlike traditional systems that have strong cultural and religious overtones, popular modern medicine has freely rendered itself to change and criticism. Modern systems evolved because they are not steeped in ancient traditions that have a way of being sacrosanct and rigid.

It is therefore surprising that these traditional systems are now asking to obtain privileges for prescribing the very same drugs that were denounced by them as being foreign, dangerous and unsuitable to our heritage. The foundation of Ayurveda, Unani and Siddha systems are alien to conventional medicine. For example, the concept of health and disease is based on the balance of the three humors namely Vatha, Piththa and Kapa in Ayurveda and Siddha. While these concepts may have merit for those who wish to follow them, they are meaningless to the practitioners of modern conventional medicine. A medical graduate in Ayurveda or Unani, tutored in these tenets will not be capable of practicing a science that has a totally different outlook to disease and treatment.

The judicial as well as executive decisions to allow traditional practitioners the privilege of practicing conventional - Allopathic - medicine is obviously based on the interpretations of the word ‘modern.’ The argument that traditional medicine is ‘modern’ is based on the specious argument that the syllabi of degrees such as BAMS and BSMS include ‘modern’ medical subjects like anatomy, physiology and pathology. Modernity in medical terms does not mean the knowledge of subjects alone. It refers to the application of modern methods in diagnosis and treatment based on well documented concepts. Drugs used in modern medicine and the rationale for their use is certainly in conflict with traditional medical systems. Systems like Siddha, Ayurveda and Unani that do not recognize microorganisms as the cause for infections cannot prescribe antibiotics. The defining aspect of modernity in conventional healthcare is evidence-based medicine (EBM). All drugs in modern medicine go through a rigorous process from drug discovery to phase trials to marketing. Even advances in surgery are based on recent developments in infection control, anaesthesia and operating devices that have been developed on the basis of principles that are alien to traditional medicine.

In this context the decision of the Tamil Nadu state government to allow traditional medical graduates to practice modern medicine, even while they adhere to different concepts about basic physiology and pathology, is a dangerous tryst with the destiny of healthcare in India. If the adherents of traditional medicine feel the necessity to practice modern medicine and prescribe drugs that are unfamiliar to their system, they are free to do so if they obtain a regular medical degree like the MBBS. Alternate medicine degrees like BAMS and BSMS cannot be used as a shortcut to practice modern medicine. One cannot have the cake and eat it too!!

Lesser Doctors for Lesser Indians!!?

2010-01-03T05:58:00.000-08:00

The Times of India on 30 th December 2009 reported an absurd proposal by the health ministry. Dr Meenakshi Gautham, a concerned health activist, filed a PIL in the Delhi High Court seeking to ameliorate the pathetic health condition in rural areas. I agree that it was something that should have been filed decades ago and then not just for the rural, but also for the urban poor. The Health Ministry and the MCI, on the direction of the High Court went into a huddle, in fact many high power huddles and then naively concluded that the magical solution for the rural folk will be to mobilize a new set of ‘doctors’ who are less trained (3 ½ years) as against the standard training of 5 ½ years for a medical graduate. This is not only discriminatory against the rural poor but a retrograde step that will create two tiers of doctors with two practice jurisdictions. The new set of BRMS graduates ( Bachelor of Rural Medicine and Surgery) will of course be expected to practice within the jurisdiction of villages while the others will stride the polished corridors of swanky city hospitals. This is an insult to the already deprived villagers who will now have the official classification of lesser Indians who deserve lesser trained physicians.

I must first pre-empt the usual argument of ‘something is better than nothing’ for these poor rural people and the repeated plaint about doctors refusing to serve in rural areas. The answer to this serious problem is not the creation of a lesser cadre for the lesser privileged but in addressing the fundamental problems in health management and manpower distribution. Most of us think that more doctors is a prescription for better health. Health, particularly at the grass root levels are achieved by education, awareness, prevention and health surveillance. It is no secret that the average doctor (rural or urban) would not be excited about pursuing these less glamorous aspects of health care.

I randomly chose a country in Southeast Asia and compared it with India based on available WHO statistics. Thailand is a much smaller country than India but has an economy that is somewhat similar. Thailand has a lesser physician density (3 per 10,000 pop) when compared to India which has (6 per 10,000) population. However every one of Thailand’s health indices is better. The life expectancy at birth is 62 years for an Indian whereas it is more than 70 for a Thai. About 79 out of 1000 live births are expected to die in India whereas the death rate in the same category is only 8 per thousand live births. Obviously, more doctors did not help the cause of public health in India. The key is commitment to health. This can be seen by the fact that the per capita expenditure on health is about three times higher in Thailand than it is India (Intl $ 109 in India and Intl $346 in Thailand). The density of nursing personnel in Thailand is twice as much as the nursing personnel density in India (28 and 13 for every 10,000 population respectively). Public spending on health in India at 0.9% of GDP is way below the public health spending in Thailand. In short, the health of a nation is not defined by the number of doctors but by the commitment of its Government. Nurses, Para -medics, health workers and maternity care givers are a greater need than poorly trained doctors. Doctors, even if they are called ‘Rural’ Doctors, are bound to chase the more glamorous aspects of health care. Nothing can stop these ‘rural physicians’ from slowly encroaching into the more financially rewarding urban and semi urban regions of the country. No regulatory body can practically restrict their activities to the ill defined concept of ‘rural’. Even legally, the courts will strike down as unreasonable restriction if a ‘qualified doctor’ is told to treat only people in a certain region (rural). It will be an infringement of the fundamental right to freedom of profession, occupation, trade or business under Art 19 (g) of the constitution. If a person can treat a rural person (as a bachelor of rural medicine and surgery) there is no way that he can be prevented from treating an urban person who has the same human features in anatomy and physiology. What is sauce for the goose is sauce for the gander !!!

The Government should focus its welfare intentions on creating incentives for doctors who are willing to serve the rural population. Creating another category of doctors and imposing unreasonable restrictions on their right to work can only be seen as an immature and poorly thought out strategy that has no respect for the sensitivities of the rural poor in addition to being hare brained and impractical.

