Sunday, October 26, 2008

Oh Doctor!

According to the Medical Council of India, the allopathic doctor to patient ratio is 1:1634 (actually is still higher as not all registered physicians practice medicine). The doctor patient ratio actually also varies from case to case; it depends on various factors type of ailment, type of specialization, etc. The doctor patient ratio comes down significantly if one takes into account the other systems of medicines (i.e., Unani, ayurvedic and homeopathic) to 1:870. This doctor to patient ratio does not take into account the relatively more number of doctors in the urban areas, which essentially means the availability of doctors are even less than this pathetically high number in the rural areas.

Globally, the ratio depends on which part of the globe you are. Most of the sub-Saharan African countries have a high number and very low in countries like USA or UK. Cuba has the lowest ratio.

This number definitely needs to improve, more so since we Indians are multiplying at a much faster rate than the medical colleges are churning doctors. According to the MCI website the maximum annual intake for the first year course of MBBS is 31,298 in 289 colleges across the length and breadth of the country. India has a population of roughly 1.3 billion with a growth rate of 1.606% which means the doctor to patient ratio will worsen with time.

This gloomy scenario can be changed, albeit it has to be a continuous process and will take time. The first step obviously would be to increase the number of colleges offering the medical courses. But alas, the governments of India is not taking sufficient steps towards it (be in NDA or UPA).

India boasts of world class engineering colleges i.e., the Indian Institute of Technology. India has 7 IITs that are producing world class engineers and 8 more are coming up, but no such luck for medical colleges. India does not have any such medical colleges in the lines of IITs or IIMs. Although common sense says health should be of higher priority than engineering, the Indian think tank perhaps thinks otherwise. So the first step according to me should be setting up of more AIIMS in the lines of the IITs and IIMs.

There are many doctors (holding MBBS degree) who pass out from government colleges (hence subsidized fees) and take up professions other than medicine, i.e., IAS/IFS. This practice should be discouraged by having a bond at the beginning of the course (MBBS) of compulsory medical practice (for a minimum of 5 years or more) or payment of full course fee (the subsidy amount).

In USA, there is a concept of physician assistant. Physician assistants’ practice medicine under the supervision of physicians and surgeons and in rural areas independently. PAs are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine and treat patients, order and interpret laboratory tests and x-rays, and make diagnoses. They also treat minor injuries, by suturing, splinting, and casting. Physician assistant education programs usually last at least 2 years and is full time. Then there are the nurse practitioners who are nothing but registered nurse who has completed masters in nursing and training in the diagnosis and management of medical conditions.

The concept of PA is somewhat similar to what we have in engineering, certificate (ITI) or diploma engineers. If a system similar to PA is encouraged, the number of practitioners can increase in a short period of time and many an Indians would be saved from the hands of quacks who are flourishing in the country side (even the national capital of Delhi has a thriving number of quacks, especially in the areas of Shahpur jat, Madangir, Tughlaquabad).

These steps could help in bringing the doctor patient ratio to saner levels and thus ensure that Indians do not die as they are today without treatment.

Al Qaeda and the credit crisis

The following is a piece of news item that appeared in the site of on October 4, 2008 {An American member of Al Qaeda pointed to economic troubles in the United States as proof that "the enemies of Islam" face defeat, in an English-language video released Saturday. In a half hour video message, California-native Adam Gadahn urged Pakistanis to unite against their government and U.S. forces, and taunted Americans over their economic crisis, relating it to their military interventions. "The enemies of Islam are facing a crushing defeat, which is beginning to manifest itself in the expanding crisis their economy is experiencing," said Gadahn, in a clip of the message distributed by the SITE Intelligence Group, a Washington-based monitor of militant Web sites. "A crisis whose primary cause, in addition to the abortive and unsustainable crusades they are waging in Afghanistan, Pakistan, and Iraq, is their turning their backs on Allah's revealed laws, which forbid interest-bearing transactions, exploitation, greed and injustice in all its forms."} This leads me to think who really is behind the credit crisis that is pushing the world to the brink of economic collapse. We all know that the US investment banks (like Lehman) fell because of subprime woes. Basically loans, subprime, midprime or prime were packaged and sold as asset-backed securities (ABS) which were split into “tranches” and re-sold. The low-rated tranches of ABS were pooled together to create collateralized debt obligations (CDO). Similarly midprime and prime housing loans were also pooled together to create CDOs. All of these instruments were rated by rating agencies (but then nobody knew which “tranch” contained which mortgage). Then there were the CDS or credit default swap which is nothing but insurance on debt (this CDS were the reason behind the failure of AIG). Once the property market went bust, more and more mortgages were foreclosed, leading to loss on the ABSs and CDOs which in turn led to failure of AIG. The European banks were affected too and Iceland is on the verge of national bankruptcy. The stock markets all around the world are reeling, investors are suffering zillions of losses around the globe. IF Tuesday, 9/11/2001 could have been orchestrated by Al-Qaeda (sitting in the caves of Afghanistan) then they (AQ) sure must have had insider people in US Government Agencies otherwise an event of such a magnitude could not have been carried out just by 19 renegades. If they (AQ) had the connections then they sure have them now (after 8 years), so if 9/11 was the handiwork of AQ why not 9/29 (the biggest single day fall of Dow Jones as a result of the credit crisis). Now, the unanswered question about the ABSs, CDOs? CDOs. Did any one knew (or for that matter know today) what is the exact underlying security of these instruments (I mean which particular mortgages). How could the rating agency rate these products as high as AA without knowing the exact underlying assets? What were the Risk Management Team at the Banks doing? (one team might be lousy but not so many, remember almost all the big and mighty fell) Is the financial crisis just because of the “greed” of the investment banks of the capitalist society or was there a bigger plan which just took advantage of the greed of the capitalistic society and the Investment Banks just walked into the trap? I do not have answers to these questions now neither did I have the answers then (how 19 renegades took on the might of Uncle Sam to such a precision on 9/11) but what I definitely know is Lehman Brothers survived 9/11 although it lost its headquarter and one of its employees but 8 years later lost its very existence.

