Unemployment vis a vis Education !

It started with a patient, who during the medical interrogation, [history taking] accepted that he was not happy with life. Rather with the present job and presumed that he was cut for bigger things in life. Another victim of psychosomatic ailments. Digging further it turned out that he had done some, I don’t exactly remember, masters degree in either mechanical engineering or Business management, as far as my memory goes, he was an MBA. Mother provided the missing links. With all the money what a middle-class family could save they sought admission for him for MBA but in some college from the interiors of Maharashtra, that did not have any standing on the National MBA scene! And I realized where the problem was!

Being an MBA, though, from an obscure college, he subconsciously was putting himself on par with the candidates passing out from the IIMs. “I too am an MBA and why am not being considered for the plum jobs available on the market” was his prime concern! I was at large. Any amount of counselling was not going to help because the root of the problem was Unreasonable expectation with poor academics fuelled by middle-class aspirations of parents to see their ward on the higher wrung of the hierarchy which they could not achieve!  

At the same time, I came across a paper as fresh as published in March 2019, stating that “More than 90% of engineering, graduates are UNEMPLOYABLE!” The figures varied with different papers but the sphere widened when the MBAs were included! It was overwhelmingly 99% for Business management; in both the cases that 1 to 10% probably, mostly, belonged to the fresh ones coming either from IIMs or IITs! And the reports seemed authentic!

The rot is not limited to these two faculties alone but encompasses practically every educational faculty today.

Speaking about my own branch, Medicine, the rot started when Late Mr Vasantdada Patil initiated the move to start Private Medical Colleges, in Maharashtra which then had only one at Solapur. The notion was Noble[?]  The neighbouring state of Karnataka had many such already and so Maharashtra was losing on two fronts.1. Our meritorious students did not have sufficient seats and 2. The state was losing lots on the revenue, in the form of ‘Capitation fees’! There is no need even to guess, all the lucky ones who got the permission, even with bending many a rule, were from the Ruling party, Congress! What started with Medical colleges, spread to Engineering, B.Ed, Management, Computer sciences, say like a beehive gone berserk! Every Tehshil with a Congress leader as the head of his fiefdom had one or the other super speciality college that opened its doors to the gullible middle-class parents.

The move was very very clever. These Congress leaders, who started calling themselves as ‘Education Barons later, were very shrewd and were well aware of the mentality of the middle-class parents. At any cost, at times, taking loans, mortgaging their properties, selling the ancestral jewellery, at any any cost they will see to it that their wards would seek higher education which they could not because of a variety of factors but totally hoodwinking themselves about the fact that ‘Whether their ward really deserved it or not!’ “ I have money, so my child must be, take whatever you want, Doctor, Engineer, MBA, Computer Consultant, whatever!”

These colleges were so ill-equipped that at the time of farce named ‘Inspection‘ one borrowed equipment or machinery from the nearest college to pass the muster, and the cheating repeated every year, in the end, students passing out in the last year,never had chance to operate the instrument even once during the course of 4 years of degree course. On paper though ‘He was graduate’! Engineer to boot!

And thus the report says further that more than 200 engineering colleges have been shut down all over India due either to lack of infrastructure or for want of just gullible students! The experts say it’s because “Lack of faculty talking about industry application of concepts in class or students getting exposure through industry talks only, but not in colleges!”

In Medicine, while doing DNB courses in Surgery in Private hospitals, Medical graduate hardly touches the patient as the patient comes for the reputed name and not for getting operated from the faceless student. In government hospitals, surgical student do not get even time to bathe, even once in a week, but do not have access to the newest equipment, as the hospitals, simply do not have them or are defunct for years, for a variety of reasons, so by world standards he ends up being just a plumber!

Many of my friends do not teach, in Medical colleges, though qualified to do so, but are on the muster as faculty, because these are the norms required by the Indian Medical Council, to run the Medical College! The college management is informed about the “Surprise” inspection visit 'well in advance' so that all the faculty that’s just on the paper; makes themselves present in flesh and blood on the said day!

