Tuesday 31 December 2019

SIMULATION LAB TRAINING – THE WAY FORWARD




The ability to acquire surgical skills requires consistent practice, and evidence suggests that many of these technical skills can be learnt away from the operating theatre. Surgical simulation offers the opportunity for trainees to practice their surgical skills prior to entering the operating theatre, allowing detailed feedback and objective assessment of their performance. This enables better patient safety and standards of care. Simulation of surgical procedures and human tissue, if perfect, would allow complete transfer of techniques learnt in a skills laboratory directly to the operating theatre.

Types of Simulators
Surgical simulation models can be low- or high-fidelity, reflecting the closeness of the model to reality. Low-fidelity models only allow practice of individual skills or techniques rather than an entire operation, while high-fidelity models can replicate an entire surgery with a high degree of realism.
Surgical simulators can be divided into organic or inorganic simulators. Organic simulators, consisting of live animal and fresh human cadaver models, are considered to be of high-fidelity. The microsurgery lab training on rabbits, frogs, mice, pigs, lambs and dogs fall in this category as do vessel anastomosis and training of use of venous couplers in placental blood vessels. Inorganic simulators comprise virtual reality simulators and synthetic bench models and these are used extensively in laparoscopic surgery training.

Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are being increasingly used in surgical training programmes in all premier medical institutions. Newer training programmes are being developed such that the educational curriculum that can incorporate surgical simulators. With the advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy, simulators will be integral components of surgical training in the future. Simulation is not a complete replacement for intra-operative experience but an important adjunct and it clearly represents an important advance in current surgical education.

Why is it needed?
Surgical training consists of developing cognitive, clinical, and technical skills, the latter being traditionally acquired through mentoring. Fewer mentoring opportunities have led to the use of models, cadavers, and animals to replicate surgical situations and, more recently, to development of surgical skills centres or laboratories. However, the effectiveness of skills laboratories in teaching basic surgical skills (eg. instrument handling, knot tying, and suturing) requires careful supervision, evaluation and accreditation.

An important goal of surgical education is the acquisition of skill and skill sets that can adapt to new technology during and, importantly, after resident training. The result of such increased skill should be improved clinical outcomes. The rich history of surgical education repeatedly demonstrates the ability to adapt to change. Advances in pharmaceuticals, such as antibiotics, muscle relaxants, and vasopressors, have paralleled development of technology, such as cardiopulmonary bypass, imaging techniques, and laparoscopy. These advances have been associated with, if not required, rapid and efficient changes in surgical techniques, procedures, and decision making. Likewise, surgical education has adapted to rapid information access technology through computer learning, telemedicine, and adaptation to the technical advancements mentioned. 

What is the cost?
A typical skill laboratory
While the costs of simulation systems can be high, ranging from about U.S. $5000 for most laparoscopic simulators to up to U.S. $200,000 for highly sophisticated anaesthesia simulators, traditional Halstedian training is not without cost either. Bridges and Diamond in a study calculated that the cost of training a surgical resident in the operating room for 4 years was nearly U.S. $50,000 (measured by the additional time that the resident took to complete procedures). 



Which is the target group?
So, at which stage of training would simulation training help. It so seems that not only resident training but this technology is useful for practicing surgeons as well, who intend to progress by learning a newer technology. So many general surgeons of my generation switched to laparoscopic surgery later in life and so many of my plastic surgery colleagues picked up the skill of microsurgery from the established training labs. The American Surgical Association recognized the importance of training (and credentialing) surgeons during the course of their careers, addressing specifically the issues of new technology and maintenance of skills. The American Surgical Association Study Group advocated for new and revised educational programs using simulation techniques to allow learning and maintaining skills with agreed metrics of performance. As a direct result of the report, new programs, such as Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery were developed.

Simulation might well offer inter-professional team training that would allow participants to acquire, practice, and refine technical skills as well as communication and efficiency of team performance. Video recordings of team assessment can be used for trauma education in the emergency setting. The American Association of Medical Colleges has supported the use of multidisciplinary simulation for team training involving patient care, interpersonal communication, and critical thinking. Video tapes are critically reviewed and feedback is immediate and directed to issues where improvement is needed.

