Monday, April 27, 2015

VIP Culture

Guest Editorial 8 (Morung Express)

When you go to weddings, you hear the announcement, ‘to my extreme right is the vegetarian table. The other tables have the same items and you can go to any of them’. This is a positive move towards equality that we have been practicing during wedding feasts. Officers’ mess or VIP tables were very common in the past. Those were the places where special treatments were given to the VIPs. The tables looked more beautiful, the food items were more special, and there were shorter queues. But thankfully in many programs, we are doing away with that VIP culture. Those who hold feasts are realizing that there should not be preferential treatment in serving food, and all guests should enjoy the same food together. I think the shift is shaped by Christian teaching of equality and the change in culture is brought through practice in church circles. But there is still a long way to go when it comes to the sitting arrangements in churches. Fashionably late comers still get the front rows. 

VIP culture is very much visible in the roadside behavior of motorists. On a big wide road where there is ample space for overtaking, the escort police stretch out their hands to slow you down so the VIP can pass. Such an instance is not about the VIP being in a hurry for an important meeting (because you are not slowing him down), but it is a sign that you are not as important, and the one passing through has greater authority over the road than you. I once attended a meeting where an MLA said that the bus and taxi drivers in Kohima must be taught driving etiquette. But going by the frequency of driving through a traffic jam and other traffic violations, the VIPs and their drivers might require such trainings more than the other drivers. 

Several years back, I went for VIP duty to Dimapur. The VVIP was to come to Kohima from Dimapur and I had to be on stand-by for any medical emergency. I thought that I simply had to go and escort him back and it wouldn’t take much time. When I reached Dimapur, he had not eaten breakfast yet. After an hour or so, he had breakfast. Then we were told that to go to Kohima early or late will depend on whether India bats first or not. I don’t remember if it was the toss or the weather, India didn’t bat first and the VVIP decided to go. He took lunch (it took a long time) and it was already late afternoon we set out. The cars were flying and we reached Kohima in about an hour. There were whistles and cars moving in both directions stood like dead meat to make way. It might appear that the VVIP was in such a hurry on a very important official assignment. But it was a day when he took a full day to have breakfast, decide his journey based on a cricket match, take lunch, and head back to base. He wasted the time of a train of escorts (there were lots of us), and others (policemen guarding the highway, fellow travelers, etc) all for his comfort. 

Having a connection works. A chit from the top works in your application for a job. Having someone on the inside helps in getting things done. Having a prefix before your name (e.g. Dr.) or a designation after (e.g. president, managing director) helps. It is tempting to flash it so people will take notice and ease your passage. So long as we resign to this culture - that our society is run this way and this is the way things are - the desire for status, power, and connection is perpetuated and VIP culture is promoted.

Friday, April 17, 2015

Pursuing a hobby

I have toyed with the idea of changing career in midlife. I am nowhere near it mentally and have no particular area of work in mind. But I am happy that I have started working on a hobby that I have been thinking of for many years. It is the art of making bonsai. Circa 2003, I went for a plant exhibition in Imphal where I was mesmerized by miniature trees planted in pots. The trees were familiar except that they looked old and small. I didn’t know they are called bonsai. As life continued in a hostel, then in the nation’s capital city, I had no opportunity to try my hand at making bonsai. But after life stabilized here in Kohima, I am happy that I can pursue this hobby at last. I have read the theory, watched the videos, and have acquired the tools including the indispensable concave cutter through online shopping.

Life can be full of tensions. It can become monotonous. It can become dull. Sometimes, you need to get away. Sometimes, you need to unwind. Sometimes, you need to refresh. So, whatever your life’s main work is, you need the meaningful pursuit of a hobby. Plants work for me. I have kept indoor plants in my hostel room. I remember keeping a small container where I planted about 10 varieties. One was a Gul Mohor tree which goes to sleep every night, and a creeper which went round the container several times. There was also a bean plant which I measured with a scale every day for growth. Trip to the jungle is a perfect getaway for me. Writing is another hobby which also becomes a grinding responsibility, depending on the circumstance. Neither movies nor music work that well for me. Find out what works for you and pursue it.

Many people are caught in the wrong job. There are doctors who should have been musicians, government officers who should have been church ministers, and so on. Some are driven by want of power, fame, or wealth, while some are forced by circumstances. While one should be sympathetic to those who are forced to work for survival, it is a challenge that we dare to give up our job and pursue what we should be doing instead. If you are sure that you are in the wrong place, motivation, health and productivity will go down. Is it your hobby which should have been your life’s profession?

While hobbies can turn into primary profession, keeping a hobby as a hobby is worth pursuing and developing. Cultivating a hobby is good for mental health. It has the capacity to keep you young, creative and active, and not give up on life just yet. Hobbies like bonsai making and trekking are also very good for physical health. To promote physical activity in order to control weight and chronic diseases, starting a kitchen garden is encouraged. In urban places, vertical gardens are possible. The added advantage is that kitchen garden produces healthy organic food.

Hobby can save money and can be a source of supplementary income. Those who are interested in DIY (Do-it-yourself) crafts can re-use household items and save money. It is wise to use what you love to do to earn some extra bucks. I could manage some extra amount for charity and also pocket money from writing. One day, who knows if I will leave my job for the pursuit of a hobby! Planting flowers may fetch a good amount during wedding season. Options are many: making cakes for birthday parties, carpentry, stamp or vintage coin collection, event management, etc, etc.

If each of us meaningfully pursues a hobby, chances are that we can bring healing to some of our society’s discontentment.

