Thursday, August 29, 2013

Aiport and Authority

"Must multitudes perish before the heaven begins to tremble?" laments the main character in J.M. Coetzee's The Master of Petersburg

The plea of this grief-stricken father siphoned a tornado of deep anguish when I first read the book a few years ago. This character, He, was almost deliriously rummaging about in Petersburg in the pretext of his son's death. Most likely it was his process of coming to terms with his son's death. But the agony of this tormented father had reached nowhere near the closure of "coming to terms." It was rather colliding with the death itself. That indescribable anguish, helplessness, was for me bottled in that plea: Must multitudes perish before the heaven begins to tremble? Had I met him, this fictional character, at that time, I would have just sat next to him and cried: cried in loud roars, tears flowing down the cheeks, water coming out of the nose. I would not have cared what he thought, I would not have cared even if he walked away at the absurdity of a total stranger. 

But that would have changed now. Had I met this man, He, haggard and smelly, wandering around in the streets of Petersburg, I would have still sat next to him and cried my cry. But I would have wiped my tears and nasal discharge and told this man, "Mr. He, if you lose shame and are capable of reckless cruelty, even the trembling of heaven would mean nothing."
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On a recent flight back home from overseas trip, I was next to a Nepali worker in one of the middle-eastern countries. During the flight, a flight attendant came distributing the embarkation card so that it would be easier for the passengers to move through the customs at the airport. When it was my neighbor's turn, he stretched out and said, "vegetable." He thought she was distributing food and he wanted the vegetarian dish. "No, no, it's not food, it's the paper for the airport, just take it," I told him in Nepali. He gave a sheepish smile, I passed along the paper to him. 

Water and Vegetable were the only English words this gentleman used during the flight. With his limited capacity to understand and communicate in another language, he might have felt indignation in the events like above. But this is the indignation that millions of Nepali migrant workers endure in strange countries, in an attempt to make a living for themselves and their families. Maybe unknown to them, they have indirectly been helping to make a living for the whole country as well if we were to look at remittance statistics of this country.  
Source: Chandan Sapkota's Blog (http://sapkotac.blogspot.com/search/label/Remittances)
When the government and rebels were busy slitting each other's throat, tying people to tree and planting knives at them, and lighting fires in the villages and homes, the wrecked country was kept afloat by the sweat, toils spent amidst the indignation and abuses of strange countries. Even now, when the bureaucrats and politicians are busy talking high talks, the actual progress is happening at these daily lives, driven by a simple desire to make a livelihood for themselves and their families. Do not these toiling lives deserve some respect from the country? 

Apparently not, according to our bureaucrats and government officials who actually live on the taxpayers' money. The Commission for the Investigation of Abuse of Authority (CIAA) recently arrested a few customs officials charging them of abuse of authority. Retaliating, the customs officials have started sending back workers home from the airport giving ludicrous reasons.  Hundreds of workers have been turned back from the airport. Remember, these are the people who have taken loans and risked everything to be able to go to one of these countries. What the truth is in terms of legitimacy of CIAA's action and customs officials' grievances is a complex matter and we will never be able to find answers from afar. We know, the world of facts and truths might be quite disconnected from that of rhetoric, rumors and speculations. The only way to figure out would be a griding exercise of objective fact finding conducted by pure intentions. That is a different matter. If they have a capability to do that it is welcome.Otherwise, they have no moral authority to desecrate the risks that a common person has taken to earn a livelihood. And what is absolutely clear is that hundreds of people are being treated with ruthlessness, the same people that fund their luxury and livelihood. Where is the shame? What a ruthless cruelty?

I can go on forever rambling on this outrage. But the wise Coetzee would wrap the entirety of this atrocity in a few sentences: In From the Heart of the Country, he writes--

The innocent victim can only know evil in the form of suffering. That which is not felt by the criminal is his crime. That which is not felt by the innocent victim is his own innocence. 

