Thursday, March 12, 2009

Jacaranda and Tabubias

Jacaranda and Tabubia are unpretentious trees when not in bloom. Jacaranda is slender and willowy and the Tabubia [except T Rosea] are small, gnarled misshapen trees.

We, here, in Bangalore are fortunate to see these exotic imports from Latin America in full bloom. The Jacaranda is all mauve blue with a carpet of blue underfoot. It is blue above and blue below. The Tabubia Argentica [Tacoma] is all golden yellow with no leaves at all. It is all one riot of flowers. The pinkish Tabubia rosea is also in bloom and this biggish tree has this year seem to object to the traffic pollution and the blossom is far less than the previous years. This is at least true in the trees that I am watching. The other Tabubia, Tabubia Avallanediae is a magnificent little tree with pink bunches of flowers all over with no leaves and the bloom is just over as I write. These trees arrived in India around three hundred years ago and have gone native in the sense they have become part of us, especially urban Indians.

While the likes of me are agog with appreciation of the beauty of these trees in bloom, have you known people who have fallen in love with them? I have known several. Mrs. Nafeeza Rahman is one of them. Her love is her Mango tree in her courtyard. This maverick hybrid does not follow the normal fruiting pattern of the regular mango. When the other mango trees are flowering this one fruits! As this fruiting time coincides with Id milad, Mrs. Rahman thinks it is Allah’s doing. My observation that all fruits are Allah’s creation does not go well with this tree lover. The fruit’s appearance is also strange. It is big but less than that of a Malgoa and when ripe the skin remains green and the taste is between that of Malgoa and Raspuri. When I said this to Mrs. Rehman, she said, ‘don’t compare my special fruit with the ordinary run of the mill Raspuri’ my aam [Mango] is Allah’s gift. Her love does not stop at admiring the tree. From the time it flowers to the time it fruits, she sits and spends time in watching it. Lately she has taken to doing this with a pair of binoculars!

I came to know about her love when she came to me with severe anxiety some years ago. An agitated and sleepless Nafeeza told me about her problem. The mango tree! The unwieldy branches where causing problems to her neighbor, who wanted her to prune the errant branches. There was no choice. The prospect of cutting the branches was the cause of her anxiety and depression. She asked me, ‘will it hurt’? I did the mistake of laughing. This woman who eats meat morning, noon and night is asking me whether her mango tree will experience pain when being cut. She said after seeing me laugh and the reason why,’ the two are different that tree is being hurt in front of me; the meat I eat is different’. When I asked her how it is different, she cut the conversation short by telling me, ‘you don’t understand, you have no feelings for my tree’.

I had to give her medication to sleep and I was told later, that on the day the tree was pruned she stayed away from home and her grief took a lot of time and medication to heal.

This, however, has not prevented her from gifting me every year when her beloved tree fruits!

Sunday, March 8, 2009

The way we do

We Indians love ostentation. It goes beyond class and creed. We all do it. The occasion to splurge can be anything from a simple naming ceremony to a major event like a wedding. There are many other rituals, occasions and festivals to indulge in this trait. There are families who save and save and make their daily lives miserable only to splurge all their savings on a daughter’s marriage. A birthday can be such an occasion if there is no other opportunity in sight.

Historically Indians respected two types of persons. One who has given up everything and leads an ascetic’s life and the other is the one who exhibits extreme ostentation. This was well understood by the British who ruled us. They followed the examples of our Nawabs [Muslim rulers] and Maharajahs [Hindu kings].They too dressed gorgeously in bright coloured [usually bright red] tight fitting material [most uncomfortable considering the weather conditions] with as many decorations stuck on or attached to from head to foot. They also built huge mansions and used only a small portion of these to live. All this was more to impress the natives than for convenience. In the course of time they got used to this miserable way of dressing and excelled in it!

This ostentation is thus a national character and has percolated to even professional bodies like that of doctors. These bodies periodically hold continuing medical education meetings and conferences and I am forced to attend these. Most often I am happy to be in the audience. But occasionally I have to suffer being on the dais. Let me explain to you the conduct of one such day long professional conference. This will come as no surprise to Indians who read my blog but to those non Indians it will hopefully provide some merriment.

