Hospitals- Love or Hate them!

Of the many things patients have taught me is why they like some hospitals and hate others. You will find streams of grateful patients in a shabby government hospital for in stance, while there would be many who would choke on their drinks in a party with the mere mention of that hospital’s name.

The factor that seems to sway opinion most is the final outcome of an index patient; if he was brought in moribund and finally walk out, then all the dirty linen, the “paan” stained corridors, the constant drone of mosquitoes and the rude words from nurses are often forgiven, and the hospital assumes the symbol of a new life.

If the end goes awry, as often it does in a referral hospital where critically ill patients are shunted to, the hospital becomes blotched in the minds of relatives and friends across generations.

But how do first timers, who have often come in for a consultation or procedure react to a new hospital? The initial impressions often prove crucial. Was the entrance clean and welcoming, the process of registration short and sweet, the signange clear, and the waiting hall comfortable and relaxed?

It is the non-medical staff forming the point of initial contact, which often makes or mars opinions. Were they in uniform? Were they receptive and helpful? What often puts people off is to find a group of clumsily clad employess seated behind the counter desk, chewing tobacco and chatting amongst themselves, while anxious relatives wait in crowded lines to have their concerns addressed, quite like the “enquiry counter” in a railway station.

Why a hospital finds it hard to please everyone however is the MWYP or “My WOW your PUH” factor. I see this happen every day in our wards and endoscopy suites. Patients coming from poor backgrounds who have slept on dirty floors of other hospitals or their homes are often “wowed” by the tiled floors, the concealed bright lighting, the laundered bedsheets and a large bed for each patient in our hospital.

What catch the attention of patients coming from middle and upper class homes however are quite the opposite: smelly wet toilets, stained bedsheets, reused mouth guards and a shabbily-clad orderly squeezing his arm while a frowning nurse, without wearing gloves, digs a needle in his forearm to draw a blood sample! 

For many patients, the long wait in the waiting-hall becomes a horrid unforgettable experience: congested and stuffy, no vacant seats, no digital display to know if your turn has come (or will ever come), no announcements, no magazines, no TV.... a long and painful wait laden with expectations that their final meeting with a specialist will end in a solution to their problem and transform their lives!

Thronging attendance is no vindication of a government hospital’s efficiency as the poor and desperate have no other place to go. Taking aim to reduce “Puhs” will increase the “Wows” and enhance the quality of our care.

As published in HT city (Hindustan Times) dated 26 February, 2012.

ARSENIC MENACE

Around 10 million people in India are unknowingly consuming high levels of arsenic in their water, with many showing signs of chronic poisoning. A recent investigation showed that the ground water (wells, deep tube wells) of several parts of eastern Uttar Pradesh and Bihar contain far higher levels of arsenic than is considered safe and permissible for human consumption.

The plight of people residing in these regions came to light due to the dark spots and patches on their skins and by their rough and scaly palms and soles. People from adjacent regions could smell there was something wrong with inhabitants of some villages and declined marrying into these homes out of fear of some infection.

While the disease is not infectious, arsenosis, as it is called in medical science, is a disease that is being increasingly recognized across the world. Geographical regions with high arsenic content in ground water and human inhabitants of the regions showing a characteristic disease pattern have been reported from 30 countries.

The first reports from India came from West Bengal and adjacent parts of Bangladesh n 1986 by Prof DN Guha Mazumdar, an eminent scientist from Kolkata who drew the attention of the World Health Organization to the blight. People residing in high arsenic zones showed, apart from the characteristic skin changes, involvement of the lungs, eyes, nerves, liver and blood vessels, and suffered from anemia. Mothers from these regions had a 6-fold higher rate of still births. Further cancers occured more frquently here, especially of the throat and bladder.

Normal drinking water contains around 50 -100 ug of arsenic per litre. Levels above 200 are considered unsafe for the human body. The ground water of several villages has been found to have ten times these levels, sometimes crossing 2000 ug/L. Consumption of high levels of arsenic causes excess accummulation of this metal in different organs of the body leading to their slow damage.

Many of the affected people often drop out of work due to weakness, anemia and degeneration of nerves. Swelling of the feet and ankles is common. Involvement of the lungs causes chronic cough and breathlessness adding to their frailty.

 It is not uncommon to see people in their forties and fifties with skin patches and rough palms, languising at home, often labelled as lazy or depressed, unable to cope with strenuous work and earn their livelihhod. Their children often grow up to suffer the same fate as do their offsprings.

As long as their water is not detoxified of arsenic, the dwellers are doomed for generations, except when some children migrate to cities and inadvertently escape the scourge. Boiling water does not help in this case as there are no germs to kill by heating.

And the inhabitants can do very little by their own to save themselves and their families. Only a vigilant and caring governemnt can help with testing, identifying and detoxifying the water in these doomed regions.

As published in HT City (Hindustan Times) dated 12 February, 2012.

Are parents the real culprits of exam stress?

Indian children, being loyal to their parents in contrast to their Western counterparts, are often diffident to blame them for their misery during exams. In Manthan 2012, an inter-school debate organized by HOPE Initiative, in which 100 high-school students from 43 schools participated, several children finally admited to what their teachers had always suspected: the main source of stress during exam times was in fact, their parents.

Researchers have noted that the phenomenon of exam stress occurs more often in the Eastern hemisphere, especially in countries such as India, Japan and Korea. It has its origin in the aspiration of parents to see their children better-settled and financially secure. Paradoxical as it may sound, this parental desire that claims several hundred lives every year by suicides, often stems from their concern for the welfare of their children, a sentiment that abounds in Indian parents. It also has roots in unfulfilled desires or yearning to see their children climb up that extra step in the socio-economic ladder. You cannot really blame a struggling clerk serving a beaurocrat to want to see his son become an IAS officer one day!

 What seems to often go awry is the parent’s ability to understand or explore what his child wants to do, is good at doing or interested in achieving. In short, it is often a case of communication failure within the home. The child often finds that his profession has already been decided for him by his parents sometimes even before he was born, and all that remains for him to do is to struggle through school and college and fit into the picture that his parents have imagined of him. If an enginner they want him to be, so must it be even if his aptitude is for literature rather than for maths or physics.

Interestingly, what drives parents to drive their children is their perception of financial insecurity. Exam stress occurs more often in homes where parents are in salaried jobs rather than in affluent business homes. Children of Indian immigrants to USA are much more stressed to perform in exams, manifesting that same spirit of struggle than their American counterparts.

It is time for parents to realize that undue and unreasonable pressure on their children to score more in exams can often be counter-productive and shattering. Bridging the communication gap and finding out what their kid wants to make of his life should be a good starting point. An objective assesment of his aptitude and capabilities will often help him choose a career that he can then pursue with motivation, zest and success.

One of the most wonderful aspects of modern times is the array of opportunities that are available today. Limiting the choice to becoming a doctor, an engineer or a beurocrat is out-dated and unproductive. Children often know what is best for them. If only we listen!

As published in HT City (Hindustan Times) dated 5 February, 2012.