Sunday, June 19, 2016

Gulbarg massacre verdict - a grim reminder of how a state failed its people



A special court in Ahmedabad sentenced 11 people to life in jail for one of the worst massacres during the 2002 Gujarat riots. Some were given lesser sentences while many of the 66 people originally accused were let off due to lack of evidence.

The Gujarat riots will always remain a blot in India's history. By being the head of the state at the time of the riots, Prime Minister Narendra Modi's legacy will always be soured by a reference to these riots. At worst, the Modi government in Gujarat actively abetted the rioters by instructing the police to 'let the outrage of the people find an expression'. At best, it failed miserably to act to effectively control the marauding mobs. Either way, it failed in its paramount duty to protect all citizens of the state, irrespective of their caste, religion or creed or as former Prime Minister Vajpayee put it - to follow 'Rajdharma'.

In this case, as expected, the foot soldiers are the ones who are finally implicated. Most of them have probably received very little education. They were probably swayed by the rhetoric of their leaders who egged them to go and commit this beastly crime. There was a reference in the verdict to former Parliamentarian Ehsan Jaffri's provocation of firing from his gun triggering the mob's fury. Well, when a mob of several hundred people gathers outside your home and the police and other high ranking government officials ignore your calls for help, anyone would resort to every possible way to try and save one's family.

As I have said in the past, courts can only act on the basis of evidence. If no evidence has been found, the accused are let off. That does not mean a crime has not happened. It just means that there is no evidence to prove it. The guilty just got lucky. So, while the foot soldiers have been sentenced, the masterminds of the crime continue to roam free.

While much of India has moved on, giving the Narendra Modi-led BJP a massive majority in Parliament, the ghost of Godhra and the carnage after will continue to haunt people who have been affected. Their lives changed that day forever.

The last has not yet been said about the Gujarat riots. It will still be a while before all cases pertaining to this horrible period of India's history are closed for good. We must all hope that such pogroms never happen in this country again.

Saturday, June 18, 2016

The futility of a lot of Whatsapp groups



The Verge reported recently that the number of Whatsapp and Facebook messenger messages per day was three times that of the humble SMS. Around 60 billion Whatsapp and FB messenger messages are sent daily worldwide compared to only 20 billion text messages!

When I look at my Chats tab in Whatsapp on my iPhone, I find a whole lot of them are group chats. While some of these groups are useful and actually serve as a very useful communication tool, a large number of them are very quiet or worse - overactive with junk. Meaningless gibberish in the form of advice on life, irritating stock pictures of nature with enough 'gyaan' to put a sage to shame and sickening jokes that are not at all funny plague most Whatsapp groups that do not have strict rules in place about not posting such spam.

The Unreal Times, a source of news that is as reputed as The Verge estimates that almost two-thirds of the messages on Whatsapp are junk that make no sense at all. Ok, I made that up.

But honestly, I have most of my Whatsapp groups on Mute for the next one year. And as soon as they become unmuted after the year, I plan to mute them again, if possible forever. You might ask why I cannot simply leave the group? Trouble is I've been added by close friends who would be offended if I left. There's a price one must pay for everything in this world!

Another large number of groups are deafeningly silent. You need to literally shake them into being active. Now these are where your close friends or family are. You like communicating with them. You want to stay in touch. This is a great avenue to do this. But people get so busy with their day to day lives that they don't have time for such groups. Maybe they should be just destroyed!

I think the presence of the junk Whatsapp groups partially cause the good groups to become silent. People are just too fatigued by the sheer number of messages they get.

Which makes me think, maybe Whatsapp should charging a very small amount for each message sent. That way, people would use it sensibly and not post meaningless crap that irritates the hell out of everyone. 

Friday, June 10, 2016

Some unsolicited career advice for those starting out


I have been working for about seventeen years now. My first job was as a part time software developer in my mother's friend's company. Currently, I am a Co-Founder and Director of Patient Services at NephroPlus. As I keep saying, my only qualification for my current job is my GFR! Surprisingly, I have never worked in the area of my primary educational qualification which was in Chemical Engineering.

One thing that I have realised after all these years is that if you want to make yourself count in things that matter in any job, you need to understand the numbers, the financial part of it all. Whether it is software development or healthcare or even in an academic institution, money is one of the most important things in any venture. If you look at for-profit entities, this is pretty obvious. The company has to make money. It has to make surplus cash after accounting for all expenses. While this may not happen immediately, in the long run this has to happen for the company to survive.

Even in the case of not-for-profit entities, it is critical for enough funds to be available for the day-to-day operations to be run smoothly. So, though the entity may not generate surplus cash, it is important for some other balancing mechanism to be in place.

Let's face it: in any entity, cash is king. You need cash to run your entity. You need cash to keep it sustainable. You need cash to oil the machinery.