George Paul

A Diwali Story

2009-10-16T08:49:00.000-07:00

Diwali (Deepavali in Tamilnadu), as everybody knows, is a celebration of the triumph of good over evil. Driving home this evening in heavy Diwali traffic I had time to recall my first Diwali in Salem as an Oral and Maxillofacial surgeon. Festivals have a way of being woven into our lives. This one is about an interesting weave that brought together my profession and the sparkling festival of Diwali. In 1986 I had returned to Tamilnadu after several years in Kerala and a short stint in Annamalai University. It was Diwali time. The festival came and went. The sulfurous odour of expended fireworks and the haze of smoke were still in the air when I got one of my first professional hospital calls. It was two days after Diwali. The young man looked miserable lying in a hospital ward with a broken jaw and several missing teeth. His demure young wife, hardly out of her teens, stood uncertainly near the bed. The boy told me his painful story- literally and figuratively . It must have been painful. Try telling a long story with a broken jaw. I don’t remember his name. Let’s call him Kannan.
Kannan had gone to his wife’s home for the traditional Thalai Diwali. In Tamilnadu the new groom mandatorily spends the first Diwali after marriage in his wife’s place. It is called Thalai Diwali. The young groom is usually given a gold ring by his in laws. Kannan for some reason did not get his ring. I think he refused to stay overnight or something. The young fellow was terribly distraught and went home smarting from the insult and ignominy of not getting his golden ring. He did what most upset young men do. He drank away his blues. At some point he became so maudlin at the loss of face that he decided it was not worth living. He added some pesticide to his hooch. The pesticide apparently did not go well with the liquor and he puked the whole lot onto his living room floor. His cup of woes was full. Now sober and brooding he decided he would not give up. He walked out into the fields and threw himself into a nearby well knowing that he would certainly drown. The well was dry and he fell on hard rock. The next morning a search party found him alive and bleeding in the well. He was inconsolable. He had lost face (and some teeth too). He had failed again. Lying in the hospital room he had time to think and reflect. His new wife and her parents rushed to the hospital. Amidst the crying, hugging and reconciliation his father in law slipped the contentious gold ring on his son in law. Everything was forgotten. That was how I saw him- Repenting in a hospital general ward, two days after Diwali, with a broken jaw and missing teeth and of course a brand new ring on his finger. I operated on him and he had his teeth replaced a few weeks later. They returned many Diwalis later with a grinning child on the wife's hip. I think he had the gold ring on his finger too. They looked happily married. Diwali has a way of letting good triumph over evil- even if it has its twists and turns.
Have a great Diwali!
George

Aptronyms of Medical Specialists

2009-03-13T20:49:00.000-07:00

An aptronym(also called Aptonyms) is a name aptly suited to its owner. I first came across the word in an engagingly funny article by V.S. Jayaschandran in The Week, where he refers to a well known neurologist called Lord Russell Brain who succeeded a Dr Henry Head as the Editor of a prominent Journal on Neurosciences called Brain. I realized that my late father too had an Aptronym. His name was Paulose (a Syrianized version of Paul). The people in Salem (Tamilnadu, India), where he practiced dentistry, ended up calling him Palu loose which roughly translates in Tamil/ English as loose teeth. It certainly helped his profession. I have another friend who is specialized as a Paediatric Dentist. Dr Baby John. Of course it would have been even more apt if he was a Paediatric Urologist.
I trawled the internet looking for some more aptronyms in the medical profession and came up with quite a few interesting ones. Dr Ima Assman’s special area of interest is obvious. He is a Proctologist.(1) Dr Knapp puts people to sleep. He is an anaesthetist (2) just like Dr John Bagwell (3). Dr Au (pronounced ‘ow’) is a dentist the specialty most often associated with pain just like Dr John Payne and Dr David Toothaker (3). There are of course other dentists with esoteric aptronyms. Les Plak who practices in San Francisco is on the preventive side of dentistry whereas Dr Tom Fillar appears to favour restoration of teeth (4)
I would have thought that Charles Butt would be interested in the hind areas but it turns out that he is the spokesman for an anti-tobacco group in Nova Scotia. No Cigarette Butts for him!!
It is inevitable for an Urologist with the name Richard to not be an aptronym. This is because all Richards are referred to as Dicks. So it is not surprising that Dr Dick (Richard) Chop is an urologist with a particularly brisk practice in circumcisions. His practice associate in Austin, Texas is coincidently Dr Hardman. I may assume that he is an Urologist with a special interest in andrology (a personal assumption) who prescribes loads of Viagra. Dr Dick Tapper, Dr Dick Finder etc are the other urologists by virtue of their first names. Urologists appear to be the most colourful of the aptronyms. We therefore have Dr Waters, Dr Gherkin, Dr Splatt, Dr Wong, Dr Wang and Dr Stone (5) amongst others who practice urology.
It would not be difficult to identify an Ophthalmologist with a name like Dr I. Doctor. On the other hand you may be wary of eye specialists with names like Luis V. Nosce (pronounced as ‘no see’) or Dr Wong See !!
No marks for guessing the specialty of these aptronyms - Dr Childs, Dr Small, Dr Bunny, Dr Tickles, Dr Toy and Dr Kidd – Of course they are all Paediatricians (5)
Dr Bonebrake, Dr Butcher, Dr Bones and Dr Bender (5) are all Orthopedic Surgeons. However Dr Dick Bone, though an osteopath, seems to belong to the league of Sexual Medicine, going by his name.