Monday, August 19, 2013

Journals, Diarrhea and Soul

  1. Asian Journal of Medical Sciences (eISSN: 2091-0576)
  2. Health Prospect ( ISSN 2091-2021 (Print) 2091-203X (Online) 
  3. International Journal of Life Sciences
  4. International Journal of Occupational Safety and Health ISSN 2091-0878
  5. International Journal of Infection and Microbiology (ISSN 2091-2145)
  1. Journal of College of Medical Sciences-Nepal
  2. Journal of Institute of Medicine
  3. Journal of Nepal Paediatric Society
  4. Journal of Kathmandu Medical College
  1. Journal of Nobel Medical College ISSN 2091-2331 (Print) 2091-234X (Online)
  2. Journal of Pathology of Nepal ISSN 2091-0797 (Print) 2091-0908 (Online) 
  3. Kathmandu University Medical Journal ISSN 1812-2027 (Print) 1812-2078 (Online)
  4. Medical Journal of Shree Birendra Hospital l ISSN 2091-0185 (Print) 2091-0193 (Online)
  5. Nepal Journal of Obstetrics and Gynaecology
  6. Nepalese Journal of ENT Head and Neck Surgery
  1. Nepalese Journal of Ophthalmology (ISSN 2072-6805, E-ISSN 2091-0320)
  2. SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS
  3. Journal of Advances in Internal Medicine
  1. Journal of Nepal Medical Association
  2. Nepal Journal of Dermatology, Venereology & Leprology ISSN 2091-0231 
  3. Nepal Journal of Epidemiology eISSN 2091-0800 
  4. International Journal of Physiology and Pharmacology
  5. Nepalese Journal of Radiology
  1. International Journal of Brain Research
  2. Nepal Journal of Medical Sciences ISSN 2091-1424 (Print) 2091-1459 (Online) 
  3. Nepal Journals Online
  4. Journal of Patan Academy of Health Sciences
  5. Health Renaissance
  6. Journal of Nepal Dental Association
  7. Journal of Society of Surgeons of Nepal
  8. Nepal Journal of Oncology
  9. Nepal Medical College Journal
    (Sources: Edusanjal, online search)
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    Diarrheal diseases are killers. In the developed world this statement might be redolent of historical difficulties, but in poor countries like ours it is still a reality. In 1970s, worldwide, there were estimated 500 million annual episodes of diarrhea in children under five years of age resulting in at least 5 million deaths per year. These are staggering numbers; losing millions of our children to diarrhea is heart-wrenching. It is quite understandable how desperate an issue it might have been to the people working in this field to bring down the mortality from these diarrheal illnesses. Unfortunately, there were no effective treatments that were accessible to poorer countries where the majority of the mortality occurred. Intravenous fluids were effective in saving lives but this was impractical to cover majority of the population in resource-starved countries. A simple discovery in the late 1960s offered a dramatic remedy. A solution made of salt, sugar and water was found to be very effective at saving lives. This is now known as oral rehydration therapy (ORT). Furthermore, families could be educated to administer the cure: there was no need of expensive health care workers to treat the ailment. Population-wide measures to make ORT accessible to the needy started in the 1970s. By 1995, 58-81% of the needy population had access to ORT and by 2000, mortality reduced by 50%. That is the number of lives saved in millions by a simple idea, a simple solution. 

    However, the history of the discovery of ORT is quite complicated. It involved meticulous lab experiments, clinical studies, casual experimentation, meticulous clinical trials, opinions, assertions, competitions, authority, serendipity. Several of these events found a place in several journals of the time. But what struck me was the frenzy and desperation that existed in these researchers to try to find a solution to this killer disease. The problem was the soul of these efforts. The publications in journals were secondary. Journals articles did not precede the horizon-changing discovery. The zeal to find a solution superseded everything else. 

    As I look at the list of the medical journals published from Nepal, I can not stop asking myself, "do these articles published in these journals have souls: like the innocent children dying of diarrhea?" If they indeed have souls, the sheer number should indicate that we are on a warpath with the health issues in this country. But having worked at a busy public hospital for a year, I had hardly shared the chest beating of a war. Instead I was bothered by indifference,  fatigue and dejection of the health care system: so disconnected from patients, so disconnected from ailments. While the energy expended and enthusiasm expressed in publishing these journals is appreciable, the value of these efforts should by scrutinized, mainly because it might not be a harmless exercise. 

    Lessons from those societies where these are scrutinized are especially illuminating to us. Those who have worked in both the worlds know that the rigor of science and scientific integrity is dramatically much better in the developed nations which have done science for much longer than what we have. But some of the recent articles about the published findings in scientific literature even at these shores are alarming. Nature, the journal, reports that, "in 2012, scientists at Amgen, a drug company based in Thousand Oaks, California, reported their failure to replicate 89% of the findings from 53 landmark cancer papers." A highly cited article in PLoS Medicine, a reputed journal says, "It can be proven that most claimed research findings are false." If that is the state of affairs in the much evolved scientific publications, do we claim we are doing a better job? I would not. 

    A little while back, I was granted an acquaintance of an eminent doctor who was making rounds at the academic communities while on a vacation trip to Nepal from the US. He was certainly a successful doctor, he had already climbed up the academic ladder at a US university to be the chair of the department, this is no small feat for an immigrant doctor. He had a good list of publications under his belt. In response to another doctor questioning his contribution to the society he argued, "Dr. Saab, I am not just doing a private practice and seeing patients, I have been publishing, doing science that has implications to the whole of humanity, not just in the US or Nepal."

    It seemed like a plausible argument at the time. But as I look at these publications, these journals, I feel offended that he thought he was a superior social contributor compared to his peers who do primarily patient care. If we are to go by the findings of the above articles, this gentleman is more likely to be contributing to the junk (forgive the candidness) than to any significant contribution (in all fairness, he might be doing significant science as well; I have not read his articles). To the soulless junk. But the soul lives in the suffering patients. At least he would be doing justice if he did not think himself more valuable than his peers who are directly tending to the sufferings of day-to-day patients. 

    There might be a plethora of reasons of why someone wants to publish or write in journals. But we can not skip asking, do these articles have a soul, are they true? Furthermore, in situations like ours with dire health care landscape, it would do more justice if we try focusing on tending to the sufferings of the people by means already available to us than be sidetracked in this mushy exercise of producing junk. Journals are useful tools to communicate our strives but there should be striving to start with. Clearly, this tiny country does not need 33 medical journals to communicate. Those in academic fields in Nepal would do tremendous justice to all if they stopped and did some reflection amidst this race of producing medical journals.