Amair ki ladki- Amair's girl

I have been planning to take my children for a visit my village, but so far have not been successful in planning the trip. My mum says with pride that I am Amair's girl, when she is wanting to praise my industriousness.

My village or my father's village is in Vaishali district, but the nearest town is Hajipur. This makes it Ganga paar or the other side of Ganges. My mum is from Gaya and listening to my nani and dadi, I gathered that there is an intense rivalry between people from this side and the other side of Ganges, both accusing the other of less grey matter amongst other things.

When I was little, I remember the key word was "steamer", I am not sure whether these water borne passenger vessels still exist on the river Ganges. They must have, like the steam engine, run with coal as fuel...I am guessing, because they hooted like a steam train and bellowed dark fumes as well.

The Mahatma Gandhi Setu over the river Ganges, was non existent at the time and therefore after we arrived in Patna, we would have to wait either for the "steamer" and then in later years, the "launch", which in turn, was some sort of motor boat. Both these used to have fixed times, steamer took in many more people but did not depart everyday where as the launch accommodated less passengers and ran an afternoon trip each day.

Another advantage of this motor launch was that it was able to take us right to the village. As far as I remember, we were able to make our way from the clayey sandy river shore where the launch dropped us, on foot to the house. While near the river Ganga, the expanse of the river and the fertile fields alongside, stretched green and bright, till the eyes could see but as we walked towards home, the village was towered by fruit trees, mango and banana. Banana plantations are quite crowded and because they constantly need water, they are also very muddy to cross, but tall mango trees have lots of shaded peaceful space under them.

It would be usual for my mother to cover her head by the time we reached the temple and as we approached the mango trees. Because we would usually meet a few elders sitting on charpoys, under the big mango trees, chatting, playing cards or simply just guarding the crop- the ripe mangoes.

Greetings would include touching of feet and introductions which would usually end in exclamations about how much bigger we kids looked.

The house itself has four approaches from the four directions. Ours is the Poorab dura (East dwar or door). The house at the time, we had counted with our cousins was home to a good 50-100 residents depending on what time of the year it was. There were rows of vegetables growing right outside the entrance and there were also corn fields. Our homes in the towns would usually have a surplus of potato chips (ready to fry), mango pickle of at least two types, dried raw mango powder or aamchoor, aam-papad, honey etc. which was our way of enjoying the produce of the land in the village.

It was good to see where it all came from. Now there is an additional house, which I have yet to see which has been constructed, but earlier on the big sloping roof house was rectangular in shape with a quadrangular courtyard in the middle, which is where we would usually sleep in our mosquito tents propped up with crisscrossing bamboos on a jute rope or woven textile charpoy. Hand fans made of palm leaves were very handy on days when there was no wind.The house, distempered with cowdung and mud solution on both walls and floors, looked exceptionally neat. However, we would always hear stories of snakes and scorpions being found at inopportune times under the bed or over head hanging from the roof or on the beams.

The most entertaining and much awaited event for me used to be a bath or shower in the village home. Right outside the entrance is a tube well, where we would usually wash our feet before we got into the house. One could choose to have a shower with water from the tube well, which is wonderfully cold and nice on a hot summer's day, but the entrance usually had the men lounging on chowkis, enjoying a siesta, a chat or the newspaper.

The next option was having it at the courtyard well, in open air, some distance away from where the food was being cooked on a fire made of wood. If we wanted some more fun, we would go to the "machine". This was a motored tube well which was used to water the banana and other crops. The pipe my guestimate is, had a diameter of 15 cm, and spouted out a thick stream of water at great pressure. This was the most popular place for us kids to have a shower, and out in the fields usually there were very few elders around to watch over us.

Then of course there was "Gangaji" as the river is referred to, in the village. We would need to be accompanied to the riverside where we could splash around in the shallows and watch as people used the red silt as soap and shampoo for washing their body and hair.

I wonder if that was the better thing to do, rather than pollute the river with soap. I don't think I bothered with anything. A sari held around, served as a temporary tent for getting out of wet clothes and getting into dry ones.