If you have gone crazy reading this article, you may want to look out for one these doctors - Dr Strange, Dr Quirk, Dr Dippy, Dr Moodie, Dr Nutter, Dr Nutt; Dr Looney, Dr Crabb, Dr Dement. Psychiatrists- all of them! (5)
All the names and specializations given above are real ones reported from lists of Medical Practitioners mostly in USA and Canada. The references and citations from where the Aptronyms have been sourced is given below. The author has used his liberty to make a few harmless assumptions for effect.
George Paul

1. http://en.wikipedia.org/wiki/Aptronym
2. http://homepage.mac.com/chapmandave/aptonyms/index2.html#list
3. http://homepage.mac.com/chapmandave/aptonyms/en/list.html#a
4. http://www.strangecosmos.com/content/item/25079.html
5. http://humor.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=humor&cdn=entertainment&tm=19&gps=305_695_1020_632&f=00&su=p504.1.336.ip_&tt=11&bt=1&bts=0&zu=http%3A//www.u.arizona.edu/%7Estoddard/doctor.htm

Turning Fifty

2009-02-06T07:24:00.000-08:00

It was a pleasant surprise to learn that Barbie Doll will be celebrating her fiftieth birthday in March. I too am turning 50 in March. We even share the same star. The similarity ends there. Barbie remains svelte and sexy. I cannot say the same for myself. She does not have a streak of grey on her full, blonde head. Age has not been kind to my hair or waist. Like me, Barbie has lived through the fashions of our times. For her it included conservative robes, tantalizingly short mini skirts, dress suits, hippie wear and even a pentagon approved military outfit. I have gone from drain pipe pants to bell bottoms to pleated baggies to whatever is available at our neighborhood ready made show room. Her dresses were designed by Christian Dior and Vera Wang. Mine were stitched by Singaram tailors who recently closed shop due to the chain of ready made outlets that have sprung up all over town. It must be said that her wardrobe is certainly more fashionable, eclectic and expensive than mine. I really cannot afford the underclothing she wears.
When I turned forty I assured myself that I was entering a new phase in life. I looked forward to the next decade as a defining one that would magically mix and blend the adventurism of youth with the experience of age. One wag even suggested that ‘Forty makes people naughty’. I am waiting for the magic and fifty is just a month away. I look forward to the next decade with the same anticipation I experienced when turning forty. 10 years down the road, Barbie doll is going to look the same. No such luck for me. Being a fashionable doll has its privileges.

George
Feb 2009

The Art of Healing!

2009-02-03T19:17:00.000-08:00

Recently, a junior colleague, Prakash complained bitterly about the step motherly attitude meted out to him in a surgical oncology unit where he went to train. As a maxillofacial surgeon he was interested in oral oncology and considered himself competent to be trained in cancer surgery in the maxillofacial region. Prakash was politely reminded by the surgical oncologist that as a dentist he was not equipped to handle the complexities of cancer surgery. The sleight and put down, not withstanding, Prakash proved himself and earned the respect of his trainers. Many medical specialists look down upon other specialties as being less glamourous. Most clinicians tend to look down on colleagues involved in the less sought after para-clinical persuasions of medicine.
Unfortunately I too have ridden the high horse of being a surgeon. Somewhere during training and practice we come to believe that there is superiority in our calling. It perhaps comes from the adrenaline of working directly with blood and danger. The general public too may carry these impressions created by perceptions borne out of dramatization in books and movies. The truth is often understood by an actual patient seeking treatment for his disease. A patient with Psoriasis needs a dermatologist not a neurosurgeon.
My father, a dentist, had practiced his profession for nearly 50 years. He was particularly adept at prosthetics. He made excellent dentures. I never realized how much he was appreciated for this until a month after his recent death. I had operated on a patient with a tumour in her upper jaw a couple of years ago. It required a fairly major surgical procedure involving the removal of part of her upper jaw. After the tumour was successfully removed, I never thought much of it. She was asked to see my father for some kind of prosthesis. In fact I saw her only when she returned for her reviews which included routine inspections of the large defect. She removed her dentures to show me the defect and put it on again. I did not even pay much attention to the prosthesis. She came to visit following my father’s death. She broke down and cried inconsolably. She confessed that she was so desperate after the ablative surgery that she did not even want to live. The anguish of an young woman with a hole in her mouth. My father had apparently comforted her and painstakingly built her an obturator and denture that improved not only her appearance but also her ability to speak and eat. I understood that she felt a greater obligation to my father who restored her function with some good dentistry rather than to the snooty surgeon who removed her tumour. It was a humbling experience which reminded me that every person has a place in the healing profession.

Where were we!??

2009-02-03T19:15:00.000-08:00

Every adult who was alive in the US when John F Kennedy was assassinated will tell you what he/she was doing when they heard the news. I was not alive when the Mahatma was assassinated, but I certainly remember what I was doing when I heard about the assassination of Indira Gandhi and Rajiv Gandhi. I don’t however remember my disposition at the time of Pokhran 1 or 2 but I certainly remember where I was when the twin towers came down and the Babri Masjid was destroyed. I guess we benchmark these occurrences based on how much they mean to us or how deeply we have been affected by them. Today with the TV channels ‘Breaking news’ every 10 minutes, it is perhaps a difficult exercise.
I will never forget the 26/11 terrorist attack. I was in Delhi with a senior journalist friend. In fact I was staying with him. It is always a pleasure talking to journalists because they have such a bird’s eye view on the happenings in the country. This particular journo is one of the best defense reporters in the country. All you have to do is ask a stupid question and you can get some terrific insights into the complexities of their specialty. As a peacenik, I asked him if he ever foresaw the possibility of India being in a situation where there would be no need for a standing army and a significant part of the defense budget being used for development- education and health in particular. He was amazingly prescient when he said that he did not foresee such an eventuality. He predicted that conventional inter-national war will be replaced by intra-national conflict!! The arms dealers will never be out of business, he promised. Terrorism and internal strife will keep our army busy. I retired early to bed. My friend arranged for me to sleep in his extensive library- filled from floor to ceiling with books-mostly about war, terrorism and other conflicts. I was tired yet mellow from a couple of drinks and went to bed in the company of voluminous tomes about war and terror.
When my friend woke me up at midnight I was not sure if it was a dream. Terrorist Attack! Terrorist Attack! He said. I was confused because reality morphed into a dream like trance of battles, guns and grenades. It was surreal. The whiskey did not help matters! I was ready to run out or jump out of the building (8th floor I think). My friend quickly pointed to the TV screens showing repeated images of the TAJ, CST and the other sites. Still groggy I went back to sleep. When I woke up in the morning, surrounded by books of war and the faint memory of some visual action, I was still not sure if it was a dream or reality. Another benchmark etched into my memory reminding me where I was when it happened!

