Friday, December 2, 2011
Monday, November 7, 2011
think oblique: conversations - 13 August 2011
think oblique: conversations - 13 August 2011: certain conversations can change lifes approach. It changed mine. Deep and penetrating as it was, I perceived the world and the relationshi...
conversations - 13 August 2011
certain conversations can change lifes approach. It changed mine. Deep and penetrating as it was, I perceived the world and the relationships in it in a contrast of intense colors. Everything became colored with paranoia. The sleeplees hours in the wee hours of the morning - left me with a reason to look back at myself. had I fallen out of the file as much.
Friday, October 14, 2011
Monday, August 22, 2011
green leaf on a wooden chair
Dear Yo [to my wife]
I was thrilled to read the type of thought you gave to “a leaf on a wooden chair”. I thought no better than you did. I am enjoying life and its time now, more than ever – to say – everything is perfect.
As for my thoughts about the same topic:
From an observational point of view-
1. It represents two living things who have become non-living and yet not nonexistent.
2. Two objects now at the mercy of somebody else to be or not to be moved away.
3. Two apparently intimate objects that can be easily separated by the slightest distraction of a breeze.
The first feeling is one in which there is a feeling of the perpetual survival much after the apparent death – of feelings as part or of life as a whole. The chair is old and the leaf is youthful, the chair has perseverance and the leaf is restless. The leaf came back to the wood for one last time, to feel it , care for it , and love it. And like a brave heart, the wood enjoyed the caress for ‘what could be more threatening than the thought of loosing what you have started to like’. I can feel an intense feeling of love between the two during the very last moment, caught in time frozen which shall pass and yet in the smallest fraction of time- there is a long way to go. Could it resemble a person’s life acquaintance with people whom they continue to love for a life time- measured as a miniscule event in the vast and magnanimous chronology of the universe?
What appears to have got disconnected from the visible and perceptible sense of life (existence or presence) may actually continue to linger for may years into the future. Take for example, your memories of your childhood friends, they grew and were inadvertently lost over time. Then many long years later, the memories, though they have very few direct requirements, continued to resurface with a new significance like the leaf and the tree which gave the wood will when they are again reborn as a sapling. Of course this is the continuity of energy- the cycle of life. Look how the simple association has effectively captured a particular moment in this process.
Or maybe
Two objects disconnected from the energy of life are at the mercy of anybody or somebody to be or not to be separated away. Whatever may be the method of separation (rudely cast away or gently lifted and placed in a respectable position),the leaf shall not be allowed to rest on the wooden chair sooner or later. It has to go and worst of all , if nobody does , mother nature will in order to preserve the process of life –“ from earth shall we come and to earth shall we go”. Did you notice, the leaf represents a small life and the chair in comparison represents eternity. One comes like the sparkle of a fire fly and the other a long smothering flame. This is the unique destiny of every entity. The leaf falling on the chair is a coincidence like Buddha achieving nirvana , Ramakrishna getting enlightened and oneness with eternal peace. Unfortunately, such a leaf falling on such a chair is indeed a rare event.
Or maybe
Two intimate objects as we have them to be ever linked together from our childhood have actually developed a fragile relationship, each with a reserved and rigid self perception and unforgiving to the other. The fragility is such that a gentle breeze is capable of ending their reputed relationship. The mechanistic nature of the chair, rigidity of thought could not care enough for the beauty of the green leaf. In the similar proposition the leaf never realised the concern expressed through the robust nature of the wood when it had held the leaf with life. And now is departure. There is no more attachment, mere regret that the leaf will be lost and so will the grace of the chair once the breeze blew by. They shall then again meet as a sapling, exchange places, and repeat the ballad of life once again.
The above is an observational view – I observed the two objects and related them as metaphors representing a continuum of thought.
Can there be another way to feel the same association?
If I were the leaf- I had fallen detached from my parent tree (my upbringing, my family, my umbilicus) on to a system of measured accuracy, completely unconcerned about my gentleness. The fragile curls with which I was nurtured, the strong hold of my roots, kept me from falling so long. When the breeze had blown very thick, when there was a storm, I was still held strongly by my roots. But I don’t know , that very day , I got free , I was left alone, I was allowed to precipitate on to this wooden framework which has no intentions or reasons to hold on to me. I never saw this chair before , but if I would have , I sure would have been impressed. Its handsome look, the lines on its body, the glaze over its varnish and the mathematical precision – all suggest a royalty. When I land on the chair , I knew my beauty will relate well with the grace of this precious crafted wood. – And yet nothing happened! Everything was just as cold as the mortal. There was only one purpose which was being satisfied for ages and had made the chair lovable to its users. It knows nothing and needs nothing. I feel lost and wish to get back to my roots. But the roots are unforgiving. They point their fingers towards the earth and they say –‘from earth you have come and to earth you shall go’.