This is probably the only common thread across all organisations.

Therefore, you need to understand the numbers to be taken seriously in any organisation. You need to understand the various financial terms. You need to be well-versed with accounting principles. You need to be very comfortable with financial statements and how to read them.

Now, you may be content being good at your domain and you may find numbers very boring or worse, intimidating. But then, you must also be content not rising to the very top of your organisation. You must also be content not being involved in the decisions that matter.

The best way to get yourself setup for a position of importance is to do an MBA or an equivalent. An MBA gives you the necessary education to become adept at these things. There are many other ways to gain this knowledge. The important thing is to realise early enough that you need to learn these things and to make a plan to do so.

After all, that famous Bollywood actor of yesteryear, Mahmood had said in one of his films: The WHOLE thing is that, ke bhaiyya sabse bada rupaiyya!

Sunday, June 5, 2016

Indian dialysis patients, please hold your horses


The internet has suddenly been agog with news about the Wearable Artificial Kidney. Many articles did the rounds about the trial on seven patients for 24 hours straight. Many Indian patients and well-wishers got excited about this news and started dreaming of the day when they could simply wrap a belt around their stomachs and live an untethered life free of diet and fluid restrictions.

My advice to them: hold your excitement.

So, here's the truth: the device, though very exciting and the first real innovation in dialysis technology in decades is still in its very early stages. As you might have read in the article:

"this trial of the device was stopped after the seventh patient because of technical problems with the device. These included the excessive formation of carbon dioxide gas bubbles in the dialysis solution, and intermittent variations in solution and blood flow."

There will be many such roadblocks that will need to be solved. I have had the good fortune to meet with Dr. Victor Gura, the brain behind the WAK. Dr. Gura is an extremely passionate man, an exceptional genius and has the determination to see this project through. But it will take time. Rome, they say, wasn't built in a day. Neither will the WAK.



Once the WAK is ready for commercial production (and I estimate this to take another five years at the very least), it will be another ten years for it to come to India, if at all.

I sound very pessimistic but take a look at a related fact. The NxStage System One, which is the world's first portable hemodialysis machine has been available in the US for at least a decade now. There is no sign of the machine coming to India. India is not even on the radar of the company. This is quite understandable because most Indians pay for their healthcare expenses out of pocket and would not be able to afford the machine or the recurring costs of the supplies. Government and private insurance coverage is also minimal. Most insurance coverages are also restrictive and have low caps.

Keeping all this in mind, I estimate the WAK to become available for patients like me and you only after 15 years at the very least. So, we must still keep our excitement under check!

Wednesday, May 25, 2016

Ganga behti ho kyun?



I've been haunted by this song by Bhupen Hazarika recently. Addressed to the River Ganga, it moans the general decline of human values and the suffering of humanity, questioning the river on why she does not do anything about it?

Here is a YouTube video of the song:



Here are the awesome lyrics of the song (taken from Hindi Tracks) by Pandit Narendra Sharma:

बिस्तिर्नो पारोरे, अशंख्य जोनोरे  
हाहाकार खुनिऊ निशोब्दे निरोबे 
बुढ़ा लुइत तुमि, बुढ़ा लुइत बुआ कियो ?

विस्तार है आपार, प्रजा दोनों पार
करे हाहाकार निःशब्द सदा 
ओ गंगा तुम, गंगा बहती हो क्यूँ ?

नैतिकता नष्ट हुई, मानवता भ्रष्ट हुई
निर्लज्ज भाव से बहती हो क्यूँ ?
इतिहास की पुकार, करे हुंकार
ओ गंगा की धार, निर्बल जन को
सबल-संग्रामी, समग्रोगामी
बनाती नहीं हो क्यूँ ?

विस्तार है अपार, प्रजा दोनों पार
करे हाहाकार निःशब्द सदा 
ओ गंगा तुम, गंगा बहती हो क्यूँ ? 

अनपढ़ जन, अक्षरहिन
अनगीन जन, खाद्यविहीन
नेत्रविहीन दिक्षमौन हो क्यूँ ? 

इतिहास की पुकार, करे हुंकार
ओ गंगा की धार, निर्बल जन को
सबल-संग्रामी, समग्रोगामी
बनाती नहीं हो क्यूँ ?

विस्तार है अपार, प्रजा दोनों पार
करे हाहाकार निःशब्द सदा 
ओ गंगा तुम, गंगा बहती हो क्यूँ ?

व्यक्ति रहे व्यक्ति केंद्रित
सकल समाज व्यक्तित्व रहित
निष्प्राण समाज को छोड़ती न क्यूँ ? 

इतिहास की पुकार, करे हुंकार
ओ गंगा की धार, निर्बल जन को
सबल-संग्रामी, समग्रोगामी
बनाती नहीं हो क्यूँ ?