Travel Stories- Almost a Vietnamese. Almost!

2009-01-17T21:33:00.000-08:00

My work as a volunteer dentist in the Philippines required me to spend the better part of the day at the Vietnamese refugee camp. The Palawan First Asylum Camp was a docking station for Vietnamese refugees (boat people) who were trying to get out of their country in the aftermath of the US departure from South Vietnam. My lunches at the Vietnamese restaurant inside the camp were a new culinary adventure. The camp dished out authentic Vietnamese home food replete with their amazingly spicy sauces. Even my brave South Indian tongue turned red at their potency. One gets used to the food in a short time but the journey from the bowl to the mouth was an arduous one. The Vietnamese are a proud people, like most Orientals. They are also finicky about their table manners. Chopsticks are ‘de rigueur.’ In the early days, they often looked at me pathetically as I struggled with a fork to discipline the slippery noodles, which were distinctly different and certainly more difficult than the user- friendly Chinese variety. At least the one’s we ate in India. A significant conversation, a few days later with Van Phuc Trinh, my translator and chopstick coach, told me that I should learn how to use their tool if I must earn their respect. Trinh and I were dining at the canteen a couple of days after I started work. Trinh leaned forward to interrupt my futile attempts to trap the noodles, which seemed to have a mind of its own. I could not, for the life of me, believe that you could actually tame these slippery spools of wormy noodles with two sticks that were perfectly smooth.
“Doc, do you know that the Filipinos have no eating manners!?” She whispered
“No” said I, distracted and struggling with the two sticks whose tips would never come together. I had always sensed an undercurrent of silent hostility between the Vietnamese refugees and their hosts, the Filipinos.
“They do not know how to eat properly,” she announced with a trace of condescension.
I had this strange feeling that she was hinting at my ineptitude. Orientals have a way of being round about in their conversations.
“They cannot eat with a chop stick…” she hesitated realizing that I had stopped my fervent attempts and the noodles were smoothly unwinding back into the bowl. “ or even forks…” she trailed away, seeing the look of guilt and embarrassment on my face. She then leaned forward as if to reveal a terrible secret and said, “I have seen Filipinos eat with their fingers…!” She waited to see the horror on my face. She obviously did not know that Indians, particularly south Indians, not only used their fingers but their whole hand. Licking streaks of curry or curds from their wrists or even forearm was considered perfectly good manners in Tamilnadu, my home state. However, I decided to show significant alarm at her revelation. It was clear that her issue was with the Filipinos and she did not care about my chop stick expertise.
“Don’t tell me…..” said I, in mock revulsion.
She nodded sagely while I got back to my struggle with the chopsticks.
Over the next few days I learnt to pick up large chunks of food with my chopsticks. My eyes had grown chinkier. Hell! I almost became like them. Well almost….. My real test came a week later. Here goes!
The cook at the Vietnamese camp was a celebrity of sorts. He was an important cultural link to their homeland. So when he had a toothache it was a real emergency. He was allowed to jump the queue - to have his tooth extracted by me. No one complained. The next afternoon, the cook, now relieved of his pain decided to honour me by making a special appearance in the service area of the canteen. He came to my table, which I shared with my interpreter, Trinh and an American intern George Davendorf. In his hand was a plate of meat, which Trinh (who obviously knew that I was being honored) explained, was courtesy the cook. He put the plate of meat in front of me and bowed low saying “Doc”
“Thanks” said I and dexterously picked up a piece of meat with my chop sticks, whose use was becoming more familiar to me. While Trinh my interpreter joined me in eating the rather delicious meat preparation, George, my other table- mate politely declined. After having eaten a couple of pieces, I asked Trinh what the meat was.
“Doc” said she.
“What is the meat?” I asked again, thinking that she had not heard.
“Doc” came the reply.
Seeing my puzzlement the American intern George clarified for me. “Dog” he said. “ It’s a delicacy they reserve for important people,” he laughed.
The chopsticks slipped from my hand as my interpreter went on to explain how a wayward dog had found its way to my table and my stomach. With increasing revulsion, I listened as she explained how the dog had created a ruckus the previous night and the cook had it killed and served up for lunch. Last night’s nuisance became today’s gourmet lunch! Two birds in one shot if you like. The cook who understood no English stood by smiling proudly at his accomplishment. “It was kept a secret” she said sotto voce. The Filipinos like most people did not find the idea of killing dogs for dinner a friendly eating habit. More importantly there would have been a stampede amongst the Vietnamese, for dog meat was a delicacy in great demand at the camp. I tried to say something appropriate to everybody around. It came out sounding like a bark. I motioned to Trinh and asked her to share it with her people at the next table. I could never look a dog in the eye….. ever again.
George
April 1990

Travel Stories- No Habla Espanol! No Habla Inglis!

