2 cents

Thursday, June 18, 2009

Is More Less?

Birth Control is a touchy subject around the world, but not so much in India. Although public discussion is absent but there is no real opposition to it either. If we were to take up the argument of population as a bane, then contraception would be an effective arsenal at our disposal. Especially considering the more disturbing alternative to get the same result: Abortion.

But if we look at population as an asset regardless of the economic and social implications then the morality of population control comes apart. The Roman Catholic faith is a vocal proponent of this opinion and their justifications are derived from the scriptures, although other Christian sects might not agree. Islam too is a not very keen on the idea of contraception and this is plain to see through the prevalent fertility rate in most Islamic communities. But Hinduism is a major religion which does not prescribe to any particular view on the subject. The lack of a moral compass from the Hindu faith on the subject has driven India's policy on population control into the hands of economists and scientists.

Therefore from the time of abortion being made legal in 1971 in India it took just a few years for the unpopular sterilization program under the Government's Family Planning initiative to get operationalized. Although the actual program was shelved due to its implementation, but the idea that population is India's burden has persisted. Today birth control is a common practice, couples are encouraged to use contraceptives, some local body elections do not allow candidates with too many children. The popularity of contragestion apart from contraception is a testimony to growing perception that population control is necessary.

The one-child policy adopted by China as a method of policy implementation is debated widely. But successive governments in India have tried to achieve similar results without creating a law. Therefore the mission of birth control was sought to be achieved through engineering consent among the public. Hence a generation was taught that excess population is a liability. And this effort has worked, although not to the levels of the Chinese extremes but to the extend that was possible without twisting arms.

Today there is practically no debate on birth control, none of the manifestos in the recent election had anything of note in this direction. The deficit of voices on this crucial issue is a matter of grave concern since birth control defines the structure of future societies and it has the power to fundamentally alter the institution of family.

A great telugu poet Gurazada Apparao once said : "Desamante matti kaadoyi, desamante manushuloyi" meaning, A country is not made of land; a country is made of its people.

Thursday, June 4, 2009

The Spoken Word

It is hard enough to convince one other person but to do so with millions of people takes some outrageous oratory skills. There is no denying that persuasion is only partly accomplished with words but without the right words it gets exponentially harder. The religions of old are a product of some profound arguments and the most effective manner of delivering these argument is rhetoric. Ideological demigods always knew oral propaganda to be the most potent tool at their disposal. And today we see a shining example of what the spoken word can accomplish in Mr. Barack Obama.

The understanding of language and the ways in which it moves people is complex and goes beyond the mere use of apt syntax or appropriate semantics. A compelling argument will do to people what a magnet does to nails: attract and align. Today Mr. Obama gave yet another rousing speech titled "On a New Beginning" at Cairo University addressed to the Muslims of the world. Someone shouted out "We love you" and no one was reaching for their shoe, a marked improvement for the office of President of United States in the space of six months. A change in voice can do that, obviously the message was different from the Bush doctrine but also the way it was delivered must hold some bearing. Here was the most profound manifestation of what one man's words can do in shaping the image of a nation in the eyes of a people.

Mr. Obama has been doing this for sometime now, from the Democratic National Convention of '04 and "A More Perfect Union" speech from his own campaign to the "Yes We Can" victory address and "A World without Nuclear Weapons" speech in Prague. Even the Tricky Abortion debate at Notre Dame was handled with sensitivity and understanding. Some of this leading to a Daily Show comedy sketch comparing Obama to Superman! Mr. Obama too has mockingly compared himself to Jesus for all the fans of his sermons.

Every country has been on the hunt for its own Obama since his rise but what the public means by this is not the just the politics and symbolism of Mr. Obama but also the appeal that such oratory kindles in them. Indian media too was awash with the search of the Indian Obama and leaders in all parts of the country have cited the American leader as an inspiration and cast themselves as his Indian avatar during the recent elections. But persuasion is a talent that is elusive to most. In Andhra Pradesh, India a popular movie actor, Mr. Chiranjeevi tried his hand at using a similar message of change in his campaign for the state election, but his speeches were a disappointment and his campaign derailed.

