Nice People May Finish Last… So What?

Sharing my article published in ‘The Deccan Herald’–in the context of a recent research study which suggests that Indians are not so “socially mindful”.

I say– nice people often finish last, still it’s nice to be nice. What do you think ?

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Beauty With An Ugly Underbelly—

Has Guwahati Become A Spit-City?

Anxious and cautious—I tread Guwahati streets and footpaths as if performing breakdance—but   fail to avoid landmines of grey grease, purple phlegm, and many-splendoured spit. I salute the artistes from the “Salivadorian School”—who paint the city in myriad hues and shades with their spit and sputum. 

Perhaps no other city has embraced spitting the way we have! Whether Guwahati has become a Spit-Hati, a Spit-City, a Spittoon? The contrast is incongruous—a city so beautiful, yet so filthy—a beauty rendered with an ugly underbelly.

Prime Minister Sri Modi mentioned this national pass-time in Mann Ki Baat. So rampant is the spitting obsession in Guwahati that the Chief Minister Sri Himanta Biswa Sarma, while inaugurating the new flyover, appealed to the citizens not to spoil it with spit. Some shameless people lost no time in creating ugly spit-patterns on the flyover and its artistic paintings.

Why blame? Besides pandering to our artistic cravings, spit comes in handy to manage the mundane—licking stamps, counting currency, and turning pages. Damn the hygiene, kill the aesthetics, murder the environment.

The poor spit while walking, the rich spit out from fancy cars. We are spot on when we spit, and spoilt for choices—pavements, parks, pillars, posts, or pits. Apathetic and immune, it is perfectly normal to spit and be spitted upon. Nonchalant, we take spit in our stride—literally and metaphorically—and carry it home. Hats off to our stoicism, we cope up with the outpourings from the sundry orifices with equanimity. We let out a peculiarly sheepish laugh to salute the free spirit of the fellow spitting on us from the bus window.

Why Spitting Must Stop

But it is no laughing matter. Public spitting is disgusting, dirty, and dangerous. It offends our senses, spoils our surroundings, and spreads disease. Spitting pollutes natural ecosystems of air, water, and land—degrading environment.

It affects aesthetics, turns off tourists, and shows state and its people in poor light. Spitting depletes the already scarce time, money, and medical resources. It is reported that Indian Railways spends Rs. 1,200 crores and oceanful of water every year to remove the spit stains from the tracks, platforms, and coaches.

Health Hazard

Spitting is a huge health hazard. It spreads Covid. It also spreads TB, hepatitis, viral meningitis, cytomegalovirus, etc. Researchers say that the spit droplets containing Corona virus can spread to a radius up to 27 feet. The pathogens remain in the air as well as on surfaces for several hours. 

We are a country of 140 crore people. Even if we take that 50% of the people spit in public—it is 70 crore people spreading dread and disease—daily. It’s mind boggling. 

Psychology Of Spitting

Many people believe saliva is a harmful waste and they must throw it out as soon as the body produces it. People also spit out of sheer habit, even unconsciously. According to WHO advisory, chewing smokeless tobacco (khaini, zarda, gutka, paan and paan masala with tobacco) and areca nut (supari) increase saliva production and enhance the urge to spit repeatedly.

Spitting—especially on the face—is an extraordinary instrument for expressing disgust, disrespect, contempt, anger, and hatred. The spitters also use it to show their superiority, power, and masculinity. 

Superstitions And Spoil Sports

Greeks practised ‘Ritual Spitting’ and ‘Spitting Thrice’ to ward off evil spirits. The Masai tribals of Kenya spit in their hands before shaking hands with others to show respect. Till recent past, the kings, the queens, the rich, and the famous in India, Europe, and US—used exquisite spittoons to deposit their royal spit. Westerners are quite sporting about spitting, and engage in spitting competitions such as ‘cherry pit spitting’ in Michigan, ‘cricket spitting’ at Purdue University in Indiana, and ‘olive pit spitting’ in Israel. 

In India, many mothers spray spit on children uttering ‘thoo thoo’ to protect them from ‘buri nazar’ (evil spirits). The rural folks spit on minor wounds for healing. People in the Hindi heartland use many imaginative idioms and metaphors such as ‘thookta hun tum pe’ (I have nothing but contempt for you), ‘thook kar chatna’ (to go back on one’s words), and ‘thook bilona’ (to speak too much).

