Book Review: Dasharajna – The Battle of Ten Kings (Harappa Book 3)

Madhuri Varma

Author: Shankar Kashyap
Pages: 313
Publisher: Indus Publishing Group

  • Ratings-

Cover : 4.5/5
Title : 4.5/5
Blurb : 3/5
Theme : 4/5
Story : 4/5
Characters : 4/5
Value for money : 4/5
Overall : 4/5

  • Blurb:

This is the story based on the main event within the seventh book of Rigveda. It is the story of an epic battle between Sudas of Bharatas and Cayamana of Anus leading confederacy of ten disgruntled kings. It takes place on the banks of River Ravi, it is also battle between the two of the most powerful sages of Rigveda-Vashista and Vishwamitra.Extensive research into the vedic scriptures and archaeological records have helped to create a fascinating insight into the geography of the battle. It is the battle whose result is paradigm shifting in that the outcome decided the future of the great epics of India-Ramayana and Mahabharatha.

  • Review:

History is one of the boring…

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Book Review: Dasharajna – The Battle of Ten Kings (Harappa Book 3)

Author: Shankar Kashyap Pages: 313 Publisher: Indus Publishing Group Ratings- Cover : 4.5/5 Title : 4.5/5 Blurb : 3/5 Theme : 4/5 Story : 4/5 Characters : 4/5 Value for money : 4/5 Overall : 4/5 Bl…

Source: Book Review: Dasharajna – The Battle of Ten Kings (Harappa Book 3)

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Derwan and the Walawalkers

Derwan.  A name that would be etched in my mind for a while now. It conjured up an image of a vast desert with camels trudging everlasting dunes and distant snow covered peaks.  I could just see myself in a Bedouin’s tent trying my best to conjure up an operating theatre.  Well, anyway that was the image that sprang to my mind when Sanjay Deshpande asked me if I would help him out in a charity camp.  Three months later, I landed in a dusty, noisy Mumbai and got into an even noisier taxi to the aptly named Kohinoor Hotel where the rest of the volunteers would meet up. MumbaiI was in fact one of the first ones to turn up.  It was not long before we were all suitably satisfied with a spicy breakfast and loaded onto the coach which would take us to the Walawalkar Hospital in Derwan.  The coach wound its way through the mountain passes of the Western Ghats many were thankful for the antiemetic  they had taken at the start.  The scenery was breathtaking and the cameras clicked away as the driver took one hairpin bend after another down a steep mountain pass.

It was quite dark when we reached the hospital to my first surprise.  20160130_173226.jpgIt looked like the entire hospital had turned up including the director and the reverential Kaka Maharaj.  The director, Mr Walawalkar turned out to be an extremely simple and a humble man who tried to keep himself in the background.  Kaka Maharaj was another matter altogether.  He was held in high esteem by everyone there, including some of some of the volunteers who had been there before.  It was soon to become apparent why.  He appeared to have an amazing influence on the people he met and he had a vision which appears to have worked wonders in the place.  Almost single handedly, he had developed a snake and scorpion infested Konkan jungle on a mountainside into a modern hospital campus with a budding medical school.  walawalker hospitalThe idea was to help the downtrodden and almost completely ignored population of the region with the highest quality of healthcare for free.  He had achieved a near impossible task and had visions of taking things even higher.  We were simply one of the tools he was using to achieve this.  The men and women who worked there gave their all to please him.  The welcome we got was an example of things to come during the next week.  Men fell over themselves to help us, carried our bags to the rooms allocated by our self appointed team leader, David Wales, who looked more like a sergeant major than a retired Nurse.

I met a quiet Dr Pavan Kohli for the first time and went on a grand round of the hospital to see all the patients admitted for surgery during the next five days of the camp.  20160204_145431The ever ebullient Dr Sunil Nadkarni, who I had met before in Newcastle, accompanied us for part of the ward round and he seemed as excited as a kid at a Christmas party.  As we moved from one patient to the next, I soon started to realize the extent of the problem I would face.  It filled me with excitement and a sense of challenge.  I was going to bring to the villagers of the Konkan region, a procedure which would help them get back to their normal life.  Some of them had not walked for months and one was stuck in a wheelchair provided by20160204_114235.jpg the hospital for 20160205_125237.jpgfree.  They were so poor that they could not afford to see a doctor let alone have a hip or a knee replacement.  I knew I was going to be busy for the next six days.

Next day, off we went to the Medical school auditorium, which put our lecture theatres back in Newcastle to shame, for a grand and yet simple, welcoming reception followed by a CME program for the doctors in the surrounding region.  20160131_092100I could not stay for long as we were starting with my first uni-compartmental knee replacement that morning.  I missed most of the social side of camp as I was stuck in the operating theatre from morning till late at night.  There was baby showers for dispossessed women of the region, visit to the local school and the women’s center.