Coaching is another arena in which simulation is coming up in a big way. The American College of Surgeons has supported efforts by “senior” surgeons, nearing or in retirement, to train as “coaches” for their younger colleagues. Several programs have established courses using simulation models. It is always challenging to offer medical educators, especially in the surgical world, the concept of “centralized” educational or clinical programmes. The loss of proximity or local control is often met with considerable resistance. However, with the sophistication of telemetry, Internet, and other “distance learning” techniques, the world of surgical educators must re-evaluate how a larger audience can be reached. Additionally, the impact of centralized learning “institutes” or “academies” should be recognized. So the centre of excellence may be in Coimbatore or Delhi or Lucknow but a microsurgery trainee can be coached, guided, helped and eventually evaluated even when he is practicing his microsurgery skills in remote medical institutions which do not have a microsurgeon!

And much more
In my own Alma mater, King George’s Medical University in Lucknow the Simulation lab is doing wonders. Besides training surgical residents it is training Basic Life Support (BLS) care to other doctors, nurses, technicians, ambulance drivers, paramedics, police, teachers and health workers.  These first-responders, healthcare providers and public safety professionals are trained to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway. The doctors who are interested are trained and certified for Advanced Trauma Life Support (ATLS), a programme conceived by American College of Surgeons to teach a systematic, concise approach to the care of a trauma patient. The simulation lab is also used to teach medical and nursing students and interns skills like endotracheal intubation, surgical crico-thyroidotomy, needle thoracocentesis and pericardiocentesis, putting in an inter-castal drainage tube and an intraosseous line. Student doctors and nurses are trained to put in a naso-gastric tube, an intravenous line, an intramuscular injection and on a pregnancy simulator they are trained to conduct normal deliveries!


Simulation training offers innovative and rewarding possibilities for the future of surgical educators and learners. There are many stakeholders, including students, residents, practitioners, but also administrators and, most importantly, patients. With the increasing sophistication of devices, cost-effectiveness becomes more important. What appears most necessary is the identification of the appropriate learners and to use the most relevant, goal-oriented simulation programs or technique for that group. The overall goal must necessarily be a demonstrable increase in the skills that are being evaluated in concert with definable results on improvement in clinical outcomes.

Wednesday 25 December 2019

NEVER ARGUE WITH AN ANAESTHETIEST




My friends in anaesthesia will tell you that I have never, in the last 35 years argued with them, whether they were junior to me, my batch mates or my seniors in medical college. Consequently, the atmosphere in my operating theatre is always congenial and jovial. It is not that I have not had my posted surgery postponed or even cancelled, but every time there was a reason, every time it was in the interest of the patient, and on most occasions I had a prejudice free mind to understand the reason.

I consider the anesthesiologist to be the leader of the medical staff in the theatre because (a) he knows the patient, as he also performed a pre-anesthetic consultation; (b) he is the internist who also anesthetizes a patient; (c) logically, he is sufficiently trained to handle any clinical complication occurring during the procedure without disturbing the "cruise flight" of the operation; (d) as so, he maintains the patient's hemodynamic and metabolic balance as well as a positive emotional atmosphere of the team; (e) fortunately, he is the first doctor to arrive and the last one to leave the operating room every other day.

Pleasing the surgeon by not disrupting the operating theatre schedule with a cancellation vs patient safety is a difficult choice and these days is driven more by economics than patient careThe tension that arises between the surgeon and the anaesthetiest is "an elephant in the room." There's not a lot of direct research on the surgeon-anesthesiologist dyad, but talk to either one of them and you'll recognize it. I am of the firm opinion that the surgeon-anesthesiologist relationships far from being strained, should be such that they do collaborate well to the greatest advantage of the patient. Though everyone in the operating theatre agrees that non-hierarchical, collaborative leadership is the gold standard, executing this kind of cooperation is difficult in practice.