Friday, April 10, 2015

Tobacco lobby, Cancer, Cow urine

First, a BJP MP in the parliamentary committee looking into rules regarding tobacco sales said that there is no Indian study linking tobacco to cancer. This was followed by another member saying that a lot of chain smokers do not develop cancer. Another BJP MP, again a member of the committee remarked that there is no fool proof evidence that smoking causes cancer.

The context is that the government had planned to increase the size of pictorial warnings on tobacco products from 40% to 85% by April 1 this year. Increase in pictorial warnings is shown to bring down tobacco prevalence. But because the committee brought out these statements, the deadline is crossed without any action being taken. What is going on here? There is no dearth of global and local evidences that tobacco causes cancer. The Indian government’s own study showed that there is a very strong link. But why are these parliamentarians making these statements which are against flood of scientific evidences? It shows how strong the tobacco lobby is, that they have the power to influence not only ordinary people to use tobacco, but decision makers at the top. Incidentally against the rules, a beedi baron is made a member of the parliamentary panel. Tobacco companies have been aggressively moving into developing countries as they are facing reducing levels of smoking in the West.

Tobacco is the main cause of cancer. So, it is not a debate about some controversial factor on the sideline for which there is no concrete evidence yet. The delay in pictorial warning therefore is a serious hurdle in tackling the tobacco menace. Every 6 seconds, someone somewhere is dying because of tobacco. Half of those who smoked today will eventually die of tobacco. According to Global Adults Tobacco Survey, 34.6% of adults are current users of tobacco in India. In Nagaland, it is 57%. A more recent data (DLHS IV) shows that in Nagaland, 64.2% of men and 34.5% of women (15 years and above) use smokeless tobacco. 35% of men and 1.4 % of women smoke.

The tobacco industry’s strong resistance to pictorial warnings is also evidence that those warnings do work. They not only deter people to start using tobacco, they also prevent relapse among former tobacco users. The increase in pictorial warning is an important move. But there are other very important steps that we can take to reduce tobacco use. There is a legislation banning tobacco sale to minors, sale near educational institutions, smoking in public places, and advertisements in any form.

Chandigarh has been declared smoke-free city since 2007. All the districts in Punjab have been declared as ‘tobacco smoke-free’. The State has also banned sales of loose cigarettes (without pictorial warnings). Raids are being periodically conducted to crack down on storage, promotion, and sales of tobacco products. It was able to raise tax on cigarettes from 20.5% to 50%. But this was rolled back after less than a year. Health NGOs allege that this roll back was due to pressure from tobacco companies. Chewable tobacco has been banned recently in Delhi which is now challenged in court.

There is no dearth of evidence. But it is an uphill task to take on the tobacco lobby. Meanwhile, it may be recollected that another BJP MP claimed that cow urine can cure cancers completely. This was said in the context of banning cow slaughter. But there is a connection here between the two issues, that lifting all restrictions on tobacco and serving cow urine to all cancer patients may make sense to these honourable MPs.

Friday, April 3, 2015

Change of focus in Health

The present healthcare system is RCH-centric. RCH stands for Reproductive and Child Health. In National Health Mission, RCH takes the centre stage and all the other national health programs follow far behind. Is it justifiable that RCH is given priority over other health concerns? The answer is both Yes and No. RCH covers a very crucial component in the health needs of a population. Women during childbirth and children are vulnerable to adverse health conditions. The quality of health services is measured by how far the benefits are reaching this group of people. Infant mortality rate is an indicator of the overall human development of a population. Healthy mother means healthy child and healthy child means healthy population. So, it is right that RCH should be focused.

But ideally health services should be free of targets. It should be comprehensive and universal. It is the limitedness of our resources which compels to plan specific and targeted interventions. The result of this is that we have RCH which looks after only women in their reproductive period and children, deafness control program just for deafness, and so on. The drawback is that lots of resources are pooled for some limited interventions. For example, women’s health concerns much more than reproduction but RCH is concentrated only on child birth related events. So, universal health care proponents would argue that such targeted interventions are wastage of resources. If the general health service is strengthened, all types of illnesses whether there is a national health program or not, will be covered.

But the more pressing question for us is, ‘should RCH be top priority in Nagaland?’ Without own resources to work with, we only have to implement what Delhi plans. That is the tragedy that beggars can’t be choosers. A Naga public health specialist remarked that RCH should not be top priority in Nagaland when compared to, say, the North Indian States where maternal and child condition is really bad. There are a lot of cultural and socio-economic determinants variations between us and those States. Our mothers and children are in a relatively better condition and consequently we have lesser mortality rates despite weak health services.

Given that we continue to have limited resources to work with, what health area should our State’s focus be? I would suggest that we increase our focus on Non Communicable Diseases (NCDs). The 4 most common NCDs that come to mind are cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases (there are many more). NCDs have become the leading cause of death globally, being responsible for 68% of all deaths in 2012. NCDs are chronic diseases (often lifelong) and are twice more costly to manage than other diseases. A household having someone with chronic disease increases the risk of falling into poverty by 40%.

The good news and the opportunity for NCD control is that they are preventable. 80% of cardiovascular diseases and stroke, 80% of type 2 diabetes, and over 30% of cancers can be prevented. There are 4 risk factors which are closely linked to the 4 common NCDs. They are all behavioural and modifiable risk factors: Tobacco use, physical inactivity, unhealthy diet (high salt and fats, low vegetables and fruits), and harmful use of alcohol. So, majority of the NCDs are non-medical in origin, and so should be their control. It is everyone’s responsibility. It requires enforcement of legislation (tobacco warnings/tax, food safety), education (health promotion), urban development (cycling/foot path), media and marketing (food advertisement), and control of one’s personal habits (tobacco, alcohol).