Indian Electoral Process – An Anomaly In The Bureaucratic Quagmire

It is impressive to see the world’s biggest democracy participate in the complex electoral process. For all the inefficiencies,red-tape and corruption that the Indian Government Bureaucracy is riddled with, the Election Process seems (in comparison) to be refreshingly better and different. The statistics for the process themselves are mind-boggling. Millions of voters (even for a state election…), thousands of polling stations, thousands of candidates … and yet, the whole machinery seems to perform with near clock work precision. Yes, there are a few irregularities, but statistically, they are much smaller than any other process of a similar magnitude.

Just watching those part-time workers (many of them school teachers) systematically process voters at the polling booths make one wonder…if only you could see this efficiency at any other government office! Clearly, full-time government workers don’t even come close.

Maybe we should get the Election Commission to run some other Government Departments! At least for a few days. We might just be pleasantly surprised to see how quickly applications get processed, permits getting approved, refunds getting sorted out, licenses getting issued, etc.

Why does the Election Process run so much better? I wonder why. Maybe it’s because this is one process where the politicians stay away (Literally – they are supposed to be a few hundred feet away from the polling stations during the voting process)

Some years back, Election Commissioner Seshan showed how he could use the ‘real’ power of this office, provided to it by the constitution. That was probably an important event, and even today plays a role in shaping the role of the Election Commission.

Wonder what your thoughts are on this topic.

Is the paranoia around H1N1 in Pune / India justified? – A look at some factoids & information resources

Honestly, I don’t have the exact answer. Only time will tell whether we, the citizens of Pune (and India) over-reacted, or should have done a lot more. All we have right now are statistics, data-points, examples from other regions of the world, and expert advisories to look at and  learn from. 

In this article, I am listing out the various relevant factoids, observations and information resources that I have stumbled upon over the past few days. I will let the readers draw their own conclusions.

What is painfully clear though is that we don’t have enough data, and we often don’t rely on credible sources of information. In absence of data and facts, the common population is always swayed by ‘headlines’ and ‘sound bites’ – Sadly, this is true even in the 21^st century. Thanks to the latest technology, data can be accessed easily; yet this same technology can also help in spreading rumors a lot faster as well.

Here are some factoids and observations:

1. According to WHO and other estimates, there are nearly 1 Billion cases of normal flu (influenza) each year.  Around 3-5 Million of these are severe and 300,000 – 500,000 of these result in deaths.

Statistically speaking (based on a simple extrapolation that India’s population is apprx 1/5 of World Population) that translates to 200 M cases, 600,000 – 1 M severe cases, and 60,000 – 100,000 deaths.

For a city of Pune, that translates to 500 deaths/year or 10 deaths/week.

All these are huge numbers. And yet, until a few weeks back, we hardly even thought about ‘influenza’ as something serious! 

2. On a related topic – Pollution levels in Pune and in all major Indian cities are at very dangerous levels. Yet very few perceived the need to wear masks over all these years. Do we know the statistics of upper respiratory problems in major Indian cities?

3. According to WHO (World Health Organization), the recommended mask to protect against H1N1 infections is the one that meets the N95 standard. Yet, these constitute a miniscule amount of the ones being worn around in Pune. The others don’t really offer any significant help. For a complete list of Do’s and Don’ts regarding masks – please refer to the next section.

4. Commonsense tells us that it is better to wear masks in crowded places; but they are not very critical when walking or driving on uncrowded, open roads. Yet, what we are seeing around in Pune is quite the opposite. It is also amazing to see so many people wearing masks that are covering their mouths, but not their noses?!

5. Last year, over 200 riders lost their lives in 2-Wheeler Accidents in Pune – many of these deaths could have been prevented had the riders been wearing helmets. Yet I see so many people on Pune roads today wearing masks but not helmets!

6. According to what I have read thus far, the H1N1 strain is not significantly more virulent than the traditional influenza virus. The prescribed treatments are also very similar to normal flu.

7. Most individuals who get infected with H1N1 will get back to normal in a few days (similar to the normal flu). This is not a virus like HIV that an individual will carry with him / her for the rest of their lives!