If I were to be the chair-
A carpenters craft is best demonstrated in the beauty of the chair he makes. I have lived so long , shaped to good precision, tempered to bear the load all my life and perform my work with dignity. And then on this fine day, I felt the gentle touch of a green leaf. It sent my mind spinning way back in the past to the days in my childhood where discipline was never defined. I was part of a big family who were rooted together for a singular cause – nurturing of our sprouts. I used to love holding to the new leaves and change from one to another as the newer ones came up. My mind was full of energy. Never did I ask myself – what happened to the beauty I had just held in my hand. For I knew not it must have fallen to the beneath. This green leaf is breathing heavy and I can’t do much about it. Coming to me happened to be a chance event in its life for it is destined to meet the earth. I know one day I too shall follow- oh! Creepy destiny- makes me sleep till the time comes for me as well to find peace in this cycle of life – make me a leaf in my next life.
Pratyush.
I was thrilled to read the type of thought you gave to “a leaf on a wooden chair”. I thought no better than you did. I am enjoying life and its time now, more than ever – to say – everything is perfect.
As for my thoughts about the same topic:
From an observational point of view-
1. It represents two living things who have become non-living and yet not nonexistent.
2. Two objects now at the mercy of somebody else to be or not to be moved away.
3. Two apparently intimate objects that can be easily separated by the slightest distraction of a breeze.
The first feeling is one in which there is a feeling of the perpetual survival much after the apparent death – of feelings as part or of life as a whole. The chair is old and the leaf is youthful, the chair has perseverance and the leaf is restless. The leaf came back to the wood for one last time, to feel it , care for it , and love it. And like a brave heart, the wood enjoyed the caress for ‘what could be more threatening than the thought of loosing what you have started to like’. I can feel an intense feeling of love between the two during the very last moment, caught in time frozen which shall pass and yet in the smallest fraction of time- there is a long way to go. Could it resemble a person’s life acquaintance with people whom they continue to love for a life time- measured as a miniscule event in the vast and magnanimous chronology of the universe?
What appears to have got disconnected from the visible and perceptible sense of life (existence or presence) may actually continue to linger for may years into the future. Take for example, your memories of your childhood friends, they grew and were inadvertently lost over time. Then many long years later, the memories, though they have very few direct requirements, continued to resurface with a new significance like the leaf and the tree which gave the wood will when they are again reborn as a sapling. Of course this is the continuity of energy- the cycle of life. Look how the simple association has effectively captured a particular moment in this process.
Or maybe
Two objects disconnected from the energy of life are at the mercy of anybody or somebody to be or not to be separated away. Whatever may be the method of separation (rudely cast away or gently lifted and placed in a respectable position),the leaf shall not be allowed to rest on the wooden chair sooner or later. It has to go and worst of all , if nobody does , mother nature will in order to preserve the process of life –“ from earth shall we come and to earth shall we go”. Did you notice, the leaf represents a small life and the chair in comparison represents eternity. One comes like the sparkle of a fire fly and the other a long smothering flame. This is the unique destiny of every entity. The leaf falling on the chair is a coincidence like Buddha achieving nirvana , Ramakrishna getting enlightened and oneness with eternal peace. Unfortunately, such a leaf falling on such a chair is indeed a rare event.
Or maybe
Two intimate objects as we have them to be ever linked together from our childhood have actually developed a fragile relationship, each with a reserved and rigid self perception and unforgiving to the other. The fragility is such that a gentle breeze is capable of ending their reputed relationship. The mechanistic nature of the chair, rigidity of thought could not care enough for the beauty of the green leaf. In the similar proposition the leaf never realised the concern expressed through the robust nature of the wood when it had held the leaf with life. And now is departure. There is no more attachment, mere regret that the leaf will be lost and so will the grace of the chair once the breeze blew by. They shall then again meet as a sapling, exchange places, and repeat the ballad of life once again.
The above is an observational view – I observed the two objects and related them as metaphors representing a continuum of thought.
Can there be another way to feel the same association?