I don’t understand some recent policies drawn out by the Education Ministry. Nowadays there is no Merit list of the toppers declared in the newspapers for 10^th and 12^th examinations. I do agree that failure hurts but to deny the glory to one who stood 1^st with his herculean efforts is simply injustice. In the life’s race there always will be somebody who would be the 1^st and somebody, the last. But life does not stop! Is there not a race for the coveted post of CM? Or are there 15 PMs, because some who could not, would be psychologically scarred? Similarly, when one gets selected for the post of sweeper he is the first one from the list. Every child has to run the race of life, he has to put in lots of efforts to be there where he wants to be, then what’s the point in not having the merit list for them who deserve!

The entire education system has gone in the hands of the rascals. It’s money that’s more important now than the values and the education, THE EDUCATION, that enlightens. It’s always lamented that ‘Though I am a graduate, or whatever, I have to do the job that’s not apt for my standard of education.’ I would like to give an example of the most literate state of India, Kerala! If everybody from the state is either 12th pass or graduate, the rikshawala, or the sweeper too has to be at least 12^th pass! So one who scores least has to do the menial job!

Last but not least. Reservations. In highly competitive courses like IIT or IIM the dropout rate is phenomenal after 1^st year itself, thereby denying the really meritorious a seat, thus in the cost the nation dearly on intelligent jewels!

A lot of hue and cry is being raised about increasing [or is it alarming] rate of ‘Unemployment in the country. But If the one who stood 1^st in the Bihar secondary school examinations could not answer the most of the simplest questions, one can judge the quality of our education and thus what more can be expected than the increasing rate of unemployment.  Level of education and Unemployment is intertwined, unless we are strict we would be producing more in number but zero in quality, just like our population!   

Doctors Loot! Really?! Part 3

If anybody really loots in the health care Industry [?], hands down it’s, the pharmaceutical industry in India. Reasons are varied and multiple, some justifiable some totally freak! It’s most disorganized  industry though having many strict rules and regulations, our ingenious traders always find so many loopholes, some even big enough for an elephant to pass through!

India has neither invented nor manufactured so far a single molecule [apart from Ayurvedic medicines, which do not stand any scientific test on any account,!] on its own. All the medicines used by Modern Medicine practitioners,[ i.e. pain killers, antiallergics, and last but not the least antibiotics, which have brought infective diseases mostly under control], have been researched and invented by First World scientists, except few by Chinese who have been successful in beating whites in their own game.[They made a very effective drug for resistant Malaria using their knowledge of ancient Chinese medicinal system, that has been accepted by the entire world, of course including Western world!]. So we have to depend on the western world for molecules as well as for the technology thereby pushing the cost of the end product. medicine skywards!

All the Indian Pharmaceutical companies import raw materials, mostly from China,[Though besides the point,  it would be pertinent here, to know, for those who shout from the rooftops  against the use of Chinese goods, that it’s not about the Diwali lamps or two rupee toys, it’s about the import of Medicinal raw material from China if stopped, our Pharmaceutical industry will be defunct, the next second!], [Also stands for heavy goods like the machinery required to build the factories, Metro coaches etc] And these imports are in crores!  

Fortunately, the Indian Government has acted firm and wisely and stoically refused to patent the molecule but not the process, keeping the loophole that the molecule can be processed by any another method! Thus all these Ranbaxys, Reddys, Sun Pharma, Cipla and so many other Indian companies import raw material at the penultimate stage, process it differently and sell in India at much lesser price by the world standard! Had it been molecule being patented, a simple fever lowering pill, Paracetamol which costs only a few rupees, would have cost so much, almost breaking the ceiling and would have been well beyond the reach of a common man. And it’s the cheapest medicine!