(In Picture: Praja Rajyam Party's Chiranjeevi projected as a Mr. Obama's counterpart in Andhra Pradesh, India)

Yet all is not lost for the Indian politician, I'll conclude this piece therefore with an example of a combative speech given in the thick of the Trust Vote debate in the Indian Parliament by Mr. Omar Abdullah on July 22nd 2008. This one speech helped many conclude that what transpired on that shameful day was atleast not a complete farce.

Monday, June 1, 2009

Crime Capital

Stuartpuram is a town in Andhra Pradesh, India which is famous or rather infamous for one particular export. Much like with the IT prowess of India exported to the rest of the world, this Stuartpuram export too is a skill. People in the know can disregard this drum roll, but for the rest - the talent is crime. There is a proud tradition of burglary, extortion and other forms of foul play at Stuartpuram. Yet this identity is not geographical but a communal identity of a tribe.

Theft and deception is said to be this community's occupation. In fact this tribe was covered in the draconian sounding "Criminal Tribes Act of 1871" framed by the British which basically supposed that there is a gene for criminal behavior. They were convinced of the "Born Criminal" doctrine and that Nature ultimately holds sway over Nurture. For good measure there is even a telugu movie by the name "Stuartpuram Police Station" starring the reigning star of the times in '91 - Chiranjeevi to further the legend.

Movie Poster : Stuartpuram Police Station

From accounts, Stuartpuram was a town that was used by the British to resettle the "Criminal Tribe" since the tribe was itself nomadic as it had to be when the stated occupation is such. To be fair though, the tribe's traditional vocation is said to be hunting for game, but they had to adapt once they were ejected from their forest habitats. The Act itself was repelled at the time of Independence but the stigma must surely remain. The town is still considered as the heart and brains of crimes both petty and extraordinary in the state. And so for all purposes this town is at the top of law enforcement's list whenever there is heist of note.

It is hard to escape one's extraction but easier to embrace cliches. Yet there have been reformers trying their hand at "rehabilitating" the citizens of the town. But the "Kula-Vruthi"- a word that means profession but in an almost karmatic manner, of these people is unfortunately not just reaffirmed by the larger society but also by the community itself on many occasion. People come from everywhere to Stuartpuram when the service of larceny is required. For the police the town is a one-stop shop for concluding their theft cases.

The irony here is that although there is scant respect for the law among the deviant elements of Stuartpuram yet these are the very people who best understand the law for what it is and its limitations in life. While rest of India lives a self contained existence which dare not test the boundaries of the norm, here are a bunch of intrepid citizens who see the country now as the British once saw it - Jungle Raj.

Interesting Readings:

Wednesday, May 27, 2009

Barca vs Man U from India

It is close to midnight of the 27th. Champions League final (football is the game under consideration) is about to begin in an hour: Barcelona vs Manchester United. Both recently champions and probably the best two club sides in the world. They said Messi vs Ronaldo, lets see what goes down. Probably the biggest match before the world cup kicks off next year. The news is full of it, sports fans everywhere must be holding their breath.

But isn't this the case every year? Now I am in India. 146 is a mere number to others, but to India its a proud ranking among footballing nations. It could be worse. Well actually it was worse back in April and May of '07 (Ranked 165) but that's beside the point. None the less, there is a renewed interest in football and most strangely among the elite and they bypass all the great games on i-league (Domestic competition) and go right ahead to Europe. I hear of all those deranged fans in West Bengal and the folks of sunny Goa who have always held pride in their football, played in their neighborhood. But for all of their professed love for the game, lets face the facts, football is tough. I know, I tried out at all my schools and colleges with limited success.

Football in India I would imagine is in fact the single largest sport played in schools as opposed to cricket. A little wiki-ing will tell you that India qualified for the '50 world cup on the back of a lot of withdrawals and again came in 4th at the '56 Olympics, 4th! Also won '51 and '61 Asian Games. I even remember reading in the papers that once footballers from Hyderabad weren't half bad. My guess is that in this period the game wasn't an elitist game. Even today football is the most accessible game in India.

European Football has been aggressively promoted to India and indeed all of Asia. It is promoted to such an extent that when I switch from an EPL match to an i-league match on TV, I find it hard to find a metaphor to describe the contrast in class. In fact last May we had Bayern Munich come down to Salt Lake Stadium to play an exhibition match against Mohan Bagan. 130,000 spectators were there and Bagan lost convincingly. The marketers know that football is such a beautiful game that people will watch it no matter who plays. But the point is to be able to create real loyalty among the fan base based on a shared identity. This is only possible when we talk of local clubs not ones that play half way arond the world.

