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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.

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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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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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Surgeon struck off for prioritsing profit

Just when the General Medical Council is considering more serious sanctions against doctors, this hits headlines. Doctors like this (BMJ2014;349:g5236) are the cause for the council to get tougher on rogue doctors. But, they bring not only shame on the rest of the medical fraternity, but also push most of us to practice defensive medicine to the detriment of our patients.

Dr Krishnamurthy Nulliah, a cosmetic surgeon at Harley Street, has been struck off from the register for using his skill to earn money rather than treat people. He has been found guilty of “subordinating his proper responsibilities as a doctor to the pursuit of a commercial enterprise.” He was running his practice as a vendor and corner shop merchant offering discounts to patients. “BOGOF” was an everyday practice for him, according to the MPTS panel. He was found to have offered discounts to one patient if she agreed to treatment in additional areas. Mind boggles at this doctors audacity.

While we cannot comment on the veracity of the claims by both sides, it is difficult to understand how a doctor could completely ignore the Hippocratic oath and deal with patients as commodities. We have seen how such panels work and come to their decisions, often to the detriment of the practitioner. The process starts off with an investigative team statement saying that they are not there to investigate the matter. They never ask the complainant to show evidence or proof of their allegations. Everything is taken as hearsay, and if it is not written down, it did not happen. I suspect, if this doctor had written down that he had taken proper consent and discussed the issues with the patients, he might have got off.

Unfortunately there are rogue doctors in our fraternity who do behave the way the MPTS panels state and they are the cause of increasing threats from the governing body. This will only lead to further inward looking practices and may even cause a stagnation in medical practice. Innovation will not be considered by anyone for the fear of “getting wrong with the GMC.”

If you want to read about how a GMC investigation really takes place read my book – A Kangaroo Court – A triumph of mediocrity.  It is available in print form as well as on Kindle (http://www.amazon.co.uk/Kangaroo-Court-Triumph-Mediocrity/dp/1468081330/ref=sr_1_1?s=books&ie=UTF8&qid=1409059758&sr=1-1&keywords=a+kangaroo+court)

http://www.amazon.co.uk/Kangaroo-Court-Triumph-Mediocrity/dp/1468081330/ref=sr_1_1?s=books&ie=UTF8&qid=1409059758&sr=1-1&keywords=a+kangaroo+court

 

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The Book Launch Tour!!

 

iic_cenetThe whole thing was like out of a dream!  From the moment we landed at the sprawling Delhi International Airport the events rolled quickly and merged into one long episode.  The publisher, Mr Bhaskar Roy came to meet us at the Royal Plaza hotel on Janpath, right in the middle of the city jostling with swank colonial buildings of yesteryears.  He took us through the following evening’s timetable and tried to reassure my frayed nerves.

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Dr Kapila Vatsyayan

There were two eminent archaeologists from the Archaeological Survey of India (ASI) who took an active part in the discussions.  Dr B R Mani, current Additional Director General of ASI shed further light on the subject of Soma.  The discussion went on into the evening and the book was well received.  Most of the books on display were snapped up very quickly and I was kept busy signing the books long after the programme was finished.  It was considered a very successful launch partly because of the presence of the Kapila Vatsyayan who does not normally attend book launches unless the book is of significance and partly because of the excellent audience participation. DSC_0139DSC_0006

We travelled to Varanasi the next morning looking forward to the charity medical camp.  We were rather anxious about the whole thing as the information about the facilities was rather sketchy.  We were in for a pleasant surprise.  It turned out to be a new hospital, reasonably well equipped.  varana

On the first day, we spent some time getting used to the place and the people.  They gave each of us a room to examine patients and the staff went out of their way to accommodate us.  Part of the problem was the language!  I did not realise that a large percentage of the local population, particularly the rural areas, spoke Bhojpuri.  It is closely linked to Hindi, but still not very easy to follow.  It became obvious very quickly that we won’t be able to manage without an interpreter.  It took over 30 minutes to see my first patient!   Even Sushma appeared to enjoy herself despite being extremely apprehensive to start with.  She saw several patients with surgical problems and we saw over 100 patients over two days.  It was tiring but enjoyable at the same time.  The director of the unit, Dr Indu Singh was a revelation to us all.  She was an extremely pleasant and hard working Gyneacolgist with a very keen interest in Telemedicine to bring modern medicine to the rural masses.  She has asked us to return next year to conduct CME programs, interactive workshops with the local orthopedic fraternity and expand the remit of the charity camp itself.  We returned to Delhi tired, yet satisfied with our efforts.

DPS gurgaon Delhi Public School;  I was not sure what to expect in the school.  Mrs Aditi Misra, the principle of the school and a very dear friend had passed my talk earlier on. But I was still wary of facing a bunch of students.  The school building was very impressive.  It must be to host 6000 students from nursery to school leavers.

