Ramadan and Corruption

A few decades ago, while filling the board examination forms for 12^th class, we were asked to pay five rupees extra by the clerk in our school.  One of my friends initially refused to pay but agreed on a condition that he will be provided with a receipt for the five rupees.  Many of us at the time thought his reaction was odd and uncool.  Trust me he was not poor and could have paid it easily.  Many years later, the same friend stormed the Vice Chancellors office at the University of Kashmir as money was being demanded by the examinations section for his marks sheet.  While he was trying to meet the VC, the police guards kept laughing at him and made him wait for hours, but he did not give up and made it through.  Did he achieve anything better by living a principled life in a corrupt society?  

When it comes to corruption in our state, we have accepted it in all forms possible.  It is no longer a taboo, but usually a path to success and respect in the society.  Those who do not play by it are often labelled as dry, eccentric or commonly ‘Khowshikh’.  Corruption has become the backbone of our black and white economy.  Without any exaggeration, it’s morally, socially, culturally and religiously accepted.  Paying in cash or in kind is not the only forms of corruption our society suffers from, but sufarish, crony-capitalism, phone calls, VVIP culture, yesmanship, and who’s who are few other examples and the list goes on.

One could assume that during the holy month of Ramadan when we fast to control our inner self, discipline our evil side and live like true Muslims, there would be an automatic end to the corrupt practices in offices, on the roads, in hospitals, and one can’t be but naïve to believe that.  The files do not move from table to table, as the so-called weight is missing and some prefer to delay it after Iftar, like somehow taking bribes on a full stomach makes it Islamic.  We spend hours in mosques when we are being paid to work somewhere else.  Some even completely give up work as it seems to them that they can’t take bribes during the holy month, so why to bother. Do we stop taking the salary?

I remember a revenue official, who was religious and practising Muslim from his outlook.  He had even sent one of his sons to a religious school to become Hafiz-e-Quran. He demanded five thousand rupees bribe from a poor father for the issuance of a backward area certificate.  The irony, it was Ramadan, he was on his prayer mat, giving the final verdict that nothing less than five thousand rupees will do- Allah-u-Akbar, leaving the humble guest bewildered.  I am not taking a dig on religion or religious practices, I am just trying to make a point that we have religiously accepted corruption and it is no longer a sin for us, although most of us have heard that ‘both the receiver and giver are buying a ticket to hell’.

During my college days, one of our friends wanted to get married.  One Friday, we ended up in a mosque in the heart of Jammu city to meet a Mufti.  His sermon was mesmerising and many people were in tears.  When we disclosed the purpose of our visit, to my surprise, the Mufti gave a long discourse how youth should marry by their own choice even in secret, than to convince us to get families on-board.   Without much persuasion, he agreed to perform the Nikah, though I was expecting he may object as there was no representative from the girl’s side.  He even arranged witness on her behalf.  How much will he charge? In my naivety, I replied that it is up to us.  Not convinced my friend blurted the question.  Respected Mufti shocked us by saying that the matter is complex and would cost a minimum of five thousand rupees.  Subsequently, he started demanding more money, and when finally he completed the formalities, he refused to hand the papers, brazenly asking for money first.  I will leave you to judge the moralities here.  The point being it was for money; he went ahead, gave a sermon and did not bother to even question what was happening, and such examples are ample in our neighbourhoods.

Any doctor will tell you how during the MBBS training, they are also taught the holy business of corruption from the day they enter the academic section. There is a surplus charge for everything and within few months the whole idea seems normal and rather essential.   When I started working as a doctor, my salary was not being released.  It was only after my friend pointed out if I had met the Madam.  He further advised me to gift a dress to her from my wife’s wardrobe as he had done the same.  I met the madam, made peace with her and henceforth my salary was always on time.  She was even saving my income tax and when I told her that I want to pay than to produce fake certificates; she was surprised and rather laughing on my judgement.  On a positive note, one of the cashiers in the directorate of health services office works honestly and he categorically refused to take anything.  But by that time, I had gone into the default societal mindset aka ‘corrupt-mode’ and now I felt that he should take some chai-pani from me.  So how does one protect oneself in not getting indoctrinated into this business of the give and take and normalisation of corruption, which has essentially taken over our society as cancer?   

I came across a recent Facebook update; talking about how in a government higher secondary school in Islamabad (Anantnag), students need to pay to sit exams. “Students are shortlisted as per shortage in their school attendance, on the instructions of administration, which is reportedly constituted of few clerks, teachers, and lecturers, who have been posted in the same higher secondary school for past 10 to 12 years.  These students are barred from submitting the examination form on the basis of a shortage of attendance, and then charged a bribe of Rupees 500 to 1000 from each of them.  This has been a practice for years now and nobody can even complain as no one wants to put his career at stake.” Further the update mentions, “I don’t have a sum of rupees 500, and I can’t ask my parents for the same; these people have asked to arrange the money before Eid, or they will cancel the admission.  I have asked my cousin to lend me the sum, and I shall return his debt after Eid from my Eidhi.” The other fellow with disgust replied, “They don’t even stop it in Ramadan; they pray- I see them going to the mosque every day but- of what use- they are a bunch of wolves.”  Hopefully, the director school education will do something about it, as he stands informed from the social media already.

