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. 

If the Big Bad Flood Had Happened in Goa

            We’ve never been as unlucky as Orissa or Uttaranchal with cyclones and floods, to some extent because the west coast (exception: Gujarat) has never borne the brunt of Nature’s fury as much as the east. Another reason is that the Brits in Mumbai and the Portuguese in Goa did something called ‘planning’ for towns and villages, a concept our ancestors kind of understood, now alien to us. In spite of having ‘decent’ rains year after year, Goan housing colonies and hotels still buy tankers of water. But we’re not talking about our fiscal stupidity here.

            Suppose, just suppose, a calamity of Uttaranchal’s proportion happened here. Since we’re fighting for special status, first we’ll cry ourselves hoarse for the centre to help us. When the water has risen above our ankles, the auto-rick guys would charge Rs 500 from St Inez to Caculo Mall. Taxis and pilots would accordingly hike their fees. You can calculate the cost for other distances.

Milk, sugar, bread and fuel would suddenly go ‘black’. Fish wouldn’t be a problem. We eat anything that swims. In a flood, should the larvae of amphibian and insects grow beyond three inches, we’d be happy to catch, fry or chuck them into gravies.

            Gravies remind me of coconuts and the trees they grow on. If the water goes above a couple of metres high and thanks to the plastic clogged naalaas doesn’t flow into the sea, (that would happen soon enough), we’d have to get onto slimy, slippery, unsafe rooftops or up the safe and sturdy emblem of Goa, the coconut palm. Problem here: it’ll be too late to take tree-climbing lessons and it’s unlikely that the bhailley who we hire to do the job (“oh-so-sloppily” we complain) will agree to take us piggy-back for money or love or threat. Forget climbing the roofs and palms, so used to wheels are we that without our bikes, scooters and cars, we’ll have to depend on our limbs: that’s a disaster in itself. Except for trained sportspersons and the getting-extinct hands-on Goan farmer… only doctors know whether and where our thigh and calf muscles exist. We make up with the strength of our jaws, but in or under water, of what use with that be to us?

            Once the number of dead and affected rises beyond the combined fingers of the Legislative Assembly Members, the Government will call in the Defence Forces. It would be a shame to call in the very Navy that we didn’t want in our state. The uniformed guys won’t say “we’ll save only Karwar or Sindhudurg”, will they? They’re not like us, they do their jobs and they do them well. They’ve proved this time and again, whether they’re dealing with enemies, or children who’ve fallen into wells, earthquakes, naphtha leaks or floods. In fact, we’ll be dependent on the people we’ve always cribbed about: the cops, the fire-brigade, the municipality workers, the labourers from the NE, Bihar, UP, Andhra, Kerala, etc.

            Our village brethren will no doubt bury all hatchets and help save each others’ dukors and mhashee. After the floods recede, we will ask for our pound of flesh for sure. Our television media will hyperventilate about how we didn’t have enough ghee to cremate the Hindu dead (do the dead have a religion?) nor any blessed land to bury the Muslims/Christians/Jews. NRIs will weep over heritage lost. Only a few will start: 1. Taking classes for children so they don’t lose out on their learning years, 2. Prepare for prevention of epidemics by disposing of decaying corpses, 3. Building shelters of all kinds, 4. Collecting and distributing food, water, clothing. In spite of what the tv channels say and we moan about, it’s the government machinery alone that does most for rehabilitation. The others do fringe work. Some even believe that techniques of meditation and prayer-chants are more important than availability of drinking water, medical aid and dealing with sewage.

            I read on the Net someone’s comment. Not verbatim: “… a shrine was ‘disturbed’, hence this calamity happened.” When will we learn that our heritage lies in our thoughts and behaviour? Principles and skills must and do outlast buildings and statues. If we face a calamity of this proportion in Goa, what will we mourn most? Destruction of our temples/churches? Our value system? Language? What?

            Lots will happen after the floods. NGOs will spring up to take care of the welfare of mosses, rodents, oldies, babies, and now that our Freedom Fighters are on their way off the planet, will demand free railway passes and pensions for their ‘causes’.

            Dear fellow Goemkars, we have to learn from Uttranchal’s tragedy. Now.

Dial 108 and Goan Traits.

               I got the opportunity to test Goa’s unique ambulance service in the middle of the night when my mother took ill suddenly. I was pleased with the experience. The phone was picked up promptly when I called. The person who picked it up asked relevant questions in a language I understood, and without an heavy accent that often makes comprehension difficult.  The driver was provided with a phone for getting to the house with personalized directions. The vehicle arrived within the promised time limit. The staff attending to my mother, Yvette, was brisk, professional and very polite. The concern showed. Hope all are like her. The problem most of us face is of manpower to lift the loaded stretcher. Unless one has young male neighbours to lend a hand, this is something that needs to be looked at. This is a free service, and one can’t have extra hands on board. That apart, 108 did give commendable service.

