No Holds Barred

Whither Survival Instinct

2026-01-14T03:55:00.000-08:00

The Statesman 13th January 2026

Survival instinct refers to the desire that an animal has for self- preservation - behaviours designed to protect an individual from harm and ensure survival and propagation of a species. When humans were in their hunter gatherer phase, an important survival skill was how to protect themselves from potential predators. People spent time finding ways to hone their own fitness, ability to use stealth, as well as the tools that would aid them. In cases where the predator was too powerful for one individual to overpower, people learnt to form groups and pool their might and energy to confront the predator collectively. Today, daunting and more complex man-made challenges threaten us, yet we seem to delight in adding fuel to the fire.

Whereas focused, task specific chatbots (narrow AI) are useful for daily chores, and large language models (LLMs) aid with research, what is unclear is: why are we allowing a more advanced entity like agentic AI, that has the potential to marginalize us, to be created?

The fastest computer, Frontier, can perform a quintillion calculations per second (exaflops). Even regular computers, working at nanoseconds, are far quicker than humans who take milliseconds to compute. AI can arrive at medical diagnoses based on data inputs from diagnostic machines, and can even create predictive mathematical models. It can generate entire speeches or videos based on simple prompts in mere minutes. A Goldman Sachs prediction estimates that 3-14% people could be at risk of losing their jobs to AI in the coming years.

Advanced AI is encroaching on human relationships. Several contemporary films like ‘Her,’ ‘Ich Bin Din Mensch’ portray bonds between humans and AI that are concerningly deep. It has even been programmed to act as a psychologist – sometimes with tragic consequences. It helps curate the content we see, often without our knowledge or explicit consent.

Each task or practice in which AI replaces humans leads to the loss of genuine skill and craftsmanship. As we keep outsourcing communication, research, planning, and creativity we are becoming less adept at all of them, not to mention, far lazier. The result is that we are losing our instinct, our nuanced communication which defines our personality, and our ability to search for words. The calculator has blunted our ability to do quick mental maths. A generation of mentally agile shopkeepers who could quickly total revenues in their minds are reduced to tapping out calculator keys.

Not content with that, we are even sharing our planet’s scarce and precious energy resources with AI. As per Anthropocene, the average energy consumption is 79 Gigajoules per person per year (1 Gigajoule is equal to the energy of 26 litres of Gasoline). This is more than enough to maintain a decent standard of living (for many lifestyle metrics even 30 GJ would be adequate). However, dozens of developing countries, several of them in Africa, do not have the energy reserves required for providing this to their citizens.

On the other hand, energy consumed by advanced AI is an order of magnitude more than humans. The human brain consumes about 20 joules per second whereas computers need thousands of joules per second just to generate simple text. An article from Frontiers in Artificial intelligence in 2023 stated that human brains were at least 9 x 10⁸ times more energy efficient than computers. There is an energy crisis facing the planet and environmentalists advocate for renewable energy to save the planet from global warming. Millions wallow in poverty. In this scenario does it make sense to allocate such a huge share of resources to an industry that can create software that may ultimately dispense with us?

Another self- defeating aspect is our willingness to wantonly and relentlessly destroy the one sure thing that sustains us all - Nature.

A recent study published in Herpetology Notes described how a few members of a rare species called the Galaxy frog were discovered in the Western Ghats in 2020. However, by 2021, they were nowhere to be seen. Apparently, groups of unmindful photographers who heard of their existence had overturned logs, used strong flash bulbs, and held the frogs without gloves causing them to die out, as per local witnesses.

Trees, forests, islands and even mountains are being sacrificed to the insatiable juggernaut of some grandiose and unsustainable level of ‘development.’ Wildlife has decreased by 65% and even national highways go through forests. Earth’s forest cover has dwindled from 48% in 1900 to about 31% ((equivalent to about 4.06 billion hectares) as per reports from the Forest Stewardship Council and Food and Agricultural Organisation (UN). Russia is blessed with the highest forest share in the planet at 20%.

On a recent visit to Coorg, I was delighted to walk past several untouched, ‘sacred forests’ – the locals believe that the abode of the deity is the entire forest and treat it as divine, therefore people are not permitted to trespass - barring one week of worship at a specified corner of the forest once a year. This tradition of sacred forests is present in other parts of the world as well. Sadly, the number of such open shrines are dwindling. One fifth of the world’s forests are in protected areas, but with ecological safeguards being overturned by vested business influences that seek to mine ores and minerals, we do not know how long they will remain safe. Since advanced technology helps people reach deeper depths in the ocean, even the ocean floor is not immune to drilling plans by humanity. Nothing is left untouched!

We have only to see the intricate patterns in nature, be it wasps using fig fruits as nurseries for their little ones, the exquisite nests of birds and spiders, towering majestic tree species and a myriad other stunning colourful life forms – to feel a sense of reverence and awe.

It takes decades for one tree to develop a thick bark, an extensive canopy, and a deep system of rootlets within the soil, for mosses and lichens to cover its trunk and bees, birds, insects and so may arboreal mammals to call it their long-term home. How can we wilfully lose such precious ecosystems? Especially when, in some cases, we lose them just for hedonistic gain like fancier furniture or land for real estate. A hundred-year-old tree cannot be substituted for by a recently planted sapling (the so-called compensatory reforestation).

In the prevailing consumerist environment, the frenetic pursuit to acquire items with huge price tags often blunts our appreciation of the things that are truly priceless. Viewing money as the ultimate panacea blinds us to its ability to erode aspects of the chance to live a longer, healthier, and happier life. As a doctor, I am astounded when successful, experienced executives already drawing stratospheric salaries are willing to trade good health, time for self- reflection and time with family for a further increment at the workplace.

Families are torn asunder when happily co-existing siblings begin to fight over inheritance. Many an aging person is abandoned by their children after signing off their property to them -they are undeservingly perceived as a mere source of money rather than being appreciated for the guardians and mentors that they have been. Humanity zealously clacks away on keyboards while in the background sits a disconsolate child, relying on their own screen for company, or a furry pet desperate for a pat. Although humans, like all species, are endowed with a profound parenting instinct, it is conceivable that the constant lure of money has subtly altered our mental blueprint. Consequentially, the proclivity to nurture future generations seems to be subverted towards nurturing megalithic corporations and individual bank balances instead.

We are reaching the event horizon of survival as a species. A species that has collectively made it through so many calamities, most recently the COVID pandemic, surely has the resources deep within to weather any storm. The Pandemic, in fact, underlined that it was human innovation using human molecules, human kindness and human collaboration that brought us out of the tunnel.

Perhaps our learning from this experience should be that humanity has reached a point of sufficiency. Do we really need further advancements in AI, especially with the added environmental price tag? Instead, we would do well to work on our own programming – to revert to developing our own potential, most importantly by thinking ourselves. It is time to get intelligent!

Banished without even being heard ?

2025-08-17T08:02:00.000-07:00

The Statesman, August 15th (Independence Day)

The news about the recent Supreme Court judgement on street animals came as a shock and surprise to many. The judgement basically pronounces that street dogs be removed completely from the streets of Delhi and sent permanently to supervised shelters in the outskirts in a time bound manner.

Though the judgement stems from a pure hearted intent to protect children from fatal diseases like rabies contracted from dog bites, the solution offered is harsh and can adversely affect the welfare of other groups in the city. Just as our children deserve safety and protection, so do the species we cohabit with. The judgement is tantamount to playing God as it literally removes an entire subspecies from its natural habitat. It goes against the friendly vibe of ‘the world is one family’ if we cannot try to coexist peacefully with street dogs (with the many useful checks and balances already in place). The oft exchanged reverent blessing of ‘Om Sarve Bhavantu Sukhinah’ (may all beings be happy) starts sounding hollow when not practised on ground.

Other aspects of the judgement are disquieting as well.

To begin with, the two judges who gave the ruling made it clear that they will confine themselves only to taking the views of the government representatives. The government, as recently as 2023, notified a set of rules called the Animal Birth Control (ABC) rules as an amendment to the prevention of Cruelty to Animals Act 1960. These are based on international models (WHO) and were arrived at after extensive consultation with animal welfare organisations and studying court judgements on animal issues. The rules unambiguously specify that animals cannot be dislocated from their current habitats in the city. However, in this recent court hearing, the government representatives themselves have opined that stray dogs should be removed and relocated to shelters. This complete volte face undermines the hard work of all the animal welfare agencies that worked together to frame these rules and ignores important recommendations of seasoned animal experts.

That the judges resolutely declined to entertain inputs from any other groups of concerned citizens/animal experts goes against the central tenet of a fair judicial proceeding. The entire framework of litigation is based on an equal opportunity for those on both sides of an argument to be heard. The perspective of one side must not be summarily dismissed or dispensed with. It does not imbue citizens with a sense of security if their voice is not heard.

The ‘accused’ in this case, vulnerable animals who cannot speak for themselves, have been unfairly bracketed into one single cohort and been left without any representation. How can an entire species be banished from a city without a formal procedure and detailed deliberations with all stakeholders? Especially when intent to cause harm cannot be ascribed to them as they do not have the intellect of humans. When even the most depraved criminals - such as those who were involved in the deliberate gang rape of Nirbhaya, are given several chances to be heard, to appeal etc. how is it that nobody is allowed/invited to present the case for the welfare of simple street dogs?

Though rabies has certainly contributed to the deaths of a few children, the number of cases would be far less compared to other medical problems like malnutrition or infectious diseases related to poor water sanitation that takes the lives of thousands of children. These prevailing problems have been around for decades, yet have not attracted such extreme measures, positive or negative.

One learned judge has questioned that when dogs are taken up for sterilization, why are they put back in the same place that they were taken from? While judges may be very experienced in the application of human laws, being conversant with some of the laws of Nature is equally important. It is well established that several species of animals, including dogs, are territorial. Whereas humans can buy and formally possess land, animals mark out their territory in different ways (the description of which is outside the scope of this article). Suffice it to say that dogs feel just as disoriented when removed from their usual habitat as internally or externally displaced humans do. Hence the key decision by the court wherein it has ordered that 5000 dogs should be rounded up and sent to shelters in the next 8 weeks (and the rest thereafter), can unintentionally come across as cruelty to animals. Moreover, an entire species cannot be penalised for the bites by a few, just as all human males cannot be held responsible for the many incidents of domestic violence or sexual assaults.

The logistics of eventually rounding up close to 10 lakh dogs are gargantuan. There are few private and government veterinary hospitals dedicated to animals in Delhi/NCR. Since the numbers of dogs that will suddenly be placed under government care are so large, has the court truly satisfied itself that there are enough shelters, veterinary doctors, and animal handlers to deal with this excess load? If facilities are overwhelmed like they were in Covid, we can safely assume that several dogs will be underfed, ill-treated and packed unceremoniously into crowded spaces. Are the judges comfortable with this scenario? There are enough relevant legislations pertaining to street dogs (the Prevention of Cruelty to Animals Act, 1960, Section 325 of BNS) Constitutional safeguards (Articles 48A, 51A), state list rules (item 14), and previous judgements (Animal Welfare Board of India vs Nagaraja & Ors; 2014), to name a few, which ensure their personal safety. It is certainly the inherent responsibility of courts to ensure that pre-existing laws are not violated in any manner.

If MCD officials are pressed into rounding up stray dogs for the next couple of months or years, would we see an even greater pile up of garbage and dirt in the city, clogged drains, and water logging, or would the government hire more MCD personnel to execute their regular duties satisfactorily? The judgement also decrees that a dog which inflicts a bite on human is to be caught in 4 hours. This judicial proclamation compels MCD and other officials to give dog related issues precedence over their other responsibilities. This is likely to lead to a collapse of normal civic services for citizens.

The judgement has far-reaching negative social consequences as well. Several citizens of Delhi are dog lovers. Many of them have a deep bond with street dogs, consider dogs a part of their family, spend time and their hard-earned money feeding them day and night, giving them the affection they deserve and protecting them from the ravages of city life. Snatching these dogs away from their human carers is like forcibly separating children from their parents-an incredibly insensitive and mean gesture. It can leave these citizens feeling depressed and bereaved. Do their lordships want to bring about an air of gloom in the city and send several kind hearted citizens down a spiral of sorrow, anxiety, and mental health problems? Will their lordships take the moral responsibility of this new catastrophe?

The importance of dogs in the lives of humans is well known and cannot be stressed enough: whether in their role as friends, saviours, healers, disaster squad dogs, sniffer police dogs, guide dogs for the blind and so on. Dogs guard homes and offices and their presence as pets is very therapeutic. The recent judgement forbids citizens from adopting any of these stray dogs as pets. This is bizarre, as it would contribute partly to solving the problem. Also, it fosters discrimination between individuals as poorer citizens who may like to adopt a pet may not be able to afford exorbitant pedigreed dogs on their meagre salaries. Is keeping a pet dog going to become the privilege of the rich? Are we class conscious humans going to create a class divide amongst animals too? Will we have a stratification among dogs where only adopted pets get to live a good quality of life and Indies/strays get banished to shelters?

It is indeed very painful to see a child or an elderly person suffer injuries whether it is a premeditated attack by a human criminal or an accidental dog bite. Pro-active and sensible steps taken to ensure the physical safety of our loved ones are very welcome and necessary but they should be such that we do not sacrifice our humanity or our sense of balance and proportion.

A traveller's view

2025-07-03T10:55:00.000-07:00

The Statesman May 2025

An increasing number of people use public transport for economic reasons, environmental concerns and so on. The recent collapse of a valuable customer service, Blusmart, robbed the traveller community of one robust travel option. Some of Blusmart’s likeable features included a homogeneity of cars, speed limit monitoring, good cooling, and assured rides. Being a frequent user of several app-based cab services, I have benefitted from the comfort of having such a facility yet also reflected on some gaps that if addressed, can truly enhance the experience for the user.

Currently, luck appears to play a big part in the sort of vehicle one gets when one books a cab. There do not appear to be any standards laid down to ensure basic quality of the interiors or exteriors of the cars in the fleet.Even dirty, dented, or dilapidated cars have on occasion been given the tag of a ‘prime sedan.’ Whereas, the proud owner of such a sedan may be as pleased as punch, the customer is most certainly not! The air you inhale during the ride hinges a lot on the habits of the driver. If the driver smokes, you may well be imbibing the stale aroma of cigarette smoke, and if the driver uses a purifier, there are pleasant smells wafting about. Also, the tools you get at your disposal, to beat the heat and humidity vary from mini fans to air conditioners to just handles to slide down the windows. Perhaps a quick glance at your horoscope may well alert you as to what to anticipate during the ride that day!

So too with drivers. Most drive reasonably well but their habits and personalities can impact your day.Sometimes, passengers who have just booked a cab may be deluged with unnecessary calls from the drivers. For commuters using the precious morning time to finish off their breakfast or complete their dressing, it is an unwelcome intrusion. Many cab drivers hail from states other than Delhi and are unfamiliar with Delhi roads. This puts them completely at the mercy of Google maps, a whimsical navigation tool. Often enough, a flyover or two turns placed close to each other can throw the driver off route with adverse time consequences for the passenger. Since passengers make phone calls during the journey and responses are clearly heard in the close confines of the car, a few drivers eavesdrop and then join in the conversation as if it is the most natural thing in the world.For example, if I give any medicine related instructions to patients or staff, I find that the driver who has guessed my profession, will suddenly begin telling me about various ailments in his body without any preamble and without even inquiring what my speciality is!

Many of these micro level issues can be easily addressed if the cab services are held accountable for monitoring the basic cleanliness level of cars, and providing hired drivers orientation workshops on Delhi routes, and some tips on customer interaction.

At a macro level, these app based services are given special facilities by the regulators. They are allowed ‘dynamic pricing’ which allows them to charge different rates for the same distance. Thus, the business fluctuations are transferred to the commuters who must absorb the problems of short supply of drivers. In fact, now there is an explicit choice to tip the driver and get available cabs quicker. This does not seem right. If people were to ‘tip’ doctors in the emergency room or judges for jumping the queue or getting faster services, it would amount to corruption.Yet in this essential service, this feature is allowed which then favours those with extra funds to spare.

Since the app-based cars take customers from their homes to workplaces and shopping malls etc., they have very precise data on customers – where they live, where they work, where they like to shop and travel etc. We have no way of knowing whether this information is sold and to whom. It makes customers vulnerable. The app service also uses clients to get feedback on the car and driver; things they themselves should vet in the first place. My own experiences of using these cab services range from the downright scary to the truly pleasant. An unnerving journey one night was with a driver who doubled up as a music jockey during the journey. He commenced by playing songs with vulgar lyrics which were assiduously ignored by me. Not feeling satisfied he tur – ned around and specifically asked me whether I was enjoying the (cheap) music. I politely de c li n ed and said our generation preferred slow ghazals. I hoped that the reference to an older generation might make him disinterested in the passenger. However, he instead started playing different ghazals and after each one would turn round to stare at me, repeatedly asking whether I had liked it. Apart from his constant turning around in his seat being risky for our collective safety, it made me truly uncomfortable. I did not really know what I could to do to change the situation at that late hour. I felt utter relief when I reached home. Another regrettable incident was when I was dumped unceremoniously on a dark road in front of a long boundary wall (the end of which was nowhere in sight) in the late evening wearing a sari, adorned with jewellery and carrying a heavy gift. The driver insisted that the journey map showed ‘done’ so I must exit from the car. I tried to appeal to his logic that the journey’s end should coincide with an entry gate or building at least but the driver was adamant that his responsibility to me had ended so I must disembark straightaway. No amount of reasoning or persuasion worked.Finally, I was forced to walk about 3/4ths of a kilometre on the dark stretch carrying a heavy load and looking nervously over my shoulder till I finally reached the entrance which was on the other side of the compound.

