The P Place, Department of Accounts, Panaji.

            Opposite the Capt of Ports, across the road where the new Patto bridge descends to an always crowded 24-hour petrol pump is lovely (but very untidy inside) old building that houses the Treasury and Pension sections of the Government of Goa. I’ve been visiting it often, to help a very old relative restore the pension due to her. It had not been claimed since 2004 because going there wasn’t worth it to collect the Rs 60. That was before two pay commissions increased the amount drastically.

            On my first trip to the department on a very hot April afternoon, I was amazed/amused to find an entire floor of people comatose. The air indicated much indigestion happening amongst them. Indeed, I thought, India should harvest the gas produced in such offices, good fuel it might make, and lots of it. To be fair, the clerks who were awake were helpful. The file I wanted was tracked even before I submitted the application. I returned impressed.

            By the first week of May, a letter was despatched to me via Post. It didn’t reach me, and one of the behind-the-benchers told another that this ‘not reaching’ was happening often. I’m not surprised, because my village, Sangolda, had no postman for several weeks and even now I have a feeling it’s a badli that’s doing the rounds. I got a photocopy of the letter concerned. The relevant Deputy Director requested me to meet the Treasury people on the ground floor. I know every tile of that sweeping staircase because I’ve avoided slipping and tripping on more than five occasions.

            My visits to the Treasury have put everyone in a tizzy, because I very sweetly refuse to leave the premises unless they do something spelled w-o-r-k. Very sweetly. My weekly visits have made them search their cupboards downside up and confidently inform me that no records exist for such and such person. For how many years do you store records? I ask. Ten, I’m told. It isn’t ten years yet, I inform them, hence the records should be there. They agree, then politely tell me that they’ve been around for two/seven/nine and a half years and that’s why they don’t know where the records are. They mumble something, I think it’s a mantra to make me disappear. Doesn’t happen, I’m still there. I ask a matronly woman staffer who looks like she’s about to retire whether she’s been around for ten years. I ask her in Konkani, Marathi, English and Hindi. Like the mantra, this doesn’t work either. She throws sad glances at the cobwebs on the ceiling, tattered papers in the trash-bin, stains of spit and the rain outside. Will someone give me in writing that my records have been destroyed, lost? Nope, now the voices are confident: they haven’t received anything in writing, see? The letter that I have from the Dep Director doesn’t have a cc marked to them, see? How can they give me anything in writing? I pen in duplicate yet another application and run to the despatch clerk to get in inward-stamped-and-dated before the minute is up, for if the shift ends, I’ll have to make another trip.

            I notice a pensioner walking in with drooping shoulders, his fingers clasped in front of his chest like he’s approaching the sanctum sanctorum of a holy place. The young male clerk who helped me in the first instance and the peon are the only ones who make any effort to approach him. The sariwali madam with the diamond ear-studs thinks yawning and stretching takes too much effort, so she just sits without moving at all. At all. It’s fascinating that a fellow human being can thus just ‘be’ day after day after day. The Art of Living guys must take a lesson in this meditation technique from her. They can earn some more millions.

            Coming back to my story: I’ve booked every Wednesday in my diary for the year for a trip to the pension office. I’ve set aside a budget for pilot ride to and from ferry (sixty bucks, equal to the amount of the original pension), chips, sandwiches, a tetra-pack of fruit juice and paper napkins. Might as well make a picnic of it. One problem though: the taxes I pay the government don’t ensure me a clean loo in that office.

Meeting Jo Masacarenhas and Cantoments in Goa.

            Considering we don’t party or socialize much, it’s surprising how many interesting Goans come into our lives. We were at a friend’s home for dinner. This was the first time I’d visited a Naval home and was more curious about the trees and shrubs lining the broad roads and the view of the Mandovi from the hill than about whom I was conversing with. I love military cantonments in India because of the well-preserved and displayed plant life. The hidden fauna occasionally do peep out, but the regular visitors to and inhabitants of the place would benefit by that. But the conversation turned out to be really interesting. First, my hosts were far better informed than I was about Goa’s natural history. Then I met the Mascarenhas family.