The reason being given by the Western pharmaceutical companies, Mostly from the US of A, is really relevant. To bring out a single molecule useful for the mankind, at the same time financially viable, the company has to invest millions of dollars in research for hundred other molecules which may not turn out to be useful so the entire expenditure goes down the drain. Here it includes the remuneration of hundreds of researchers working on the molecule, ancillary staff, cost of the equipment, cost of raw material, taxes, oh so many other aspects. So the company has to recover the cost of this colossal waste from THE only “Molecule” that’s financially viable!  India at this stage just cannot afford such a sophisticated research system, at the most, she can buy the ready-made research and/or the technology and so the COST!

Another malady that plagues our Pharmaceutical industry is Authenticity. On this point, the score on the board is ZERO, big ZERO!

Many big names in the market, do not manufacture their own drugs. They outsource! So if you are buying a drug at an astronomical price because it’s branded, coming from a reputed a company, you are getting cheated, maybe, because THE Company outsources it to a smaller unit to cut the costs, but in the bargain compromising on the quality because the smaller manufacturing unit just doesn’t have the “Quality Control”. The flack may not stop here, Next It very well may be manufactured in a Gala, having a Horse stable next to it!  And the big companies? They are outsourced by their counterparts in Europe, mostly Italy because the labour is cheap in India!

I got to know from a very reliable source that out of 100s drug manufacturing units, he examined all over India, hardly 5 passed the muster!

And I believed him immediately. To show the transparency in dealings, every government institution has to float tenders to buy even the paper pins. By my misfortune I always had to be the part of it, being the most senior. Once a carton of Vit ‘B’ tablets arrived where there were no tablets in the strips, but if you open it, some yellowish powder flowed freely! [It must have come from some dubious firm having 'understanding' at the top levels, otherwise how would you explain?] On refusing to accept the indent; I was told bluntly that I was the one who had signed the final document! Even then I put my foot firmly on terra firma and said ‘No’! Maybe they showed the repent, which was façade! Definitely! RMO in charge of the drug purchases made student nurses peel off every strip and store the powder in a glass jar. The instruction doled out was, “whenever Dr Benurwar writes T. Vit B, give the patient a spoonful from the jar!” Aghast is a very mild word. After years of doing the job in a semi-government organization, I had realized that the nexus so vast and deep, was beyond me, the best option would be to keep mum! And I kept mum thereafter in every such dealing! In a juggernaut, if you are a small wheel, you have to rotate with the bigger one, if not, you are just deaxeled!

Barring few, 90% Indian pharmaceutical companies are small scale. They operate practically on the clandestine level but charge marginally less than the big sharks! None of the big operators is ready to bring out the medicines/drugs under Generic category fearing that they will lose the monies. The companies who have come out with generics, their credentials are a big question mark? All the government hospitals dispense medicines which are made available to them by someone sitting higher up [and having the hand in the deals], so if a patient is getting drug ‘X’ for his hypertension, next month he will get antihypertensive no doubt,but from a totally different group ‘G’ No consistency of supply, no authenticity, poor bioavailability, to be born in India as poor patient is a curse!

All in all, if entire expenses for the medical emergency are scrutinized, Doctors’ charges are always less than 10%. Majority of the chunk is taken away by the medicines, the investigations, hospital charges and other sundry expenses and the allegation is ‘Doctors Loot!’ If you have read the above blog carefully and with heart, you too would say,' Really?'

  

Doctors loot! Really?! Part 2

The Doctor has to take the flack for the allegation about the Astronomical [?]Charges in the health care because he is at the forefront. The very face of the Medical Profession. What really goes into it apart from him, either nobody knows or rather nobody wants to know!

To understand the breakup of charges, rather a big sum for a common man, one has to go into the economics of the Medical profession.

