What is Ophthalmic Plastic surgery?

“It’s better to do a dull thing with style than a dangerous thing without it.”- Charles Bukowski

What is Ophthalmic plastic surgery or Oculoplasty? I often get asked this question when I tell them what I'm specializing in. Most people are not aware that such a speciality exists  including majority of medical doctors. They ask me how can you be an Ophthalmologist and a Plastic surgeon at the same time. It's a tedious exercise explaining it to people what my work comprises and one which makes my wife make fun of me when I explain because she's heard it so many times. I thought it would make sense to pen it down. Here it goes....

Ophthalmic Plastic Surgery is a subspecialty of Ophthalmology which deals with the orbit (eye socket), eyelids, tear ducts, and the face. It also deals with the reconstruction of the eyelid, the eye socket, and surrounding structures. Lately as a natural progression this branch has been getting into Facial Aesthetics in a big way in the form of Brow lifts, facelifts,Botox, fillers and Facial Rejuvenation.

The subspecialty of ophthalmic plastic surgery was born in the mid-twentieth century in the United States at the conclusion of World War II. The art of oculoplastic surgery, however, is centuries old, bearing its roots in antiquity in India,the Far East, and Europe.

The various procedures that have evolved over centuries can be divided into several general categories: reconstructive, restorative,and cosmetic.  Oculoplastic surgeons have perfected, refined, and pioneered new techniques of lacrimal surgery, ptosis repair and blepharoplasty, orbital surgery, lid malpositions, and flaps and grafts. With the close relationship of this speciality with Eye Cancer and eye reconstruction after removal of tumours,  Oculoplastic surgeons are de-facto Ocular oncologists. Since the treatment of the above conditions often requires multidisiplinary approach the possibilities of this field are endless. It also requires good working relationship with other specialties and to create a valuable team to treat the patients.

Oculoplastic surgery became recognized as a unique subspecialty of ophthalmology at the end of World War II. Numerous orbital and periocular injuries were treated by general ophthalmologists without prior training or exposure to ophthalmic plastic surgery. More often than not, trial and error were keys in developing these procedures. Among the earliest pioneers was Dr. John M. Wheeler who established a full practice based on oculoplastic surgery. He is known as the father of oculoplastic surgery. His student Wendel Hughes was the next major force in this field. Further Hughes' students Alston Callahan,Byron Smith and Crowell Beard propagated this field across the world. This group of Oculoplastic surgeons went on to found the American Society Ophthalmic Plastic and Reconstructive Surgeons(ASOPRS) in 1969. This was the first such society in the world for oculoplastic surgeons. Later more such societies got formed in other parts of the world. Europe (ESOPRS), Canada (CSOPRS), Asia-Pacific (APSOPRS) and even India (OPAI).

It is a relatively less known specialty. ( I myself did not know about it till I joined residency). There lies the challenge in this field and also the greatest opportunity to grow. The specialists in this field are there in it only for passion since the other sub-specialities in Ophthalmology are much more rewarding monetarily. This sub-speciality is quite hard to master yet it is incredibly satisfying. I am honoured and privileged to count myself among these stalwarts. Like I said the possibilities are endless and there is so much work to be done....

References:
1. Smith and Nesi's Ophthalmic Plastic and Reconstructive Surgery
2. Local Flaps in Facial Reconstruction by Shan R. Baker and Neil A. Swanson

The curious case of the Tilted Buddha

Was intrigued on a recent trip to Bhubaneshwar when I saw a sculpture of a tilted head of Buddha and I asked the significance to the sculptor. He couldn't explain me the significance and me being me went on to check why the Buddha's head is tilted. It all comes to one of the quotes apparently attributed to Buddha.

“When you realize how perfect everything is, you will tilt your head back and laugh at the sky”- Buddha

What it apparently means is this:

Since everything is but an illusion,
Perfect in being what it is,
Having nothing to do with good or bad,
Acceptance or rejection,
One might as well burst out laughing!

I don't really know whether Buddha actually said that and that inspired this tilted version of Buddha or its is just down to coincedence. Nevertheless its interesting.

From Oculoplasty and back

“Just don’t give up trying to do what you really want to do. Where there’s love and inspiration, I don’t think you can go wrong.” —Ella Fitzgerald

Its been an incredibly long time since I've been active on this blog. Partly because I have been busy and mostly because I haven't been inspired to write in a long time. I was in Bhubaneshwar sometime back and it has kind of brought me back to a place where I almost gave up on Oculoplasty as a career. In my earlier blog posts I had professed immense interest in Oculoplasty and haven't really updated what happened afterwards. Its a huge story worth a potboiler at the very least (ha ha I'm kidding). Well I wont bore you with all the details.

But something incredible happened in the end of September 2013. I got an offer letter from National University Hospital, Singapore accepting me for their Orbit and Oculoplasty clinical fellowship program. I had applied to NUH after my residency  just like the many other institutions I had applied to. Somebody there had seen a spark in me and selected me. I was ecstatic and that hunger to get into the fellowship kept me from giving up during the protracted paperwork process to start my fellowship.

I'm now more than 4 months into my fellowship and its been an amazing experience till now and I feel I'm in the best place that I could be. I have finally found a mentor who could really shape my career the way I would want it to go. I'm learning new things everyday and things I never thought I'll be doing.

I'm training in navigational surgery of Orbital fractures,small incision endoscopic browlift, Aesthetic procedures, attending orbital fracture implant courses and a myriad things I hadnt even imagined I would be able to do.  I realize that i'm at the forefront of technology and innovation in my field here in Singapore. The real challenge will be to use the knowledge and training that I have gained here into a place like India where there are always impediments to one's growth. A lot of it is economic and most of the rest of it is politics and nepotism that thrives in my profession in India. I sometimes worry that I'm getting spoiled by all the high tech gadgetry that I see here in Singapore and I fear becoming obsolete in India. Also I'm recently married so to get the kind of solid support from my wife has been comforting but I understand the sacrifices she's making for my career and it sometimes troubles me.

But after a lot of reflection I realize that the basic emotion here is "Joy". Joy in what I am doing despite hectic schedules of this fellowship and finding happiness in an equally important marriage at the same time. This beats every fear that I'll ever have. I figure that if I'm enjoying what I'm doing I'll find a way to make a living out of it.

The witty patient!!

Lot of our daily practice in our clinics would involve seeing patients,making quick diagnoses and discussing various treatment options. We do sometimes joke with our patients to make it a more comfortable environment but most of our work though intellectually stimulating is not so much humorous. So just yesterday one patient of mine impressed me with her quick wittedness so I thought I just had to share it here:

A lady came into my clinic with red eyes and red angry lower eyelids. It wasn't fitting into any particular diagnosis other than allergic dermatitis.
So on repeated questioning she finally confessed that she arm twisted her dermatologist to prescribe her bimatoprost for getting long eyelashes.

Bimatoprost is an anti glaucoma drug whose side effect is long eyelashes. So drug companies and cosmetologists have started using this side effect as a cosmetic tool. But another side effect is it can cause allergic reaction which was the case here in this patient.

I explained to her that the eye drops  have caused her allergy.
Just then my boss walks in.
She says to him "Doctor we just discovered what caused my red eyes"

"What would that be?" My boss asked not knowing the whole history of this patient

She replied with a straight face

"Vanity"

The puzzled look on my boss' face was the funniest thing I have seen in a long time!!!

Living in a Fish Bowl!

“When a man is denied the right to live the life he believes in, he has no choice but to become an outlaw.”
― Nelson Mandela, Long Walk to Freedom: Autobiography of Nelson Mandela

We often believe that the information that reaches us is always the right information. why wouldn't we? We are not living in China where information is censored by the government nor is there any dearth of information with the world wide web which has largely been free of any restrictions till now! I recently understood the perils of listening only to one side of the story for too long. Over time that one side of the story is perceived as truth.

Last month I was working in a hospital which has international fellows coming in from different countries to train in specific disciplines and then go back to their countries to use that training. I had the good fortune to meet one such fellow from Palestine who was working in the same department I was. We shared a common love for the sub-specialty we were working in and over discussions of ophthalmology we also discussed a whole lot of international politics too. The information junkie that I am I was only too happy to know about stories I would probably never ever hear about.

The stories the international media feeds us or even the Indian media feeds us is that Palestinians are a group of people governed by terrorists and that Israelis are always the victims of Palestinian intolerance. We’ve been fed these pro- Israeli stories so many times that we believe it as fact. But the true picture is not so straightforward.