If I were the leaf- I had fallen detached from my parent tree (my upbringing, my family, my umbilicus) on to a system of measured accuracy, completely unconcerned about my gentleness. The fragile curls with which I was nurtured, the strong hold of my roots, kept me from falling so long. When the breeze had blown very thick, when there was a storm, I was still held strongly by my roots. But I don’t know , that very day , I got free , I was left alone, I was allowed to precipitate on to this wooden framework which has no intentions or reasons to hold on to me. I never saw this chair before , but if I would have , I sure would have been impressed. Its handsome look, the lines on its body, the glaze over its varnish and the mathematical precision – all suggest a royalty. When I land on the chair , I knew my beauty will relate well with the grace of this precious crafted wood. – And yet nothing happened! Everything was just as cold as the mortal. There was only one purpose which was being satisfied for ages and had made the chair lovable to its users. It knows nothing and needs nothing. I feel lost and wish to get back to my roots. But the roots are unforgiving. They point their fingers towards the earth and they say –‘from earth you have come and to earth you shall go’.
If I were to be the chair-
A carpenters craft is best demonstrated in the beauty of the chair he makes. I have lived so long , shaped to good precision, tempered to bear the load all my life and perform my work with dignity. And then on this fine day, I felt the gentle touch of a green leaf. It sent my mind spinning way back in the past to the days in my childhood where discipline was never defined. I was part of a big family who were rooted together for a singular cause – nurturing of our sprouts. I used to love holding to the new leaves and change from one to another as the newer ones came up. My mind was full of energy. Never did I ask myself – what happened to the beauty I had just held in my hand. For I knew not it must have fallen to the beneath. This green leaf is breathing heavy and I can’t do much about it. Coming to me happened to be a chance event in its life for it is destined to meet the earth. I know one day I too shall follow- oh! Creepy destiny- makes me sleep till the time comes for me as well to find peace in this cycle of life – make me a leaf in my next life.
Pratyush.
Saturday, August 13, 2011
think oblique: The fallen glass of water
think oblique: The fallen glass of water: "Inextricably intertwined with the practice of not-knowing is the primacy of direct experience. “Don’t take my word for it,” the Buddha sai..."
The fallen glass of water
Inextricably intertwined with the practice of not-knowing is the primacy of direct experience. “Don’t take my word for it,” the Buddha said “Seek out your own salvation.” Though there is always room for distortion, the insistence on direct experience is fundamentally an antidote to fundamentalism. For to be genuinely focused on discovering for oneself what is true or not true is inherently different from attempting to conform—and getting others to conform—to someone else’s record of the truth.
Forgive me if at any stage in what I write I forget. I am in great grief. It is in this state of emotion, I am attempting to break through a event which has overnight shaken me up. I realised that entire strength of a person is built within a microcosm which interacts with its surrounding. Sometimes this energy may be able to break through and other times will be broken.
I saw a glass of water fallen on the table with water spilled all over. The water which was a whole well shaped by the volume of the glass, has now been broken into pieces as if someone which was a part of the whole wanted to break free. So it spilled itself. It fell nice to begin with since its heart paced and it broke new ground. There was a new energy that it saw and sought. And then there was the little water in the glass which had been left behind. With pain it watched the rest of the water flow away. It was jostled and shaken and weak but it knew that the apparent liberty was merely a pretence. I saw the glass fallen. I saw the water spilled both silently experiencing the pleasure and pain.
My grief awaits the transition of ‘not knowing’ to the ‘direct experience’ for the water remaining within and the water spilled. I am to be thankful to the one who spilled the glass of water as well as the one who promptly flowed away. The question is how long it will take to answer myself what or rather when I shall learn not to ask question. This day of 12th of august shall be remarkable for will start losing my spilled half.
Monday, April 25, 2011
Father with a sick child (7/12/2009)
We are in constant conflict within ourselves related to the moment we have lived and the moment we are to live. The span of time considered may vary but the child and the father constantly live through in one relation of happened and to happen. I wanted to live back in my childhood with a variety of feelings nevertheless predominated by the shades of blue. There is no remorse but neither is there the feeling of great happiness. The truth is, I feel like clinging on to my past till I am tired and let-go. And then another bout of passion surges within me to trail my bygone days.
