A Doctor who has been a Medical Messiah for us

My father is almost 86, he has been living with some chronic diseases in a small town called Mandi in Himachal Pradesh after his retirement. He got diagnosed with CKD in 2021, largely due to mismanaged or rather unmanaged ( if that's a word) BP and Diabetes during covid period. He had these issues since a long time but both BP and blood sugar had been absolutely under control for close to almost 25 years. In Mandi we neither have an endocrinologist nor a nephrologist. Medical College Ner Chowk, AIIMS Bilaspur (when I last checked) also didn’t have these specialists. Since I have lived all my life in Delhi before we moved to the mountains, the next best option for us was to get in touch with specialists in Delhi. I must start from the very beginning. Around 2020 when Papa was hitting 80, we could see that he was growing weaker by the day but he would not listen to my sister, mother or me when we would ask him to see a doctor and get the tests done. He was checking his BP at home and doing random sugar tests on his own and then justifying one way or the other every high figure of blood sugar to convince himself and us that everything was good. There was no discipline left in his life as far as timings of eating his meals was concerned. His intake had ceased to be balanced and nutritious as they had always been since he was diagnosed with diabetes and then later with BP. Covid had wreaked havoc with his life style. Since there was no routine to be followed, no social life, no meeting with people, no going out anywhere, eating habits became erratic both in terms of timings and the quality of food. My brother in law Dr Satyavrat who papa listens to most also tried his level best to get papa to do some tests but nothing was really working. He needed a thorough examination, change of medications, a discipled eating schedule, we couldn’t get any of that done. One day a very dear friend of mine Dr Suchitra Behl who is a diabetologist and is based out of the US was visiting and i requested her to sit down with my father to figure out what was going on with him. It was a tough task to get my father to talk about his medicines etc. He thought he was doing everything right and we did not have any right to question his judgement or decision. I knew that he had been taking the same medication for years. Though his medicines were prescribed by the best doctors but it was done a long while ago. It needed a review and Suchitra readily agreed to do the initial review. She had a tough task as my father did not even have a prescription that she could refer to but the great thing was that he was willingly talking to her and answered all the questions that she had to ask. He knew about her being a great doctor and that helped. She painstakingly jotted down each and every medicine that my father was taking, spoke to him very patiently and advised him to get some tests done. She told me to talk to Dr Piyush Vaidya who is a very competent MD Medicine in Mandi town. Dr Piyush happens to be my father's very close friend/colleague/cousin's son and he thinks very highly of him too, so readily agreed. Papa was diagnosed with CKD, his test results were all over the place. His blood sugar and BP were not with in the advisable range. Piyush managed papa's case for a while and then advised us to see a nephrologist and an endocrinologist. My hunt for doctors in Delhi started and I went to a couple of very renowned nephrologists for their opinion. The consultations with these doctors were so transactional and mechanical that I didn’t have the heart to go back to them. I was not getting the comfort feel that one needs to have, could not repose faith in whatever these doctors were telling us because they very evidently lacked empathy and did not engage with our unique circumstances where my dad could not travel to be present in person. My dad was just another patient to even the doctors that we thought were either children or friends of family friends. I was complaining to Suchitra about this when she said that we should go to Dr Ritesh Gupta from Fortis C-Doc Delhi. My husband Rakesh Vaidya established contact with him and fixed an online consultation. Our life changed forever after that. Before we knew, Dr Gupta took charge and ownership for my father’s health. Initially for a very long time we needed to talk to him almost every day, as papa was being introduced to insulin to manage his blood sugars and it took a long while and several titrations before it could be managed. He was always just a phone call away. He never rushed any of us whether Rakesh was doing the talking or I was doing the talking. He always listens, understands, empathises, engages and sounds invested. He makes you feel heard and important. When I talk to him, I know he is paying attention and is taking everything as seriously as I am. He sounds as concerned about papa’s problems as I am. He inspires confidence, I feel reassured and have the confidence that my father is in safe hands. It has never happened that he has not responded. I have lost count of the number of calls we have made to Dr Gupta especially those initial days and over the years till today and will make for many many years to come as am sure papa will live 100 years. A private doctor from Delhi who is super busy, working for corporate hospital and is still accessible and listens to you every single time you have a problem and solves it without ever bothering about his consultation fee is like a miracle, we are truly blessed to have him in our life and I sincerely mean this as he is our lifeline when it comes to papa, almost like a medical messiah for us. There is no way we can ever pay him back for his kindness and graciousness. We didn’t know what was the right way to navigate this, we did whatever we could but we haven’t paid him anywhere near enough at all for the amount of calls that we have made to him (still make) in these five years. He hasn’t seen my father but he has been successfully managing his health till date and papa’s creatinine hasn’t really increased since diagnosis. His BP and blood sugar also remains largely within acceptable range. Upon my request he recommended us a nephrologist in Max who we go to in time of need when Dr Gupta tells us. No one can be like Dr Ritesh Gupta. It's not been an easy ride but then it’s not been that tough primarily because we are extremely fortunate to have a doctor who has been making himself available to us almost 24x7, 365 days in a year since we went to him in end of 2021. The turn around time with him is varying from a couple of minutes to a couple of hours in case he is really caught because busy he sure is all the time. I feel we can not be a special case. I am sure, since he is a  person with deep empathy and a kind heart, everyone has a similar experience with him. We as a family, are and shall always be indebted to him for what he has been and still doing for papa. Dr Gupta we are grateful to you and shall always be.

A day in my life at the farm....

It’s been 7 days now (counting..) and about a week earlier that I had to do and currently doing everything as in everything that you can conceive of to run a well-oiled house for the first time in almost three decades of my married life. Before marriage running the house was my parents’ remit. Covid time was an exception and because we were all together in that we all worked and got out unscathed out of those extraordinary times.People do it all the time in the west, we all admire them for doing everything by themselves. Infact this very thought has not only kept me going but also encouraging me to do things happily around the house. Yes you are right I am an upper middle class, privileged woman. I am professionally qualified but pursued my career in accordance with the needs and circumstances of my life giving priority to things that mattered to me more at any given stage of my life. You are also right if you think you don’t want to hear me rant just because I am having to work for a few days or think I feel entitled because I feel the need to talk about it. Your lack of interest in what I have to say is totally justified and yes I think unbeknown to me whether I like it or not entitlement about certain privileges, services and amenities are deeply entrenched or may I say I have always taken them for granted all along thus far. I used to fancy myself someone who could live without anything much but that’s of course not true. I find myself in this situation because I am not living in a city anymore where most of us live in apartments and services, which are quite affordable, are easily available. I now live in a small village, in a big house surrounded by gardens and orchards. Here in the village finding people who would happily work for you is quite a task. It’s not a sign of prosperity in the village unfortunately but a result of a very complex socio-economic milieu in the village. There are a lot of unemployed people of all age group, youth, middle aged and old who need work and are technically available for any kind of a job that pays living wages. It is a separate story and for another time why they don’t work or how they work if they for some reason choose to. Today I want to tell you another story. So sweeping, mopping, dusting, washing and ironing, doing dishes, buying groceries, cleaning the corridors around the house and paths in the garden, putting biodegradable waste in the pit and dry waste in the bin, are some of the many tasks that need to be done on everyday basis. One also has to put food on the table thrice a day apart from making tea or whatever else is required during the course of the day. In these two weeks I have been thinking hard involuntarily while I am also working incessantly on various things to keep my house running “business as usual”. Firstly I am proud of myself that I could keep up and have not let the routine and the rhythm of my house get disrupted dramatically, though it’s been a big ask on my time and on my routine. I don’t read as much as I used to, I don’t write and no research is possible, haven’t been to my gym which in any case was a new found hobby as whenever I find time I need to just lie down read "Mother Mary Comes to me" and feel rested. By the way let me clarify its just my husband and I and we have a big house as stated earlier in an orchard lest you think I am slaving to serve my parents or in-laws or children. I am working only to maintain the life style that we have grown accustomed to. I realise that all these tasks are done unaided everyday by zillions of housewives all across the world and of course also by millions of working women who can’t afford any help. These tasks are unending, repetitive, mundane, mind numbing after a while and thankless. They don’t ever end, women are stuck with these Sisyphean tasks for their entire life. Like Sisyphus could never roll the stone uphill, house chores also don’t ever get finished. Once you are done for the day you have to think, plan and prepare for the next day. Every day house needs to be cleaned, food to be cooked and washing and dishes to be done. Same things to be done till you die…… However Sisyphus like most of these housewives were content with their fate I don’t see myself being like that for too long. I am already looking for breaking this cycle, planning and plotting to save myself from this Sisyphean fate. I am amazed at the resilience, patience, tolerance and tenacity of women who do this all their lives without complaining. I can now say that I understand how time consuming and back breaking these tasks are apart from being monotonous, boring and both physically and mentally exhaustiing. Not that I didn’t know but then I only knew it theoretically and now I am living that life. If you want to do a good job, which most housewives do, there is something always pending, waiting to be done. I always considered these tasks beneath myself and thought that I could use my time better given the education, expertise and experience I have. I always did them with a grudge whenever I had to do the same due to temporary absence of staff. I always thought my time was getting wasted. The other day I was thinking what have I done with my time when I didn’t have to do these mundane tasks. Is there anything that made even a tiny change in the way the world works around me or in general? Could I leave a mark in the area of my expertise or bring about happiness to others or people in the community? Have I been useful to anyone, make anyone’s life better or have contributed in any meaningful and productive manner to the social set up that I am a part of? Will my absence be felt? Will the newspaper call me to write about the latest environmental issue ? Will my voice be missed in the meetings and seminars or in the court? No I don’t think so …it was my ego that made me feel so important and considered all these tasks not worth my time. My absence will not be felt anywhere. I am not even important forget about being indispensable anywhere. Be able to live on daily basis whichever way one chooses to, takes a lot of effort. Each one of us should have this experience to understand what all does it take to make the life we live without ever thinking about things that are readily available to us. To be honest I find this harder than the arguments I do in the courts, tougher than the work that one has to do to write respectable articles, more time consuming and strenuous than my legal policy research and last but not the least more thankless and more unproductive than the policy advocacy that I do. Might as well go with the flow and live life happily the way it meets you.