There are also many instances when the ride has been a truly joyful one. Some drivers are very courteous, wish you politely, keep to themselves, and will be good Samaritans when it matters, such as patiently waiting for you when you buy an urgent drug from a chemist en route. One elderly driver I happened to be journeying with swerved left a little sharply which resulted in a collision with two motorcyclists, one of whom got a few superficial injuries. I expected a fight to break out and feared for the old driver.The driver got out of his cab and offered to take the injured biker to any nearby hospital for wound dressing. I was very pleasantly surprised when the affected motorcyclists as well as the collected bystanders exhibited kindness to the aging driver and assured him that they would manage everything themselves, asking him to resume his journey. Clearly, Delhi at its best.

To conclude, app owner business teams can make the journey a most satisfying experience for the public should they put in a few more value-added services. The regulator should ensure that the overall average driver rating (across all drivers) is made publicly available. This will indirectly ensure a more thorough selection process. Travellers will stand to benefit.

The curse of Capitalism

2025-07-03T10:49:00.000-07:00

The Statesman March 25

Capitalism, the ‘saviour of the free world,’ was touted as an economic paradigm that incentivised effort, encouraged barter and most crucially, brought power back into the deserving hands of the masses of regular, hard-working people. Sadly, many of these objectives have not been achieved. Moreover, capitalism has generated some popular narratives and engendered ways of living and thinking that bear significant reexamination.

Power has once again become concentrated in fewer hands than ever before. A handful of corporate megaliths use their economic clout to stifle competition, effectively discouraging diversity. Additionally, the non level playing field thus created even blunts the pace of their own research, turning innovators into mere mass producers. For example, a well-known chip manufacturer, once ad mired for dynamically improving computer processing speeds, lazily plateaued into monotonously releasing slightly better versions of the same chip every year once they gained a sizable monopoly. Some tech mega brands that dominate the market coast comfortably every quarter more on the class consciousness of their loyal users rather than genuine upgrades of their products over time. Even revolutionary technology like the large language models of AI was deeply influenced by market forces.

A small cartel controlled the research which was as expensive as it was exclusive. It took a small start-up from China to shake things up. By providing a version that was a fraction of the cost and freely available to everyone, they totally changed the narrative. Capitalism justifies its own ideas and actions, while blaming others: The key ingredient to a fruitful business idea, as many executives will say, is ‘solving a common problem.’ Capitalism some times can create a problem, partially solve it to feign progress, and generate a new problem along the way. We notice how big firms in developed nations outsource production to third world countries, availing cheap labour rates and thus increasing their profits. They are welcomed by the officialdom in these countries on the premise that jobs are being created locally. However, these jobs are quite basic and often exploitative (underage workers, unsatisfactory working conditions etc.). Ironically, these profit hungry megaliths are not accused of taking away valuable jobs from their own country by outsourcing. Rather, the spotlight falls on foreign immigrants to their country ~ these are blamed for usurping local jobs. In fact, much of the employment taken up by these immigrants is that which local people shy away from doing. The lenses and metrics capitalism chooses to view overall economic progress ignores imp – ortant nuances.

One would think, rationally, that the indicator of a strong economy is the ability of the common man to sustain himself financially. When we look at India’s economic prosperity through the lens of GDP growth, it is easy to think that we are doing extremely well ~ due to the huge turnover of corporate powerhouses. However, this measuring tool masks the pitiable living circumstances for the myriad poor and thus is not very reliable. Capitalism has somehow normalised the discrepancy between senior managers of companies on business trips being put up at five-star hotels after journeying by business class and masons and bricklayers not getting even a decent dormitory to sleep in when they cross state boundaries to work. The narratives spawned by the big fish portray themselves in glowing terms while being a little derogatory about the smaller players. Robust small size enterprises are pejoratively termed ‘mom and pop’ shops. On the other hand, big conglomerates confer on themselves epithets like ‘unicorns,’ when they could well be labelled ‘King Kong’ enterprises (that destroy others in their path) for example. Likewise, NGOs sourcing funds (to help others) are dismissively deemed to be ‘begging’ for funds yet regular business companies pitching for funds (for their personal growth and profits) are painted as brave warriors who tamed the ‘sharks.’ Capitalism weaves itself into processes and subverts healthy trends: Capitalism is slowly seeping into various professional ecosystems and modifying them in ways that could be unsuitable. Take the world of medicine for example.

Rather than concentrating mainly on professional excellence and service with a smile, corporate hospitals are increasingly focusing on going deluxe. The outcome of hospitals simulating destination res or – ts comes at the cost of raised tariffs, out of the reach of many. The content of medical literature is also changing, with the incorporation of heavy amounts of (to my mind) unnecessary economic data. When we were young medical students, the articles written focused chiefly on the disease entity itself. Now a days, there seems to be a requirement to write about the economic implications of diseases and interventions. Is this necessary? Is the impact on the GDP an appropriate focus for students reading journals to learn the medical nuances of diseases? Similarly, nowadays, discussions in corporate hospital monthly meetings are as much about the revenues generated by various specialities such as cardiac, orthopaedic etc. as they are about hospital policies. Where once senior doctors on grand rounds held up patient charts for groups of students to scrutinize and learn from; we now have hospital administrative staff holding up excel sheets with graphs depicting departmental earnings and ‘educating’ doctors, nudging them to not ignore fiscal responsibilities to the hospital even while dealing with responsibilities to patients. Medical insurance companies in some countries have found a way to skim profit at every stage of a patient’s interaction, creating a new angle to medical care that denies access to many who severely need it simply because their life-threatening disease is not on a list of preap proved conditions. Doctors who take conservative approaches to diseases or choose gentler cures that take longer may well be blacklisted by insurance companies who prefer a quick solution or surgery. When did society agree that black suits should hold more power over healthcare decisions than white lab coats? Capitalism insists that the financial net worth of an individual overrides everything else: Well-wishers and professional psychologists alike tell us of the overriding importance of investing time and effort in no – urishing our souls, minds, bodies and becoming self-aware. Then along comes capitalism and persuades you that your bank balance overrides everything else. Many companies have a ruthless professional ethos that dictates employees must first and foremost be robust cogs in the professional wheel ~ and family, life, health, and liberty are lower on the rung of importance, firmly below corporate targets.

Clearly, capitalism has managed to trick us into believing that a rich slave is somehow freer than a poor one. Gullible executives grossly neglect their personal life and family chasing higher packages and designations in the corporate world. This often does not end well; the executives discover they are professionally dispensable when the company happens to downsize and the people who they have neglected at home for years are not exactly waiting for them with open arms. Capitalism persuades you that you must keep putting the details of your life out there on social media, to build your personal brand. The bigger the ‘influencer’ you become, the more wealth you could attract.

Slowly and surely, rather than products, it is humans who have become the advertisement. We have been persuaded to change our perspective from ‘I think, therefore I am’ (cogito ergo sum) ~ to ‘I influence therefore I am.’ Focus on money/profits contributes to severe lapses of judgement: Recent news carried stories of immigrants from third world countries deported back from the US. Amongst these were fellow Indians who sold valuable land, gave staggering sums of money to unscrupulous agents, got into debt, risked getting arrested or killed ~ all in the belief that it would improve their monetary prospects in the future in the US. Such is the illusion of success created by capitalism that it makes people leave the priceless comfort of home, family, and friends, and take a difficult gamble on making it big in a foreign land ~ likely after years of more sacrifice and struggle.

What is not clearly thought out, is that if the same vast sums of money were invested in the home country itself, the immigrant would have a likely chance of economic success here itself, in some form or another, while simultaneously being on more predictable and familiar territory along with the benefit of familial support. It is a similar desperation for profit that has often brought out the inhumane side of supervisors in charge of factory or agricultural workers. In Beed, Maharashtra, for example, you may have read of the harrowing tales of women workers forced by their contractors to undergo hysterectomies (often in unhygienic, unsafe conditions) just so that they do not have to take a day or two off from work during their periods. Rather than promote true merit as envisioned, capitalism has instead somehow spawned an environment where the act of generating profits (by hook or by crook) is itself deemed excellence. There seems to be no end goal with capitalism.

Considering the failings of capitalism, it is important to question some of its entrenched narratives. At an individual level, we can surely try and lead our lives on a much broader scale than that envisioned through the narrow pecuniary confines of Capitalism. As far as governments are concerned, they must put humans before banknotes. Much like the land ceilings which got rid of the Zamindari system, regulatory adjustments can put healthy limits on mega capitalism (e.g. no single entity can own more than 10 per cent market share) to encourage other players and strictly monitor monopolies and restrictive trade practices. Not getting unduly influenced by the profit-oriented outlook of capitalism is what will truly enrich mankind.

An Ageda for G 20 meet

2023-10-20T10:37:00.001-07:00

The Statesman, Sept 7 2023

There is much excitement about the G20 summit to be held in Delhi this week. The city is looking beautiful. We have Ashoka lions placed at regular intervals and cut-outs of Langurs to keep away the common monkey. For animal lovers like me, this gives an earthy feel. The G20 slogan ‘One Earth. One Family. One Future’ is very positive. This summit is a wonderful opportunity for world leaders to follow the spirit of the slogan and set a new narrative wherein ordinary citizens’ concerns are treated as paramount.

When we think of a country, we think foremost of its people and culture. When we travel to a country, we are enticed by its natural beauty, wildlife, and heritage monuments. Travellers are not attracted to a country for its GDP, armoury, or foreign relations. Yet, often, when our elected leaders return from international visits, newspapers are filled with headlines outlining the intricacies of negotiated arms deals, lauding them as milestone achievements for our country. Unfortunately, there is rarely any mention of shared concerns regarding the environment, gender, race, or citizens’ rights. These issues are systematically swept under the carpet by categorizing them as ‘internal problems.’ This is reminiscent of when domestic violence used to be considered a ‘personal, family issue’ until it reached a point where almost one in three women became affected.

A wiser triaging of topics that must be given importance is necessary. Considering that the most serious challenges citizens face today are environmental issues, mass migrations and human rights violations, it makes sense to keep them centre stage in global, political discussions.

Here are some of the issues many citizens would appreciate seeing addressed by the heads of state in the G20 summit. Resolutely putting true wealth forests, above superficial wealth, machine-generated banknotes: Today, most countries face significant environmental problems, such as the raging wildfires in Canada and Hawaii or the fast-sinking townships in our Himalayan foothills caused by unrestricted construction.

Despite this, serious discussions about a green future are relegated to the annual conference of parties (COP). The complex financial arrangements countries draft at the COP with respect to compensation for past carbon footprints are time-consuming. Nor have COPs achieved consensus on putting a hard stop to coal mining. Relying on a single annual global climate summit for dealing with a pandemic of daily natural catastrophes is incredibly inadequate. It may be wiser to take small steps towards environmental collaboration at each intergovernmental meet, starting with G20.

For example, India could build on its ancient culture of revering trees, including the Peepul, Ashok, Neem, Coconut, and Bodhi tree (where Gautam Buddha is said to have found enlightenment). This would resonate with many other cultures such as Japan and Madagascar for example (with their love for Cedar and Baobab trees respectively).

A joint declaration by a handful of nations to protect our common natural, green heritage of ancient trees and prevent even one tree above 25 years old from being cut, as well as rebuilding our lost forest cover, is important. A concrete target of increasing mixed species forest cover by 5 per cent annually for three years, followed by 1 per cent annually thereafter, is easily achievable and will preserve our most precious universal commodity – natural carbon sinks.

Cutting trees or clearing forests under the pretext of ‘development’ must now be declared a crime against mankind. It is ironic that large business houses are allowed licences to destroy the creations of God – pristine forests, while climate activists who destroy man-made paintings to raise awareness about the need for environmental protection are sentenced to years in prison.

Leaders also need to talk about rogue governments that thwart international aid to citizens for political reasons when extreme weather phenomena wipe out lives, houses, and livelihoods. A grave collective threat to mankind’s existence is nonbiodegradable plastic, which harms the environment greatly. Insidious micro-plastic creates several health hazards in our bodies, affecting many systems such as the endocrine and nervous systems and exacerbates cancer development. Leaders, while sipping tea in sustainable earthen ‘Kulhads,’ a lovely Indian lifestyle accompaniment, can work out modalities of banning plastic altogether, rather than allowing its mere tweaking to the still hugely damaging ‘bio-plastics’ Capitalism as a failing model: Though political coffers benefit greatly from capitalism, it is time to acknowledge that unchecked capitalism has proved to be a failure.

According to a recent Oxfam report, the top 1 per cent richest humans garnered 63 per cent of the total increase in wealth during the last 2-3 Covid years. At the other end of the financial spectrum, we find 47 per cent below the poverty line and 8 per cent of the world living in extreme poverty. Three billion people (out of a total of 8 billion) cannot afford a healthy diet. That millions remain entrenched in poverty indicates that this economic model is spectacularly inefficient on a larger scale. In other fields, ineffective models are quickly replaced. In medicine, for example, before any drug is licensed for actual use, it must surpass the efficacy of pre-existing drugs. For any surgical technique to be widely adopted it should have a high success rate across patients.

Given that only a small fraction of humanity has benefitted from it, capitalism needs huge overhauls or replacement. It is also truly concerning that a significant part of the economy of the world over is based on war, smoking, and illicit drugs sales. For example, the sales of U.S. military equipment to foreign governments rose 49 per cent in 2022. A joint resolution on implementing curbs on market shares of any one company to a maximum of 10-15 per cent will discourage monopolies, facilitate diversity, and spread economic prosperity among more citizens. Independent India abolished the Zamindari system, and put in place the land ceiling act (which sadly has been diluted in many states in more recent times) to curb excessive land ownership by individuals.

This experience and equitable thought make India ideally suited to usher in meaningful change for a more just distribution of market resources as well. Common justification for capitalism centres on the idea that without financial incentive, people would lose their desire to excel. This is debunked by the existence of several creative geniuses, who lived and died in penury, including Gauguin, Modigliani, De Kooning and Mirza Ghalib. Chore-burdened housewives are not paid, yet they create delicious food and decorate their houses stylishly.

The present model of capitalism does not suit today’s environmental needs. For an idea to be implemented or even researched, it must first prove its market viability (profitability). Due to this, we are losing out on scientific progress that could assist with the worsening climate change crisis. For example, fuel-driven cars are being replaced with electric ones but why not more research on faster versions of simple, light frame, human pedalled ones that would cut down on all external energy and keep human beings fitter too?

Human rights issues: Human rights discussions are frequently brushed under the carpet at important summits. Poorly executed military operations and botched up intelligence reports have often resulted in an unacceptable loss of civilian lives, conveniently glossed over as ‘collateral damage.’ The recently made movie ‘Oppenheimer’ reminded us of the most devastating face of collateral damage when entire cities full of civilians were blown up in Japan, in total contravention of wartime conventions (such as the Geneva convention). Some states in India have suffered unusually prolonged internet shutdowns due to ‘security reasons,’ due to which decent, innocent citizens have lost jobs, students have been unable to study and medical assistance has been difficult to find. There is no redressal or compensation for the loss of productivity, happiness, or destroyed futures.

Apart from the bugbear of unemployment, even citizens in secure jobs find it difficult to flourish. Academicians cannot publish research or direct theses that are unapproved by politicians, journalists are troubled and often jailed for speaking candidly. Artists and singers invited to a public event to perform, suddenly find their shows cancelled if their political leanings upset some official in charge. All these factors lead to a very poor quality of life for the average citizen. Citizens cannot speak freely in many countries specially when their ideology does not match that of the ruling party. In India, for example, elected representatives can freely expound their views on any topic as per their convenience from any forum at any time, with security forces helping with the arrangements for such ‘political rallies.’

On the other hand, citizens who want to express their views, or raise legitimate concerns are only allowed to do so in small designated areas and often treated very shabbily by uniformed policemen. When our Constitution unequivocally confirms the equality of all citizens, these differential rules are jarring. The lovely rural Indian ethos of village elders deliberating every evening on village issues under a large canopied tree (likely in several other countries too), can be magnified to a bigger stage with inclusive spaces for wise elder citizens to openly contribute their wisdom to leaders, with more women members and fewer Hookahs of course! It is unfortunate that when elected representatives of people meet, they prefer to talk more about arms sales, military alliances, and strategic relations rather than share concerns and ideas for the wellbeing of their citizens.

India can make a bold positive contribution at G20 by pulling out the world from the rut of discussing stale agendas to invigorating the hopes of citizens by discussing vital human topics on priority. For as Ellen Glasgow once said ‘The only difference between a rut and a grave are the dimensions.’

(The writer is a Delhi-based medical practitioner.)

Up in Smoke !

2023-03-30T09:12:00.000-07:00

The Statesman, March 28, 2023

Whilst travelling recently, I noticed booths selling cigarettes at two well-known international airports in India. This, even though smoking is officially banned in public places. I recalled an incident of a few months ago. That day, while driving to work, I happened to pass by a young girl in a car who was being fined by two policemen for smoking in a supposedly public place - the confines of her own car! She looked terrified so I stopped to enquire if all was well. A crowd quickly collected around us and there ensued a lively debate about whether someone’s car constituted a public space. My learning that day was that a personal car when driven out of the home and especially with its windows open was deemed a public space. It was jarring to note how young college students who are not even earning must pay fines for lighting a cigarette whereas tobacco companies can openly indulge in tobacco sales in public places right under everyone’s noses with no adverse consequences.

On yet another journey, I noticed a special smoking room for passengers in the transit lounge of an overseas airport. I wondered about the necessity of pampering adults like this. Could grown-ups not be asked to desist from smoking for just a couple of hours? Contrast this with the strict enforcement of austerity for widows in India some years ago for example – where they were expected to suddenly change their entire lifestyle forever.

