Reading the fine lines....

During my lifetime , I have seen technology advance from punched-card data processing, to wi-fi on laptops, black and white photos to biometric data capture including your eyes, cars that were pushed, to cars that spoke,  and tomatoes that were eaten, to those that were used to hit political opponents, and even used as projectiles in Tomatino festivals.

In the big urge to sit up there with the "advanced countries", we ran rough shod across many things, without understanding them. It was a climb with an abnormally steep slope,  and it involved jumping on to several bandwagons, aided greatly by an opened up economy, becoming an outsourcing capital, the onslaughts of IT hardware, cell phones, and miniaturized wonders from China.

Suddenly, the concept of what you thought "expensive" underwent a huge change. It was OK if clothes/makeup now cost half as much as a small flat, so long as they were authored by a European fashion house/designer.  Watches no longer remained something you got for graduating, but became  one of the several you wore and threw away. We appropriated Tomatino festivals because someone in Spain did it, and never mind that middle class housewives were in distress over the rising cost of tomatoes in a double digit inflation world.  We started the showing of commercials on TV, like abroad, without worrying about something advanced countries have : a "truth in advertising"  Act, and we showed  "cassettes and CD's"  and "soda"  being substituted as words for alcohol ads of well known hard liquor companies and no one in control, bothered.  We started showing dangerous things on TV,  with a a warning running below in an ant size font, spoken in an unintelligible manner by some guy in a huge hurry, because that was the way to protect yourself.  This applied to businesses too.  In the big hurry  to become world class, we simply skipped some things. The emphasis has been on external show, and unfortunately, what got ignored was the thinking inside, or as one might say, the anatomy inside.

One recently had the opportunity to function as a caretaker for someone who had some cardiac emergency procedures done in what is touted as a world class, XXXX credited hospital. Everything was very well organized, spic and span, constantly being monitored and cleaned, moved like clockwork, the technology worked seamlessly, the medical expertise and communication was excellent. Of course, the proclivity of us Indians to arrive in droves, full family in tow, to see patients, had the security folks at their  wits end, one felt they needed some PR lessons in communication,  but one let them be.   This hospital has rules displayed all over the place, and they simply pointed out the rules.

Before we were discharged and left to go home, we had to fill in several feedback forms. One of the questions pertained to we being shown the "patients' charter of rights" . Well, we were not shown any such thing, so I was about to tick "No", when they hurried to present one sheet to me. I read through it, didn't think there was anything to crib about in that, and ticked "yes". Didn't want someone up there to chew out some dedicated nurse who was doing an excellent job of her nursing.

This morning, I returned to the hospital to ask for some detailed report ,  indicated by our office  as a  "reimbursement" requirement. Mind you the data  was all there in their system. The menu to generate that report  existed, and the front office fellow who could do that was yet to arrive . Fair enough.

The guy at the counter looks at me.

" We cannot give you a copy. We will email it to your section office." He fiddles with the mouse.

" Maybe you can email a copy to me ? " Me. Thinking it to be a routine thing.  

" No Ma'am. We cannot email it to you . We always send it directly to the office in question."  He gets a call and stops to answer it.

" Can I speak to your PRO, or even your Director ?  I insist. This is data pertaining to medical procedures we underwent, what we paid for,  our name is there, I have an ID in your system, and how can you refuse us this ? "   Things are happening in a familiar way. I foresee a battle.

"Ma'am, they wont be here till an hour from now. But our superior should be here in 15 minutes, if you care to wait. "   I park myself firmly at the counter.  In a lifetime of standing in queues, and battling queue-jumpers, leaving a place at the top of the yet unformed queue, seems a bad idea.

There are a whole bunch of framed notices on the counter. One pertains to the aforementioned "patients' charter of rights".  I read through the whole sheet, as I alternate between leaning from one foot to another.  They urge me to sit.

But I have seen  the charter of rights, item no 16, and I have seen the light.  I stop leaning from one foot to another.

The adrenaline  flows. There are wheels within wheels churning.

The guy finally arrives, a decent smiling chap. He has a look at my request. I repeat it.  I need to mention the patients charter of rights. Item no 16, says, I have a right to my own clinical data.  I straighten up, a few notches taller.....

"You see , you guys are refusing me something that is guaranteed to me by the patients charter of rights.  My clinical data. By emailing it to someone else ( even if it is the concerned  office )  without my permission, you are actually trespassing on the patient data confidentiality aspect ." ( I wasn't sure of this but said it anyway. Most of the time the other side doesn't understand anyway).

