FEATURE

INDIA STORY - WHERE IS IT?

Dr.K.Shanker Shetty

 

“While all other sciences have advanced, that of government is at a standstill little better understood, little better practiced now than three or four thousand years ago”.

 

John Adamns

A cursory glance over political, economic, social, military and technological upheaval in India reveals the unmistakable impression that as a modern state it has no longer anything but rights yet it does not recognize duties of all stakeholders. Indian rulers of the day refuse to change and it is often said that a state without some means of change has neither a present nor a future. Since 1947, Indian governments led the country on the path of ideologically camouflaged policy till it’s economy was ruined. But for the timely action through reforms in 1990s, India would have perennially existed as a ruined state with devastating impact upon the common people. The reform process enabled Indian nation emerge as a strong nation in terms of political, economic and social achievements. However, that golden phase started dissipating. Though greatest asset of any nation is the spirit of its people, it has been misled and mismanaged by the government, lacking leadership, governance and policies. A nation’s greatness resides not in her material resources, but in her will, faith, intelligence and moral force led by able, dynamic and effective leadership. It is needless to say that what makes India great is not primarily its great men, but the stature of its leadership.

Recent events in India stand as testimony that present governing dispensation is devoid of such stature and versatility plunging the nation into economic darkness. India grew at a rate between 8 to 9% in 2008 - 09 as against 3.5% during pre - reform era. Reforms enhanced scope for flow of FDI; savings rose to 35% of GDP, investment by 38% ably assisted by global market environment. India secured its rightful place at the international head - tables. It came out unscathed the economic tempest in S. E. Asia in 1990s and global economic recession in 2008 - 2009.

However, what has happened after 2009 is a matter of grave concern. 'India shining' has receded into the dustbin of economic history of India; `India story’ does not evince any interest in global arena. India as future global power, remains a suspense. Questions are being asked as to why India is on a reverse gear? Why India has descent with depression on its growth story? Why its dreams are shattered? It hardly need extra efforts to find reasons. Apart from lack of reforms, fiscal and current a/c deficits; retrospective tax laws, limitations to monetary policy regime, lack of vision and confusing investment policies have contributed to the downfall of Indian - economy, precipitating reverse flow of capital and investments from our shores, including investment by Indian corporate.

Ofcourse, it is very clear that political system has failed to function; democratic principles have been bartered away by the selfish political class, leadership failed miserably to lead. It is obvious that even as democratic policy paralysis is rampant; disappointing status of governance is frustrating; wide communication gap between the people and the leaders like Prime Minister is pervasive; federalism is under strain, even the opposition proved to be mediocre at times with unprincipled approach by many political parties; there is irrational power hungry approach among UPA, NDA, regional and other political parties pushing the country to a point of disastrous failure. Obviously, whereas, there is a competitive greed for power within the opposition, the ruling congress led UPA has contradictions from within which has stymied the growth story of India, almost into a nullity.

During the last several years, millions go hungry even while millions of tons of foodgrain rots in rain. Credibility gap between government and the governance is widening with a hopelessly ageing leadership. On the otherhand, more wealth, better jobs with high salary, bigger cars and political muscle power by a few taunts the lower strata of the society. Though government announces ceaselessly its intention to tackle corruption, everyday new skeleton of corruption is falling down to the ground with a thud. Black money coffers estimated to be Rs.24 lakh crores still is well - protected in the lockers abroad. Finance minister's brave attempt to introduce a “white paper” on black money on the last day of parliament session is justifiably termed as “a black paper on black money”. Corruption is rampant in every walks of life involving ministers, politicians and bureaucrats without any preventive or remedial actions. A survey reveals that 66% of the population is frustrated, angry and crying for relief. Price rise is pinching their pockets; inflation makes their lives miserable; food security is eluding the needy; Lok Pal bill remains a mirage; reforms are a part of history; poor - rich gap is increasing. Four member family of Mukesh Ambani stays in a 48,780 sq ft building; just 7 K. M away in Dharavi where 2 - 3 families live in a room of 10’ x 10’ dimension; progress under power and energy, infrastructure like roads, railways and ports are far behind the projected targets; lack of planning, execution, lack of vision are the rules of the day. Due to restrictions under the pretext of environmental issues, new industrial projects are prevented and all these and many woes are attributed to the compulsion of coalition politics!

In reality cycle of politics within the precincts of democratic edifice, India suffers potential ignonimity. After 8 years of UPA rule, governance suffers from Policy paralysis said Mr. Kaushik, PM’s economic advisor. How true he is ! Obviously, there is lack of direction over - ruled by political exigencies. Otherwise, how can one explain the regimental approach on foreign investment in retail, provident fund, insurance?