20160204_121059.jpg

My team in theatres!!

I ended up performing  twenty three knee and hip replacements during the week.  It soon became a routine to start the day with an excellent vegetarian Indian breakfast and operating through the day followed by a ward round ending around 9 or 10 at night.20160205_122027.jpg  Lunch was often a quick bite in the surgeon’s room, sitting on a couch meant for rest.  20160131_152018This routine was broken when Sanjay suggested that I should give a talk on Harappan civilisation to the volunteer group and the students and staff of the hospital and medical school.  The talk on the Story of Indus Valley Civilisation was well received by one and all.

It was all over so quickly, I thought.  The week had gone by very fast indeed.  The highlight was on the last day of the camp when we were felicitated by Kaka Maharaj.  All the girls had been given Sarees and the local nurses helped them dress up and they all looked fabulous in their colourful sarees.  20160202_213127The local tailor had a bumper business stitching up their blouses.  All the men wore new shirts given by Kaka Maharaj the day before. 20160205_180354

After the evening meal we found ourselves sitting in a quaint little railway station, Sarwade waiting for the night train to Mumbai.  20160205_232928.jpgThe sleeper was very comfortable and the conductor was very helpful and got all of us to sleep in the same compartment.  My dear friend, Seema’s driver picked me up at Dadar station, teeming with traders with trucks loaded with vegetables for the early morning market.

Flight to Bangalore was uneventful and the next week would be full of meetings, newspaper interviews and lectures.  That is another story for another time!!

 

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Seven Day Working NHS

The speech by Jeremy Hunt, our erstwhile Health Secretary has caused undue stress and anger among the health professionals, particularly consultants. He claims the consultant do not work over the weekends! I am not sue where he got this information from. I was operating last Saturday and counted not less than 11 other consultants working in the theatres along with number of junior doctors, nurses and allied professionals. This did not include those working in A&E, path lab, radiology etc.hunt
He has taken a poorly performed study which only looks at gross statistics without taking into account the numerous variables which affect mortality for any admission. McCartney M in his paper (BMJ 2015;31:h3575, 6th July) unfortunately does not take into account the type of illnesses. Patients with milder illnesses are less likely to call the doctor or attend the emergency services at weekends, so there are fewer admissions and the average severity of illness is probably greater.

Prof Barer, Consultant in Stroke Medicine at Sunderland Royal Hospital has written a letter in the latest BMJ (1st August 2015) where he points out “Acute Cerebrovascular disease is the biggest single contributor to the excess of weekend deaths.” The Gateshead Stroke register shows a crude death rates of 15.5% for weekday admissions and 17.5% at weekends. There were 36% more admissions with “suspected stroke” during an average weekday than a weekend. Often the weekday admissions included higher proportion of TIA (Transient Ischaemic Attacks) and Stroke Mimics with a much lower mortality rate. The register also shows that the strokes were “milder” during weekdays.

NHS spends ?989 million on management consulatants

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Instead of looking for causes of increased death rates during the weekends using standardised models, the secretary of health has used on flawed study to back his claims. If we start to change our treatment modalities based on such an example, the outcomes for our patients would be disastrous.

Sick Notes g2 column 160615 Ian Wiliams

Mr Hunt has been bombastic about his claims and statements during his speech of 16th July. He claims that he wants to change the NHS to a more “human service.” Such statements have been made by politicians in the past and the service has veered gradually towards a Manager driven service than a clinical driven service. This has caused a top heavy service lead by managers with little or no knowledge of the clinical nature of the NHS. More often than not the service is treated in the same format as a car spare part factory. It has become a numbers driven service with managers deciding on the priority of treatment. I have had patients crippled with severe arthritis cancelled by managers to allow Bunion surgery to take place purely because they “came first”!!!!

He claims that he understands Doctors and in the same speech commands “We are ready to impose a new contract if negotiations are not successful within six weeks.” He must have taken the words straight out of Stalin’s workbook!

'I like it. Our corporate structure in sticky notes.'

The online petition (https://petition.parliament.uk/petitions/104334) now has has more than 200,000 signatures. As Mahathma Gandhi once said to Lord Curzon, “It is time you left,” it is time Mr Hunt left and allowed someone else with a better understanding of the health service to take over the mantle of Health Secretary.

Prof Barer ends his letter by saying “It is time to show that policy can be based on reliable evidence rather than political expediency.”
Ref:
1. Basing seven day working on evidence not expediency, Prof D Barer, BMJ2015;351:h4061
2. Skirmish over seven day working, Mark Newbold. BMJ2015;351:h4082
3. Petition calling for health secretary’s resignation exceeds 200 000 supporters
4.McCartney. The Zombie Statistic behind the push for seven day working. BMJ2015;351:h3575

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2014 in review

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 1,900 times in 2014. If it were a cable car, it would take about 32 trips to carry that many people.

