A tribute to the Noida Police

On February 8, 2011, it will be the 16th Anniversary of my father passing away in a road accident and the day that I began to thank Noida Police and do so off and on in my mind.

My dad on that fateful day, took a bicycle to a post office less than a kilometer from home and was hit by a truck on his way back. All he had on him was the receipt of the letter he had just sent by registered post and the change from the fifty bucks he gave the post office for the same. He was hit close to a doctor's clinic and was taken their immediately. Dr. Chauhan administered what he could and called for an ambulance and the police. By the time Dad reached the hospital he was no more. Stuck with no identification, Cop Extraordinaire R S Singh, actually had the brainwave of using the registration receipt to trace a return address and though about three hours after the accident, did knock on our doors to check if anybody had gone out and not returned. He even showed the sensitivity of first asking to see a picture of the person who was out, before asking me to accompany me to the hospital. Only after I refused to go with him unless he told me what this was all about, did he break the news. I still shudder at the thought that if he had not found us, i would have had to go from morgue to morgue to find my dad.

In these days when the Noida Police is maligned for their bungling the Aarushi Talwar case, i think often of RS Singh and wonder if anybody ever thought of training him regularly on new techniques. If any of them had ever been exposed to what to do at a crime scene? If they were so used to taking "politically correct" calls that they had lost any ability to do a clean job of anything?

Aarushi's family deserve closure that they may never get. I feel for them. I knew her uncle Sameer in our younger days and some of my friends know Nupur well. I do understand what they all are going through. But a part of me is thankful that on one fateful day, Noida Police did do its job well enough for me.

And no, they did not trace the truck that hit my dad, because none of the bystanders managed to catch the license plate. But you know what, I somehow don't care about that. I am just thankful for small mercies.

Three days at AIIMS as a commentary on Indian Healthcare

My servant's 22 year old son slipped on some liquids at his workplace about a year ago and paid scant attention to it. Over time he found his right hand giving him problems. He could not make a fist, lift things and his forearm was wasting away. They pinned hope on a referral to one of my servant's other employers' to a doctor. The reference never came. Then someone in their neighbourhood referred them to a doc and they began to go to him. Several months later she mentioned to me that rupees five thousand down, he has had no relief. Honestly, until she said 5000, i had shown no interest in the case. Now that she had my attention, i called him over to take him to a neighbourhood family physician to assess if the problem required an orthopedic surgeon or a neurologist. He referred us to a neurologist and suggested a MRI.

A trip to oneof the largest private hospitals in Noida was scheduled. The neurologist there agreed that the problem was neurological (brachial plexar injury). Basically the nerves around the shoulder had sustained major strain and had possibly broken. The doctor estimated that just the tests to check whether the nerves are still live would cost over Rs. 10,000 and the surgery if required would run into a couple of lacs. He said may be 3-4 hospitals in NCR were probably equipped to do the tests and the surgery and hence AIIMS is probably our best bet. The boy obviously had no clue where or what AIIMS was. So i bravely said i would take him there for a few days until the a diagnosis and line of treatment is established.

Day -1

Ijust vaguely knew that the biggest part of going to AIIMS is getting a “card” made. A check of the AIIMS website told us that the card counter is opened between 8:30 and to 1 pm. Taking indian population into consideration, i decided we should be there by 7:15 am.

i talked about the impending trip to a friend who said it would be impossible to get into AIIMS with out “patti' or an inside helping hand. So got a reference to a doc there and spoke to her. She was not going to be there the next day but said we should not have a problem. Also said to call if there is any problem.

Day 1

So my driver, the boy and i left at 6:30 one dark january morning. Needless to say we were not the first to reach there. There were three longish lines already in place. Two for a slip to say which speciality to send the patient to (one for men and one for women). The third for those who got their slips earlier but didnot cards yet.

8:15 am. The doors open and there is staff walking around taking their places. The place is now buzzing with energy. The lines are compact with people pressing against each other. There a few hangers-on hoping to break in with out having stood in line for the extra hour but on the whole the discipline is maintained admirably given that there is no one monitoring the line.

I must confess that i have a ADD , OCD and the works at various levels at different points in time. After having walked the perimeter of AIIMS several times since reaching there, i now found myself tired of my ipod and reached the entrance.Having found the information desk being manned,i had this unexplainable urge to check if we were in the right line.

Of course we were not. The woman there said Neurology and neurosurgery has a separate building window, card et al. I went and checked it out after telling the boy tostay on the current line.