During the year 2012, Fiscal deficit is expected to be 5.1% of GDP; GDP growth at 6.9%; Rupee has been depreciated by 25% against dollar in a year is a matter of serious concern. Inflation is likely to be in double digits; FDI have migrated back to greener pastures; current account deficit has been very high at 4.5%; foreign exchange reserve started dwindling from the high at $350billion; Industrial sector is at a disadvantage with a negative growth rate compared to 2011 - 2012.

In view of the above disappointing scenario, there is an urgent need to sustain high growth; Recent policies on telecom, retrospective tax legislation, must be reviewed as these have created a negative sentiment about India in the global market. GST must be introduced as early as possible. UPA government seems to be aloof, tired, directionless. Capacity and willingness to provide good governance seems found wanting. Miracles cannot happen in the art of state craft. Solutions on issues like Lokpal, NCTC, reservation for women, bills on RBI Act amendment; Mines and minerals, Food security, must be found. People must be taken into account and placed on board. Youth must be offered active role in the task of nation building. Federalism ought to be respected.

Indian governance to revive and reform the economy cannot wait till 2014. The difference between austerity v/s profligacy must be understood properly. Land reform must be taken up without delay. Blackmoney cannot be wished away through amnesty which is an immoral retribution to those criminals who have illicitly and illegally carted national resource abroad for personal benefit. Blackmoney perpetuated mostly by the political, corporate and bureaucratic class, must not be allowed to go scot free with amnesty gift. It is a pity that out of 1110 million Indians only 33 millions pay taxes. Moreover, tax system itself is defective. India can fight the future danger of oil - price hike only if they succeed to bring back the Rs.24 lakh crores worth black money from abroad and penalty proceeds must be used for the growth of the nation. What is more intriguing is that even as the government did not hesitate recently to hike the petrol price by Rs.7.5 a litre at a stroke, it withdrew the budgetary import duty on gold. India imports 1000 tons of gold annually at a high volume of outward flow of foreign exchange involving about Rs.50000 crores subsidy and only 2 ton of domestic production. Government does not hesitate to offer Rs.30000 crore relief to Air India as a reward for its omissions and commissions; Rs.16000 assistance to banking sector through recapitalization. No government has ever dared to tax even rich agriculturists and instead subsidy is extended to them. Government though announces austerity measures, makes no efforts to reduce administrative cost; instead, borrowing has exceeded Rs.1,00,000 crores to meet such costs. It is also a fact that through budgetary proposals even the corporate sector has been extended a series of innovative subsidies to the extent of Rs.86,000 during 2012 - 2013. In short, the policy of the government remains lack lustre, distressing, non - transparent and at times whimsical.

No one can deny the fact that as on date, India as a nation is going down the road to statism. Where we will wind up, no one can forsee. Yet, there is the need for imperative changes through active participation by farmers, workers, manufacturers, lawyers and doctors. In other words, national progress is the sum of individual industry, energy and uprightedness, where as the national delay is the consequence of mismanagement of financial and human resources by the political and bureaucratic classes. Political class must govern by serving the people, not serving their own selfish objectives. If this rule is accepted without exception, India shall grow faster and stronger. Civil service in India has itself become such a spoils system that it refuses to move forward. Our prime minister and the entire gamut of politicians must be aware that the government is itself an art, one of the subtlest of arts. It is neither business, nor technology, nor applied science. It is the art of making men live together in peace, think alike and secure reasonable happiness. Obviously, greatness of India, depends upon the resolution to be taken by all stakeholders, the government, the bureaucracy, politicians and the people at large. However, people in India at present have become the pawn in the hands of politicians and bureaucrats in the chess game of politics. The question is who will save India from its downward move into a dark future and restore the glory of first decade of 21st century, into the great future?

“Future belongs to those who are virile, to whom it is a pleasure to live, to create, to what their intelligence on that of others” - Sir Henry Deterding.

In nutshell, if India has to `shine again’ and `India story’ has to be revived, global situation must not be quoted as the cause for our mismanagement of economy. In this direction policy must be activated as a dynamic weapon to improve our exports in tune with increasing imports as in China; shrinking industrial production must be increased through conducive policies and management practices; high - interest rate regime ought to be tamed by banishing policy paralysis forever; FDI and FDI inflow must be stopped from exiting through appropriate policy formulations and policy flip - flops must be avoided by adopting positive approach to revive sagging capital / stock market; every step must be initiated to pull the rupee back from its present journey towards the brink.

However, all these and many others can be achieved in India only when our leaders determine to `de - politicalise’ the economic and redistributive policies forthwith. But, who will bell the cat? Let it be known that future belongs to those who are virile but with a vision for the future. India has the strength but it’s government lacks will; because action practice always succeed `will’, to perform.