Balkanization II

I talked about how the politicians are giving precedence to regionalism and castism over nationalism to gain votes and thus power. Over the last few days, I have read quite a few articles denouncing Raj Thackeray and his party MNS (including mine). I received a mail from one of the readers (of Balkanization that appeared in MSN) asking me a few simple questions. If ethnic cleansing of Kashmiri Pandits could not be resisted by the Indian Government why go gung-ho over Raj? If Tamil is encouraged in Chennai why not Marathi in Mumbai? Didn't our cities lose their cosmopolitan nature after being renamed Mumbai, Chennai, Kolkata, Bengaluru or were they renamed because they lost the cosmopolitan nature?

Then I started thinking? Is Raj a problem? Is he doing something for Marathi manoos? Or is he just doing what other political leaders are doing? After much pondering I feel the answer is Raj is doing exactly what other politicians are doing (albeit differently), i.e., divide the Indians amongst themselves.

Why cannot any Indian (nonKashmiri) buy property in Kashmir and yet buy property in Mumbai, Patna or Kolkata? The reverse; however is not true i.e., any Kashmiri can buy property anywhere in India. Why does an Indian need an Inner Line Permit (ILP) to enter Arunachal Pradesh when nothing of that sort is required for Pune, Bengaluru or Hyderbad? Why a child born to some particular tribes or castes (OBC/SC/ST) get preference over other Indians? (TN has 69% reservation)

Sixty one years have passed India got independence from the British, do we still need quotas? Do we still need article 370? My guess is reservation and article 370 has more to do with vote bank politics than upliftment of any community.

Today, it is Raj Thackeray. Tomorrow it might be someone else. Today, it is Mumbai (60% of the population in the city is non-marahati) tomorrow it might well be Bengaluru (more than 50% population is non-kanadigas).

The solution to this problem is not Raj bashing but to give equality to all Indians. If there can be quotas based on caste, creed or religion then why not based on region? Is it not sheer hypocrisy to have article 370 on one hand and blame Raj for asking something on similar line for Maharashtra. Either remove article 370 or let it be for all states and union territories of India, give all Indians a level playing ground.

Government money should not be spent to give interest free credit (oil companies providing 90 days credit) to Jet Airways and Kingfisher Airways (owned by the most flamboyant and extravagant Indian ever) but to build infrastructure and job opportunities in the remotest parts of India, so that people need not go to cities for jobs (I guess given the opportunity people would stay at home and earn rather than go to an alien city for livelihood).

The solution to prevent Balkanization of India according to me is threefold:
1. Government should abolish all quotas and article 370 and thus treat all Indians equally and none should feel alienated.
2. Government should try and spend money and create infrastructure and jobs in the poor parts of the country so that no one needs to migrate.
3. We the citizens of India should vote for a national party and avoid the regional parties as a national party will be answerable to all of India and MAYBE will not promote one region over the other.


"Balkanization is a geopolitical term originally used to describe the process of fragmentation or division of a region or state into smaller regions or states that are often hostile or non-cooperative with each other. The term has arisen from the conflicts in the 20th century Balkans. While what is now termed Balkanization has occurred throughout history, the term originally describes the creation of smaller, ethnically diverse states following the breakup of the Ottoman Empire before World War." This is how Wikipedia describes balkanization.

The 1991 break down of the Soviet Union into 15 countries can be called as the "balkanization of the Soviet Union."

India is the seventh largest country of the world. India has 28 states and 7 union territories. India is a diverse country where parts of the country are very poor (little or no opportunity for getting work) and part of the country is affluent (more of opportunity to get work).

Bihar is one state which is underdeveloped, lacks infrastructure, corrupt government officials and much of Bihar is economically underdeveloped. Biharis are found everywhere in India. A great percentage of all manual workers across the length and breadth of the country are Biharis. The great Bihari migration has lead to lesser opportunity for the local people or cut in wages (demand supply theory). This has lead to racist hate crimes towards the Biharis, be it in Assam or Maharastra. Biharis are not alone as far as racial crimes are concerned, non-Kanadi software professionals have faced the ire of hate crimes in Bangalore (although rare episodes). There have been instances of Bengalis beaten up by Assamese in Assam and Bengalis versus Tripuris in Tripura. In the entire northeastern part of India it has generally been the Bengalis who have been in the receiving end (historically though Bengalis had taken advantage of the tribal people but then 2 wrongs do not make a right).

Today, on October 19, 2008, rod yielding MNS supporters have beaten up examinees in Mumbai and other parts of Maharastra demanding only Marathi speaking people get jobs in Maharastra. If indeed this continues then a day will certainly come when Marathis outside of Maharastra will face the same royal treatment. The problem is that none of these hate crimes are being committed spontaneously (not that then it would be applaudable), but most of them are being provoked attacks by political parties (MNS being the prime) for vote bank politics.

Even religious vote bank politics are playing a big role, which indirectly is fuelling hatred between the several communities (Jammu and Kashmir - Amarnath land row) in India.

Then there is the caste politics which is creating hatred, a child born to a Brahmin peon will have less opportunity in education and/or jobs than a child born to a OBC, SC or ST IAS/IPS officer (although I do not understand why we do not have 49% reservations among the ministers for SC, ST, and OBC.)

If the politicians do not mend their ways, India is headed the way USSR went.