I do not want to go into the whole history of Israel- Palestinian conflict which is extensive and most of which is available on the internet. I want to talk about stereotypes and misconceptions created by international media. It’s interesting to note that Israel is a country that was formed only in 1948 on Palestinian land and now ironically it is the state of Palestine that is not recognized by the UN. The British who  ruled over the Palestine area could not handle local tensions between Arabs and Jews so after the world war II out of a sense of compensation for the Holocaust granted the formation of the state of Israel.This in turn resulted in the large immigration of Jews into the Palestine area hence making it a Jewish majority. The Israelis have been fighting the Arab countries ever since and the conflict with Palestinians have continued to this day while Israelis have peace treaties with Egypt and Jordan.

As an impressionable teenager I read with tears in my eyes the story that Anne Frank was narrating so calmly in her autobiography. The Holocaust was a truly horrific episode in Jewish history. The 1972 massacre of the Olympic athletes was tragic as well (Steven Spielberg made the movie ‘Munich’ from this episode, who incidentally was the director of the Holocaust movie ‘Schindler’s List’). I had concluded after reading so extensively about Jews, about the tortures and concentration camps during the Nazi regime that Jews were the most oppressed race in the world and that anyone who are against Jews are inhuman by default. But i failed to realize until I met this Palestinian doctor, how instances of injustice to the Jews have been documented over the years in print, broadcasting and movies but the Palestinian stories are somehow elusive to all of us. I’m not belittling the Holocaust nor am I endorsing the terrorist attacks on Jews. I want to shed some light on the other side of this Israel-Palestine conflict.

You would be surprised to know (I was too) that Palestinian territories are landlocked territories surrounded by Israel and people from these areas are not allowed to go towards the sea by Israeli authorities (though it is only 40km from their border) and all the Palestinian borders are controlled by Israel including its borders with Egypt and Jordan. There are no airports in Palestine and anybody wanting to leave the country will have to go through Israeli airports for which you would need loads of paperwork and permission. There are two Palestinian territories, the Gaza strip and the West bank but these are separated by Israel and hence have two different governments with no common governing mandate and ruled by different political outfits. A Palestinian from one territory is not allowed easy access to the other territory hence both these territories are mutually exclusive and independent of each other.

Despite being highly educated there are limited employment opportunities in Palestine hence many Palestinians choose to live and work in Israel. Israel is a developed country while Palestine is barely there due to restriction of Palestinian border trade by Israel. Palestinians who chose to live in Israel are forbidden to marry, have a family or even ever visit Palestine again. Even this Palestinian doctor i met works in Israel in a Christian hospital. He lives near the border with his family and makes the daily to and fro journey from Palestine to Israel just to earn his livelihood. His wife too does the same to work in some telecom company in Israel. All these journeys and checks to have the right to have a family!!!

But the most touching story I heard from him was this. His elder sister married and emigrated to Australia with her In-laws in 1987.Since 1987 she has never been able to visit Palestine again. So she decided to visit her country of origin with her two kids last year. After landing at the Israeli airport she was stopped at the border check point. She and her kids were Australian citizens with Aussie passports. The Israeli authorities told her that her sons had the right to pass the border but since she had been a Palestinian before 1987 she would have to produce a Palestinian ID to do the same. His sister and her kids had to return home without visiting anyone from their family. My Palestinian friend has not seen his own sister for the last 25 yrs!!! These stories are not exceptions but these are commonplace instances in that region.

This is like a goldfish living in a fishbowl…. despite seeing everything the goldfish can never go out of the bowl nor can it hope any other goldfish to give it company. Its life is governed by the rules of whoever feeds the goldfish and not by what the goldfish wants. If you make them live like goldfish is it any surprise that they retaliate in a violent way? Humans were not meant to be in a fish bowl nor are they goldfishes.

When he spoke about the whole situation there was no anger in his voice, only sadness.Sadness over all the Jewish friends he has lost over the years, over the misconceptions that dominate all over the world about Palestinians, about all the family members he can never see and how their freedom to live life the way they want it is not there but no one knows or cares about it outside their country.
His words at the end were very profound, “No Palestinian ever killed a Jew in the Holocaust yet today it is we Palestinians who are paying the price for it.”

P.S. just check out this one article i found on the net which can be said mildly anti-Israel…. its by Arindam Choudhury of whom i’m not a huge fan but in this case he seems to have got his research right!

http://www.thesundayindian.com/en/story/when-weapons-are-to-be-tested-the-gazas-become-the-casualty/44225/

The Surgeon Conundrum

“From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.”

Sir Robert Hutchison, 20th century physician, British Medical Journal, 1953

I often hear descriptions of famous surgeons as “great”, “amazing””, “brilliant”,etc. and wonder how those adjectives get decided. The corollary used in describing a surgeon is somewhat akin to a performing artist or an athlete. The problem with such an approach is unlike an athlete who can be assessed by statistics or artists who is assessed by cultural expertise of common people, a surgeon does not lend himself to such assessment. A surgeon does not have a publicly available success rate statistic nor do common people have any expert knowledge of surgical procedures to know if a surgeon is great or not.
Is surgery so hard? Yes and No.
YES because one needs to put in years and years of study to even have the opportunity to hold a scalpel and from then on has to practice relentlessly for many more years to actually master the surgeries in his/her specialty. For that relentless pursuit the surgeons usually have to sacrifice the prime years of their lives to this task, having no time of their own, decreased social and personal life and often living under debt or their parents’ financial benevolence for a little less than half their lives. 
NO because its not magic. Most surgical procedures have certain established techniques which if practiced over many years become second nature to the surgeon. So if you know the rules you are set. Of course it goes without saying that you would need a certain level of aptitude and intelligence to learn the complex machinations of the human body,decent memorization ability and a whole load of patience but essentially surgeons are human beings like the rest of us. Only that we surgeons are the lucky ones among humanity who get to wield the scalpel to help humanity as a reward for all those years of hard work.
Skill can vary of course like in any profession, they can be excellent, good, average, poor and miserable. Skill, we surgeons are often told is what separates the great from the rest and yet there are many average skilled surgeons doing incredible service to mankind which many highly skilled surgeons could not.
So does mere skill of a surgeon decide his greatness? Here its a big no. From what I see from the inside of a surgeon’s world, having started my surgical career 3 yrs back, the greatness of a surgeon has to be measured beyond just skill. Like my Professor in college used to say, “ Any fool can operate,even that cobbler on the street or that OT technician, maybe even skilfully but what should separate you from those fools is that you should be able to judge what surgery the patient needs or if he needs surgery at all?” (he had more colourful words to say, this is the watered down version of it, LOL). I recently heard an amazing perspective from a very famous surgeon (he’s a brilliant surgeon by the way) : “ The reason older experienced surgeons do lesser types of  surgical procedures than younger newer surgeons is not because they are any less fearless or capable than the younger ones its because they are tempered with the wisdom of what works and how well. The ability to cut down on trying too many things and to bring more efficiency and longevity to surgery is what experience brings”  These are two different perspectives with a converging opinion on the importance of clinical judgement of a surgeon being paramount!
Doing too much or doing too little? Where do surgeons draw the line?
For that the “art of judgement” is the crucial quality of a surgeon. I sometimes feel we as surgeons are often guilty of “surgical over-aggressiveness” . There are times when doctors operate when in hindsight just waiting would have done the trick. Sometimes when a medical treatment would be far more beneficial than a surgical one. Other instances when after surgery the patient is worse off than before. It’s not to say these doctors have any vested interests to operate. They mostly always want to help the patient and often in their zeal probably do too much. Sometimes its more harder for the doctor than the patient to accept that nothing more can be done. But again in trying to solve the “doing too much” problem, surgeons should not fall into the “doing too less” trap which so often happens in many hospitals these days where patients aren't demanding or in the know. There are several instances when doctors just chooses to delay instead of taking that acceptable risk to operate since they don't want to be responsible for somebody’s poor surgical outcome. Some don't even refer to a specialist who is capable of doing the surgery with lesser risk. In the end such a patient’s surgery is not done at the correct time resulting in handicap or he/she succumbs to the disease. This attitude is worse than the “doing too much” phenomenon. As an example i distinctly remember one little girl of 5yrs who came with multiple metastatic cancer to my hospital when the original small eye tumour which was detected a year earlier was not operated by the doctor assuming it to be benign. A clear case of doing too less and the experience is so heartbreaking for everybody concerned.
There are no definite answers to most surgical decisions because medicine is a field where results cannot be predicted with pinpoint accuracy like a mathematical model. But surgeons have to take these calls everyday and no one else can do it for them.The surgeon’s judgement sometimes lies between life and death of a patient so its not as simple as people believe it is. I am happy to say with full confidence though that for the most part more good than bad gets done in the full balance of things. The ability to do as much as possible to help the patient yet never letting one go overboard is a balance every surgeon should aspire to attain and this balanced judgement is what makes a surgeon truly GREAT.

