A Stitch in time saves Nine- I

DU perf suturingWhat would a doctor in a public hospital do when a 19 year old boy is wheeled into the casualty with 2 tubes exiting his abdomen and a bulky dressing over his belly?
Try to send him elsewhere.
But what would the same doctor do if his family was made to run from pillar to post and not accepted in any other public hospital?

That was the story of nineteen year old Akshay, who’d been operated in a private hospital and had developed complications after the surgery.

Akshay had an ulcer in the duodenum (the part of the small intestine just beyond the stomach), the kind most of us have had and attribute to ‘acidity’. The only heinous aspect of the ulcer was that it had perforated. The ulcer had penetrated the wall of the duodenum and exposed its interior to the abdominal cavity.
The entire gastrointestinal tract is sealed off from the body, with the only two openings being the mouth and the anus. Millions of organisms thrive in the gastrointestinal tract serving many purposes. Any breach in this tract would lead to contamination of the body with these organisms, which underlies the importance of sealing the gastrointestinal tract from the inside of our body.
Intestinal juices (bile) were pouring out through the perforated ulcer into the sterile abdominal cavity, hence contaminating it. Any doctor, in his right mind, would’ve advised surgery at this point in time. And so did Akshay’s physician.

Any Indian who can afford private medical care prefers a private hospital to a public hospital. Due to a lack of interest in healthcare, shown by the ruling class since Independence, the infrastructure in the public hospitals is poor. The wards and corridors are dirty and infested with various kinds of insects and animals (citizens must take the blame too, what with spitting and open air defecation rampant in the premises of these ‘premier institutes’). The operating rooms have cobwebs and leaking roofs and the wards have an unusual stench, one which is unbearable if one isnt used to it.

It’s only once the underbelly of the private medical centres is exposed by these complicated cases, does the common man turn to the public hospitals to salvage the situation.

Akshay was operated on an emergency basis in a private set-up not too far from the public hospital we were training at. Simple sutures were taken to seal of the perforation and standard practices were followed for post-operative care.
Three days after the surgical intervention, however, the drains placed during the surgery (to suck out any residual fluid) showed a change in colour. Green colour, in a drain, is an alarm bell for a gastrointestinal surgeon. The tubes were draining bile, implying a give way of the sutures placed over the perforation.
Duodenal perforations aren’t notorious to leak, but there are always exceptions to the rule.
Akshay was managed in the private set up for a few days, before his parents ran out of money and patience and took the decision to shift him to a public hospital. Without prior intimation by the private hospital, the patient was paraded to the various public hospitals around the city, with each of them providing novel reasons to refuse admission. After all, this wasn’t an easy case to manage.

Facing rejection from the other three public hospitals in the city, Akshay’s parents turned to our institute as a last resort.

Akshay was wheeled into the ward accompanied by his family. Akshay’s father came up to me, as I was in charge of the emergency ward at that time, folded his hands and was readying himself to touch my feet.

“Please save my boy’s life,” he stuttered, as tears rolled down his eyes, along the side of his nose.

The chaos of the emergency ward blurred itself out for the next ten minutes as Akshay’s father, Mr. Yashwant narrated his story to me. His mother, who looked more like his sister, stood by his side, stroking his hair as if to tell him that he’d be all right soon.
The chaperone accompanying him seemed least bothered, ready to dump him in that mess of an emergency ward and run away. That was all his duty demanded of him, after all.

Akshay sat there motionless, least bothered by the surroundings. He was stationed on a wheel chair, outside the door of the emergency ward, mildly breathless, with a grim expression on his face. A dressing was placed over his belly, the size of which was twice his body circumference. Two tubes were placed on either side of his abdomen, connected to bags draining greenish fluid (bile), and the skin around the draining tubes was excoriated due to the irritant action of bile. He’d already been through enough at that tender age of nineteen. Sitting on the wheel chair outside the emergency ward and watching patients die/gasp for breath/vomit blood seemed trivial to him.