The fellow looks up. "Ma'am , let me see. "

"No.  I insist on a hard copy first. You may email it later to the office with my express permission, with a copy to me , so i can check the version.  Else , I am writing to your board, about violation of my rights as a patient. Whats more, I am approaching the consumers court about this, and will not hesitate to file a query under RTI. "   (I wasn't sure what I was going to ask under RTI, but said it anyway. I could think about that later. In this day and age, RTI was the magic word....)

The fellow went in with the paper. Another guy comes out and asks me to wait for 5-10 minutes. The stuff is being processed.

I get my report in the next 5 minutes !

What a complete waste of time and words.  The hospital has not trained its fellows at the front office in the patients' charter of rights; what is an acceptable request and what is not.  Displaying stuff in pretty fonts all over the place in transparent frames, is considered enough.  It impresses.   That is what all world class hospitals do.  It simply isn't enough to train people on the various systems.  They must be cognizant with whatever information is displayed on the counter. 

And I wondered what would have happened if it was someone not familiar with reading these framed notices.  He/she would have got overawed with all the presumed sophistication,    would have never known who the clinical data was being sent to, what was sent , despite the fact that one paid through one's nose for the entire hospital stuff.

Sometimes, folks just keep quiet, thinking that  whatever the counter types are saying is the gospel truth.  Some may think it is better to just shut up and let them do whatever they say, because they don't want to be seen having an argument, regardless of the fact that they are being wronged.    They would have made several trips between the hospital and the reimbursing authority, and been , maybe, but hopefully not, taken for a ride.

Is it too much to ask, that there be no doubt when I ask for access to data pertaining to myself /us ?  When it is an individual filing in an office for reimbursement of the hospital expenses as per rules, ,  doesn't it make sense to have all the hospital papers routed through the applying person ?  On what basis did the guys refuse at first ? 

I admit I threw in the RTI bit just to see the effect.  It did no harm. Like they say these days when they present some new thing, no trees were killed in the process, no pollution was caused, no flora and fauna was destroyed,  etc etc  

I foresee several guys rushing inside or suddenly occupying themselves otherwise when they sight me approaching the counter next.

Never mind.

I just hope I don't have to go to any hospital soon, anytime in the near future.......













     

Shortage of Shame ....

A hot summer morning two years ago. S. , my house hold help of 25 years was away at work at the two-three houses she goes to everyday. She, her 3 sons, 2 daughters-in-law, 1 daughter and 1 little grandson (around 2 years plus) lived quite peacefully in the 1.5 room set up, with creatively made lofts, a spic and span functional kitchen, and a sense of trying to be happy with what they have .

One daughter in law, was pregnant for the second time, and was alone in the house, waiting for the other younger daughter-in-law to return from some errand, when a lady with a file and a sling bag landed up at the door. She smiled, asked about everyone, and introduced herself as a health worker.

They got talking about the older one's pregnancy, and the health worker starts a spiel about how her child and the forthcoming one were too closely spaced. It was yet two months, and maybe she could help do something (abort) about it. She gave a bunch of facts on how it's not good for the health of the mother to have pregnancies so close together. Besides the government gave you a money grant if you underwent these procedures when and as advised.....

Soon the other (younger) daughter-in-law returned and heard all this. The older one thanked the persistent health worker, but said that she would consult her ma-in-law on such matters. And only then decide .

The health worker lady, left after painting a alarming picture of health for the pregnant lady because her 2 pregnancies were too close. Besides she , the health worker, had just lost out on a monetary incentive from the government (for motivating folks to use family planning measures).

S. told me about this when it happened. Urging someone to abort , when another school of thought said, this way the two children would grow up together, and the mother could always get sterilization done after her delivery. The older one would be more than 3 years by then ! There were many folks in the house to help, and the only reason the health worker lady was saying what she did, was for her incentive commission from the government.

(Aside : In stratas of society where no incentive is required and folks are materially secure and overinformed, I once knew someone 20 years ago, who simply went to a fancy place and got an abortion done, because the older child had just started school and this was SO inconvenient....She never got a second chance.....)

Not all health workers are like this. Some have great understanding , knowledge and empathy. But wonder what would have happened if the household was not as enlightened and united as S.'s. Planning children is one thing. Giving misleading information to someone already pregnant , might even endanger lives.