There is hope though, cricket went from an elite colonial sport to what it is today in India regardless of all its shortcomings. With football there is less to overcome and more to gain in India if only kids are allowed to take up the sport with the knowledge that there is a livelihood there.

Meanwhile Eto'o scores for Barca 10 minutes into the game.

Interesting Reading:

Tuesday, May 26, 2009

Market for Mandate

Honesty is such an important virtue, but in places where trust can be misplaced, credibility needs an audit. In every deal struck, the parties involved look at their own benefits before the illusive benefits of synergy arrive in the elaborate non zero-sum games. Although trust is claimed as the bedrock of any business, this trust is easier arrived at by keeping the other party honest.

And one of the most crucial deal made is the five year periodic bargain for an endorsement at the seat of power. The vote is akin to awarding of a contract, the stipulations of this contract are present in the constitution and the contract is awarded by the voters. Much like the tenders that are floated in the newspapers, the bidders have to come up with a winning offer for the contract. Ideally the winning offer should be of just & fair representation, development and what have you, but in India the offer can be converted into plain old money.

At the recent elections and in the elections of the past a curious resource is created, one that is perishable and whose rate is not fixed: The Commodified Vote. The selling price of a vote is subject to so many political conditions that the parallel to the market seems almost flawless. If it wasn't illegal, there might have been an exchange for votes with options and derivatives. It might seem naive of the candidates to trust people who sell their votes with keeping their word when the ballot is "secret" yet that is what most candidates have to settle for their money. Hardly a safeguard on their investment. But with the limits imposed by the law and public outrage, the mechanism behind the highest-bidder votes have to necessarily not get too complex or formal yet arrive at a model that delivers.

Enter Mr. Campaign Manager, the instrument for winning elections. It is only fair to have expertise on your side when faced with a seller's market. Make no mistake, if you have voted either because of a convincing campaign or by ending up with a heavier pocket, the Campaign Manager has done his job. The average going rate for a vote in 2009 was Rs. 200 to Rs. 300 depending on who you ask. Anything less and the voter is swindled and anything more and the candidate is desperate. Even at those rates, loyalty is tough to ascertain. There is always a threat that the voter collects from multiple sources and does as he wishes. That is exactly the reason why poll management is such a demanding job.

Therefore I'd like to illustrate an example (Courtesy: Dad) of a successful mechanism of election fraud mastered in India. This is a method to ensure that a vote that is bought does not end up with another candidate on counting day. (Spoiler warning: This method is no longer possible with the advent of Electronic Voting Machines used in India now)

Modus Operandi:

Assumption: The money exchange has already taken place prior to the election date
On the election day, each candidate is allowed to have his representatives outside the election centers seated at a designated locations.
At the start of polling, one of the candidate's representative goes into the center to cast his vote but inadvertently puts the the ballot paper with the candidate's symbol marked in his pocket and walks out without voting.
Later when the voter (who sold his vote) turns up at the representative's desk outside the center, he is given the previous ballot paper with the party's symbol marked on it. This is carried with him into the booth and he brings out his new ballot paper, which he hands over to the representative. Thus the operation is repeated all day.

This method obviously is not fool proof i.e. when the voter simply fails to drop the paper in the ballot. But it does ensure that the voter does not vote against the candidate after taking his money, which has to be worth something.

Interesting Reading:

Thursday, May 14, 2009

A Wasted Vote

It is the 14th of May and the pundits are out! The Election Commission only allows the media to come out with their exit polls after the elections are over (and by that, they mean all the phases). So now its over to the experts, the verdict is for them to call until the truth (a.k.a mess) is for all to see on the 16th.

Babies might have started talking in the month since I voted. My estimate (no opinion polls or surveys here) is that atleast half a million people who voted this time wouldn't make it to the date of the final result (people can wither and die in a month, especially in this Indian summer). For a whole month all were equal in this country. At the table was the control over our lives for half a decade.