Akshay and his parents had suffered enough. After due consultation with the seniors in the unit, Akshay was admitted, stabilised and shifted for a CT scan. Akshay had to be operated and was prepared accordingly.
Operating him was not as difficult as anticipated. The cause of the leak was identified during the surgery. The sutures that had been placed to secure the ulcer, had given way leading to leakage of the intestinal juices into the abdominal cavity.
The ulcer was re-sutured and Akshay’s abdomen was closed. We were all glad it went off well and counselled Akshay’s parents about the procedure with guarded optimism. Akshay was shifted to the ward after the surgery, not requiring either intensive care or ventilatory support.

Re-operations are always tricky. As the body heals from the stress of surgery, the immune system forms fibrous bands in the abdominal cavity, as a part of the healing process. The easy access to Akshay’s abdomen worked in our favour, as did his age. Younger patients always heal better and faster than older ones.

First post-operative day- Evening rounds.
All five residents of the unit were on rounds that day. The wards were full and work was pending. On reaching Akshay, the junior resident pointed out, “Check his drain Sir, it looks like bile.”
The senior residents and I immediately turned our gaze to the drain. It was indeed bile. Akshay had leaked again. Akshay required surgery again. What the hell was wrong with his luck?
The same routine of preparing the patient for surgery was followed.

Akshay and his parents were distraught. They didn’t know how to react. Their boy, who was in his last year of his teen hood, was to be subjected to a third surgery in a week. The initial reaction was to transfer him to a private hospital, cursing the public hospital system and the lack of care thereof. Better sense prevailed, however and his parents consented to the surgery.

Akshay was operated again the following day, i.e. two days after his second surgery. The sutures had given way again. His plight had left everyone dumbfounded. The access this time around was a lot more tricky than it had been two days ago.
The human body is a mystery. Inspite of the extensive research performed on it, no one seems to have a conclusive answer to the plethora of problems faced by doctors regularly. There was no logical explanation to justify the difficult access to Akshay’s abdomen just a couple of days after the same operating surgeons had a relatively easier access.
The surgery this time around was a lot more complicated than it had been previously. Due to the adhesions and scarring around the stomach and the intestines, an unfortunate complication arose.
The pancreas and liver connect to the duodenum via ducts opening at the ‘Ampulla of Vater’, which is surgically defined as a ‘no touch zone’, except for procedures involving the pancreas. Due to the extensive scarring, identification of the ampulla proved to be difficult and while operating, the ampulla opened up inadvertently.

This was neither expected, nor anticipated. Akshay’s problems had now travelled a full circle, starting from a simple leak to a failed re-surgery to the most dreaded complications of all. Pro’s and con’s of various procedures to repair the ampulla were discussed hurriedly amongst anyone who would be brave enough to provide an opinion.

The most amazing thing about surgeons is their decisiveness. No matter how good or bad a decision maybe, the decision is made in a split second. The surgeons are always brash. The quintessential Alpha’s of their field (whether male or female). The physicians are always behind the surgeons in this aspect (and maybe in this aspect only), as they dilly-dally with every decision that has to be made. A physician will always ponder over his decisions before putting them into effect, sometimes losing valuable time in the process. If a patient is critically ill requiring urgent attention, I’d bet a surgeon would do a better job than a physician as far as the primary management is concerned.

A decision to anastomose the Ampulla to the small intestines (jejunum) was taken after a short discussion. The procedure was underway. 3 surgeons and 2 residents were scrubbed in for the surgery, one which took a total of 9 hours to complete. No tea breaks. No bathroom breaks. Adrenaline was flowing through the veins of every doctor in the OR.

The Operating Room is a social set-up where various cultures interact and work in harmony to provide quality care to the patients. Chattering, gossiping, music in the back ground are some of the various characteristics of every OR. As opposed to popular perception, a lot of friendly and unfriendly banter takes place in the OR. It is far from the silence one expects in the hospital.

Silence in the OR was an ominous sign. And while Akshay was being operated, one could’ve heard even a pin drop. The silence was eerie. The jovial atmosphere had transformed to a grim one. It seemed like the silence had galvanised all present in the OR to perform efficiently and in perfect harmony. After all, the life of a nineteen year old was at stake!