What a Nightmare but Thank You Hackers

Sounds counterintuitive right and am sure you all must be wondering why am I thanking the hackers. Let's begin the story, at 9.33 a.m. on a Tuesday, a working day, when I was busy doing numerous things I got a what’s app message from my sister-in-law saying that she by mistake had sent me a message which contained her “what’s app code” whatever that means and she wanted me to resend it to her to enable her to operate her what’s app. I could not quite get the message, saw a red flag and called her back. I was wondering why would she want me to resend the message as she would still have the massage in her sent messages and she was operating her whats's app. Despite sensing a red flag I failed to take as much precaution as the situation demanded and made a fatal mistake. I called her back thinking I should verify with her but I made the call on what’s app audio instead of a regular call. I intended to make a regular call as in any such situation where an unusual demand is being made especially vis a vis a code or an OTP one should get alerted that there could be something wrong with the what’s app so to be on the safer side the call should always be made by any other mode like a regular call or a landline. I made a what’s app audio call inadvertently as I just looked for her number in my call log. In an I -phone the call log is mixed, what’s app audio and regular calls both are recorded together in the call history. I knew this for a fact but at that moment instead of being super careful and making sure I was calling on the regular number I faltered big time, didn’t pay as much attention as I should have and did the unthinkable which landed me in a thick soup and taught me several life lessons . Let’s first talk about the mundane before I share the sublime and the life lessons with you all. I pressed her number from the call log which unfortunately was a what’s app audio call as the last call I had made to her was a what’s app audio call in the morning to enquire about her health. My call was denied and that was another red flag which I miserably failed to take cognizance of. I got another message saying, “I am not feeling too well and will call you later could you please immediately forward the message.” As luck would have it she wasn’t feeling well since the last evening and this message made me fall right into the trap and without making any further enquiry I forwarded the message. I violated the golden rule. The hacker obviously knew that she wasn’t well from my chat history. When I thought I was talking to my sister in law I was talking to the hacker as her what’s app was also hacked unbeknown to her or to me at that time . My mamaji told me later that the message addressed to him started with Hi mamaji and to my chachaji as hi chachaji. A few of my friends and well-wishers who reacted immediately tried calling me back but made the same mistake as I did, called me on the what’s app audio which was in control of the hacker. Upon confirmation from me as far as they were concerned as they didn’t know or realise that it was the hacker who was impersonating me responding on the what’s app massage, a few of them went ahead and helped by sending money on the QR code /phone number. A lawyer friend in the morning as soon the message was received by him realized that my what’s app was hacked and got the person tracked with the help of cybercrime police and sent me the details. I then officially lodged a complaint with the cybercrime police. A few of my friends engaged with the hacker to get us the details of his bank accounts thinking that it could help the cybercrime police to trace the person and his location. I submitted all such evidence collected by my friends to the cybercrime cell. I reached out to my friends in the police even across the state borders to expedite the matter so that with their intervention my what’s app could be restored to me at the earliest. The hacker had disabled me from getting logged out, I could not uninstall the app or reinstall it on another device. The hacker was deleting messages from the groups I was a part of. They knew who my husband was and threw him out from many groups . Anyone putting a message alerting people that my phone was hacked was being deleted by them as they were in complete control of my what’s app. They could do whatever they wished in all the groups that I was a part of and especially where I was an administrator. I had to tell my sister and cousins to broadcast it on their social media account as LinkedIn is the only social media presence I have. With the help of the AI the hackers knew my relationship with people and also the current status of our conversation. In the case of my sister-in-law from where the whole story started if the second message was not as specific as it was I still give myself benefit of the doubt that I would not have fallen for their tactics. I was quite distressed and felt very vulnerable and threatened. I got all my on-line banking apps, credit/ debit cards frozen including the G pay and Paytm. I didn’t know whether that was required or not but I didn’t want to take any chance. Later when we knew for a fact that it was only the what’s app that was hacked we realized that freezing my banking apps and others was an overkill. Golden Rules to get saved from hacking • Don’t ever help anyone by sending money till you speak with that person on a secure line which could be a regular cellular call or a land line call. • Don’t ever forward/resend any codes of any kind to anyone whatsoever Now let’s talk about some great things that were the unintended fall outs of this almost nightmarish experience but enriched my life and gave me insight into who I am and how much I am loved. Between my husband and I, we were flooded with calls may be 50-60 people all of who had got the distress message for help from me. Then there were people who couldn’t reach us as our phones were perpetually busy who called my parents and sister. So after a while I really felt overwhelmed with the concern, family and friends were expressing. I was beyond touched by peoples’ generosity who without hesitating for a moment gave me money or were willing to give me money. I felt so much loved and I mean this howsoever stupid it might sound . I am a human after all that too an emotional one and my heart was filled with gratitude for the goodwill I never thought I had amongst my family and friends. Another very humbling discovery was my own stupidity. I never thought I for one could fall for something so stupid like this but I did, exploding the myth of my own smartness, alertness and presence of mind in my own estimation. I thought I couldn’t suffer fools but this experience made me realise that I too have some more than fair amount of foolishness in me and I need to be more accepting and forgiving of others’ failings. I always wondered who are the people who would send the codes to hackers and practically hand over the phone to them. I am also one of them and the fact that the hackers were very smart don’t make me any less foolish. Now I think I will have more empathy for people who fall prey to such crimes. What a day it has been. I am still trying to reactivate things that out of fear I got frozen. It will take minimum of a week before the fresh physical debit card will reach me and I would need that to reactivate my money apps.