8. Apparently, a vast percentage (by some accounts, up to 90%) of the Indian population tests +ve on the skin test for TB (Tuberculosis). Majority of these tests yield a –ve result on a follow-up (and more reliable) X-Ray test. Disease causing germs (viruses and bacteria) are present everywhere – in most of the cases, the immune system should be able to take care of them! It is only when the immune system becomes weak (in case of old age, young children, patients suffering from certain chronic ailments, etc.) do these germs present any significant danger.

 

Here are some useful information sources:

1. Flu related statistics (from Roche Laboratories – makers of Tamiflu)  http://www.flufacts.com/impact/statistics.aspx

2. Comprehensive Flue Related Information from US Dept of Health & Human Services and CDC (Center for Disease Control)  www.flu.gov  http://www.cdc.gov/h1n1flu/

3. Comprehensive Flue Related Information from WHO (World Health Organization) http://www.who.int/csr/disease/swineflu/en/

4. A map based depiction of Flu cases across the globe http://www.healthmap.org/en

5. WHO – FAQ about H1N1 http://www.who.int/csr/disease/swineflu/frequently_asked_questions/what/en/index.html

6. WHO – Document regarding use of masks http://www.who.int/csr/resources/publications/swineflu/masks_community/en/index.html

7. WHO – Document regarding cleaning hands as a key preventive measure http://www.who.int/csr/resources/publications/swineflu/AH1N1_clean_hands/en/index.html

Issues With America’s HealthCare System – A Patient’s Perspective

I had the misfortune of suffering from an extended illness in America and experienced firsthand the many problems and issues with the American HealthCare system. In this brief article, I will try to list some of the major ones that I can recollect from my personal experience (See list below – points are in no particular order).

 

Please note that I still believe that the American HealthCare system is amongst the best in the world; especially when it comes to treating really tough medical conditions, and performing complicated surgical procedures and emergency medical services. It still retains some of the best doctors and other medical talent in the world.

 

My issues are more systemic and process related. In the end, one would expect a little more from world’s most advanced and expensive healthcare industry! Note these are my personal observations – whether some of these points can be generalized further needs more data points from other patients and consumers of this healthcare system.

 

1. Cost of HealthCare Insurance – The cost of healthcare has undergone a major increase over the last decade. The increasing insurance premiums have forced many private sector companies (that offer health insurance to their employees) to increasingly pass on a bigger chunk of these costs to the employee. This increase has been significantly more than the rate of inflation, and has resulted in no perceptible change in the service quality.

 

2. High costs for the un-insured, and the under-insured – This issue is extremely critical and has already been discussed ad nauseum in every media outlet, by numerous experts.

 

3. Insurance Claims Processing – Even for patients that have some of the best insurance coverage, the process of settling claims is far from perfect. Discrepancies and errors are common. In certain cases, interpretation of ‘what’s covered vs. what’s not’ is not clear. The 3-way communication across, Doctor’s Office – Insurance Company – Patient, further adds to the process complexity and mismatches. I personally had to deal with many of these claims related issues. To resolve these, often times you end up spending hours on the phone with the insurance company.

 

4. Impact of ‘medico-legal issues related complications’ on behavior? – I am not a legal expert and cannot pass explicit judgments here, but sometimes one gets a feeling that the entire medical staff’s (not just the Doctors, but also the Nurses and other support personnel) interactions with a patient are biased by a ’medico-legal’ angle. Most answers are very generic, vague and filled with ‘disclaimers’. I understand that this is a big issue, but it is a bad trend if it affects the medical staff and patient communication. This communication channel needs to be one of those most ‘open’ ones!

 

5. Accessibility of a doctor – Most doctors work during the regular office hours and are not available on evenings and weekends. Hence seeing a doctor often times results in a forced half-day vacation during weekdays for many patients. Evenings and weekends are out of bounds and if you are in urgent need to see a doctor, in most cases an Emergency Room is your only option.

 

6. Difficulty in getting to a specialist – Often times it’s very difficult to schedule an appointment with a specialist. Many are booked out weeks into the future. And if you can’t see them right away, and are in some serious trouble, the standard answer that you might get is ‘Go to an Emergency Room!’

