Needle Stick Injury - Who Bears the Brunt?

A hospitalized patient with AIDS became agitated and tried to remove the intravenous (IV) catheters in his arm. During the struggle, an IV infusion line was pulled. A nurse at the scene recovered the connector needle at the end of the IV line and was attempting to reinsert it when the patient kicked her arm, pushing the needle into her hand. The nurse who sustained the needle stick injury tested negative for HIV that day, but she tested HIV positive several months later. This is not the only case. Everyday healthcare workers are exposed to dangerous and deadly blood-borne pathogens and are at risk of occupational acquisitions of blood-borne illnesses. Occupational exposure to blood-borne pathogens among healthcare workers include percutaneous exposure i.e. exposure to needles and other sharp objects, and mucocutaneous exposure i.e. contact with intact or nonintact skin, the contact with mucous membranes. In the healthcare settings, percutaneous injuries are the most common form of occupational exposures and most likely to result in infection. Needle stick injuries account for upto 80 per cent of accidental exposure to blood-borne pathogens. It is one of the greatest risks faced by the front line healthcare workers in the light of HIV/ AIDS pandemic and Hepatitis B and C. Yet, these exposures have often been considered as part of the job and neglected.

         You may be among the thousands of health care workers who annually receive a needlestick contaminated with HIV. According to a recent report, more than one million needlestick injuries to health care workers occur every year. Anecdotal information considers that this exposure figure is under reported. The use of intravenous cannulae is generally regarded as representing the highest risk of transmission of blood-borne disease to health care workers. Hypodermic needles are commonly used in medical, veterinary and laboratory work and needlestick injuries are a known risk for people who work in these areas. Carelessly or maliciously discarded needles can present a risk to people who clean or service such areas. Although an unusual event, hypodermic needles may also be found in areas frequented by the general public. Hypodermic needles are hollow needles designed to penetrate the body and either introduce or remove liquids. 

The use of safety devices, such as guarded needles, resheathable needles, bluntable vacuum systems, and blunt suture needles, could reduce the risk of injury. The effectiveness of each varies considerably; however, the use of blunted suture needles showed a significant reduction in the number of glove punctures compared with cutting needles. Staples and glue are also safer methods of wound closure because there is no exposure to suture needles and should be encouraged when appropriate. Relatively new intravenous systems are available such as safety cannulae and needleless IV systems, and these can significantly reduce the risk of needlestick injuries.

What are the Fact Sheet on Needle Stick Injury?

-Health care workers (HCWs) suffer between 600,000 and one million injuries from conventional needles and sharps annually. These exposures can lead to hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV), the virus that causes AIDS.

More than 20 other infections can be transmitted through needlesticks, including: tuberculosis, syphilis, malaria and herpes.

What is your role when someone presents to your practice after a needlestick injury or any other hazardous exposure to blood or other body substance?

-Your initial efforts need to be directed at reducing the risk of the exposed patient contracting an infectious illness. Immediate first aid is required if the event is recent:

-Contaminated needlestick, sharps injury, bite or scratch - encourage bleeding, wash with soap and running water.

-Blood or body fluid in eyes or mouth - irrigate with copious quantities of cold water

-Blood or body fluid on broken skin - encourage bleeding if possible, and wash with soap under running water (but without scrubbing)

-Report incident and discuss with local public health consultant immediately.

-The next step is to collect blood from the patient for baseline testing after counseling and obtaining informed consent.

The following estimates of disease transmission rates from percutaneous injuries have been made for occupational exposures and these may be used as a guide in explaining the risk to the patient.

HIV 0.2-0.5%

Hepatitis B - HBeAg absent 2%

- HBeAg present (prompt administration of HBIG and hepatitis B vaccination can prevent transmission in most cases) 40%

Hepatitis C 3-10% 

Is Prevention possible?

According to the CDC, up to 86% of needlestick injuries can be prevented by using safer needlestick devices. Advances in engineering controls have made it possible to eliminate sharps from many uses-such as IV piggybacks-and to blunt or retract the needle so it's no longer a danger. Placing sharps containers within reach and at eye level in every patient room also reduces the risk of injury. You can be active on several levels in order to help prevent needlestick injuries. Review needlestick injury data in your facility and ask the following questions:

- In what areas have needlestick injuries increased, and where has there been a decrease?

- Have nurses and other health care workers been reporting injuries?

- What happens at your workplace in the event of a needlestick incident?

- Can you receive support, including immediate evaluation for postexposure prophylaxis?

- What is being done to reduce the injury rate?

Can we reduce the risk?

