Prathap Reddy of Apollo

(25 May ’14)

          I came across this 520 page hard-bound book by Pranay Gupte which I thought was a good read about private healthcare in India. The cover has a portrait of Dr Prathap Chandra Reddy, founder-owner of Apollo Hospitals and Reddy’s Laboratories, and says “Healer….and the Transformation of India.” I don’t know about the transformation of the country, but certainly as far as corporatization of healthcare goes, in India there has been life before and after Apollo came into the picture.

          The book gives an insight into what life in rural Andhra Pradesh was (or possibly still is) like for the very rich. Dr Reddy was born wealthy and privileged. His education and work experience in the USA prepared him to bring ‘home’ technology and systems we never thought could exist here.

          Importantly, the book brings out how difficult things were for an entrepreneur who came in with a good commercial idea. The government was geared to discourage people who brought in novel ideas. It took long years of perseverance to make any dream come true. In Dr Pratap’s case, it also paved the way for other players like Escorts and Asian Heart to come into the field of non-charitable trust hospitals. He knew the time was ripe for bringing in private healthcare into India. He introduced the concept of super-specialty healthcare and preventive healthcare, too.

          There was a time when private hospitals were but family-run nursing homes. The few big hospitals were run by family-owned charitable trusts. No one had thought of or brought in the concept of having a profit-oriented hospital. People were willing to pay good money for high quality diagnosis, latest treatments and the comforts of a good room, too.

          Having worked in a tertiary-care multi-specialty hospital, I know how difficult it is to woo back good talent from abroad and retain it in India. It’s not just the money, but the work environment that has to be conducive to keeping the brains and skills here. According to biographer Gupte, Dr Reddy managed to keep his large team content and productive by giving them professional freedom, an enviable income and the latest technology. Apollo hospitals now have a presence in many Indian states and abroad as well. Apollo was the first to reverse brain-drain. Access to quality, affordable healthcare became a reality. Dr Reddy changed people’s attitude towards healthcare. Amongst the network of nationwide private hospital systems, Apollo is the world’s largest.

          Over and over again, the writer has stressed the warmth and sense of belonging that the Apollo staff shares with the Reddy family. All four of Dr Reddy’s daughters are involved in the ‘business’. This is a typically Indian phenomenon, where all staff are helped out when they are in need. In exchange, unalloyed loyalty is expected.

          So it is not surprising the author has interviewed very few ex-Apollo people. Once a person leaves, s/he isn’t encouraged (and I’m putting it mildly) to return. Also, other than a fleeting reference to Dr Reddy’s explosive temper, Gupte has not mentioned a single flaw in the healthcare leader’s character. As a reader, I felt there was more adulation than required. But the author has also repeatedly pointed out Dr Reddy’s connect with patients, ward-boys and consultants alike. That’s a rare quality. Unusually, Dr Reddy also welcomes competition, says the biographer.

          Priced at Rs 899, this book should be read by anyone interested in a) the history of healthcare in India in recent times, b) biographies, c) wanting to start up a private hospital of their own or d) what life is like in a corporate healthcare environment.

          Books like these document history, encourage future leaders and should be compulsory reading for any youngster aspiring to make a dream come true. Alongside, one must have an equally well-researched book on the public (general) hospitals across India. I didn’t come across any, but even a cursory homework done over the internet gave me an insight into what’s happening in healthcare in India. Not as dismal as I had imagined.

          Coming to the literary quality of the book: the prose is easy to read, well-edited and the font size comfortable on the eyes. I’m certainly looking forward to Gupte’s next release on Capt Nair of the Leela Hotels.

         

Letter to Pritish Nandy.

(26 Nov ’08)

            Last week, Mr. Nandy wrote in the Times of India about how he believes that drugs, alcohol shouldn’t be banned, that children shouldn’t be told not to experiment, that how his own father came to know of his taking drugs when he (Pritish) confessed to him (father) that he’d given them up….when he was in the tenth standard. He doesn’t like the idea of the State playing Big Daddy, telling citizens what to do…you get the trend. He also wrote that much of the world’s music and literature was created by people who did drugs. Well, be that as it may, it’s a possibility that they were a minority.