The conference begins with registration of the delegates. Outside the venue, spread across several tables, sit the members of the reception committee. The duty of these members is to welcome the delegates, confirm their registration and give them the detailed information as to the subjects and the speakers. This is not all. There is also the job of handing over what has come to be called as delegate bag and other goodies. The delegate bag can vary from a mini suitcase to a hard cover document holder depending on the level of splurge. The goodies vary from toiletry, stationary, writing material, clothing, drug samples and promotional material on display. You should see to believe the glee on the faces of receivers of these goodies and the attempt made by each of them to garner as much of these as possible and stuff them inside the delegate bag.

A word about the delegates. If one considers the cost of holding such conferences it comes to around 1500 to 2000 Indian rupees in a reasonable conference venue for about 200 delegates. Normally the delegate fee is fixed around a nominal 200Rs. Where is the rest of the money coming from? Yes, you guessed it right. The drug and equipment manufacturers foot most of the bill including that spent on the gifts. Some pharma companies even go to the extent of carting the delegates from far off places and foot the bill of their stay and entertainment. Here I must digress and tell you a real life story.

Some years ago I was the convener of a national level conference with the registration of nearly 1000 doctors. It was a three day conference and on the second day of the conference I saw a commotion at the reception. A doctor from Bengal was bitterly complaining about the ill treatment that he had to undergo because of the mismanagement by a pharma company which had sponsored him. He was in fact looking for that company’s local representative. He had arrived a day late because the car which was hired for this worthy’s use for a trip to Ooty [a popular hill station 5 hours away] broke down on the way back and this doctor was forced to take a bus with a halt at a town on the way over night. The ignominy of it all! All because of the incompetence of the pharma company and he wanted to vent his ire at the local representative of that company. I knew where that youngster was but did not tell this to the delegate who after a while quitened down. I talked to the youngster later who had successfully dodged this doctor. In my heart of heart I felt this was a punishment from gods above for extreme avarice.

Thus most of the expenditure is sponsored and we doctors who can easily pay for our learning will not do so as these companies are there to spend for us. It is demeaning but who cares when there is someone to pay and which fool will refuse?
Because of all this involvement and goodie distribution, the registration takes more than an hour. The timing for this is 7.30 am to 8.30 am. Before they listen to the talks should they not be fed? So they are given breakfast which simultaneously goes on with the process of registration and sometimes beyond.
It is a sight for sore eyes to see the delegates doing the balancing act of holding the plateful of food in one hand and the now heavy delegate bag in the other!
The actual conference which was to begin at 9 am actually begins at 9.15 am with the first talk which lasts for 45 minutes. We now have what is called as inauguration. If you are wondering why this inauguration that too after the first talk, here is the explanation. If one has the inauguration at 9 am then, of the expected audience of 200 there will be about 20 in the hall. If you delay it by an hour then you will have at least 100. Why have a ceremony at all? Why can’t we get along with the conference with just a few minutes of welcome? You westerners don’t know the importance of ceremony in our scheme of things. There are important people to be honored, there is a chief guest who should give a talk, then there is the president of the local body who has to have his say, then the secretary has also to speak a few words which may stretch to quarter of an hour. There has to be an invocation to gods for the success of the conference and lastly there has to be a vote of thanks. All this will take anywhere from one to two hours of valuable time. When I made bold to tell the committee on one occasion I was made to shut up as no conference can take place without giving an opportunity to all these important persons to speak and then to thank the sponsorers.

An additional feature of our function is gift giving and floral offering. This is another hilarious aspect. Everyone who has anything to do with the conference is publicly honored with a memento. A popular gift is a watch mounted on a decorative wooden platform. One enterprising president of the local association saved a lot of money by buying these in bulk and used these for the next four years!

After this laborious and often boring inaugural is over, the delegates get down to the serious business of learning. But the boredom of the inaugural is not easy to get rid of. To help them do so, a cup of coffee is served soon after the inaugural function. Despite the announcement that they must get back within the next 15 minutes, it is half an hour before they get back to the next talk.