Risks to the healthcare workers of the future are rising because of increasing rates of viral infection in patients. This is particularly relevant to medical and nursing students undertaking electives abroad in areas where procedures for infection control are sometimes poor; standards of supervision vary; and students often take part in invasive procedures that may place them at increased risk of bloodborne infections. Also unfortunately many students and even senior staff are indifferent to these injuries and often don't report them. Often injuries are not reported because the exposure is not deemed "significant." 

In summary, needlestick injuries among HCWs in training are common and often not reported to an employee health service.

These findings underscore the need for ongoing attention to strategies to reduce such injuries in a systematic way and to improve reporting systems so that appropriate medical care can be delivered. With considerable lifetime risks for health care workers contracting serious bloodborne diseases and the greatest risk in a long career occurring at the start, there is a greater need for sharps safety and training in medical schools and affiliated hospitals. The introduction of devices designed to reduce needle exposure during suturing and phlebotomy would help protect students, particularly in units where safety methods are not well enforced. Clearly, there is much room for improvement in protecting the healthcare workers from needle stick injury, which can be accomplished through a comprehensive programme that addresses institutional, behavioral, and device-related factors that contribute to the occurrence of these injuries. Apart from this, greater collaborative efforts by all stakeholders are needed to prevent such injuries and the tragic consequences that can result.

Dr. Rubina Lone

Consultant Clinical Microbiology 

SKIMS Medical College

Srinagar, Kashmir

India

State Cronyism

Disturbing reports are showing the latest human rights violation against civilians in Srinagar and we are witnessing another incident of Government sponsored corruption, harassment and crime, this time in the garb of harassing people who live in custodian flats. Custodian department in connivance with police officers, bureaucrats and politicians is harassing various current lease holders of custodian properties in Srinagar and are trying to evict them forcibly and illegally so that houses could be allocated to some blue eyed bureaucrats and their cronies.

     Although the current lease holders have been legally living in the custodian properties for more than 20 years, regularly paying their rents and maintaining these houses, the Custodian department is still breaking all laws in unduly harassing, terrorizing, abusing and attempting to literally destroy these people by issuing threatening show cause notices and giving them only few days to respond so that these lease holders aren’t able to get relief from the courts. Many of the lease holders are elderly couples and have been living legally in the custodian houses for decades having valid leases lasting 40 years. Custodian department is leaving no stone unturned even in harassing dependant families of legal long term lease holders who are maintaining these properties at their own costs and paying rent in advance, but have temporarily moved or travelled out of the state to pursue employment and career which is enshrined in basic fundamental rights of freedom to movement/travel/pursuing a career, job and profession. This is particularly important when there are so few educational and employment opportunities available in the state. Unfortunately, engagement in such egregious human rights abuses is not new to us. The Government has been caught red handed doing such things umpteen number of times. Such sick conduct has no legitimate place in any civilized society, if we can dare to call our society that. It is depraved beyond words and illustrates conduct one would expect from a rogue regime, not a democracy.

The various Government agencies, supposed to protect individuals, have actually become a dreaded mafia who are willing to stoop to unprecedented lows to neutralize and terrorize these individuals. The government trying to dislocate and displace its own people is unconstitutional, unseemly and unbecoming. To preach liberty and justice and tout the Constitution at every turn, then so viciously and abominably violate it against its own people time and again is bald-face hypocrisy. It tells us the government doesn't stand for squat - only what is expedient to a particular administration. 

This unholy alliance between the police, bureaucracy, politicians and the custodian department in trampling the rights of these poor and middle class, whilst arrogantly trying to officiate the illegal allotment of these houses to their favorites, giving impunity to such criminals stealing from others, in acting out of self-interest, has permanently damaged our State. Government corruption has destroyed us, via its destructive and haughty behavior. One would think such a terrible wake up call, via the civil war crisis we have gone through, would be a catalyst for change within the government, but they have refused to desist the corrupt conduct. 

RUBINA LONE

Heroines of peace and victims of war!