As I said, I voted. I voted for a party which made the right noises, refusing to believe that the point of voting is predicting the winner. My expert friends on the TV now tell me that my vote will be a "Wasted Vote", that my candidate will go home. Moreover they say mine was a "Spoiler Vote", meaning all I did was make it difficult for my second choice candidate to win: I spoiled his chances and wasted my vote.

Clear conscience is difficult to find in election season. Back until November I followed the US elections, all the websites and blogs, TV too. I had an opinion, but that wasn't my place. Now this summer I finally had a chance to excercise my opinion and choose. So I prepared well, watched all the 13 telugu news channels, a few of the national networks and the papers too. The political satires were out, the cartoons and songs, all the political TV spots. The absurd mixed in with the pertinent. After all of that, I voted along with the 710 million others (well atleast 55% of them anyway).

And now I am told my voice was not in unison with my neighbours. That I am the problem in a democracy: people who don't take a hint. I am like the 97,421 citizens of Florida back in 2000 who, in all good faith and clear conscience voted for Ralph Nader only to be told that they inadvertently brought in the greater of the evils to power by 537 votes. I always wondered what these people did in their next shot in '04, did they buy the spoiler argument or did they stand by their dented convictions again.

In the media, for months we had all these campaigns basically saying "Vote!". They told us that's what is wrong with the country - me not voting or voting without sense. Well I voted every opportunity I got, but never with satisfaction. I even asked the polling officer this time if I could cast a blank vote, he asked me if that's why I came all the way for. I fell in line, I voted. Any case, it turns out that that legislation is not in place in India.

The word "Rajnithi" is both apt and profound. I do not share in the disgust that some might hold towards politics. I realize that the smarter people in any society would obviously choose to rule over the rest and most often the smartest would actually make it. I just hate that I am made to play the fool at the end of it all.

Saturday, May 9, 2009

But the LORD ponders the hearts

Every way of a man is right in his own eyes: but the LORD ponders the hearts. - Proverbs 21:2

How does one justify dishonesty? By being dishonest to the self too, perhaps. Our actions and words may not always coincide with our intentions. But to live with that disappointment, one has to start down the difficult road of forgiving oneself. And forgiving self is nothing like absolving others, it means that one has to understand one's limitations, vacate long held dreams and ambitions and wake up to bitter reality - an end of innocence. This is such a trial-by-fire process that many times we choose not to accept reality so as to avoid the pain, by refusing to recognize the shattering of a dream. And to this end a logic builds in us justifying our actions or inactions. By avoiding the truth we give ourselves reprieves for the transgressions committed against the self since no law holds in such a domain.

If we were brought to trial for the crimes we have committed against ourselves, few would escape the gallows - Paul Eldridge

Doing the right thing is a tough decision to make. It is hard not only because of its consequences but more because the right choice is so difficult to identify. Indeed, it is almost impossible to define this notion of "right", but even with the assumption that it is defined and known, with all the inherent limitations that we are bestowed with, it would become crippling if every decision had to be weighed to the extent that it is determined to be infact "right". Yet it is the responsibility of everyman to own up to the decisions made, imperfect as they may be and understanding that there are consequences to actions and learn to understand and forgive oneself for not being right.

Saturday, April 25, 2009

Image of the Gun

I have never used a firearm with live ammunition. The closest I ever got to it was shooting an air-gun at the shooting range. The story is similar for most people. Guns are not a part of life in India for the most part. The elections are done, atleast here in Andhra and there is not one incident involving a firearm. Armed robberies are not reported frequently. Last time there was a shooting incident of note in Hyderabad was when the police fired on agitators protesting power prices back in 2001.

Yet a gun is a symbol that is not easily ignored. Movie posters have the hero wielding a gun, either as a weapon or as an accessory. The theory and the methods of using the gun are elaborately explained to the viewers. An average kid knows a revolver has six bullets, it is common knowledge. The fascination with guns is not limited to India, everywhere people are curious.

Among the many misdeeds of the British rule in India, history will look upon the act of depriving a whole nation of arms, as the blackest
-Mahatma Gandhi

The peculiar situation with the gun control laws in India under the Arms Act create a state where very few citizens get hold of guns for any stated purpose. Admittedly there are illegal weapons in circulation, yet their penetration is limited. And ultimately the state has successfully limited the prevalence of guns in India among citizens. But the image of the gun and the sense of power it evokes is a constant. Gun is a symbol of power or a leveler of injustice or the perpetrator of crimes.