The powerful tobacco lobby has created an enormous market for itself. Millions spent on advertising helped generate the aura that (the addictive) smoking was somehow cool and smart. As a youngster, though I did not smoke, my list of favourite advertisements included the cowboy in a checked shirt welcoming people to ‘Marlboro country’ and one glorifying the special thin cigarettes for women – Virginia Slims – which had the tag line ‘you’ve come a long way, baby.’ People lit up to feel smart, and to attract a potential mate. Today, about an eighth of the world’s population -1.3 billion people-use tobacco and an overwhelming number of these (80%) live in medium to low-income countries. As the sales of cigarettes went up phenomenally - about 6 trillion cigarettes are currently manufactured every year -; on the medical front, the rates of lung cancer, a truly rare occurrence in the beginning of the 20^th century, increased concomitantly.

The lungs, heart, and blood vessels are very vulnerable to the effects of inhaled tobacco smoke which contains harmful chemicals like nicotine, tar, etc. The spectrum of lung problems is vast: irritation of the airways causes a smoker’s cough (bronchitis); acute lung infections (pneumonia) as well as chronic structural lung changes (emphysema, chronic obstructive pulmonary disease) can occur; and of course, there is the dreaded lung cancer. Changes in the blood and vessel linings increase the chances of heart attacks, strokes, and peripheral circulatory problems. Smoking impacts other organs like the eyes, causes cancers in multiple organs other than the lungs too, and increases the propensity to develop diabetes. About 8 million deaths a year are attributed to Tobacco. For a country like India which is reeling from a spurt in cancers in the North West (a likely fallout of pesticides and crop modifications used to bring about the ‘green revolution’), and is also known as the diabetic capital of the world with 77 million or so diabetics, we can ill afford the smoking addiction. India currently is the second largest consumer of tobacco products, after China, with 267 million adults using various forms of tobacco.

Along with vigorously promoting the sale of cigarettes, tobacco companies in the mid-twentieth century actively suppressed information emerging out of scientific research that showed the link between lung cancer and smoking. This evidence had been painstakingly collected from diverse sources: large population studies; live animal experiments; cell pathology studies. Scientific scrutiny of the composition of cigarette smoke revealed that it contained numerous carcinogens such as polycyclic aromatic hydrocarbons and nitrosamines, among others.

Realizing that their star product, tobacco, might well go out of fashion, even sworn rivals in the tobacco world colluded to protect their common source of profit. These companies created a deliberate smokescreen around the compelling scientific research showing that tobacco was harmful to health. They poured in money to induce other scientists to question these studies to ensure that the public remained in doubt. Their actions were clearly unconscionable, as they subtly promoted an addictive substance through behind-the-scenes manipulation. Criminal groups that openly and illegally peddled drugs were labelled cartels but these companies deliberately propagating an addictive item with full knowledge of its destructive potential got away with the less pejorative collective epithet of ‘lobbies’.

The stranglehold that the tobacco industry has on the decision-makers ensures that the product is still sold freely albeit with a warning printed that smoking is injurious to health. The so-called ‘safer’ alternatives to conventional smoking such as E-cigarettes are also harmful as their vapour contains nicotine and other toxic chemicals and they can be as addictive as regular cigarettes.

The ill effects of smoking reverberate far and wide, affecting not only the smoker but those in the vicinity as well. Formal scientific studies have highlighted the perils of ‘passive smoking’ which refers to the smoke inhaled by a bystander close to a smoker. Passive smoke has been found to have a 2-4 times more toxic effect since it is inhaled into the lungs without going through any filter (as is found on the end of a cigarette). Though malnutrition, the early age of marriage of women, inadequate healthcare facilities and not enough health education are some of the factors blamed for the huge number of low-birth-weight babies in India, the contribution of passive smoking has not been highlighted to the extent it deserves. Pregnant women, even when very careful themselves, often have limited influence on the smoking habits of other family members. Inhaled smoke can impact foetal development negatively. According to the National Family Health Survey number 5 (19-21) the prevalence of low-birth-weight babies in India is 18%.

Tobacco deserves far greater attention at climate change discussions for many reasons: it is not a soil-friendly crop; the process of curing tobacco prior to consumption is expensive; the disposal of cigarette butts and packs adds greatly to toxic waste as well as creating plastic micro waste. The fine smoke particles that settle on surfaces around us like clothing, hair, carpets etc form the ‘thirdhand smoke.’ They can persist for a long while and can be acted upon by oxidants in the atmosphere to release carcinogens into the air such as tobacco-specific nitrosamines and toxic aldehydes which pollute our environment.

Today, a significant number of people are suffering from long Covid (estimates put this between 7.5% to 45%). Amongst general symptoms indicative of this like chronic fatigue, memory fog, insomnia etc, lie specific cardiovascular effects such as hypertension, tachycardia, and heart attacks. Many patients who have recovered from severe Covid have highly reduced lung capacities. Thus, people now are even more vulnerable to the ill effects of tobacco smoke than before. Moreover, smoking reduces a person’s general immunity – something one can ill afford in a Pandemic and where millions are being spent on vaccines to boost immunity.

So instead of putting our health and our environment on a slow burn, we can do away with smoking, and by this single impactful act save our civilization from literally going up in smoke!

We, the climate affected....

2022-12-07T17:33:00.002-08:00

The Statesman 7 Dec 2022

As a citizen of Delhi, I am dismayed at the toxic effects of the air pollution on all of us, as also on visitors from neighbouring hilly terrains. People from nearby states travel to Delhi to avail of the well-developed surgical facilities here. Many of these are non-emergency surgeries like cataract, chronic hernia, or joint replacement. However, even before they can undergo the surgery, the patients fall prey to the ill effects of the bad air quality and develop respiratory tract infections and a generalised weakening of immunity. They begin to feel depressed and want to rush back to the cleaner air of their hometowns.

Conversely, many Delhites are buying residential property in the hills nearby, all the better to escape choking for at least a few weeks in the year. In the foreseeable future it seems certain that people will migrate towards the few remaining areas that have breathable air. Like the well-established migrations for better job prospects, for fleeing political persecution, natural disasters and wars, the new waves of migration are likely to be towards places on earth where one’s lungs can still sample a whiff of fresh healthy air. It is truly ironical that the political- industrial nexus that has exploited and dirtied the environment on a mega scale (compared to those with simple sustainable lifestyles like fishermen, farmers, forest dwellers etc) will have the edge in this resettlement, given their ill-gotten resources.

Years ago, as a young student studying at an army medical college, I took part in a photography contest which required us to submit imaginative entries for the caption ‘the young and the old’. I requested a bunch of sweet young urchins playing in the street to come and sit on the low bough of a very old tree with a gnarled bark. For me, trees have always held a certain timelessness. I remember the awe I felt looking all the way up, my neck flung back, gazing at the tops of the giant redwood trees in California and similarly, at the huge horizontal expanse of an old Banyan tree in the botanical gardens of Kolkata. It takes decades, nay centuries, for a tree to acquire such dimensions. I feel deeply disappointed when grand old trees are sacrificed for any reason and replaced with the ugly inert concrete of buildings. I read a recent report about a mega infrastructure development project in Great Nicobar Island that has received initial environmental clearances. A very rich treasure trove of a whopping 8.5 lakhs trees on an idyllic island will be gone. Why would anyone destroy what is the equivalent of gold or rather Fort Knox itself? The justification of ‘military advantage’ does not cut ice. For if the various wars have taught us anything, it is that these costly, visibly big , power- guzzling edifices are often the first targets of enemy fire. Even though humans may like to take the credit for destructive valour in the many crippling wars, ironically enough, the accidental but great role of nature - the mountain overlooking a valley, the advantage of stealth provided by darkness or forests, the sea transporting navies or the safe belly of mother Earth where soldiers hid in trenches can hardly be discounted. Governments promise ‘compensatory afforestation’ in lieu of hacking down forests -where old trees cut are replaced with new plantations. How can tiny immature saplings be a substitute for developed trees with dense canopies or rich fruit bearing abilities ? How can one equate a decorated general with years of experience with a new rookie for example? The senseless destruction of priceless forests is as futile as the destruction of humans in the many military mega- wars this planet has witnessed.

Today’s biggest battle, however, is against habits and business models that destroy our planet. The best ‘generals’ for this sophisticated and difficult combat are climate scientists, indigenous tribes and forest dwellers who understand the terrain better (literally and figuratively). They can help set in place practical and genuine climate change policies. When politicians negotiate in climate conferences, they often do so on behalf of the businesses which have strongly funded their election campaigns. Local people that do not have these vested ‘obligations’ can better focus on the planet’s survival rather than the survival of a political group or ideology.

There are thousands of innovative ways for individuals to join the battle against global warming as foot soldiers. Apart from recycling, composting, greening, gardening, scattering seeds on empty plots en-route to work and so on, we can also incorporate green actions into our professional lives. As a personal example, we have started distributing green plants along with medicines to beneficiaries attending our holistic eye and general health grassroots medical camps. We explain to the patients the oxygen-producing abilities of the plant and encourage them to nurture it. My routine medical prescriptions also carry a printed message of harmony with nature at the bottom of every page.

If we as a race of consumers are serious about mitigating our personal impact on global warming , the time has come to ensure that each finished product has a biodegradability index printed on it. This should mention how many days it would take for the product to disintegrate completely. Plastics, we know, are largely non-biodegradable (many degrade only after 500 years or so)

and they harm the environment, plant and animal life and cause serious health issues in humans. Currently, almost all food products for sale mention the calorie breakup. This helps us make correct choices to safeguard our internal health. The time has come to purposefully shape our external milieu as well. Reading the biodegradability label could truly help us reduce the purchases of items that are not biodegradable.

In the recent climate conference, number 27, there was a much-hailed agreement reached (after years of painstaking negotiations) that developed nations that have consumed the Earth’s resources at a faster rate will contribute towards funding the countries that are most vulnerable to the effects of climate change (the carbon footprint of these developing countries has been much smaller but they are getting more affected due to global contributions to climate warming). While a broader redressal of grievances may play out at governmental levels, the same disbursement of compensation does not happen with individuals within states and countries. If destruction of forests and displacement of indigenous people continues with impunity within boundaries of states, then having a centralized UN conference has very limited impact.

The deep understanding of and harmony with nature of indigenous people is brought out well in a famous letter attributed to the native Indian Chief Seattle who wrote to the ‘White man’. Excerpts from the letter….. “This we know: the earth does not belong to man, man belongs to the earth’; “We know the sap which courses through the trees as we know the blood that courses through our veins”; reveal the intimate connection with nature experienced daily by them. Now, even city-dwelling citizens keenly feel the importance of a green cover in their lives. A straightforward pledge by each and every nation to increase its forest cover by 5% every year for 3 years and then 1% every year may work wonders. It is easy, non-controversial, and urban citizens and indigenous people alike would be delighted to participate with governments in this crucial endeavour to safeguard our collective future.

Since always, Mother nature has been providing us pure air to breathe but in return, we have been spewing noxious chemicals into her atmosphere; where her fertile soils support our crops and gardens, we plough toxic pesticides into the mud; her gift of fresh water to us is repaid by our spilling oil and garbage into her oceans. When the story of Homo Sapiens and Mother Earth is told, it can either be one of unrequited love by Gaia for humans and the certain destruction of our species or an inspiring tale of a deep and abiding love between man and nature that lasts till eternity.

On condition of anonymity

2022-10-19T11:37:00.000-07:00

The Statesman (30 September)

During our school days, handwritten notes were a popular means of communication between students during monitored study periods which required a strict silence and a full focus on the homework for the next day.

Our teachers, who invigilated these periods, seemed to have eyes in the back of their heads, for many such notes being passed around were

deftly intercepted by them.The writer of the note was admonished and often given a mild punishment too.

Over time, note senders adapted to the risky terrain by omitting to sign their names. They reasoned that anonymity conferred safety. Contrary

to their calculations, the situation worsened. The teachers punished the entire class. They seemed angrier in general, especially about the fact that the notes were unsigned.

The values the teachers held dear made them deeply uncomfortable about any person not taking responsibility for something they expressed. They reckoned that a person should be able to stand by what they stated. Owning your words forced you to consider carefully what you wanted to say and also, how you wanted to say it.

The only time anonymity was somewhat appreciated, was when someone hesitated to take the credit for something good. Whether for an elegant poem, an impactful quote or a kind donation. In fact, true philanthropy in those days was supposed to be done discreetly so as not to cause any embarrassment to the beneficiary. Like white lies, 'white anonymity' could thus sometimes be acceptable.

Our teachers of old, would however, be dismayed at the high level of anonymity, accompanied by a lack of transparency that pervades every aspect of our lives today, ranging from everyday social media communications to economics to politics.

In the cyber world, people hide behind false identities, and artificial intelligence bots are programmed to masquerade as humans.

This anonymity is very unwelcome as regular social media users can be bullied with few consequences for the culprit. Much of the trolling on social media happens via anonymous handles. Hiding behind a veil makes people reckless. Should all social media users be forced to identify themselves customarily, incidences of harassment would reduce substantially. The tremendous resources that are currently utilised in investigating unwelcome speech would be cut down. Tracing identities of trouble makers would not be necessary as it would be plain for everyone to see who is at fault.

Apart from bullying, the cyber user is open to manipulation as well. This is on account of the non transparency to the public of the company’s algorithmic designs and principles.The manipulation is insidious and here is how it plays out : users of several popular SM platforms choose topics and handles to follow. However, non-transparent algorithms regulate the content that comes on view. So, if for example, a user ‘likes’ a couple of photos of cuisine, their feed will be flooded with images and content related to delectable delicacies, even though they are not following any chefs or have not selected food as a chosen topic of interest. The critical issue here is, explicit permission has not been given to anybody, leave alone an anonymous bot, to ‘curate’ our lists for us. This curation is across sites e.g. the ‘percentage matches’ of movie viewing sites. Nowadays, the ‘word of mouth’ of family and friends is increasingly getting replaced by ‘word of bot’. All this targeted meddling discourages deeper deliberation, making users mentally lazy. They are ready to go with the manipulated ‘flow’ and become statistics for money generation apart from getting more deeply hooked to their screens.

Also, certain types of conversations get amplified by these programmed algorithms and others not. They are designed to pick out 'leanings' (such as right or left leaning) rather than meaningful conversations (such as climate change or gender equality for instance). So instead of the popular mediums of communication being used to bring about impactful change, they accidentally or deliberately end up increasing the polarisation of thought and bring more divisions in society.

Were it widely known what instructions computer algorithms for social media have been programmed with and under whose direction, checks and balances could be put in place.

Currently, there are few truly effective external checks. Whistleblowers from social media companies have highlighted how some company bosses take cyber safety feedback from in- house as well as outsourced professional experts poorly; their main focus being on hooking followers and garnering profits through selling user information. It is ironical that there are 'weapons inspectors' to stall the build up of arms and ammunition in countries but no such stringent safety checks for algorithm creation. Whereas creation of new platforms of communications among people can be conducive to inclusion and social cohesiveness, manipulation of people’s minds can inculcate addiction and lead to mental breakdowns. Behind the scenes manipulation of content can give an unfair advantage to businesses and political parties.

In fact, the alarming negative power of anonymity was demonstrated recently, when a prominent journalist in India was arrested on the basis of an FIR lodged by an unknown handle. It could well have been a bot. It was indeed sobering to think that artificial intelligence could actually get a human into jail, no questions asked. It took the police several months to identify some face behind the handle, retrospectively, long after the journalist was released on bail.

In case no anonymity was allowed on any platform, enormous resources would be saved. Cyber police could free up a large proportion of the hours spent in uncovering hidden identities. Like the traffic rules which prevent owners from driving cars with blackened windows, similar rules of transparency would work wonders for cyber traffic!

Beyond anonymous words, lie anonymous transactions. In a country where representatives are elected on manifesto promises of transparency, the electoral bonds - donations to political parties - are opaque. This has been challenged long back by an NGO but the case still languishes in court. Hidden political donations encourage corruption at the highest level as rich businessmen can influence policy and pull strings in the govt. through these 'gifts'. Scientists and professionals are obliged to make financial disclosures before giving their medical or technical opinions.This helps others decide for themselves whether there could be a personal bias in the professional’s recommendation of a particular drug or technology. For example, such a suspicion (albeit fairly unfounded) of bias by pharmaceutical companies also happens to be one of the reasons for a huge pushback against Covid vaccinations in some countries. Strangely enough, although govt decisions impact lives and livelihoods on a large scale, the elected representatives have not seen fit to similarly disclose to the public as to who or what is influencing their actions.

At the level of the state, the veil of non transparency has traditionally surrounded the working of the intelligence services of any state. Thus there is limited recourse to justice when there is lack of skill and planning leading to substantial ‘collateral damage’. It is not uncommon for hundreds of civilians to lose their lives as a result of botched up operations with little accountability of the state.

Contrast this with officials who have to wear their badges when dispensing their state duties. In the sad case of George Floyd who lost his life unnecessarily and wrongfully in a police encounter, justice could be dispensed as the officer's identity was known.

It is clear that non- anonymity in speech and social media and transparent processes in social life enhances responsibility and accountability, saves resources and money and reinforces the good value systems of old. Our teachers sure knew what they were talking about!

Regulating Doctors

2022-10-19T11:34:00.000-07:00

The Statesman (8 July 2022)

A comprehensive bill by the National Medical Commission that provides renewed guidelines for the expected professional conduct of medical practitioners and some standardization of healthcare is under consideration now. Suggestions have been invited on the draft of recommendations.

Previously, what has been followed are the medical conduct and ethics guidelines notified by the Medical Council of India in 2002. For dissatisfied patients there are robust grievance redressal mechanisms. Perceived gross negligence by medical practitioners attracts criminal lawsuits. Lesser medical malpractices by doctors attract fines in civil consumer courts. Quacks, i.e., conmen masquerading as doctors, are dealt with strongly and have no connection with the medical world.