What women want…

Before you mistake this for another sexist diatribe against the female sex by a testosterone charged male, let me clarify its no such thing. To the contrary I want talk about how society is oblivious to what women want. News channels these days are filled with “human interest stories” of sex crimes, rapes, assault, domestic violence, etc. on women and children all over India. It is as if there is a sudden epidemic of perversion and sexual frustration by men India-wide. I see a lot of people on these TV channels and outside say this is due to western influence –their clothes, relationship concepts and habits. It is as if sexual crimes never existed in India before. Well what the TV channels are gladly ignoring in their project to create this “breaking news” phenomenon is that these crimes are not new events in Independent India. The perverts,the sadists, the paedophiles were always there but we as a society never acknowledged them. We protected them among lies, cover-ups and  false family honour. Every time we see some new report on a ghastly crime, we as a part of society give an appalled shocked expression, shrug it off and move on believing such things are rare events in civilized society. The real fact of the matter is the problem lies in the mindsets of society as a whole. The sad part is the crimes are not as surprising as the comments by leading political figures and officials in law enforcing agencies. These politicians and the police are supposed to be representatives of our country’s people and if they think thus by projection the country also thinks like that.What do they say?

“The woman who got raped was wearing a mini skirt, was an alcoholic and a prostitute. She tempted that rapist to rape her. She had it coming”
“ The man’s affection for the child has been misconstrued as child sexual abuse. There are no paedophiles in India. It is a western phenomenon”
“ Women should know how to dress decently in order not to get raped”
“ Women should not work in offices after dark so that they will not tempt rapists at night”
“ The western influences are ruining the culture of our country. Women should not dress in western clothes, should not drink, not use mobile phones and internet, not have male friends,……(list goes on)”

If these statements shock you then you really haven’t been reading the news lately. There are many more such banal statements being given on a daily basis.I don’t know who was asking for their explanations but nevertheless they did provide their distorted logic for public consumption. What is unfortunate is that these statements are coming from not just religious fundamentalists,policemen and politicians but from some members of the National Commission for Women. If people appointed to safeguard interests of women (who are women themselves) think like this then really women in our country have no hope. I think the actual rape has happened in the brains of these commenting people.

The ploy to put the blame of rape squarely on how women behave is an old one. They will tell you men don’t have any control over their sexual craving and its only natural that they will rape someone who will sexually arouse them. They believe that the onus is on women to avoid rape. It’s like saying that any man can become a rapist if present in the given circumstances which commonsense should tell us is not the case. Chivalry and gentlemen have not died in this world and not all men are rapists if it even needed to be said. The rapist will rape anyone without regard to looks,clothes,behaviour, age and sometimes even gender. Instead of acknowledging this problem these people will try to put morality and culture into the equation. Aside from the fact that I don’t think two hoots about the culture of our country (much less ruining it), there is no credence to the belief that it is somehow ok to rape a sex worker or a lady who drinks or a woman who wears revealing clothes. It is behind this belief that rapists, sadists and paedophiles in our country find shelter in. If society acknowledges that the crime is committed in the minds of rapists rather than due to situational happenings, only then something can be done to curb these crimes.

Women in our country should be free to wear the clothes of their choice, work in professions they want to, go to any place at any time,to eat and drink whatever is legally allowed to all citizens AND STILL NOT GET RAPED. That should be the societal standard and not primitive ideas of these dinosaurs called politicians and policemen who are probably living in a cave.

The idea that women are respected in our country is a myth. Except in certain pockets where women find a pride of place, in most places in India everyday we see women being insulted, abused and exploited. The IT boom and corporate culture has improved the stock of women in our country. We find that more girls are getting educated and making a living for themselves than the previous generations did. But societal prejudices still remain and the behind those signs of progress among women hides an ugly truth. A truth nobody is willing to acknowledge : “Society still considers women as inferior to men.” These men and women( the voices of society) who give statement after statement believe that its always the woman’s fault (even some in the NCW think so).Unless this mindset is not corrected no law will control these savages committing crimes.

The media which is supposed to be the progressive voice of our country is as regressive as can be. Recently we saw footages from a Guwahati based news channel showing images of about 20 men molesting and stripping a 17yr old girl. This episode teaches us two things. ONE: People who would seem normal are the people capable of such serious crimes. There are no signs to separate these savages from society as a whole. TWO: There are no ethics and sensitivity left in the media. While seeing the video we are also listening to the cameraman actually encouraging the molesters to go further in their ghastly crime despite futile pleas by the girl to leave her alone. The reporter of that news channel even has the gall to interview the molested victim and ask her personal details immediately after the incident. Then they broadcast it live all over India and say they actually helped identify the culprits while actually they were just creating a TRP raising story. They did not even try to help the poor girl. This is how depraved our media is. Its not just one news channel, every news channel in India broadcast it without any shame. The identity of that girl was flashed like a sign of victory thus destroying the last shreds of humanity. The govt. did one better (rather worse), they sent some elite high brow delhi socialite women who claimed to be from the NCW who conducted press conferences along with the victim. Even a molestation is treated as platform for politicians. What law will these politicians bring in when they themselves behave worse than those molesters.

This is not to say some good work is not going on. The child abuse bill and domestic violence act are some examples of good legislation. But unless the powers that be change their prejudicial stand point no law can be enforced to actually decrease such crimes.

feel free to read what western media thinks about the rapes in India:
http://www.slate.com/blogs/xx_factor/2012/10/26/rape_in_india_a_sexual_assault_spree_in_haryana_brings_out_the_crazy_in.html

Lessons learnt in Kolkata

Three years spent in Kolkata has been an experience which changed the way I looked at life. Here are few of the lessons i learnt in Kolkata.
Lesson #1: There is no clear distinction between good and bad people.
People who are good hearted are not good in every aspect and they will still do the wrong things sometimes so that it suits their situation. While they say there is something good in everyone, I found out this to be untrue. There are genuinely bad people in this world and they have no guilt nor remorse in what they do. People who do good are not necessarily rewarded and people doing bad things get away scot free despite everybody knowing it. In Kolkata i met some of the best human beings as well as some of the worst products of humanity. I met people who genuinely cared about others and others who would use people to further their own agendas. This was one of the first lessons I learnt while I was here.
Lesson #2: Integrity is the only currency in the world...without it all the money, fame and achievements count for nothing!
Integrity is the first virtue people lose when they want to get ahead at any cost. The cost? putting other people down, lobbying, flattering their superiors, scheming to achieve an advantage over their peers, losing friendships and trust in order to get ahead. I’ve seen them all during my 3 years in Kolkata.  Some of these people might even go on to tell you there is no other way to be successful in today’s world yet there are people with impeccable integrity living dignified lives even today.  We should do our job the best way it can be done and everybody else play their part. Often times others don’t play their parts but that should never lower our ideals and integrity. Our purpose in life should never be affected by the bad things other people do! If you keep your integrity(and whatever you stand for) despite all temptations and rewards to lose it, you have something to be proud of about your life! Everybody keeps a safe distance from people with integrity and will think twice before they mess with them. Not only that all your achievements have incredible value as its all yours and not dependent of somebody else’s generosity. I would like to quote Ayn Rand who is an authority on these matters.

Honesty is the recognition of the fact that the unreal is unreal and can have no value, that neither love nor fame nor cash is a value if obtained by fraud—that an attempt to gain a value by deceiving the mind of others is an act of raising your victims to a position higher than reality - 