GIPSA; Its Ramifications and Implications

Our 20 years old son needed to fix his knee which got injured while playing a football match for his university team. MRI revealed his ACL had a grade III tear and as per the medical experts’ opinion, if he wanted to continue to play football, he needed to get it reconstructed. We, as a family have had a medical insurance cover forever, earlier during our active working days, a corporate one, after stepping off the corporate treadmill, a family floater. We have chosen to be with a government medical insurance provider, as that to our mind was more reliable and dependable based upon our research and also on anecdotal evidence available around us, which to my disappointment turned out to be a myth. We were always intrigued when people around us would say that they were denied cashless facility or have been chasing their reimbursement with their medical provider as we thus far had a smooth ride. We discovered in a hard way now since we didn’t have a corporate medical insurance cover that we belong to the lowest rung of the customers i.e. retail medical insurance buyer who are given the rawest deal when it comes to facilities by these public sector insurance companies. In any case it is a well-known fact that any medical insurance whether issued by public sector company or by a private player is beset with numerous fine prints and one has to be very careful while buying one and should always consult a trustworthy, knowledgeable person. Our story below will give the readers a fair idea into how medical insurance works and how retail customers of public sector insurers are at the receiving end of this complicated, opaque system. I would also like to flag at the outset that ours’ was an elective surgery, we have a little bit more awareness as customers because of our professions and we had all the time in the world to take on the system and ended up in a hospital which turned out to be more ethical than most of its peers. I wonder how people, unsuspecting common people, in time of medical emergency manage to navigate this system successfully. So, after an in-depth research, survey and meeting a few doctors in different hospitals about available options to get our son’s knee fixed, we had finally zeroed in on a doctor and a hospital to carry out the ACL reconstruction surgery. We had taken a decision after weighing in all options and were happy that a date was fixed for the procedure. We applied for a pre-approval from our TPA as is the norm for availing the cashless facility for medical insurance. The expense estimated by the hospital was quite well within our insurance limits and we thought it was just a matter of procedure and would get the approval easily. I was totally taken a back when I was told that since the surgery fell under GIPSA, the insurance company would not cover the expense to the extent as was being demanded by the hospital but would only cover the agreed package amount as the hospital we had chosen was a GIPSA empaneled hospital. This information was given to us as a matter of fact during the processing of our pre approval for cashless facility by our TPA / hospital and we were basically being asked what next did we propose to do? This was the very first time that we ever heard of GIPSA, no one had ever bothered to inform us actively including our insurance company or agent. I wanted to dive deeper and figure out where we stood and what options we had as we were very clear that we wanted our insurance company to pick up the tab in our chosen hospital and we wanted the doctor that we had after painstakingly chosen for his super specialization and expertise. We naturally wanted the best we could afford for our son like any parent would. Afterall that’s why we pay our insurance premiums diligently year after year and renew the policy in time. GIPSA stands for General Insurers Public Sector Association. It is a group of four public sector general insurance companies who as a group have negotiated special package rates with hospitals they could manage to negotiate with for many regular, common, most prevalent procedures/ surgeries and treatment on the premise that the hospital are overcharging whenever a patient goes in for cashless facility for availing these medical services. The so called overcharging causes underutilization of the sums insured as the same gets exhausted for simple procedures leaving less protection for the insurer for the rest of that particular financial year. This is a perfectly sound argument and surely needs addressing but in a manner that does not boomerang on the patients as does in the current system. The other more pressing motive behind the GIPSA regime appears to be the fact that all these companies were running in huge losses due to various reasons (as per CAG report) and they needed to stem the revenue outflow. In a bid to curb the increasing losses apparently due to fraudulent and inflated claims, GIPSA had decided to restrict the cashless medical facility only to hospitals that agree to join the Preferred Provider Network (PPN) and gave GIPSA rates. The rule, was implemented on 1 July 2010. That ended hassle free cashless facility for crores of customers of these insurers and the worst hit was the retail customer. The empaneled hospitals called PPN (Preferred Providers Network), as per the agreement entered in to by them with these insures, cannot demand more than the agreed package tariff for these identified GIPSA procedures/surgeries and treatments. Whenever a patient having a medical insurance of any of these PSUs approach a PPN healthcare provider they can’t be denied the services. The healthcare provider/hospital is under legal obligation to give the agreed package rates and facilities that an insured person is entitled under the terms of his/her insurance policy but more often than not it has come to light that the PPN hospitals try to cut corners or try to manipulate the situation by inserting things in the bill which are not a part of GIPSA. To work around the situation they make a patient fill up a PPN network declaration form at the time of admission in the hospital. Many a times unbeknown to the patient they sign an undertaking in this form saying that they will pay the difference between GIPSA package and the actual bill raised by the hospital. I think it is incumbent upon the hospital at the time of admission to clearly define the patient’s rights and entitlements and the items that could fall outside the scope of GIPSA as per the insurance policy they hold so that the patient does whatever he/she chooses knowing the financial repercussions fully. Just to illustrate my point this is what PPN declaration form says; On my own option, I wish to avail above better facility and I hereby agree to pay on my free will, after being explained in detail by the Hospital authority in my own and understandable language about the above mentioned Additional Facility/Procedure/Treatment and associated cost of it, which is over and above the agreed PPN tariff. Further, if I opt to go for final bill reimbursement with insurance company, respective insurance company will reimburse only as per agreed PPN tariff rates and balance amount will be borne by myself or patient only. I have also been explained that when room service of a category better than eligible room rent is availed by the patient, not only the difference in room rent but also an equal proportion of all other charges associated with the treatment shall be borne by me. In our case it was a GIPSA surgery, the hospital we had chosen turned out to be a GIPSA empaneled hospital and we were not explained anything that is written above in the form. We were by that time aware so didn’t sign the form and were not asked twice about the same. The hospital had raised a demand of 2.58L whereas under GIPSA agreement they had capped this at 92K plus the cost of any implant. The problem becomes intractable sometimes for PPN hospitals when some very senior and sought after doctors who work for the hospital as consultants and command very high fees due to their expertise and vast experience are not interested in doing such surgeries as it eats in to their well-deserved fees (this is open to discussion) despite their hospitals being legally bound to honor the GIPSA packages. Many hospitals have panels of doctors specifically who do GIPSA procedures, meaning thereby the services of the most senior and experienced doctors is not available to people who come under these insurance policies. Many of these people if their insurers didn’t have a PPN network and GIPSA package could have afforded the best doctors as per the terms and conditions of their respective policies. We were very fortunate that our chosen hospital turned out to be more ethical than many others and didn’t have a PSU panel of doctors. PPN network hospitals are not very happy to honor the GIPSA package rates and going to a non PPN hospital means saying good bye to cash less facility and making upfront payment and then waiting endlessly for reimbursement depending upon many fine prints. In our case it was both our good and bad fortune that our chosen hospital turned out to be a PPN hospital, good fortune because if it was not a PPN hospital then we would not have been able to avail of a cashless facility at all at our chosen hospital and bad fortune because of GIPSA we were in the first instance told that we would have to pay the difference. PSU insurers took the initiative to have their own network of hospitals called PPN but even after 13 years, enrolment of hospitals under PPN coverage is far from being adequate. To my horror I discovered that in my state of Himachal Pradesh there is only one PPN hospital meaning thereby that by this decision and due to the inability of PSU insures to get on board as many hospitals as possible, people living in certain parts of the country like my state have been virtually denied the cashless facility which is the most important facility in time of a medical crisis and also the most important attribute of a medical insurance. This is against the letter and spirit of the basic medical insurance agreement that these companies have with the customers like us. Retail customer of these companies are the worst hit as corporate and group insurance policy holders do get cashless facility even outside of PPN network hospitals (this needs to be double checked). If we had chosen to undergo this procedure in some hospital in Himachal Pradesh we would have had only the facility of reimbursement. It is a matter of investigation to find out how many people get reimbursed for the entire amount that they spend on availing of a health care service even after the known deductibles are taken in to account. Now question that begs answer is why shouldn’t all government registered hospitals and healthcare service providers be made a part of the PPN? Why should the patient have to look for a PPN hospital when a medical emergency has befallen a family? Why shouldn’t all the tertiary care hospitals/healthcare establishments automatically be considered a part of the PPN network? It is well understood that empanelment is a result of an agreement between the four insurance companies and the healthcare provider/hospital but in a scenario where there are no PPN hospitals why shouldn’t customer be entitled to go to any hospital and be allowed to avail of the cashless facility. It is not the patient’s fault that they live in a place where the Public sector insurance companies have not for whatever reasons been able to get anyone on board with PPN. Another very important question that needs to be answered is as to why would a PPN empanelled hospital raise a bill which is not as per GIPSA rates? They are legally bound to honour these rates and the patients can raise a grievance with their insurer that could even result to their de-empanelment if taken to a logical end. Well I don’t have a straight answer for that but what I have been able to dig up is that these GIPSA rates are not reflective of ground realities as per the hospital sources and have been almost unilaterally imposed by the public sector insurers on the PPN empanelled healthcare providers and hospitals.The government companies have followed the process as always in a box ticking approach manner, their inputs for pricing had been taken but unfortunately their views about pricing were not given its due and the prices have almost been unilaterally imposed upon the healthcare service providers and hospitals. The next most natural question that will spring up in any prudent person’s mind would be as to why these healthcare providers/hospitals in that case agree to be a part of the PPN where GIPSA would be applicable? The reason is simple as one cannot lose sight of the fact that collectively these public sector companies have had a large share of market in the medical health insurance historically (which although has been on a rapid decline) so not wanting to agree to be a part of PPN would mean saying no to the business of these PSUs. Another very important factor that was discovered was that GIPSA only covers some regular, common, most prevalent procedures and surgeries and there is a lot of business which lies outside of GIPSA where these PSU companies don’t insist on GIPSA pricing but are willing to give a better price. So the healthcare providers/ Hospitals have done their business mathematics and have unwillingly done this agreement to be able to transact the business of PSUs both that falls under GIPSA and is outside the purview of GIPSA. Apparently the pricing of business that falls outside of GIPSA purview to some extent cross-subsidizes the GIPSA component and helps these facilities keep afloat according to hospital sources. This to my mind is a not a very healthy scenario at all. This is arm twisting and exploitation of a situation where government companies are trying to bully healthcare providers/ hospitals to provide medical healthcare at a price that they believe is just and correct and tantamount to administering healthcare services pricing. Overcharging by healthcare service providers/ hospitals to my mind cannot be dealt with by bullying them to agree to a price package which is not entirely acceptable to them. I would also like to know as to what stops other private players in the market to lobby together and ask for a price from these hospitals and healthcare service providers, a GIPSA like package, which they deem just and reasonable? Where does that leave the healthcare industry? Would it not rob them of their autonomy in the first place for pricing the services that they provide? Would it also not rob them of any incentive to innovate and endeavor to provide the best and the cutting edge facilities to their patients especially who are seeking healthcare services with medical insurance and are not paying upfront cash.? Are we not dooming the health insurance customers to mediocrity? Are we not instead of guarding the interests of the patients, which is the rationale behind GIPSA, doing them a disservice by creating an environment where the healthcare service providers/ hospitals do not see any reason why they should continually upgrade and build upon their infrastructure facilities and expertise when they have to adhere to unreasonable price packages because of market compulsions? Are we not creating a situation where hospitals are trying to work around this by not making the services of their top doctors available to GIPSA cases? While it can not be denied that a lot of healthcare service providers and private hospitals have been over-charging the patients and that needs to be addressed. To deal with that situation the public sector insurers in their wisdom had created GIPSA and PPN which has turned out to be a double whammy for the patients. The patients now cannot get cashless facility outside of the PPN network which is abysmally low pan India and the PPN empaneled hospitals cannot charge more than GIPSA administered rates for procedures and surgeries in the ambit of GIPSA so trying to work around it in many ways all of which are not good for patients. By doing so the access of such patients, who use public sector insurance, to hassle free healthcare services is reduced in big cities where this PPN network and GIPSA is applicable in some hospitals and not in others, and no cashless facility for customers where there are no PPN hospitals. Having to organize money when one is dealing with a medical emergency defeats the purpose of having a medical insurance to a very large extent. We surely need a system to ensure the pricing of healthcare services are just, fair and reasonable but instead of stifling the pricing of the healthcare services using medical insurance companies’ bargaining power is it not better that we use a collaborative method where all stakeholders including the healthcare service providers/ hospitals, insurance companies and TPA collectively arrive at the pricing of the services which is reasonable and also acceptable to all so that the healthcare service providers/hospitals don’t try to dodge their responsibility and impart services to these patients under GIPSA without any grudge. In the alternative we could also look at a scenario, keeping in mind the fundamental and critical nature of services healthcare industry provides, where their profit is capped at a certain percentage of their investments so that they can continue to provide the best possible services and have ample surplus to be able to expand and grow. This suggestion to most market supporters would sound preposterous but given the nature of this profession I think it is quire desirable and in any case the collective bargaining power of the public sector insurance companies at present is trying to achieve the same by means which are not totally above board and also not transparent or just and in times to come private sector insurance companies will try to achieve the same using the same tactic. MCI could be of help in this matter. We should have a system where healthcare providers can be classified into different categories based upon the quality of their services, infrastructure etc. on the basis of some objective criteria laid down by IRDAI. We have QCI’s (Quality Council of India) NABH ( National Accreditation Board for Testing and Calibrating Laboratories) and NABL ( National Accreditation Board for Hospitals and Healthcare Providers) who already are benchmarking the hospitals and healthcare providers and the laboratory facilities that they provide. The pricing of the services for different categories of healthcare providers and hospitals then can be done in a consultative process which is fair to all stakeholders in the system including patients, hospitals and insurance companies. In the existing system this classification of healthcare providers and hospitals is kept in mind again perfunctorily but the fixation of prices is not done in a consultative manner. GIPSA seems more like a unilateral arrangement where prices have been almost imposed upon the hospitals which they do not seem very happy with. Public sector health insurance companies are in a way exploiting their unique position where historically they have been the biggest market players and have control over a large business even today and health care providers and hospitals find it hard to completely let go of this business. We are a welfare country and it is incumbent upon our government to provide affordable, accessible and competent health care services to its citizens. Governments over the years have failed in discharging this responsibility and without a doubt the private sector have been doing a commendable job of bridging this gap between demand and supply. Instead of having a collaborative and a constructive approach with these healthcare service providers and hospitals to evolve a system which is most suitable for patients, it is unfortunate that in their wisdom to make the system fair and reasonable they have adopted an approach which is nothing less than bullying and hitting the customers hard. The very rationale for which GIPSA rates were introduced to safeguard the interests of the patients are being compromised. Many healthcare providers and hospitals agree to GIPSA and then find ways to get out of it or bypass it or frustrate the purpose entirely by raising a bill in such a manner that only a part of the bill gets covered by GIPSA and the rest the patient has to deal with. I want to know how many patients when they are dealing with a medical emergency can question these things or even understand the repercussions. In any case hospital patient relationship is of fiduciary in nature and nobody thinks or should think that it is important to ask questions before patients are required to sign bulk of documents. Patients’ gullibility and vulnerability can’t be allowed to be predated upon. Patients buy medical policies at a rate that is offered to them and have to accept healthcare services at a rate that is offered to them. In both scenarios they don’t have any say in the matter and by creating tension in the system, by having forced pricing, the patients are at the receiving end both in terms of their access to cashless facility and their inability to do anything even if they find a PPN hospital but hospital is trying to evade its responsibility in terms of GIPSA. In our case with good sense prevailing, the hospital honored GIPSA upon our raising the issue, we were given a full bill out of which GIPSA rates were reimbursed to the hospital in a cashless transaction and the rest was waived off by the hospital in our favor. We just had to pay a couple of thousands. I think the hospital wanted to flag their rack rate and the gap between the rack rate and the GIPSA rate and make its grievance public yet another time. I am sure not too many stories of this kind have happy ending, whereas everyone who has bought a medical insurance deserves to be able to avail of cashless facility in any hospital and be indemnified as per the terms and conditions of the policy. I urge the IRDAI to take immediate note and fix the system please.