            I know many people right here in Goa who believe that adults must never be ‘monitored’,  for they are mature and can look after themselves, that every and any rule is stupid and meant to be broken, that all government agencies/officials are cretins. Well, here’s my reply to him and those who believe that discipline of any sort is outdated and uncalled for:

“Dear Mr. Nandy (and others who think like you),

You did speak my mind in your article, took the words right out of my mouth. I, too, can’t understand why anyone should forbid anyone from doing anything at all. Why can’t we drive on pavements and over pedestrians. Am sure if someone bangs a nasty dent into your car you wouldn’t mind, just a prank that the naughty driver will grow out of one day. It’s not habit forming after all is it, this bad driving/parking? In fact, I don’t even believe in having licences. For the same reason that I don’t believe in having exams. Or curriculi, syllabi or schools.

          The use of drugs, alcohol, smoking, are definitely adult, personal choices. As you’ve mentioned, people have actually written outstanding literature under their influence. Tell you the truth, I believe India’s a treasure-house of geniuses…specially Mumbai’s streets. They’re full of adolescents just bursting with brilliant ideas. Unfortunately, they can’t afford their next shot and the withdrawal symptoms prevent them from putting thoughts to paper. Encouraging citizens like you must support their cause. It’s so sad that a couple of them die without writing down their magnum opuses. You see, they don’t wait to grow out of their ‘choices’, they just die. Very inconsiderate of them, doing that before writing those fantastic books.

            I really loved your article, Mr. Nandy, because you presented a point of view that’s different from the others. Oh yes, I believe children should be allowed to experiment and learn for themselves. Give them a library and they will get educated. Give them charas, ganja, heroin, cocktails, and the right atmosphere and one fine day they’ll stop it on their own. As for those psychiatrists, cops and other torture-masters, creeps, what do they know about life, eh? Have they ever experimented with drugs? How’d they know about childhood? Are they mature adults? What do they know about passing fads and growing out of them? What’s their exposure to life? Limited! As for teenagers, experimentation is part of life, of nature. Curiosity takes people places. Give an adolescent a rope, a fan and let him/her experiment with what suicide feels like. Encourage new fads. They’ll learn on their own. ..and if they don’t….well, at least we adults will have the comfort of knowing we gave them full freedom.         

            What say? You agree??

Warms regards.”

            I belong to the breed that believes that disciplined children grow up to be disciplined adults, that if spoon-feeding is one extreme, then being bohemian is the other, and that moderation needs to be practiced in the growing years. I also believe that we’re an undisciplined lot, we Indians, and many of our children have been spoilt because the rod was spared. Would love to get a debate started on this. Any takers?

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An Exhibition and A Cup of Coffee.

(9 Nov ’08)

            I’ve never had a career. I started working at jobs pretty late in life and have been exposed to several industries: the print media, hotel and healthcare. Also, I’ve set up home in various parts of the country. As a result, I have a motley collection of acquaintances.

            Recently, I went for Anjali Purohit’s exhibition of paintings. I wasn’t really friends with her in school though we were in the same batch. It’s only a couple of years back that we bumped into each other again, and since she lives very close to my work place, we meet occasionally, have discovered common interests, and shared interesting conversations. She’s a lawyer-ex-bank-manager-turned artist. She’d actually given up her job to raise her son, but now that he’s in college, she has the time to express her creativity. The theme of her exhibition at Nehru Centre, Mumbai, was “Erasures”. It was a trip down nostalgia. I got to see the sights of my childhood: Irani restaurants and mills, mainly. A bit melancholy, but it held one’s attention, for it’s part of Mumbai’s history, recent and old, and being razed rapidly to give rise to monotonous, sky-blocking buildings. She’d invited me for an evening with some ‘good people’. A film maker, some journalists, a college principal, a printing press owner, and others. The talk revolved around what Mumbai no longer is. I’ve visited art exhibitions but never been part of the talk behind, around, about them, so this was a novel experience for me. Anjali belongs to the rare breed of women who makes everything at home: masalas, naanchni-biscuits, nothing is bought off the rack. Ah well, once upon a time, I did that, now looking back I wonder how…. So much simpler to encourage those talented housewives who sell puran-polis/chaklis/ladoos to earn some pocket money.