विस्तार है अपार, प्रजा दोनों पार
करे हाहाकार निःशब्द सदा 
ओ गंगा तुम, गंगा बहती हो क्यूँ ?

रुदस्विनी क्यूँ न रहीं ?
तुम निश्चय चितन नहीं
प्राणों में प्रेरणा देती न क्यूँ ? 
उनमद अवमी कुरुक्षेत्रग्रमी
गंगे जननी, नव भारत में
भीष्मरूपी सुतसमरजयी जनती नहीं हो क्यूँ ? 

विस्तार है अपार, प्रजा दोनों पार
करे हाहाकार, निःशब्द सदा 
ओ गंगा तुम, गंगा बहती हो क्यूँ ?
ओ गंगा तुम, ओ गंगा तुम 
गंगा तुम, ओ गंगा तुम 
गंगा... बहती हो क्यूँ ? 

Wednesday, May 18, 2016

Completed ten years of home hemodialysis!



A few days back, I completed ten years of home hemodialysis. When I look back at that time, I think I was quite brave to take this modality up. There were barely a handful of people in India doing home hemo and no one that I had come across was doing daily nocturnal home hemo - the modality I was planning to adopt. If the circumstances of that time faced me today, I doubt if I would ever take that up.

Today, after ten years of taking the plunge, I can safely say that I am alive today only because of this modality. Yes, there are many on regular, thrice a week hospital-based dialysis who have been on dialysis for longer than I have been. However, one major difference between them and me is the level of 'compliance'. Now, that's not my favourite word in the dictionary but it is true - I am an extremely non-compliant patient when it comes to diet and fluid.

My weight gain between sessions (with daily dialysis) is at the very least 2.5 litres and at times goes to 4 litres. Even with daily dialysis, I have developed heart issues. I am pretty certain my heart would not have tolerated those large weight gains on regular thrice-weekly dialysis. Or I would have had to restrict myself so much that I would not have found life worth living any more.

I absolutely need to thank some people for enabling me to opt for this modality.

First and foremost, my nephrologist at the time, Dr. Girish Narayen. He was the one who told me about this modality. Only after he mentioned this, did I get onto the internet looking for more information and start the whole process. If he would not have told me about it and sowed the seed, I would never have even begun.

What can I say about Jayaram Reddy? I knew Jayaram from KIMS Hospital where I was undergoing hemodialysis at that time. Jayaram, to me was nothing short of superman! He was an expert cannulator. He could handle emergencies that happened in the dialysis centre expertly. He also was tremendously confident in his own abilities. I remember asking him if he would come home and do my dialysis. He readily agreed. Again, if it wasn't for Jayaram, I would never have dared to actually get started.

My parents played a huge role in supporting me. Without their encouragement and continuous help, this would not have happened. Right from coming with me to Mumbai and visiting people who were doing hemodialysis at home to arranging the funds to buy the machine and RO plant at home to actually supervising the entire setup, they have been there at every stage of this decade.

A lot of what I have done in my life today is thanks to daily nocturnal home hemodialysis. And I intend to go on for much longer!

Wednesday, May 11, 2016

Spare a thought, shed a tear


In health care, seeing misery, suffering and even death becomes quite commonplace. Doctors, nurses, and dialysis technicians especially see this on a daily basis. People coming in breathless into the dialysis centre, people getting cramps during dialysis, going into hypotension, the needles paining endlessly are all things seen quite commonly in a dialysis centre.

In the beginning, staff working in a dialysis centre and nephrologists probably gets quite upset and tries to do a lot to bring some relief. The first death nearly always shakes them up. Over time however, they would see so much of it that they would become immune to these sights.

Obviously I don't blame them. I myself have become sort of stone-hearted over the years. I remember myself going into a room and crying bitterly when I got to know of a fellow-patient's death. These days, I react much less emotionally.

For the patient and the family, however, the suffering is intense. It can bring about a deluge of emotions apart from the obvious physical stress. They don't see it from a distance. They experience it first hand and there is no such thing as 'getting used to suffering'.

Health care, however mired it may get in spreadsheets, is basically a noble profession. It is therefore important for people in this sector to continue to have an element of compassion in their work. Without this, it all counts for naught. However successful you might be as a doctor, however well you may have done as a nurse, without compassion, you have failed in your basic duty - of caring for another human being.

There are always two ways of looking at something. When you picture yourself in the patient's shoes, compassion will come naturally. Remember, you are not isolated from disease. Just because you are in health care does not mean you won't fall sick. A hospital owner may be diagnosed with a chronic illness. A technician may himself one day need dialysis. So, be kind to the suffering patient. Think of his problems. Realise what she is going through. Don't belittle it. Every individual has a different ability to bear pain and discomfort.

"Therefore, send not to know. 
For whom the bell tolls, It tolls for thee."