Am I a liberated woman ?

Am I a liberated woman, liberated in the real sense of the word. Liberated means free from traditional opinions or ways of behaving that might limit you in what you think or do. It means not following traditional ways of behaving or old ideas as per Cambridge dictionary. I fancy myself a liberated woman, am I mixing up being emancipated with being liberated? Emancipated means free from another person’s control or free from social or political limitations and surely I am one to a large extent. I have grown up in a very democratic household, an open household where though my father was clearly the head of the family but he never behaved in a dictatorial or for that matter in a manner that even ever smacked of him imposing his will on us. My mother’s deference towards my father was out of genuine respect, love and affection, though she would have her way whenever she needed to. I never felt while growing up that my mother was subject to my father’s authority, which she wasn’t and is still not or she and her actions in any way were restricted or constrained because of her being a woman. It looked like a very comfortable arrangement. Papa was getting the money in to the house and mummy was running the household. Our nuclear family was a part of a large, deeply connected and a loving larger family. I would see similar arrangements in other households also. Two of my aunts were working women, even then they were discharging similar duties towards the household that others who were not going out to work were discharging albeit to a wee bit little lesser extent if I may say so. I was never told by my parents, especially my father that I could not do or get something or have to do some specific tasks or behave in a certain way because I was a girl. In fact to be honest I didn’t realise the difference between being a girl or a boy while growing up for a while. Once I was around ten or eleven I started to hear people around me say things like, you need to behave like a girl or girls don’t do this or that or why are you always wanting to do what boys do. These were innocuous comments made by people who otherwise were very loving and caring and if I say that these comments were being made according to them in my interest would not be wrong. It never bothered me because it was not being reinforced by my parents inside our house and since we were a nuclear family it didn’t matter much what others had to say. I was a little girl, would forget these things very soon and continue to behave the only way I knew again when we met these people who were making these comments. After a while I realised that people would tell my parents especially father that girls have to be raised like girls and you have given a long rope to your daughters. My mother around this time I think wasn’t so sure of herself so often she would also question my father as to why he wasn’t being more careful with us. I had all masculine qualities my mother would say and by that she would mean I had zid( stubbornness) , hath (insistence), temper, ego, assertiveness. Girls were supposed to be calm, composed and submissive. She would also give me examples at times of other girls within the family or friends’ circle who were submissive or demure, behaved like girls according to her and helped their mothers’ with the household chores. I remember telling her that I didn’t behave like them because I wasn’t them and I don’t want to be like them. My refrain used to be that why should I help you with anything when you have people working for you to do these chores. My mother used to get worried and frustrated with me and also with my father who had allowed me complete freedom to grow as a person. To be fair to her, I can’t blame her at all as she was a woman of her times, a product of her circumstances and her social milieu. She was thinking ahead and was making herself unnecessarily worried about how would a girl like me find a suitable match. I didn’t fit the description of a girl who is supposed to have all great feminine qualities. Apart from the attributes mentioned above I also had a mind of my own, I had a voice which I used very often to ask questions from everyone around me and also to debate with people who I wasn’t supposed to argue with at all. For my poor mother this was not a good sign for things to come. I am not saying that my father was socially bohemian if that describes what I want to say, he wasn’t though a disciplinarian but he had his own ways to make sure that we worked hard, we develop work ethics, we learn to value integrity and honesty, we have confidence in our self-worth and most importantly we have ample self-esteem. He was invested in our overall development and always encouraged us to explore everything that we came across and engaged with us like the new age dad does at present. He treated us as an aware, sensitive, doting, loving father would treat his children irrespective of their gender. This was in contradiction with what was happening outside our household, in our larger family, friends’ houses and society in general. This dichotomy started to have an impact on my psyche without my conscious awareness or even slightest realisation at that point in time, in fact till much later in life. I started to figure out that what happens inside our household is not how the world works. In general even in educated and well-heeled families girls were supposed to behave a certain way if she was to be liked or get approval, dress up according to the sensitivities of everyone around her and speak only when it is appropriate for a girl to speak. Asking questions that too uncomfortable ones, challenging the established norms and the accepted way of life or even their authority if that didn’t make sense, from elders was out-rightly bad manners and reflected upon my mother’s skill of raising a daughter. People around her would often make a cutting remark that my mother wasn’t doing a good job as her daughter was what she was. Wanting to be treated as an equal in every which way not just the portions of goodies or clothes but even when it came to choosing my subjects in college or pursuing a particular profession to an opportunity to speak my mind in extended family gatherings and to have full authority regarding who I wanted to marry and have an independent opinion on anything and everything like everyone else was something that didn’t go well with many people. When I tried to have a say in how rituals or customs would be followed in my wedding, I was rebuked and reprimanded. When I reminded my family that my male cousins before me have been lauded for their belief and action they relented. When I called out the hypocrisy, my family yielded, they were defensive and in principle agreed with me. They said they were trying to protect me as the world outside was still not ready to deal with and accept girls like me. When I told them that my fiancé is onboard and he knows who I am as a person, they were relieved. I must however credit everyone in my eco-system to have made their peace with who I was and hopefully who I am by treating me like a different species of woman. I don’t think it was an acknowledgement and acceptance of who I was as a person but was a kind of an arrangement where I was allowed to be myself. People around me still make comments and statements which sometimes I can’t figure out whether are complements or complaints, sarcasm or even grudge dressed as compliments. The point that I am trying to make is that even though I was very fortunate to have got the parents that I had especially my father who had the courage of conviction and raised us the way he felt was right for his daughters, I don’t think we are or I am a liberated woman in the real sense of the word. My free spirit got tempered by the atmosphere of my surroundings, by the community mores and societal norms that I was observing while growing up. No one could stop that, neither my father’s conviction, nor my own awareness which in any case came pretty late in life. No one has any control on what happens outside of a house and no one can stop a child imbibing from observing the larger family, the community and the society around them. Extended family, friends, community and society was still working on the premise of girls being the weaker sex, on the premise that there is a difference between a girl and a boy and both genders have their specific roles for families and society to work normally and efficiently. No one still questioned these premises in any significant way in those days in the society that I was growing up in. Girls were happy being girls and looked down upon girls who were not the quintessential girls. These are called structural and systemic biases and condition a child in a manner that when they grow up, they fit in the system and by and large play their supposed roles. This is social conditioning and I was no exception as I too was subject to all these biases though in a little diluted form because of what was happening inside the house. I became a person that I have become as a result of my experiences both inside of my own house and also outside of the house. The confidence that I got from inside my house equipped me to a large extent to deal with what I was facing outside but could not ensure that I don’t get affected by that deep inside me . My thinking and thought process is a result of this mixed experience. I rejected things which were out rightly, blatantly discriminatory for women but could not even recognise stuff that had very nuanced and subtle biases. I never questioned Kanya-Daan when it was perfommed at my wedding because it was a done think. It is a very emotional subject and a great example of social conditioning of girls since they are told being 'paraya dhan' since the day they are born but now it doesn’t agree with me as a concept. My instinct after I got married that I need to run my house which essentially meant the kitchen and the general up keep of the house since I am the lady of the house, a feeling that i had some duties towards my in-laws without anyone having to tell me are to my mind examples of social conditioning. I don’t think my husband would have had any such feeling towards my parents. Yes technically I became a part of his family as per the trsditions but we were not living with them. We had set up our own house as we lived in a different city so both of us left our parents’ house to set up our own and since we were married to each other, my family was also as much family to him as was his to mine. Another example is when I became a mother the feeling that child rearing was my primary responsibility. I am just looking back at my life and trying to make sense of everything. I don’t have too many regrets and have lived a good life and looking forward to living a fulfilling one. I have been as liberated as my circumstances, socio-economic background, education and experiences have allowed me to be. It’s just that instead of having some fanciful ideas about myself, I am trying to delve deeper to discover who I really am.