            Through Anjali, I met Rita, who is now an ‘email friend’. I have ‘road friends’ and ‘hospital friends’ and ‘market friends’ and ‘friends’ friends’, too. Rita confessed that we wouldn’t know how ‘deprived’ she was for human company and so we met over coffee at a little shop in the neighbourhood. That was another round of stimulating talk. From adoption to fashion to Chaatt Puja, we voiced our opinions over plenty of laughs.

            Now am looking forward to an evening with my classmates from school. One of them has made her annual trip to India from the US, and it’s time for us to get together with those who can make it.

            The nature of my job requires me to meet people, but that doesn’t culminate in friendships. These meetings, at home, over snacks and beverages (chai-coffee-limbu sherbet) help to forge relationships and stimulate the mind. One gets to know about Obama from the tv channels, but one can’t ask the screen questions. One can’t respond to an opinion as one can in a small, lively group. One gets to know different points of view and learns to accept them. One builds relationships in spite of conflicting ideologies. Provided one has opinions and ideologies, that is.

            I dislike the idea of having a statue/picture of a god in an office area. The staff working under me insisted and practically quarreled with me to have a Ganapati idol in one corner. I said it shouldn’t be more than two inches. They listened, but gave it a stool to sit on, and a canopy to cover it, and the whole thing comes to six inches now. It was installed with a small puja, and for many months each morning someone would enthusiastically put flowers on it. For Diwali, there was a small rangoli there. Now I’ve found that the interest has waned. The flowers were stale one day, the rangoli had smeared. My lectures on tidiness didn’t work. Then I threw a fit. If they couldn’t keep the place clean and tidy, the Ganapati would have to go. It worked. They’ve become more particular. So I have learnt to accept their point of view. In the name of religion they can keep a place in order. I now want to make friends with some holy man or woman (I’ve steadfastly stayed away from all such) to ask whether they could make a difference to the garbage situation in the country.

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Asha Bhende: an actress and academician.

(12 Oct ’08)

            A prize-winning actress (for some reason, the word ‘award’ wasn’t as much in vogue then), she was a triple M A, plus she did her Ph.D. after twenty years of marriage and two children. The first MA was in Sociology from the University of Mumbai, the second was a Diploma in Social Service Administration from the Tata Institute of Social Sciences (this is recognized by the UPSC as equivalent to an MA) and the third,  a Masters in Public Health Education fro the University of California, Berkeley. She couldn’t have done any of this without enormous support from her husband and mother in law. Remarkably, whilst it was her brother who pushed her to the Ph. D. program, it was her husband and her mother in law who helped her execute that dream. It’s so hard to believe that an actress could be actively on stage and still work as Professor and Head of the Department, Population Policies and Development at the International Institute of Population Studies, Mumbai. How could one live seriously at one level, and do farces and comedies at another? After her retirement, she got involved in a zillion (ok, let’s bring that down to fifteen…fifteen!!) different projects, assignments and more, as consultant, guide, leader, that sort of thing. And all the while, still being involved in theatre, even modeling for advertisements in between. Just these things could’ve made a best-seller.

            But there’s more. Way back in the ‘fifties, she married a Hindu. Lily Ezekial became Asha Bhende. Even today, that’d make headlines. If it was 2008, a news channel would have interviewed her and asked her about her views, personal life, and would have plauded her attitude, and would have interviewed the aam aadmi  on the street to find out what he felt about it, and so forth. Asha and her husband (mitr, she calls him) Atmaram didn’t think it was worth such hoohaa. They were in love, had similar interests, were practical, fun-loving and young, and they simply went ahead and got married. There’s so much, so much that could have been written about in her biography. It feels empty when one reads it and one craves to know more.

             She’s eighty now and on her birthday, she released the book she’s written on her life, aptly titled Majhya Jagaat Me (In my own world, am I).  Shobha De, who was the chief guest, correctly pointed out that all that the ‘liberated’ women are crying themselves hoarse about she’s done with a giggle and no fuss.

            Born a Jew, in 1928, she married a Hindu in the early ‘fifties, without eloping, fighting, getting headlines in the newspaper at a time when inter-religion marriages were really, really rare. When ‘working women’ were still to come into their own, her mother was the principal of a school, her sister a doctor, and she, eventually, became an expert in her own field. Not much struggle, not much strife? I doubt it. Had she delved deeper into her own world, she could have given examples today’s eves would have loved to know about. I, for one, am curious about her conservative, widowed mother-in-law who cared for her home and sat her children when she was at study/work. Once, a group of women came visiting and pointed out that there were no deities in the house. And her mother in law replied, that her grandchildren were her ‘gods’.  That was when Asha Bhende realized how much her mother in law had adjusted to her marriage. Jews don’t worship statues, so the thought hadn’t ever entered her mind that her husband’s family may have different views/beliefs.