Ayn Rand

Lesson #3: The best punishment to people you don't like is to ignore them.... you can live in peace and it drives them nuts!!!
Heh! Heh! This is a practical lesson I learnt while I was in Kolkata. With time I came to know that it is impossible to  change somebody’s view/opinion/behaviour/attitude if the concerned person does not respect you. No matter how many logical arguments you may produce to prove that what they are doing is wrong they will never move from their position. So when it comes to these people I preferred to give them the “silent treatment” which worked wonders. It drove those very people so crazy that they straightened up to doing things how i wanted them to. If they didn’t mend their ways i at least had the peace of mind since didn’t have to talk to them.
Lesson #4: Genuine interest is key to most things.If you haven't got wonder in your life you have very little else.
During my residentship i saw many residents- senior and junior who took up Ophthalmology even though they were not interested in it and took it since they did not get the subject of their choice. They were in various degrees, uninterested, critical of the subject and mostly non-working due to it.I am a moderator in an online career guidance forum for doctors and I met several people who joined ophthalmology and were regretting their choice. I took up Ophthalmology since I was interested in the subject and once I started my residency I was totally hooked. There was no looking back. For me Ophthalmology was the best subject in the world. I was initially pained that all the above people did not see it that way but slowly understood why. Ophthalmology is a tough subject to like if you are not interested. It involves learning a new set of skills quite different from what medical students are exposed to during their undergrad period. So its a paradigm shift in their learning process. Also in most medical colleges (fortunately not mine) in India they give very little surgical hands on experience to residents of Ophthalmology. This may contribute to them being frustrated but mostly it is because of lack of interest. We all have to make compromises in life at some time or the other, but I feel even when we compromise we should choose a path which we will go through till the end. Again interest is the most important thing.
Lesson #5: There are no born surgeons. The surgeon who does not work hard to improve is the bad one.
When I first started my residency my biggest fear was whether I'll be able to do surgery competently.I did not want to play with human eyes to humour myself. But surprising even myself I did turn out to be good enough. I had a good reputation among my colleagues and my teachers regarding my surgical skills. But surgery never came naturally to me or probably I was a slow learner. I did struggle to fit in initially and due to peer pressure I did go through some periods of depression. But I picked myself up and worked hard to improve myself. Reading about surgery I found out was the best way to improve your technique and minimize your complications. Watching live surgeries and videos by experienced surgeons was the second best way.  My boss was the biggest inspiration behind me. Every time I had a set back he was the one who motivated me. He said to me “If i could learn eye surgery at the age of 37 yrs, you being so young have a lot going for you”. I did improve and did quite well eventually. So every time I wanted to learn a new surgery I read extensively about it, assisted in many surgeries and watched many videos. This was the philosophy I tried to inculcate in all my juniors with varying success. A lot of people want a short cut in everything. But surgery is such a field that there are no short cuts. You have to do the long haul or not do it at all. So whenever I saw any of my juniors not willing to work hard even for their own selves it always disturbed me. But those who were willing to listen did very well. I feel a slow but careful surgeon is better than a fast, over-confident and talented surgeon. The ideal surgeon is the one who is open to constructive criticism and advice from seniors and teachers while remaining confident about oneself. He should leave his ego when operating and be sensitive that he’s operating on a human body. He should always work hard to improve his skills in every way possible yet be prudent enough to understand that complications happen in the best of hands and our goal is to minimize our complications and not to eliminate them. This was my career defining lesson.

Lesson #6: A doctor's life is tough but it's an uniquely gratifying experience! Doing good is easy if you want to do it.
My friends in other disciplines would have me think that Ophthalmology is not a satisfying branch since in most cases we are not battling to save patient’s lives. But I beg to differ because sight is as precious as life itself and saving vision of patients is as satisfying as saving lives. In fact since we see very few deaths in our practice we have happier lives. When I was doing my residency I was exposed to the abject poverty of patients in West Bengal which is much more grave than in Karnataka. It was tough for me to handle initially but gradually I learnt how to give efficient care to the appropriate patients. I learnt to listen to patients problems (not necessarily health related) to help them make the right decisions for their situations. I tried to reduce their hospital spending by effective means. I sometimes went to great lengths to convince my superiors to take timely decisions. It was a great management lesson for which I did not need to go to a B-school to learn. In the end I found that if you truly care for your patients, have empathy towards their varied problems and have respect towards them you will find a way to help them in the best possible way.
Lesson #7: Never compromise with personal relationships…friends and family.
Always stand up for people close to you despite all odds. In their time of need you should be their biggest asset. You may sometimes stand to lose your footing supporting them but in my experience it’s been worth it. When you are in trouble you’ll see how they will come for you.  I am blessed to have the most amazing friends wherever I have lived and my family has been my pillar of strength all my life. Friends and family are the most important people for you in success and in failures.
Lesson #8: Positive attitude cures a lot of bad luck!
This is my lifelong aspiration. To see the positive side of things. To believe that there are no wrong turns in life, only new roads to find. Anything that happens to us which may initially seem like bad luck may be an opportunity to do something different. There will be plenty of people who will say some things are impossible. They will discourage you from pursuing your dreams. They are all liars and are people who lack  vision. Belief in what you do is paramount, so if you believe in something never give up half way. Go the whole distance and  you'll see you were right!

Careers, Decisions and Priorities!!!

I am like a wide eyed boy in a huge toy store who wants to find out what every toy can do before his parents take him home.  I'm passionately curious about the world around me since when i can remember and that trait has never deserted me even now.I tend to be fascinated with more things than i can probably give my full attention to. I remember as a child dismantling electronic equipment to understand how it works despite being punished for it later or reading extensively about some interesting story the day before some exam which would not be asked in any exam. I don't know whether this has been actually a good thing or detrimental  in my life but I guess I cant be anything else but me. Mine has been a life of curiosity and facination! I have this uncanny ability to find a sense of wonder in the things i'm doing which i think is a gift. All the elders in my life(parents,relatives,teachers) are very effusive that I make a career for myself but I dont really know if i have planned for a career as such.Some years ago I read an article by Shekar Kapur, the world renowned Director of Hindi and English language films.He said " I had removed the word career from my dictionary when i was 22yrs old as i find that word restricting" Well though i took more time than Shekar Kapur did to realize this I have come to the same conclusion too, more so in the last 3 yrs when I was doing my residency. I think i can be more than a single body of work. I can have multiple roles and do it just as well. Yes I would like to work as an ophthalmologist like i'm trained to but what i will eventually become will not depend on furthering a career or on monetary consideration but on what I believe i should be doing and how I think I can touch people's lives.

Now that i'm nearing the end of my residency I'm contemplating my next move from here on. During my residency I was first introduced to a sub-specialty in Ophthalmology called Orbit and Oculoplasty which initially did not much appeal to me until one day in the OT i saw a face being reconstructed after removal of a large mass of malignant tumour of the eyelid. It immediately caught my fancy. But i guess the turning point of my residency was when i assisted my boss in a procedure called Lateral orbitotomy where you have remove a tumour from the back of the eye after sawing through bone. I found that procedure so fascinating that I thought to myself,  thats what i want to do! That was when i first thought of pursuing Orbit and oculoplasty as my sub-specialty and over the years it has become my favorite sub-specialty. The interest is so apparent i don't think anybody in my institute has any doubt as to which specialty I shall pursue. When told of my plans, my parents though supporting weren't very enthusiastic. So were many of my professors and relatives. They told me "why do you want to do something where you wont have enough cases and there's no money in it?" or that "why would you want to do anything other than cataract surgeries when there are so many to be done and also so much money in cataracts? " Well I dont know how but i was able to ignore all these people and i applied for a fellowship in orbit and oculoplasty in LVPEI, Hyderabad which is the best place in India for that sub-specialty. As i write this i'm waiting for the selection results which may or may not go in my favour.

I recently attended a conference where 2 of the leading figures of Orbit, oculoplasty and ocular oncology, Prof. JRR Collin and Dr. Carol Shields were conducting a workshop in their subject of expertise. They are the very people whose text books we read and i was completely bowled over by their enormous knowledge and genius in their subject. The clarity and simplicity with which they spoke has been so inspiring. I've been touched by Dr. Shields' passion for her subject. Their talk probably removed the last shreds of doubt from my mind about orbit and oculoplasty.

I guess money has never driven me as much as passion has all my life. I have achieved whatever i passionately wanted to do and fortunately it has never really been for financial gain. So i guess my next step should be to do what I would love doing. That said i find even cataract surgeries and corneal  surgeries fascinating too and maybe would not mind pursuing that either if for some reasons I may not get to do oculoplasty...John Irving, one of my favorite writers once said "I could have been a lot of things and even good at it but if I had been anything other than a writer my life wouldn't have been quite as satisfying" I guess Irving echoes my feelings towards orbit and oculoplasty. My life wouldn't be as satisfying if i couldn't pursue it. But unfortunately there are not many fellowships in India for this upcoming sub-specialty( in fact only 1 vacancy each in 3 big eye institutes in south india). So it has been a huge risk on my part by not applying for anything else. Right now I remember a sentence my professor of pediatrics in medical college used to say "Always give your best because if suppose you do not succeed, find peace in the fact that you couldn't have done anything more than your best".... So i'm keeping my fingers crossed. :-)

The 3 miracles!

It has been quite sometime since I've posted something on this blog...I was busy the last 6 months or so

preparing for my MS Ophthalmology exams. I'm happy to say I have passed my exams with flying

colours. This degree has meant a lot to me. I think I have finally found something I'm truly passionate

about.My experience over the last 3 years of residency in Regional Institute of Ophthalmology,

Kolkata in has been some of the best years of my professional life.I've learnt so many things and also

realised how much potiential I have to change people's lives. Today I want to share three stories during

my residency in which I was instrumental in somebody's happiness and which brings immense

satisfaction to me. There are many many more but I dont want to bore you with it all. These 3 stories

are what i call miracles not only for those patients but also how it changed my outlook towards my

profession.

Miracle 1 : When i was ending the 1st yr of my residency, I had just started doing cataract

surgeries independently and confidently. One day in the OPD a woman about 60 yrs of age entered who had mature cataracts in both eyes. In fact she was so blind that she had to be supported by 2 people into

the OPD room. For all practical purposes she was totally handicapped. I examined her and did the work

up and got her admitted. My boss gave me the opportunity to operate on her.i operated on both eyes

just a week apart from each other. The day after i operated on the second eye i entered the wards

early in the morning and observed the most beautiful sight in the world. That same patient who needed 2

people to support her everywhere was running around the wards excitedly laughing and talking to all the

other patients. The patient and their relatives somehow knew i was the one who operated on her. They

were so thankful to me that I was touched. That was the the most satisfying moment of my

professional life until then.