A Stitch in time saves Nine- II

DU perf suturing12 hours, 16 mops and 5 blood transfusions later, the surgery was finally over. It’d started at 9:00 am, the ampulla was opened at 10:00 am, the decision to perform the ampullo-jejunostomy (anastomosing the ampulla to the small intestine) was taken at 10:30 am and the procedure was formally completed at 9:00 pm.

Akshay was wheeled out of the OR, with a tube in his throat and a bag (AMBU) attached to it, being pressed manually to ventilate him (an accepted method to shift ventilator dependent patients). The Surgical ICU (SICU) was prepared in anticipation. The first bed was emptied for him and the most sophisticated gadgets available in the ICU were set up to monitor him.

The immediate post-operative period is the most critical for the survival of patients undergoing major procedures. Fluid imbalances, clotting disturbances and hypothermia (a decrease in the core body temperature) being the major culprits in early post-operative period. An intensive care unit (ICU) with the physical presence of a doctor to monitor the patient is the bare minimum requirement for such patients.

I stayed in the SICU all night monitoring Akshay, who was drowsy and unresponsive at the time of shifting. In a few hours, Akshay was awake and fighting the tube in his throat and the restraints that had tied down his hands and legs. A mild sedative knocked him out again. Fluids were managed judiciously as per his urine output and ventilatory settings were changed as needed all night. Besides a mild drop in his blood pressure (owing to under-hydration) Akshay survived the night without any major mishaps. His chances had just increased manifold.

Over the course of the next few days, Akshay was weaned off the ventilator, without rushing him into anything. The recovery seemed promising. A feeding tube placed directly into his small bowel had allowed us to resume his feeding, avoiding the more dangerous parenteral nutrition (high concentrations of nutrients injected directly to the heart through a catheter placed in the neck).

Akshay, however had become reticent. He spoke only when addressed and did not take an interest in the surroundings. All of us were so consumed in making him better, that we’d overlooked his fragile emotional state.

 

Post-operative day 5. Morning rounds.

The previous nights wound dressing over the abdomen was soaked. It smelt and had a greenish tinge. Nothing in the drains, but something from the abdominal surgical site? On opening the dressing, a litre of bile drained out onto the sterile gauze pieces.

Every surgeon has only one enemy. Not the physician, not even the anaesthetist, but PANIC. A part of every surgeons training is to avoid panicking in tricky situations. And we held our own, that fateful morning.

Akshay had developed a fistula (a communication between the intestines and the skin), a known complication of such procedures. The bile draining into his abdominal surgical site had to be addressed soon, as devastating complications could’ve followed. Such fistula’s were known to close spontaneously as long as the causative factors were taken care of.

 

We came up with a novel idea for Akshay. A home made closed suction dressing. In simpler terms, a dressing that would drain the fluid out of his abdominal cavity and at the same time facilitate healing. A simple rubber catheter was places as an atraumatic tube into his abdominal cavity. The other end of this tube was connected to the suction apparatus available in the SICU. A sterile plastic adhesive film was placed over the partially open abdominal wound containing the rubber catheter, to create a vacuum, which would allow the suction to take effect. Utmost care was taken to avoid spillage of the vicious bile over to the surrounding normal skin, to prevent it from damage.

The dressing had to be changed every time there was even a hint of fluid spilling over to the surrounding skin, which would range anywhere from a few hours to a few days. It took 2 residents, a staff nurse, a ward boy and a relative to complete every dressing.

As time passed by, the amount of bile draining through the wound decreased. Akshay would go on for hours without the suction attached to his dressing. Yet the amount was not so insignificant that we could wean him off the suction completely. However, this decrease in drainage from his abdominal wound drew our attention to another reality.

The environment of the ICU was taking a toll on Akshay. Akshay was depressed. He hadn’t interacted with us in days. His parents too complained of the same thing. His face bore the same melancholic look as when he’d first come to us. A complete recovery from surgery meant physical, mental and social well-being. Akshay was recovering physically, but his mental health was on a downward slide.