These are just a few examples and one can write an encyclopaedia.  As a rule, we all are corrupt unless proved otherwise.  The fact remains that may it be education, health, other civil services, recruitment, and even religious services, unfortunately, corruption is a norm than an exception.  It has reached a level where the more corrupt are seen as role models and people work hard or pay for such jobs or posts, may it be civil service, police or revenue. Similarly, when it comes to postings within the departments, there is a defined rate for plush postings.  People who are honest are the odd man out and posted to places considered punishment by the mainstream.  Hence, an honest engineer would be posted to civil secretariat or an honest police officer to an airport, as the means of extra income are limited in such places. The corruption starts top down and no one is allowed to challenge it.

Finally, the question remains, why these students wouldn’t become corrupt on their way up.  If corruption is systemic and being practically taught at homes, in schools, offices, and mosques, why are we pointing fingers at each other when it comes to other social evils of no significance? Why do we blame our daughters for natural disasters?  Does this mean that we as a society have become so rotten that our noses have given up smelling the putrefaction? Others may not have as much integrity as my friend and even he is struggling to keep his head above the water in a toxic environment. The ball is in our court and we cannot blame others for our downfall.  The money which pays for the Sehri and Iftar cannot be from unfair means, nor do the times spend in the mosque when one is supposed to be working.  And please let us not fool ourselves that taking a bribe after Iftar or Ramadan is approved.  Are we starving for sixteen long hours for nothing? 

http://www.risingkashmir.com/news/ramadan-and-corruption 

Festivity not Radicalisation

By eating in secret, pulling down the curtains on restaurants, taking bribes after Iftar, a woman covering up in Hijab or playing spiritual records than Bollywood songs in the buses, is not hyper-religiosity but simply a mark of respect towards the holy month of Ramadan. Those who fail to understand this and blame all such acts on radicalisation should see a mirror. This does not mean that people will change forever, or not sin or a woman may again give up her headscarf. But let's respect the essence of this holy festival and not mock those who try to observe it.

Also, those of us living in the West may fail to understand that the Ramadan is like a festival and there is a change in overall societal mood. The children are excited and elders in humility. Those who believe seek forgiveness and refuge. Those in ill health seek to get well.

PS: The teacher has every right to suddenly wear an Abaya and remove it as well. This is a simple act of respect for the Holy month and nothing more. She may choose not to use it later or may continue wearing it, but let there be no coercion or denigration for what one does of their own free will. The school should have apologised to her than to those who are making hue and cry.

©Mudasir Firdosi 

Tale of a Doctor

I was lost for words. He sounded desperate, helpless and fed-up.  He wants to serve his people to the best of his expertise but has become a victim of an unhealthy health care system, losing his skills with every passing day.  Though he never thought of leaving his home, he is even considering moving out of the valley.  As he narrated his ordeal, I kept thinking of hundreds of sincere doctors in his shoes, who want to alleviate the suffering of their community but are rendered unworkable by a corrupt and badly run health department.  This is how the story unfolds.

After completing his MBBS, he decided to become a child specialist. While training as a paediatrician, he would often feel helpless seeing the pitiable state of neonatal care in the Valley.  You may recall the headlines of hundreds of neonates dying not that long ago.  There is not only lack of infrastructure and equipment but also a dearth of trained professionals like neonatologists and allied specialists.  With this in mind, he decided to become a neonatologist. He left valley joining a specialist centre for a period of 3 years.  That meant leaving his family and a few months old son at home. He missed his son’s babbling and the first steps.  Whenever he would visit home, his son would refuse to play with him, taking him for a stranger.

While in the far off land, he used to dream day and night that once back; he will serve his people by starting a new era of neonatology in the Valley.  He would often talk about the feats he was able to do in a properly run system, how even a few hundred grammes premature neonate, is saved by right equipment and professional help. But once back, things did not work as planned.  He gathered that health authorities are more interested in the head count than competence and training of a professional.  He was even not posted to a place which caters to children, nor has any equipment or infrastructure to allow him to do his job.  Probably he is just supposed to collect his salary at the end of the month.  Who cares about neonates or their worried parents? Moving from pillar to post, requesting and pledging the top officials in the department, he went unheard.  Why would a highly trained professional, who declined job offers from across the world, be posted in a place where he will even forget his basic training? ‘Kareh Najjar Badasteh Gilkar’.  Let me remind you that J&K was awarded for the best healthcare in India.  You are free to believe.

