Saturday, January 28, 2017

My take on the first half of PM Modi's first term

We are about half-way into Prime Minister Narendra Modi's first term in Government. With what was the biggest mandate anyone has been elected with in recent times, he was sworn in as India's Prime Minister in 2014. We are about half way into his first term. I say 'first term', not because I am certain this will not be his only term, but because it well may not be. Given his performance and the terribly bad performance of the opposition, notably the Congress, it would be surprising if he does not get re-elected.

Overall, I think the performance of the government has been good. There have been some very good initiatives in various areas - the economy, foreign relations, fighting corruption etc. Some would argue that a lot of it is more style than substance. However, there have been many genuine achievements. Yes, some have probably not been seen through. Many of the initiatives will take much longer to complete and be judged. Some will be continuous and will not have a defined end date.

I am, what people call 'right-of-centre' in my thinking. This probably makes me slightly biased in favour of Modi than against him. However, I think I am very balanced in my assessment of the man. I have written a number of blog posts on what he did wrong and many blog posts on what he did right.

I am too naive to see behind the scenes (if there was anything like that) the actual reason for demonetisation. I remember listening to the speech on November 8th and feeling that it was a master stroke against corruption and black money. A lot has been written about the poor implementation and even hidden agendas. I really don't have an opinion on this.

What rankles me still is that the man was responsible for the 2002 riots. I was reminded yet again about the horrors of Gujarat at that time when I happened to see a part of 'Schindler's List' playing a few days back on television on the occasion of Holocaust Remembrance Day. The terror in the eyes of the Jews being massacred by the Nazis was gut-wrenching to say the least. Well, yes, the comparison is too far-fetched. 6 million Jews were killed whereas about a thousand Muslims and Hindus together were killed in 2002. To me, what is similar is the feeling of being victimised by the state for being born in a particular religion.

Modi will never be forgiven by the families of those that were slaughtered in those horrible riots. To those who say that the Congress did the same with the Sikhs, I agree with them entirely. We cannot justify one wrong by citing another wrong. Both the actions were completely wrong. Both the leaders at the time must be blamed.

So, while Modi can be praised for the good he does, he must also be blamed for his wrongs. We cannot justify one by the other.

Most people of India apart from the Muslims, I believe, have moved on. For the others, he will always remind them of 2002. Fair enough. At the end of the day, if an election is held today, he will win hands down. That's the way democracy works. We must accept it and also move on.

Thursday, January 19, 2017

My address to the United Nations opening of the NGO Committee for Rare Diseases

I spoke (via video) at the United Nations opening of the NGO Committee of Rare Diseases recently. The committee aims to address issues pertaining to rare disease patients across the globe.

I spoke about the issues of access to drugs in developing countries. I also said that the work of the committee can help patients from countries like India. Here, patients did not have access to drugs that can cure them even though the drugs were available elsewhere in the world.

This is a picture from the event.

Tuesday, January 3, 2017

Encouraging healthcare workers to admit mistakes without the fear of retribution

Recently, someone on Facebook posted this link. It described a doctor who made a mistake during a procedure and refused to admit it. Later, when he remembered an incident from childhood when his doctor had done something similar to him as the patient, he went back and apologised to the patient. This led me to think about simple mistakes that healthcare workers make.

We all find it difficult to admit our mistakes. It is human nature. However, when there is a possibility of being penalised for the mistake, then the disincentive to admit it is even higher. This can lead to some dangerous consequences.

Let us take an example. A nurse in a hospital has to do a number of procedures ranging from the really simple to some that are fairly complex. Let us say that while opening a syringe, the needle unintentionally touched a non-sterile surface. The best thing to do would be to discard the syringe and use a new one. However, if the hospital had a stringent inventory control process and the staff was penalised or scolded for using excess consumables, then what was the nurse likely to do?

Human nature would make him continue to use the same syringe. Who wanted to be penalised for this? Who wanted to answer questions from the audit team? At the end of the day, the patient would be the one who would suffer the most. This could potentially cause a serious infection depending on what the syringe was being used for.

So, while it is important for the Inventory team to do its job and ensure that operations are run in a prudent manner, hospital authorities need to figure out ways by which situations like the above can be avoided. While Inventory shortages were easy to identify, it is very difficult to identify the real cause of, in this case, an infection. Often, from the point when something like this happened to it actually manifesting itself in the form of symptoms, a lot of time has passed. So many things could have happened in the interim. How can anyone, then pinpoint that usage of that contaminated syringe caused the infection? This makes it easier for the nurse to continue to use the syringe rather than discard it and take a new one and then be reprimanded by the authorities for not being more careful.

What could be the possible solutions?

I think the first thing that needs to be done is to remove any financial penalty on the individual that commits the mistake. This can be the worst way to fix the issue. Assuming that a financial penalty, (especially when the stakes are so high) would cause the staff to be more careful in such cases is wrong.

Hospitals should allow for such instances while putting SOPs in place. Staff should be encouraged to document such instances so that audits can take these into account without any reprimands or penalties.

In some cases, proper training and education can also help avoid repeated mistakes.

Healthcare poses such challenges all the time. There is a very thin line between prudence and foolishness. Crossing this line can harm patients. At times, this harm can be irreversible. It is upon the administrators to identify the ways in which this can happen and fix the issues.