Right at the outset one has to know that even though it’s Noble profession in the eyes of the common man, none of the Corporations, Municipalities, for that matter even the so-called well-wisher Government of the people, for the people, does not think so. All of them charge all the Clinics, Hospitals big or small, or any other heath establishments like Diagnostic centres or Maternity Homes, for all the amenities provided, like water, electricity and other taxes like property tax, professional tax, at the “Commercial” rate! No concession here because it’s a Noble profession! The flak does not stop here. To start a nursing home even on the smallest scale, the Doctor has to procure umpteen numbers of licenses from hundreds of authorities. And once you enter the maze there is no way out. The inauguration of a prestigious hospital was stalled for more than a year because some officer in the corporation was not releasing the necessary certificate unless his palms were greased and because that did not fit in the policy of earnest proprietors, the hospital stood tall but vacant for a year or so! And mind you because you have to renew these licenses every now and then, lot of ‘Grease’ goes in the process!

Mind you, here we still have not considered the cost of the land or establishment. For a student coming from a modest background to purchase 200 sq ft gala to start his clinic or consulting room on a commercial basis is well nigh impossible in cities like Mumbai and/or Pune. At the most he can have lots of dreams in the eyes, zeal and zest to work hard, enormous hopes but pockets, still empty! From where does the lad in his twenties going to raise the money in crores? Banks offer loans, but not without their pound of flesh! Here I am talking strictly about the meritorious ones and not the ones for whom their fathers buy the degrees to run an already ready four-storied hospital or the ones, the pets of the government for whom everything is reserved from admission in an undergraduate course to PG degree and the jobs those are offered on the platter!

In bigger hospitals Doctor is the only answerable commodity, A Class four worker with the strength of Union backing him, knows ‘What’s NOT his work, but if you ask him, ‘What’s his work’, you draw a blank! Everybody has fixed hours of duties except Doctors, because theirs is a ‘Noble Profession’, they have to be on their toes even if the rest has eluded them for days together! In a poor area I have made umpteen number of night visits with peanuts as the fees because I myself was very well aware of the fact, that even if I ask for my legitimate rational fees, most of the patients are just not in position to afford them, thus I had to forgo it many a time, losing my precious sleep in the bargain because mine is a ‘Noble Profession’ and I am not supposed to get my dues as that amounts to looting!

If the patient has to pay from his pocket for the investigations, even if most necessary to diagnose the ailment, he is most reluctant and so will ask hundred times,

’Are they necessary, have they to be done now?’

I then have to be extremely patient and say.’ If not, why would I ask for them and you are having complaints NOW, so earlier the better.’

The same patient, if is insured will insist on getting the investigations which are absolutely not necessary. ‘I have never claimed before, so let’s get MRI done.’ ‘MRI for common colds? What for?’ is my exasperated reaction.

Second most expensive item in health care is ‘Investigations’. The most popular notion amongst the half-literate junta is, If Investigation comes negative, MONEY is WASTED! It’s extremely difficult to get the investigations done in such class!

Two important branches without which I as a consultant just can not come to conclusion are 1. Pathology with Biochemistry and 2. Radiology.

There are certain diseases, rather complications of diseases, which can be treated only on Biochemical parameters. Diabetic Coma for instance. The internal chemistry is so fucked up,[Sorry to use the word, but cannot recollect the apt alternative], that every minute, every hour Doctor has to keep on assessing the status very keenly, by asking for umpteen number of biochemical tests, that too repeatedly. Naturally the cost mounts. But the firm opinion is Doctors loot!

A drop of blood can give so much information about the person by doing myriads of tests, which may be or may not be having satisfactory treatment, but it’s going to cost all the same. To start pathological laboratory not only one has to have immense expertise but has to invest in the lab equipment in crores!

And if you talk about radiology? A single doctor just cannot afford to have highly sophisticated machinery. So in radiology either they have to have group practice or it’s institutionalized. Now here the economical mathematics is easy to understand.

If a particular instrument or equipment, say like Gastro scope costs about Rs 100,000/- and if it performs a finite number of procedures,[with each procedure few fibro-optic fibers break] say 100, then each procedure IS going to cost Rs 1000/-. Plus the doctor has to pay for the maintenance. He has to purchase a new one after the magic number of 100 is crossed, so provision to buy the new one has to be made from the procedures done by the previous one. Pay of the assistant, rent of the operation theatre where the procedure is performed and last but not the least, the fees of Doctor himself! Why not! So from the total sum spent by the patient, the Doctor gets the minimal!