Nations have been built on citizens carrying arms. The United States of America was possible because of armed militias constituting of citizens. The flag of Mozambique has the image of an AK-47 rifle on it as a symbol of defending its freedom. But India has no significant history of guns, independence was gained but not through an armed struggle. The nation was unified by and large voluntarily. This is not to say India is a peaceful nation. There are riots and killings, but here too guns are not the weapon of choice. Swords and knifes, sticks and hands are the tools most preferred. But a gun does arouse a sense of awe.

The public encounters the image of the gun on a daily basis. Children have a special place among their toys for gun toys. I believe that this is because as children we understand the essence of what a gun is capable of, without the justifications. A gun gives the bearer the power of life and death, a realization that control over others is possible. Hence a instrument of this nature is most sought after. This same knowledge is at the back of our minds and every image of an arm summons and reaffirms this realization.

The above picture (street art by Banksy) is an example of the potency of the image of a gun and when it is replaced by say a banana, like in the picture the impact is just not there. Yet the picture makes for a compelling viewing. Without the guns, the characters played by John Travolta and Samuel Jackson (from the movie "Pulp Fiction") are not the same people. The fear, respect or admiration is replaced by, well bananas! It is like a drink after all the fizz is gone: a symbol of impotency.

Wednesday, February 4, 2009

1 every 1.4 million

A good friend and doctor once narrated a story about a neighbor, a young boy who contracted Polio after being vaccinated. He went on to explain, in a matter of fact manner that in some rare cases the small dose of the virus that is used for vaccination is enough for a few people to be stricken with polio. This he knew from what he was taught in medical school. But he reassured all the intent listeners to yet another of his medical nightmare stories, that this was a far off shot with the probability being something like one in a million. The discussion then moved on.

Most people around the world today are vaccinated for a number of diseases and with good reason. Vaccination has dramatically reduced the infant mortality rate around the world and has been the main cause for the reduction in new cases of mental and physical disabilities. In India, vaccination is an ongoing drive, a mission which mobilizes large armies of doctors, nurses and resources with the objective of eradicating diseases which much of the world has already conquered. Actors and sportsmen are roped in to promote the vaccination drive. The government machinery visibility at these drives is next only to the general elections. A successful series of drives means that a generation is saved from the scourge of disease. Almost everybody is satisfied. Almost.

Coming back to earlier story of the boy. His condition is known as Vaccine Associated Paralytic Poliomyelitis(VAPP) and the statistics from the US show that the risk of VAPP is 1 case in 1.4 million first doses (according to Brown University [1]). It might be true that without the Oral Polio Vaccination the boy might well be jumping and kicking like most other kids of his age today. In his eyes, he has paid the price for a society to achieve its ambition. And as my friend had assured me, this is a risk that is considered 'acceptable'.

Utilitarianism and Medical Ethics

In other words, the gamble (for lack of a more potent word) for the government is laid out with the odds in favor being 1.4 million to 1. Odds which the Government of India through its Pulse Polio Campaign seems to have enthusiastically embraced since 1994. But the question remains, is it the government's role to gamble, especially with people's lives? The argument for such immunization campaigns have their origins in Utilitarianism; when the sum of all the benefits outweigh the losses that are incurred then such actions are acceptable. I suspect this is the same 'acceptable' as the medical literature prescribes in the previous paragraph.

I am sure that the subject of Medical Ethics is teeming with such predicaments. The profession of medicine dictates a certain disconnect from such philosophical issues for effective delivery of care. But it is important to note that these tough questions remain to be answered at some point and with some conviction. To attempt to answer these issues, the society and therefore the government have to reach a consensus on how to tackle such difficult matters. Thus the bargain for a better life for most (if not all) might lead to sacrifices by a few. These sacrifices might be voluntary or forced. A government or society functions because certain liberties of the citizens are withheld and controlled by it. A democracy conceals this fact better than any other form of government. In this regard, the politics of medical ethics is no different from politics in general.