Keen to serve and learn, he visited many health care facilities across the valley and interacted with his colleagues to understand how to work.  But apart from disbeliefs, he did not achieve much.  It became clear to him that postings and transfers are not done using any method, taking into consideration the qualifications or the training of the doctor or need of a particular area. It is usually based on who knows whom, sufarish, crony capitalism or the mood of the official at the time.  No one thinks of the poor patients or the doctor in question.  It does not matter if practically an unqualified person is treating you.

Many buildings along the national highway have been named as Trauma Hospitals. Interestingly, there is no trained doctor to manage trauma.  Glorified load-carriers driven by untrained personnel are called as ambulances.   A room, named as the neonatal intensive care unit, has a warmer, weighing machine, and zero number of support staff.  He also came to know that a brilliant surgeon was transferred from a district hospital to a far-flung village, not because of his inefficiency but being upright who was trying to do good for his patients.  A dermatologist was forced to manage complicated pregnancies and then blamed for the adverse consequences.  There are hundreds such examples of a square peg in a round hole.

 He came to know that wounds are being stitched with bare hands, putting both the doctor and patients at risk of infections like hepatitis C and B.  When he suggested asking patients to buy gloves from the market, he was advised that “the vigilantes from the revenue department will be dispatched within a jiffy on the directions of the local henchman, to cut doctors to size".    Who is at fault here, administration or the civil society is for you to judge.  I am not advocating patients should buy anything when the healthcare is allegedly free.  But who pays the cost for the treatment of rampant hepatitis C cases? Unsurprisingly, some do ask medical representatives to supply gloves and other equipment, as hospitals are always in shortage.  Whom would you blame for the alleged doctor –medical representative (MR) nexus?

A consultant friend was encouraging him to join his native district.  When they met last, he found his friend distraught.  His friend had been lobbying to procure some equipment for the hospital, with intensions that a maximum number of patients will benefit from the latest technology.  He was warned by a class fourth employee from the administration that he is a non-entity and should refrain from defaming the hospital.  Trying to improve the facilities is taken as defamation; some would say it as progress.  When he mentioned his plans (rather dreams) of starting a neonatal intensive care unit (NICU) to his colleagues, having trained in latest technology including use of high-end ventilators, there was a loud laughter, whether on him or his naivety, one cannot be sure.   

Finally, he reached back to Srinagar rather dismayed.  While lost in his thoughts, he boarded a bus.  He had thought that buses are obsolete now and probably not many people use them.  Within no time, there were more people standing in the middle than those apparently seated, and more people hanging by the doors than those trying to stand relatively straight, and sandwiched in the middle.  He thought, contrary to popular belief as our leaders often claim, most are still economically deprived and socially unprivileged.  How can people afford healthcare if boarding such unsafe is a norm?

The bus conductor was shouting at the top of his voice to get more passengers on board. Within no time the conductor started yelling at the passengers, who were virtually hanging, to close the door. How can we close the door when there is no space inside, someone shouted back? Despite knowing everything, the conductor kept on insisting on packing more people into the bus. When the bus reached its final destination, surely many people had their backs and knees in a condition needing repair. Once off the bus, he could relate the condition of the health department to this bus in the 21^st century.  Our health system is like an overloaded bus, and those supposed to administer the department, hardly care to change it.

One would have thought that administration is paid to improve the system and not just rule and control people by punitive postings and transfers.  Isn’t it is up to the civil society to hold health authorities accountable than getting fooled by false promises of new hospitals which then fail to deliver for obvious reasons? It is time to get a proper system in place which is patient centred, professionals working as per their competence, and are held accountable for their actions.  The department needs to utilise doctors as per their expertise, encourage and reward them than to punish them for not having right contacts.  Let paediatricians look after children and ophthalmologists treat eyes, by forcing them to treat heart attacks or conduct deliveries, you will not only kill the patients but loose doctors as well.  The opening of new medical colleges or announcements of model hospitals only makes sense when right people are chosen for right jobs.  Otherwise, constructing concrete jungles only helps a few people to get rich and nothing more.  Big buildings do not make good hospitals, but the professionals working in them do.

http://www.risingkashmir.com/news/tale-of-a-doctor 

Open Debate – Is NEET good enough?

A common entrance test (CET), also called National Eligibility-cum-Entrance (NEET) test was proposed by the Medical Council of India (MCI) in 2012 for the admission to MBBS, BDS and postgraduate courses (MD/MS) in all colleges across the country.  Many State governments opposed the proposal and moved to court with the plea that NEET infringes upon their right to keep education as a State subject.  NEET was declared unconstitutional by the Supreme Court in 2013.  The private medical colleges were completely opposed to the idea as they seemed to be the biggest losers if NEET is implemented.  Recently, the Supreme Court of India ordered the implementation of NEET overturning its previous directive.  The MCI claims that NEET will improve the process of admissions, bring transparency and remove observed malpractices.  It is thought that many States do not have a robust mechanism of admissions and situation is worse when it comes to the private medical colleges.  There are often allegations of corruption and favouritism.