 DPS dance The programme was started off with an impressive dance performance by the students to a Bengali song sung by Amitabh Bhachan.  The dance was extremely professional and inspiring.  I did not understand the song, but the dancers were so good that it was easy to understand the theme of the dance and the story behind it.   One of the girls from the Editorial Board of the school then introduced me to a packed hall and invited me to start an interactive session.  I was not sure what to expect and started off tentatively to try and see how much the students knew of Harappan history.  I need not have worried.  The kids definitely knew more about it than I did at their stage in career.  As I went on, the questions came thick and fast.  Their desire to know was unstoppable.  Finally, the Principal of the school, Mrs Aditi Misra signalled me to wrap it up and go on to my talk.  The talk again stimulated a lot of discussion.  I was then invited to be interviewed by the Editorial Board of the school.  This was made up mainly of students from across the school, of all ages with one teacher guiding them in the background.  This was a daunting task as their desire for information was enormous.  The session was stopped by the Principal again as the school time had run out.  I was on the floor for over two and  half hours!!!

 century club There was two segments to the Bangalore launch.  First one was a talk to the Rotary Club organised by Srinivas Rajanna at the prestigious Century Club.  The venue was overflowing with standing room only for the talk.  There were a lot of questions and discussions went on into the night.  There was an interesting question to finish the evening – “Are you a Doctor or a Historian now?”.  I was not sure what I am now!  I am a doctor by profession and history is my passion.  I answered it with “I am neither.  I am, but a humble orthopaedic surgeon, a frustrated carpenter!” 

The last stage was a formal book release under the auspices of the prestigious MES College in Malleswaram.  Known for its extremely conservative values, I was rather apprehensive about the evening.  The audience was made up of journalists, authors and historians along with well wishers.  MES college

There was a panel discussion with historians and experts in the scriptures along with a professor of ancient history and an author.  The evening ended well and my talk was extremely well received.  All the books on display at both the venues disappeared very quickly and I ended up spending last hour signing the books.

Has it been a successful launch?  Only time will tell.  It was a success as far as I am concerned as it generated a lot of interest in the people who attended the programmes!!

The book is now available for sale on http://www.amazon.com and http://www.snapdeal.com as well as from the publisher’s website – http://www.palimpsest.co.in

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Last words of the Old King

Last words of the Old King.

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Great Reviews for “A Kangaroo Court”!!

front cover smallGood News!! Just had two reviews on A Kangaroo Court. One from a professional reviewer on GoodReads and a personal letter from a reader.:
Masquerade Crew’s review
Mar 23, 13

4 of 5 stars
bookshelves: non-fiction

ROY’S REVIEW

This is an inside story of one man’s unfortunate experience at the hands of the (British) General Medical Council. it was the misfortune of Mr Shankar Kashyap, eminent consultant surgeon, to become the victim of the GMC’s own disciplinary processes.

With extensive use of the transcripts of the various hearings Mr Kashyap takes us from the point where life is good for him and his family. He has become an acknowledged expert in his particular specialism of hip replacements. He works hard and productively, bringing new efficiencies to his hospital and is in demand worldwide for lectures and demonstrations. His family are happy and settled.

The initial notice of complaint against him was a shock, but nothing happened for two years. Thereafter things rapidly deteriorate as he and his team of advisors battle to deal with the allegations against him. In a ridiculously long drawn out and expensive process it appears that the various assessors and panellists assigned to his case have prejudged his guilt. The charges are patently trumped up and minor but those in charge of Mr Kashyap’s destiny seem determined to ignore the mounting evidence in his favour. Meanwhile his career and life generally nosedive and he becomes understandably depressed. It takes, astonishingly, six years to determine the case and I won’t spoil the ending.

This is a fascinating read, even for someone who dropped Biology like a stone at the earliest opportunity at school. For medical practitioners and students it will shock and astonish. Although it is maybe overlong the author has a flowing and engaging style that draws one along relentlessly.

One big minus point though. I’m afraid there is little evidence of proof-reading after the half-way point. The text is dripping with poor punctuation, typos, misuse of capitalisation and mis-spelling. I would recommend that the Kindle edition is thoroughly overhauled in this regard, as well as any future print edition if applicable.

But in summary the author exacts his revenge with words as sharp and clinical as his instruments and I wish him every future success in both his chosen career and his writing.

Second review was a letter from a reader –

“I was most impressed by your book “The Kangaroo Court”. It was an incredibly well written and restrained account of a terrible and unfair ordeal. It brought to mind the novels of Franz Kafka about the terrors of heartless bureaucracies.” – Dr S Galvin, Consultant Psychologist.

To be compared to works of Franz Kafka is an ultimate complement indeed.

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