All this was bound to make us hungry and we were provided with buckets of mangoes soaked in water, which we proceeded to demolish one by one. Strangely nobody knows about cutting and sharing mangoes in Amair. After all when our cousins invited us, they said "Come to Amair to eat mangoes" "Aam khane aana". That invitation has been oft repeated, wonder when I will be able to do justice to it.

Now for many years, since the bridge was built over the Ganga, the village is accessible anytime of the day or night, if you have a vehicle; but even with public transport it is much easier that the steamer and launch days. There are regular buses up to a certain point and then taxis and autos take you to the doorstep.

The capital Patna, being accessible has changed a lot of things in the village. One hopes it increases aspirations, fires ambition and encourages the younger generation to get out of the village and find out different things to do or do the same things differently.

Girls seem to be doing better than the boys which is no different from the national statistics....but they are also given free bicycles to go to school when they reach the age of 14. This has seen high school enrolment of girls triple in four years in Bihar. High schools being fewer and far away had a high drop out rate for girls, which has been stemmed by this initiative and is being rolled out to other states.

Infrastructure and most of all political will can transform lives and in turn statistics. Here is wishing I will get to visit my village, soon.

Empowerment and suicides

Talking to the car mechanic gave me an idea of how the patient coming to a doctor's clinic or emergency room must feel like.

If I can feel so ignorant about a car, which is man made; surely the human body is much more of a complex creation of nature.

It was like this guy was telling me- "we need to take the kidneys out as they need a wash and the liver, thanks to the wine on weekends does look like it is not going to last your next health check up... so be prepared to have that replaced and the heart....well it doesn't help that your body is so heavy and the fact that you run it so little...." I just had to agree to whatever he was telling me because I have no clue whatsoever, about how a bloody car works. Needless to say every health check for the car runs into hundreds of pounds subtracted from my bank account.

Sadly not all human organs are so easily replaced. Today I read a facebook post about Jiah Khan's suicide and the fact that his ex boyfriend being arrested for abetting suicide was just unfair and gives women a chance to blackmail men into commitment.

All this macho talk about- "women should be strong" "Relationships are not the be all and end all of one's existence" "Parents should have given her better values so that she did not get herself in this situation" etc etc is all very well but the fact remains that for a young beautiful girl with so much potential, to be driven to take her own life, she must have been in a very sad and horrible state of mind. She must have needed help which wasn't forthcoming in our society and she could not bring herself to ask for that help.

Just around the same time we heard of suicides amongst celebrities and celebrity children, I happened to see a young beautiful and pregnant girl who was crying and saying things like- "I want my baby to be safe" "It has taken me a long time to ask for help" "I have been searching the net for ways to kill myself"

I don't often feel like this, but while talking to this desperate girl, I actually felt like bursting into tears myself. To put things in perspective suicide is amongst the top 4 causes of maternal death in UK and has recently become the leading cause of death in women aged 15-49 in India. Second is childbirth, earlier it used to be at the top.

I asked this girl if it would help if we admitted her into hospital and she said-"I can't change my brain, it doesn't matter where I am and who I am with"

When we started reading psychiatry in medical school, we realised that there was such a thin line between the normal and abnormal. We had all encountered people who were Obsessive compulsive neurotics, the uncle who checked the garage door lock at least 3 times after turning away from it, the aunty who was getting an allergy to soap, from washing hands all the time...etc etc.

But significantly mental illnesses are just like physical illnesses. You don't say, your mum should have brought you up better to ensure you never had a heart attack. Yes, had you not been overweight, inactive, alcoholic and smoker (i.e. had not had a brake fail or a broken windscreen), there was lesser likelihood of meeting with an accident/ heart attack but yet having everything in perfect working order, doesn't guarantee anything.

Similarly, being born wanted, having loving parents; who along with loving you, loved one another, having a good education, having friends etc etc must shield us from mental illnesses which have more of an environmental causation but yet there are a host of illnesses which are genetic, endogenous and are not brought on by circumstances and depression leading on to suicidal thoughts is one of them.