If you are under the impression that the master of ceremonies just calls the speaker to the dais and lets him get on with the talk, you are sadly mistaken. There is another ceremony before each talk. Two doctors are called on to the dais. One is called the chairman and the other co chairman. The chairman is asked to introduce the speaker and the subject and the co-chairman moderates the Q and A session and thanks the speaker. The M.C takes time to introduce the chair and the co-chair as these two would otherwise take offence [are they also not important people?] Now chair and co-chair are comfortably seated and the speaker is at the podium. The chairman starts the introduction of the speaker. Of all the funny things we do at these conferences this takes the cake. The introduction starts with eulogies. How brilliant the speaker was as a child, how different he was even at that tender age and the way he sucked the milk out of his mother’s breast, this goes on till he finished his brilliant education and the how he was then let loose on the patient population and the tremendous service that he has rendered since then. Needless to say all the information is provided by the speaker before hand and he sees nothing amiss in this. Now that the audience is made aware of the greatness of the man who is going to speak, the talk begins with thanks form the speaker. Beginning clichés like, now that you have had a cup of coffee and awake you can hopefully follow what I am going to say or it is always difficult to keep awake after a hearty lunch etc. Needless to say the introduction ceremony has eaten into the actual talk time and the speaker has now the job of condensing his talk of 35 mins to 15 mins. He has prepared 45 slides and he will not leave the audience at peace unless they see all of them. At breakneck speed he will go through all of them and still will not be able to finish his talk in time and there is usually no time for Q and A. Now it is the turn of the co- chair. He will heap praise on the speaker with all the adjectives he can muster. Now the chairman gives a gift to the speaker for the wonderful job done and cochairman and the chairman exchange gifts or the M.C will call two more important persons sitting the audience to come over and do the gift giving. This eats into the time of the next speaker.

Around 1pm comes the lunch break. In a conference where learning is the motive the luncheon should be simple and not take more than half an hour. But we do things in style. Our lunches usually have five courses with a three course dessert to top it with. Even a full hour is not enough. This is also the time for delegates to visit he various stalls where the drug manufacturers exhibit their products. There again are incentives for doctors to visit these. So when all these are over the delegates reassemble at the hall at least an hour late. So what should have begun at 2 pm will now start at 3 pm. Same thamasha described above repeats till the end of the conference. What should have been over by 5 pm gets over by 6.30 or 7 pm.

This is followed by a photo session for the hard working committee members. Time is spent on congratulating each other for the wonderful job done and then at last, worn down by the day long productive and unproductive work, the team leaves for home.

Thursday, March 5, 2009

Gandhi,his sandals,spectacles and eating bowl

Indian news media is all agog with the news of Gandhi’s personal effects are being auctioned in distant Newyork. Words like we will never allow this to happen. This [a pair of sandals, spectacles. A bowl and a plate] is our heritage and auctioning them is blasphemy. It was great fun watching these guardians of our tradition suddenly becoming fond of what were once used by the Mahatma. A nation which has forgotten Gandhi and has gone in the direction exactly opposite to what he preached is now crowing over these! I wish they get auctioned and someone who reveres Gandhiji and looks after these buys them and not my government which only has lip sympathy for this great man.

Moobs

Talking about mind I was thinking about the sex drive that controls human behaviour. The location in the brain is a body called Amaglyda and the chemical responsible is dopamine which is reponsible [it is not that simple]. If it is the same chemical that motivates sex why it is different for men and women? A male is ever fascinated with the female breast but not vice versa [?]. But who knows if men were to have big breasts, would they be more attractive to women? While surfing the internet I came across the news that many men who have bigger than normal breasts are getting surgery done to get them removed. A new name is coined for big male breasts. Moobs!

Moobs can be normal or can be due to some illnesses when the surgery may be indicated. But normal moobs should not be removed unless the wife of the moobs owner permits!?

Recycling used syringes and hepatitis B outbreak

Improper strerilsation and use of recycled syringes was the cause of the recent outbreak of hepatitis B in some parts of Gujarat region of India. Hepatitis B unlike hepatitis A is a very serious infection and can result in considerable morbidity and moratlity.It has some peculiar features. One is that it can only be transmitted by contaminated blood and blood products. That is if you swallow a sample containing this virus, unless you have an ulcer or abrasion in your gastrointestinal tract you will not get it. But having sex with a partner who is a carrier of this virus, or coming into body contact [contact sports] can be risky. So also those who deal constantly with blood and blood products [surgeons, dentists, blood transfusion workers, hemodialysis workers]. Effective immunization is available and it is important to immunize children more than adults, though vaccine manufacturers don’t say it. The percentage of children becoming carriers is very high in contrast to adults. Carrier state involves the risk of the carrier developing cancer liver and Cirrhosis of liver after a lapse of ten to twenty years [both are deadly] makes it necessary that all children must be immunized. This is not so in low risk adults. Nevertheless, to eradicate this illness from our country universal immunization has been advocated.