And that’s why most of the time the equipment and instruments in government hospitals are defunct. The poor resident has to perform procedures 10 times more with the same machine because of the patient load and so the result….! Plus there is so much apathy about getting the machines repaired that it may take even six months just to float the tenders!

Third, and the largest chunk of the expenses is taken away for Medicines, but about that later…..

The Doctors Loot ! Really?

The reaction to one of my posts on FB was really beyond me. May be someone, from some brigade with the hot head but no reason, replied and what was it? Stupid, hilarious, ridiculous or downright insulting?! I really do not know where to put it. Putting down his version of looting, he has observed that, “When Intensivist takes a round in ICCU, he spends 15 minutes with patient No 1, charges in thousands and then moves on to the second one. After spending another 15 minutes, he charges AGAIN, in thousands and moves on to the third one. Thus if he sees 5 or 6 patients in the round, in the end, he amasses in thousands, coolly!”

Excuse me !!!

Every patient in ICCU is critically ill. In fact, that’s why he is in the ICCU. Every patient suffers from a different disease so requires a different approach. And those 15 minutes spent by the doctor are going to save his life, really a question of life and death. And to achieve this status, every doctor has to put in the efforts of years of studies. I remember, I literally used to study for 18 hours a day for my MD examination. One of the son’s friends developed Skin disease while doing residency because he did not get time to take a simple bath consecutively for 6 days, as the workload in Corporation Hospital was that high. Those 15 minutes spent are the culmination of, what we call in our culture, is really तपश्चर्या coming through commitment, hard work, immense experience and dedication!

And again these so called'Thousand' vary from Doctor to Doctor and from hospital to hospital! In the hospital where I give my services is run by right-minded social workers and the fees are really reasonable. But somebody or the other blame the management for charging astronomical fees! Again I will blame Nehruvian Socialism where people have lost the sense of proportion. We want 'Hinduja' like treatment at 'KEM' like cost! And If possible totally FREE! 

Though I do not feel like lowering myself to that level [I respect any profession which is carried out with dignity] but cannot help to cite the corollaries! The person is saying as if, if you buy potatoes from a vegetable vendor, why should he charge for the tomatoes!

The Supreme Court lawyers and advocates like, Mr Kapil Sibbal, Mr Manu Sanghavi, Mr Mahesh Jethmalani,[ His father late Mr Ram Jathmalani] charge in millions for one appearance in the court for defending something which could be totally untrue and people pay. People pay through nose for their own doing! At lower level too, people pay to the lawyers even if they very well know that they are on the wrong foot.

Is it so in the case of doctors? Patients come to the Specialist doctors [even qualified doctors in general], especially in India, as a last resort, mostly when the disease is in its advanced stage. Why, because as they do not want to spend money for the right cause, they try every remedy, including quacks, other pathies which do not have any scientific basis but only because they are cheap and last but not the least, the religious rituals! We Indians have thousands to spend on God, whose very existence is doubtful but money spent on maintaining the health is a colossal waste!

We save money to buy expensive gadgets, to better our residences, invest a lot for our trouble-free old age, money-wise, but do not save money for our illnesses of old age! Neither do we invest in our bodies by having regular exercises to face the old age which is inevitable. Most of the Indians have an absolutely unhealthy lifestyle. They do not exercise regularly nor do they have scientific knowledge of what they eat. I have come across umpteen families who have strong religious beliefs about their diet, that won’t stand the scrutiny of science even for a fraction of a second! And then if they land with an ailment worth visiting a doctor, admission in Hospital or worse in ICCU, they blame doctors, saying ‘Doctors Loot! Really?