Menopause

Menopause the word, seems to mock me and dares me to figure out what this monster is all about. The word seems to say everything loud and clear that it does to a woman or doesn’t let a woman do when it is at her throat. Does menopause without any compunction say ‘me, no pause, come what may’ as in I am a deadly monster, I don’t spare anyone and will inflict myself upon you in all my glory whatever might be your fate or is it bellowing at me to say aloud ‘me, can’t pause, whatever I might be dealing with’ thus forcing me to speak out my fate? Both are true, neither life or its motions and other myriad stuff we call life stops nor does the ferocity of the onslaught of this monster abate. It continues to unleash a toxic mix of sometimes mysterious, inexplicable mostly invisible symptoms and a woman who looks hale and hearty from the outside is on the verge of a volcanic eruption triggered by a seismic emotional tremor from inside. It is a very complex state of mind that one finds oneself in. Hormones and chemicals inside a woman are having a free run, physical strength and appearance is taking a beating and most of us don’t know what to do with ourselves. In my case I have had what I call a ‘bonsai career’. I never let go of my profession completely but adapted it to suit my maternal instincts and I must add out of free will and as a choice made by myself without any external factor influencing my decision. As a result I have had a career but it could never reach its potential as I wanted it to grow in a certain way only so that I didn’t lose touch with it and at the same time didn’t get consumed and subsumed by it. I was confident that the day I decide to go full steam in to my profession I would be able to do it. Today I am working towards it in my own way but it is tougher and I still don’t know, how many more order of magnitude tougher, than I had thought it would be. It’s not a rant, I am just stating facts. I don’t need pity, I might do well with empathy. I wanted everything in my life and I was confident that I could achieve that if I change the order of doing things a little bit. The years that usually in an ordinary course women spend nursing and nurturing their careers, I spent nursing and nurturing my children and I wanted it that way. I carried on with a bonsai career and at the cost of repetition I must say as a matter of choice. I wanted to take a leap of faith and go full steam in to my career after I thought I was done with my active motherhood duties. I knew that this would coincide with me being peri-menopausal but never fathomed that it could upset my plans in any significant manner. I still don’t know with certainty how my present state of mind is affecting my plans. My plans are not going as per my schedule, something is amiss in me as a person, in my motivation, tenacity and focus and for good reasons I am tempted to pronounce this monster guilty. I was and I still am hopeful of being able to carve myself a niche despite life having become what it has become. Menopause to me was another milestone that as a woman I knew I would reach one day. I didn’t know the journey to this destination would be fraught with so much anxiety, physical discomfort, unexplained ennui and emptiness in ample doses. I didn’t have even the faintest clue that it would be much more arduous and protracted than I ever thought, to say the least. This is when I am not suffering from any of the symptoms in extreme at all. I have been experiencing anxiety and nervousness occasionally but most of the time I can counsel myself to my senses and other times I am ok after talking to a friend or reading something or distracting myself by doing some physical activity. The strangest part is that no one talks about it, even us women, amongst ourselves, as much as I think we should. We don’t warn one another of this impending storm that each one of us has to weather. We don’t get to prepare ourselves to deal with this life altering experience mostly because it is not a part of the discourse. No one around us usually know or let’s say can fathom the extent of our grief and pain both physical and mental when we are going through pre-menopausal and menopausal phase. I think everyone, including us women, feel that it has been happening since always and women before us never made much fuss about it so why are we making a big deal about it. Since we women aren’t talking much about it amongst ourselves in a meaningful manner I am sure at some point each one of us feel that may be we are overeating or being hypersensitive or behaving in a very entitled manner. We have a sense of guilt thinking that since I am not the only one going through this upheaval then why am I the only one complaining and talking about it. Once you start to talk with other women you realise everyone is struggling in one way or another. Very few women have an easy ride. Every battle is unique in the sense that each one of us get different symptoms in different measures. Some have excessive bleeding while some get hot flushes all the time. Some feel weepy, some feel anxious, some have panic attacks, some have palpitations, some have a sinking feeling, some have a foggy brain, some get a weak gut, some have a disturbed sleep pattern and some get pigmentation, some have mood swings and some get full blown depression. Some symptoms will stay with us for life and some abate with passage of time. I was talking to my gynaecologist and she told me about the entire spectrum of symptoms that a woman could experience and the bandwidth of that spectrum was absolutely mind boggling. She advised me to be more aware of my health, my heart and not to dismiss everything that I feel as a side effect of being in this phase. She wanted me to take care of both my physical and mental health, look after my diet and keep myself hydrated. Incidentally the timings of this monster’s arrival in a woman’s life are also perfect. The moment usually a woman starts to breathe a little easy after having raised her family and is either settling down in her career yet another time after innumerable breaks ( talking about typical middle class women who immigrate to cities for earning their livelihoods, this description might not fit everyone) or struggling to reinvent herself to find an occupation suitable to her education, experience and aptitude, this monster starts to knock at your door. This is usually a time in a woman’s life when her nest is either empty or on the verge of getting empty, parents are growing old and she herself has come a long way in her life without actually realising it. You are in the process of reallocating your time and energy more towards your own well -being, dreams, ambition and desires when suddenly you start to wonder that there is something really wrong with you. Either your mental health or your physical health is definitely compromised. All of a sudden the energy level starts to dip, multitasking for which most of us women pride ourselves, looks the most difficult thing in the world. A feeling of inadequacy and worthlessness starts to engulf you. You find yourself a different person in the mirror, the greys on your head are breeding like rabbits, the adipose comes uninvited as if with a vengeance and settles down at all unwanted places despite having successfully enforced a very strict ‘no vacancy’ and ‘no trespassing allowed’ rule all your life. Skin is not as soft and supple as you remember it was when you last saw yourself in the mirror. The laughter lines, crows’ feet, pigmentation are a few other uninvited but still expected guests I would say, who come to settle down with you for good. Everything that people say seem to either hurt you or make you feel small, is an unwarranted feeling, that you can’t most of the times seem to get rid of. You start to analyse your life and don’t find anything you have done in your life worth giving yourself a pat on your back. Every decision ever made by you in the past looks either suspect or bad. Even if everything is fine in your life you are hell bent upon nit picking and find faults with everything. I must say that though these thoughts don’t stay with you forever but such moments keep coming back to you with startling frequency and its scary if your life in reality doesn’t have any problem as such. I think if we have more open conversations about this stage in a woman’s life, both amongst us women and with men, navigating thorough it could become easier. We might not have to explain every time we are indifferent, uninvolved or disinterested in something or may be snap at someone in that moment when we are feeling the lowest in our lives. We all know that this too shall pass and when women feel assured that there is nothing wrong with them it would be an empowering thought. The fact that everyone is actually going through something makes you feel that you are not alone and don’t have to feel bad or guilty about the state of mind that you are in. People around you in the family and friends could become your support system and with their understanding and empathy life could become a wee bit simple in these years.

Why don't we speak up and get involved?