The aspiring candidates, medical students and doctors mostly welcomed the NEET.   On the positive side, candidates can just appear in one exam and this will save their time and money. They do not have to apply at various places and pay every time.  The allocations can be done with ease choosing their favourite colleges depending on merit.  The psychological stress of appearing in multiple examinations will be lessened.  On the other hand, the sudden introduction of the NEET meant that some candidates may be at a disadvantage due to their background or the way they were preparing for the exam etcetera.  Candidates from Jammu and Kashmir will lose the advantage of filling all the seats in the J&K Medical colleges, as non-State subjects are not allowed admission.   The fifty percent reservation for women in government colleges will also be lost in J&K.

Coming to a bigger question, is NEET the only solution to the declining standards of medical education in the country?  What else has MCI done so far to advance the medical education? It is a welcome first step towards the long awaited reforms.  It will make the life of the aspirant’s easy; avoid unnecessary bureaucracy and red tape.  The NEET is a multiple choice examination (MCQs), which is the gold standard for entrance examinations in India.  In view of the prevalent crony capitalism and corruption, an MCQ type of exam is the best option to cut down fraud and favouritism.  As there is no interview, it limits any outside interference.

Across the globe, the methods of admission, teaching and assessment have advanced keeping up with the developments in medicine and technology but India is still stuck in the early fifties of the twentieth century.  The MCI has proved to be a big disappointment due to its inability or rather inaction to reform the medical education over last six decades.  It is a shame that the MCI has not even been able to put together a proper syllabus and curriculum.  Every medical college trains and teaches, depending on the beliefs and whims of the faculty and there is no uniformity or standard across the country.

Becoming a doctor is not an easy task and apart from the academic qualifications and merit, one needs to have right aptitude and personality.  This cannot be examined by a simple multiple choice examination.  The overall personality, career goals and resilience to stand the gruelling exams and responsibility which comes with the job need to be kept in mind.  In the United Kingdom, admissions to medical colleges are done by a multistage process.  Aspirants with good grades in A-levels (10+2) are eligible to apply to the medical schools of their own choice. There is an initial longlisting process.  There is no MCQ type exam and they do not have to waste time revising and cramming the 10+2 syllabus again.  UK applicants must take one of three additional tests- the UK Clinical Aptitude Test (UKCAT), the Biomedical Admissions Test (BMAT) or the Graduate Medical School Admissions Test (GAMSAT).  The candidates have to demonstrate suitability for becoming doctors by working with charities, hospitals or simply shadowing doctors, so that they can test themselves in real life situations and make an informed decision to enter the medical profession.  Such work experience is scored in the shortlisting process.

Candidates who are shortlisted are invited for interviews by the medical schools.  Interviews are a complex process of assessment (Multiple Mini Interviews-MMI) comprising of multiple stations in which various attributes of the candidate like attitude, ethics, compassion, resilience, and conscientiousness etcetera are assessed.  They are given clinical scenarios and asked to comment and give their opinion.   Interestingly there is hardly any stress on the theoretical knowledge as it is presumed that candidates have already done well in the 10+2 examinations and there is no need to assess the rote memory again.  Compare this to the MCQ type of examination.  Apart from testing the rote memory, there is hardly any emphasis on testing other attributes. While as the candidates in the UK make an informed choice to join medicine, many of our candidates sit the entrance because of social pressure.  Such candidates often become frustrated in the future leading to dangerous consequences like suicide, as there is usually no going back due to pressure from family and stigma. 

It is too ambitious to suggest switching from the MCQ type exam to this multi-stage assessment, but more needs to be done if we want to produce high quality and safe doctors. Having a common exam like NEET is a good start, but much more needs to be done if the deteriorating situation has to improve.   MCI needs to reform the curriculum and subjects taught in medical schools on a war footing.  The focus needs to shift from reading thick books and theory to practical skills, empathy, ethics and accountability just to name a few.  There needs to be a common minimum standard of doctors passing out of the medical colleges.  If the MCI is not able to deliver, then it may be better to start with disbanding the monster as recommended by the parliamentary committee.  The Committee on petitions (Lok Sabha) has already invited views/suggestions on the petition “Medical reforms in the country” which is a good start and may hopefully lead to some positive changes.  Interestingly, due to pressure from various state governments, the central cabinet passed an ordinance postponing the implementation of NEET by one year.  Only time will tell if it will be implemented or not and who’s interests will be dearer to the politicians running the country.

http://healthanalyticsindia.com/healthopinion.php?id=198