The 2011 Nobel Peace Prize has been awarded to a trio of recipients: Yemeni activist Tawakkul Karman; Liberian President Ellen Johnson-Sirleaf; and Liberian peace activist Leymah Gbowee. The three women were cited ‘for their non-violent struggle for the safety of women and for women's rights to full participation in peace-building work.’ These laureates follow only a dozen other women to have won the prize over its 110-year history. Before them Wangari Maathai was the first African woman to receive the Nobel Peace Prize for her contribution to sustainable development, democracy and peace.                   
Does this mean we are marching forward and recognizing the need for gender mainstreaming and institutionalization of women as leaders at peace building table and ultimately peace building enterprise? Have we realised that sustainable peace can not be obtained unless women, who apparently are the worst hit during conflicts, obtain the same opportunities as men in the development at all levels of society? The sad statistics here are that, of the 1.3 billion people who live in absolute poverty around the globe, 70 percent are women. For these women, poverty doesn’t just mean scarcity and want. It means rights denied, opportunities curtailed and voices silenced. Consider the following UN figures:
• Women work two-thirds of the world’s working hours. According to the United Nations the overwhelming majority of the labor that sustains life is done by women and universally this work is accorded low status and no pay.
• Women earn only 10 percent of the world’s income. Where women work for money, they may be limited to a set of jobs deemed suitable for women – invariably low-pay, low-status positions.
• Women own less than 1 percent of the world’s property. Where laws or customs prevent women from owning land or other productive assets, from getting loans or credit, or from having the right to inheritance or to own their home, they have no assets to leverage for economic stability and cannot invest in their own or their children’s futures.
• Women make up two-thirds of the estimated 876 million adults worldwide who cannot read or write; and girls make up 60 percent of the 77 million children not attending primary school. Women do not have the discretionary income to invest in their own or their children’s education, where girls’ education is considered frivolous, and where girls are relied on to contribute labor to the household, they miss this unparalleled opportunity to develop their minds and spirits.
The Security Council passed its resolution 1325 on women and peace and security on 31st  October 2000, almost 11 years to this day. The resolution reaffirmed the important role of women in the prevention and resolution of conflicts, peace negotiations, peace-building, peacekeeping, humanitarian response and in post-conflict reconstruction and stresses the importance of their equal participation and full involvement in all efforts for the maintenance and promotion of peace and security. Resolution 1325 urged all countries to increase the participation of women and incorporate gender perspectives in all United Nations peace and security efforts. It also called on all parties to take special measures to protect women and girls from gender-based violence, particularly rape and other forms of sexual abuse, in situations of armed conflict. The resolution provided a number of important operational mandates, with implications for Member States and the entities of the United Nations system. However, 11 years later the scenario is at best dismal. United Nation could not disguise its wretched failure to act on its own resolution to clear space for women at all peace tables, both real and metaphorical. The unforgivable fact is that during the decade under review, women’s participation in formal peace processes actually declined and their participation in conflict resolution and peace-building is less evident today than it was before the Resolution 1325 passed.
Why are women still not participating equally with men in public dialogue and decision-making and influencing the decisions at peace building tables? Why are they not getting the opportunity for empowerment into poverty reduction, democratic governance, crisis prevention and recovery, and environment and sustainable development? These are some of the questions we need to look into and ponder upon. We must start where the women’s movement has always started; Women’s rights are human rights and to recognize that we need leaders who are steeped in notions of gender equality, human rights and social justice. When we have women and men like that, our world will be rejuvenated, rearranged and transformed.
( Dr. Rubina Lone is Assistant Professor at SKIMS Medical College and can be reached at rubynask@gmail.com)

Bullying at workplaces - a silent epidemic!

                       

“Borrow trouble for yourself, if that’s your nature, but don’t give it to your neighbor.” 

Perhaps Rudyard Kipling knew something about bullying…He didn’t want it, nor do I. Harassment at places that necessitate an unavoidable social interface has always been considered more of a civilization attribute than an adverse and abominable human behavioural pattern so much so that our reaction mechanisms to any kind of harassment are often finely-adjusted by this ubiquitous conformist mindset. If not disregarded as cynicism it can be said with a fair amount of leniency that bullying and its various forms have become more of an office-accessory now, engendering the whole gamut of interpersonal relationships at the work-place. As such it becomes imperative to study this unhealthy tendency in its various contexts, given the profound impact it has on the productivity of organizations. Also accusations of bullying have become much more common, perhaps representing an increased perception and awareness rather than the rise in the abusive personalities in the system. 

‘Workplace bullying is a major source of stress, breakdown and malfunction in modern systems. It is an important issue for organizations especially the health services because of its potential impact on staff health and patient care. This petty tyranny or mobbing can take many forms ranging from subtle to the most obvious. Having said that, it is also important to  distinguish between  hard driving bosses (ladder climbers) who push aggressively for positive organizational results and bullies (dinosaurs), who are demeaning and destructive to the workplace as such’, says Dr. Javed Latoo, Consultant Psychiatrist and leading Neuropsychiatrist working at National Health Services, United Kingdom.  He further adds, ‘Work places are a fertile breeding ground for interpersonal conflicts and development of dysfunctional relationships especially in hierarchical systems where the potential for conflicts is pronounced but Kashmiri workplaces, I believe,  are more of melting pots and a lot of the bullying and discrimination which is taking place in there can be  cross-cultural.''

        The most detrimental bullying is not conspicuous and does not fit the stereotype of a bully having an outburst in the office. It is more covert and tends to be more subtle: condescending rather than straightforward abuse, and aggressive, sarcastic remarks rather than outright insults. And because bullies are at the top of the food chain, the bad behavior of even a few of them can set a virulent and trenchant tone for the whole organization. A lot of organizations get in dire straits, where tempers flare easily and interpersonal problems have been allowed to brandish unabated. While many organizations have anti-bullying policies on the books, too few see it as a serious issue.    