The Laws

Covid came in handy for the government of India to enforce the Disaster Management Act, 2005. It made spitting in public places punishable with a fine or imprisonment or both. Spitting in public places is also an offence under the Guwahati Municipal Corporation Act, 1971. Guwahati Municipal Corporation(GMC) has recently announced a cash award for reporting public spitting, and requested citizen’s participation in keeping the city clean. It can do much more.

The Spit Free Street

Making laws is not enough. We need effective enforcement and monitoring. Installing CCTVs and deploying flying squads will help in catching the culprits. Government must be strict in imposing ban on sale and consumption of gutka, paan masala, tobacco, etc.

Curbing spitting habit requires change in public attitudes, behavior, and choices. Persuasive tactics, rather than coercion and control through stringent laws and blanket bans, will yield better results. Spitting can be tackled if a mass awareness campaign—akin to a crusade—is launched and sustained till it is wiped out. This must become the city and state priority. 

Covid has given an opportunity to put this problem on radar, and to bring an end to it. It is now or never. Speaking only about masks, hand wash, and maintaining distance—and not cautioning about spitting—is like closing three windows but leaving the fourth open for the evil to enter.

We can teach spitting etiquettes through grassroot campaigns and participation of citizens. “No Spitting” signposts will warn people. Advertisements on auto-rickshaws, taxis, and buses will create a buzz. Social media campaigns will have a wide reach and awaken netizens. When ‘Swatch Bharat Mission’ was launched, children taught the elders to not to litter—these kids can do wonders in the war against spitting. 

People listen to religious, community, and political leaders for right or wrong reasons—their words will have the required impact. Artists, sports persons, film stars, teachers, press, and the medical fraternity can lend tremendous support.

The awareness campaigns have to target both—those who spit, and those who don’t. Involving non-spitters is the most effective ant-spit strategy. Imagine 70 crore non-spitters persuading 70 crore spitters—each one stopping one. 

Our City Our Character

I write this because I love my city, and wonder—can we ever hope to remove the perpetual spots which stain our life, time, and place? And I write with screaming sarcasm, hoping to awaken citizens from their stupor. Can we all spit on spit—so we don’t have to exclaim ‘Oh shit, spit’—at every step.

We can continue to split over spit, or be in splits over it; drown in spituphoria, or rise in spitcstacy. But think—people’s habits define a city’s character, and what is a city—if not its people.

I recently visited my hometown Guwahati. The rampant spitting was so much in face, I had to spit out my disgust, ‘dos’, and ‘don’ts’. “G Plus” carried my sentiments in the published article below:

G Plus Spitting Article Image

When Hospitals Become The Disease.

Needed health sector regulator with teeth… Now.

14 years-old Prashant was in Delhi’s Batra Hospital for treatment of typhoid in April 2006. His condition worsened and he died in May. Prashant’s family alleged that he became brain dead in April itself, but the hospital did not inform and put “brain dead” boy on ventilator without family’s consent. The moment family ran out of funds, the hospital stopped ventilation. (timesofindia.indiatimes.com-24.06.2021).

There are hundreds of such hospital horror stories reported in the media. Besides ‘Covid Pandemic’, ‘Rape’, and ‘Murder’—the deafening headlines scream:

  • “Covid positive infant dies at hospital doorstep, mother cries for help” (indiatoday.in: 28.4.21);
  • “After Fortis, Medanta hospital in Gurgaon charges massive Rs. 16 lakh; 7-year-old dies” (financialexpress.com: 24.11.2017);
  • “5 year stay and a Rs. 6 cr. Bill: Bangaluru woman’s family blames hospital for her vegetative state” (News18: 30.1.2021)

“Hospitals have become a big industry instead of discharging their responsibilities to provide succour to distressed patients”—lamented Supreme Court (Times of India: July 20, 2021).

All hospitals are not guilty. But, when a strong health sector regulator is absent, the culprits remain unpunished. The rot continues and spreads.

State Of Affairs—Hospital  Or Hotspots Of Wrongdoings?

Many hospitals exploit by extending hospital stay for no reason. They shift patients to ICU, or put them on ventilators when not required. They hold patients or dead bodies hostage over payment issues. It’s akin to—skin the body, devour the flesh, then force the skeleton to give away its bones.

Many hospitals force doctors to prescribe unnecessary hospitalization, tests, and surgeries, and charge huge sums for these. Such hospitals don’t inform patients about their rights, line of treatment, or cost.