The new bill draft suggests five levels of disciplinary action which can be taken by state and central medical commissions against erring doctors. The first level termed ‘reformation’ includes counselling for minor administrative or procedural lapses and advisories can be issued to doctors to attend generalized or specialized workshops on medicine/ethics/other. The second level of punitive action allows suspension of a medical practitioner up to one month. It is to be employed in those instances where there is no evidence of direct harm by the doctor.

To my mind level one and two are completely superfluous and should be done away with. They vitiate the enabling atmosphere and peace of mind doctors need in order to give their very best to the patient. Officially rapping doctors on their knuckles for minor transgressions makes them feel they never transitioned from school to responsible adulthood. It would also unnecessarily add to the work of the officials of various medical commissions, distracting them from bigger issues.

There is much self-correction built into the medical profession. Teachers and mentors keep tabs on those working with them and regularly point out the finer aspects of the profession to their junior colleagues. Almost all doctors belong to professional bodies or work at hospitals/registered clinics that follow prescribed norms (without which they don’t get a licence) so there are regular audits, reminders and well-worn guidelines.

As far as level two is concerned, even the country’s judicial system at large finds a person innocent until proven guilty. It is worrisome that even when the examining officials are sloppy or unsure about the doctor’s attributability, they will still be able to penalize this cohort of sought - after professionals.

Level three and four prescribe longer suspensions from work -up to 3 months and 3 years respectively. In this case there has to be evidence of direct harm caused by the doctor’s actions. Level 5 seeks to debar medical professionals permanently for grave negligence. The last three categories make sense. For actions of the doctor that result in direct grave harm to the patient there should definitely be thorough investigations and full accountability. This is already being ensured through judicial recourse.

Overall, there plenty of reassuring checks and balances in the medical profession. Difficult entrance exams cull out people with fine brains and the ability to work hard. Long arduous years of study, tough competitive exams for getting into a speciality and doctors’ inherent desire to be cutting-edge ensures they remain abreast of developments in their field. Many institutions have doctors working in units or teams and hence collective decisions are made after thorough discussions. A doctor’s reputation is closely linked to the patient getting healed successfully and there is heavy competition in the private sector.

No doubt, medicine is a vocation where quality of life and prevention of death are at stake, so it is always under scrutiny. However, the actions of many other professionals have a deep impact on our lives and therefore this umbrella of accountability has to be widened to include them. Doing this would ensure standardization of care in a holistic manner across professions and not just single out the medical community for having to labour under a plethora of rules.

For example, wrong conclusions arrived at in courts of law have sent many an innocent person to jail. We read about influential rapists who are given bail and then hurt and threaten their victims. Many illiterate people are not able to understand the court proceedings but this doesn’t translate into a reprimand for their lawyer. The court enjoys many honorific titles and can penalize someone who is deemed to have held the court in contempt. Judges have the freedom to ‘interpret’ the laws according to their own understanding. Their judgements cannot be scrutinized on merits per se. There is no judicial ombudsman or grievance cell where the public can ask for review by senior judiciary/ legal peers when an occasional judgement seems illogical or absurd. Citizens can certainly appeal a lower courts’ judgement in a higher court. However even if a judgement is overturned the lower court is not held accountable. Despite laws being well defined, their interpretation is rather ‘fluid’. Imagine the outcomes if doctors were allowed their own ‘interpretations’ of medical textbooks!

Similarly, police reforms are long overdue. A recent report in the paper described how eight people were wrongly arrested by the police for fomenting trouble in a crowd. They were released after their families submitted categorical video evidence of their absence from the scene. It is sobering to think that the police can round up anyone they suspect without due process or accountability and the individual then has to run from pillar to post to free themselves. Of late the police seem to have become a weapon for politicians to bully the public with. Policemen deviate further day by day from their friendly ideal of ‘with the public, for the public always’. The tragic death a few years ago of a dentist’s daughter in Noida, made headlines for long. Despite police thronging the house that day for the express purpose of discovering clues, they failed to pick up an enormous clue – another lifeless human body in the same house! The body being discovered only the next day -the blundering nature of the investigation became equally sensational. Citizens have to live with the spectre of tardy arrests, delayed FIRs, poorly written chargesheets and faulty evidence collection. However, there are no well laid out procedures for police officers to be held directly accountable to the public for poor quality of services rendered.

Politicians imagine they are special and above reproach. From broken manifesto promises, horse trading and jumping parties after elections to hogging all the resources and security, the list of misdemeanours is endless. Political decisions that decimate the environment (for short term ‘development’ gains for a few businessmen) are contributing to global warming and sending our planet hurtling towards a collapse. Poverty, prices and unemployment are surging everywhere. Yet there is no provision to change the representative for non- performance and even the most unpopular ones are allowed to complete their full term.

Doctors are probably the only professionals today that agree to double work shifts - OPD during the day and emergency night duty – in rotation with colleagues. The fact that the world has been through a pandemic where doctors have worked overtime, suffered great emotional and physical burnout and risked their lives for others must never be forgotten. The population is still reeling from ill-health, emotional, financial and mental stress brought on by this pandemic. Patients do need the strong reassurance that doctors provide.

However, doctors can function well as pillars of support if their worth is well recognised and they get appreciation rather than overzealous regulation. Also, rather than the national focus being selectively sustained on doctors’ conduct, it should be holistically broadened to include accountability from all professions. This is the most sustainable way forward.

There is much at stake in the US abortion debate

2022-05-11T20:29:00.000-07:00

The Statesman, 11th May

The Roe versus Wade 1973 judgement, which helped legalize abortion in the United States, is in danger of being overturned by their Supreme Court justices. This is rightfully causing great consternation. If reversed, it would deprive women of the right over their own bodies, thereby infringing their constitutional right to liberty. It also impinges on their right to life; pregnancy-induced physiological changes render a woman more vulnerable to morbidity and death; therefore, the choice to be a mother must be hers. Criminalizing abortion forces women who seek it (for a multitude of compelling social and personal reasons) to get it done quietly in unsafe conditions thus putting their lives in danger (4.7% - 13.2% of the maternal mortality which currently stands at 152/100000 live births internationally is due to unsafe abortions). As per WHO research, 45% of the overall abortions performed are unsafe as they are carried out surreptitiously, in countries that have officially made it illegal. This cohort of women therefore unfairly gets excluded from the excellent advances in medical science that all other citizens enjoy. The right to an abortion (medical termination of pregnancy) on demand is available in only about 27% countries though many do allow it on various medical and social grounds and almost all countries allow it as a life-saving measure. In Ireland, the right to abortion was introduced only in 2018, after the public outcry following the preventable death of Savita Halappanavar who was not allowed even a life-saving abortion. The upper time limit of legal abortion ranges from 12 till 24 weeks (these decisions are based on age of viability of the foetus and maternal safety). In India it is thankfully allowed till 28 weeks (with some caveats).

Rescinding any hard-won welfare measure for women is grossly unjust as it forces women to keep going in circles, while men progress forward linearly. Once born, a human is protected under several human rights laws. Insistence on special rights for a foetus before its birth creates unnecessary judicial tension and confusion. For example, no such ‘rights’ are accorded to the artificially fertilized eggs in petri dishes in medical establishments (which are thrown away/ used for medical research after one amongst them is implanted in the woman) for childless couples availing of in-vitro fertilization. Also, a law aided coercion of women to carry pregnancies resulting from rape or incest, totally ignores them as being a victim of a heinous crime. The Geneva convention unequivocally categorizes sexual assault and rape as war crimes. Today there is conflict (and assaults by army soldiers/guerrillas/terror groups on native women) everywhere. Is it ethical to force women to give birth to the children of enemy soldiers?

There is blatant gender inequality in not having any legal binding on fathers (who are at liberty to abandon their pregnant girlfriends or the idea of fatherhood), yet not allowing a woman to change her mind about a lifelong commitment such as motherhood. The anti-abortion lobby must not ignore the enhanced risk of teenage pregnancies (a Lancet meta-analysis highlights that those mothers in the 15-19 age group have a 28% increased risk of dying as compared with those in the 20-24 age group and this is even higher for mothers aged below 15 years). Also,the courts are silent on the critical issue of the foetus’s rights on its biological father. It is imperative to put a legal onus on the father for lifelong parenting and fiscal responsibility when talking about the ‘rights’ of the unborn child.

The anti–abortion lobby focuses on the ‘right to life’ of the foetus. It is noteworthy that the earliest age that a foetus can survive independently is after 28 weeks when the lungs are somewhat capable of gas exchange (modern medicine can accelerate this somewhat). The lobby however wants a total full stop on abortion at any stage. Some believe that a ‘soul’ inhabits the foetus even when it is not physically viable. This is highly presumptuous given that no human can claim to be aware of what happens in the realm beyond life.

Pro-lifers ignore the human right of women to choose what happens to their body and do not take into account situations where women may be mentally and financially ill-suited to raise a child. The quality of life of a woman changes with conception. Even before that, the overwhelming burden of contraception in most societies falls on the woman. Few men use the simple and widely available condoms with responsibility. Oral contraceptive pills for women can have side effects ranging from relatively milder nausea, weight gain and mood swings to the more serious susceptibility to blood clots (and the effects of embolism).

When a woman does conceive, there is a risk of morbidity and death before, during and just after her delivery. Pregnancy-induced nausea and vomiting, and gestational hypertension and diabetes are fairly common. Peripartum complications can have a lifelong impact such as Sheehan’s syndrome where many endocrine functions may be lost due to the blood supply to the master endocrine gland, the pituitary, being cut off. The mental anguish of those mothers that fall prey to severe post-partum depression is terrifying to behold. When women’s bodies and lives undergo such major changes after conception, is it fair or reasonable to deprive them of agency over their own bodies?

12-24% of all pregnancies end in spontaneous abortions, a majority of which are due to genetic malformations of the foetus. The parental contribution to this genetic pool is equal. Another factor is active and passive inhalation of tobacco smoke. How many family members give up smoking when their wives are pregnant? Some other factors are the mother’s ill health and lesser education levels, poor access to medical care and lack of proper rest. How many pregnant women are encouraged to stop tilling their fields or have the water from the well carried for them by men? When spontaneous abortions can be brought on by the actions of others or prevalent social mores, then why deny just the woman the right to safe abortion when she herself needs it?

Female foeticide is a flourishing evil and our country accounts for 40% of the females that go missing out of 1.2 million per year (China is ahead at 50%). It is no secret that women are sometimes subjected to clumsy abortion attempts by their own relatives. A patient I once attended to in the army MI room gave me a graphic account of how her mother-in-law tried to abort her pregnancy using the thorn studded stem of a rose plant. Relatives who indulge in such barbaric practices have hardly ever been arrested but if a woman legally seeks abortion herself, she falls foul of the law. Is that just?

These biased rulings denying women control over their bodies stem from patriarchal thinking. They are neither conducive to gender just order nor are they rooted in logic. They also are in total contravention to two of the four pillars of medical ethics -namely autonomy of the patient and beneficence. Why should pregnant women be excluded from receiving the benefit of two central tenets of medicine as well as its advances at a most vulnerable stage of their lives?

I sincerely hope the justices will acknowledge the risks a woman goes through to bring forth life, and support her wholeheartedly in her pregnancy-related choices. Most importantly, she cannot be forced to spend her entire life dealing with the outcomes of sexual assault on her body rather than realizing her own potential and dreams.

Shrinking spaces and expanding horizons

2022-01-13T09:55:00.004-08:00

The Statesman,

January 13, 2022

Some years ago, I saw a mesmerizing dance show at the Purana Quila in Delhi where the accomplished dancer Astad Deboo, straining every nerve and sinew, slowly contorted his body into a tight ball – he was simulating an embryo. Today I am reminded of that contortion as I look around. The Pandemic and man-made factors have relentlessly compacted our lives to fit into the shrinking spaces around us.

Concerns around disease transmission have restricted our physical space. Humans that once roamed free on Earth are not able to do so now. Students do not have the pleasure of attending schools, gym enthusiasts have to lift weights at home and increasingly, access to public places is being determined by vaccination or RTPCR status. Humans are experiencing the same uncomfortable reality of depleted common territory that so many magnificent creatures of the wild have been subject to for several years.

Almost 68% of wildlife has declined due to the large-scale attrition of forest cover which now stands at a mere 31% or so of the total land area. Commercially driven takeovers of their habitats have forced animals into close proximity with humans. Despite now understanding first- hand what being hemmed in feels like, many humans remain unempathetic. For example, several resident welfare associations are deeply divided on the issue of the need to provide shelter and food for stray dogs. This is a far cry from the days where we grew up watching our older relatives regularly feeding birds and kind-heartedly throwing a morsel to dogs and cows that wandered close. Displacement regularly affects humans as well, now. Human conflict, ethnic cleansings and calamitous natural phenomena brought on by global warming have created homeless refugees. Such people often face hostility and have a poor quality of life in the countries they flee to.

Women have had it a tougher since the Pandemic has kept people confined to their homes. Domestic violence has risen – even by as much as 30% in some countries. With the entire family being at home, their space for quiet reflection has been lost in the interminable swirl of increased household chores.

Authentic, fun-filled online social media exchanges are getting swallowed up by the superficial quest for ‘likes’.The fulfilling and joyous banter amongst private groups of friends, college and school mates, or neighbours is corrupted by having to designate one (or a few) as the overall administrator - responsible for the ‘conduct’ of the group. Surely the responsibility of not hurting others with our speech rests with each adult human. There are well established laws against hate and incendiary speech. The deliberate creation of such a post strongly places the entire group at the mercy of the administrator’s own personal and political biases.

In the more public platforms, interesting conversations leading to a build- up of consensus among groups or the emergence of sustainable solutions on diverse issues are quickly thwarted by trolls who instead flood the platform with politically motivated, sensational, and fake news. They stalk and abuse women online. We recently witnessed an extremely depraved attempt to auction Indian women on cyberspace. Not surprisingly, the online places where women feel safe and welcome are reducing.

The space to love someone of our choice and even to pray to a deity of one’s choice- two integral aspects of life- is dwindling. Even in this modern era, we hear of young lives being sacrificed to caste related ‘honour killing’. Some state laws make religious conversion punishable. Hoodlums masquerading as moral keepers of society tyrannize young couples in interfaith marriages. Many such young couples facing harassment are compelled to seek judicial intervention.

The space for seeking the truth and telling it is contracting. People are subtly manipulated or outright coerced into following a particular political ideology. Dissenters are treated shamefully. Genuine investigations of crimes or scams are thwarted and instead a lot of money is spent on covering up or whitewashing the incident. There have been instances where journalists out to uncover the truth have been harassed, bullied, jailed and outright killed. Whistleblowers, usually people of rare courage, are made to feel as if they have done something wrong in exposing the truth. Powerful lobbies accused of fraud swing into damage control mode and save their own skins while making whistleblowers look like fools and liars.

The scope for fun and laughter is lessening. Jokes which made us laugh because they were funny and irreverent, now can elicit punishment rather than laughter for the teller. This is because many disgruntled authorities lack a sense of humour and can be childishly vengeful. The regular umbrage-taking by those in authority creates an atmosphere of all-pervading seriousness, vastly different from yesteryears where the wonderfully satirical cartoons of RK Laxman brought a smile to the face of even the crustiest official!

The chance to get a proper education is reducing. Extremely high entrance cut-offs make securing a university seat a nightmarish struggle. For those who are lucky enough to gain admission, there are frequent disruptions in their studies – usually due to some ruckus created by the student wings of political parties. Even the choice of thesis topics has become limited. Rather than subject experts being allowed to design such studies as will address gaps in the current knowledge in that field, they are unethically pressurized to allot research topics of ‘national interest’.

The space for thinking critically and heartily examining controversial topics through debate or discussion is shrinking. There is a sustained attempt by those in power to introduce a conformity of thought and ideas, forcing even the imagination to shrink.

Mirroring the ever-expanding universe, a human’s imagination is limitless, and a stifling of this deep resonance between a human and the stars above is to shrink the very essence of being a human. In astrophysics, black holes in space are bordered by a line called the event horizon. Cross this threshold, and you are sucked into the infinitesimally dense void of the black hole where even light cannot enter. Similarly, if the room for expanding one’s thoughts and expressing one’s views gets compressed further and further, it is going to be impossible for the light of knowledge and discovery to enter.

Meanwhile, a few things grow rapidly, out of tandem with the world around them. The virus is unfettered and continues to multiply its presence exponentially by making neat alterations to its spike proteins. Several billionaires’ financial net worth is still growing by leaps and bounds in a world with a decidedly inequitable distribution of wealth. Some powerful leaders across the world expend their energies in lengthening their own personal ruling tenures, fairly dismissive of environmental and citizens’ concerns, even as our planet sinks deeper and deeper into peril.

In a world that seems continually programmed by irresponsible leaders and a relentless disease to cave in upon us, we can regain valuable space by expanding our own consciousness, broadening our thinking and enlarging our heart’s capacity to give and receive love. The greatest gift in these times of paucity is to just allow a fellow being a little more space to live, laugh or learn. A little more space to breathe. And watch Astad Deboo’s ‘embryo’ blossom gracefully into a contented and complete being.

Will a better human strain emerge after the pandemic ?

2021-07-04T09:27:00.001-07:00

The Statesman 5 May

The Indian public is trying to cope with the gravest medical crisis in recent history. There is an acute shortage of hospital beds and oxygen, leading to a high fatality rate among Covid patients. Everywhere, people are grieving over the loss of loved ones and there is palpable anger at the lack of preparedness. These shortages which hinder treatment and cost lives make even doctors feel very helpless. Over and above their medical duties, doctors find themselves being pulled in different directions. They are having to get involved in chores such as sourcing scarce oxygen supplies and to get multiple forms signed from relatives. These protect them from liability not related to medicine – such as medicine stocks running out or ICU beds not being available.