               The problem of bullying needs to be approached with purpose. Acknowledgement of the problem could be done for starters. Anti bullying policies to be formulated and implemented as first course and teaching appropriate skills to  deal with bullying, program for trainees to confront bullying adequately and appropriate reward-punishment for the concerned, could follow suit. It is not easy to prevent bullying and harassment in the workplace. It requires people to moderate their behavior so that they become positive role models and demands considerable changes in institutional culture. The negative impacts of bullying on the well being of people and overall morale in the organizational workforce demand our continuing efforts to resolve the problem.  Needless to say, it would take a lot of time and resolve before this problem is controlled or eradicated. However, if it is allowed to grow it will not only frustrate our combating efforts but also cripple the current working system. It is high time to show zero tolerance and say no to bullying.

Health and peace building

                      

‘There year was 1994. Another crackdown was announced. But this one we will not forget for a very long time. Army men after ravaging our village home took my 15 year old son into custody. He was sodomized by these men and later released in half dead condition; Diagnosed as Post Traumatic Stress Syndrome, he died a month later. They said he committed suicide. We knew it was the shame and guilt he felt that made him take this extreme step. Two of my brothers got shot down at point blank range by unidentified armed men. Cause: unknown till date.’ This is a recollection by a dying man who remembers his son and brothers who lost their lives to bullets. Needless to say this is just one of the hundreds of heart breaking realities (not stories) which I have had the misfortune to hear.

I took up the profession of medicine when my motherland was engulfed in a mayhem which was consuming human lives.  I have seen conflict and the ugliness it creates, very closely in my personal as well as professional life. As a doctor I come across the diseases caused by conflict in the form of violence - armed conflicts in particular - which pose a direct threat to physical health like malnutrition/starvation, loss of limbs, amputations etc as well as psychological trauma.

        The encompassing maxim of our times is conflict and violence. In conflict-ridden and politically insecure areas casualties caused by diseases far overshadow the numbers killed by violence, which include psychosocial and sexual violence. For a better future we need to scrutinize the relationship between health and peace-building in humanitarian crises and development, and focus specifically on the over all health and social impact of violence. Health constructs important structure for social healing and the restoration of social relationships disrupted by political violence. Humanitarian practices at the basis of health and the work of health professionals can provide the platform for rejuvenating communities, cultivating long-term progress, development and peace building. In order to prevent conflict and form more amicable and harmonious societies, there is an urgent need to novel approaches to address the effect of political conflicts. As a doctor I firmly believe that health care is one means by which society institutionalizes feelings of care and compassion; its juxtaposition with humane objectives can beat human differences. Since we are living in a world which is perpetually infected by conflict, it only makes sense for doctors to take active part in brokering peace. Health is mot merely the absence of disease and swallowing of pills. It is integrated and unified with lots of social fibers including human right, economic disparity, violence and many more.

As a health care professional, I feel it is our responsibility to use knowledge and skills for the betterment of all in a manner that transcends political concepts and considerations. We need to apply a multi pronged approach to tackle conflict and help in peace building, demonstrate knowledge about the impact of direct and structural violence on individuals and societies, highlight the range of different ways in which we as doctors can contribute to the reduction of peace deficits and do their bit for violence prevention and peace promotion. Few things could be more rewarding than knowing that you have contributed to world peace. It is a worthy goal that should be embraced by us all.   

(The author is Assistant Professor at Department of Microbiology, SKIMS Medical College and can be reached at rubynask@gmail.com)

The hassled medical student

Not many tortures and rapturous delights of life juxtapose with the rich variety and depth of acquaintance, the agonies and dangers shared by medical students in their voyage of evolution from unrefined school kids to accomplished doctors in their swan-like white-coat exaltation. During the initial overwhelming exhilaration of qualifying for a premier medical college, most fresh enthusiasts do not comprehend that they are asking for grievous injury to their dura mater. The selection process filters exceptional students used to be the toppers in their school, and brings them as equals in Medical College on a common platform. So the brainy one in the elementary school becomes just one of the guys in the anatomy hall! Thus, begins the medical student's tedious and uphill sojourn, where small achievements are few and far between and kudos and appreciations a rara avis.

                  Throughout the 5 tough years in a Medical College confusions amid disagreements plague him. Hardly has he acclimatized to the feeling of achievement at having made it to the medical college that he has to contend with failure and get used to the idea of flunking, supplementary exams and more flunking. Considering the resilience and toughness peculiar to his breed, the medical student adapts readily to the changed scenario. He learns to grin and bear it all- the cadaveric gloom of the dissection table, the soporific lassitude of biochemical reactions and their kaleidoscopic colors over the spirit lamp; the slimy frogs and black drums of physiology lab that leave him with debilitated spirits, questioning what he ever did to earn all this! He clutches at strings nevertheless, and tutors himself to cross the first obstructions of medical life and starts the conceptual coup d’etat with disease.