Miracle 2 : It was sometime during the second year of my residency. A 22yr old woman came to

our OPD. She had a condition called Congenital Blepharoptosis of one eye, where one of the eyelids

cannot be lifted like the other hence creating an asymetry in her facial features. Its not a life-

threatening or a significant visual handicap but it made an unsightly appearance due to which she was not

getting married. Lot of hospitals had refused to operate on her saying its a cosmetic problem and was

finally referred to my institute since its a govt institute and the patient was poor. I personally took up

the case and worked it up and my boss as he has always done entrusted me with the operation. I

operated on her and the operation was a huge success and it improved her appearance manifold. She

was discharged and I had almost forgotten about it. Then one day about 5 months later when i was

seeing patients in the OPD, that woman with her father had searched the whole hospital looking for me

and finally found me in the OPD. They had come to invite me to her wedding which was fixed after the

operation. This was such a humbling experience. That day I realised that no problem of

the patient is small and that we have so much power to change their lives if we show empathy to

their woes.

Miracle 3 : I was in my final year of residency and was working in a retina unit. A depressed

young woman walked into our OPD. She had a painful blind eye which needed to be removed. She had an

unsightly eye since childhood due to an accident and was very depressed with how it looked. I wanted to

remove the eye and have an artificial prosthesis fitted so that it looked like a normal eye. My present

boss was not that enthusiastic since in government hospitals due to the high case loads, they often

remove a painful eye and leave it like that without thinking of the social stigma it may cause. And being a

retina surgeon he was not sure whether it would turn out well. But I persisted and finally convinced him

to admit that patient. I operated on that eye and fitted an implant and prosthesis. It was a success. in 2

months time she had a prosthetic eye and nobody looking at her would have realised she did not have an

eye. Even my boss who was skeptical initially was very impressed. I was travelling in the metro after work one evening and that woman and her husband approached me there. I almost didnt recognize them. Both of them were looking so happy and they were so grateful.

I wish i could have captured their joy in my camera but couldnt. This was the best gift I could get for

all the effort I took to get her operated "properly" : HER SMILE.

Healthcare in India: myth busted

The other day i read that India is one of the top destinations for medical tourists.for those not in the loop this refers to foreigners mostly from developed countries like US, Russia, Germany, Singapore, Korea, etc who do not qualify for healthcare insurance in their home countries who come to India for cheap medical care so that they can get similar or better care for less than one tenth of the price in their home country.When i read this article i couldn't help but wonder whether we should really be gloating over treating foreigners for cheap while millions die in our country due to dire need for basic healthcare.We in India apparently follow a socialistic policy in healthcare. Is it really so?
I recently read an article by Dr. Devi Shetty,a famous cardiothoracic surgeon and leading philanthropist in the field of healthcare.He said only 8% of the people needing cardiac surgery actually get operated and in a country like India we have a huge backlog.In his own words this is ridiculous even for a developing country like India.He has bought down costs of heart surgery to less than Rs. 1lakh and he’s desperately trying to get it to less than Rs. 40k.He’s doing a commendable job and needs every bit of adulation and support he can get.But really where is the Government in all this? its conspicuous by its absence!
I work as a resident in the premier Govt. Eye Institute in West Bengal which incidentally is the top govt  eye inst in the whole of eastern India. we have top of the line instruments, microscopes, lasers, machines, diagnostic aids and first class infrastructure.we undertake all kinds of surgeries done in any of the top institutes of the country.This should in effect should help the masses.But unfortunately not everything is free.True cataract surgery covered by the national program for control of blindness in India is free but nothing much else is totally free of cost for the patient.the patient still has to buy consumables for surgery such as silicone oil or perfluro-gas(Retinal Detachment surgery),silicone prosthesis,sutures and many other consumables.A typical RD surgery costs the patient around Rs. 12,000 in our institute(only consumables).In other diseases for proper diagnosis CT scans,MRI,histopathology,expensive blood reports,immunohistochemistry,etc. needs to be done for which the patient has to shell out from his/her own pocket.All this and not to mention other daily expenditures in eye drops,costly antibiotics,pain killers and sometimes hospital fees.Drugs supplied by the govt. form a woefully short list or for the most part ineffective probably due to adulteration and poor quality control.So many expenditures in a Govt Hospital which is a premier institute at that in a supposedly socialised medical healthcare.This much expenditure to a man/woman who probably earns less than Rs. 100 a day.does it sound right? can our conscience make peace with this fact? if this is the state in a premier institute what is the state of peripheral hospitals.I’m not blaming the people who run our hospital for all this.they are doing a great job to the masses with the limited resources at their disposal.the costs that are being borne by the patients is due to the helplessness of these doctors and due to their endeavour to provide world class care to patients with limited expenditure to the society. In this scenario doctors are stressed to provide healthcare and the public blames them for any incident that happens. This is the reason why doctors in govt sectors are getting frustrated with the system. its not them but our healthcare policy that is to blame.It is flawed left right and centre!
I’m speaking in the midst of one hospital and i’m talking of ground realities in one govt hospital as i’m a part of one.But this is the story of nearly every govt hospital in India.it is just that the categories of expenditure changes.Our society will be judged by how we treat the weakest(read poorest) among us.And our country falls terribly short of an ideal.
As i have mentioned previously in my blogs,Indian govt. spends less than 1percent of our GDP on healthcare.Even countries like Bangladesh and Sri Lanka spend 16 and 32 pc respectively.UK spends 7pc and yet provides Universal free healthcare to every citizen and immigrant.In India 80pc of the health care burden is borne by the pvt. sector.We are quick to downgrade the insurance based healthcare of the USA but in India we neither have an Insurance based healthcare of USA nor a Socialised Healthcare like UK,France,Sweden,Denmark,etc. the common retort by the govt is India is a poor country and we do not collect sufficient taxes to sponsor universal healthcare in India.But this is a poor argument because though only 3 pc of the population pays income tax,we all pay tax in every other way.sales tax,wealth tax,property tax,road tax,service tax,luxury tax,custom tax,education cess,advertisement tax,service tax,value added tax,….phew just to name a few!!!! Only birth tax and death tax is left to be enforced.where does all this money go? We have a horrendous education system,pitiable healthcare and a treacherous bureaucracy and yet we have any non-descript politician worth his salt(not necessarily elected) being ridden across the country in a fleet of 10 cars or helicopters or jets! govt officials,bureaucrats and govt aides lead a life of extreme luxury.our politicians and bureaucrats must be among the richest politicians and bureaucrats in the world(and we are a poor country mind you!!!)No other country in the world has more black money in Swiss Banks than India.So who do you think owns all that money? the above people and also some huge businessmen. So do I still hear somebody call India a poor country. We now know who are the beneficiaries of these many taxes.
Solutions are quite often very simple but simple things aren’t done without a political will in this country.The masses don't demand healthcare because they have nothing to eat so why will anybody talk about health? Healthcare needs to be removed as a state subject and be transferred to being a union subject.Doctors and healthcare professionals need to be paid more as professionalism demands money.you can’t attract the best talent in any industry with pitiful pay packets.same should hold true for healthcare.Govt budgetary allocation to healthcare should increase to 5pc of GDP for a start and should eventually increase to at least 8pc.another 10pc to our education system because to sustain a healthcare this massive we need an educated population.All these budgetary allocation should come from defence cuts.We don't need bombs and missiles.we need medicines and medical care.there needs to be a stringent quality control body for healthcare delivery and of course for the quality of drugs and consumables being supplied.In effect we need a complete overhaul of our healthcare and education policy.Do these sound difficult. hell yes!!! because attitudes need to be changed,awareness needs to be increased and most of all corruption should be minimised.All this is easier said than done but it still is simple stuff no?
I sometimes feel really bad when patients suffer because they either can’t afford treatments or we are restrained from giving them the best treatment due to the many impediments i have mentioned above.There is a certain joy in treating patients and you need to have empathy to understand their varied problems.Its a hell of a tough job but there is nothing else in this world which gives the same high as that got by alleviating suffering of people.It is for this incredible satisfaction that most doctors work even in trying conditions,amongst apathetic govts.,and high personal sacrifices(both monetary and social).So if we doctors can treat our patients without worrying about whether the patient can afford the treatment we can at least bring back nobility to our profession.its not only the rich who deserve to get sick and be cured.even the poor have every right to lead a healthy life.So the next time you fall sick and get treated think about the millions who are not as lucky as you and be grateful for the same.Also try in your own way to do something about it.sometimes a simple thing such as a change in attitude will do.