It is the surgeon's responsibility always to pre-screen his or her patient ideally two weeks before the procedure. As a plastic surgeon, who primarily does a lot of trauma, I am truly appreciative of my anaesthesia colleagues. Trauma cases and other emergency cases come to the operating theatre all the time where no pre-op evaluation is possible and the vast majority of those anesthetics are successful.  If the surgeons and anesthesiologists work together, most surgeons will see their colleagues doing their best to keep their patients safe during induction and maintenance of anesthesia which is a tremendously stressful procedure.  Not all surgeons do unfortunately and some surgeons either do not appreciate what the anesthesiologists are trying to do for them and their patients, or they are too big of control freaks to allow someone else to tell them they can't proceed as they wish.

Just the other day I was sipping coffee in the surgeon’s lounge when I overheard this less than cordial conversation. The surgeon had a high risk patient scheduled He knew the man's history because he kept telling the anaesthetiest "But, he has a normal ejection fraction!” over and over again.  Finally when the anaesthetist had enough of that she snapped, "Sir that just tells me he's not in failure.  It doesn't tell me he won't have an MI on the table."  Surprisingly the surgeon’s response was, "That's not my concern!".  Had I not been so flabbergasted by his response, I might have had something snappier to say than what the anaesthetist did “we are cancelling his case until the man was seen by a cardiologist.” 

While the job of surgeons is far more glamourous as he / she is the one whom the patient approaches, and gives all the credit of success, they should never forget that they are just the display window of a very big team and it is on the efficiency of this team that their success depends. Also worth remembering is that just as the success is attributed to him so is the failure. Having said that nobody should go into anesthesiology with the expectation that life will be full of recognition and applause; that satisfaction usually has to come from within.  Mutual respect that is earned by years of working effectively together builds good professional, collegial working relationships. 

The relationship between the anesthesiologist and the surgeon is like dance partners. We each need to know the other's steps or we will trip and fall.   Saying 'No.' to a surgeon who wants to take an unprepared sick patient into the OR for an elective case is a heck of a lot easier than saying 'No.' to a family member asking the anesthesiologist if their loved one will be coming home from the hospital.

Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication.

I have never argued with my anesthesia colleagues concerning cancellation. Firstly, the medicolegal exposure is obvious. But secondly, why take risks for elective procedures? Isn’t that what prudent medical decision making is all about? Aren’t we always balancing risk VS reward with every decision, every script? It seems morally, strategically, and legally stupid to put convenience over patient welfare.


Monday 23 December 2019

THOSE 22 SACRED YARDS



Cricket lovers all over the world have their favourite players, favourite teams, favourite teams and favourite captains. What they also cherish is their favourite cricket ground. Having watched cricket in four continents I have to say that I am unable to choose the best between two great sporting arenas – the Eden Gardens in Kolkata and the Melbourne Cricket Ground, Down Under. But this blog is not about these stadiums and their festive atmosphere. It is about something much mundane, their pitches, the 22 yards on which the glorious game of cricket is played. While the Eden pitch after being relayed in 2015 is no more a spinner’s paradise but a sporting one for all – batsman, spinners and pacers, the MCG pitch is a strip with a few concerns.  
Big venues have multiple pitches so they can be used for different matches during a season, during which they will host Shield matches, Big Bash games, limited-overs internationals and a Test, the showpiece event. So to find three to ten playing strips in a stadium, besides the practice pitches, is not uncommon.

The complain about the MCG pitch was that it was too boring, too hard and did not deteriorate as the matches proceeded, becoming a soul-destroying "road" for bowlers. It’s curator Matt Page tried to inject some extra life into the pitch. In December 2019, before a domestic Sheffield Shield match between Victoria and Western Australia he watered it, but it seems he went too far. When the ball hit the moist pitch on the first morning, it created divots, which hardened under the sun into an uneven surface. The ball then reared up unexpectedly into the helmet and body of WA batsmen Shaun Marsh and Marcus Stoinis, respectively. Play was abandoned for the day, then called off the following morning after the pitch was deemed unsafe.