Author is an economist and a former General Manager of Vijaya Bank.

 

Bedside Medicine

Introduction:

Bedside medicine, the very foundation of medical practice, has been given a go by in the west, which is being followed in the east as well, thanks to technology and the attended affluence that accrues by this practice to the practitioners and hospitals, to the sad detriment of the hapless patients. There have been sane voices in the west decrying this new trend but the medical clap trap drowns their pleas preventing the practising doctors from getting to know the great loss that they have suffered in the bargain. Time has come, as Walrus said, to “talk of many things….” about the benefits of clinical bedside medicine to the practice of medicine in general and the anxious patient in particular.

Medical consultation, which is the summit of all medical care, consists of two human beings coming together-one who is ill or imagines being ill and, the other in whom the former has confidence. This will remain so for all times to come. Man’s greatest enemy is pain which was so in the past and will remain so in the future as well. Any ill person needs another human being, the physician, to help him get well. The physician can never be replaced by technology and robots. Recent scientific research has thrown up a new concept that explains the consultation very scientifically, if ever that was needed. Expectation Effect (EE) is the latest mantra in science circles. It is this effect that stimulates the immune system that ultimately results in healing. The drugs and interventions are only tools in that process. Expectation effect depends on that confidence, mentioned earlier, in the context of medical consultation. Even from the scientific point of view bedside medicine takes the cake.

With the advent of the first clinic and then the hospitals, bedside medicine started a long journey to almost oblivion today with the onslaught of technology and the attendant claptrap. The pitfalls of the latter have now made people to sit up and think that it is necessary to go back to the basics of bed side medicine for good patient care. After all, patient care is just caring for the patient. The first meeting between the patient and her/his chosen doctor is the most important one for the former to develop that confidence that is vital for healing. Logically a humane doctor would fit the bill very well in this scenario. Let us, before we go further, define the ingredients that go to make a humane good doctor. Doctor should be able to smile at some one naturally, should be able to pat some one on the back comfortably, and should have an insight into others’ problems! It is not at all a tall order. If one possesses those qualities of head and heart one becomes naturally a good doctor, placebo doctor. It will be difficult to be a natural good doctor if one is not made that way. Life then becomes a distress to practise medicine.

Nocebo doctors, that do not command the respect and faith of their patients, might end up with poor treatment outcomes. This explains why individual treatment outcomes differ significantly although, in the midst of our statistical assessments, these differences get blunted. However, this shows very clearly in surgical outcomes measured these days for individual surgeons in the UK. Every doctor should try and become a placebo doctor sooner than later as the modern medical outfit is on the threshold for being run over by many alternative systems that offer compassion in large measure in addition to their craft. Many of those systems also have many scientifically authenticated management strategies backed by long standing experience in the field. Some of them are more ancient compared to modern medicine that started around 5000 years ago on the Nile Valley as sorcery, mumbo-jumbo and witchcraft gradually transforming itself en route from there to the west via Arabia and Greece. The journey of modern medicine had transformed medicine with influence from many sources. What has not changed, though, is the compassion that goes with the practice of medicine. Every doctor should remember that while a patient could survive without the help of a doctor; a doctor, on the contrary, can not survive without patients!

This book will go through the whole gamut of bedside medicine, starting with the most important part of talking with the patient through systems review and gives, at the end, a logical plan to arrive at a bedside clinical diagnosis. Clinical diagnosis is very important lest the patient should be put through unwanted investigations resulting in the patient (or any payer) wasting precious money. It could also expose the hapless patient to the dangers of some of those tests. Bedside clinical diagnosis with reasonable differential diagnoses is our goal in training the young minds to become good doctors through the best practice of clinical bedside methods. Line diagrams and photographs, where needed, are an added attraction here. One picture might spare a thousand words of description. Good doctors with a conscience are the need of the hour today as there are thousands of patients that can not access modern medicine for want of financial support.

Poverty being the mother of all illnesses and not knowing where one’s next meal comes from being the greatest risk factor for major killer diseases, we doctors have a duty to the poor. The gravity of the problem could be guessed if one knows that there are well over 824 million people below the poverty line and around 540 million people are severely malnourished. Poverty with the consequent undernourishment depletes the immune guard of our body to the invasion by germs that otherwise coexist with us in this universe. Poor immune guard also assists the major killer diseases. Even heart attacks are seen to be commoner among the poorer sections of the society even in the industrialized west! Bedside good medicine could be one of the ways of taking modern medicine to the poorest of the poor to do most good to most people most of the time, the very basic ethical tenet of a modern medical doctor.

“A man’s vanity tells him what honour is; a man’s conscience tells him what justice is.”

Walter Savage Landor.

to be contnd. in next issue...