Laws in India reflect the fact that suicides amongst women have been found to have a strong association with domestic violence. Dowry deaths and deaths from fires were many times staged as suicides. But now men are considered guilty unless proven otherwise. I have known married women with children on long term prescribed medication for depression,  where husbands were arrested and considered guilty when the woman decided to kill herself. Collateral damage from the laws meant to empower women.

Yes we need to enrol ourselves and our children into daily inbuilt art of living classes, where we live healthily, have a healthy balance of love, togetherness, friendship, companionship, tolerance and self reliance but mental illnesses have long been neglected. The result is that going to a shrink carries a stigma. There isn't the level of awareness or infrastructure to help people when they need help but don't know who to turn to.

Kiran Bedi used to write a column where she used to ask the question whether the education system in India is failing the young women, who after having worked for and completed post graduate degrees still consider their lives a failure if their spouse decides to reject them.

Empowerment is a big word, difficult to understand and much more difficult to achieve with or without laws and in laws.

So long!



 

The innocent cauliflower

Looking at the innocent cauliflower in the supermarket takes me down the memory lane.

The schools in Asansol did not have a school bus of their own. Children came by private cars or students from the collieries came in Eastern Coalfields Limited (ECL) buses. We unfortunately, were a class apart, we were a bunch of kids mostly children of doctors, nurses, radiographers and technicians who worked in the Central Hospital Kalla. Kalla was a good few kilometres away from the city and had nothing else to call its own, except the hospital and a remote village.

The vehicle earmarked for us, schoolchildren, was a big military style lorry, with a very worn out canvas covering the metal framework at the back where we all climbed in. The good thing was that the driver and his assistant sat in the protected cubicle in front, leaving us all girls and boys from neighbouring schools to do as we liked around the back.

The way the canvas rested on the metal framework, it would after a night of rains, in its numerous depressions collect puddles of water. There were many holes in the canvas and the boys would strategically poke one of these depressions from under the surface of the canvas, from inside the lorry, to enable the water to drain into one of the holes inside the lorry and it would invariably result in a screaming girl shaking her shirt to get rid of the unexpected stream of water down her back, which would amuse the boys no end.

Apart from that, it was a very comfortable and airy journey for all of us. It was open at the front and the back so protected very little from the elements. But the lorry broke down very regularly and once its brakes failed. We found out after we reached home to crying hugging parents, that had we not been stopped by crashing into the oncoming vehicle, we would have been hurtled over the precarious rusty iron bridge which was one way and was built few hundred feet above the rocky bed of a river.

Anyway, when this lorry was not in working order, the ambulance would have to make two trips but better still when the ambulance broke down, we would be packed into a Mahindra jeep which would in turn make three trips.

Naturally everybody wanted to get into the jeep, so little children were first packed inside systematically, the older boy had his throne marked, he sat on the bonnet, on the opposite side of the driver. One young hero who used to sing in those days the hit song from Yaraana- "Tere jaisa yaar kahan..." would hang out of the jeep while standing on the the step, holding on to the side. I would try to get the best seat which was sitting on the spare wheel which was attached to the rear door, with torso and head outside the jeep, enjoying the breeze. If that seat was taken the girls would stand on the back step hanging on with one foot inside. Worries about a flying skirt would mean one hand on the iron rods of the jeep frame and one pulling the skirt in place.

Being able to drive now myself, I wonder how Hussain chacha, as the driver was called lovingly by all of us, could see anything except a tunnel view in front of him. Mother used to say he had an alcohol problem, but we never noticed anything except a half empty bottle in the glove compartment. We loved him. He was not as strict as the lorry driver and used to be so much fun.

In winters when there would be vegetable venders walking on the roads, with baskets full of neatly stacked hill shaped mounds of cauliflowers, he would slow the jeep down, go really close and those of us hanging out of the jeep, standing on the steps, would outstretch their arms and steal a cauliflower for Hussain chacha (May God Bless him!). Sometimes we were able to get the top one and sometimes we toppled the basket and an infuriated farmer/vender would then throw stones at us.(girls being at the back were more likely to get hit)

My father used to travel out of Kalla each day and could have easily dropped us, my brother and I to the school, but he never ever offered. Health and safety??? Well!!! He was such a worrier, I am sure he must have worried about his daughter hanging out of a jeep driven by somebody who had an alcohol problem but I guess it would not have been fair on the rest of the children, whose parents did not have the means and who needed an education as much as us.