The mind of the miserable medical student is an arena of emotions where he desires enviously to be like non medical students as they rejoice the spring of their lives, while he struggles with bacteria and viruses, drug pharmacokinetics and dynamics, forensic perversions and delinquency. He learns to, mix carminative mixtures and rabbit ileum, stretch his imagination in the microscopic world of vague and ambiguous life-forms and scrutinize the bizarre architecture of pathological specimens.

No less disturbing is the student’s reconnaissance into the clinical battlefield and hospital wards. All his extravagant hallucinations regarding the magnanimity of his chosen profession languish like waves on the shores of reality. On one hand he is deluged with theoretical facts, while on the other, he is increasingly crippled by the futility of his inadequate tools in the face of human suffering. As all the presumptions of his adolescent naiveté and candor disappear like dew in the cacophonous blaze of the real world, his immature psyche grapples to keep step with savior faire, extravagant knowledge and graying experience of life.

As he struggles with his own miserable adulthood, academic chauvinists wait at every step to annihilate his enthusiasm. He comes face to face with internal disagreement: ‘How in the world can dedicate his own life, to bulwark life, if the excitement for life itself is dead within him? How can he safeguard life, if the passion within him is gone?’ Under siege from foes of his unwavering spirit, the medical student learns to camouflage his enthusiasm but keeps his fire burning from inside, never extinguished, his determination bruised but never crushed. Skillfully like a ballet dancer, he dances his way through the labyrinth of gargantuan egos, where stalwarts await their prey with tentacles spread.

As the rest of humanity understands life in its gory and glory after the sixth decade, we as  potential doctors perceive and testify it before we turns twenty-five. For all the brave and valiant doctors trying to interpret the mess and marvel of human existence, this tribute goes out from an ex-medical student and teacher to the present medical student and potential healer - Just hang in there!

You are always where I am

"I look out and see you there

In the glorious sun so gay…

there in the park across the way,

you distract me, bother me everywhere,

you are always where I am... 

I dream to be with you there,

 on that golden sand under our feet

 under low moon with a rhythmic beat

In the morning delight we would meet

that starry night you promised me here

but then I realise you are always where I am.... 

You call me your distraction.

For you am I but just an attraction?

I think you are my destination

But why it casts an unknown fear

 and why do I have this solitary tear

when I know you are always where I am…

Domestic abuse – Badge of Shame? Based on true events

“In remembrance of the victims of domestic abuse who on the wings of eagles soar to the heavens in the arms of God”        

You punched holes through my heart,

Ripped  my soul and tore it apart.

Fists that bruised me inside and out,

My trust you took away to rot.

Wasn’t I your so radiant bride?

Why did you steal away my pride?

Leaving me imprisoned in every tear,

These fists are what you made me fear.

Now when you wonder why I no longer care,

Look at your hands, the answer is there.

        Written and contributed by a victim of domestic violence.

A friend called. Weeping bitterly! Her sister, Rafiqa, was admitted in the hospital and could I have a look at her? Badly beaten by her husband, her body bruised all over, her spleen ruptured and three teeth broken, she was immediately taken to the theatre for emergency surgery. The year was 2007. Two years later Rafiqa died. They called it suicide. I knew better. She died of shattered dreams and the shame of being beaten and battered in front of her children. Modern culture may see it as a disgrace, for a man to be labeled as an abuser but the fact remains we underestimate how wedded our culture is to domestic violence. Statistics show that a woman is battered every 15 seconds by someone who promised to love and cherish her and be with her, “till death do us part”. Even more frightening is the fact that scores of women die everyday of abuse and one in every four women who commit suicide are actually victims of spousal abuse. Think about it in real life terms: Imagine that one in four of your women friend, or relative or neighbour is a potential victim, being beaten or threatened. Upsetting, Isn’t it? And this is just the tip of the iceberg. The reality is much uglier and far nastier than meets the eye.

Apart from physical abuse which leaves broken bones, bruised flesh and spilled blood, the emotional abuse caused by unseen punches and invisible jabs can cause deeper scars to the woman abused. She is demeaned, demoralized, disgraced and degraded. Her self esteem plummeted to rock bottom; she is stripped, to the very core, off her self esteem and pride.