            Her book makes one hunger for more. What comments did others make at her unusual choices? Who were her friends and what were their opinions about her lifestyle? How did she cope with the nitty-gritty of balancing work and serious hobby simultaneously? It’s a rich history that needs more details to be woven into the chapters. Hope she comes out with an English edition so that more people can read it. In the meantime, for Marathi readers, I’d recommend it: a slim volume, a quick but interesting read.

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Twenty Years Hence

(28 Sept ’08)

            All those big houses in Dona Paula, and Brittona, and Calangute (a bit passé now, that place, what with the South and the Interiors getting popular), were built for servants to live in. An entire generation of caretakers and their many children abide in them, making way for the childless or single-child owners during the vacations, perhaps for a few days otherwise. Annually or quarterly, seldom more often than that. Rest of the time, maids’/drivers’ brats rattle all over the property and their parents get paid for the trouble. As for those who can’t afford servants living on the premises, I always wonder why such expensive properties were invested in. I know friends who have wonderful houses built in exclusive neighbourhoods, who spend their Diwalis/Christmases dusting, mopping, wiping, tidying, paying bills, taxes, arguing about broken walls, cracked windows, the piling garbage. The well-meaning well-to-do owners meant to have their offspring live in those mansions. What happens in reality is no different from what has happened to many of the ancestral homes in Goa. Crumbling ruins. The children…now longer in double numbers, go off to study, for work, and settle in places from where they may or may not visit the land of their ancestors or chosen by their parents. If at all they do, it’s post-retirement. The houses eventually perish…well, unless occupied by servants/illegal ‘tenants’.

            Our mutton-wala in Jodhpur was a Goan catholic. He had, he told me, a lovely ancestral home someplace in south Goa. His father had forced him to visit it a couple of times during the summer vacations when he was in school, but he didn’t/doesn’t do the same to his children. For all practical purposes, he was a Rajasthani…by birth, education and so said his domicile certificate. As many like me are Mumbaikars.  His children, there’s no way they’ll be Goan, tho’ they’ll call themselves so. My cousins, spread all over the world, speak a bit of Konkani, yet none of their children can recognize the language and, two decades hence, their children’s children won’t have heard of it. Unless one of the brood takes over my maternal ancestral home, that, too will go one day. Twenty years hence.

            Whatever’s true about Goa is true about many small towns of India. My generation has bought land to ‘settle’ in, in Alibag/ Kalshet /Dahisar /Karjat, near Mumbai, and built wonderful bungalows on it, and then, in a couple of years, the place gets dilapidated and sold off. Perhaps at a profit, but the idea it was built for, to live in, doesn’t get realized. Twenty years down the line, we can see what will happen.

            Literacy has ensured that Goans don’t marry, or don’t marry young, don’t have children young, don’t have many children (as compared to some other states), and earn well. I wonder what’ll happen when these pampered babies grow: what’ll they do with all that property. Spending is an art. What we’re cultivating right now is only investing skills. The one family that’s made headlines in recent times because of money well-spent is the Bindra clan that helped India bring home its first Olympic gold. 

            Is there anyone one in this state who would consider a school for ‘leaders of the future’ where children with high IQs, exceptional talents and gifted minds, blessed with good health, can be groomed? We need well trained, thinking people at the helm, not half-witted, quarter-baked, ill-educated minds. Foresight is important.

            We need men and women who want industry, technology, but without devouring forests. We need people who love computers and cattle, for we can’t do without either. We need data-entry operators and song-writers alike. We have the advantage of education, a head start in healthcare, we’re not a poor, developing state. We need those who can think about harvesting water, harvesting electricity, and, importantly, we need those who can execute ideas. Goa seems to have a surplus of thinkers and dreamers. The doers have flown, let’s woo them back. It’d be unfair to say all Goans are non-doers, but they are seriously out-numbered, that’s for sure, presently. Twenty years down the line, will things be different? Not sure if I’ll be around to notice.