            Jo and Sharmila Mascarenhas impressed me because a) they were open about the poor value system in some of Goa’s expensive private schools and b) they felt the daily need to expose their children to people from different economic, religious and ethnic backgrounds. Of all the young parents I’ve met, these have been the only ones who have shared my opinion. Most of the time I find parents more concerned about whom their children will network with when they grow up. They sow the seeds for the contacts they will harvest as adults. Groan. That’s why I found this couple’s point of view refreshing.

            Secondly, Jo, who works with an institution I think is India’s unsung educational success, the ITI, took part in an inter-government hockey tournament. The participation was creditable because of his age: 42 yrs. If he’d been regularly in the circuit, I’d not have had much to say. But this happened over two weeks, and hurriedly put together Goan team with but fifteen days of practice, beat Karnataka 4-1. What’s more, Goa also returned with the trophy for the best march-past. Out of 42 teams, Goa won. Marching involves teamwork, co-ordination, rhythm, smart alertness, and more. My state has all that, it’s the best in India.  I take pride in writing this. Sadly, they told me that the school they had admitted their children into, did not take assemblies and marching seriously enough. I listened to what they had to say because they told me interesting things.

            They told me they ate much of what they grew in a tiny area surrounding their house in a dry neighbourhood of Porvorim. “We have to often buy water as the supply isn’t enough.” My take on this is: in India, we need to have two kinds of water supply. One potable, the other for toilets, cleaning and plants. It takes a lot of energy, money, effort to provide drinking water the consumption of which is much less than for the other uses. If our panchayats/governments/municipalities were to take water resource management seriously, we need never have to buy water privately. One thing needs to be drummed into every Indian head, specially politicians: harvest the rain, harvest the rain, harvest the rain, harvest the rain…  By eating what they grow, they’re setting a good example to their children.

            Over plate, napkin and fork, I learned that Jo knew how to catch snakes.      

           The snake-lovers of Goa are a unique breed. They belong to various professions, come from unusual backgrounds and are passionate about catching, identifying and caring for snakes. I remember my son’s friends, Aaron Lobo and Luke Victor who were avid snake fans, getting into near-fatal venomous trouble because of this love of theirs. It was all the more of interest to me because just that morning, the guy who cleans our plot, who isn’t afraid of reptiles and usually tosses them across into the jungles with a twig if he encounters one, killed a baby cobra whose venom wouldn’t have been of the dosage to sedate a kitten. If the creature hadn’t walked over the man’s hand, it’d have been alive today. His being in the vicinity wouldn’t have scared the man, but touching him, crawling over him – that was another matter.

            By coincidence, within 24 hours, I visited another ‘Camp’ as military areas are called. In Vasco. Wondered how they managed to keep their neighbourhoods so tidy. No signs of plastic or any other litter.

            One of the lessons I’d learned early in my hotel and later hospital-administration career was: a motivated workforce follows a code of conduct. Basic skills taught at the highest level are important. Equally important are grooming, greeting and gentleness (this word encompasses punctuality, behaviour and a sense of honour). Our Defence Forces have followed that tradition and it shows in the ethos of any Camp. The environment is about large trees, well-kept gardens and people walking or jogging for good health. It’s also about politeness, civility and couth attitudes. There’s so much we can learn from the Forces. If only we were willing.

           

           

How I Get My Gas.

            Last New Year, if your ‘gas was finished’, you stayed home day after day until you heard the growl and clank of the delivery truck. Or your servant or neighbour yelled out to alert you of its arrival. Then you ran to it and paid a premium for the cylinder. If you missed the truck, you went and threw a tantrum somewhere. Our local distributor, Mr Kavlekar, told me that earlier, 10% of his customers booked cylinders, the larger majority followed the method mentioned above.