What is the meaning of development and progress? Where are we headed as a country, as a system, as a community, are some questions that refuse to leave me. I am at an age where looking after aging and ailing parents is one of the most important tasks that I do almost on daily basis apart from dealing with my own aging. So, I end up interacting with many doctors, specialists who are supposedly the best, in their respective fields. Not long ago I also got an opportunity to look in to a legal matter (I am a qualified lawyer) that my family was fighting for many years after their land was compulsorily acquired for a national highway. To my dismay, when I opened the file, I figured that we were fighting in a forum that has ceased to have jurisdiction long back and none of the parties involved either knew or cared enough. When I brought this up with our lawyer, the gentleman was appalled himself and was cursing the presiding officer for being careless, leaving me absolutely dumbfounded at one level. When I was discussing this with some learned friends who know the system, I was told that I could not put the blame on the lawyer as the poor guy apparently does thousands of matters and a mistake of this nature can happen with anyone and that I should not read much in to it and pursue now whatever remedy is available to me . I was also told by many that he is a competent man, which to some extent I also endorse, that there has been a genuine oversight in our case and one can’t really find fault with lawyers as they are not paid well in small towns and there is only so much that anyone can do in a given case. Basically, I was told and made to believe that this incident does not in any way reflect upon our lawyer’s competence or integrity or commitment to our brief. While this discussion was happening, I also chanced upon a discovery in a related issue that many matters are being filed in a court which does not have pecuniary jurisdiction and again to my horror, no one was actually horrified and gave me tens of other examples where things were not happening, the way they should have been. I was given numerous examples of existing laws which are against the principle of natural justice, where existing provisions of law are in flagrant violation of the constitutional mandate of fundamental rights but go unchallenged or are challenged unsucessfully or are awaiting their fate as matters are sub-judice. Matters where our Supreme Court acknowledges that justice warrants change in the law but refuses to intervene on the basis of technicalities despite almost having a carte blanche under Article 142 of the Constitution of India to do complete justice. This power can surely be invoked when at the receiving end are hapless farmers and people whose land is being compulsorily acquired under the state’s power of eminent domain and people are left with no right of an effective judicial remedy. A case where unreasonable classification has been made on the basis of the purpose for land acquisition and when the same is being acquired for national highways people are left high and dry, at the mercy of revenue officials for getting a fair and just compensation without getting even a single opportunity where judicial mind is applied on the merits of the case. Essentially the point I am trying to make is that no one seems to get alarmed or even surprised when matters of such nature are brought to the attention of people who understand the system and everyone in fact on the contrary tries to justify the lapse or error or negligence or whatever one wants to call it depending upon their perspective. I am a qualified lawyer, so could figure out the lapse and legal infirmity in our matter but I shudder to think of all those who have no choice but to go with and blindly follow the lawyers that they hire. I do not think that once a lawyer has taken a brief , insufficiency of fees or overload of work can be pleaded as a reason to justify for not being able to pay adequate attention to the matter according to my understanding, whatever it is worth. I don’t think it would be entirely ethical to say that what I am doing is all that is humanly possible especially if what is being done is not adequate and leads to undue delay, legal lapses and eventually denial of justice. This was a system that I had some clue about so could intervene. The following experience shows my plight and helplessness, where I am stuck in an alien system. We live in a part of the country where tertiary medical care is not quite available. Covid has done a big favor to all people living in these semi urban, rural and remote areas of the country as the specialists in the cities have started doing tele consultations and therefore are available and accessible to people not living in the cities. I could get my father the very best medical advice because of this facility of tele consultation. However, I also ran in to some trouble when one doctor, whose advice is critical for my father’s well-being and who we need to consult as and when there is a situation, told me that since he looks after 5000 patients it’s not possible for him to be available or accessible all the time. I felt heartbroken, utterly helpless and also angry. It reminded me of the poor lawyer I mentioned about earlier, who since was doing thousands of cases, couldn’t humanly be expected to be one hundred percent sure in every case about his own efforts, sincerity and commitment. The fact that the people in small towns are not willing to pay their lawyers what lawyers think they deserve, people don’t realise that they unwittingly have relinquished the right to be represented to the best of the lawyer’s ability. The clients are getting in a situation where they have to be satisfied with whatever best the super-busy lawyer can do in the given circumstances. I was in an identical situation again but here I was talking about my father, his health, his well-being, his life and I couldn't be satisfied with only what the super busy doctor could offer me due to lack of time on his part. I needed to be able to reach him when it was needed without any ifs and buts. I wanted to turn around and request this doctor gentleman that maybe he could start to charge more (he was already every expensive) and see instead 2500 patients and be accessible or available to them in time of emergency. Wouldn’t that be a better deal for everyone and make all the patients feel safe and secure? I couldn’t muster courage to propose that as I knew I ran a very real risk of being thrown out which I could ill afford, given the situation I was in. What I don’t get is the compulsion these people (whatever profession, I am discussing just two as I am dealing with these two systems on daily basis) have to take on more work than is humanly possible? Another thing which is absolutely beyond my comprehension is the acceptance by us mere mortals of these people being super busy therefore put up with whatever is doled out. The third point I keep mulling over is as to why doesn’t the system intervene? Are we not shortchanging everyone in the process? We know we have the capability to deal with a problem, a situation, but due to paucity of time we do not do justice to them. As a result, delay in imparting justice, miscarriage of justice and fatalities due to lack of access to timely medical advice is common but the victims aren’t there to tell their tales. We all have accepted the way the system works and if anyone even raises a voice he or she is called either utopian or an entitled, privileged fool. I think intervention also becomes a little tricky for the government as our government hospitals are overflowing with patients and reeling under shortage of doctors, wherever one might go. We expect our government doctors to work 24 hours in a day. I have seen first-hand situation even in AIIMS, the most prestigious hospital in the country and it’s the same in all OPDs across the country I am given to understand . Every time I go to a government hospital I can’t sleep for a few days, as the doctors over there are always almost mobbed despite which most of them work tirelessly. Most of them are kind, show empathy and see as many patients as they can. They are delivering despite the systemic flaws. When I go to the courts, judges are burdened with the herculean task of doing hundreds of matters a day. If justice is expected then we are assuming that both the judge and the lawyers of both parties have read the files and done their homework. I personally feel that it’s not humanly possible for anyone to do that kind of reading relentlessly day after day after day. As a result, the quality of work suffers and justice gets diluted or even denied . When the system expects these doctors and judges to work incessantly 24x7, with what moral authority can it even think of regulating how much work can private doctors or lawyers do so that the services they provide do not become deficient in any form. What is the idea of having a fundamental right to access to justice, to speedy justice and to health, if the systems meant to enforce these rights are not adequately equipped and themselves are overworked and overstretched beyond imagination. The state of our access to justice and access to health care services would obviously continue to suffer till we strengthen these systems and we the people will always be shortchanged. What do we do with progress, development if we can’t fix these basic services? I am not expecting a perfect system, all I am hoping for is a system where human life and dignity is valued for everyone with equality, as our constitution professes to ensure. If a person of my socio-economic strata and intellectual capital can feel lost and betrayed am sure most of the people in this country are feeling worse. Why don’t I hear enough hurt, wounded voices clamoring for better systems? The system needs to address these problems comprehensively at all levels and this is going to take consistent commitment, efforts and resources for many years. We need to make sure we produce adequate number of well qualified doctors every year and for that we need to have world class medical colleges’ infrastructure, commensurate with the population of this country, world class medical school teachers, funds and technology apart from intent. Efficient, effective regulatory system in place is a must to ensure the medical education is world class and quality is not compromised. We will have to need to fix our primary and secondary education also so that the system is fed by appropriately equipped students when they enter the professional colleges. We need to fix the quality of teaching, have dynamic secular, scientific curriculum. We need effective, accountable execution at every level to translate the desire in to an outcome. We need to fix our judicial system, have more judges appointed at all levels. Make the system of appointment of judges at all level merit based and transparent so that the independence of the system can be ensured. We have to make sure we have enough judges at all levels so that the quality of justice dispensation is not compromised. We have to regulate legal education also more efficiently so that the quality of lawyers joining the system is by and large the same coming from different institutions. Alternate dispute resolution mechanisms have to be made more reliable and efficient on the ground also. On the paper they are efficacious, fast and effective but in reality they are also turning out to be another burial ground for disputes. Lots of things on our platter which need fixing, till then can we as citizens please up our game to increase our collective empathy, sensitivity and accountability? Can we, the people, in the meantime, who have the wherewithal to make a difference, start by making small changes? Can we, all of us, become more engaged as a citizen, as a member of the community we live in and show more sensitivity and empathy? Making money and making more money cannot be the only pursuit of life for people who are well educated and well placed in life. I am sure, if we all do our bit, the society and the system would reflect that sensitivity and empathy and we can at least last without getting harmed and damaged till systemic structural changes are made by the state.