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Doctors’ Instinct

          Our friend fell down some steps, then couldn’t move because the pain in his hip was terrible. His wife took him by public ambulance to the closest, very new hospital, partly owned by a semi-retired orthopaedic surgeon. He gave the friend a pain-killing shot and took an x-ray. Later, the wife found him (doctor, not friend) poring over the film, palm on forehead, mumbling, “… the neck should be broken, must be broken..” She wondered whether the semi-retired doctor was also semi-stupid.

“How was I to know,” she told me later, “that he meant neck of femur (thigh bone)? To me, a neck is something that attached one’s head to one’s shoulders.”

The only way to prove the neck-was-broken was by doing a CT-scan. The closest CT machine, this was in Noida, UP, was some kilometres away, even in an ambulance an agonizing ride. Friend’s wife did some sms homework and was assured that doctor had a good ‘hand’. So without ‘photographic’ evidence, she signed the consent for the surgery. In a couple of days, the friend’s hip was fixed and functioning. Opinion-based diagnosis had saved the day.

During my recent back-pain episode, my Goan doctor DB, sensing agony in my phone-distilled voice, recommended: “Complete bed-rest.” The Mumbai consultant who saw my MRI via Picture Archiving and Communication System on Everest Base Camp, sent realtime instructions via smartphone to his registrar sitting by my bedside: “Complete bed-rest.”

When I mentioned opinion-based versus evidence-based practice to someone, this is what he said: “Without doubt, evidence-based. How can anyone say I think the patient has fever? You check the thermometer, read the value and you have proof of temperature.” (Healthcare professionals reading this, hold your giggles; that’s how lay people perceive it.)

Even the brightest physicians are thankful to ultra-sound inputs to pass judgement on ‘pottanth khubba dukhtaan’. Who might be responsible for the painful crime: gall-bladder stone/ renal colic/ appendix/ secret tumour?

Experience versus modern technology, that’s the debate. Can skills (l)earned over 18 hrs/day x 11 months/year x 25 years of practice be superior to blood tests done in a laboratory? There are times when an opinion-based practitioner won’t wait for a typhoid result, but start treatment pronto, not wanting to waste time/ lose patient.

But… in evidence-based practice there is no guesswork. Therefore less chances of making mistakes when one depends on lab-tests. Think blood-sugar levels, typhoid/ dengue detectors.

There are those who don’t believe in modern technology, who believe that doctors must use their heads and hands alone. But should the doctor made a mistake, they say: aaj-kaal beshta suvidhaa aastana kitya upyog karap na. Would they include stethoscopes and blood-pressure checking gadgets as ‘modern’ things?

(I know people who believe landline phones are acceptable technology, but mobile phones are not. It’s ok to have a fridge, but no micro-wave. No one complains about cars, air-conditioners and electricity. No one even realizes that technology goes into the manufacture of office-chairs, sliding-windows and shaving-gear. Where does one draw a line regarding ‘modern’?) 

When it comes to curing our ailments, we want both, experienced doctors with great instinct plus state-of-art technology.

Experience crawls. Young doctors lack it and benefit with the evidence-based method. What doctors of my age learned through their MBBS and PG years, the youngsters cram into a short period because the amount of knowledge they need to know is more.  Cutting-edge stuff is cold, distant, without the human touch. And expensive. If we were to depend only on it, we’d need diagnostic centres next to every other biscuit stall and even then we’d have long queues, so dense is our population.

Leave aside serious road traffic accident cases or those with bleeding in the brain, where no surgeon would touch a scalpel without following the protocol of checking on blood-clotting time, exact location of ‘trouble’, etc, there are many illnesses that can be prevented by modern methods. Dyes injected through arteries and the presence of higher-than-normal levels of creatinine in the blood can detect heart/kidney troubles. Same with some kinds of cancer.

Evidence-based practice is here to stay. To prevent thoughtless prescriptions, to know how and when to use which tests, how to interpret the results correctly, doctors will have to fall back on Experience. Those who have insights through medical humanities, who recognize the importance of the natural history of a disease, will be more accurate in their dealings with different diseases/ ailments/ injuries/ illnesses. At the end of the day, opinion-based practice will still have higher value. Doctors’ instinct develops over time.