We increased the time we spent by Akshay’s bedside everyday. We cracked jokes around him, involved him in our stupid banter while sitting in the ICU and allowed his parents to visit him more often in the ICU. Unfortunately, Akshay couldn’t be shifted outside the ICU as the suction apparatus in the wards were non-functional. He was shielded from seeing patients die in the ICU by strategically using the curtains provided. We even arranged for a small laptop with a collection of the latest Bollywood films for him, procuring special permission from the sister-in-charge and the doctor-in-charge.

Slowly, but steadily Akshay recovered, both physically as well as mentally. The surgical wound over his abdomen had begun to heal, contracting in size. Owing to the fistula, Akshay was still not permitted to take anything orally. Feeding through the tube, however accounted for his nutrition. A brief period of feeding him the bile sucked out through the surgical wound also helped in improving his nutritional state.

3 months after first entering the hospital, Akshay was en route to a complete recovery. The fistula had closed partially and the wound was contracting at a rabbit’s pace. He had finally been weaned off the suction dressing.

On our morning rounds on one of the days, we urged Akshay to take something orally. The smile that followed was the broadest smile I’d ever seen. It was the first time in 3 months that Akshay had smiled. His mother got ‘khichdi’ (porridge) and fed it to him in front of all of us. Mr. Yashwant and Mrs. Nita (Akshay’s mother) were in tears. My eyes welled up too. Crying, however, would seem unprofessional and I held back.

“I want some chocolate,” Akshay demanded as he looked towards us. Our boss nodded. Chocolate was immediately arranged for and fed to him. His impish smile and childlike enthusiasm caused immense joy amongst us. We realised this was something special. Every human being has an instinct to survive. Akshay not only had the instinct to survive but the will to fight against all odds and emerge victorious. I was honoured to bear witness to this amazing exhibition of will power and courage.

Akshay was discharged, 3 months and 10 kilos of lost weight later. My unit and ward switched, weeks after Akshay was discharged and I hadn’t seen him in a while.

 

A year later.

I ran down the corridor wheeling my patient into the SICU. Ganesh had aspirated and needed an urgent intubation. I saw a familiar face as I hurried down the corridor, but didn’t pay much attention to him. Ganesh was shifted to a bed in the SICU, intubated, his bronchial tree was suctioned dry and he was put on ventilatory support. After giving the SICU Registrar the relevant instructions I walked back towards the ward. The same familiar face was still standing there.

“Sir,” he said as he embraced me. It was Mr. Yashwant, Akshay’s father.

“I’d touch your feet today, but you had asked me not to when we came here first. Thank you for everything.”

Behind him stood Akshay, unrecognisable from his past form. He’d transformed into a plump teenager with a rotund face, with the same impish smile. He hadn’t let the 3 months spent in the hospital hamper his subsequent growth.

I couldn’t keep up with my normally stoic demeanour. Emotions got the better of me. I cried…………..

 

Shocking Saturday- II (The Accident)

 

Screen Shot 2014-07-15 at 4.53.32 pm

3 weeks had passed by, since Mr. Dattatray (the patient with Gas Gangrene) had been admitted. 3 weeks had passed by, since I’d had a good nights sleep. Not that one really expects a good nights sleep as a junior resident.

It was a Friday night and our morale was on an all time high, having supervised Dattatray’s almost miraculous recovery. A proposition was put forth by the Chief Resident of the unit (registrar) to step out for a celebratory dinner. We agreed.

Within minutes, the 3 residents of the unit stepped into my vehicle to drive away to a famous joint at Matunga, serving delicious South Indian food. We devoured the food with gay abandon. A heavy meal followed by refreshing beetel leafs laced with some lime, areca nuts and sweet tit bits (Paan) later we retraced our route to the hospital.

Midnight had passed by, as it did on most days, without a refreshing sleep in store for me. Today was different. The work was done, the patients were accounted for and the following days orders were written down.

As I was about to slip into bed, thankful to everyone who made it possible for me to get those few extra hours of sleep, I heard a knock on my door. “We have to dress Dattatray’s wound, buddy,” a female voice percolated through the half open door. My immediate senior and I had both forgotten to do so. “In a minute, Ma’am,” I grumbled, as I put on my pants and any shirt I could grab hold of to adhere to the general principle that a doctor must be well dressed at all times. Sleep was all-consuming, but duty beckoned.