We are in constant conflict within ourselves related to the moment we have lived and the moment we are to live. The span of time considered may vary but the child and the father constantly live through in one relation of happened and to happen. I wanted to live back in my childhood with a variety of feelings nevertheless predominated by the shades of blue. There is no remorse but neither is there the feeling of great happiness. The truth is, I feel like clinging on to my past till I am tired and let-go. And then another bout of passion surges within me to trail my bygone days.
Sunday, April 3, 2011
Monday, March 21, 2011
Wednesday, March 16, 2011
Saturday, March 5, 2011
Wednesday, February 23, 2011
dismal images of a nursing home in semirural India - owners were on a Europe tour
I happened to be in a hospital and was surprised at the level of service provided by the owner and accepted by the patients. This is true of India in almost every region. I gather, it is the very poor standard of living which is responsible for acceptance of this kind of facility.
Saturday, January 8, 2011
think oblique: Future of health care in Ratnagiri.
think oblique: Future of health care in Ratnagiri.: "It is reasonable for any intellectual and capable youth to ask wether it is safe to live in Ratnagiri with regards to its medical services. ..."
Wednesday, January 5, 2011
Future of health care in Ratnagiri.
It is reasonable for any intellectual and capable youth to ask wether it is safe to live in Ratnagiri with regards to its medical services. I did the same 5 years ago. I found that it was far from the need of time. During the last 5 years, I witnessed remarkable change in the services now available in the town. The objective of this essay is to prospect the future of health service in ratnagiri with its practicle limitations keeping in view the progress of the years recently gone by.
To make the discussion easier to understand, I would like to dichotomize the issue into facilities available, long term care services, geriatric medicine, pediatric medicine, emergency services , super-speciality services and paramedic services. Before I start any part of the discussion, I should acknowledge, the contribution of the new governmental programmes and policies are helping these betterments to happen. I am proud to be associated with the Ratnagiri Civil hospital, which continues to provide service as its resources can to a very large population of the society. I congratulate the Civil surgeons efforts and the political will of the administration which has made this possible.
This discussion pertains to the private health sector which has the potential and the freedom to show progress and also is a reflection of the market forces.
With regard to the facilities available or rather more precisely, the technology available, there continues to be a misconception that the poverty in the region probably will not support the investment. During the last 3 years I am witness to more than four such events related to successful investments. It is the doctors confidence that probably far more important because only when the service is available will the community take it. There is definite evidence that the confidence race has been triggered and the results will be seen in a few years. The insecurities of the past are giving way to the bold and dynamic decisions of the future. I have also witnessed the harm of erroneous decisions or sub-optimal application of a technology resulting in failure of the project in terms of the financial expert. It therefore becomes more important in the future that each investors knows his machine and it potential to stand the competition rather than be a old failing horse. The availability of multiple CT scanners, Dialysis machine, MRI unit and dedicated pediatric hospital have been but the beginning of this future. Unknown to many because it is not seen easily, surgical techniques have been remarkably good in our town. Spine surgery patients go home on the 2nd day after surgery, awake brain surgeries are being regularly done in this town and the endoscopic surgical work have reached high levels of excellence. Better equipment has made it possible to perform difficult pediatric surgeries possible. The talent has always been here, the confidence and the competition have now come in as well.
Long term care of patients is another aspect with very different kind of requirements for the patient. At one end of the spectrum are those who are highly dependant for medical care like severely brain injured patients to the others who required relatively shorter period of stay and less expensive treatment. Ultimately it is all related to the availability of services. The attitude of shrugging of responsibility off the shoulder appears to be taking a changing face with more centres providing such care. The care delivered to the cost of therapy is obviously going to become favourable as the population requiring the service increases. Long term care of patients also require active and supportive staff members and doctors. Groups have been forming where this kind of group activity is becoming possible. About 4 years ago I was not able to get a trained nurse to deliver effective home care within ratnagiri but presently nurses and nursing bureau provides this service in the private sector.
Geriatric medicine will be the practice of the future because of the growing elderly population. 60 to 65% of Ratnagiri’s living population will be in the geriatric age group. One of the important factors related to the elderly population growth is the fact that many families are preferring the return back to there home town from the cities after retirement due the increasing difficulties in city life. At the same time some families from the rural segment are migrating to the smaller towns like ratnagiri for safer environment. Basic care facilities were probably present from a very long time with cardiology work being done regularly. It is estimated that 73 to 80% of financial allotment is towards the health of geriatric age group. In the near future further advancement is expected with regard to diagnostic and therapeutic potential in Ratnagiri. Cath-lab, an essential equipment for cardiology will soon be setup in the town with visiting cardiologist initiating the service and a full time cardiologist settling down in this town. The potential is obviously high considering the growing population density. Better pathological laboratory and advanced technologies is already present in the town. I am able to get almost all forms of investigations done in the town with hassle free and cost effective services being developed by most centers. Economic viability is very strong since the demand in this segment is very high and the ability to travel is poor.