            Then phone booking happened. The number dialled took my booking, told me my place in the queue, and up to which date the deliveries/bookings were being handled. When I discovered that it wouldn’t tell me when I’d get our ‘gas’, I tried the company’s website to track what was happening. Didn’t help me get my ‘gas’ until I complained via email, to the company. Mr K immediately sent me a refill in his own car. Not once, but three times. Once I didn’t get a receipt. Many days later, I got an sms telling me that ‘my’ cylinder was delivered. I wondered, where and to whom!

            Why, I asked Mr K a few days ago, does the truck not come to my wado on the given day of the week? “I have too much ‘gas’ to give,” he answered, rattling off statistics of how many hundreds of cylinders had to be delivered where no four-wheels could go. “’Gas they carry on their backs, haan, my staff. They have to carry to the doorstep. Not like Panaji where so many people stay in one building and there are lifts. Here everything is far-far.”

            Can Hindustan Petroleum or Bharat Petroleum or other such companies make cylinders of equally strong but lighter material? Better still, can we not provide the transporters with trolleys? Just asking. Until then, the staff will have to do their jobs, right? “Right,” Mr K agreed.

            “Now,” Mr K continued, “after this phone-booking business started, 90% of the people book on the phone.” He sighed. I didn’t see the problem. Had the company not been supplying properly? “That’s not it,” he sighed again. The problem, apparently, were the customers. They were used to stopping the truck and getting their refills, and now that that wasn’t happening, they came to the office to argue with him.

            Logic isn’t my strongpoint and neither, apparently, is it Mr K’s.

            “Why don’t you tell your staff to follow the system?” I asked.

            “They don’t listen,” he said. Stupid me, I should have guessed.

            “Why aren’t you strict with them?”

            “I can’t. They make money on the side.” (I must learn to shut up. I must learn to not laugh at inappropriate moments. I must not ask stupid questions. I must… )

            Then I broke my own rules: “Why aren’t you strict with them?”

            And deserved this: “I just told you, they don’t listen they do what they want.” A moment’s sombre silence, in memory of common-sense. We both calmed down.

            At my request, Mr K continued his explanation: “You see I have enough transport, enough staff also, in fact more than enough, but since this fixed day per week per route isn’t working, I decided to have monthly dates instead.”

            I had been told, after on the 18^th day after I’d made my booking, that the delivery in my area would be on the 8^th of the month. One delivery round per area per month. If you missed that date, you’d have to wait for another month. If you ran out of ‘gas’ despite having a second cylinder, you burnt the neighbourhood garbage to cook your meals. Or, if you owned a micro-wave or some other oven, you experimented with a different cuisine. Ooh, did I look forward to that!!

            After both of us had finished entertaining the others present with our (il)logical arguments, we calmed down and heard each other out. He heard how nerve-wracking it was for me to stay home whole day, day after day, just waiting, waiting for the ‘gas’. I heard how lucky he was that two of his naughty drivers had quit their jobs with him and the newbies could be trained properly. Umm, ‘properly’? Luckier still, two of his desk staff had left too, so his wife now came to the office as replacement. So now someone would pick up the phone when it rang, I guessed, to tell me just when I’d get my ‘gas’. It’s like being told my daily horoscope. I don’t believe it, but read it anyway.

             

Panzorconi on the Healthcare Map.

            Goa throws up surprised. Within 3 lakh kilometres, the only National Accreditation Board for Hospital certified medical care centre is in a picturesque place in south Goa: the NUSI Wockhardt.

Until Monday, 15 July, I hadn’t even given much thought to the place. Then, it got the above certification and I looked up what that meant. This is the first hospital in Goa, South Maharashtra and North Karnataka to get the certification. What it means is that it has a definite standard of care. It will have qualified nurses, and technicians, the laboratories will be dependable, patients will be assured that they aren’t taken for a ride.