As the minutes passed by, while dressing our patient, an adrenaline rush stimulated every anti-sleep centre in my brain. I was no longer sleepy. We finished the dressing efficiently in an hour, with able help from the nursing staff and patients relatives.

Sleep was behaving like a deceitful wife, overpowering at one time and absent minded at another. As my parents stayed close to my work place, I’d repeatedly go home for refreshments and rest for a few hours. A strong desire to go home and catch a few hours of uninterrupted sleep, came over me. I stepped into the parking lot and squinted in the darkness to find my car. I got into my vehicle and sped away. The roads were empty and the signals were non-functioning.

I got my first sleep attack while negotiating the first turn beyond the hospital. Slapping myself out of my sleep with the music blaring at a deafening volume, I drove along.

The second sleep attack came a kilometre later, as I drove along the deserted roads. Driving at a speed of 50 kph with the windows rolled down and the music blaring into the dead of the night, my senses betrayed me at the wheel.

Road traffic accidents are the leading cause of death and disability, with the biggest culprit being user errors and drivers dozing off while at the wheel. I could never comprehend how anyone could fall asleep while at the wheel. However, this early Saturday morning made me learn it the hard way.

As the car moved along, sleep overpowered me again with my awareness lowering its guard. A loud, screeching sound startled me, my foot pressed the brake pedal subconsciously. I passed out. My head rested on the wheel when I came to my senses with blood trickling along the side of my face. I tried to cry for help, but to no avail.

Reflexly, I checked the function of my limbs and any injuries elsewhere. Within no time, I’d realised the only injury I’d suffered, was a cut above my eyes. Using a handkerchief to stop the bleeding from the cut, I stepped out of the car, trying to balance myself. Just then, I realised the severity of the accident.

The left side of the car had hit a circuit box over the pavement of the road, one where fortunately no human was resting, as is the norm in the city. That side, including the windshield had been smashed into pieces with a burst tyre hanging onto the axle, as if it were on its death knell. An immiscible layer of water and oil formed over the road. The radiator grille detached itself from the car and came crashing down on the road, splattering the liquid mixture in all directions.

Dazed and confused, I managed to retrieve my cell phone from the crashed passenger seat and dialled ‘HOME’. And I waited, with a kerchief over my eye and a prayer on my lips.

The policemen arrived within ten minutes of the crash, considering there was a Sub-station opposite the site of the crash.

Fortunately, no one was injured, excluding myself. As I narrated the sequence of events to the inspector, who was very helpful and even offered to take me to the hospital, my brother arrived at the scene of the crash. The legal formalities and implications were minimal as there were no casualties. The process was expedited at the Main Police Station by  a police officer, who immediately recognised me from my work at the hospital. The hospitality doled out at the police station rivalled that at a 5-star hotel. The process was carried out in a professional manner, that helped me avoid any court cases or complaints, but allowed me to use the car insurance for reimbursement. Arranging for a towing truck to tow the car to our garage at home, we proceeded towards home.

I was still a little dazed, but very thankful that the injuries sustained were minimal. Arrangements were made for a Plastic Surgeon to suture the cut above my eye. All this, while I was still in a daze, due to lack of sleep. After having caught a few hours of sleep, I returned to work like it was any other normal day.

Seven stitches and a bulky dressing was all that I had to endure from a horrible crash such as this one. I was one lucky man.

Never again did I drive out of the hospital after midnight.

Reservations- The Plague that has hit the Indian Society

It all started with the Poona pact, 1932. Reservations were provided for the ‘depressed classes’ in the central legislature to the tune of 18%. The champion of the OBC’s (other backward classes) cause, was pushing for a separate electorate for the backward classes, a move strongly opposed by the Father of the Nation. A compromise was eventually reached, with the common man being burdened with the modern social evil- “RESERVATIONS”.