Now coming back to the epidemic. When plastic disposables came to be used in preference to the old steel and glass reusable [after heat sterilization], I had wondered when this epidemic would arrive, given our mania for injections and the unscrupulous elements who would wash these repack and sell again as new syringes. This has now happened. Adulteration is rampant and reuse of plastic contaminated syringes must have been going on for a long time and quite a few of the unexplained cases of hepatitis B we see must be due to this. Hepatitis B virus unlike the AIDS virus is robust and survives outside the body for years and washing the syringe with detergents will not kill it.

Then what is the solution? No doctor or institution should discard the syringe where it can be accessed. They have to be destroyed and then discarded preferably incinerated [equipment to do this is available] Patients should not demand injections and most illnesses don’t need drugs in the injection form. What about quacks? [Qualified and unqualified] I have no answer. Quackery exists as long as the society remains ignorant and uneducated [love for injections is an Asian and African phenomenon].

So next time you visit the doctor, don’t insist on injection. The drug given by injection takes 15 minutes to reach the blood and that given by mouth takes one hour. Therefore there is really no advantage. It is all in the mind.

Sunday, March 1, 2009

Despicable

I read with increasing dismay and anguish the stray attempts at intimidation of women who don’t conform to certain norms set by the conservative society. This society needless to say is dominated by men who have not understood women as human beings with their own value systems which are at times far superior and far ahead of times to that of men.

Indian thought has venerated women for their motherhood and their ability to procreate and thus give life. Is that all our women capable off? Should they forever be subservient to men? Which norm of human behaviour dictates this hegemony of men over women? What kind of culture is this which allows the attack on women who are seen outside wearing clothing which is comfortable and easy. And why should they not visit pubs/ If drinking alcohol is bad for women it is more so for men who are more given to excesses. My own feeling is that, all this is due to inherent inferiority complex and inability to bear and watch women doing well in all spheres of activity and men losing out. There is also the sex part of it. A woman who is educated and well informed will not give in easily and will not allow to be treated as a sex object to titillate and satisfy the male. She will no longer be satisfied with motherhood and child bearing, she wants to do more and asset herself and is doing it very well. This is the provocation. The moral policing is in fact the worse form of immorality that I have had the misfortune to witness.

Women should carry guns and shoot these goons. I, a normally non violent soul, will not hesitate to do so.

King of fruits and queen of flowers

For us Indians the king fruit is Mango and the queen flower is Jasmine. I am aware some of you may place Rose above Jasmine but my choice is Jasmine. But most agree that Mango is the undisputed king. Both these are indigenous and get mentioned in texts written more than 1500 hundred years ago. I like Jasmine not because it is a favorite of the ladies [it is] but because of its elegance and scent. No other flower has the extraordinary scent of the Jasmine. A Jasmine shrub when in bloom tells you that he [she] is there from a distance. The flower itself lays no claim to the beauty of the rose or the hibiscus but the fragrance of Jasmine it is the creation of gods. Unlike rose bush it needs no pampering, grows anywhere, needs little care and little or no insecticide use and unlike rose it can be woven into a variety of garlands and hairdos. In the south the young girl’s braided hair is often decorated with Jasmine and is a favorite flower in most Indian marriages.

Mango with its rich sweet pulp and flavor is the Indian’s favorite and is the king of fruits. Some of you, Americans in particular, with your peculiar noses, don’t like the scent of the Mango and I am very surprised! Such a devine gift to mankind and there are persons who dislike this fruit! Like the Jasmine there are hundreds of varieties but the most popular is the Alphonso [exported]. Its second cousin is our own Badam. In the north it is the Dussheri. The little Apus may weigh as little as two ounces and the giant Malgoa as much as a kilogram, but to me the tastiest is the Badam. Those of you, who reside out of India, when you get a chance, have a go at Alphonso [the fruit arrives in the US market sometime in May/June]. You will then realize why I call it the king of fruits.

Right now the mango trees are in full bloom and the fragrance of the flowers herald a bumper crop and hopefully the prices will be affordable this year.