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Letter from Chennai
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Mani M K. Letter from Chennai. Natl Med J India 2019;32:379-380
Another English Invasion?
Our chief minister, generally seen in a spotless white dhoti and shirt, suddenly donned a lounge suit and flew to Dubai, the UK and the USA for a series of photo-ops. We were informed that the purpose of the trip was to attract investment in Tamil Nadu. The news media gave much publicity to the fact that he signed a Memorandum of Understanding (MoU) with the King's College Hospital of London to open branches in Tamil Nadu. I wonder whether this is one of the foreign investments in our state, and what will be the financial arrangements? Will the London hospital hire staff from here, or bring their own people? This hospital is run by the National Health Service (NHS) of the UK, and it is widely recognized that NHS funding is not keeping up with inflation, and services are actually being cut. Does the NHS hope to derive some income from Indian patients, or does it intend to do charity for our poor? I have written to the health secretary to the Government of Tamil Nadu asking for some clarification about this. I do not expect a reply, but will certainly inform you if I receive one.
We are also told that the chief minister, and our health minister, who also sported new western wear, have arranged with the London School of Tropical Medicine and Hygiene, and the International Skills Development Corporation to upgrade our health services.
Tamil Nadu is, as always, leading a hand-to-mouth existence, thanks to the initiatives of our politicians to provide various consumer goods to the public free of charge in exchange for their votes. Our government doctors threatened to go on strike if their demands for implementation of a pay band at 13 years of service instead of 20 years, providing posts in proportion to the number of patients, and restoring the 50% quota for service candidates (denied by the High Court) in postgraduate courses, were not met. Some months ago, the government promised to give them a favourable response, but even after the doctors gave an ultimatum and fixed a date there was a stony silence from Fort St George, and the doctors went on strike on 25 October 2019. The association said more than 60% of the 18 000 government doctors were on strike. There were no outpatient or routine inpatient services. Emergency and critical care services were maintained.
When we cannot satisfy the demands of our doctors, how can we afford to pay UK doctors for their services? The only way we can afford to utilize their expertise is if they provide us subsidized or free service. Perhaps our government is counting on them to act as strike breakers. I find that difficult to conceive, given the financial constraints of the NHS. However, I should make it clear that I do not support the striking doctors. While we have always demanded Central Government scales of pay, we have never been willing to give up our private practice. Second, I firmly believe that doctors have no right to strike. We may not have been declared an essential service like the army or the police, but if we stay away from work en masse, some people will inevitably die, and we would have betrayed the trust society places in us.
The East India Company came to Madras to trade, 475 years ago, and led us into slavery. To paraphrase Virgil (Aeneid c. 20 BCE) ‘Beware of English (Greeks) bearing gifts.’
Pity The Poor Policeman
In response to a public interest litigation (PIL), the Madras High Court asked the Government of Tamil Nadu whether it was implementing an 8-hour day, and providing a weekly day off, for policemen in the state. The home secretary in an affidavit said it was not possible to fulfil either of these provisions due to the demands of the service. There were 16 108 vacancies in the ranks of the police, against 124 738 sanctioned posts. We of the medical profession remember our early years as junior doctors when we worked long hours without sleep and days off. However, we knew it was going to be for a short time, and we looked forward to a good life after this period of privation. There is no such relief in sight for the policeman. When he rises through the ranks to be a sub-inspector, his hours and conditions of work are no better. He is at the beck and call of every politician, minor or major, and is often reviled by the public. While the system of policemen being allotted to domestic duties in the houses of senior officers has been officially banned, in reality the practice goes on. It is humiliating for a grown man to be at the beck and call of the children of a senior police official, and to know that this should not happen but to be helpless to protest must be a severe psychological strain.
Our Ministry of Home Affairs said in a statement that between 2010 and 2014, 166 policemen committed suicide in Tamil Nadu, compared to 161 in Maharashtra and 61 in Kerala. This is eloquent testimony to the fact that our policemen (and those of other states) are under severe stress. We recognize the police to be an essential service. Should not the government treat it as such? Do we not have enough able-bodied young men in Tamil Nadu to fill these vacancies, and should we not hire enough policemen to give them regular working hours and days off? All over the world, businessmen who employ labour in sweatshop conditions are reviled for exploiting the poor. Is our government any better? Since the police service is classified as essential, policemen are not permitted to strike, and cannot resist the callousness of the government.