2009-01-17T21:10:00.000-08:00

Language guide books teach you nothing. I landed in Guatemala city armed with just one sentence “ no habla espanol” (I don’t speak Spanish). The problem was that I could say it so well that most people wouldn’t believe me. It did not help that I looked a little like them. Come to think of it most Mayan Indians look like Asian Indians!!
A quick conversion of the Quetzals (local currency) into dollars (and then of course into rupees) told me that I couldn’t afford more than one drink at the paid for business hotel I was put up in. I decided to take a stroll to find a liquor shop. I stopped every friendly looking guy on the pavement to enquire in English about where I could find a liquor shop. I hated myself for not having learnt the useful words. They would smile and indicate that they did not understand English. No habla Inglise. I tried different strategies and words. I tried ‘Rum’. No chance. Beer? A cock of the head and a slow shake. Whiskey? Blank. Finally I stopped an elderly man and did a mime of drinking and then lolling my head around like I was drunk. He glanced curiously at me. When he showed interest, I repeated the act once more and added a few staggering steps to indicate drunkenness. He now looked at me with great interest his hands on his hip like he was watching a street play. He watched for a while then shook his head sadly and said something before walking away. I thought it was loco. This time I understood him. I also understood that it was a hopeless adventure. I went to my room and slept off the jet lag in absolute sobriety.
Paul Smyth was a lanky guy with great uncombed curls on his head and a scraggly beard. His ill fitting pair of jeans looked like they would slip down any moment and trip him at the ankle. He looked straight out of Greenwich Village in the sixties. Paul introduced himself as the parish priest from the Parroquio San Antonia. Padre Pablo as he was fondly called by his parishioners had come to fetch me. I was to be transported to a small sub-urban community in the Barrios district on the Caribbean coast. The Fronteras was eight hours away from Guatemala City. I had volunteered to be a Rotary Volunteer dentist for the Quiche’ Indians who lived in the villages (aldeas) nearby. I almost grabbed Paul’s hands when he spoke English. We obviously shared more than a common name. That was my first conversation since I arrived in the city the previous day. I toyed with the idea of asking him about the liquor shop and decided it would be inappropriate to ask a catholic priest. We drove in silence through the streets of Guatemala City on our way out. I looked out at the numerous shops and almost pointed excitedly when I saw what I thought was a shop selling some kind of alcohol. Now! I am not an alcoholic, but the prospect of living in a strange place with a bunch of priests definitely cried out for some entertainment. The stuff found in the bottle was convenient and uncomplicated.
Two days at the Parish and I was bored and thirsty. Father Smyth was the only other person who spoke English. In fact he was the only other occupant of my living quarters, if you excluded the extended family of cats and kittens purring in every room. I am distrustful of cats and for that matter all kinds of pets. I finally picked up the courage to ask Fr Paul Smyth if I could find a place to buy some beer. He laughed aloud and took me to his refrigerator (run on gas). It was stocked up with bottles and bottles of beer. He thought I showed no interest because Indians had some serious issues with alcohol. I didn’t ask him because I thought the Church had issues with alcohol. In any case I got myself a drinking buddy for the next one month. My Spanish vocabulary on that front improved to discover that beer is called ‘cerbeza’, whiskey is called ‘scotch’ and rum is called ‘ron’. No wonder I had a communication problem
The problem of the drinks was solved pretty easily. Food was a more complex issue. Alicia, was a pleasant young woman with a ready smile. We had long smiling conversations. Not a word spoken. She was our cook and she took her job very seriously. I should have been happy, considering that my most adventurous cooking was the making of a boiled egg. I was capable of botching up even that! I was therefore completely at her mercy. And she had a job to do. Make me eat Pasta morning, noon and night. She was some kind of pasta angel. I can digest an occasional pasta meal. But Pasta for a month was too much. I suspect that she never did know to make anything else. So it was Pasta! She made this very good looking pasta, yes! Only good looking, topped with some kind of grilled meat and plenty of tomato ketchup and cooked in olive oil. I am not a fussy eater but the olive oil really had me. Every forkful of the pasta was a painful process. I would somehow clear the plate with Alicia hovering at my back. She would then lean towards me and ask me in that sensuous way of Latinos “Beuno?” (meaning “Good?”). The only word opposite to ‘beuno’, which I knew, was ‘mal’ and that meant bad. Oh! I was caught in that terrible disposition between losing that smile on good Alicia’s sensuous lips and the indignity of throwing up on the plate. My language disability precluded using a complex expression such as “ its good but thank you” or some such thing. I would roll up my eyes and make funny noises to express my hesitation and would end up saying without enthusiasm “ Si, Beuno….”.and try to cover the plate with my hands. It never worked. She dumped all the pasta she made. This went on day after day with only Sundays for holidays, when she went to church or maybe torture her poor husband with her pastas. Why did she not just make regular Guatemalan food like tortillas and beans or Enchiladas or Tamales?
One weekend I decided that I would cook myself something to eat. Alicia, as I said, did not cook for us on Sundays. I looked at all the canned food in the pantry. The names in Spanish meant nothing to me. It was food alright….and it couldn’t be worst than Alicia’s pasta. Finally, I settled on a can with a picture of a smiling fish on it. Underneath it was written “Por Gatto”. It looked friendly enough. I opened the can and smelt its contents. Definitely fish. The smell was a little too fishy but then this was Guatemala. I put it into a frying pan and generally heated up the contents. It was just about edible- slightly better than Alicia’s Pasta.
That evening over a bottle of beer (cerbaza), I told Paul Smyth that I had cooked myself a lunch. I then showed him the empty tin with the picture of a fish. Father Smyth, in his cool English manner told me with a wry smile that “Por Gatto” means “For the Cat”. I looked at the tin in horror. Yes I had cat food for lunch. The only lunch I had cooked myself! The fish on the can’s label really was smiling!