               In all my previous jobs, the atmosphere was cosmopolitan. This is the first time my colleagues are true-blue Goans who have not stepped out of their village(s) and who are not in the age-group to change or learn new stuff easily.  It’s interesting to note that they will talk behind each others’ backs but be very sweet to the face. How courteously they talk: can be misleading. Yesterday, when the tempo driver came later than at the time agreed to, my only non-Goan colleague gave everybody a lecture on punctuality. The chap was to report at 2 pm. He did, only to inform that he’s returning after lunch. So for our purpose, he arrived 45 minutes late. Strangely, everyone took the tempo-fellow’s side, saying that he was a ‘good chap’. Why was he a good chap? Because he lent a hand with the luggage and loading (as did the ambulance driver above, I must add). The other strange reason was: he didn’t mind if he was paid late. Why is that considered a ‘good thing’? Why do we not pay on time as the norm, I asked. No we do, the old-timers said, but you know, he doesn’t mind it, doesn’t ask for the money, they repeated over again. Strange are the ways of Goa and Goans, I thought.

               Two of the staff had to go to Vasco without warning. Everybody was reduced to tears like they were going on a long journey. Call an air-conditioned car, suggested one. The owner of the business said ‘bus it’. The eyes and shoulders gave indications of unwillingness. Bus? In the afternoon? Bus? All the way to Vasco? When would they reach? What will happen to their lunch (ah, this question was SO important)? Each question was fielded, answered, and they had to leave. “Never done it before” they grumbled as they bid the others ‘bye. Till they returned safely and soundly, it was live tiatr time in the office.

               Unlike most places I’ve worked in, here snakes visit my office through the window.  My true-blue Goan colleagues are unfazed by their wriggly arrival. They play around for a bit with a rolled newspaper and then toss the reptiles back into the flora outside. I remember once a pigeon had flown into the library of the hospital where I used to work and there was chaos with people running helter-skelter in panic as if they’d been hit by a bomb. Goans are ok with Nature; at least the villagers.

               Dealing with customers is another thing. They’re polite and courteous. They’re so nice that they are ready to part with items without asking for payment. “He can give later, no” used to be the attitude in the beginning, one of the owners told me. I’ve inherited a ‘trained’ bunch that knows that money must be asked for. They have yet to learn to keep track of who came, make a data base, follow up cases, advertise wares and market the goods aggressively like the Delhites do. Am glad at that reticence, though, for I hate to get badgered into buying anything, and expect others hate it too.

               My new job is in a place that deals with luxury stuff. Surprising how many Goans are interested in such things. I thought Goans were simple and weren’t good consumers. I was wrong. Wrong. There’s a lot of money floating around just waiting to be spent. And willing spenders digging into their pockets. I’m looking forward to writing about the customers in future stories. Love their quirks and eccentricities. Lots of fodder for my column!! Ha!

Goan Guests and Some Things in the Market.

          Those from the past, friends and family, who are visiting Goa think that if they’ve come here, they must have a Goanese (yike, that word again) meal. They’re not sure what that means, but they’ve read on the net that prawns balchao, sorpotel, pork vindaloo and fried kalamari are a must. There must be salty breeze to breathe and feni to drink alongside. Unlike in Goa Portuguesa, Mumbai, few restaurants here have floppy-stomached men wearing long-chuddies, flowery shirts and frayed straw-hats plucking on out of tune guitars, singing jaded numbers.

          Friends from Jodhpur who came visiting were surprised that we weren’t interested in living anywhere near the beach. Our little patch of jungle, away from traffic jams and foreign accents, was where Goa really lived, I told them, and we were happy there.

“You always were weird,” their eyes seemed to say. Ignoramus zindabad, I figured, and kept the tongue under tight control. I die to give lectures about the Real Goa whenever I host some people.

          Coming to the other half of today’s topic. I always buy a new indigenously-made (food) product to encourage entrepreneurship. I want to believe that India can grow strawberries and make strawberry jams as good as the ones available in the best stores abroad.  I enjoy the Amul cheeses and gift them proudly to family and friends from across the oceans. What a pity they’ve stopped making that wonderfully versatile and tasty cheese-powder. Trouble is, many of the packaged products are of poor quality. I have no idea whom the manufacturers are trying to fool. I bought a packet of Limbu Pani Masaledar made and marketed by Mumbai’s Neel Beverages Pvt Ltc, which the packet claims is “India’s first in the Premix manufacturing category, an ISO 22000-2005 Certified Co.” I wonder whether the certifiers tasted the product. Or whether they did a survey of the customers. I’m sure they’ve perfectly followed the management procedures and documented every move without error. And the powder that is the outcome of that system tasted … I won’t tell you like what.

In contrast, another new product, called ‘nature-cola health drinks’ which sounded like something made at the back of a garage, manufactured by Team24 Beverages right here in Goa, is something I’d happily serve my guests. (I or my family, descendants, neighbours, etc don’t get a paisa in kind, favour or cash from any manufacturer, factory owner, shop-owner dealer or their relatives. That’s to set the record straight that whatever I’m writing here is objective and impartial.)