Where they were once able to offer comfort and reassurance to most people, they themselves are at their wits’ end. They feel very uncomfortable at having to ask prospective patients to come for admission with their own medicines and cylinders. Outside, at the hospital gates, people wait expectantly, hoping a miracle will happen and an empty ICU bed will surface. Such miracles are rare.

Many people don’t make it to the inside of a hospital and breathe their last on the roadside. Even crematoriums are overburdened and have run out of space. The new mutated virus strain in this wave is causing a lot more medical uncertainty as it is not easily detected anymore. Because the Rt-Pcr tests were designed on the genome of the original strain, they are often not able to detect the presence of the new virus.

Could the virus be having a dormant form like the Varicella Zoster virus (Chicken pox, – which rests in various nerve ganglia and gets active producing shingles years later), when the host immunity is lower or the environment conducive? Maybe this form erupts suddenly once its gestation cycle is complete. Who knows? In India, this massive outbreak has occurred just when the beautiful flowers of spring were blossoming everywhere.

Echoing Darwin’s theory, the virus is trying to survive, by evolving. Whereas evolution in contemporary species is slow, this virus seems to be doing so at supersonic speeds. It also now seems to be taking a faster route to its target organ of choice, the lungs, bypassing the nose and throat areas. And it has cast its net over a much wider area.

We see so many younger people getting infected with Covid compared to the ancestral strain which largely spared the young and healthy. Matching this uncertainty are various man-made ones. There is uncertainty about the availability of vaccines and their efficacy against newer strains. The data on the disease is not fully reliable or transparent. It does not seem to accurately reflect ground realities.

For example, in many instances, the official death toll has been starkly different from the crematorium records by a factor of 20-25 on some days. Due to this patchy data, it becomes difficult to formulate and test various medical hypotheses.Yet, in the midst of this absolute pandemonium caused by the stealthy attack of the virus, there is a group of people carrying on with their lives with an enviable certainty as if nothing of import has happened.

We have an international cricket league tournament going on towards which already meagre resources are being diverted. People fly off on exotic holidays and post vacation snaps even as journalists post pictures of a profusion of pyres and lines of waiting ambulances.

We have seen elected representatives host crowded public religious events and address large election rallies, totally unmindful of the fact that this can help propagate the virus and spread sickness and death countrywide. This indifference is strange, coming as it does after a severe round of suffering caused by the first wave of the pandemic last year.

Can we really live in a bubble, impervious to what is happening around us? We have suggestions from people to stay happy even as the world around us collapses. Of these, some sensitive souls are truly well meaning. Some others do not want to face reality, and want to bury their heads in the sand. A third group wants to hide reality and diffuse public anger. It may be most healthy to allow feelings and moods to play out in people in their own natural way.

Hiding rage and grief beneath an artificial veneer of inappropriate cheerfulness may adversely impact minds already traumatized with worry and sorrow. A false sense of security may also cause people to lower their guard. Accepting harsh reality may render us better placed to deal with it. Far worse than callousness, are those trying to profiteer from the grim situation.

We have medical vendors who are building up their personal fortunes by selling oxygen cylinders and medicines at highly inflated prices, while people desperately fight to save their loved ones. We even have priests who have hiked rates fourfold for performing the last rites of the deceased. For immediate redressal of the black marketing in medical commodities, the answer is likely very straightforward – the products should be made freely available.

A simple regulation can be made for suppliers and chemists to not sell more than a limited amount to an individual buyer to ensure a more equitable distribution and pre-empt hoarding. The huge amounts of foreign aid in the form of medical supplies coming into India from countries all over the world needs to be transparently documented by customs and distributed to the most vulnerable. The public will feel very reassured if they can track the life-saving goods directly.

Not everything, however, can be painted black. We are also witnessing models of selflessness. People rallying round to help others. There is a sea of concerned humanity, people sharing resources with each other- literally saving lives and stepping in wherever the need arises. Gurdwaras have been at the forefront of providing free oxygen to the community and NGOs are back in action distributing free meals.

Despite having faced severe scrutiny and an acute depletion of funds due to complex regulatory laws, NGOs have still bounced back. Even in an extremely weakened state they are standing tall and inspiring everyone with their work ethic and abundant social responsibility. In fact, in his public address on combating Covid, a prominent leader appealed chiefly to civil society groups and NGOs to help turn the tide. What would undoubtedly add punch to this effort would be for the leaders to themselves lead by example – in terms of wearing masks and ensuring distancing when addressing the public.

The pandemic has brought out both the generous as well as the selfish sides of humans – ‘the good, the bad and the ugly’ as the title of a popular Western movie goes. In this macabre dance for survival, hope springs eternal that it is the human species that survives. That it can mutate into a superior species after its literal trial by fire. Our fervent hope is that the new human variant can live in a responsible manner and in greater harmony with each other and with nature. Apart from healthcare resources, what human behaviour patterns prevail may well decide the fate of mankind during and after this pandemic.

(The writer is a Delhi-based medical practitioner)

As Special as a Woman

2021-03-21T12:18:00.032-07:00

The Statesman, March 2021

International Women’s day will be celebrated on 8^th March this year, and as always, one’s thoughts turn towards women. We reflect on their struggles, their achievements, and their sometime extraordinary lives. The theme for International Women’s day 2021 is -Women in leadership: achieving an equal future in a COVID 19 world. I laud some unsung leaders who take the reins of life firmly in their capable hands.

The first are the girls and women who work in fields, or rear cattle, to keep their homes and hearths running. It seems an ordinary enough life, but in actual fact they effortlessly tackle a daily spectrum of tough challenges. Women in the hills rise early and take their goats for grazing on mountainsides. Armed with sickles, they climb up on trees to cut branches and leaves for a rainy day, while the goats contentedly graze on the grass below. They are compelled to go out and face the elements -rain, hail or snow, and maintain their balance on slippery slopes, to keep their herd well-fed. Not for them the protective gear that professionals or sportsmen enjoy - golfing gloves to grip smooth irons better or the cricket shin pads that save muscular legs from the thump of a hard ball. In the olden days, it was the men who were considered the hunter-gatherers, but women play that role now. A lady in our caretaker’s family, Asha Devi, once bravely snatched her goat back from the jaws of a leopard. Of course, the goat was cooked for dinner by the poor family as it was too badly injured to survive.

In the plains, many young women face perils of a different sort when they go to gather the crops. The predators here can have a more human form. One hears unfortunate tales of many a young girl who is accosted while out in the fields alone or harmed by a stalker whose feelings she didn’t reciprocate. Ancient drawings depict young warrior men heading home after the hunt with animal carcasses slung on their backs. Now we see young girls on village roads heading back with the household water carried on their strong heads and shoulders.

In the urban areas too, very young girls are literally holding the fort. We had an eye camp in Khora colony recently at a school for underprivileged children. I was concerned whether the children would be able to carry their camp documents home safely to their parents and not lose them. The principal assured me that some children are so responsible that they manage their entire household, even locking the dwelling prior to departure, themselves. She narrated stories of young children who cooked and looked after their alcoholic fathers and other siblings after the demise of their mother. It was remarkable, as also a testimony to her commitment that these children somehow showed up at school daily, even with all these burdens on their young shoulders.

All these women, young and old, keep the wheels of life turning. Despite this, the prevailing social circumstances do not allow women to take pivotal decisions pertaining to their lives. Rigid stereotypes still exist of their destinies being governed by hookah wielding patriarchs sitting comfortably under trees while women face exclusion and marginalization in decision making.

The second group I would like to laud are the fearless and feisty women activists who have been at the forefront of several popular protest movements in India. Many have been subjected to media trolling, bullying by the local authorities and undeserved jail sentences. I have a deep respect for activists because of their high level of empathy for others and their sense of justice which makes them work selflessly. Among many others, we had activists like Pinjra Tod NGO members, Natasha Narwal and Devangana Kalita, fighting for the security of immigrants in far-off states, though they are themselves based in Delhi. I saw a news clip on Natasha’s father (she lost her mother as a child) where he speaks so fondly and proudly of his daughter’s gender related activism. It was very moving. Though many people stand loyally with family and friends through their upheavals; it is activists who are the refuge of strangers in trouble.

History is replete with stories of activists who made great personal sacrifices for the good of the community. Like Nangeli of Cherthala village of Kerala, a poor Ezhava woman who cut off her breasts with a sickle when she was forced to pay tax for the ‘luxury’ of being allowed to cover them (only higher caste women were allowed to cover their breasts in Travancore in those days, anyone else doing so, was taxed). Her actions led to the abolition of the tax.

What is ironical is that people who spend millions advertising their products and lobbying officials to increase their own net worth, are deemed ‘successful’ in society, but activists who work to bring in changes that improve the quality of life of thousands are held in disdain by authorities for their social lobbying.

The third group I would like to focus on are housewives. A friend gave me a lovely definition of a mother as ‘someone who can contain you’. Indeed, housewives have been the glue holding large joint families together and the generous sponges soaking up the disappointments faced by spouses and children. Like alchemists they turn the nadirs in their families’ lives into opportunities, hope and even positive outcomes through sheer strength of effort and character. Housewives work long hours without payment and even without adequate recognition at times. They learn to draw their sustenance from the welfare and happiness of their families. A recently released movie ‘The Great Indian Kitchen’ highlighted exquisitely the monotonous and relentless drill in the kitchen that some housewives follow day in and day out, till they are literally ready to drop with exhaustion at the end of a long day of chores.

In the times of the COVID pandemic housewives have faced exceptional challenges – increased demands on their time from family members confined to the home, the frayed nerves and tempers of relatives displaced by the turn of events, increased incidents of domestic violence and reduced outlets for relaxation for themselves (in the form of friends or outings). Yet they have soldiered on, graciously believing that they have not been singled out, that others are facing their own challenges during the pandemic. As always, they think empathically of others.

In the professional world, a lot of care and enormous amounts of time go into apportioning credit for work done, and dealing with the angst of professionals who feel they did all the work but someone else got the pay hike or promotion. Yet at home, the same detail of appreciation is rarely meted out by the ‘head of the family’ or other members to the Atlas- like woman holding up the family’s personal world on her shoulders.

On International Woman’s day 2021, let us celebrate each and every woman as a special being with an important role to play in the changing world. That means shattering the barriers that hold back women. Let us truly hope that this women’s day is a turning point where women find a greater respect for their voice, their work, their thoughts and get to realize their full potential.

Sustainable Actions in an Uncertain Time

2020-12-23T06:40:00.004-08:00

The Statesman, 14 December 2020

The Corona virus pandemic has brought in its wake sickness, unemployment, stress and uncertainty. Despite being overwhelmed on multiple fronts, people are struggling valiantly to make the best of a bad situation. The younger generation in particular has shown remarkable forbearance. As my daughter’s friend ruefully put it – “I went out to college and excitedly began the process of carving out an independent niche for myself in the world, yet here I am …. back to square one, cocooned in the family nest and confined to the house”.

We all think about a better future for our children but how do we go about ensuring that under such trying circumstances? After some ‘triaging’ what springs foremost to my mind as being of vital importance is: understanding and building up immunity to higher levels, practising kindness and compassion more abundantly, realizing how mother Earth is suffering along with us, and helping her heal simultaneously.

Nowhere has the role of immunity been highlighted more dramatically than during this pandemic. At one end of the spectrum, it supresses the infection so efficiently and stealthily, that patients are alerted to its presence only if perchance they test positive for Covid. At the other end, our immune system itself can harm our body by over recruitment of immune mediators - the much talked about ‘cytokine storm’. Studies of diseases that cause autoimmune microangiopathies (involvement of small blood vessels) or Leprosy, where the type of immune response varies depending on the bacillary load are among those that can help provide valuable insights into treatments.

In his book “Quantum Healing’ Deepak Chopra speaks eloquently of the elusive ‘switch’ which connects an abstract thought to a concrete neurotransmitter molecule and thus translates an idea into tangible action. Somewhere behind this mystery lies the fascinating potential ability to be able to consciously unleash complex immunological cascades in perfect balance. However, till we make this magical evolutionary leap, we can rely on a balanced diet as well as freely and abundantly available resources: sunshine - known to play a mitigating role in seasonal affective disorder related depression; massages, laughter, playing with pets – all of which release endorphins (natural mood elevators and pain relievers) in the body, and meditation with its scientifically proven ability to induce structural changes like an increase in grey matter as well as its beneficial effects on calming the mind, boosting immunity, steadying our heart rates and lowering blood pressure.

Kindness and thoughtfulness, often underrated, have never been of greater importance. Nowadays we often find ourselves dependent on total strangers. Elderly people living far away from their families are being looked after by neighbours with whom they may not even have interacted earlier. In hospitals, we find young and old patients, unable to fully fend for themselves, who are cut off from the loving care of their families while admitted. However, many of the doctors and nurses who tend to them often go beyond the call of medical duty and act as a surrogate family to them. With the work and study from home format and social gatherings being best avoided, a far larger slice of the population is now experiencing loneliness, depression and isolation. Unlike before, we can’t always rely on our usual pillars of strength to be there for us – for all over, people are fighting their own battles and their resources and reserves are stretched. Yet there is a virtual bonding amongst strangers. People share their experiences and advice generously on social media. Sometimes a heart- warming post can provide a surge of hope to someone sitting halfway across the world.

In the initial days, kind heartedness towards those who had contracted Covid was not much in evidence. In some places, Covid positive individuals were shunned by neighbours. Petty-minded landlords even turned away doctor and nurse tenants who worked at hospitals, to safeguard themselves. However, an overall social awakening towards being kind and helpful was discernible with thousands of ordinary citizens reaching out to support the migrant labourers in India for example. Some elderly patients in Europe made the ultimate sacrifice for their fellow humans when there was a shortage of ventilators - giving up their chance in favour of a younger patient.

Another entity that desperately needs a show of kindness is planet Earth, who is reeling from a pandemic of human acts that have relentlessly depleted her reserves. Earth’s ‘lungs’- her forest cover, have been greatly weakened by profit-driven and uncaring human activity. Even as we humans hope and pray that we contract the asymptomatic version of Covid if at all, yet our lifestyles of consumerism leave mother Earth violently symptomatic. These manifest as natural disasters– devastating floods, strong cyclones, raging fires and the like. Perhaps now is the ideal moment for each one of us to be a frontline worker in healing the Earth.

It is deeply ironical that the planet once provided us pure air abundantly, yet we polluted it to the extent that we have to sip clean oxygen out of cylinders. To restore the green status quo there are several initiatives that can be taken both at an individual level - such as growing plants and vegetables in our own backyards to the government level - establishing far more universities for plant and wildlife studies, strict environmental laws that protect forest lands from road construction and mining and not allowing shops/kiosks in gardens, to prevent littering in and concretization of green spaces.

We can also reduce the ‘toxins’- plastic and concrete – from the surface of the Earth by a determined plan to use alternatives. Currently, one needs to reduce the additional load of plastic waste generated by the life- saving personal protective equipment (PPE). A good viable alternative is PPE made from recyclable material for example, maize outer leaf husk (fairly waterproof) or otherwise soap paper. The small, rectangular soap paper strips that are popularly used during travels can be manufactured in longer shapes – such as PPE overalls. Soap paper is naturally virucidal (soap molecules have a lipophilic component that binds to the lipid cell membrane of viruses, inactivating them) and very affordable. We can consider decreasing the use of alcohol-based sanitizers. Here too soap (in liquid form) could be a potential alternative. Also, it may be worth doing a study to see if blowing soap bubbles into the air (a useful talent that most kids excel at) helps to inactivate airborne viruses by adhering aerially to them. Moreover, when the bubbles burst, they would provide a fine protective film on the surface they rupture against. We can similarly make a deliberate attempt to reduce the use of concrete by removing it from where it is not really needed - for example from pavements. Pavements anywhere can be made simply of pressed mud with a brick edging only. This will help in replenishing the groundwater better, prevent flooding of roadsides in the rains and will allow trees to be planted on pavements which will discourage two wheelers from appropriating them.

To my mind, this pandemic brings a single message for mankind -that it is imperative to follow a sustainable lifestyle. If our collective actions now begin to spring from consciously caring about our own well-being , thoughtfulness towards our fellow humans and genuine love for Mother Earth and its species, this terrible suffering would be partly comprehensible.

A Meaningful Rakhi Gift

2020-08-18T10:28:00.000-07:00

The Statesman, July 31 2020

The much-celebrated occasion of Raksha Bandhan is around the corner. This used to generate considerable excitement when we were young. We made rakhis with Anchor thread and brushed them with used toothbrushes until the thread fibres shone.We then braided little beads onto the two side threads left long to tie them around our brothers’ wrists. Brothers busied themselves selecting the most thoughtful and appropriate gifts for their sisters. Rakhi highlights the strong and enduring bond between siblings. Sometime ago, someone asked me what the best gift was a brother could give a sister.

I felt the best gift was for the brother to truly understand his sister. I thought that one of the best ways in which this could be achieved was for the brother to step into his sister’s shoes for that day. To undertake the daily chores she does, visit the places she visits and so on.

Today, I feel the brother can go one step further and intervene to ensure that his cheerful, sprightly sister has a bright and safe future. He can oppose his sister’s child marriage with all his heart if he encounters it. If his affirmative action helps his sister to continue to enjoy her childhood, complete her education and be saved from the stress and physical danger of a teenage pregnancy, there can be no greater gift. Child marriage is a rampant social evil that has destroyed many young childhoods that should ideally have been spent in pursuit of knowledge and in gaining confidence.