The big question here is; who gave these men the carte blanche to abuse women? Is it the blue print they are handed over as soon as they are born- the blue print which says you are a man and you are superior? When you start trying to figure out what makes these men tick, you enter realms so foreign to normal experience that you are taken aback.  Imagine the horror of discovering that your dream man is actually a Dr. Jekyll and Mr. Hyde – a nice, charming, caring man in public but an angry, domineering, abuser at home. Same was the case with Shireen (name changed). Like so many abused women, she walked on egg shells for years. “Why does Prince Charming change into a terrifying beast as soon as the honeymoon is over?” A well educated female working as a Lecturer in a Degree college, Shireen faced 10 years of violence- violence in which she lost every shred of her being. She reluctantly recalls the day when her husband beat her to the pulp, so much so that she could not lift her head and had blood pouring down her face. That was the last straw for her. She mustered up the courage to finally leave him because staying would mean sure death since the beatings and abuses were getting uglier by the day. “It starts with a scream, often silent but deafening. It is the sound of dreams being shattered like glass and fear that is so real, it can make you feel there is nothing left inside of you, not even your heart.” She says.  

However, Shireen, who now lives with her parents, won't show you her scars. She is determined that survivors should not glamorize their wounds. “Self pity can be as addicting as any drug”.

What is the solution though? Ultimately, what will make the difference? When will every part of the community; clerics, law enforcement agencies, responds and holds batterers accountable for what they're doing?  We must become a world of people who understand this kind of violence. Batterers deserve stiff penalties for perpetrating domestic violence — a crime that feeds on fear, shatters lives, and keeps communities in denial. It's not somebody else's problem or someone else's responsibility. It's mine and it's yours and its time to act.

PS: There is not a single shelter or home for victims of domestic violence in Kashmir and no one has ever thought of making one either! Most of the victims suffer because they have no support system and nowhere to go. Left with no alternative they submit to their fate, commit suicide or get killed!

(Dr. Rubina Lone is Assistant Professor Department of Microbiology at SKIMS Medical College and can be reached at rubynask@gmail.com)

Pay and get paid

“Many men stumble across the truth ... but most manage to pick themselves up and continue as if nothing had happened.” Winston S Churchill

When I applied for my driver's license, I learned that I had a choice. Either I could take the test, fail and then pay a bribe for a license, or I could bypass the test and simply pay the official a bribe and receive my license. Judging from the standard of driving in here, I would say that most of us chose the latter course.

      Everything is legal  in Kashmir as long as one doesn’t get caught. And the good news for corrupt guys out here is that nobody ever gets caught.  All  know what is happening behind the closed doors, but no one feels the need to blow the whistle. Why? Because we understand nothing is going to change. On the contrary you might be the one to get punished. Corruption here is as much a tradition as the winter Harisa – A must have! In our offices there is more greasing going on under the table than in a red light area.  If the new building is having trouble passing a Municipality rule, the chief there might find a new Ford Icon in the driveway and the problem is solved.

            Corruption is present in many forms, namely political corruption, bribery, trading of influence, graft and undue patronage. Other forms include nepotism and cronyism, electoral and voter fraud, embezzlement, kickbacks, unholy alliances, tax doggeries and tender rigging. In our setup, corruption is not only an offshoot of collapsed social and governmental institutions, nor is it just the result of a hostile economic environment. The roots go much deeper and are symptomatic of the gradual but residual breakdown of our societal values and morality. It is the result of our failure to distinguish right from wrong, and of a collective refusal to condemn dishonesty. It reflects the wrenching reality of a city of shame. This stems from the fact that from a peon to the top echelon, this predatory organism has eaten away our integrity and bit each and every stratum of people.

              We are a society full of people with no scruples. Most of us go on a rampage and binge on endless quantities of lucre, trying to milk out everything and anything to the best of our abilities. All rationales crumble in the face of our greed as we are determined to rip off at all costs. We have become just mini-me effigies of our heroes who are at the helm of the affairs in higher authority - the central government administrators.

              Of course it is much easier to condemn corrupt practices than to actually eradicate them. But we can start by enforcing the many laws that already exist to fight the kickback culture. We can also use motivational techniques to rectify the apparent lack of civic duty among those guiding the workforce. And, of course, promote leadership at all levels of society that actually set a positive example worth following. From our streets to the Ministers, from individual families to big organisations to the communities, transparency must be nurtured and groomed because it is corruption’s worst enemy and, therefore, the most effective tool in fighting it. 

           Corruption is in the soil, and pruning the stray branches won’t get the job done.  So to eradicate corruption, one must tackle both the givers and the takers. Egregiously corrupt, high-profile, public figures and institutions must be singled out for harsh treatment and thus demonstrate that no one is above the law. The strengthening of institutions is of critical importance including the police, the courts, the tax authorities and the media which must be subjected to a massive overhaul. It most probably would entail the replacement of most of the current, irredeemably corrupt personnel. But to believe that we can fix it completely and get it out of our blood would be unrealistic unless there is an attempt of moral revolution to destroy the quagmire in which we are stuck in today.