Our Encounter with Omicron and the System

Keshav’s wrongful confinement in a mandatory institutional quarantine against the mandate of existing guidelines as far as I as a lawyer and my advocate understands and denial of Fortis to let him take a RTPCR test has been simply one of the biggest dark hours of my life. I for the first time realized what total helplessness feels like. I understood hopelessness in its full glory and got to know first-hand what happens to a system if is run by people who lack compassion, are apathetic and on top of that would do well with a bit of more integrity, intelligence and maturity. You feel trapped, dazed and actually disenfranchised. The feeling became much worse when we could not convince the court in the first hearing that the government should be asked to follow their own guidelines strictly. We had approached it as a last resort. I would have been happy if I thought we had been given a hearing and then denied what we were asking for. Anyway, that’s where we were, directionless and didn’t know what next. On the second hearing we got some respite and the court asked the hospital to do the RTPCR. We are feeling a bit relieved but still a little apprehensive after what we have been through and hoping for the best so that the new year brings much deserved freedom to my son. During the course of this ordeal, I found very few people in the system (who I had to interact with) who had a voice, a spine, some courage and also a pinch of integrity. To me though it was not a revelation but surely I didn’t expect the situation to be so bad. Voice, spine, courage and integrity together I knew would be rare but had no clue that it is almost near extinct. People want to save their own skin, can only look after their own interests and do their jobs in a clinical manner without any compunction, without having any regard to the fact that they are dealing with real people, like their own children and family are. It’s absolutely amazing to see how indifferent, insensitive, ruthless and drunk people can be on their authority without sparing a thought for a moment that everything is transitory including the power and authority they enjoy by virtue of the position they occupy. On the positive note, I found people amongst our friends and acquaintances who had the balls to stand with us, by us and who could find time from their busy schedules, in this hour of our ordeal. I salute them all and want to place our gratitude on record as without them, this journey would have been lonely and much more tough. Tops among them would be my advocate, Vikram Hegde. I hardly knew him, we worked together pro bono, on a matter, two years ago and kept in touch since then. A young, sharp and an articulate lawyer from National Law School Bangalore, who I bonded well with, when we met and continued to exchange news items, views and opinions on matters of mutual interest since then. When I didn’t know what next could I do to help my son, to get him justice, after having explored all possibilities which included meeting hospital authorities, bureaucrats and politicians and make them see reason, I thought of filing a writ petition in the High Court of Delhi. I don’t know why, the first name that cropped up in my mind was, Vikram. I know a lot of other lawyers and close friends who also I am sure could have helped but I chose to stick to Vikram for some reason which I also have no clue about. I called him and told him everything and without any hesitation and without losing a second this gentleman said he would help me and then in the next one hour we were sitting in his office. This was December 28th 2021 and Keshav had been inside the quarantine facility for five days. Vikram made sure the matter got listed after being admitted as urgent the very next day. I don’t have words to describe how respectful, sensitive and empathetic this gentleman is. He made us feel absolutely comfortable and gave us some hope at a time when nothing seemed to work. We discussed the pros and cons of approaching the High Court but decided that since the only downside is that we might not get the relief we are seeking. However, we thought that there is no harm in trying, as we stand a good chance to get some relief given the conviction we had about the merit of our case. Maybe we could make the court see our point and get Keshav out earlier than he normally would be in the messy circumstances that we were trapped in. Vikram had no reason to go out of his way, to do what he did. On top of everything he remained accessible to us all the time, open to everything we had to say, responded to every single message that we sent without any delay and was as committed and invested in the matter to get relief for my son as we were as parents. I could feel his sincerity. There was no personal gain for him in this matter, he didn’t owe anything to us but he became our biggest support system. Vikram please continue to be who you are and I bet you will go far. A lot of people have caliber and a lot of them are hard-working also but you on top of that have qualities that are hard to find and makes you stand out and the combination of all these attributes will take you to the top. Every day that Keshav was spending in that quarantine was like a slap on my face because I saw it as perpetuation of a wrong that was being done to him and as a mother, as a lawyer, I could not do anything. To me it was like incarceration and the court only could give the bail orders which it didn’t the first day of hearing. Our family, cousins, friends and colleagues from college, Oxford, work, my husband’s friends all tried but to no avail. Some of them rallied around us and called us almost every day and came up with probable solutions on their own and tried whatever they could. I never expected such an overwhelming support and so much concern and empathy. This goodwill kept us afloat while we were fighting a hopeless battle. Every dark cloud has a silver lining and ours was kind hearted, helpful people around us. After the court order today, which directed the hospital to do the RTPCR and asked the GOI and Government of Delhi to produce his G sequencing test, I can finally breathe and sleep easy.

Management of Omicron - Need for more Rationality and empathy

The management of Omicron in the National Capital of Delhi is proving to be ominous especially for people who are testing positive at Indira Gandhi International Airport and are coming in from the so called “high risk countries”. As per the details available, following is the list of officially recognised high risk countries as of 9th December 2021 when it was last updated. List of Countries from where travellers would need to follow additional measures on arrival in India, including post-arrival testing (Countries at-risk) 1. Countries in Europe including The United Kingdom 2. South Africa 3. Brazil 4. Botswana 5. China 6. Ghana 7. Mauritius 8. New Zealand 9. Zimbabwe 10. Tanzania 11. Hong Kong 12. Israel The situation has dramatically changed since then and our understanding of this “variant of concern” has also been enhanced. The reports and studies coming in from various sources have been saying that this variant is definitely more transmissible but not dangerous. The data for hospitalisation rates across the world and in India speaks for itself. What is beyond comprehension is that since the whole world now is under the grip of this new variant, why are people who are testing positive on arrival only from these select countries are required to undergo mandatory institutional quarantine? Why other countries are not being put on this list and tested on arrival, if we are so serious about tracking omicron? Why people in India who are testing positive but have no travel history, not being made to undergo gene sequencing test and then undergo mandatory quarantine? The institutional quarantine for people who test positive from these select high risk countries on arrival here at the international airport lasts till the gene sequencing report establishes it is not omicron, meaning if it is delta (or any other variant) which by the way has been very dangerous and we have witnessed it first hand in the summer of 2021 -, a person will be released and can do home quarantine. However, if it is Omicron the person concerned has to mandatorily do institutional quarantine till she/he tests negative, irrespective of whether the person concerned is absolutely asymptomatic with very low viral load thus requiring no medical help or intervention; there is no option for home quarantine in these cases. I understand there is a policy lag in every government, but in times of disaster and pandemic policy has to keep pace with new developments and ground realities. How does it make sense for keeping people in mandatory institutional quarantine who are Omicron positive, especially people with low viral load and are totally asymptomatic that too only those who are coming from an outdated list of select high risk countries? Is it not time to re-evaluate this policy and update it to bring in conformity with the ground reality around the world and also with the knowledge that has emerged vis a vis this new variant of concern? Why do we need to cramp our hospital beds with people who can safely quarantine at home and need no medical attention? Why should such people be made to undergo this ordeal when no other country in the world is doing that since by now there is widespread understanding that it is not required and advisable? Why shouldn’t only those people who need medical assistance go to hospital whatever the variant is? To make the matters worse the gene sequencing test report which determines your fate is being done in a very opaque manner. Patients don’t have any information about which lab it is being conducted in and how much time would the report take. It could be anything from a few days to two weeks or may be more, leading to mental trauma and anguish in people who are trapped in institutional quarantine, amongst which are very young students coming home for their vacations. Another aspect of this whole saga is the money involved. If you choose to quarantine in a private facility that the government has designated and apparently has fixed price for, you could end up paying much more than what the government has fixed if you choose to claim cashless insurance. There is a confusion about cashless medical insurance transaction Vs if you chose to pay the hospital upfront and then get it reimbursed. Choosing private facility over a government hospital is a Catch-22 situation. While the government facilities follow all the protocols and guidelines they mostly can’t keep the facility clean and hygienic; now asking for that can’t be termed elite as it is a basic human necessity and also by the way a fundamental right of every person, if that matters. If one chooses to go to a private facility it is comparatively better in terms of infrastructure and cleaniness, but the processes and protocols are the main casualty. You are totally at the mercy of the hospital and their doctors. Can the policy makers please wake up and rationalise the whole process? Can we please acknowledge, without hurting our pride, as has been acknowledged across the world that while Omicron while may be more transmissible it is definitely less dangerous and therefore not requiring institutionally quarantining. Can we please have a more transparent process for G sequencing, and can it be done in a time bound manner while keeping the patient in the loop? Can we please have all Omicron positives coming from all the countries in the world and not just the “so called dated high risk countries” and also Omicron positives we already have in India, treated equally? Can we please monitor the private designated Covid facilities more closely so that they don’t innovate, manipulate and do tricks to bypass the government mandate for payment in any event?

Triple Talaq decision – has the apex court given us a reason to celebrate?