Globally, in around 21 per cent of marriages, girls have been married off before the age of 18 – that is about 650 million girls. Out of these about 250 million were married even before the age of 15. One third of the child brides in the world reside in India. Though the scourge of child marriage affects both girls and boys, the proportion of boys is far lower. The median age of marriage of a girl in India is 16.8 years (much below the legal age of marriage for girls which is eighteen years), while that of boys is 22.6 years (which is higher than their legal age of marriage, twenty one years).

Though cognizant of the complex social pressures including poverty, lack of physical safety and many others that compel people especially in rural areas to marry off their daughters early, I feel the human price of doing this is paradoxically far steeper. The deaths due to teenage pregnancy are two times higher in girls aged less than 18 years and three times higher in under 15- year-old mothers. Though our country is showing a slight dip in maternal mortality in the last decade from 130 per 100000 in 2014 to 122 in 2017, this figure is still unacceptably high. Pregnancy-related complications are the cause of the greatest number of deaths of girls in the age group 15-19 years. Poignantly, that is the very age when young children are deciding their futures and what they dream of achieving in life.

To have your childhood abruptly cut short because of a forced marriage and then to have your life cut short because of pregnancy complications seems a tragic waste of potential. Apart from outright mortality, many girls are left with permanent damage to their pelvic areas or urinary systems from the ravages of pregnancy on such a young body. This makes them have permanently morbid conditions for the long term and contributes to a lack of self -confidence. Not only is the mother’s health at risk, but the babies born to teenage mothers are more likely to be preterm, of low birth weight, or stillborn. They also have a higher morbidity and mortality rate. It is estimated that 15 to 18 per cent of children born worldwide have low birth weight (less than 2.5 kg) representing more than 20 million births a year.

India has the highest number of pre-term babies in the world – about 25 per cent of the overall share. Over 25 million babies are born annually in India and about 1.7 million have low birth weight – below 2.5 kg – and 0.4 million have very low birth weight – below 1.5 kg. Several articles in peer-reviewed journals provide data establishing that the young age of mothers – less than 20 years and low birth weight of mothers – BMI < 18.5 per cent were both risk factors (National Family Health Surveys of India) for low birth weight babies. Low birth weight and prematurity are associated with higher rates of stunted growth, chronic illnesses like obesity, diabetes and cardiovascular diseases in later life and neurological problems relating to cognition and neurodegeneration.Such children are also at risk of retinopathy of prematurity (ROP), a potentially blinding condition.

Prematurity is a leading contributor to neonatal mortality. India’s own infant mortality rate is 32/1000 live births (2018). Low birth weight babies are 40 times more likely to die in the first month of life. Thus, we can see that babies born to teenage mothers start life with a huge disadvantage. There are other social implications. Reports such as the 2006 one by International Centre for Research on Women highlighted that girls married under the age of 18 were twice as likely to be physically assaulted by their spouses and to feel that this was justified. The study of psychology tells us that children tend to internalize the blame for events around them. If a child bride who is mentally immature decides to take upon herself the blame for being beaten by her spouse or the ill health or low IQ of her child, you can imagine the mental stresses she would be living with for a lifetime.She and her spouse would also not be in a strong position to bring up their children well, if they are young and inexperienced about life.

The UN World Health Assembly goal is to achieve a 30 per cent reduction in the number of infants born with a weight lower than 2500 g by the year 2025. Reducing the number of child marriages will be a powerful way to achieve this goal. It will also pave the way for gender equality.

In 2017, a small group of social activists including myself had worked on a PIL on equal age of marriage for girls and boys (which currently stands at a differential of 18 years for the girl and 21 years for the boy respectively), since the Constitution recognizes all citizens as equal. The exact age would be the decision of medical experts and child rights activists who understand the deeper nuances. But having an equal age (whatever it may be) would shift the mindset away from child brides for older men. Though ultimately our PIL did not come up for discussion for reasons outside our control; a ray of hope is that recently the Union government has constituted a task force to examine the issue of child marriage. It could either support the NGOs dedicatedly working in the field of child marriage for several years or else, working jointly with them, come up with an effective solution to curb child marriage. This would address a multitude of issues in one stroke – overpopulation, illiteracy, gender related disadvantages such as domestic violence and wage gap.

So, awaken brothers! If you can picture your smiling and carefree sister, whom you played with lovingly as a child, turning into a mental and physical wreck because of a forced early marriage, it should bother you greatly. This Raksha Bandhan, give your sister a gift born out of deep courage and love. Do all in your power to prevent her from getting married before the legal age of 18. Gift her your unconditional support to realize her full potential.

(The writer is a Delhi-based medical practitioner)

The virus that won’t go away

2020-07-20T19:03:00.000-07:00

The Statesman, 10 July

The ‘new normal’ is a term we often see used in journalistic writing nowadays. It pertains to the drastic changes in lifestyle and work pattern brought about by the corona pandemic. There is one area though, where another pernicious virus lurks that is fairly resistant to eradication – the virus of disparity between the genders.
Across diverse fields, women have been judged harshly, have had to struggle harder and have been compensated less for the same amount of work.

Consider sports. Several youngsters, like my son, enjoy playing and watching basketball. Though there are slight differences in the game for women and men, such as the ball size and the distance of the free throw circle etc., the hoop height from the ground is the same – ten feet. A fancy trick in basketball is ‘dunking’ where the player jumps up and literally slams the basketball into the hoop. More men are able to dunk than women. Their games attract more audiences. Is it because women have less sporting ability? Not so. It is because the courts and hoop heights are designed keeping the average male height in mind. Ideally the hoops should be higher for men, given that the average male height across countries is more than that of their female counterparts.For example, in 2020, the average male height in the USA is 175.3 cm and the average female height is 161.5 cm and in India it is 166.3 cm and 152.6 cm respectively. This difference holds across all countries and is significant. Though allowances are made for male competitors with lower weight categories in certain sports, this thinking has not extended fully to factoring in gender. Structural parameters remain the same whether it is swimming pools or games courts or hoop heights.
Women earn less in sports events partly because they are judged on standards calculated for masculine weight and height. While this has probably caused them to excel more, the talent required to do this has not been well acknowledged.

In the armed services, there are ongoing discussions on whether women are fit for actual combat roles or not. There is no doubt they are. With the sophisticated weaponry available, one doesn’t necessarily have to be physically very strong to handle it, though strength may be a desirable asset otherwise. Good, sharp reflexes and training are what is needed. The issues are actually more about logistics and additional infrastructure that the military will have to provide along with the patriarchal reluctance to taking orders from a woman.

To understand this argument better, one need only to look at rural areas where women do considerable heavy lifting, be it lugging water, grass or firewood. They carry enormous bundles on their heads. This has not changed even now, when many men are present at home. Men rarely lend a hand with these demanding physical chores in their own homes. If women can be relied upon to do the heavy lifting of several kilograms at home, why cannot they be entrusted with lighter rifles?

The bias against women has crept in a little into our laws. If we see the debate raging around abortion we find that the legal system chiefly focuses on ‘independent rights of a foetus’ versus the mother’s right over her own body.
Why should the advocates of a foetus’ independent right to life not debate equally energetically its right to enjoy the lifelong protection and financial assistance of its father as well? Why is the concern and care limited largely to its being born? Even in the case of unwed parents, there are laws in some states that accord the biological fathers some custodial rights over the child though he is not married to the child’s mother. Conversely, however, on the subject of abandonment of the family by the biological father, the onus rests on the spouse to file a specific case. My daughter, a law student, shared some research on how mothers are even retrospectively made accountable to the foetus in some cases in USA and elsewhere. In the Grodin vs Grodin case from the Michigan court of appeals in 1980 for example, there was an attempt by the child to hold the mother liable for taking Tetracycline antibiotic (prescribed by her doctor) during pregnancy which caused the child’s teeth to become discoloured as a result.
There are thus people who seek to curtail a woman’s rights over her own body, snatch away her privacy and her choices and even cast aspersion on the legendary maternal instinct she shares with the members of her sex. Meanwhile, there is scant debate on the responsibility of older males producing children, even when medical journals inform us that the offspring of older fathers (more than 35 years of age) have reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia. Instead, of being held negligent in any way, men are lauded for their ‘virility’ even at an old age.

The legal system thus does not seem to pin equal responsibility on the father as a parent. The norms of society end up placing additional stresses on women at the most vulnerable period of their lives – during pregnancy. A woman may be battling daily fatigue and nausea. The nearest good quality gynecological care may be available only very far away. The woman is often not supported with help in daily chores or ensuring she has the best nutrition. Sometimes, she is even blamed for being careless if she accidentally slips or gets hurt. Far less emphasis is laid on the conduct of the father in maintaining a peaceful and harmonious environment at home during the pregnancy. At work, women lose out on wages and career growth when they exceed the stipulated period of maternity leave. Why can’t the government make it a point to create adequate jobs that women can execute from home? Why must women pay a heavier economic price than men for the privilege of parenthood?

Recently, there was a case of a pregnant student activist seeking bail. Pregnancy was not accorded a special ground for consideration of temporary bail for her. It is well established that pregnancy can carry risks to the life of the mother and needs special care. This is reflected in many areas; insurance companies do not agree to new insurance for a pregnant woman till after the post-delivery discharge; pharmaceutical companies clearly state on drug labels whether a drug will harm the foetus if taken during pregnancy etc. When the welfare of companies and fetuses can be factored in, why must women have to fight for concessions for themselves before the judiciary?

We must recognize all these prevalent subtle and overt biases if we seek to establish a holistic ‘new normal’ way of life that is equitable. Will the ongoing pursuits of those working towards gender equality slowly usher in a more just ‘new normal’ or will it need the advent of a magic vaccine? Without factoring in the critical aspect of gender, we will simply be lurching from one abnormal state to another.

(The writer is a Delhi-based medical practitioner)

Ambrosia or a sip of destruction?

2020-05-13T10:47:00.000-07:00

The Statesman , Tuesday 12 May

Alcohol, which was in the news recently when liquor shops re-opened after a gap, has been central to human existence since ancient times. The Egyptians indulged in wine making and the Greeks had a deity for wine - Dionysus. Old ethnic groups had their own sacred drinks. The Mayans had their Balche’ and the Voodoo religion, its Clairin. Special herb-infused drinks were used to cure anything from sore throats to back aches. The significance of spirits has not lessened over the ages.

As curious youngsters we pleaded with our parents to allow us to have one sip from their glass of liquor. More often than not, when teenagers did get to have that first sip, it was a disappointing anti-climax. Most would screw up their noses in disgust and feel extremely cheated. Thus we became acquainted with the meaning of the phrase ‘it is an acquired taste’.

I ventured beyond a sip, to my very own first glass, when I joined medical college. In a celebratory mood on my birthday, we went to dine and drink at a local restaurant. One friend kept me company and the other girl declined saying someone had to look after the first two!

Apart from sampling it, we students learnt about alcohol and its effects in our pharmacology class. A pharmacology textbook authored by Lawrence gave one of the most memorable charts depicting the effects of alcohol through a series of funny drawings. I can still recall the property of ‘easy distractibility’ depicted by a car driver driving with his face turned sideways, looking at a lady on the pavement even while a pole looms in front . Or of ‘over cautiousness’– where our friend in the car simply refuses to overtake a slow animal-drawn cart. Shakespeare too has painted a vivid picture of the effects of drink in his play Macbeth. A character notes that it provokes ‘nose painting’, ‘sleep’ and ‘urine’. The nose painting likely alludes to a facial flushing seen in some who have a greater sensitivity to the effects of alcohol.

During our medical education we learnt how alcohol induces poor motor coordination, impaired judgment and drowsiness. Regular alcohol consumption is causally related to several medical conditions such as hypertension, vitamin B12 deficiency, hand tremors, liver cirrhosis, and pancreatitis among a long list. Some of these can be attributed to increased cortisol (the stress hormone) levels in the blood. In Forensic medicine, we learnt about how crude alcohol containing methanol caused acute swelling of the optic nerve and induced the sudden blindness we would read about in the papers after spurious liquor had been consumed. We discovered that there are two main categories of alcohols here - local country liquors like Arrack, Tharra, Daru etc. and the Indian made foreign liquors (whisky, rum and such - apart from the directly imported foreign) and of course illegally fabricated drinks which could be anything! Much later during post graduation we learnt of the effects of alcohol on the eyes such as possible accelerated age related macular changes, and changes to the nerve–tobacco and alcohol related amblyopias.

Alcohol is a substance which can induce addiction. Signs of chronic alcohol dependency, as distinct from its repeated abuse (which may have social, medical, or judicial consequences) are many (eleven criteria in the DSM book) and include: increased tolerance to alcohol (greater quantity required to achieve the same effect), impaired control over drinking and drinking despite adverse effects relating to work, relationships or health. A reformed alcohol addict from a de-addiction centre was invited to our college to speak and discourage students from travelling down the path of addiction. He narrated his story in a lively manner, using English words matching the proficiency of an Oxford don. The most important word of course was ‘sobriety’.

We students also gained a firsthand account of alcohol abuse from one of our bais (house- keeper) in the hostel. She worked very hard to nurture and educate her family, but was often waylaid by her unemployed husband who made off with her salary to buy alcohol and frequently ended up drunk.

Later, as interns, we attended to victims of road traffic accidents brought on by the excesses of alcohol. Apart from enhanced recklessness, alcohol seemed to bring on a flood of emotions as well. I vividly remember how copiously some of them would weep if we scolded them about drunk driving, after tending to their wounds. A recent study in The Journal of Clinical and Diagnostic Research (July 2015) tells us that of 200 drivers in a hospital in northwestern India who reported to the trauma emergency services, 54% had medical evidence of substance abuse and in 40% of cases the substance was alcohol.

Our army life found us with easy access to liquor. Some traditions included alcohol as part of the proceedings – such as drinking beer with the junior commissioned officers (JCOs) on Holi or newly promoted officers drinking from a chalice filled with alcohol into which their brand new pips had earlier been submerged. Being able to hold one’s drink was considered a coveted ability.

The associations continued in civil life. We enjoyed Urdu poetry where wine has always been an important topic. A gamut of emotions was linked to wine drinking – it was a refuge from unrequited love, it induced euphoria, and sometimes a welcome oblivion. Bars were described as extremely inclusive spaces. A memorable evening of Sufi music left an indelible imprint on my young mind. One of the song couplets which received thunderous applause from the audience translated as “People construct houses of worship…then set about excluding folks from them. Hindus are declared infidels at mosques. Muslims are declared infidels at temples. It is suggested that instead of building these houses of worship, build liquor bars (maikhanas) as they are the most inclusive places. At these, even infidels are not considered infidels.”Poetry clearly extolled the virtues of drinking.

Real life was a different story. Our work with the gender and social aspects of medicine helped us become more aware of the widespread impact of alcohol on domestic violence. Many studies linking alcohol to intimate partner violence are reported in well-respected journals which publish on alcoholism, family, psychology and interpersonal violence. A study by Carol Cunradi et al in 2009 of over 800 male and female industrial workers in the Journal of Family violence, reiterated this association between drinking and intimate partner violence for both male and female workers and additionally highlighted that male unemployment played a significant role as well.

Fast forward to recent news pertaining to alcohol - we saw long lines waiting to buy alcohol, largely without distancing or police supervision. The stated aim was to revive the economy through the sale of liquor. This however, is a moot point. Is this the ideal time to open liquor shops? Should economic revival be based on encouraging a habit which could later lead to addiction? A heavy drinker tends to suffer from poor nutrition and vitamin deficiencies. Added to this is the current spike in unemployment, relative starvation of many, and domestic violence at a high peak .Is it not the need of the hour to operate with caution and safeguards when introducing another element, that is alcohol - into this potent brew of uncertainties prevailing during this Corona pandemic?

To Post or not to Post

2020-04-10T02:53:00.001-07:00

The Statesman 2 April 2020

(This article examines the dilemma of numerous posts on Corona Virus - is it a boon or a bane?)

'To post or not to post’ seems to be the collective mental dilemma of the present time. A strong case has been made for staying away from the huge overload of information related to the Coronavirus. Conspiracy theories abound about its origin and spread. Well known personalities have advocated not thinking about or discussing the virus for some amount of time. Yet others insist it takes a toll on our mental health and can induce unnecessary panic. There are concerns about the authenticity of some posts. Many wise folks rightfully point out this is an excellent time to ‘look within’

My point of view is to have a continued conversation on the subject. Here’s why I think this is a good idea.

Corona virus posts/articles encourage discourse in real time. In this uncertain and rapidly unfolding situation, we don’t have the luxury of formal medical trials with long - term follow up results. All that we can bank on right now is an exchange of medical information, experiences, and ideas of those countries that have had a head start on having had to grapple with the disease. As a professor from AIIMS said ‘there is more learning in the corridors of the science department than in the laboratories’. He was alluding to the discussions between colleagues as they passed each other in the hallways, picking each others’ brains or offering solutions. It is well known that universities acquire their reputation not only from the infrastructure and staff but largely from the students they attract. Prospective pupils know that much of their learning will be from the animated brainstorming with their bright, talented peers. In a rapidly evolving, global and complex medical situation, it makes a lot of sense to communicate in all spheres - medical, social, civil; to ensure better coordination and allotment of resources. While doctors are exchanging medical information on treatments and susceptibility to the disease (older age groups are more vulnerable than younger people), geography and climate; epidemiologists, social scientists and economists among others are analyzing how and why the virus has travelled faster to some countries but not others. Technology and textile companies are focusing on equipment supply and upgrades. Successful state and country models are being highlighted.