 

7. Difficulty in asking any simple follow-up questions to a doctor – If you have the most mundane follow-up question, it is still very difficult to directly ask your doctor. Even if you call during office hours, your call is routed to a nurse who often has no background about your particular case (except for some case-papers). Typically, the nurse is very busy and answers a simple – ‘I will get back to you’. If you call outside office hours, then your best bet is an answering service! I agree that many times it is not feasible for a busy doctor to directly talk to the patient. But some intermediate solution needs to be worked out. After all, I think that the most expensive healthcare system in the world should have at least some ‘personal touch’.

 

8. Information Technology in Healthcare – I get the impression that the Healthcare industry hasn’t leveraged IT to the fullest extent as compared to many other industry sectors. This can be seen in hospitals as well as in doctor clinics. From basic things like Electronic Medical Records (also referred to as Electronic Health Records), to a better integrated hospital management system (across billing, insurance, clinics and service providers) a lot of improvement is needed. Even today, there’s hardly any electronic data interchange of a patients reports, health records and doctor’s notes across practices and hospitals.

 

I have had to fill in volumes of paperwork every time I went to see a new doctor. Why can’t there be some automation of a patient’s insurance records and medical history? Why does a new patient have to arrive at a new doctor ‘15 min early’ to fill out reams of paperwork, many times when he is not in a mental/physical condition to be dealing with this? A patient has to maintain an increasingly heavier load of files, and paper documents, and make it accessible to any new doctor that he might be seeing.

 

9. Difficulty in Scheduling Simple Procedures – Even simple diagnostic procedures (e.g. Ultra-Sound, Endscopy, etc.) can sometimes take days or even weeks to schedule. I don’t really know why this happens. Is this merely a scheduling problem or a supply scarcity of resources?

 

10. Newer patented drugs are regularly being introduced and are prescribed in many cases. Not sure if the incremental benefit that some of these provide over the existing older (and still under patent) or off patent/generic drugs can be weighed against their exorbitant costs. I am not an expert and cannot make this judgment, but do think that this is something that needs to be researched further. Again – since the US consumer is supposedly the ‘richest in the world’ he has to pay the highest (in most cases) for the patented drugs compared to other developed countries. This is another issue that has been a big point of contention, with lot of discussions in the media.

 

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What is Twitter? And why should one start using it?

Many of my professional and social contacts are already using Twitter, and yet many more are still not fully aware of it.  I am writing this brief article to introduce this great new medium to those who are not on board. If you are already familiar with Twitter, but are not actively using it – please, get onboard….you are missing out on a lot! If you are already a regular Twitter user, that’s great! Feel free to skip this article.

 

Just 6 months back, if someone had mentioned ‘Twitter’ outside the confines of some Silicon Valley coffee shops and offices, chances are they would have received a blank stare. Further more, many ‘techies’ who understood the concept would have dismissed it as another one of those Web 2.0 websites. How much difference 6 months can make! Today people from all walks of life are entering the ‘Twitter-o-sphere’! Twitter already has more than 6 Million users.

 

Initially, these new users start off with a few tentative steps to test the water. Like any new communication medium, there is some acclimatization (learning) curve. However, in Twitter this is typically very short. Many Celebrities, Politicians, CEOs, Authors, Business Gurus have started ‘tweeting’ (sending messages via Twitter). When geeky words and phrases such as ‘Google It’ and ‘Reboot’ enter out lexicon, that’s a clear signal of mainstream adoption of the technology. ‘Tweeting’ is almost there!

 

Almost all major news organizations (TV/Print Media/Blogs) are also leveraging this new medium. President Barack Obama used Twitter quite effectively in his election campaign; and in this week’s State of The Union Address Session, it was reported that a congressman was sending live updates of the President’s speech on Twitter.

 

Twitter is as fundamental a medium as ‘Email’. You can use it the way you want it. Unlike a social networking site, or a professional networking site – it doesn’t compartmentalize the user into a specific domain. Like email, you can use twitter for catching up with friends, for personal networking, for business connections, for marketing, for following news & sports, etc.