Click here to see the complete report.

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Was steppe the home of the Aryans?

Was steppe the home of the Aryans?.

 

Incontrovertible evidence for the presence of Horse in Indus Valley during Bronze Age.  Fascinating Blog article.

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The New GMC – The Spanish Inquisition?

http://www.amazon.co.uk/Kangaroo-Court-Shankar-Kashyap-ebook/dp/1468081330/ref=sr_1_1_twi_2?s=books&ie=UTF8&qid=1416155115&sr=1-1&keywords=a+kangaroo+court%3A+a+triumph+of+mediocrity
The GMC was set up by an act of the Parliament in 1858. Since then there have been several modifications and changes to its role. The Medical Act 1983 (amended) notes that, “The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public”.
The GMC website states that it is concerned with ensuring that doctors are safe to practise. Its role is not, for example, to fine doctors or to compensate patients following problems.

What the GMC can’t do
The GMC cannot:
deal with concerns or complaints about nurses, pharmacists, dentists, opticians, hospital or practice managers or administrative staff, or anyone who is not a registered doctor;
normally give you a detailed explanation of what happened to you. This can only come from the doctor or health provider;
order a doctor to provide the treatment you want;
pay you compensation;
fine a doctor;
order a doctor to give you access to your records;
make a doctor apologise to you.

An independent report cleared the GMC of racial bias in 2000 despite finding 50% of doctors struck off in 1999 were from overseas qualification whereas only 38% were UK qualified.  While the overall number of complaints received about overseas-qualified doctors was roughly representative of the group as a proportion of the medical profession (about 27%-29%), the number of cases, which were then referred up to the Fitness to Practice Panel, was extremely disproportionate. The study found this bias “impossible to explain”.  Several excuses were put forward for this anomaly – doctors working in pressure areas, locums, high-risk specialties and even the influx of doctors from the commonwealth in the fifties and sixties when the regulation was not as strict as it is now.  Concern has also resulted from several studies, which have shown that GMC handling of complaints appear to differ depending on race or “overseas qualification”.

Mortality among doctors referred to FTP:

In a response to a request for information using the Freedom of Information Act, the GMC revealed that 68 doctors had died during FTP proceedings.  The mortality and morbidity amongst doctors going through these procedures is one of the highest of any profession going through similar investigation.  In 2003/4 between 4 and 5% of doctors undergoing fitness to practice scrutiny died.

Dr Clare Gerada, chairperson of the Royal College of General Practitioners warned of over-regulation in 2011 (http://www.pulsetoday.co.uk/gerada-warning-on-over-regulation-after-documentary-secretly-films-gp-consultations/12822006.article#.VGjJGfmsWX8):

We already spend up to £1bn regulating doctors. We are one of the most over-regulated professions around and there will always be people who fall through. If we pile on more and more regulation, we will never win.

Sir Liam Donaldson, the then Chief Medical Officer, echoed concerns about the FTP procedures in his report “Good Doctors, Safer patients” in 2006 – In his view, complaints were dealt with in a haphazard manner; the GMC caused distress to doctors over trivial complaints while tolerating poor practice in other cases. In his report, which was broad ranging, he accused the GMC of being “secretive, tolerant of sub-standard practice and dominated by the professional interest, rather than that of the patient”.  (http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4137232).

The GMC has now released this new guide to sanctions, which goes a long way to make it draconian to say the least.  There is nothing in the document to safe guard doctors against incompetent assessment.  We have seen that any doctor referred to the FTP is more often than not treated as guilty unless proven otherwise.  In a court of law, the accused is treated as innocent until proven guilty.  I would not be surprised if the statistics of deaths and morbidity among doctors referred to the FTP will increase due to the new sanctions guide.

Changes to our sanctions guidance

Reviewing how we deal with concerns about doctors:

A public consultation on changes to our sanctions guidance and on the role of apologies and warnings

 

Our proposed changes guide panels to:

  1. Take appropriate action to protect the public interest without being influenced by the personal consequences for the doctor.
  2. Take action in all cases where a doctor’s fitness to practise is impaired, unless there are exceptional circumstances which meet a specific definition.
  3. Take appropriate action to maintain public confidence in doctors even when a doctor has remediated.
  4. Consider more serious action where cases involve a failure to raise concerns, failure to work collaboratively, discrimination or abuse of professional position involving predatory behaviour.
  5. Consider the factors that may lead to more serious action where specific issues arise in a doctor’s personal life, which undermine confidence in doctors (e.g. criminal or civil proceedings).
  6. Consider specific aggravating and mitigating factors when deciding on the action to take in cases involving addiction or misuse of alcohol or drugs.

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