17th April,2011                                  Raghuraj Hegde

The anatomy of hate and the geography of patriotism

The world cup is over and India have lifted the world cup in grand style after 28 long yrs.I am happy and proud as every other Indian ought to be.But I'm not going to talk about Saturday's game or the many  wonderful moments this world cup has given me.I’m going to talk about the impact sports has on people.

Sport is essential in life.It provides joy to so many people playing it and the so many more watching it.Some say sports does not affect the common man.I disagree.The same thing can be said about music,movies,dance,art,fashion,etc but we all know how important these are to our lives.So sport has its value and its high up there.I’ve been a true sports fan for so long.It started with cricket,moved to football,tennis and F1.I've enjoyed every bit of watching these sports and also the suffered the heartbreaks that comes with it.So i know first hand how sport fans think.Joy,grief,faith and un-reasonability all in equal measure

The days before the India-pakistan semi-final the tension was building intensely.There was so much hype surrounding the clash that most people just wanted that match to get over as soon as possible to spare them the anxiety.There was a lot of pak-bashing going on.I assume there equal India-bashing on the other side.Even I joined in all the excitement and maybe indulged in some myself.But then as the clash was nearing the things being said in public discussions and forums,over news channels,SMSes,newspapers,e-mail forwards and social networking sites got ugly and then it was plain indecent at times.there was so many hate filled messages and statements going around everywhere.Much more than before the Australia quarter-final clash or when India lost to South Africa.Some insecure fans threatening the Indian team against losing to Pakistan.Things being said about pakis mothers and sisters.It was somehow ok to the fans with India losing to Australia or South Africa but it was a strict no when it came to Pakistan.I asked myself at that point…why so?

True that since the partition there’s always been tension between our countries And Pakistan being a very poorly governed country this tension had just increased over the years.True our borders are being challenged everyday as i speak.They might be infringing on our internationally recognised land.Pakistan is also the safe haven to so many terrorists  who repeatedly attack India and also other countries. causing so many lives to be lost.We’ve had two wars with them and there so many wounds yet to heal.But my point is what has the Pakistan cricketers,cricket officials,common people of Pakistan have to do with what is essentially a political problem.More over what has sports got to do with it? Maybe the partition was not the best thing to happen to us but it happened more than 63yrs back and we cant with all our powers change that.What gives us the right to abuse anybody just on the basis of him belonging to a country we think we hate.Why do we forget that these are people who suffer the very same problems that we face or maybe at times even more than us.

Some months ago,Sania Mirza decided to tie the knot with Pakistani cricketer Shoaib Malik.There was a huge furore in the country which was reflected by “Breaking news” features everyday in the news channels.Sania Mirza could have got married to anybody in the world(or any foreigner for good effect) but the fact that she was marrying a Pakistani was not acceptable to our people.I found it bemusing at best.We Indians think just because Sania plays tennis for our country(and of course we are proud of her for that) we have a say in her personal life.Well that’s not my point here actually.my point here is her husband being a “Pakistani” was offensive to Indians.Again why so much hatred for individuals? The country was quick to react with threats to Sania’s life,controversy regarding some non valid earlier marriage of Shoaib and lastly the fatwas issued by the muslim community of India.Sania was labelled a traitor for marrying a Pakistani.I’m not in anyway suggesting the discord is just from our side.Shoaib Malik who was captain of the Pakistani team when India beat them to win the Inaugural T20 world cup in 2007,his first words at the presentation ceremony was ”I want to thank all the Muslims of the world who supported the Pakistani team”.He apparently forgot that the man of the match in the final was Irfan Pathan and the Indian team had two other Muslims, Zaheer and Yusuf.I guess a less educated Shoaib Malik did not have enough maturity to realize such a blaring fact and he uttered publicly what he thought his country believed.This in part reflects the queasy feeling that Muslims in our country get when such things occur.They are somehow anxious not to be be seen as supporting Pakistan in anyway lest they be seen as traitors.But really it can’t be the case.There are more Muslims in India than in Pakistan and also we have the second largest Muslim population in any single country behind Indonesia.So Muslims in India are as Indian as anyone else.Nobody has the right to question their allegiance to our secular country.This to India’s credit reflects our amazing culture of tolerance.I’m not an idealist.I too at some level share some of the prejudices against Pakistan hence I understand the hatred that seems to be all around us.But in my few years on this planet I have realized that so much hatred is bad and brings negative energy to our country.It stunts our progress.We invest 20-30pc of our budget on defence,weapons and to maintain a million strong army all for the fear of our neighbours, Pakistan.If we shared cordial relations with them we wouldn’t have to invest so much on the military.we could use that extra resources towards eradicating poverty by good education to our countrymen.Even Pakistan can stop investing in weapons and do good to their country.Its not enough to be anti-war its more important to be pro-peace.We need an atmosphere of peace to stop this kind of hate taking root in our hearts.We shouldn’t let these politicians sell us false stories to create hatred to help their own political agendas.Let us all live in peace.

India finally won the world cup after 28 yrs.It was an extremely emotional moment for me to witness India winning the world cup in my lifetime(i was not even born when they won in ‘83).The scenes around my house was overwhelming and the joy one witnessed in everybody’s faces was incredible.For one night the whole of India forgot all their problems,biases,prejudices and celebrated whole-heartedly.Those scenes will stay with me for the rest of my life and i shall always cherish it.It was truly a kodak moment in history for all Indians.It is also imperative that one highlights the unforgiving Indian fan in the midst of all these celebrating and euphoric days.We Indian cricket fans make gods out of cricketers when they win but our whole world comes down when India loses.These very cricketing heroes become India’s most hated people.They are publicly abused and vehemently castigated.I understand that Indians are emotional people and maybe we have some right to criticize the players but only up to a point.The rule of sport is that one team wins and another team loses.Either one individual wins or loses like we experience in our daily lives.So we should treat sport as part of our life and not our whole life’s endeavour so our reactions to wins and loses must be appropriate.

Its incredible that Indian cricket team has so much support across the country.Nothing seems to unite the country more than a cricket match win(or maybe in times of war).But our patriotism is restricted to these few moments.Our patriotism is not evoked when we vote for all the wrong men who after getting elected are involved in a number of scams eating up crores of the tax payer’s money in the bargain.It never pains us that not a single politician in India is convicted of corruption.Even very few bureaucrats are punished for corruption.Our patriotism is never evoked when we bribe the traffic policeman to let us go or buttering a government official’s hands to make our papers pass through the red tape.But our blood starts to boil when India loses a cricket match against Pakistan or when an Indian marries a Pakistani or some irresponsible Pakistani minister makes an inflammatory statement against India.In the true perspective of things don’t we think our reactions are unbalanced and mostly misplaced.I hope you see how blind this hate for Pakistan has made us.For all we know,for all the unbridled and unreasonable hatred we have for these unknown Pakistanis if you go to their homes they might turn out to be as hospitable and warm as we are to our guests.Think about it!

 

4th April,2011                               Raghuraj S. Hegde

The Year that went by….

Of course every new year’s eve presents a moment to reflect the life you are living and how you want to live it from there.This new year’s eve has been a different experience. Maybe it is because I've had an ordinary 2010. But of course I'm not here to bore you to death with the travails of my boring year gone by. One important lesson I've learnt is that a lot of us spend a lot of time complaining about everything which prevents us from enjoying what we are blessed with.I for one remember 2010 as the year i got pissed off with a lot of people.I got lost in an unending routine in work that i got fed up of the drab life i was living.I somehow let small situations,petty people and quirks of fate upset my incredible balance in life i had earlier enjoyed.2009 was the best year of my life largely because i concentrated on all the positive aspects of my life and all good things came to me.New friends,new life and whole new view to life.But 2010 was a total anti-thesis to 2009.Many misunderstandings,a few fights,uncomfortable realisations, changing equations with people and life’s not that hunky-dory anymore.Of course people would say the good comes with the bad and 2010 can’t be all that awful.It certainly wasn’t.it was just that i spent so much of my year getting pissed with things i couldn’t see all the good things that was happening to me throughout the year.Probably looking back after a few years i might have had one of my most productive years.But that's the way our priorities line up when we spend a lot of our time being angry. My point is if we dwell on negativity our life will be an unsatisfactory one.we need to remove all the unpleasant experiences from our lives and take only positive constructive lessons from it.So now i have to take the constructive lesson out of this experience too.Of course i hope 2011 will bring me better joy since i resolve to remedy this malady.The real compass of our lives is our own desires.They show us the direction our life should take.So you are happy only if you choose to be happy!!!