Sex Assignment Surgery
Some unfortunate children are born with ambiguous sex organs, casting their equally unfortunate parents in a quandary as to what to do. They tend to decide on which sex they wish their offspring to have, and take the help of the medical profession to modify the external genitalia accordingly. While this might work out well in some, it could be disastrous for an individual who is assigned the wrong sex.
In April 2019, the Madurai bench of the Madras High Court decreed that parents could not take a decision on sex reassignment surgery, and should wait till the child was old enough to opt for herself or himself. Presumably the child should be able to consult trained psychologists after he/she reaches an age when he/she can understand the implications and voluntarily decide on surgery. I have often wondered how doctors could fall in with the wishes of parents and perform complex sex reassignment procedures. Does the desire to demonstrate their skill and art blind them to the psychological trauma they could inflict on the child?
In August 2019, the Government of Tamil Nadu passed an enlightened order to ban such surgeries until the child can make the decision as to which gender to opt for. Except in life-threatening situations, parents will not have the right to decide on what could be an emotional disaster for the child.
On more than one occasion, the Madras High Court has decreed that hoardings are illegal and should not be erected, except by the government itself in the public interest. These orders are consistently ignored, especially by the political class, who regard themselves as above the law. Birthdays of politicians, or their visit to any place for a function, inspire lesser functionaries to inform the public at large of their undying loyalty and affection to their seniors in the hierarchy, by means of large hoardings along busy roads. I presume the corporation and the police force should remove these illegal hoardings and take action against the perpetrators. There should be no difficulty in identifying the culprits since they make sure that their names, and often their portraits, are prominently displayed on the boards, of course in smaller fonts and pictures than those of the main person who is being lauded.
A few weeks ago, one of these politicians celebrated the wedding of his son. The deputy chief minister had accepted his invitation and was expected to grace the occasion. Naturally, the host had to make the world aware that he had enough clout with the great man to persuade him to attend the wedding, and so he erected some hoardings to welcome him. No official took cognizance of the offence.
A young woman, the breadwinner of her family, was riding along that road on her two-wheeler, and a gust of wind toppled the hoarding as she was passing. It fell on her, she fell from her scooter, and was run over by a water tanker that was being driven behind her. She died on the spot. The driver of the tanker was arrested. I do not see that he was in any way to blame if the unfortunate victim unexpectedly fell in front of him. The real culprits are the police and the corporators who saw the law being broken as the hoardings were erected, and took no notice. The most guilty is of course the politician who broke the law and had the hoarding erected in the first place. No action was taken against him at first, but the public outcry that followed led to a warrant being issued against him. The police found it very difficult to trace him, and he remained at large for several days, but finally he was apprehended after many complaints from common citizens. The law will, we hope, take its course, but the tragedy of the untimely death of a woman at the start of her career can never be remedied.
The police and the corporation woke up to their responsibilities and have launched a drive to remove the hundreds of illegal hoardings all over the city. I hope this will be sustained permanently.
Another death by negligence followed a few days later. People all over the country must have heard of this one, as the rescue efforts attracted much publicity. It was even reported on BBC news. A 2-year-old boy fell into a disused bore well. Efforts to extricate him failed and he died. The owner of the bore well is culpable for this death, as the rules clearly say that bore wells, whether in use or abandoned, may not be left uncovered.
It will not be easy for authorities to find all the open bore wells, as these are scattered all over agricultural fields, but exemplary punishment for the culprits may serve as a stimulus for all others to seal their bore wells immediately. The newspapers of 31 October 2019 carried a government notification asking all owners of wells, whether bore wells or surface wells, to have them registered with Metrowater in the appropriate form. Having both in my compound, I reported at the local Metrowater office, only to be told that the forms are not available.
We have no shortage of laws that would benefit all of us. The problem is that such beneficial legislation, from the speed limit to the wearing of seatbelts and crash helmets, is never enforced.