Ram Bahadur

2008-12-26T00:42:00.000-08:00

Ram Bahadur was referred to me with a large growth in his cheek. When I first saw him two months ago, he was in pain. This gentleman was obviously not from these parts. Ram Bahadur was a Nepali. His features confirmed that fact. The rest he told me in his clear unaccented colloquial Tamil. He came to Salem as a young man and became the security guard at Rajendra Mills, one of the leading cloth mills in Salem. Gurkhas were always in high demand in the security business. Some years later he got married to a local girl and settled down in a friendly locality, most of who worked in the same mill. Over the years he had completely integrated with the community. Although they had no children of their own, the Bahadurs adopted all the kids in the street as if they were their own. Ram Bahadur eventually retired. His wife died. The street adopted the old man. He was now 70 years old. Bahadur was the quintessential relic of urban goodness. The common grandfather. He played with the little ones, many of them the children of boys and girls whom he had cared for as a young man. He worshipped at the community temple and visited the Church of St Anthony every Tuesday. Bahadur’s life was certainly not lonely. At least not until he had this tumour bulging angrily out from his cheek. When I first saw him it was threatening to burrow out of the skin. It was not a pretty site. Ram Bahadur was concerned and it showed in his feigned nonchalance. He was brought to my clinic by two young men whom he had carried on his shoulders when they were little boys. They were barely employed young men struggling to make a living. One of them, Veerapan, worked as an unskilled office boy in an office which belonged to a good friend of mine. Unlike his infamous namesake, Veerapan was a docile self effacing young man who was genuinely concerned for the Nepali Thatha of his street. He asked to speak to me privately and went on to tell me that he and his friends had decided to take care of all the expenses that they could afford. I explained that Ram Bahadur had a tumour that was too far gone. He had nodes in his neck. He was unlikely to survive long even with surgery and radiotherapy. My silent concern however was whether these young people would indeed look after him if he needed prolonged convalescence. Even close family sometimes experienced fatigue and disgust in these situations. After getting a positive biopsy I anguished over the decision to operate. On the one hand there was the futility of a long operation and a very long and turbulent period of healing. There would be significant impact on his quality of life. On the other hand who was I to make a decision for treatment based on his social situation. I admitted him in the charity hospital of which I am the medical director. That night Ram Bahadur rebelled. He hallucinated and the devil of loneliness got to him. He lashed out against the nurses and showed significant signs of psychological instability. We calmed him down with anti-depressants and two days later I made my decision. In consultation with a psychiatrist and considering his advanced disease we decided that surgery would be inappropriate. He was discharged. Ram Bahadur was given pain and anti-anxiety medication. Veerapan and his friends were assured that it was a non communicable disease. Indeed, the whole street was apprehensive. They however stood by him. They bore the stench and fed him for two months. When it got too much they brought him back to the hospital. He was given three days of palliative care at Sharon. He died one morning in absolute peace. Veerapan and his friends took him home and gave him a grand farewell.
A week after the funeral the young men of the street found that Ram Bahadur had Rs3 lakhs in bank deposits. There was another Rs13,000 in cash. There were no relatives. There was no nomination. The young men refused to take a single paisa as compensation for the money they spent for their Nepali Thatha. They finally came to me and asked if I would accept the money to help other poor people at Sharon. Goodness dwells in the heart of the poor!

Should Radha's Sacrifice be Rewarded ?

2008-11-05T08:59:00.000-08:00

Last week I had written the sad but glorious story of Radhakrisnan’s supreme sacrifice. I would like to bring to it a new dimension.
To understand the realities of life in the aftermath of sacrifice, let us go back to Radha’s story. Radha was a married man. In fact his first wife passed away after bearing two of his children. He remarried and has a 10 month old baby. His first two children are technically orphans, though I am sure his second wife will take care of them just like a real mother. The little one will never know the pleasures of a father. Radha’s wife now has the unenviable task of feeding, clothing and educating three children as a single mother. The economic burden is real. Reality comes when the TV crews have packed up and gone home, when homilies have been preached and paeans have been sung, when the public have clapped their palms to soreness. At the end of it all there will remain only the penury of a widowed woman and her three children. We need to examine what the family got out of all the publicity and praise. They got Altruism. Altruism is a nice word. Unfortunately you cannot eat or pay for groceries with it.
Yes! I am suggesting that his family should be rewarded. And why not? When you consider that the woman who received the heart transplant is a dollar millionaire and the recipients of the Kidneys and Liver are probably rich too. They will, hopefully, live meaningful lives because they could afford to pay for a transplant service. At the end of the day we must also remember that all these transplants cost money. The money goes to virtually everybody in the chain. The hospitals, the ambulance owners, the immunologists, the doctors, the surgeons and multiple small beneficiaries all make some money as professional or service fees. The drug companies in fact have a lifetime commitment from these patients with all kind of drugs. The immunosuppressant will ensure a steady prescription of long term medication. In all of this, only the donor or his family is expected to exercise the ‘noble’ virtue of altruism. In the transplant scenario, compensation is a bad word when it comes to rewarding the donor or his family. They are expected to be altruistic. Any benefit accruing to them would be stamped as being unethical, undignified and avaricious.
This question has been often addressed in the context of live voluntary donors who make up a significant number of kidney donors in our country. In this context I would like to address an issue that is different from Radha’s sacrifice. Adult voluntary donors should have the choice to donate their kidney or any organ which will not compromise their own lives. If this is legitimized it will cut out the criminal elements in our system. Malek, who teaches economics at San Jose State University, in an Internet post, questions the noise being made about paid transplants. He says “If money is the catalyst that relieves shortage, and if the money/organ exchange is voluntary, then why prevent this transaction? Obviously, I want the money more than an (extra) kidney, and the sick person wants the kidney more than the money. This is a mutually beneficial exchange.” Contrary to popular belief, these open transactions will cut out the middlemen and the benefits go to the donor and recipient (and of course, the hospital) only. Frank Adam et al., in Contemporary Economic Policy, April 1999 and William Barnett et al., in the Independent Winter Review 2001, ask the same rhetorical question “Who owns my body?”.......I hope it is clear that the answer is not, and should not be, the Government! The argument that the poor are incapable of taking decisions is a specious one. The same with the argument that there are surgical risks to the donor. Malek questions governmental concerns with, “-- but should Government legislate risk taking? Would driving a car be illegal? What about flying? Bungee Jumping? Roller Coasters? Where would it stop?” People may argue that health is all about welfare and ethics, but it is impossible to leave out economics. Henry Hazlitt’s ‘Two main points in economics in one lesson,’ tells us that “bad economists look at the short term, not the long term, and they look at the effect on one group, not all. In other words, good economists consider the unintended consequences of public policy legislation. Obviously, our policy makers do not have good economists advising them, or, if they do, they are ignoring them.” A well made out argument in favour of an open market has been suggested by Nancy Scheper-Hughes of Berkeley, California. She has personally visited and worked in 12 countries and collaborated with national governments to end trafficking of human organs. She argues that ‘everyone under the current system benefits, except the donor’. The patient gets a new kidney. The hospital and physicians are paid. The drug companies get to sell life long drugs. Why should only the donor be governed by altruism??”
Coming back to our present discussion we need to ask if Radha’s family should be compensated. I am certain that Radha’s family should benefit. It would be peanuts for the dollar millionaire to fund an educational scholarship for one of the kids over the next ten years. The same with the other recipients. The Government could chip in with a Government job for his wife. They do it all the time when it brings in votes. If somebody is listening, it might actually mean that Radha’s sacrifice will not only be meaningful to the men and women who got a new lease on life but also to Radha’s family which has been impoverished by the loss of an earning member and a loving father and husband.
George Paul