Dr. Rubina Lone is Assistant Professor Department of Microbiology at SKIMS Medical College and can be reached at rubynask@gmail.com

Gender biases

Male chauvinism

 “I have given the best of myself and the best work of my life to help obtain political freedom for women, knowing that upon this rests the hope not only for the freedom of men but of the onward civilization of the world” – Mary. S. Anthony.

“Did you ever feel gender discrimination in your professional life”? asked the anchor of a television show to one of the female participants. Superfluous question! Of course she did, but then every woman does. Isn’t it an axiom rather than an exception, happening everywhere and to all of us? A stark and recent example of sexism is Hina Rabani Khar, Foreign Minister from Pakistan, who visited India and was judged according to the clothes and bags she adorned, thereby belittling what she stood for intellectually. And there you have it, despite the emancipation of women in the West, there has not been a single woman President in the United States yet – what can be more telling! Sexism is a mindset that has the potential of affecting practically every aspect of women’s lives, preventing them from accomplishing their full potential.

 Picture this: As the plane reached cruising speed, the captain's voice crackled to welcome us aboard and give us details about the flight ahead. Almost immediately the guy next to me began to shift nervously in his seat. Not because we were being told of impending turbulence or being given giddy-making statistics about our altitude and speed. What unsettled him was the voice coming over the loud speaker. Our captain was a woman. With a female pilot at the helm, some immediately made comment about women drivers.  

Why do men get instant bruises in head the moment any woman tries to match her shoulders with them?  Why it takes the wind out of their sails as soon as they realise women are no more show pieces to adorn the world, but are walking neck to neck with them? Why they feel fathoms deep in troubled waters every time a smart woman comes near them?  As k them, and they deny it vehemently.

To gets a man’s perspective on this, I asked one male colleague, “Why are Kashmiri men such chauvinists.” His clichéd reply, “We are just more protective towards our women, not MCP’s”.

Protective! A place where the female to male ratio has hit the absolute pits, where every 1 in 4 women is a victim of domestic violence, where women are regarded as unfit when they are unable to bring forth male children -  I would hardly call that protective.   

While social constructionalists argue that men and women are essentially same and roles played by them are largely constructed by society, the essentialists suggest that the differences are biological. What ever the out come of the debate, the fact remains that in this patriarchal world, women get an inferior status.  Discriminations and biases are hidden by a veneer of non-existence in the more advanced countries. Conversely, lesser advanced a society, the more visible and obvious are the manifestations in which gender biases prevail and predominate.

. In a world full of male chauvinists, muscling your way is not easy. We as women face many a glitches, be it home or the work place. Albeit we walk with our head held high designating ourselves socially and culturally toned to 21st century but the reality isn’t parallel. Rousseau's observation that men are born free, yet everywhere they are in chains, is an apt description for condition of women in our society.

We are rich in allegories that dishonour women. So the question is how riveting are talks about liberation of women and equality for women today? Many people support the diaphanous talk that role of women within the society has changed, more women work than even before & most of them have careers. I call it diaphanous, because as far as I can see it is just talk – flimsy, airy and gossamer thin. Gender equality is still the toughest battle we are fighting and things will not change overnight. A thorough change in the mindset of people is the most required solution to give equal and respectable opportunity for women.  That being said, until this generation takes flight, for the womenfolk in God’s own country, it is still a long road to independence.

Dr. Rubina Lone is Assistant Professor, SKIMS Medical College.

Email: rubynask@gmail.com

What happened to medical ethics?