This article was writtem in August 2017. I have now decided to put all my write ups which were not accepted for publication over here on my blog. This is dated but relevant. The decision of the Supreme Court of India was awaited with bated breath by both Muslim women rights groups and the Muslim clergy. This decision was also being looked forward to though with a lot of skepticism I must say by all those who would like to see the men and women of this country, irrespective of their class, caste and religion, being able to enjoy fundamental rights guaranteed by the constitution of India without any discrimination and encumbrance. The minority judgement given by the chief justice had to resort to its powers under Article 142 of the constitution of India to deal with the inequality imposed upon Muslim women due to admittedly arbitrary and discriminatory practice of “triple talaq”. They chose to beseech the government of India to bring in a necessary legislation to deal with the injustice and inequality perpetrated by this practice. It is extremely unfortunate that in a democratic country like India where the constitution guarantees fundamental rights to all its citizens and some fundamental rights are guaranteed to all people residing in this country irrespective of whether they are citizens or not and where Supreme Court is the guardian of those rights, it chose to pass the buck. The minority judgement sought to create a six month window within which the government would have to bring in the necessary legislation to either do away completely the practice of triple talaq or amend it in a way that it ceases to be arbitrary and discriminatory. The learned judges have stated we are satisfied in injuncting Muslim husbands, from pronouncing ‘talaq-e-biddat’ as a means for severing their matrimonial relationship....till such time. However, if the government does not take any action in the next six months then the injunction would cease to operate and they thought they did justice to these women. Despite accepting and acknowledging that the practice is an antithesis to the right to equality of Muslim women it chose to turn them away with a sop of injunction. The learned judges, whether the ones who gave the minority judgement or the ones on the side of the majority judgement, have chosen not to deal with the issue head on. Justice Kurian Joseph delivering the majority judgement has said, “What is bad in theology was once good in law but after Shariat has been declared as the personal law, whether what is Quranically wrong can be legally right is the issue to be considered in this case....”.He further stated, “therefore, in any case, after the introduction of the 1937 Act, no practice against the tenets of Quran is permissible.” I wonder what would have happened if this was not the case. Does this mean that the women of this country, whichever religion they belong to, have to put up with whatever their religion dictates and if that is considered an “essential religious practice” then fundamental rights can be damned ? Are we saying that there is a hierarchy with-in the fundamental rights and one right can overpower and transgress the other fundamental right? In this case, it seems that the right to religion supersedes Article 14 and Article 21, which have been slaughtered at the altar as far as women are concerned. For ease of discussion and understanding, Article 25 of the constitution of India is being reproduced: Freedom of conscience and free profession, practice and propagation of religion 1. Subject to public order, morality and health and to the other provisions of this Part, all persons are equally entitled to freedom of conscience and the right freely to profess, practice and propagate religion 2. Nothing in this article shall affect the operation of any existing law or prevent the State from making any law a. regulating or restricting any economic, financial, political or other secular activity which may be associated with religious practice; b. providing for social welfare and reform or the throwing open of Hindu religious institutions of a public character to all classes and sections of Hindus Explanation I The wearing and carrying of kirpans shall be deemed to be included in the profession of the Sikh religion Explanation II In sub clause (b) of clause reference to Hindus shall be construed as including a reference to persons professing the Sikh, Jaina or Buddhist religion, and the reference to Hindu religious institutions shall be construed accordingly Careful reading of the first clause of this Article makes it abundantly clear that the right guaranteed under this article is not an absolute one as is the case with other fundamental rights. This right is made categorically subject to the other provisions of this Part among other riders. This should leave no doubt in anyone’s mind that the fundamental right to religion is subject to other fundamental rights and have to pass through the litmus test of Article 14, right to equality and equal protection of law and Article 21, right to life and personal liberty, of both men and women, as these rights have been conferred upon both, in equal measure. We would have had a real cause of celebration if this practice had been struck down on the ground of being violative of the fundamental rights of Muslim women conferred by Article 14 and Article 21 rather than being against sharia or using legal semantics. This is a well- intentioned and laudable effort to grant relief but is a circuitous route and falls woefully short of what is expected of a Supreme Court which is the protector of fundamental rights guaranteed by the constitution to all. Justice Joseph Kurien has stated that a reconciliation between religion and constitutional rights is possible, but the process of harmonizing different interests is within the powers of the legislature, thereby completely abdicating the constitutional duty and responsibility of the apex court to protect the fundamental rights of all people and apply the same principles of harmonious construction while interpreting fundamental rights to resolve apparent conflict between the mandate of different fundamental rights. My only submission is that the time has come when the fundamental rights of women of this country are also guaranteed and protected with the same fervour and sincerity as that of the men of this country. The courts and the government should not hide behind the personal law; all those personal laws which conflict with the fundamental rights have to go. The moot question is whether one fundamental right can transgress another fundamental right. Even if for a moment we assume that triple talaq is a practice that would get protection under freedom granted by Article 25, it is widely acknowledged of being violative of Article 14 and 21 of Muslim women. If one fundamental right can tear in to the freedom granted by other fundamental right, then we are reducing theses in-to empty rhetoric. Plain reading of Article 25 makes it amply clear that if its mandate is interpreted in the true spirit of the constitution, learned judges of the SC would not have had any issue striking down not only triple talaq but several other discriminatory practices carried out in the name of religion across all religions. I also would like people to ponder whether these fundamental rights are only granted to men and not to women in the same measure. If yes, then right to freedom of religion can mean different things for men and women, as the current religious practices are not just and equitable and very evidently seems to have been made by men for men.

Article 370 made inoperative; By an Amendment by Presidential Order

President Ram Nath Kovind in “concurrence” with the “Jammu and Kashmir government” promulgated Constitution (Application to Jammu and Kashmir) Order, 2019 on Monday, August 5, 2019 which states that provisions of the Indian Constitution are applicable in the state. The President issued Constitution (Application to Jammu and Kashmir) Order, 2019 which comes into force “at once”, and shall “supersede the Constitution (Application to Jammu and Kashmir) Order, 1954“.“All the provisions of the Constitution” shall apply in relation to the state of Jammu and Kashmir, it said.

Any lay person would wonder about the usage of the words ; 'concurrence', 'Jammu and Kashmir government' used in the above Presidential order as we have no government as of now in the state. The state of J&K has been under Governor’s rule.
President however could issue the Constitution (Application to Jammu & Kashmir) Order, 2019 by which Article 370 has been made inoperative that too “with the concurrence of the Jammu and Kashmir government” because of the amendment that was crept in to Article 367 by this very Presidential Order.
The order has added a clause to Article 367 of the constitution so far as the state of J &K is concerned, which reads as under:
“(4) For the purposes of this Constitution as it applies in relation to the state of Jammu and Kashmir-
(a) references to this Constitution or to the provisions thereof shall be construed as reference to the Constitution or the provisions thereof as applied in relation to the said State;
(b) references to the person for the time being recognised by the President on the recommendation of the Legislative Assembly of the State as the Sadar-i- Riyasat of Jammu and Kashmir, acting on the advice of the Councils of Ministers of the State for the time being in office, shall be construed as references to the Governor of Jammu and Kashmir;
(c) references to the Government of the said State shall be construed as including references to the Governor of Jammu and Kashmir acting on the advice of his Council of Ministers; and
(d) in the proviso to clause (3) 0f Article 370 of this Constitution, the expression “Constituent Assembly of the State referred to in clause (2)” shall read “Legislative Assembly of the State.”

One thing that has been baffling me since yesterday is almost complete silence, barring a few muted voices, of our legal eagles on this aspect on various television debates where this move is being hailed by most of them as historic and bold, which in any case this is. I understand this surreptitious amendment to Article 367 is only with regard to the erstwhile (by the time this write up would see the light of the day the reorganisation bill would have become an Act) State of J&K but nonetheless it amounts to amendment of Article 367 of the Constitution of India. As per the mandate of Article 368 of the Constitution, an amendment to the constitution can only be brought about by following the procedure laid down in Article 368.

I do not wish to on purpose speak on the merit of scrapping of Article 370 as that is a separate discussion and would need thorough understanding of the historical context, terms of Instrument of Accession etc. and is being discussed by virtually everyone who knows something about the turbulent past of the State and its politics. One can understand the fact of Article 370 being a temporary or a transitional provision but even if that had to be done away with, the procedure had to be duly followed, is my only submission since we call ourselves a constitutional democracy.

Misuse of Article 356 is something that we have been a witness to in the past also but this time we have seen it being misused in a way that could and should make all states shudder, whether they have special status or not.

It is understandable that Article 370 could be made inoperative by a notification issued by the President of India, in view of its clause (3) which reads;

(3) Notwithstanding anything in the foregoing provisions of this article, the President may, by public notification, declare that this article shall cease to be operative or shall be operative only with such exceptions and modifications and from such date as he may specify:
Provided that the recommendation of the Constituent Assembly of the State referred to in clause (2) shall be necessary before the President issues such a notification.

The proviso to this clause puts a condition i.e. recommendation of the Constituent Assembly of the state. In order to meet this constitutional requirement, the government has amended Article 367 and has inserted, as mentioned above, a clause numbered as (4) with 4 sub clauses with respect to the state of J&K.

As far as plain reading of Article 368, which deals with amendment of constitution goes, amendment means any addition, variation or repeal . In this case a clause has been added, therefore as per my understanding an amendment has taken place therefore procedure in the subsequent section of Article 368 had to be followed. However, in this case that procedure has been completely ignored. I am sure the government would have their defence ready in this regard and I can’t seem to wait to know that. A clever way to get out of the mandate of the constitution without violating its spirit would be indeed enlightening for all students of constitutional law. A part of Article 368 is reproduced herein below;
368(1) Notwithstanding anything in this Constitution, Parliament may in exercise of its constituent power amend by way of addition, variation or repeal any provision of this Constitution in accordance with the procedure laid down in this article.]
(2) An amendment of this Constitution may be initiated only by the introduction of a Bill for the purpose in either House of Parliament, and when the Bill is passed in each House by a majority of the total membership of that House and by a majority of not less than two-thirds of the members of that House present and voting, 4[it shall be presented to the President who shall give his assent to the Bill and thereupon] the Constitution shall stand amended in accordance with the terms of the Bill:

It might be a bold step but it has filled me with fear, fear for my legal and also constitutionally guaranteed fundamental rights, fear for the very existence of my state as in province , fear for my identity and what I stand for. I fear because I witnessed that the constitutional mandate and spirit can be subverted, brutalised by brute majority. The constitutional safeguards can be consigned to the bin of history by brandishing numbers and circumventing the norms and established precedents and procedures. Yes, it can be challenged in the court of law which I am sure it shall be but the faith of the law-abiding people and all those who understand how system works has suffered an irreparable loss. To me all the venerable concepts of constitutional safeguards, constitutional democracy, due process of law and rule of law sound hollow.