The famous paos and pois that we Goans love to feed visitors as ‘our’ bread isn’t always tasty. We may herald the arrival of the poder on his cycle, alerted by his honking outside our gate and rush to buy this ‘really goan’ thing. The experience can be disappointing; few bakeries have maintained their quality.

The balchao and recheado masalas, as well as the chutneys and powders that are sold as ‘home-made’: do the makers actually use them in their own homes? At Sangolda, on CHOGM road, there’s a table where some hard-working women sell ladoos, chaklyo, and other snacks. They sell and make a profit, I’m sure. The buyers are drivers and low-end tourists who aren’t likely to come back ever. I don’t think they’re trying to make a name so that people return just to eat the stuff again. No pride in the product, no name to be gained, no reputation at stake. But surely those who put labels to their product, who have invested in factories, machinery and manpower need to rethink quality? Sometimes I feel allowing the FDI into the country might be a good idea just so we get a feel of competition and improve our products. The debate of how it will affect the poor is a different story.

Coming back to the visitors: most tourists go home happy with the food eaten in the restaurants. But the take-away gifts, other than cashews and daarue, are lousy: the less said about the soaps-on-strings the better. 

         

The News in the Olympics Week

            The Olympics have been a pleasant change from girls being harassed, Assam being burned, power failure and train deaths.

I’ve learnt that Indian sportspersons (at least at the Olympics) don’t lose. They ‘crash’, ‘get knocked’ or ‘get kicked’ out of events. Anyone who has qualified for an event is an Olympian, that’s something to be proud of. Winning is the icing on the cake, but the cake itself is valuable. But our channels haven’t figured it out yet. No doubt, the heartbreak and tension of the archers, shooters, badminton players and boxers were shared by those like me who were sitting crossing fingers and limbs hoping hard for good news.

Assam’s riots and deaths kept cropping up. I was surprised this hadn’t happened earlier, for the area’s been simmering for years now. One reporter irritatingly said, “the Army made lame excuses” about why it hadn’t reacted earlier. As a responsible viewer, I’d say sack the guy for homework not done. It took the channels four days to understand that cops and the paramilitary had to be called in first. The Army is basically meant to fight enemies, and help civilian administration only in rare circumstances (in India these ‘rare’ circumstances happen so often that we fail to recognize as not-routine). And even then, it needs a nod from the Ministry of Defence, who needs a nod from the Ministry of Home Affairs. Not a single channel asked why or how this hadn’t happened earlier, the riots. Had the government not known trouble was likely to erupt? I could guess that sitting here in Goa. What did the government do, what had it done, to prevent it? No channel asked this question. They were more keen on putting the blame on who wiped the mess last. A medal for their effort, I say.  

The power collapse eclipsed the big, big disappointment of Mahesh Bhupathi’s bowing out of his last attempt at The Olys. Silly questions ruled the screen: ‘Hesh created the row and didn’t play with Paes, what does he have to say now?’ The answer given by another reporter says: ‘there’s always joy and sorrow in life,’ etc, etc. Fundas and facts versus talk-talk-talk opinions. The power collapse news bite was handled better by a regional channel (Marathi) that wasn’t even affected by it. The Delhi based folks gave us obvious feedback about office-goers being stranded on railway stations and teenagers not being able to study (like they weren’t relieved about it). Again, not surprising at all, for this was yet another disaster just waiting to happen. If you’ve ever seen the net of wires and cables criss-crossing the Uttar Pradesh-Gurgaon-Ghaziabad-Noida skies, you could have made an accurate guess yourself. Specially if you’ve spoken to people who’ve told you their bijli-bills were in three digit figures in spite of having air-conditioned kitchens and bathrooms… which weren’t attached to the mandatory diesel-sets that every factory, farm and home seems to have in those areas.

The thing about girls getting molested: it’s time we raised a Seetha Sene instead of running off to complain to the government. Learn judo, girls, or taekwondo. Learn to box, wield sticks, swords, nails, teeth, elbows, wrists, anything that’ll help keep you safe. What you wear isn’t important. Where and when is. Be appropriate. After taking care that you’re in the right, if goons hassle you, be ready to kill them if need be. Then walk out with your heads held high. (Now my comments on the Assam girl: the channels said the girl was sixteen years old. Do we have age limits for pubbing? Should we?). As for the goons labeling themselves as Ram’s sene…. According to the Ramayana, they were monkeys, right?

At the end of the week, I find that the television channels that I like to watch are Doordarshan (specially the Prasad Bharati channel which continuously gives India’s best music and dance) and the Goa channels that tell us the good that’s happening in the State. As one who believes that there’s always more good than bad in the world… Goa has got the JRD Tata award for doing well in Reproductive Health and Family Planning. And theoretical physicist Ashoke Sen, a string theorist at Allahabad's Harish Chandra Research Institute, became a millionaire overnight as he is one of the nine winners of the first Yuri Milner Fundamental Physics Prize which at Rs 16.7 crore is the most lucrative academic prize in the world. After the DD and the Goa channels, I flip back to the Olympics to see what mankind is capable of. Vive la good times.