I solemnly pledge to consecrate my life to the service of humanity; I will practice my profession with conscience and dignity; the health of my patient will be my first consideration.
 (Declaration of Geneva [amended 2006)
Wow, trip to Europe with family and five star accommodation! Did you win a lottery by any chance?” I asked my friend, albeit a bit jealously, who had recently returned from her foreign vacations and posted her pictures on the facebook.“Are you bonkers? Practitioners don’t need to win lotteries. Our profession is our ticket to everything.” Noticing the perplexed look on my face, she continued airily, “Dumbo, the whole trip was financed and funded by a pharmaceutical company.”Her reply echoed these sublime lines in my mind, of course with melancholia:
“You swore the Hippocratic Oath!
In dishonour you are deeply steeped 
You stole from mates for tarnished gold
Do you know you have lost your soul?”
Phew Rubina! Welcome to the world of new age medical (un) ethics and distorted moralities.
What has allowed this immoral penetration into the most revered profession which till late was held together as a sacred calling for centuries? Have we as doctors, considered to be demi-gods and messiah, dumped the Hippocrates oath beneath heaps of lust and greed? Is it no longer sanctum sanctorum? Attempts to answer these questions prove agonizing as they seem too close to reality for comfort.The rot has already set in and the unholy nexus between doctors and pharmaceutical companies runs deep, having snowballed cancerously. What we are witnessing is perhaps the greatest scam to ever hit us- modern medicine and corrupt doctor practices. The philanthropy which had once been part of this profession has been replaced by chicanery, bribery, deception and lust for making quick and easy bucks.A disgraceful business between doctors and pharmaceutical companies runs like this: On sale of 5000 samples of drugs, get an air conditioner or blackberry set. On sale of 10,000 samples, get a motor bike and on prescribing high-priced outlandish drug, the doctor can even get rewarded with a brand new car. The list is long and endless and the maxim simple- Quid pro Quo. Exotic vacations get financed at the blood of the poor patient.  Dodgy doctors medicate patients up to their eyeballs and prescribe drugs which they don’t need and at prices they even need less.
Unfortunately and unforgivably, the sacred precincts of this hallowed profession have hollowed out and emptied out of its sanctity.  What was previously tantamount to sacrilege is considered smart entrepreneurship by these callous practitioners. We have eroded the very essence of medical services and done an irreparable loss to the once called noblest profession.  How can these who doctors accept the bribes, look in the mirror afterward and face even their own self?  This dark descent into barbarism, a product of unscrupulous doctors satiating their greed at the expense of hapless patients, should not be allowed to happen: The lessons of history sagaciously reveal wherever a society has degraded to such an extent, the results have been as perverse as they have been disastrous. I guess nothing short of a divine intervention can change this murky situation we are in today. We are at the mercy of these tainted practices and till our law enforcing agencies wake up, I can but advice you one thing: Please don’t dare to get sick.

The Trash Culture

Sometimes kids freak you out. It came as a rude shock when my 6-year-old rolled down the car window to throw the just devoured chocolate wrapper out. Spotting my horrified look, she quickly said, “Don’t worry Mamma, everyone does this, even the teachers in our school!”Did I have an answer? No I didn’t. Teachers are supposed to be always right. 
 Late at night when I was pondering about it, I remembered the 19th century French traveler, Victor Jacquemont, who wrote about Kashmir being an ugly picture in a magnificent frame. Was he right? The sense of paradise being bestowed upon the wrong people prevailed inside me. Is the erstwhile paradise burgeoning into a rubbish heap? As long as our lawns are pretty, ‘I give a damn’ attitude being commonplace with us - aren’t we using an out-of-sight out-of-mind policy? Are we, as individuals and community, making every effort to turn this place into an eye-sore? These questions tormented me. Once a picturesque place, known for its crystal-clear waters, lofty mountains and lush forests, Kashmir seems to be turning into a big garbage dump and unfortunately we have no one to blame but ourselves. 
 “But, of course it is the duty of the city Municipal Corporation to collect garbage and keeping the streets clean,” said one of my highly-educated doctor friends during a tete-a-tete. As a society known for shifting responsibility and playing blame-games, it was no wonder when she started hurling abuses at the present Government, especially the Chief Minister for all the garbage mess in our beautiful ‘Jannat’ (paradise; her words, not mine). It was same as saying that the pencil was responsible for my bad test scores!
Circumventing responsibility and blaming others for individual failings is tempting. But that temptation carries a serious price, especially when such comments dismantle us of our individual responsibilities. We leap at the opportunity to castigate Government for the failings of individuals or groups which offers a sense of release and exculpation. But those of us, who embrace the notions of character and accountability, would say that a person himself (or herself) is responsible for his (her) actions. If an individual or community tends to make our heaven an environmental wreck, then I would point to defects in our character and hold us for these actions. Having said that, I am not exonerating the Government for its lackadaisical attitude, but the onus, I believe, lies on the individual first.
So when will the tipping point come for greater personal responsibility in our society’s engagement with environmental abuse? Certainly, not by mere talking and writing on the subject. We have to find a remedy. Environmental civilization, not short of enlightenment, is becoming increasingly important in our lives. As our cities become more congested and busy, acquainting ourselves with the impact and influence each of us have on our surroundings, becomes more and more compelling. Equally important, however, is the perspicacity of how we can contribute to protecting the environment around us and bequeath something of value to future generations.We cannot be extenuated for our unkempt places and make light of the situation we are in today. Our standards of hygiene and cleanliness need to change. Even if the governmental authorities do not promulgate restrictions, there is no need to establish a poor environmental milieu. I do not believe that punishments should be delivered to everyone; instead individuals perpetrating the offense should be brought to book. It’s high time our society learns to take responsibility for the trash culture.Litter is everyone’s problem and there is never an excuse!(Author is Assistant Professor, Deptt of Microbiology, SKIMS Medical College, Bemina Srinagar. She can be reached at rubynask@gmail.com)