I do not understand, why our profession, the only other one is Teachers', is put under the category of 'Noble'? Why not every other profession? Grocery vendor, even one at the corner to the one at mall who sells clothes with foreign brands has the right to loot, right, left and centre but when it comes to paying the legitimate rational fees to the doctor for well-deserving cause it becomes a loot?  

In India, everybody can make money in every damn way, right or wrong but the Teachers and the Doctors are like Caeser's wife, they can't, they loot!

The Accent

Though the medium in middle school was English, all the teachers who taught us were Marathis. So much was the influence that our English teacher, though he taught English excellently, [grammatically], made us go through it like reciting the hymns in Sanskrit. The rhythm still reverberates in my ears. The entire class used to repeat after him, 'I, Me, My, Mine’, a gap then ‘He, She, It’, again a bit longer gap and then with stress on every word, ‘They, Them, Their, Theirs!’ Why did it come to the mind? Remembered after years as if it was deeply buried somewhere in the abyss but surfaced, just on little fingering!

It so happened that 2 girls in their mid-twenties had come to stay with us on some exchange program, One American, total Yankee and the other very docile Chinese from Taiwan. I prided in speaking good English, , grammatically, so the verbal exchanges with American were quite lurid, lucid, enchanting and revealing. On the other hand, when I tried to have conversations with Taiwanese using even the simplest English, she used to stare blankly in my face! It was perplexing. I used to feel very awkward, at times taking that the poor one is poor in English! She then used to stare at American in askance with big question mark writ large on her face. And in a jiffy, they used to exchange a few fast sentences which used to go over my head! The reaction of the Taiwanese then used to be like’ ‘Oh Ho’’ as if, getting solved the most intriguing mysteries of the universe!  The duel thus used to go on painstakingly. Delving deeper I found to my amazement that Taiwanese was taught English by American 'English' professor in “THE” American accent with that so obvious Texan Drawl that she used to be at large with, though tried hard, but unable to wash off my ‘Marathi English’ accent!

That was not the only instance when I fell flat on the face due to this ‘Accent’ thing!

We were in Switzerland where they speak four languages, Italian, German, French and Romansh, a local Swiss one, effortlessly while shifting from one to another. English is spoken like icing on the cake, mostly for the tourists. Here too the accent changes, especially if you are speaking English, with every native speaker. After the conductor of the train to Jungfraujoch explained along with the information, itinerary and all, without break in languages, one after the other I just was totally confused about what exactly was happening. I was just going to ask him to explain everything in English, when my children started pulling me back and said, ‘Baba Don’t Baba please Don’t!’ Not knowing their intention I went ahead and asked him politely to explain in ‘English’

With a cool face and like a teacher of KG, he said almost icily but with mock politeness, ‘Sir I WAS speaking in English, Ask your children they will explain to you!’

In India, the scenario is beyond weird! Everybody from every state has such an accent, it’s difficult to fathom that it’s English. Especially the South Indian states! I don’t know what animosity they have with the alphabet ‘H’! They will put it when it’s not required and omit when it’s absolutely necessary. When somebody spells my name as ‘Sashikanth’ I really lose my marbles! In Roman English  ‘TH’ is pronounced in varied ways, like in This, That, Thug, Thief but never like soft ‘T’, which is correct for Shashikant, like in French. And when somebody from the south does that it gives me jitters!

Will, anybody tell me, whether it is Sridevi or Shridevi?

And here I come to the point immediately ‘Shridevi’ starrer ‘English Winglish’ was a well-made movie with a purpose and it was a decent commercial success too. But along the way, it lost its soul, the very crux of the entire narrative. English naïve, Shashi Godbole, from Pune learns English from blue-blooded English teacher native of 'THE' America. So with that base, why would Shashi speak in the climax with her staccato Indian English Accent? Contents might be broken but the accent has to be American because American taught her the English and Not any Kulkarni, Aiyyar or Singh from India.

Maybe it’s too late to write about ‘English Wiglish’ but I felt it’s pertinent so……..