Pediatric medicine is my passion and I always felt what ever be the outcome I shall go ahead with the needful investment. In the initial phase there were suggestions about viability of good quality technologies in our town. But my practical experience says that quality does survive well. Pediatric medicine has improved remarkably with better intensive care facilities coming up and more pediatricians willing to join the effort. One of the constant problems related to pediatric intensive care practice is the rising cost which many young parents are not yet prepared to spend. A reasonable accounting practice can actually provide facilities at a far affordable rate. For example , we estimated the cost of oxygen – an essential product – in medical therapy. It might surprise the reader that your town dosent have a self sustained Oxygen supplier. All of it is being purchased from Kolhapur at a very high rate for reasons I have not understood. The Kolhapur supplier inflates the price to 200% and the the cost is further increased by the service provider. Though the cost remains the same as in other towns ~ Rs 60/hr [also sanctioned by some government bodies], we found it to be a major burden to the population. Re-calculation reveals that Rs 35/hr will suffice even if bought from another town. Hopefully, in the near future there will be self sustained unit in this town of Ratnagiri. There are special pediatric operating unit now available in the town which will provide better and safer environment for the child and the outcome will eventually improve.
Emergency services take the lime light in any discussion related to medical care. Interestingly, the discussion is more often related to the failures of management than the successfully managed patients. Let me recount what I consider a recent success in emergency medicine. The most important is the fact the more doctors are willing to participate in emergency care with presently 2 dedicated intensivists specialist in this town. There specialization has certainly contributed to the over all outcome of the patients. Early detection and intervention can revert an impending complication. This shortens intensive care stay and cost. The same holds true for pediatrics and superspeciality like Neurosurgery. As the environment improves, the possibility of survival of critically ill patient improves. I had made a statistical assessment of the survival of patients of head injury coming to me from other hospitals in critical state. Whenever a effort to give primary therapy was made in the referring hospital the survival had improved to 78% from 53%. What I am hoping to see in the near future is an emergency patient care system where the patient will get primary attention during transport by trained paramedics who will be able to deliver primary care and thereby improve the ultimate outcome of the patient. This will require preparedness from the patients relatives to accept and pay for such a service. Emergency service also means preparedness for any mass catastrophy. More hospitals are becoming 24hr working and providing facilities through out the night. This is a welcome sign and we are hoping that in the near future patients will not be running from pillar to pole for a late evening emergency.
Super-specialty medicine and surgery are those areas in which the required infrastructure are both financially demanding and professionally intensive. They are not necessarily expensive. But if not attended in the proper manner, the problems compound. At this moment neurosurgery, neurology and urology are the specialties established in our town. There is all the potential for a plastic surgeon or cardiologist to come and practice in Ratnagiri. An issue that concerns me is about the floating or visiting surgeons and physicians who actually come in search of patient and do not take responsibility of the same as long as they are not having enough patients at home. The moment they have patients at home they will stop coming and start luring the patient to their centre. This is cheap practice and employs many other issues like secondary financial benefits. They wish to keep the difficult cases back for the locally placed doctors and damage their reputation. This is an issue which the population at large has to understand. Even in peripheral Ratnagiri, I often encourage patients to closely follow-up primarily with the family doctor because he is available at the time of dire need. All super-speciality is not related to technology and more often to dedicated service. For example, this town can very well support a well equipped burns unit, but we still need a young dynamic person to take up the challenge.
Paramedic services are a real deficiency in the town and this country at large. We need to organize our emergency pick up units, nursing staff, home and auxillary nursing service and pharmacy services. The need is ours and no textbook can dictate or provide guidelines to where the service should go. The need to develop alert groups in small towns , villages and of course in the city is a gigantic initiative. Probably my first effort is paying its results. We started the stroke network and many doctors are effectively managing the basic and essential stage of the treatment at remote areas. A similar wave has to spread in the care of children and trauma with an emergency. The initiation of an equipped baby ambulance had the same objective- to transport the baby in the safest environment to the specialist unit. An paramedic training program is being started at the Nirmal Balrugnalay to train common man about how to work like a paramedic, upgradation training for auxillary nurses in the field of child nursing and Family physician in the field of neurology and basic neurosurgery. I can feel the difference when patients are referred from these units after better primary care. I dream of a day when we shall be able to similarly secure the coast and the sea beaches with a self sustained bay-watch and emergency medical service system.