The Solution

But as with everything else in a nation such as India (as opposed to say China), a sense of dharma somehow prevails even in the most difficult of moral decisions. In the case of Vaccination Campaigns, the solution has always been presented along with the question: Pulse Polio Vaccination in India is Voluntary. Therefore the gamble is passed on by the government/society to the parents - the people with the most to gain or lose and hence the apt decision makers.

Interesting Reading:

Thursday, October 2, 2008

Healthcare and Livelihood in India

Healthcare and livelihood are connected. When a government has to look at healthcare, it is bound to look at effects on livelihoods. In India where most people fend for themselves when it comes to healthcare, the causality between health expenses and livelihoods is most obvious to the patients and their families. The country does not have a great national healthcare system to guarantee the citizens at least basic care when in distress. This is more acute in the rural hinterlands of India, in fact most of India functions as it always had when it comes to issues of health and sanitation. A degree of inevitability and fate has built up in the minds of the population which combines with a sense of karma which is the anesthesia for all the nation's troubles. Hence the calls for improvement in healthcare is the last issue on anyone's agenda. This is evident when the budgetary allocation for healthcare is a meager 1.3%. It is easier for all to overlook the deficits in healthcare as matters that are political in nature.

With all the troubles in healthcare in India, the question of livelihood are not comprehended or at best ignored. For the vast majority for whom survival is subsistence, any damage to health will lead to loss of income which combines with the absence of savings lead to consequences which go beyond mere healthcare. In fact this inability to sustain through treatment or even the mere knowledge of this possible plight changes the psyche and therefore the behavior of a large parts of the population.

Right vs Responsibility

In the recent US elections the two presidential candidates were asked to state there view of how healthcare should function. Barack Obama said Healthcare is the Right of every citizen while John McCain saw it as the responsibility of every citizen. The Right vs Responsibility debate is at the crux of healthcare. The big pieces such as Government, Drug Companies, Medical Fraternity, Health Insurance providers etc can only fit into place when the choice or balance between Right vs Responsibility is understood.

First, if we look at the 'Right' side of the debate. Healthcare as a basic right of the citizens is a position that can only be possible when there is a government in place to ensure and carry out the right. In fact all the rights written into constitutions need guardians to enforce them, without these guardians these rights become hollow promises. Hence the role of the government increases when healthcare is seen as a right. When the mantle of healthcare then falls on the government, the complications might be many but what is for sure is that in the eyes of the law, every citizen is entitled to healthcare.

With India being a country of limited resources, its not a surprise that health has been a subject of the government. And just as other resource allocation schemes undertaken by the government such as Public Distribution Schemes (PDS), healthcare has also been on a path that leads to nowhere. This is understandable since it is unfair to expect one sector, even if it is as critical as health to be treated different from any other by the government, be it in efficiency or effectiveness. Therefore as a right, healthcare will only improve along with the performance of the government if it is left alone as a right.

But when healthcare is looked at as a responsibility of the citizen, then there is a huge difference in the outlook. With the responsibility shifted to the beneficiary of healthcare, so does the burden of the means to provide the service. As healthcare becomes a service commodity with the laws of supply and demand being applicable, the role of the government becomes that of a watchdog while the role of the Drug Companies, Hospitals, Insurance providers increases. But the biggest change in role is that of the beneficiary of healthcare as he ceases to be a beneficiary and becomes a consumer of health services. And if we are of the inclination that market economy will find its way, then eventually people will start to work towards providing for their health costs just as they provide for their other expenses.

Here again the scenario in India is such that for a section of the population healthcare from birth to death is a responsibility because of the inadequate heath facilities that they can access through their rights. This a sign of the stratification of the society in terms of education and wealth. The government too welcomes any move away from the 'right' notion as that removes the direct burden on it. But the fact remains that when a section of the nation cannot afford to carry their own cost of treatment and if healthcare is continued to be seen as a responsibility then the government will have to share their burden. Thus subsidizing healthcare for some, but not lowering the quality.

Thus, India presents a case where healthcare both as a right or a responsibility will work.By not choosing either one of the means of focusing on the problem there is a risk that there is a lack of the sense of direction to the efforts and hence the risk of ultimately wasting resources and lives because of a lack of unified perspective on the problem. But as the target is to first get everyone under either one of these umbrellas before shuffling around or opting for one, a change of course will itself bring huge costs.