But then it's all about quick earnings.

Very recently, the other daughter-in-law got pregnant . (S. had worried about some gynaec treatments, and asked me and I had blogged about her).

She was rushed to hospital for her delivery 10 days ago.

S., her entire family, and the girls parents all took turns being there while attending to household matters. This was a municipal hospital near the suburb where we live, and S. had registered her second daughter-in-law's name there for pre-natal checkups and delivery. The entire thing was free of cost. That it was close by, would save on transport costs.

Post the 26/11 carnage, when one of South Mumbai's Municipal Children's Hospitals was attacked, security at these hospitals has been increased. Stories about babies disappearing from hospitals still show how bad the security is, but S. is someone who abides by rules.

So when they told the entire family to wait outside the hospital (almost on the roadside), while only the daughter-in-law in contractions was taken upstairs, S. asked people to stop cribbing, and have patience. Rules were rules.

They stood there for a couple of hours with no news. Talking amongst themselves. Then suddenly, their name was announced on the P.A system, and one person was called to the door. Her son went, and came back to announce the birth of his son.....

They still weren't allowed in. And while they all breathed a sigh of relief at everything going off well, and celebrated the new addition to the family, two attendant ladies (ayahs) came to the door.

Did they want to see the child ? They would have to pay 200 Rs to these ladies. Then they would bring the child , swaddled in the first clothes of his life, to show them.

And S., who had given birth to 4 children herself years ago, educated not only her kids, but also daughters-in-law after marriage, decided to splurge. They would scrimp on something else. ( She had requested me last year for a loan of Rs 500 to pay the fees of one of her daughters in law for some computer course, which I had gladly helped with).

But this was about welcoming the latest member. Without much thought, they all emptied their pockets, organized those 200 Rs, and once these were pocketed by the attendant ladies, the grandson was brought out to be admired in his first hour or more on earth.

What an introduction to life , as it exists in Mumbai.

Doors are locked for security, but open for as little or as much as Rs 200.

There is really no difference between the health worker, and these ayahs. The former gives misleading and incomplete information to presumably uneducated folks, and is paid for it , by the government, once someone has an abortion or sterilisation. The latter, untrained but street smart, give real time correct information, and extract unofficial money from worried family members.

S told me this story last week. And we thought how it was all about making money any which way one could. And playing with peoples emotions and aspirations.

All you needed was an immense shortage of shame.........

Stopping the Spitting....कश्याचा गवगवा , कश्याची छी थू .........

My awareness of the Cama and Albless Hospitals happened almost 20 years ago, when one of our family friends had a pre-term delivery. It was the raging monsoon season, and it was advised that the baby be admitted to a place which had good neonatal facilities. Neonatal care,incubators and the like were still new things for us, and the little child was admitted to the Cama and Albless Hospitals , and remained there for a couple of months, till it was strong enough to be sent home.

This is one of the many municipal hospitals in Mumbai, and this particular one is dedicated to women and children. An old sturdy British structure from the days of the Raj, there are people who do their post graduate specializations registering there, and it conducts various types of gynaec training for government medical personnel across the state.

Why do I mention this hospital ?

The lead players in the Mumbai Carnage, first went to the main CST train terminus , and indulged in a wild spree, killing 45. Much to their surprise, the terrorists were then chased by cops and other people bearing guns and big sticks (lathis), and contrary to their plans, they ran helter skelter, landing up at the Cama and Albless hospitals. Service folks living on the premises, were threatened and shot and there was mayhem there, which attracted Mumbai's Police's best. There was complete mayhem, the jeep was commandeered by the terrorists and they careened out of there wildly shooting, till they were stopped, overpowered and almost beaten by a mob and arrested.

Other than reporting that the women and children patients were all cloistered in a huge ward with medical personnel, closed from inside, the TV channels had nothing more to report. Close by at the GT Hospital, another government hospital, casualties of the wild shooting at CST etc started appearing, and one heard terrible stories about a mother and her 3 month old child, in separate wards, the child crying for her mother, the mother with wounds on her chest, neck, back and arms, demanding to see her child to feed her, but unable to do so due to the injuries, and no one had the heart to tell them that the father of the child had died.

In all the brouhaha over the "iconic "structures of the Taj and the Oberoi/Trident, all the so called leading investigative and influential, TV channels forgot about these places, except to mention them once in a while in passing.