In Goa, by word of mouth one knows which doctor to trust and which ‘nursing home’ will not take you for a ride. Most often, the nurses aren’t well trained: in fact, they aren’t nurses at all, just women wearing white clothes. The consultant doctors have to monitor everything from bandaging to dispensing medicines. It means a lot of work for them, ‘but what to do we are like that only’. House-doctors not adequately qualified to handle things gone wrong. There are doctors from other branches of medicine handling patients in allopathic institutions. Just as allopathic practitioners must not handle homeopathic or Ayurveda medicines, the reverse must also true. The newer, slightly bigger than usual hospitals like Vintage, Vision, Vrindavan, Galaxy have taken the trouble to professionalize patient care, but costs and treatments need to be uniform and transparent.

With this sort of certification, quality control will be accessible to patients: for eg, tests will be reported within a specified time. Also, the patient will know within how much time after admission a consultant see him/her.   

As a relative, one can know whether all the registrars qualified in the subject of the patient’s ailment, whether all the nurses skilled enough, etc. Bills will be itemized and clear to understand. Clearly printed, too.

            In NABH certified hospitals, patients’ rights and responsibilities must be available to the patients. The names of the doctors, their qualifications, the names of all staff on duty, timings, facilities available and their locations, must be readily available, too. Bills must be presented at reasonable intervals and the approximate cost of treatment told in advance, from time to time. With accreditation, transparency comes in and the patient (as consumer) can handle hospitalisation (the service) responsibly.

            The hospital is run by the Wockhardt group, but owned by NUSI, the sea-farers union. I’m told the Wockhardt Institute of Aesthetics is the first of its kind in Goa. The looks-conscious can have their tummies tucked in, their hips, outer thighs, flanks and buttocks reshaped, their noses/chins/eyelids shapelier, their jowls got rid of, their breasts made to suit the rest of their body… will Wockhardt use these facilities to help burns cases? Surely plastic surgeons and dermatologists are adept at handling far more serious problems (like psoriasis and fungal infections) than hair transplantation?

            I visited the place. The lobby had colourful brochures that educated patients on various conditions: hernia surgeries, high blood pressure and heart care, hip resurfacing (must find out if anyone else in Goa is doing this already) and joint replacements.

            The hospital also has a urology centre with separate clinics for prostate problems, stones, cancer, andrology (antonym: gynaecology), blood in the urine, and pediatric urology. Goa’s private sector has a long way to go as far as organ transplants are concerned. GMC still leads.

As expected from a hospital that’s into aesthetics, reconstructive urology is also done; this, of course, is to help patients who have medical difficulties due to dreaded diseases or conditions, not for cosmetic reasons. The Casualty and ICU are well-equipped and yet to be used to the optimum.

            I’m a great fan of public hospitals, and GMC would be my hospital of choice for tertiary care. But there are many people in the state (and yes, tourists who would like to be here to get a new look, some teeth-work done or even an abortion conducted) who are willing to pay for treatment if they get the quality. It’s a ‘market’ (I hate this word to describe healthcare, but there, I’ve said it) to be tapped. Potential ‘customers’ looking for cataract operations are shopping around for more than a doctor with a good ‘hand’ (an Indianism that means skill and success rate): they want a comfortable and modern ambience, good air-conditioning and blankets to combat the resultant temperatures. Customer service staff to carry their documents and stand in the queue to pay the bills. A menu for snacks and meals that will meet with the patients’ approval and the accompanying relatives’ also. Valet parking, follow up visit reminders… these are given weightage, too.

            But behind the scenes, keeping medical records, generating error free reports, doing work within a specified, reasonable amount of time, charging correctly and evenly, not based on place of origin of passport or income, are things being considered and questioned. Accreditation involves documentation. Following a fine-tuned system leads to reduction of errors. No patient wants to suffer because of a hospital staff’s mistake. Accreditation ensures (or at least drastically reduces) chances of human or systemic errors. That’s why this NABH certification of a private hospital in Goa is welcome.

            Will it mean that the bills will increase? Market forces govern that. Time will tell. Until then, just happy to note that Goa’s finally arrived in the Big League in medical care.