There are posts which suggest radical conspiracy theories. People delight in being the first ones to post new and sensational information in their respective online groups. This raises eyebrows and can also inflame passions and stress. These posts, however, serve a very useful purpose. To be able to accept or reject the allegation prompts one to search for the truth and a lot of useful data is put out that can help one make up one’s own mind. There are the various conspiracy theories surrounding the virus’s country of origin, China, especially the nature of its origin. Whereas some feel it was due to cross contamination from Pangolin or bat viruses from China’s wet market, (there a lot of live fish and animals are in captivity prior to being slaughtered and sold) others talk about the viral research laboratory in Wuhan. For example, a published article (authored by scientists from Wuhan Institute of Virology, Universities in Shanghai and Peking and Australian Animal Health Laboratory) in the Journal of Virology , as early as Feb 2008 describes the successful experimental exchange of viral nuclear material between a SARS human infecting virus and the Corona, Horseshoe bat infecting virus.

Due to the lockdown and the important role of social distancing in breaking the chain of virus transmission, people are confined to their homes. There are some who live alone. Many need to talk about this overwhelming experience with others and understand how they are coping. Some people relieve their isolation by following up on posts related to the virus and some people their fear. I followed a thread on Twitter where a health professional wanted to know how patients, who reached the respirator stage, fared. Several doctors from across the world shared their experiences which left her feeling more reassured. Posing questions, sharing apprehensions and interacting gives people the sense that they are all together experiencing this challenge. No one needs to face it alone.

For all the accurate statistics and real life video shared by recuperating patients that may induce a sense of fear, there also abound many uplifting messages. Some of the spiritual messages talk of how the Coronavirus is a positive force, compelling us to reprioritize our lives. Messages encourage us to build our innate immunity; they underline how deeply connected we are-literally our lives are in each other’s hands. Wildlife enthusiasts are posting wonderful pictures of how animals are seen in larger numbers, now that humans have receded from many common natural spaces. Contact numbers of government shelters/ NGOs distributing food or collecting donations are shared. Doctors who are working long shifts without breaks are sharing their experiences and drawing their energy from the overwhelming support and gratitude they receive on their timelines. Due to a high transmission risk through doctors and hospitals as well as an enlightened decision to channelize medical resources towards COVID and emergencies, routine OPDs have been closed down in many countries. Doctors who are temporarily at home (or working in shifts) keep abreast on the disease through media and personal communication. A medical colleague told me how she is enjoying surfing through messages and savouring the ones that really appeal to her.

Moreover, diversity of opinion on any subject is very important. For global issues like climate change and the Corona scourge among others, people largely hear the political viewpoint as the official one. But how a politician looks at a scientific subject is vastly different from how a healthcare official or a scientist or even a patient views it. Myriad perspectives help create a holistic picture in our minds. Political announcements, though relevant as they outline the overall picture, don’t tell us the minutiae. We decidedly need other voices to fill the gaps.

We can either look the problem squarely in the face and not get intimidated by the news surrounding it or we can choose to bury our heads in the sand much like the ostrich and just hope that it will blow over. Will it create a panic? It is difficult to say. As a family member pointed out - many people in our country have a fatalistic attitude and believe in destiny. Such people are not likely to panic easily. Also there are controversies about fake and real posts. To clarify, one can check the source (e.g. standard E newspaper sites should be reliable) or references, as well as rely on posts of known people (those you know personally sharing their experiences or opinion) or verified handles.

For those who are as overwhelmed by the posts around the virus as they are by the virus itself, they can just switch off from the welter of information. They can do so secure in the knowledge that if they feel like connecting to their wider ‘family’ in the world at any time, all it takes is the tap of a button.

The Perception of Sedition

2020-04-10T02:47:00.000-07:00

The Statesman 26 February 2020

A recent occurrence at a public event in Bengaluru caught the attention of many. The video showed a young teenager standing on the stage saying something and the very next minute she was being manhandled by a large number of the men on stage who towered over her. The plucky teenager seemed undaunted and kept trying to grab back the mike to continue speaking, but was overwhelmed by the sea of swarthy men jostling her, snatching the mike away, till finally she was led off the stage by uniformed policemen.

As a woman, I was dumbfounded at watching fellow speakers on the dais physically bully this young girl. On paying greater attention to details, it seems that the teenager, 18-year old Amulya Leona, had chanted “Pakistan Zindabad” at the commencement of her speech. Several people took umbrage to that. The politician who was hosting the show was worried that it would go against his patriotic image. She shouted out “Hindustan Zindabad” a couple of times thereafter and some on the stage joined in the chorus. I later learnt that she has been booked for sedition under section 124 A of the Indian Penal Code. I was stunned for many reasons.

If a young girl’s statement could be quoted out of context (it seems she was advocating peace amongst all the neighbours in the Indian subcontinent and celebrating these neighbours) and she could be arrested for that, it didn’t augur well. In all our teachings in school and the answers we have written in exams till date, one is always asked to provide a background before embarking on the answer. In her case, the context was blithely ignored.

If merely voicing the name of a neighbouring country attracts arrest, then what of Indian officials who have engaged with our neighbour at various levels of cultural exchanges and overt as well as backdoor diplomacy? What of controversial TV anchors who invite Pakistani nationals on their prime time programmes to get the views of both sides or even just to increase TRP ratings? Here they are going one step ahead and actually engaging with Pakistani citizens. Would that attract harsher punishment under ‘advanced sedition’?

In the current Indian scenario if we take the literal definition of sedition ‘incitement of resistance to or insurrection against lawful authority’ into account, then many people in authority would themselves be guilty. For, in our country, the main authority is actually the Constitution of India. Those who try to undermine it or dilute its spirit in a big way are the ones actually indulging in sedition. What of politicians who destabilize state governments by luring parliamentarians this way or that by offers of money? Doesn’t tampering with lawfully elected state authority fall into the actual realm of this definition? The teenager’s sloganeering did not represent disaffection with the Indian or any government for that matter (as she broadly invoked the names of countries), no force was used, nor did her words incite anyone except a handful of burly males sharing the dais with her to push her off it! If anything, friendly relations with the neighbouring state were promoted as we are not currently at war with any state. The teenager was merely exercising her right to freedom of expression under Article 19(1)(a) of the Indian constitution. Some may find her plucky and some consider her a nuisance. But she is clearly not jail material.

Keeping our country’s history in perspective, many families in North India have elderly members who were born on the Pakistan side of undivided India. The Freedom struggle gained us our independence in 1947, but political circumstances led to the painful and violent partition into two countries. Many elected to come to the Indian side of the fence and many were caught unawares as they were holidaying here. Despite the traumatic turn of events, members of both these groups speak warmly and nostalgically of their childhoods and the neighbourhoods they grew up in. My father was born and brought up in a place called PakPatan, district Montgomery, undivided India. At a change of guard ceremony at the Wagah border, my mother-in-law looked longingly across and said that Lahore is less than 30 km away - so near yet so far! Is it possible to hate the land of your parents’ birth? So what if different people live in that place now? Just like an old house you loved and lived in when you were young (hear the nostalgic ‘the house that built me’ by country singer Tanya Tucker to understand what I mean) remains in your memory no matter who the new tenant may be. Wanting to revert to an old status quo of peace certainly doesn’t seem to amount to sedition.

At a global level, the United Nations was formed with the chief objective of promoting world peace and security and friendly relations between countries. Respected dignitaries the world over offer to broker peace between warring nations in strife torn, volatile regions. The celebrated poet Rabindranath Tagore tried to elegantly uplift our thoughts above the confining boundaries of geographical regions and an aggressive nationalism which eroded our sense of a larger humanity. This is also reflected in the Indian philosophy of Vasudhaiv Kutumbkam. If the people who inhabit countries at war don’t want to have their lifetimes defined by mortar, shelling and hatred, would we call them reasonable and sane or a seditious bunch?

India is a signatory to the the United Nations International Covenant on Civil and Political Rights (ICCPR) which exists to ensure the protection of civil and political rights of citizens. It includes the right to freedom of thought (Article 18) holding one’s own opinions and expressing them (Article 19). Article 15 also suggests that ‘no one can be guilty of an act of criminal offence which did not constitute a criminal offence’!

Whether the sedition law itself is even necessary is a moot point. The judiciary has thus far been inclined to safeguard the freedom of speech of the Indian citizens in almost all their judgments. It is clear that if one’s thoughts are not in consonance with those of the government of the day it does not amount to sedition. The Indian Law Commissions recommendation of 2018 was to invite a greater public debate on it and amend it to make it more citizen friendly. This law was put in place by the British to keep us ‘natives’ in our place and safeguard the authority of their colonial rule. Freedom fighters that attracted the sedition laws in the pre-independence era included JC Bose, Bal Gangadhar Tilak and Mahatma Gandhi. Ironically the British do not have such a law in their own constitution. The post-independence list of those booked under sedition law in India includes writers, thinkers and all manner of citizens, only a few of whom were actually declared guilty.

If we aspire to be a great democracy, we must support the building blocks that go into its making, especially free speech and thinking. Attempting to jail a young girl for reasons that are not compelling does greater damage to our standing as a democracy than to her.

Whose Sentence is it anyway ?

2020-04-10T02:42:00.000-07:00

The Statesman, 19 January 2020

Every evening at 8 pm, the same poignant scene unfolds outside the apartments in sector 19, Dwarka, where Nirbhaya’s parents currently live. Some RWA members and Nirbhaya’s parents stand with lit candles for an hour in the cold, reminding the country’s institutions, in their usual dignified manner, that justice still eludes them at the end of seven long years. They have been holding this evening vigil for 31 days now and will continue to do so till the culprits are dealt with as per their sentence. The group of candle bearers is growing daily. Other satellite groups have formed, in solidarity with Nirbhaya’s parents.

What is unacceptable is the way the criminals are exploiting one legal loophole after another, right under the gaze of lawyers and government. Three different courts, the Sessions court, the High court as well as the Supreme Court examined the case in detail over several months and reached the same unanimous verdict of the death penalty in 2017. The law allows the filing of mercy and curative petitions after such a penalty as well as the ability to apply for presidential pardon - but within a ‘reasonable time frame’. Secure in the knowledge that our legal system is tardy, the criminals were caught napping for two years. Now that the date of their execution has been declared, they are filing one petition after another. Since most petitions and PILs on a common topic are clubbed together, it also seems a miscarriage of justice to allow criminals to file their applications serially rather than collectively. Are we to understand that a victim who is gang raped by a larger number of people must expect a longer delay before justice is awarded? The judicial system must not be allowed to be subverted to give such dreaded criminals one undeserving chance at delay after another. When the same courts and government are dragging their heels over possible violations of constitutional rights of citizens a such as those protesting peacefully against CAA/NRC/NPR implementation, as well as the citizens of Kashmir; giving these people who have indulged in such a monstrous act so much judicial leeway is palpably unfair. The Central government has demonstrated the ability to effect changes almost overnight such as in the case of demonetization and abrogation of article 370 (which was complicated and fraught with constitutional implications). Given this background it is incomprehensible how the combined might of the Central and State governments is not able to provide justice to a forlorn, long suffering, anguished mother and father even at the end of seven years in a proven case of rape and murder.

There is a worldwide debate on whether the death penalty stands scrutiny and there are strong arguments for and against. Suffice it to say that our Indian legal system currently allows the death penalty to be prescribed for the rarest of rare cases. Rather than discussing that aspect, I would rather like to draw your attention to the ‘sentence’ meted out by criminals to innocent citizens for no fault of theirs.

When our citizens’ group first met Nirbhaya’s parents a year or two after the December 2012 incident, one of the things that Badriji her father said, are etched vividly in my memory. He said ‘I nearly lost one more member of my family that year’. The allusion was of course to a grief and depression so deep that it can kill a person. It is by no means easy to deal with such a great loss. Asha ji would agonize for years afterwards about the fourteen odd days she spent with Nirbhaya in the hospital when Nirbhaya was in a critical condition. She would keep remembering her desperate desire to give in to her daughter’s request of just one sip of water, which she couldn’t, given the doctors’ strict instructions to the contrary. The mental trauma and stress which the family has undergone is tremendous. Even then, they have got back on their feet and work towards justice and empowerment for all girls. Does this long suffering mother and father duo not deserve the court and government’s empathy and support? Should they be standing day in and day out in the cold while the criminals explore one legal remedy after another, wasting the taxpayers and courts’ time and money? What makes these remorseless persons who inflicted such cruelty on Nirbaya so special that we provide them chance after chance to keep challenging their richly deserved and ethically and legally arrived at sentence? Why are governments mulling the political advantages and timing of addressing such a grave travesty of justice rather than mitigating the suffering of the parents? When will everyone gracefully acknowledge the verdict arrived at by all the courts?

When we consider the struggle of a victim of sexual assault in India, their agony is compounded multiple times after the incident, which does not allow them to put it behind them easily. The difficulties begin right from the time when the FIR is filed. Dealing with insensitive and brusque officials, makes the victim feel worse. Mental counseling is rarely provided. Then come years of court appearances where some of the illiterate victims, do not even fully comprehend the court proceedings and just get the feeling that they are being given one date of extension after another as the case drags on. The defense lawyers of the accused often are brutal in the cross examination. Somehow casting aspersion on the victim’s character is a cheap and popular ploy.

At home, the victim has no respite. Often insensitive neighbours avoid interacting with a ‘violated’ girl or are intimidated by the families of the accused into not meeting the victim. The relatives of the accused, sometimes abetted by the local officials put pressure on the victim to withdraw the case by bullying and threats. The victim and their family thus live in fear and constant dread. Often, they have lifelong gynaecological or other medical problems for which they need to be on prolonged treatment and medication. Some spend a lifetime on antidepressants. Many lose out on a promising career.

Instead of focusing on the human rights of criminals, why do we not vociferously argue about the right to life and liberty of the victim as guaranteed by article 21 of our Constitution ? Or the human right against cruelty in the Universal Declaration ? It is truly ironical how those who brutally violate the rights of another clamour for their own rights to be protected and are listened to with a great show of fairness.

Those adults who commit these heinous crimes know full well that it is punishable with severe sentences.It is their conscious choice to tempt judicial fate. But what of innocent citizens who are sentenced to a lifetime of mental agony, physical trauma or lose their lives ? Did they deserve such a sentence ? Are they getting any chances at being whole and healed again ? Not so. Then why an inordinate number of chances for depraved humans indulging in heinous acts?

The resources in a democracy should be focused on the greatest good for the greatest majority. Sadly there is a tendency for reasons of sensationalism to direct these resources, our time and empathy towards an undeserving handful of the worst behaved citizens. It is time that this thinking changed.

It is time for the victims to be supported instead. Simply, by thinking of them for a change.

Taking The Lords name in vain ?

2019-12-13T10:05:00.001-08:00

The Statesman . Nov 25

There is no universally accepted way to interact with the Almighty. Some consider Him (or Her as the case may be) as a friend and do not hesitate to seek His help to overcome their worldly woes ranging from a tough exam to some coveted financial gain. Some hold the Almighty in deep reverence and leave it to Him to shape their lives. Some swear by elaborate rituals and others prefer a lack of adornment. I personally think highly of the Bhakti movement that first originated in South India in the 7th and 8 th century, CE, which strongly emphasized simplicity.

The Bhakti movement centred around the existence of one God, the equality of all worshippers, the non-necessity of elaborate rituals and the importance of humaneness and brotherhood. The omnipresence of God has always been widely accepted by most of humanity. However, His name is increasingly being misused by people the world over as a cover for their own dubious intentions. Several actions do not reflect true reverence for the Almighty. For example, it does not seem at all right when a suicide bomber is blowing up someone to bits or a mob is lynching people, all the while invoking the Almighty’s name.

It is certainly questionable that the path to salvation be littered with the corpses of fellow humans. In recent times, a few popular institutes of worship were found harbouring secret dens of worldly pleasures. While the gullible masses reverently sat outside chanting God’s name with their eyes gently closed and a prayer on their lips, steamy scenes were unfolding in the darker portals of the buildings. One so called ‘godman’ even had a pleasure cave resembling the typical luxury villas of gangsters on tropical islands. Perhaps only the sea, the sand and the blue skies were missing!

It is very unsettling to find people donning the special robes that identify them as ‘men of God’ and then indulging in a wildly hedonistic lifestyle away from the public gaze. A beautiful song asks the Maker how the devotee can ever face him on the day of reckoning , given the sins and trespasses committed – the lyrics run thus : “Maili chadar odh ke kaise , dwar tumhare aaoon”- “(Lord) how will I be able to face you at the end with this body cloaked in sin”? More shocking discoveries have emerged as priests of diverse religions have been accused of sexually abusing the followers of their faith.Surely, harming other devotees by molesting them against their will can simply never be the path to God. Moreover, whereas one would associate an ascetic with kindness or gentleness, it is noted that some ‘men of God’ can be particularly vicious and vengeful. Submit to their unwanted attention and all is well. If, however, you point out their malfeasances, they will hound you to the ends of eternity. In recent times a vengeful Bishop has hounded a sister right out of her convent and a disgraced Swami has used his influence to have his young accuser clapped into jail on charges of extortion.

Another dubious activity is grabbing land in the name of the Lord. One fairly popular modus operandi starts with putting a small photograph of a deity (even a rock with tika or tilak usually suffices) with a garland around it, on a pavement or under a tree and counting on peoples’ fearful superstition to not remove these items from there. This happened outside our colony. Someone put a picture of some deities under a shady tree with a large trunk. Soon worshippers started leaving coins there. Over a period of time, enough had accumulated to be able to create a tiled enclosure for the idols where people on the way to the bus stop just outside the colony duly stopped to worship.
Our colony already boasts of an actively functioning Gurudwara and Mandir since many years, so this was a ‘bonus’. No one objected to the status quo till a little shop came up adjacent to the ‘tree mandir’. Tea and tobacco items began to be sold here and it attracted a lot of middle-aged men who would sit there smoking and gossiping. The so called ‘mandir’ was now forgotten and a small commercial pavement hub (possibly the real lucrative intention?) developed. Several citizens who found the public footpath blocked and the presence of unwanted hangers-on near the bus stop a big nuisance complained to the municipal authorities to demolish the tree mandir and help them reclaim the pavement.Their requests met with stiff resistance, mainly from the hangers-on in the tobacco joint as well as some devout worshippers from the area. This story ended well with the tobacco shop and mandir ‘complex’ being ultimately dismantled. However, such scenes are a regular feature at many public sites. Such occurrences should alert us to the multiple ways religion can be put to self-seeking or nefarious use.