The average Mumbaiker does not go to the Taj or Oberoi.

These are places you glance at, from outside, while returning, from a dieseled open boat ride opposite the Gateway of India, as you avoid the clutch of photographers who insist on photographing you for a price. It's something you look at , reassured that you are making it back to the quay, as your boat chugs into its docking place.

For many ordinary people, a visit to the city involves a crushing train ride in the train, getting off at CST, and then taking another crowded bus, sometimes doubledeckered, to the area close to the Gateway of India. A walk in the sea air, admiring the Taj from a safe distance, dreaming of telling your friends , "you were there ", buying of , maybe balloons for the children and some snacks; maybe the mother will come out with a bunch of packed things she brought along, and the family makes an afternoon or evening of it, till some security personnel suddenly decides to whistle from somewhere.

The Oberoi evokes similar emotions, but the Taj probably evokes more personal admiration, , as it is older, has a lot of history and legend associated with it, and is owned by the Tata's , who are admired across the board by rich and poor alike .

All throughout the 52 hours of non-stop TV coverage, the emphasis was on the Taj, The Trident/Oberoi, and the Nariman house. Understandable, since the hostages were holed up there. But there were lulls, when old visuals were shown again and again by the channels, and even the reporters started getting repetitive .

At no time, did a channel go over to CST, where, those whose daily meal depends on a daily wage, were back on the trains a day later. There were no interviews with passengers, hawkers that throng daily outside the station , motormen and railway guards on their way home.

At no time did anyone go interview, those employees that live in outhouses of the Cama and Albless Hospital , who had casualties, that happened simply because someone opened a door to find a terrorist there. An old mother losing her only son, employed at the hospital. The day after the attack, women who had Cesarean deliveries just 1 day earlier, were so traumatized that they discharged themselves along with their newborns, and went home with worried families, possibly from CST, in the now empty trains, grateful for the space to lie down, something that would never be otherwise possible.

The only visual one saw regarding the hospitals was a board outside with a list of names of the dead and injured, and anxious people trying to read , amidst eyes that threatened to get clouded with tears.

Mumbai has had several calamities in the last 4 years. This was without doubt the most horrifying and long lasting.

But somewhere, at the back of a shocked and doubting mind, is a thought, that it was the Taj and Oberoi, that declared this to be a "happening" piece of news. The Cafe Leopold in Colaba, normally considered "happening" by all visitors , was similarly ignored. No visuals, no interviews.

Just reams and reams of interviews with people who apparently visited the Taj like I visit my local library. A justifiable regret over the loss of various arts and artifacts displayed there in. Interviews with people who remembered the plushness and wonder of it all.

There is a world outside the Gateway of India and Nariman Point(where the Trident stands). Mumbai runs on a daily basis because of those who inhabit that outside world.

Unfortunately, Our rulers too have this "posh" obsession. Visits are made in Z-security splendour by ministers , to the Taj and Oberoi. One of them even indulged in disaster tourism , as the TV channels called it, after every thing was over.

Did any of them visit CST and give a special pat on the back to the announcer , whose quick thinking directive to people, directing them to use a particular exit, saved hundreds of lives.? Did any of them go visit and reassure the staff at the ticket windows , who were threatened by terrorists and their windows smashed ? Did the minister for public health visit the hospitals , to commiserate with the staff and patients ? And let's not say that visits couldn't be made in the confusion . Those that were obsessed about being seen in their powerful accompanying outrageous security, managed to do so, in the midst of it all, and never mind of the police suddenly got diverted from the carnage.

Did I hear any one of the pillars of Mumbai society, so to speak , mention these ordinary places as they sat with outraged faces in TV discussions, shaking their heads about the Taj and Trident ? Did those TV anchors that organize candlelight vigils and then pretend they suddenly happened, even think of these other places ? Did those that showed rotating candles on their screen with changing images of the police top brass who were killed, even think of that ordinary policeman who was killed on duty, the 4th generation in his family to join the force , or even interview his family and/or colleagues ?

Doing all this now , is nothing new. The moment has gone.

Frank Lloyd Wright once said that "television was chewing gum for the eyes".

How true.

They kept chewing and chewing , looking at the Taj and Oberoi/Trident. Chewed some more, shuffling from one cheek to another.

Then they turned and spat.

It stuck.

At CST. And Cama and Albless. And GT Hospital.