This institutionalised robbery ruins lives and shatters dreams. A fly caught in the spider’s web, the patient gets entangled in permanent poverty.

The Covid crisis of 2020 has proved how rotten the hospital system has become and how deep-rooted is the problem. There was nation-wide hue and cry about the products, processes, and prices related to Covid testing and treatment in the hospitals—a grim and gory story of organised loot.

 Affairs Of The State—Inadequate Laws, Implementing Agencies, and Budgets

Under pressure from public and media, authorities promise action against erring hospitals. But as seen in Covid cases last year, they issue mere warnings. This is as effective as putting band-aid on a fracture. Hospitals remain immune because both the regulating agencies and the laws are weak.

There are laws such as The Clinical Establishments Act, The Consumer Protection Act, and The Nursing Homes Act. But most states are not strict in implementing these laws.

There are governance bodies such as State Medical Councils (SMCs), Indian Medical Association (IMA), and National Medical Commission (NMC). But it is rare that these cancel an erring doctor’s or hospital’s registration, or take other legal action. These bodies exist to serve the hospitals and doctors. The Consumer Courts are not effective–they take long time in delivering judgments and lack expertise in health related technical matters.

According to Global Burden of Disease Study 2016, India ranked 145 out of 180 countries on access to healthcare. Ranking at 179th out of 189 countries, India has one of the lowest public healthcare budgets. According to Organisation for Economic Cooperation & Development (OECD), the government healthcare spending in India was 1.3% of GDP in 2018. Compared to this, the average was 7.6% for OECD countries and 3.6% for other countries.

In 2021 India has increased the healthcare budget by 137%. This is in line with the “National Health Policy-2017” (NHP) target of 2.5% of GDP by 2025. But is too low considering the health sector’s numerous needs as well as multiple malpractices.

Remedy—Health Sector Reforms And A Powerful Regulator

Given the pathetic situation, the government has to usher in health sector reforms on priority as it has done in agriculture, labour, and education. The remedy lies in a comprehensive health law. And the states must be strict in implementing it in private as well as government hospitals. If states don’t enforce health laws, bringing healthcare under Concurrent List of Constitution is an option.

Government can create competition for private hospitals by building AIIMS-like health institutions in every state. These will become the first choice for patients, doctors, and other health workers.

If hospitals act in illegal and unfair manner, the government has the power to suspend or cancel their licences. Other measures are to impose exemplary financial penalties, and name and shame them. Government can force hospitals to have patient grievance cells for speedy redressal.

It is crucial to have a hospital monitoring and evaluation system based on their track record of ethical operations. Setting up Medical Tribunals and appointing Health Ombudsmen will give speedy justice to patients.

To put these reforms in place, a strong health sector regulator with punitive powers is a must. Insurance Regulatory and Development Authority of India (IRDAI) has reformed the insurance sector to a great extent. Other examples are: Real Estate Regulatory Authority (RERA) and Securities & Exchange Board of India (SEBI). The government can take a cue from the Quality and Outcomes Framework (QOF)-2004 created by the National Health Service (NHS), U.K.

In India, regulatory enforcement is critical because patients themselves finance either the entire or a large portion of the treatment cost. Also, not everyone has medical insurance, and the insurance doesn’t cover every medical problem.

Section 14.2 of the NHP emphasises the necessity to regulate the clinical establishments. It also recommends setting up of an empowered medical tribunal for quick justice to patients. In Section 28, the NHP recognises that “A policy is only as good as its implementation”. It provides for a robust independent mechanism to ensure adherence by public and private hospitals.

The Economic Survey 2020-21 too recommended a healthcare regulator considering that:

(a) the bulk of healthcare delivery in India is through the private sector, and

(b) whereas the treatment is very costly in the private hospitals, its quality is not very different from the government hospitals.

The Road Ahead

We are at the end of 2021 but the government is yet to create the regulatory set-up based on its policy framed way back in 2017. There is dishonourable monetization of disease, disability, and dignity. An independent regulator with powers of exemplary punishment is the answer.

Health is a very basic need. It has a multiplier impact on citizens’ well-being and nation’s development. Human greed doesn’t care for decency in dealings or for health and life. The government must not allow malpractices in hospitals. We need a regulator with teeth and the power to bite… We need it now.

The edited version of this article was published in The Assam Tribune on 19th November, 2021, as below:

AT Mast 2When Hospital Become The Disease-Narendra Sarawgi-19.11.21