Religious premises or financial collections can sometimes be used for dubious activities.

Caretakers of religious precincts may lose sight of their sacred duties and mislead, extort or bully the trusting worshippers. The gullible public may save themselves from many a rude shock and bewilderment were they to keep their minds open and alert and not approach religion and religious authority blindly. Many true ascetics, who could have been excellent role models for us, chose to lead austere lives in fairly remote places, well away from humanity, to reflect on life and God.
Intuitively, they knew that the deepest and most important thoughts are likely to arise when one is sitting quietly with scant worldly distractions in the lap of God’s most beautiful creation, Nature.

Seeing that we don’t often have access to many real prophets around us it may well be time to think more profoundly about the Lord ourselves and make our own judgements about how to comport ourselves in an ethical and wise manner.

Links To Ophthalmic Publications

2019-09-04T20:30:00.002-07:00

JOURNAL: ORBIT

1. Rare Orbitocranial Tumour in an Adult

Anjali Mehta , MBBS, DO, DNB & Mithilesh Chandra , MD, FIC

Orbit :The International Journal on Orbital Disorders, Oculoplastic and Lacrimal Surgery

Volume 28, 2009 – Issue 5

LINK: https://www.tandfonline.com/doi/abs/10.3109/01676830902920652?journalCode=iorb20

JOURNAL : INDIAN JOURNAL OF OPHTHALMOLOGY

1. Sudoriferous cyst of the orbit of adult origin after trauma

Anjali Mehta, DNB, Aparna Rao, DO, and Apoorva Khanna, MBBS

Indian J Ophthalmol. 2008 May-Jun; 56(3): 235–237.

PMCID: PMC2636125

PMID: 18417827

LINK : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636125/

2. An unusual variation in the anatomy of the uncinate process in external dacryocystorhinostomy

Anjali Mehta, DNB and Nitin Puri, DO

Indian J Ophthalmol. 2008 Sep-Oct; 56(5): 413–416.

PMCID: PMC2636146

PMID: 18711272

LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636146/

3. Unusual markings on an intraocular lens postoperatively

Anjali Mehta

Indian J Ophthalmol. 2012 May-Jun; 60(3): 241–242.

PMCID: PMC3361829

PMID: 22569395

LINK : http://europepmc.org/articles/PMC3361829

JOURNAL : DELHI JOURNAL OF OPHTHALMOLOGY

1 Ductal Cysts of Lacrimal Glandular Tissue

Anjali Mehta, Sudipta Ghosh, Aparna Rao
DJO 2007 Jan-Mar; 12(4): 89-92

LINK : ttps://www.djo.org.in/pdfs/DJOvol12no4.pdf

Seeking Space For Conversation

2019-08-23T21:17:00.000-07:00

The Statesman, Aug 15 , 2019

When growing up, one of the simple joys of life was talking: long, animated, often uninhibited exchanges punctuated by smiles, laughter, gasps or even silence. A friend was someone you could talk to about everything under the sun. I remember sitting up late at night conversing with friends till sleep overtook us, or discussing ideas passionately over a single long drawn out cup of coffee in a restaurant where the waiters thought it more important to let friends talk rather than earn an extra buck with a new set of customers. People talked, argued, laughed, reasoned, teased, cajoled, and admonished. The act of talking was a relief, if not an outright pleasure.

Although we are in the midst of an explosion of social media, this unfettered, meaningful communication seems to be difficult to achieve. The reach of our conversation has increased, but its quality and our satisfaction has reduced.

Much of the talking that was done face - to- face is now over social media apps. A lot of the warmth and the nuances of good conversation, the non - verbal cues are lost in the exchange. This leads to greater miscommunication and misunderstandings as the expressions and tone cannot always be correctly inferred. Communication on social media thrives on brevity as attention spans are limited. Excellent conversationalists suddenly find themselves challenged by the need to constantly abbreviate and summarize. Some are not technically conversant with tools on social media and have a limited understanding of emoticons thus making their conversations sound sterile and robotic.

We now focus far too much on the speakers’ background and affiliation and too little on the content of the speech. Suspicion runs deep in today’s polarized world and distrust abounds. Recently, when the question arose of whether doctoral dissertations in universities should come under political scrutiny it led to a justified public debate. On one hand was the academics’ view that being experienced, they could better identify the critical and in-depth studies needed in their field of expertise. On the other hand were politicians who wanted to put their stamp on academia by allowing funding for only those theses which they deemed to be of ‘national importance’. Such citizens that simply just debated this topic were deemed to be anti -government. Similar conundrums have existed for ages: for example, should scientists who have a deeper understanding of the subject decide climate change policies or should politicians? Most conversation now has acquired a political flavor. People are uncomfortable plumbing the depths of a topic as what they say is made out to have a deeper political meaning, even if none exists.

Conversations are open to a large group of people and this attracts trolls also. These trolls disrupt meaningful conversations. If at first the trolls do not succeed, their involvement with the conversation becomes increasingly abusive and hostile till the speaker is either forced to defend himself or get angry and distracted or simply block/report the troll. The end result is that the original idea gets totally deflected, lost in an obfuscating smoke of negativity. It also makes one very uneasy to find that one’s conversations are monitored.

There exists a conversational overload. If you subscribe to several platforms like Face book, Whatsapp, Instagram etc, a substantial amount of your time could be taken up in interacting with friends or colleagues or just anyone else who may have posted something that catches your attention. In attending to too many conversations at the same time, we are unable to let a worthwhile conversation blossom.

Finally, it is difficult to converse with the many ‘anonymous ‘people ubiquitous in every group. In ordinary conversations on social groups, it is not easy to talk as naturally and freely as one would like to as there remains an air of formality with strangers - nameless, faceless individuals who would also end up getting addressed in the conversation.

Given these challenges to wholesome conversations, there is a great deal to be said about engaging in good old face - to - face interactions more frequently. Also in order to have a more meaningful conversation, conversing in smaller groups on WhatsApp is better, where the thread is not lost due to random forwards. Larger groups should be used for professional discussions and invitations to programmes or putting out useful information for the public at large.

In bygone times, it was known as the Art of Conversation, where the personality of the persons engaging in conversation shone through. The joy of a deep conversation, in a safe environment with the right people is almost therapeutic- it is satisfying, stimulating, and rejuvenating. Nowadays people always seem to be in a rush so conversations are also getting abbreviated. Into the realm of healthy discussions there have crept in undesirable changes reflective of the times we live in .So is there not some innovative way of reclaiming the art of good conversation and rediscovering its lost joy?

Everything Counts

2019-06-21T09:46:00.000-07:00

As a child I held this rather unshakeable theory that God is inherently fair. If He/She let trouble come a person’s way, it was certain to be compensated by rewards later, evening it out. God also likely allocated resources equally. On the surface, if a particular child seemed luckier than others in terms of intelligence or material resources, they were probably facing their own battles in other spheres, unknown to the rest. Philosophical adults that we encountered taught us that monetary wealth cannot buy happiness and true riches pertain to intangible things like the soul, joy and friendship.

As an adult, I ponder more about this equality and try to put my finger on what it is that we as people have been granted in equal measure? We are all blessed with an outer casing, the body; but the makeup industry, the busy offices of plastic surgeons and the touched up photographs on social media testify to common dissatisfaction with what we have been given. Advancing age with all its physical changes only compounds this. Under this shell, is the core essence of a person – the soul. Though all our souls are supposedly derived from a universal divine soul, how deeply we are in touch with this soul whilst alive, is a matter of conjecture. True equality comes with death - when our souls are believed to merge back with the original common one.

If equality inheres in us, there must in all likelihood be at least a faint hint of this possibility if not an overt phenotypical manifestation during our sojourn on Earth.

The well-regarded scientific study by Dr Paul Ekman and Wallace Friesen conducted over four decades found a universality of facial expressions for the basic human emotions irrespective of race, culture, geographical location and literacy. This had originally been predicted by Charles Darwin and interestingly, they had initially thought that Darwin would be proved wrong! Humans use the same facial muscles to convey basic emotions like anger, happiness, shock etc .This holds true even for remote tribes that have never been in contact with humans from outside (in Ekman and Friesen’s case they studied the Fore tribe of Papua, New Guinea). Cultural and circumstantial influences may mask or modify expressions but the underlying facial muscles called into play when experiencing a particular basic emotion, are the same.

Does this also mean we are fundamentally equal in our ability to communicate? If we consider a spectrum of people ranging from those with various types of autism, those with personality traits like introversion, to orators speaking effortlessly to vast audiences, we find that this particular skill is differentially distributed. A subgroup of this may be our ability to smile. We all acquire this fine social tool after a few weeks of settling into the world as newborns. The smile of a baby is adorable even though it may lack teeth. But those who have facial paralysis or Parkinson’s disease for example, can only convey their joy through the expression in their eyes.

Is it the ability to love and be loved? Love is one of the finest, most exhilarating and nuanced emotions. Though there are several of its variants to indulge in, ranging from parental to filial to romantic, yet sadly one finds hatred to be a strong driver for many people and love gets consigned to the shadows. Or is it the ability to feel per se that homogenizes us? We find that many of us are losing this capacity and being ‘thick skinned’ is becoming a common enough adjective.

Does drawing breath render us equal? As long as we are alive, we all breathe. Spiritually advanced persons and those who practice yoga regularly often have an impressive control over their breathing. For the rest of us, our breathing quickens and slows in tandem with our moods and activities and we don’t really have mastery over it.

I intuitively think what really makes us equal is our ability to contribute to shaping the world. We are all assistant co - creators. Speaking metaphorically, the world is like an enormous clay mound waiting to become a beautiful vessel on the Potter’s wheel - an analogy often used in religious works. Building on this, I feel while the Master Potter (God) keeps the base spinning we all add our imprints to this mound of clay representing Earth. It is so huge that we get glimpses of only a part of it.

Everyone is equally important because everyone shapes the world. Each human is special; he/she interprets the universe through an individual outlook derived from influences of parents, teachers and friends and life’s myriad experiences. Hence the output is also customized.

Every action, effort or powerful thought acts like a touch or pat on the clay. Whether we lovingly shape it or punch holes in it is entirely our choice. We can throw on more clay or gently chisel away some based on our perception and energy. It doesn't matter because sometimes it is a rough edge that makes the design stunning or a subtle touch that makes a significant improvement.

Occasionally the patterns are so exquisite that everyone sits up and takes notice.

The impact of our actions can be localized or globalised and independent of the public position we hold. The students participating in the March for Life campaign in the US or the little Swedish schoolgirl, Greta Thunberg, fighting for climate change protection, have demonstrated that you don’t have to occupy a high office to effect great change.

We can condition ourselves to be engaged and creative assistant potters. Masterpieces executed by painters, sculptors and other artistes are treasures lasting centuries. Social workers facilitate upliftment of many humans less fortunate than themselves, enabling and empowering them to make meaningful contributions in turn - a positive ripple effect.

You can even shape the world by just being. As Milton said in the concluding line of his famous poem ‘they also serve who only stand and wait’. A baby is totally dependent, able to interact in a very limited way with its environment; yet can have a tremendously powerful effect. He/she can generate love, and can influence the work and lifestyle choices of parents and family significantly.

Everything counts.

To come back to my childhood belief, it would be reasonable to assume that the invitation to shape the world is open to all. We cannot at all judge whose contribution is lesser or greater as we do not know the Grand Design. Moreover the shape keeps changing a little every second. Our mind’s eye aided by our imaginations, can only guess at the overall shape. Many religious texts including the popular Srimad Bhagavad Gita, advise us to refrain from worrying needlessly how our contribution fared overall. It is perhaps more important to fully and responsibly enjoy this privilege we have received.

Don't Shoot the Messenger

2018-08-23T11:14:00.000-07:00

The Statesman, August 9

Since it was introduced to the world in 2009, WhatsApp has become one of the more popular messaging apps with an estimated 1.5 billion users worldwide.
It was acquired by Facebook in 2014, an event which seems to have resulted in a massive spurt in the number of users in India. Currently, there are around 200 million WhatsApp users in India, of which more than 50 per cent are from rural areas.

Recent lynchings of five people suspected to be child-lifters by a mob in Maharashtra were sparked by a rumour circulating on WhatsApp. This generated much debate about this messenger service.
The Indian Electronics and Information Technology ministry asked Facebook Inc (which owns WhatsApp) to find ways by which they can curb transmission of irresponsible messages.

I believe that putting external curbs on this particular medium may not be a sound or practical idea. Here’s why:

To my mind, someone inclined to spread a rumour, create a ruckus or induce a riot, will do so by any means at their disposal. It could be through public or private meetings, sermons, lectures, Facebook and other social media sites, YouTube videos, loudspeakers, pamphlets, in fact anything in the firmament.

Violence has been an integral part of mankind’s existence since millennia. So has gossip. As have rumours. Social media is a fairly recent entrant into the list of human preoccupations.
On the Indian continent we witnessed the carnage of partition with thousands of lynchings. Millions of refugees worldwide will tell you of the atrocities that have been committed on them.
Human greed, intolerance, a lust for power and money and divisiveness are to blame. Social media is merely a communication tool. One does not need mass phone aided mobilisation to lynch a man or even a small group. A few barbaric citizens will suffice.

Humans have been communicating through sign language, through drumbeats in forests and mountains, Morse codes, smoke signals and several other ingenious ways.
How can you prevent human beings from communicating with each other? History is replete with examples of ‘underground’ resistance movements. There was no social media in those days. Decrying WhatsApp will only make users switch to another format.

The app itself is really well designed in that one can share messages, videos, attachments, photos, rendering it quite complete in itself. There is end to end encryption which means that no third person can view a message including the service provider.
There are no distracting advertisements. Being so easy to use makes it an effective communication tool for villagers and an apt app for facilitating a ‘ digital India’. It is currently a free service.
There are options to mute or block a number, exit a group, delete a group, delete a message within seconds. It is very self-regulatory. Users can actively choose to ignore or not forward a rabble-rousing message or one can call it out publicly or report Spam.

WhatsApp features allow a large degree of privacy as well as autonomy. It is contemplated that WhatsApp can be a payment portal in the near future as well as a safety app as geographical location is pinpointed.

Attempts to ‘sanitize’ the conversation by having all posts filtered through an administrator on WhatsApp create practical and ethical dilemmas. People would not be able to communicate swiftly and meaningfully in real time as there would be a time lag – related to the availability of the administrator.
The administrators themselves may have personal biases or lack discretion. This post of being an arbiter of conversations, by its very nature would have to perforce be a full time job. If not compensated, the job’s fairly thankless nature would have few takers. The moment it becomes a paid job, it would then be liable to be controlled by those rendering the payment as often happens in the classic editor-owner ideological/ethical clashes of print media.
In the past, an idea was mooted, to hold the group administrator accountable for any inappropriate posts on that group. This suggestion is bizarre because nobody can determine beforehand what is on a person’s mind.
People are invited to a group because they form part of a particular cohort: say people who work together, or have studied together, etc. To try to first filter out who would be welcome in the group based on their leanings and personalities attacks the very foundation of healthy interaction – a multi-faceted, inclusive and rich dialogue.
Moreover, people’s opinions, likes and dislikes change with time. Sometimes, an otherwise very responsible citizen may be unable to maintain their cyber composure under emotional duress. Above all, the truth needs to be told.
It is critical that everyone who has attained adulthood be deemed responsible for their own thoughts and actions. To burden a third party with this responsibility seems to completely absolve the author of an unsuitable post of their duties and instead targets an innocent bystander – administrator/medium instead.

Misuse of social mediums across the board has often resulted in disastrous consequences. Examples include the Blue Whale internet game driving teenagers to suicide, or stalkers and paedophiles on Facebook (using information voluntarily provided by users themselves) or the notorious ‘trolling’ on Twitter.
Recently our own external affairs minister was openly and abusively trolled on Twitter. Astonishingly the government was relatively silent and low key in its defense of their own minister. It was citizens who tried to come to her rescue.

In these times, when a large section of the print and TV media is perceived by many to be deeply influenced by the government, the viability of alternate channels of communication between citizens is imperative. WhatsApp has an important role to play.
Though there are many fabricated videos which aim to spread hate or falsely discredit someone, some such videos are deliberately introduced to obfuscate things and discredit the medium itself. To make people doubt the validity of some of the horrific but true things they see and prevent them from reporting it or taking useful action.
To counteract this trend, there are now helpful tutorials available which educate people on how to spot a doctored video. The bottom line remains that individuals must have the self-discipline to not share a video which is not from a trusted source or which contains inflammatory material.
There are already reporting methods in place to report cyber abuse or misuse of cyberspace though guidelines can be made more clear-cut. One can highlight it electronically to the office of the app provider as well as register a FIR with the cybercrime units of local police stations.
The company office can debar the accused individual from using this medium. The company often needs to do a balancing act between enabling freedom of speech and increasing user base versus conscience and social responsibility.
The company can further report them to police officials. The local police can apply any section of the Indian penal Code as relevant and have the person booked.

In conclusion, people themselves should show a low level of tolerance for divisive or incendiary posts on WhatsApp, calling out the person or reporting them to authorities.
We can come to each other’s rescue on any medium when someone is being bullied, or ourselves attempt to combat and thwart rumour mongering by ignorant or ill motivated people. Try as we may, if we are to be intellectually honest, we cannot pass the buck for our shortcomings onto a messaging app.

The writer is a Delhi-based medical practitioner.