Reservation is a form of quota-based affirmative action, amending the rules to service the weaker sections of society in order to bring parity. The Indians are not primarily Hindus. There are Christians (native), Anglo-Indians (descendants of the Britishers who ruled India), Muslims, Parsis etc. However, the division on the lines of caste is prevalent only amongst the Hindus. None of the other communities have casteism as a part of their social structure. Hence, the reservations, per se, are applicable only to the Hindu community.

Mr. JawaharLal Nehru, our first Prime Minister, had the common sense to exclude communal reservations from the legal framework. Any such provision would lead to communal disharmony and riots in the name of communal reservations. “This way lies not only folly but disaster,” he’d said about communal reservations.

The moot point of reservations was the upliftment of the economically and socially backward classes. It is a shame that the upliftment has not been achieved after more than 60 years of Independence and reservations. What was meant to be only a stop-gap measure to bridge the social divide, caused by the age old caste based social structure, turned out to be a major weapon for the ruling classes to appease the masses (especially those belonging to the backward classes). Is there any guarantee that these reservations are benefiting the deserved ones?  Is there any guarantee that the ones who have been uplifted by means of these reservation policies are now willing to let go of their caste status to benefit the needy ones? There isn’t.

The Poona pact was followed by the Mandal Committee (constituted by the Janata Dal government in 1979 to assess the feasibility of reservations in the various government fields, be it jobs or education.). Exactly a decade later, the Janata Dal government under Prime Minister V.P Singh attempted to implement the findings of the Mandal committee, which recommended an increase in the reservations from 27% to 49.5%. Inspite of several protests and self-immolations, the recommendations eventually came into effect. The recommendations were based on the 1931 census estimates of the backward class population of India, the biggest fallacy of the recommendations.

Notwithstanding all this, there are a large number of students who do actually deserve assistance. But these are the ones who rarely ever have access to any form of education. Most of the reserved seats are occupied by students, who have the means to achieve something themselves, without any aid in the form of reservations. A sizable number of students admitted through the reserved categories travel to colleges in swanky cars with chauffeurs, some of which are changed every month. At the other end of the spectrum, there are some who walk to college everyday, in order to save money spent on public transport.

These are the ones who require the assistance from the government, financially, more than anything else. Give them free education, give them free books, free accommodation, but free admissions! The line must be drawn there. Achieving anything without effort undermines the value and importance of the achievements.

Theoretically, these differences should be taken care of by application of the “creamy layer” principle, i.e exclusion of the financially stable families that still fall under the ambit of reservations. However, the reality is far from that. The purchasing power of the ‘reserved category’ students is equivalent to and at times even exceeds that of the general merit students, proof that economic upliftment has taken place amongst the reserved classes. Do these students still need reservations?

There are a host of people who support reservations and argue in its favor. A particularly reasonable argument was put forward by the Mandal Committee (the proponents of the now prevalent 49.5% reservations for the backward classes), which invited every opponent of the reservation scheme to live the life of a backward class citizen. Their contention being, that everyone was born equal but into unequal circumstances. And when the reason for inequality is the social system, reforms become absolutely necessary. It argued that by reserving seats and providing education to the deprived classes, the morale of that particular backward class would rise. Cant it be done by providing them the facilities to be competent instead?

Too often, candidates admitted through the reserved categories fall behind in studies and/or performance at their job, thus impeding the overall quality of professionals churned out by the educational institutes and decreasing the efficiency of government functions. If parity is to be restored, let it be restored by having a level playing field.

Take the case of the Medical entrance exams, for instance. People all over India take an Entrance Exam at the end of their 12th standard to enter prestigious institutions offering the course MBBS (Bachelor of Medicine and Bachelor of Surgery). Once the grueling 5 and a half year course draws to a close, there is another entrance exam for an entry to a post-gradate course (Masters of Surgery/Medicine). Each of these exams have 49.5% of the seats reserved for the various castes. That leaves 50.5% of the seats for the ones who don’t belong to any particular caste. The division is half and half in most states. There are however, some states that have twisted laws to bring about reservations to the tune of 70%, including community based reservations, an entity that was looked down upon by the makers of the Constitution.