Radha's Last Diwali Gift

2008-10-31T19:55:00.000-07:00

I was called in to see a patient on the day before I left town for the long weekend before Diwali! The young man in the ICU had multiple facial bone fractures. He also had a serious head injury and was on a ventilator. I glanced through the neurosurgeon’s notes which gave him a grave prognosis due to a bad brain stem injury. In fact my opinion about the facial fractures was superfluous. The Glasgow Coma Scale at less than six indicated that he was unlikely to make it. I was writing down my notes when the duty medical officer who was looking over my shoulder asked me if I recognized the patient. I had not. I suddenly felt greater remorse when he told me it was Radha (short for Radhakrishnan) a theatre assistant in the same hospital. Someone I knew well. The doctor told me of how he was involved in a hit and run accident on the highway near Salem and of how he was left untreated in a large corporate hospital for six hours before his colleagues went over, put in a breathing tube (intubated) and brought him to Kamala hospital. He was unrecognizable due to his facial injuries and the tubes. I told his wife that I would see him again when I returned on Tuesday, although I knew that he was unlikely to make it.
On my return after Diwali , I learnt that he had created magic over the weekend. Dr K K Rajagopal the owner and Director of the hospital, in consultation with the neurosurgeon had decided that Radha was brain dead. He convinced Radha’s wife on the benefit of an organ donation since he was well perfused on a ventilator. A young boy’s parents had made a similar decision a few week’s before and the media had covered it well. The public were waking up to the benefits of this good media coverage about organ donation. Dr Rajagopal contacted Dr K M Cherian a Cardiac Surgeon at Life Line in Chennai. It turned out that there was a very sick lady with dilatory cardiomyopathy waiting for a heart transplant. Within the next 24 hours Radha was transported to Chennai (6 hours away by road) still hooked on to a ventilator. Even as he arrived at Life Line the adjacent operating room was prepared and they had the lady who needed a new heart on the table. After going through the necessary compatibility tests a team of doctors removed Radha’s heart, liver, two kidneys and corneas. While the heart was plumbed in to the lady waiting with her chest open, the other organs were harvested by doctors from other hospitals in the city. Within fifteen minutes the organs were transported under special conditions to the respective hospitals while the lucky recipients were already readied to receive them in the shortest time possible. The police had cleared the traffic to allow the Ambulances to go unimpeded through the otherwise snarled traffic. Finally a team of plastic surgeons from the Stanley Medical College removed sheets of skin for the skin bank and a team of orthopedic surgeons removed his bones for the bone bank at Kilpauk Medical College. The lady patient was off the ventilator the next day, Radha’s heart ticking away in her chest. Two patients with end stage renal disease got a new lease on life with Radha’s kidneys. One very sick patient with liver failure was given a new and healthy liver. Two persons will shortly see better with Radha’s corneas. His banked skin will probably save the life of a critically ill patient with severe burns. Radha’s bones after being appropriately prepared will replace lost bone in some accident victim and help him move around. Radha himself was subject to a post mortem (autopsy) to record the events of his great sacrifices before he was declared dead. Well! not really. Radha will go onto live a multiplied life in others. These are the real heroes of our lives. Radha gave the ultimate Diwali gift! The gift of life.

Railway Toilets-Use and disuse

2008-09-05T19:55:00.001-07:00

Traveling, in fact the thought of traveling, triggers off a major shut down in my lower gastrointestinal system. This protective mechanism has served me rather well except on a few occasions.
Despite the fact that toilets in the Indian Railways have improved significantly in the last decade, it is still a bit of a gut stopping experience and that is literal!. One, of course, has a choice between Western and Indian ‘styles’. Do not take the use of the word style too seriously. There is nothing ‘stylish’ about both. The western ‘style’ usually comes without a seat. This is a frightening proposition particularly for some one with a narrow hip and waist, say a child or an anorexic fashion model. On the other hand, the few that have a seat are invariably soiled. Men, as we know, do not care to lift the toilet seats before using it. I know of one friend who carries a newspaper which he expertly cuts and uses as a protective barrier between his butt and the seat. On the few occasions when I have needed to sit/ squat, I have shown immense patriotism by choosing the Indian ‘style’ which consists of two platforms to place your feet on while you squat. Between the two platforms is a metallic receptacle that has a gradient leading to a hole which empties on to the railway tracks. If you look carefully, there is usually a tap in front of the seating arrangement which has a pushing device to dispense water. I have seen no use for it except as an anchor to hold on to while you go about your business. How one effectively uses the water that comes out of it is beyond me. Of late the Indian Railways has provided a mug chained to the tap (or to some contraption at the side). This chain is about a foot long and one cannot expect to use it meaningfully for anything. A longer chain would no doubt have dragged itself over so many undesirable areas making it a messy business. Not having a security chain will understandably result in some one taking it home. My advice is to use toilet paper or carry your own mug if you cannot manage without water (as is the case with most of us Indians). The flush works half heartedly, and certainly does not do its intended work. The Railway however urges you to flush before and after use. The Indian Railway also requests you to not use the toilet while the train is stopped at a Station. It certainly is a reasonable request to prevent passengers at Railway station platforms from having to see unsightly heaps on the track while waiting for their train to arrive. On the other hand it is an unreasonable request on the toilet user. Aiming for a 4 inch hole while the train banks from side to side needs quite some experience. If you are squatting on an Indian style toilet the chances are that you will not only miss the target but may end up soiling your ankles as well.
I have heard of all kind of things going down the chute of the toilets- wallets, glasses and cell phones. A most bizarre story was recently reported in the Indian newspapers. A woman delivered a child and she chose to do so in the toilet of a running train. The mother watched aghast as the new born disappeared down the toilet chute on to the tracks. Hearing the distressed mother, the train was stopped by fellow passengers, who pulled the emergency chain. They found the child on the tracks a kilometer away, a little soiled but without a scratch- alive and kicking. Happy endings are common in India!
George