Needless to say, I think about it now as a parent but back then it was a lot of fun. Kalla was a close knit community where everybody knew everybody and my dad would always stop the car and give a lift to anybody waiting at the bus stop towards Kalla, who looked vaguely familiar and wanted to go to Kalla.

My love for Bengal, Bangla and Bengalis stems from my stay there, where I watched Jatras, Baul gaans and enjoyed the four day long festivities of Durga Puja (my best memories being of the aarti competitions, I can smell the dhoop and hear the sounds as I write this).  I attended the weddings, where brides were dressed in Rajnigandha flower tiaras and sandalwood paste face decorations, where friends and family lovingly served food, one course at a time. The tomato chutney, the roshogullas, the luchi and the fish....yuuuummmyy.

Ofcourse not everything was traditional, even in those days. There was the orchestra which belted out popular Bollywood and Bangla numbers and there was the open air cinema.

We would all make our way to the ground with modhas, chairs etc. Vendors selling peanuts would collect as well and then we waited for the sound of the train, which was supposedly bringing in the "Boi" followed by the sound of the guys shrieking jubilantly on the two wheeler. Then the reels would be loaded and we would watch, enraptured, on the white screen.

I couldn't have imagined then that there would be 24 hour cinema channels on television. I wonder if we are the generation who has seen the most change, or maybe the more rapid change is yet to come.
Change is inevitable, but values are important.
Hope these values will stand the test of time!
 

Diversity multiculturalism or lack of integration

Some time back, a few of us Asian families organised an Indian Mela, to raise funds for a charity which works in the field of wildlife conservation, and which is organising an expedition for our daughters.

None of us had done this kind of thing before and it was a great experience for the girls who created posters and tickets, kept the accounts, went on door to door trips around the neighbourhood and the High Street to sell tickets and to get sponsorships for auction and raffle prizes, respectively.

On the day, they dressed traditionally, in half sarees, did tika and aarti to welcome people and performed Bharatnatyam.

Our major clientele was the neighbourhood and the hospital. They came and gorged on the food, all authentic home made stuff except for ice cream, which was served with GITS Gulabjamun. They also danced to Bollywood, bought Indian trinkets and shawls and pronounced it a success. We partied on the leftover food, patted ourselves on the back and discussed organising similar events in future for hospital attached charities.

We believe that our children should be proud of their culture, should know where they come from and the values we stand for. We often discuss the fact that NRI kids seem much more in touch with their culture as there is an exoticism attached to it and parents seem to encourage it. But is clinging on to our indigenousness likely to cause a problem for our children, will it impact their ability to integrate and assimilate into the British society?

As a doctor one hears about the areas dominated by ethnic minorities, where women don't access health services, face language as well as cultural barriers and in turn put themselves at risk due to all these factors. These are places where people have not moved on...So if they left India or Bangladesh in 1960, they have maintained a community and family which behaves like India or Bangladesh in the sixties, not taking into account the fact that their children are growing up in 21st century Britain and even if they were growing up back home, times have changed back home in our countries of origin in a major way too.

As a people, we Indians should be used to the slogan "Unity in diversity". But every state of the Indian Union has a different language, cuisine, dress and culture which the people of the state are quite rightly proud of and it results in phenomenon, which people from outside India find difficult to understand.

In Norfolk, a county in the tiny island of  Great Britain itself, we have a Malayali Association, a Sikh association with their very own Gurudwara and of course numerous smaller social groups of Gujaratis, Tamils, North Indians, Bengalis...We celebrate our own and get together for many others depending on many factors including religious alignments.

So it is often fun to watch people get defensive brickbats from wronged communities in response to posts on Facebook which are hilarious impersonations of how a Malayali or Bengali or Bihari person's accent would sound or some other not so politically correct jokes.

Of course politicians in India would like us to remain divided. But English being so important for employment, Internet, Satellite TV and acceptance & popularity of inter state marriages have all meant that more and more regional languages, traditions and cultures are losing their sheen.