That apart,though 2010 has been a largely uneventful year for me.The earth hasn’t stopped revolving nor have people stopped living their life and rocking their worlds and ours.My foremost remembrance of 2010 is the year that Sachin Tendulkar,a man born to just play cricket resurrected himself to the top echelons of the game.Of course after 14,000+ runs and 17,000+ runs in test and ODI’s respectively he was already a legend before this year.But his double against SA in an ODI and his 50 centuries mark that he achieved stamped his class as the best batsman the game has even seen.And to top it all he had the best year of his professional career in 2010.i have always admired people like Sachin and Dravid the way they play the game for the love of it and nothing else in this world concerns them except their game.i guess that’s why I'm their fan rather than all the records they have broken.They are true gentlemen in every sense of the word.

India has reached the No. 1 in the test cricket rankings.I’m absolutely proud of that fact but something doesn’t seem right.I’m not saying they don’t deserve the ranking but to win the coming world cup with a bowling attack like the present one seems difficult for me.But i guess this is our best fast bowling attack that has ever been and Zaheer is the man to look out to.Hope the other fast bowlers and Bhajji give him enough support.Moreover I have incredible faith in the little man Tendulkar that he’ll give us the world cup before he retires.

Spain won its first world cup and anyone seeing them play had no doubt who would win.They looked the best team and played like one till the end barring the forgettable first game of the tournament.I was supporting Argentina too since my favourite player Messi was in in it but was disappointed to see him playing alone with 6 defenders attacking him and yet he managed to show his magic.He certainly deserved better teammates.Maradona erred terribly by not taking Riquelmé and Cambiasso.By 2014 i hope Messi will lead a much better team.

One of my favourite sports which i have never played but always watched with wonder…Tennis.People like Agassi,Ivanisevic,Pat Rafter and now Roger Federer have kept me amazed by this game.Of course Kournikova ,Sharpova ,Ivanovic and the likes have kept it interesting :-)…one of my biggest sporting heroes has been Roger Federer.I have always found inspiration in the grace of his game! he’s had an ordinary year in 2010 and he now seems a shadow of the greatness that enveloped him earlier.but he’s a man who could find sanity in the kind of incredible success he enjoyed.I never saw,heard or read about him misbehaving,showing his airs or any of the now common among sports celebs-sex scandals right through his career.Never before did success sit so well on a human being.It is for  this that i shall remain his greatest fan! But his game is immortal because even his shadow is reaching semi-finals and finals of every tournament he plays.That's testimony to his amazing game.And I’ve got this inner belief…kind of a hunch that he’s not done yet and he’ll come back to win more grand slams before saying goodbye!

Closer home our CWG games was saved from disgrace by some last minute adjustment for which we Indians are famed for.we actually pulled it off!!! And we also won more than a 100 medals.Kudos to all the athletes who made our country proud.They continued the good show in the Asian games(59 medals,14gold)) but of course they were paled in comparison to China(199 Gold) and Korea who dominated the field.A country of a billion people is sure to have better talent than that.Again I'm not belittling the efforts and achievements of our sporting heroes but the medal tally shows our country’s collective apathy towards sports.These sportsmen need better facilities,funds and sponsors to fuel our sporting growth.I hope that the CWG and Asian games foretell a better future for all budding sportspersons.

Politically,the central government run by the UPA which is lead by the Congress probably had their worst year in their history…scams after scams.tainted politician after tainted politician.They need to show something concrete to hold their own from here on in.The huge 20,000 crore CWG mess was messy enough and coming in its heels the 1.76lakh crore 2G spectrum sale scam resulting in the resigning of A Raja.Coalition politics,ulterior motives or vested interests? Can somebody please explain because sometime in the future if these people don't answer our questions we shall not vote for them.We may even vote for the saffron that we don't particularly like but we certainly don’t like liars and people who take our votes for granted.

These are the few highlights of the year gone by that i felt i had something to say.There may be many more important events that begs a lot of importance but i certainly have nothing substantial to contribute to it.So here i am again bringing my long story to an end!

 

3rd January,2010                                   Raghuraj S. Hegde

The tale of two cities….

The difference between Bangalore 

and Kolkata

A few days back i met a person who is Bengali by origin but had gone to Bangalore to work for a software company ten years back and now is settled in Bangalore for good.Almost the whole of his immediate family lives in Kolkata but he does not want to return back.He says he’s fallen in love with Bangalore so much that he can’t leave it now.On the other side of the spectrum,I regularly come across people from other states who are forced to stay in Kolkata due to work and are looking forward to going back to their home state as soon as their situation permits.(there are exceptions like people from UP,bihar,jharkhand and north-east but that’s understandable for obvious reasons).These people  i meet absolutely loath staying in Kolkata and have a thousand complaints about the city and state…food,politics,red tape,infrastructure,locals,etc..I too in some way belong to that group.This contrasting experience prompted me to write this piece.Why are there such extreme feelings regarding the two cities? I’ll try to explore in the next few paragraphs what contributes to this phenomenon….

I’ll start closer to home with Bangalore.I spent all of my childhood and did all my schooling in Bangalore up until i joined medical college.I have wonderful memories of my childhood in Bangalore as childhood memories ought to be.I went to one of the best schools,got a wonderful set of teachers to teach me and had an incredible city to enjoy my school days.For me Bangalore was the best place on earth for the simple reason that i didn’t know any other place.It all changed once i went to Mysore to pursue my M.B.B.S.;I got the opportunity to observe Bangalore from a different perspective since so many of my classmates were from different parts of the state and country and belonging to different backgrounds.I observed that people from outside Bangalore disliked Bangaloreans generally.The reasons were many.Bangaloreans tended to be the spotlight of the class and leadership roles were taken by them naturally.They generally tended to have an air of superiority about them.Add to the fact that we Bangaloreans have an affinity for speaking good English also used to get their goat.This was inevitable as we came from places of better facilities and greater exposure to the outside world.Initially i was shocked by the hostility of the others in my class but gradually they saw the foolishness of their grouse and we eventually mixed well.But my point is Bangalore has separated from the state of Karnataka in pure cultural terms though not physically or politically.

I was one of the people who celebrated with the rest when Bangalore was fast becoming the IT capital of India.But i didn’t realize the effect it would have on my  beloved Bangalore i left behind in 2002 when i went to Mysore for further studies.Of course i used to regularly go home every few weeks.But i saw first hand how Bangalore went from good to horrible within the span of 6yrs i was in Mysore.It came to a point when i failed to recognise the city i was brought up in.The whole city had changed.Some said it did for the good since so much infrastructure came into being.The congress govt earlier had invested in a lot of flyovers,roads and tax reforms for IT companies to open shop in Bangalore.They said it was all good.People in Bangalore had more money in their hands,better standard of living and more happy as a result.Huge shopping malls cropped up in every street,exotic hotels started popping up,all the latest cars started zooming around the city,in short everything was looking so hunky dory at that time.Even i believed the half truths at the time.But in time i realised that all that infrastructure could not keep pace with how fast the city was growing.Roads got worse,public transport was a nightmare,the land prices and cost of living shot up and inevitably Bangalore could not promise a great life to everybody.The unstable governments of Devegowda, Kumarswamy and Yedurappa only added to people’s woes.There was a nearly non-existent  public transport to contend with;people had money so every house had two cars and two motorcycles.That in turn resulted in more traffic problems and the vicious cycle continued.Sometimes when i got to Bangalore it was difficult to believe i was still in Karnataka as almost every corner of India was represented in the city.This cosmopolitan nature of the city is not something i hold against Bangalore.I’m proud that we have always let people from other places come to our city and make it their home without even a hint of resentment.That i believe is a credit to the open mindedness of the city’s people.But what I'm hurt to note is that we haven’t preserved our culture.We kannadigas don’t seem to have pride in our language and traditions.Increasingly even local people are speaking to each other in english and hindi rather than kannada.People in Bangalore somehow feel ashamed to speak publicly in kannada.There are people living in Bangalore for nearly 25 yrs and still don’t know to speak in kannada.Our food,lifestyles,weddings and festivals are conforming to north indian sensibilities.That for me is a failure on our part to preserve the most precious asset of the city:it’s culture.Recently when i saw MLAs in Karnataka legislature creating ruckus inside the Vidhan Sabha with one MLA even tearing away his shirt to expose his bare chest I wondered how civilised we can call ourselves.We are slowly resembling the legislatures of Bihar and UP.This was just waiting to happen.With so much money coming into Bangalore we have let go of decency and courtesy,the bulwark of Kannadiga tradition.The average auto-driver in Bangalore speaks so rudely to the passengers that he would have you believe that he’s doing you a favour and auto-rickshaws are costliest form of transport in Bangalore beating even the airlines.Today your regular Bangalorean  when he takes his family out he sometimes can’t afford both the cinema tickets and the restaurant food on the same day.Forget everybody else even i don’t have the courage to go out when i am in Bangalore.This is the Bangalore that the Bengali I spoke about earlier has fallen in love with for it’s almost indistinguishable from New York,London,Paris or Tokyo other than the people living there.I don’t so much like this version of Bangalore.