Lastly, I should bring to your attention a wonderful process in the happening. There are young and dynamic doctors who are establishing well equipped centres in the smaller towns thereby assuring this process of better and faster care to the patients living in the remotes part of the district. Many would not need to come to the city at all and a new economy will thrive in the local area. Young girls and boys have decided not to go to the city but bring the same to there town.
To make the discussion easier to understand, I would like to dichotomize the issue into facilities available, long term care services, geriatric medicine, pediatric medicine, emergency services , super-speciality services and paramedic services. Before I start any part of the discussion, I should acknowledge, the contribution of the new governmental programmes and policies are helping these betterments to happen. I am proud to be associated with the Ratnagiri Civil hospital, which continues to provide service as its resources can to a very large population of the society. I congratulate the Civil surgeons efforts and the political will of the administration which has made this possible.
This discussion pertains to the private health sector which has the potential and the freedom to show progress and also is a reflection of the market forces.
With regard to the facilities available or rather more precisely, the technology available, there continues to be a misconception that the poverty in the region probably will not support the investment. During the last 3 years I am witness to more than four such events related to successful investments. It is the doctors confidence that probably far more important because only when the service is available will the community take it. There is definite evidence that the confidence race has been triggered and the results will be seen in a few years. The insecurities of the past are giving way to the bold and dynamic decisions of the future. I have also witnessed the harm of erroneous decisions or sub-optimal application of a technology resulting in failure of the project in terms of the financial expert. It therefore becomes more important in the future that each investors knows his machine and it potential to stand the competition rather than be a old failing horse. The availability of multiple CT scanners, Dialysis machine, MRI unit and dedicated pediatric hospital have been but the beginning of this future. Unknown to many because it is not seen easily, surgical techniques have been remarkably good in our town. Spine surgery patients go home on the 2nd day after surgery, awake brain surgeries are being regularly done in this town and the endoscopic surgical work have reached high levels of excellence. Better equipment has made it possible to perform difficult pediatric surgeries possible. The talent has always been here, the confidence and the competition have now come in as well.
Long term care of patients is another aspect with very different kind of requirements for the patient. At one end of the spectrum are those who are highly dependant for medical care like severely brain injured patients to the others who required relatively shorter period of stay and less expensive treatment. Ultimately it is all related to the availability of services. The attitude of shrugging of responsibility off the shoulder appears to be taking a changing face with more centres providing such care. The care delivered to the cost of therapy is obviously going to become favourable as the population requiring the service increases. Long term care of patients also require active and supportive staff members and doctors. Groups have been forming where this kind of group activity is becoming possible. About 4 years ago I was not able to get a trained nurse to deliver effective home care within ratnagiri but presently nurses and nursing bureau provides this service in the private sector.
Geriatric medicine will be the practice of the future because of the growing elderly population. 60 to 65% of Ratnagiri’s living population will be in the geriatric age group. One of the important factors related to the elderly population growth is the fact that many families are preferring the return back to there home town from the cities after retirement due the increasing difficulties in city life. At the same time some families from the rural segment are migrating to the smaller towns like ratnagiri for safer environment. Basic care facilities were probably present from a very long time with cardiology work being done regularly. It is estimated that 73 to 80% of financial allotment is towards the health of geriatric age group. In the near future further advancement is expected with regard to diagnostic and therapeutic potential in Ratnagiri. Cath-lab, an essential equipment for cardiology will soon be setup in the town with visiting cardiologist initiating the service and a full time cardiologist settling down in this town. The potential is obviously high considering the growing population density. Better pathological laboratory and advanced technologies is already present in the town. I am able to get almost all forms of investigations done in the town with hassle free and cost effective services being developed by most centers. Economic viability is very strong since the demand in this segment is very high and the ability to travel is poor.