Whether good or bad, with so much immigration within countries and out of countries, multiculturalism and integration is inevitable. It is important for us to maintain a balance between being true to our culture while being able to adopt the new.

Indians have always been lauded for doing this quite well in the countries they have immigrated to. As a result they contribute to the British economy while not being a burden, unlike some other ethnic minorities. But they are also known to live in tight knit communities, who tend to socialise and marry amongst themselves.

I wish my son would speak better Hindi or that my daughter would not be excluded from being able to enjoy the wonderful works of Premchand or Amrita Pritam, but.....

There are other things to worry about- I still have to deal with dates, late nights, clubbing and God knows what else!!!

Sheryl Sandberg's talk

http://www.ted.com/talks/sheryl_sandberg_why_we_have_too_few_women_leaders.html

Sheryl Sandberg's talk

http://www.ted.com/talks/sheryl_sandberg_why_we_have_too_few_women_leaders.html

Doctors

A school time friend's seventy six year old mother had been a victim of substandard care in one of the top corporate hospitals in Mumbai. She had had a fall with significant injuries when she had actually gone there for a minor planned procedure on her foot.

I cringed as I read this on the Facebook. I had recently attended a meeting in my hospital about such "SUIs", serious untoward incidents. Sadly, they happen everywhere.

There was an outburst of comments from friends all over the world. While some were sympathetic and wished and prayed for a speedy recovery, a lot of them were angry comments advising my friend to complain or take the legal route. I had expected this. (Serves me right for constantly berating other professions like administrators, on Facebook). At some point an outburst against my fraternity was going to happen.

When I decided to become a doctor, it was considered a respectable and noble profession but now if people around you in a party or in the train (in India) find out you are a doctor, you get to hear the worst horror stories of a disillusioned, suffering yet helpless populace, struggling against a society which treats Healthcare as a money making proposal.

When I heard about my friend's mum's predicament, I remembered our experience when my mother was admitted to a private hospital (in the Central Government Health Scheme panel), with fractures involving her back bone.

My brother, a plastic surgeon had given strict instructions, nobody, and he meant nobody was to move mother unless he was around. I now understand fully why he was so careful. He did not expect the staff to be aware of what multiple fractures in the spine meant, how one wrong move would impact mother's condition, present and future. Unfortunately he was right, most of the staff were clueless.

Today when I attend all the various training sessions which have been identified as mandatory for all the staff , we joke about how tedious they are and in spite of all the training, we don't completely avoid errors in the system. Manual handling, fire, infection control and medicines management are a few of the sessions which all staff have to do. But at least doing training sessions brings about awareness of the standard operating procedures and that minimises risks.

When my mother and my father in law fell ill, I realised how difficult it is to get accurate unbiased advice which one can trust, in the mayhem of private providers of healthcare in the city of Delhi. This was when there were so many doctors in the family and amongst friends.

Healthcare Costs are spiralling everywhere. It impacts in different ways. In America the cost of improved drugs, devices and treatment and better diagnostics along with more litigation, pushes up Health Insurance costs.

In UK, where the National Health Service is state funded, it has led to a tier of middle and more senior management whose job should have been to facilitate safety and quality in health care but has led to the opposite, while trying to drive down costs.

The  Francis enquiry into excessive deaths in one of the hospitals in NHS is now asking for a change in culture, a culture of openness, where staff and doctors are able to voice their concerns without being bullied for whistle blowing.

One is always suspicious of pharma companies' marketing budgets, which allow for multiple travels abroad for prescribing doctors in India and the cuts which diagnostic laboratories and imaging facilities have on offer for referring doctors.

When Aamir Khan brought this up in Satyamev Jayate, the doctors were up in arms. But in my view, the profession needs to introspect. It is because we have not been able to regulate ourselves, because our regulators and institutions are not working for the people, we are seeing a host of others joining in the feast, controlling and pushing up costs. Spiralling costs will lead to increased expectations, more litigation and mistrust in the profession.

The basic duty of care is something we should hold ourselves accountable for, morally and ethically before we think about the fact that we are legally accountable.