The population in the country is not divided as per the reserved seats. There are a greater number of general merit students competing for these exams, as opposed to the smaller number of students belonging to a particular caste. This effectively provides an unfair advantage to those students belonging to the reserved categories. Lesser competition, easier access to seats and lesser pressure. They are bound to have an easy going laid back attitude.

There have been innumerable demonstrations, various strikes and dharnas, to bring to the governments notice, the plight of the general merit student. They have all been met with false promises, re-assurances and eventually ignorance.

One such strike was organized on a nationwide scale in 2009. A public demonstration followed by a hunger strike and a few more rallies. Every institute in the country had a core committee organizing efforts in that particular college. As routine preparations were ongoing (making banners, penning slogans etc.), this message beeped on one of the phones,

Don’t you dare go against the reservations, we have political connections. You and your friends will be harmed and cast away and no one will be able to help you.

Signed- your Well-Wisher.”

On further inquiry, we realized that each of the core committee’s had received a similar message. Regardless of the consequences, our resolve strengthened. The messages galvanized all the committee’s to work closely and make the strikes and rallies a grand success.

One must take the words of the ruling class with a pinch of salt. Hunger strikes, unlawful arrests, water cannons, tear gas and all such drama ensued these strikes. The participants in these peaceful strikes were dealt with in a brazen and unlawful manner. The ruling class had shown its commitment to the cause. Garnering public sympathy is one thing, changing the thought process of the ruling class is quite another. The strikes managed to harness public sympathy, but the Government remained indifferent.

2014.

The same government which remained apathetic to the strikes and rallies has now decided to introduce some more reservations. 16% for the Marathas, 5% for the Muslim’s. It doesn’t require a rocket scientist to figure out the reason. A poor performance in the national elections, with the state elections being only a year away, is reason enough to force into effect this bill advocating reservation. Notwithstanding the fact that other more important reservation bills, such as the Women’s reservation bill in the Vidhan and Lok Sabha have been pending since 2009. The motive is clear. Appease the Maratha’s who form a large part of the vote bank, appease the Muslims who come in second and leave the rest of the population to fend for themselves.

Reservations for the Marathas may not be unconstitutional, may not even be against the law (It is! The supreme court has laid down a rule limiting the reservations to 50%, one which has been blatantly flouted by so many governments) but it is against the Spirit of this Nation. A secular, democratic nation should strive to provide an equal opportunity to all, irrespective of caste, creed or religion.

2015. (most recently)

The Patidhar community of Gujarat, also widely touted as one of the most successful communities in the state in terms of economic stature, has started a state-wide agitation to demand for their inclusion in the OBC (other backward classes) category.

The rationale of their demand being that if reservations exist, they should get a share of the pie too. However, they aren’t averse to the idea of the reservations being done away with entirely. The Patels are leaders of the MSME movement in India and boast of some of the most successful entrepreneurs.

The Pathidhar community (Patels) opine that, if the economically strong sections of the Hindu community are being offered reservations under the current system, why not them?

The basic fault lies in the community leaders being greedy. In a state and a community that prides itself for its belief in ahiṃsā, the violent nature of their protests do not belie their stature. Why propose a me-too strategy? Why not oppose reservations altogether?

Two wrongs do not make a right. And by trying to justify that its right, they have lost the battle before they even started. Violent clashes and wreaking havoc in a peace loving state is the poorest form of protest.

Isn’t it a Shakespearean tragedy that a “forward community” is coming out to the streets to get recognition as a “backward class”?

How do we solve these problems?

Provision of a high-quality primary education with financial assistance will help the ‘backward classes’ equate themselves with the rest of the world. This will help every child born into a lower caste family compete with a child from the so called upper castes. Every student must be judged on the basis of his merit and not based on his caste or religion. The changes must take place at the grass-roots level. Reservations are a temporary way to placate the combustible communities in India. The worrying fact is that no one in the upper echelons of power in Delhi has a game-plan to bring about parity and abolish reservations altogether. All they are worried about, is the next elections and the welfare of their vote bank. It is, truly, a sad state of affairs!