Strange Names, Strange Places, Strange Professions!!

2008-09-02T03:31:00.000-07:00

My name is George Paul. I am a Maxillofacial Surgeon practicing in Salem. It might actually occur to some that this is some weird guy with two first names (and Christian ones at that) practicing an ominous unpronounceable profession in Salem. Since Salem (Massachusetts) is historically linked to witchcraft I would not be surprised if people thought that maxillofacial surgery was in some way related to that dubious craft. So let me explain. Maxillofacial Surgery is a surgical specialty of Dentistry/ Medicine and Salem is a ‘witchless’ city (I believe) situated in Tamilnadu, India. But first, the business of the unusual name.
I do not know of any place in the world where people have two Christian first names. It is a unique practice amongst the Syrian Christians of Kerala in India (where I was born). In fact I know a young man who had the not unusual name of M.M. Mathew. Indians in the South of India often prefix their name with an initial. Therefore the name is not unusual until you got him to expand his initials. It turns out that this gentleman from Kerala is indeed Mathew Mathew Mathew. So George Paul is not too bad. I am now a naturalized domicile of Tamilnadu. The name George gets a bit of a battering in these parts. For some reason most people cannot spell it correctly. Those who can, sometimes pronounce it wrong. This is again surprising when one considers that the official seat of Government of Tamilnadu is housed in a building called the Fort St George (a carry over from the British East India Company). In any case I get by with being spelt as Jorge, Gorge, Geroge and other such combinations which invariably involve the addition, deletion or replacement of some vowel or consonant. The only time I was actually offended was when I ended up being spelt as Garage in a hotel register.
Most people (anywhere in the world) would find it difficult to even pronounce ‘maxillofacial surgery’. It is therefore unfair to expect them to know what part of the body gets chopped up by the practitioners of this unpronounceable surgical specialty. In fact the specialty is a fairly complex one- at least as complex as its origins. The Wikipedia, and for that matter most authoritative sources, call it a surgical specialty of dentistry. Dentistry its self has a rather tenuous origin. It branched off from mainstream medicine (and surgery) a spot earlier than it ought to have and established itself as a separate specialty of the teeth (and later the mouth and jaws). Most medical specialties have gone through the mainstream of medicine and then separated out. If you ask me why Ophthalmology or Otolaryngology did not go the way of dentistry, I have no reply. We can only call dentistry an anomaly of medical history. The Maxillofacial region was annexed to dentistry by adventurous dentists who moved their surgical ambitions from the teeth to the gums to the mouth to the jaws and finally laid claim to a good part of the face. This insidious expansion is best captured by the evolution of the specialty’s nomenclature. It went from being called dental surgery to oral surgery to oral and maxillofacial surgery. Here it must be mentioned that the military violence of the two World Wars and the subsequent violence of high speed motoring and bar brawls, with heady ‘spirits’ as a catalyst for both of the latter, contributed to its establishment as a sound surgical specialty. Today maxillofacial surgery involves facial trauma, pathology, oral cancer, cosmetic surgery and more. At the risk of sounding morbid, I must admit that it is a good livelihood in Salem. The chaotic (and often spirited) traffic and the average motorist’s disdain for any protective gear keeps me and my family well fed. Today Oral and Maxillofacial surgery requires a double qualification (dentistry and medicine) in many parts of the world due to its complexity. Thank God, we do not need that as yet in India!!
Now Salem. This Salem that I live in is in Tamilnadu. It has nothing in common with the many other Salems around the world. I know of two major cities/ towns in the USA and there is one little Salem that I whizzed past in Jamaica. Of course Jerusalem has an etymological connection with Salem (Shalem). Other Salems include a popular brand of cigarettes, a rock band in Israel and an accused terrorist who for some reason spells his name as Salem (Abu Salem). Our Salem is a sedate city of a million people. Nothing dramatic happens here. No earthquakes, no floods, no terrorist bombs, no witchcraft (as in Salem Massachusetts); in fact it has nothing that merits ‘breaking news’ kind of publicity. It is relatively clean by Indian city standards. It has better than adequate facilities on nearly all fronts (relative to Indian standards again). In fact it has a surplus of hospitals, eateries and more recently educational institutions. Other surpluses include trucks, HIV/ AIDS and other unpleasant stuff, but we will pass those. The food is unique in these parts. The famous non vegetarian joints serve up some real mouth watering, spicy and biologically suspect food from small innocuous looking joints. The hospitals do good business, thanks to two national highways which intersect here, the chaotic city traffic and its central location, fed by numerous smaller towns and villages. The teaching institutions range from fly by night operations to highly rated professional institutions.
On a personal front my interests range from reading, writing, traveling (I hope there was a way of getting to places without the drudgery of car, bus, train and planes) and surgery to weekend appointments with Bacchus. Thanks to a recent qualification in law and ethics, I have a new interest in medical ethics. I also like talking. That’s right, talking. If I cannot find anybody I just talk to myself. Crazy? Well maybe a little bit of that too!
George