Pediatric medicine is my passion and I always felt what ever be the outcome I shall go ahead with the needful investment. In the initial phase there were suggestions about viability of good quality technologies in our town. But my practical experience says that quality does survive well. Pediatric medicine has improved remarkably with better intensive care facilities coming up and more pediatricians willing to join the effort. One of the constant problems related to pediatric intensive care practice is the rising cost which many young parents are not yet prepared to spend. A reasonable accounting practice can actually provide facilities at a far affordable rate. For example , we estimated the cost of oxygen – an essential product – in medical therapy. It might surprise the reader that your town dosent have a self sustained Oxygen supplier. All of it is being purchased from Kolhapur at a very high rate for reasons I have not understood. The Kolhapur supplier inflates the price to 200% and the the cost is further increased by the service provider. Though the cost remains the same as in other towns ~ Rs 60/hr [also sanctioned by some government bodies], we found it to be a major burden to the population. Re-calculation reveals that Rs 35/hr will suffice even if bought from another town. Hopefully, in the near future there will be self sustained unit in this town of Ratnagiri. There are special pediatric operating unit now available in the town which will provide better and safer environment for the child and the outcome will eventually improve.
Emergency services take the lime light in any discussion related to medical care. Interestingly, the discussion is more often related to the failures of management than the successfully managed patients. Let me recount what I consider a recent success in emergency medicine. The most important is the fact the more doctors are willing to participate in emergency care with presently 2 dedicated intensivists specialist in this town. There specialization has certainly contributed to the over all outcome of the patients. Early detection and intervention can revert an impending complication. This shortens intensive care stay and cost. The same holds true for pediatrics and superspeciality like Neurosurgery. As the environment improves, the possibility of survival of critically ill patient improves. I had made a statistical assessment of the survival of patients of head injury coming to me from other hospitals in critical state. Whenever a effort to give primary therapy was made in the referring hospital the survival had improved to 78% from 53%. What I am hoping to see in the near future is an emergency patient care system where the patient will get primary attention during transport by trained paramedics who will be able to deliver primary care and thereby improve the ultimate outcome of the patient. This will require preparedness from the patients relatives to accept and pay for such a service. Emergency service also means preparedness for any mass catastrophy. More hospitals are becoming 24hr working and providing facilities through out the night. This is a welcome sign and we are hoping that in the near future patients will not be running from pillar to pole for a late evening emergency.
Super-specialty medicine and surgery are those areas in which the required infrastructure are both financially demanding and professionally intensive. They are not necessarily expensive. But if not attended in the proper manner, the problems compound. At this moment neurosurgery, neurology and urology are the specialties established in our town. There is all the potential for a plastic surgeon or cardiologist to come and practice in Ratnagiri. An issue that concerns me is about the floating or visiting surgeons and physicians who actually come in search of patient and do not take responsibility of the same as long as they are not having enough patients at home. The moment they have patients at home they will stop coming and start luring the patient to their centre. This is cheap practice and employs many other issues like secondary financial benefits. They wish to keep the difficult cases back for the locally placed doctors and damage their reputation. This is an issue which the population at large has to understand. Even in peripheral Ratnagiri, I often encourage patients to closely follow-up primarily with the family doctor because he is available at the time of dire need. All super-speciality is not related to technology and more often to dedicated service. For example, this town can very well support a well equipped burns unit, but we still need a young dynamic person to take up the challenge.
Paramedic services are a real deficiency in the town and this country at large. We need to organize our emergency pick up units, nursing staff, home and auxillary nursing service and pharmacy services. The need is ours and no textbook can dictate or provide guidelines to where the service should go. The need to develop alert groups in small towns , villages and of course in the city is a gigantic initiative. Probably my first effort is paying its results. We started the stroke network and many doctors are effectively managing the basic and essential stage of the treatment at remote areas. A similar wave has to spread in the care of children and trauma with an emergency. The initiation of an equipped baby ambulance had the same objective- to transport the baby in the safest environment to the specialist unit. An paramedic training program is being started at the Nirmal Balrugnalay to train common man about how to work like a paramedic, upgradation training for auxillary nurses in the field of child nursing and Family physician in the field of neurology and basic neurosurgery. I can feel the difference when patients are referred from these units after better primary care. I dream of a day when we shall be able to similarly secure the coast and the sea beaches with a self sustained bay-watch and emergency medical service system.
Lastly, I should bring to your attention a wonderful process in the happening. There are young and dynamic doctors who are establishing well equipped centres in the smaller towns thereby assuring this process of better and faster care to the patients living in the remotes part of the district. Many would not need to come to the city at all and a new economy will thrive in the local area. Young girls and boys have decided not to go to the city but bring the same to there town.
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