8:40 the boy gets his slip saying he needs a orthopedics card. Instead to getting the card, i decide to go to the neuro window. The line there is smaller and his turn comes in reasonably quickly though we reached there after 8:45. the woman at the window looks at the papers we are carrying from the doctors in Noida with askance and then sends us to another window. That guy looks through and asks for details of what the referral etc. After 10mins of getting us to hang around he says the referral is not acceptable because the paper says “ suggested follow up from hospital like AIIMS”. Get a new referral.

So we go back to the general OPD to get a AIIMS card. But they have run out of cards. I say how? The guy at the window says only 200 are issued a day through 6 windows. Helpfully he says, now that you have that slip you can get a Ortho card made any day over the next 12 months. Thank you. We get back to Noida.

Day 2.

We reach AIIMS later today. 8 am instead of 7 15 of the day before. 8:15, doors open and the boy is number 6 in one of the windows. The card require a fee of Rupees 10 which is duly paid and we reach the ortho ward . A guard showed us the room we were to wait in. We were the first there. A guy cleaning the floors said put the card on the Doc's table and wait. The Doc would come sometime between 9:30 and 10:30. We sat down and watched more and more people walkin. One kept close tabs on the cards on the table so nobody gatecrashers.

9:45

the Doctor's assistant arrives. The Doc is on the way, he announces. First follow-up patients will be examined and then new patients. I am shocked. So i tell him, we only want a reference to go to the neurology deptt. Where cards will only be issued until12 noon. He pretends not to hear me. I am agitated. Doc comes and assistant again comes out to call first patient. I again protest politely.He asks for the boy's name and says he will think about it.

The patient inside needs to get weighed or something. The Doc is basically waiting for them to do it. Thankfully the Assistant pitches us. The Doc looks at the papers, checks the boy's hand and quickly writes out the reference. I gloat to the boy that talking a lot helps most of the time.

10:20 we reach the neuro window. In 10 mins we have the card and are sent to a room where junior doctors will first do a work up. We enter what can only be called a labyrinth.

The doors have a sentry who tells you the way to the room you have to . We walk past a open corrider with two waiting areas on both sides into which four doors open and the waiting areas are filled with people, all chairs taken and enough people standing around. But that is not our room. We need to go to one of the interior rooms. We take a couple of turns and reach this waiting area near our designated room. The ceiling is about six and half feet or so it seems.definitely not ten feet i am usually used to. There is no opening to the outside world, i cannot feel the a/c vent spewing anything.maybe because it is winter. There is nowhere to sit. A couple of spots available are in the last row in the middle of a seat for seven. We pass and stand. We have no idea how we will be called in.There is no token given or displayed. We ask people around. The window where cards were made apparently also create files and send it in and when in reaches, we would be called in.

10 minutes later, i start to feel claustrophobic. I tell the boy am going out to sit in the open and he should call on my phone when doc calls. 10 mins later no call so i come to check. No idea how much more we need to wait. I go out again. 5Mins later the boy comes out to call me in.its his turn and the phone gets no coverage inside. When called in the boy had told the doc that i was outside and the doc said he would wait and to go call me. I enter the doc's room and am stunned. In a room which is at best 6ftX8ft is one table, three doctors and three patients' stools. Two doctors sit at two ends of the table. The third has no table. I can now understand jokes in the Ananda Vikatan of doctors holding up a hand and asking whose pulse this is. The Resident Doctor does a full check of the boy's hand asking questions and recording all data. As i hear them,i can also hear other docs handling a 4-5 year girl with blood cancer and a 12 year old twin who has a birth defect in the spine,while the other twin is healthy. I can see the girl's mother react to my expression as i realise what she is going through. I smile at the child who is looking at me, trying not to let pity enter my face. How do you show comradeship to a complete stranger whose business you should not be overhearing anyway?

The three docs share torches, hammer heads etc. But seem thorough. The work up of the boy was definitely was more exhaustive than either of the two private doctors had done. After 10 mins of the work up, the doctor hands us the file and sends us to the senior doctor. We go across the corridor to another overcroweded waiting area. We elbow our way to the door to hand in the file to join a new queue. I check how many patients before us from the assistant. Five he says. At even 2mins a patient that is ten minutes. I go out into the open for a breath of uncirculated air. 6 minutes later i come in not wanting to push my luck that this doc would wait for me too. Another 7 minutes later we are called in. Thankfully the senior doc has a room to himself with a sofa and patient's stool. Basically the other room all to himself. Sparse but space is clearly the luxury.The doc looks at all the data and asks his first question, looking at me: who are you and why are you with him. I explain. He looks surprised but lets the same be. He checks the boy again and says a couple of tests are required and we need to get referrals made from another doc in another room. Off we go to another cramped docs room. This room has three docs and about seven patients. I elbow myself in and announce i have been asked by the senior doc to get a reference for the tests. One of the docs, holds up his hand for the papers. The papers travel to him through the other patients. I inch my way to the doc and get the referral.