Now coming to Kolkata where I’ve been staying since a little more than a year.When I first came to Kolkata last year to pursue my MS i was surprised and i admit even i was a little annoyed when people here refused to speak to me in Hindi or English despite them knowing the language.They expected me to learn their language to converse with them.This included my colleagues,seniors and faculty of my institute.I was forced to learn the language which I did in good time due to interaction with my patients and picking cues from the Bengali banter that went on in my hospital.I was not very impressed due to their refusal to consider my language handicap but i slowly realized that all this stemmed from a deep love for their language and culture which isn’t present in Bangalore.I even started admiring their passion towards their language,state and city.

If there is any advertisement needed for Kolkata culture you needn’t look beyond the Durga Pujo.This annual festival is celebrated with such fervour that it’s highly infective.Here I digress a little bit to describe the pujo.During the 5 day festival the people from the whole of Kolkata and surrounding areas are on the streets.They go around watching the endless stream of pandals on offer.There are usually nearly 2500 official pandals or 10,000 if you count even the smaller ones.Here you are exposed to amazing human creativity.The kind of effort that goes into designing each and every pandal is impossible to believe.You find it hard to believe sometimes that all these structures are temporary structures which will be present only for a week.It’s hard to express it in words what i experienced during the durga pujo for the last two years.The whole city is lit up and converted into one huge art gallery.You can call it the world’s largest art gallery as a matter of fact.I absolutely loved the experience.i tried to capture the festive spirit in camera but failed to give complete justice to my endeavour.

Coming back to the original theme of my treatise i want to say that Kannadigas have something to learn from Bengalis.They say Kolkata is a dying city but they have managed to preserve their identity and are not ashamed to display it.Whether it comes to language,traditions,food,weddings or festivals they have never tried to modify their culture the way we kannadigas have done.True the politics in Kolkata sucks.They have two  political parties who spend all their time putting the blame on each other while they have let the city and state rot in poverty, low infrastructure,union problems and counterproductive socialist policies.Communism has long lost it charm and is outdated.This philosophy has impeded industrial growth in the state.They have several bandhs throughout the year for frivolous reasons.Their food is typically without variety and don’t offer consolations to people having other tastes.The main city still is replete with buildings belonging to the 19th century and pre-independence era.Roads and traffic are probably as bad in Bangalore.Their saving grace is the underground metro which though the best  form of transport in the city is bursting in the seams these days.Add to that the barmy weather,red tape and old practices ,you have a lot to complain about.In more ways than one Bangalore is a much better place to live in for a person earning a decent salary.But my point is Kolkata is distinct by it’s uniqueness and they celebrate it with impunity.People here are less ambitious than their counterparts in the south of India but people here are happy living their lives in sync with Bengali ethos.This is something that you can’t hold against Kolkata.It’s truly a city of joy for them and what more could one want than that!

So in conclusion i would like to say that though Bangalore has been such a friendly place for all and sundry it fails to retain the regional flavour that Kolkata still permeates of.Bangalore is thus paying the price for it’s cosmopolitan nature which may not be bad in real terms but I’ve lost a Bangalore I really loved.

 

23rd October,2010                           Raghuraj S. Hegde

Mysore, the foodie paradise

It’s been more than 2 yrs since I've left Mysore but I still feel like going back again and again.Apart from the beautiful city it is, it’s also home to quite a few unique food experiences which is possibly not available anywhere else in this world.I miss it a lot when I'm in Kolkata where I'm deprived of such gastronomic pleasures.Here’s a list of such uniqueness of food in Mysore.Feel free to add to this list if you feel so.

1. Masala and set dosas from Mylari.
2. Chicken Biryani from RRR and mysore sport’s club
3. Vegetarian meals again from RRR
4. Kachoris from Danavantari road.
5. Meals at Tegu mess in K D road
6. Alu and Gobi parathas from Bhattacharjee’s
7. Ghee rice from Vaibhav
8. Chicken stronganoff in red wine sauce in Planet X
9. Midnight Chai in R M C circle
10. Vanilla ice cream and chocobar in front of Joy Ice cream factory…yeah you might say Joy icecreams are available in other places too but vanilla ice cream never tasted that good any where else.
11. Fruit Juices and Egg-ma-puffs at Ami’s Bakery in Bannimantap
12. Cheese bionic burgers from Downtown, K.D. Road
13. Gobi manchurian from Gokul chats,Gokulam
14. Sizzlers at Jewel Rock
15. Chinese food at Shanghai Chinese Restaurant

its not an exhaustive list.just whatever came right on top of my head…I'm sure there are many more incredible things i failed to mention about food in Mysore

Patriotism,poverty and independence

The day before yesterday I was watching a movie called Peepli [live].It’s a dark comedy/satire on the farmer suicides,media circus and politicians in a backdrop of rural India.I couldn’t help think to myself that now we consider the poverty in our  country as a selling point to the west.We showcase to the west how poor our country is and how we need their money.Today we celebrate 63 yrs of independence and ironically we have more people living below the poverty line than 63yrs ago.Yes there has been an almost 4 fold increase in population from the 300 million then which would account for that increased no.But my point is what does independence mean to those 300-400 million who are below poverty line and have a  pathetic life to look forward to everyday.I doubt they even know that  we have gained independence because that knowledge does not feed them or their children.Why would these people even be patriotic towards a state which has shown just pure indifference for so many years.

At the other end of the spectrum we have the political class, bureaucrats, government officials and huge businessmen.These are people with unlimited incomes at their disposal and yet chose not invest it for their country at some level.The Commonwealth games fiasco does not come as a surprise to anybody.That for me is the worrying factor.The fact that we take corruption so granted that we are hardly overwhelmed  even when such a magnitude of money is being swindled from the the taxpayer’s (read our) pocket goes to show how deep rooted corruption is in our country.The costliest Commonwealth games ever which was initially pegged at Rs.655 crores in 2003 which considering inflation and further works should have cost a little more than Rs.2,500 crores on the upside has ended up at more than Rs.11,000 crores and yet we get to host the worst Commonwealth games ever.Come October and we will all hang our heads in shame not only at our dismal medal tally but also for the substandard training and event facilities.Really when you consider that Rs.11k crores have been wasted out of which 60-70pc have gone into the pockets of private parties ,with nearly 300 million Indians living below poverty line and probably more than 600million who are really poor could we afford such an extravagance and in hindsight where has it got us today other than being the laughing stock for the whole world.Couldn't we have used that much money for improving our country instead of showcasing us as a corrupt poverty stricken country that this commonwealth games is going to do.It is strange that we don't have the excitement that South Africa had during the football world cup or what China had during the Beijing Olympics.We really do not feel any sense of association with the Commonwealth games being hosted in our country.And the people responsible are our political and bureaucratic class.I sometimes wonder how they sleep at night without all these things affecting their mindsets.

Our sports culture is so awful that we have the lowest Olympic medal to population ratio.When a country like Uruguay with a total population of 3.4 million people can produce a football team which can reach the semi-final of the world cup while we don’t even have a half decent team which can even be among the top 100 there should be something worrisome.Our Hockey team did not even qualify for the 2008 Olympics and are in doubt for qualifying for the 2012 event and Hockey is supposed to be our national sport.Cricket is the only place where we have some respectability but who knows about cricket other than the commonwealth nations? who is responsible? the Athletes? these people who have staked their entire careers on an unsympathetic country who don’t even value their sporting heroes or the didactic sport officials running the sport because they have interest in it though no qualifications for it and intend to make profits from these?

We spend 10-12% of our annual budget for defence purposes to buy arms and bombs which may never be used.Yet the government spends less than 1 percent of the annual budget on health care.We spend less than 5 percent of our GDP on health and 80pc comes from the private sector.This figure is the lowest in southeast Asia.Even a country like Sri Lanka spends 16pc and Malaysia 32pc.Who is to explain such huge deficits?

Why is the Maoist problem reaching a head these days?The answer lies in the unequal distribution of wealth.When a poor farmer has nothing to eat,to survive and save his family he would be extremely willing to take up arms against his own country because for a hungry farmer patriotism has little value.When we see that more people are poor than rich we should be thankful that the Maoists are not ruling us already.This is how complex the naxalite problem is.

This brings me back to the movie i mentioned earlier where the protagonist Natha is a helpless man in this system.No matter how many programmes or the incredible amount of money being spent for the the poor in the country not a single rupee reaches the poor man like Natha.when the people with the highest power in the country(read politicians and bureaucrats) chose not to do anything what else is there to say.These are the issues that needs to be addressed first before I would be proud to call myself an Indian.Till then Independence day means little to most of the country and this day serves only to let the elite among us to wax eloquent about our achievements over so many years and discover some annual fake patriotism.Yes its true we have achieved a lot but if we willed we could have achieved a lot more.

 

15th August,2010                   Raghuraj S. Hegde