 

Twitter user base is growing exponentially and has started rivaling some of the most popular sites on the web.  As the number of users grows, so does the reach and the types in which it used. Whether it was the Mumbai Terror Attacks or the Hudson River emergency landing of a passenger airliner, breaking news was being actively disbursed via Twitter, before any of the conventional media. One primary reason for this popularity is Twitter’s cornerstone design of limiting message length to 140 characters (something that can be sent through a SMS protocol on cell phones). This forces the user to write brief and crisp messages, and enables readers to focus on the real topic quickly.

 

So what exactly is Twitter? And how does one start using it? Instead of re-inventing the wheel, I am simply going to point the reader to a great overview article & presentation “Why you should be on Twitter – and how best to use it” that was compiled by Navin Kabra, the founder of PuneTech. After going through this presentation, I hope that you can start ‘tweeting’ soon! My twitter id is ‘aparanjape’ – look forward to connecting with you there!

  

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Slumdog Millionaire – The Most Over Hyped, Most Average Movie Ever?

Disclaimer – I am no film critic, so read this review (more of a rambling…) with a pinch of whatever it is you take J. If you agree with my views, thanks! If you disagree – sorry about wasting your precious 5 minutes!

 

Imagine its early 2009 and aliens from a distant galaxy ‘happen’ to visit earth. Technologically they are 1000s of years ahead of mankind…proven just by the mere fact that they made it all the way here J. Yet they are completely confounded in their understanding of the human mind! After researching through each and every human behavior pattern and psychology, they still cannot figure out why these homo-sapiens are so crazy about this new hit movie called ‘Slumdog Millionaire’. And it’s not as-if they didn’t do their homework!

 

Thanks to their superior screening and learning abilities, they have already internalized all the great Hollywood classics from the past eight decades. They admired the depictions of space travel in Star Wars, the portrayal of prehistoric worlds in Jurassic Park, the history lessons from Ben Hur to Gladiator; and the drama in God Father. A simple love story that translated into probably the biggest all-time movie, ‘Titanic’ also aroused their strong interest. All these movies had terrific music, direction and cinematography.

 

These aliens have even tried (admittedly, with less success) to understand India’s ‘Bollywood’ and have studied great musical works of A.R. Rahman such as ‘Roja’, ‘Lagaan’, to name a few. After all, the language of music translates across galaxies J.  They have seen stark and realistic depictions of harsh realities of urban life in the developing world, in movies such as ‘Salam Bombay’ and ‘Traffic Signal’.

 

And now they are hit with this new challenge…How in the world (Sorry, How in the Universe J  ), to explain this phenomenon of Slumdog Millionaire! I and a few others (it seems for sure…) sympathize with their predicament.

 

I mean, there’s nothing wrong with the Slumdog movie, for starters. But there’s nothing, absolutely nothing great either! An average story, with hardly any plot! Music that doesn’t even come close to any of A.R. Rahman’s better efforts. Cinematography that primarily revolves around some ‘slum’ shots and some ‘train’ shots… Acting is probably the only one above average component in the movie…but calling it great, is a stretch as well!

 

For this ‘original’, ‘realistic’, ‘unique’ and ‘special’ depiction (of an extremely typical ‘Rags-To-Riches’ story format) – why is the movie stuck with those extremely stereo-typical India portrayals? Taj Mahal, Railways, Call Centers, and Slums – this theme doesn’t look that original and imaginative.

 

There is so much hype; to the point where it is getting long standing ovations?! Is the hype coming out of the doom and gloom that majority of the world finds itself today, following the 2008 Financial Crisis? Is the situation so bad, that such a movie can ‘uplift’ the mood of so many people? ‘Look at the misery around the world, and you are thankful for what you have’ – didn’t some philosopher say something like that?

 

Or has India suddenly become the flavor of the season? Or, are the rest of the movies (I haven’t watched any of the contenders) from 2008 so bad, that the juries of prestigious awards are stuck with this one?

 

Well…just as those aliens, we would probably never no! J 

 

 

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