Seeing these young doctors makes you wonder at life. These are rated the best medical minds in the country and the facilities and infrastructure provided are clearly abysmal. That they are still there just shows their dedication to the cause. No way can anybody work there out of snobbery. Any brain drain that AIIMS has is way lower than i would have predicted. The work atmosphere is claustrophobic, stressful and tough. Work may be exciting but it can hardly be enough to keep most people. I cannot imagine very many of my batchmates from IIMA,myself included,who would be willing to work in such circumstances day after day for years with anonymous patients with little time for building relationships or receiving gratitude.

12:00 noon

we reach the lab for the tests. An assistant takes our papers and says to wait. The waiting area is the corridor which is itself only about 6 feet wide. The roof 7 ft. There are three other labs close to ours and the patients and their attendees take up all the space. There are three seats next to each lab. A refrigerator with a thick chain around it and a big lock stands a little way away. A little away stands a steel cupboard. Two of the patients are in wheelchairs and take up part of the corridor. There are people walking through too. The nearest exit is a couple of turns away. The Doc calls us in. Says one of the tests can be done right now but the other one only a few days later since the doc who does it has left. Where i have no idea. He then asks me to wait outside. This room is actually more than twice the size of the other rooms we had been to earlier that day. But i guess they didnot want people hogging space here. I sit outside trying to read as i hear of a Kashmiri boy who lost use of his legs after a fall in school when he was 12, a lady who is losing her sight to diabetes. People feel the need to share experiences at other places. They are clearly overwhelmed by AIIMS and are thankful for it. The hardships are not difficult to go through if things end well.

12:30

the test is done.results would be given on the day of the other test. We move to the physiotherapy department where too we are referred to. The junior doctors look at the boy and say only our senior resident can help you and he is not around. Come back after 2. i ask the boy if he can handle it himself or he wants me around. He can possibly see my eyes wide with nausea from the claustrophobia i have told him i am experiencing. He says he can handle it. I get back home.

Day 3.

We reach the hospital lab at 9 as told to, having purchased the special needle that we need to get ourselves. The needle costs Rs. 500. The boy is second in line. I am feeling better today so stay in the corrider the entire two hours till the test is done. Actually the test took about half hour, the doc took about an hour to get there and another half an hour to get ready. They give the print outs of the results and say to go the senior surgeon doc who had asked for the tests. We reach his room and peek in. He asks why we are here. We explain that results are here and wanted to show him the same. He lets us in, finishes with the patient he was seeing and takes the results from me. Looks at the boy and says your arm is not as damaged as we were worried. It should be okay with physiotherapy. We thank him and go to the physiotheraphy.

The physiotherapist who was to see the boy was missing but the last time he met him, the doc had given the boy his phone nmber and had asked him to meet him after the test results were in. The boy calls and is told he would be in within the next fifteen minutes. We hang around a corridor. No chairs in ths waiting area. The Doc comes in. The room has been carved out of the corridor i think. It is five feet by 12 feet with the door at the narrower end. We walk past another doc and patient to reach our guy. The doc asks whether i am here because he fell in my office. I say no. He asks if i was willing to spend rs. 1200 for a frame to straighten the boy's hand and fingers. I say sure. He says he will call the company that makes the frame and let me know. Until then the boy is to continue the exercises he was taught in the last session.

There after the doc has not met the boy and keeps postponing any appointments.

And there we are stuck.

Here's a boy who can apparently become better than he is right now but we are stuck because the doctor will no longer meet him.

Anecdotal but i think this is pretty much representative of the medical system in the country.

Infrastructure is abysmal, number of patients challenging, doctor morale low and finally patients end up feeling shortchanged. Sure we spent only Rs.10 on the card and 500 on the needle but two of us spent three half days at the hospital in oppressive surroundings when we could be earning a living (the boy is a day worker and i self employed).

I feel sorry for the doctors working there who are underpaid, over worked and clearly frustrated. This is a solvable problem. The solution is clear. Invest in infrastructure. Expand facilities. Invest in people. But you can see when it will happen. Never. The government has never presented a plan to improve these hospitals. VIP wards are probably good to be in.They may not have even seen those low roofed unventilated rooms where patients wait and doctors share rooms while examining patients.

But for this boy, i would have never seen it. Or experienced it. I have spent enough time in military hospitals having been born in one and visiting one everytime someone in the family fell ill. There is a ocean of difference between the two in terms of cleanliness, space and doctor morale. But the MH s show that it is possible for government organizations to build and run good hospitals. Doctor salaries is another sore point that should be handled ASAP. It will pay off more exponentially than i would say MPLAD funds.