Now the historic Boxing Day Test match is to be played between the Trans- Tasman rivals Australia and New Zealand on the same pitch and so it has become perhaps the most scrutinized stretch of grass in Australia. This Boxing Day, the eyes of the cricket world will be trained on the turf as much Australian and New Zealand teams. Another problematic pitch and my favourite MCG's reputation will take another hit! Let’s keep our fingers crossed!!

So what is an ideal cricket pitch?
This is a difficult question because cricket today is not one but three games and pitches for all the three – Test matches, One Day Internationals and T20 need to be different as the very nature of these games are vastly different. While the latter two need to be high scoring to be entertaining and attractive, a Test match is Cricket in its most classical mould, the art form! A Test match pitch changes over the course of a Test. It is scheduled to last five days, favouring the bowlers at some stages and batters at others. Just as the most artfully bowled cricket balls are designed to change and degrade over the course of a match, defining how the ball behaves, so too are changes in the pitch pivotal. On the opening day, it should offer pace and bounce, and potentially swing or seam movement for the fast bowlers. A bouncy pitch conducive to sideways movement can also help spin bowlers. The surface should also be "true", allowing batters to trust the trajectory of the ball and play their shots, having survived the early onslaught from the quicks.
During days two and three, the pitch should dry out and deteriorate slightly but be in its optimum condition for batting. This is the time to cash in and pile on the runs. Come day four, the foot-marks created by the fast bowlers as they follow through should become more prevalent, creating a patch of "rough" near the batting area.
Days four and five are when the spinners should have their chance to shine, aiming the ball into the rough, where it grips and turns off the pitch. The team that bats last has to negotiate these tough conditions, which can create a mesmerising contest if they are trying to win or save a Test against a world-class spinner. The deterioration can also help fast bowlers because it can make for uneven bounce and, as the ball gets older, reverse swing.
Types of Cricket pitches
Some teams have genuine fast bowlers and some have crafty spinners and as it is the prerogative of the host team to choose the pitches traditionally pitches in England and Australia have been green tops, ideal for speedsters like the WAKA pitch in Perth and Headingly in Yorkshire.  Some teams rely on spin as their main weapon and so pitches in the Indian sub-continent show early cracks and break easily. There are however 4 types of cricket pitches:
Dusty
A dusty pitch features loose sand or clay, providing slow bowlers with encouragement to extract spin and bounce but frustrating fast bowlers. These type of wickets were typically found on the sub-continent, such as in Mumbai and Chennai when India played with four spinners Bedi, Prasanna, Chandrashekher and Venkataraghvan.
Green top
This surface generally assists fast bowlers by helping the ball's seam grip and produce movement, making it difficult for even the best of batsmen to score, particularly in overcast conditions and/or if the pitch has been left to sweat under covers when there has been rain. There are not too many seen in world cricket. They are generally found in England, where they can become “graveyards” for batsmen, and Australia – WACA in Perth and Belierive Oval in Hobart. These pitches have high clay content and hence are hard and don’t crack easily. So, balls come to the bat quickly and bounce is high. South African pitches have slightly more moisture. Hence, their bounce isn’t as high as Australian pitches.
Dead
This has been the MCG's biggest problem in recent years, for the lifeless drop-in pitches are up to 20 years old and have not offered any encouragement for fast bowlers or spinners. They may be suitable for Twenty20 matches, and even one-day internationals when high scoring is often the desired result, but it's these type of wickets that are ruining Test cricket. The problem at the MCG in recent years has been that the pitch has not deteriorated as much as it should. Nor has the ball bounced and carried, smacking into the wicketkeeper's gloves on the opening morning of a Test. Instead, it has been a "slow" pitch, with balls dying at the ankles of the wicketkeeper or even getting to him on the second bounce.
Drop-ins
These are grown and maintained in a tray outside of the venue and transported by crane when cricket season begins. Drop-ins were pioneered by Gabba curator John Maley during World Series Cricket in 1977, when Kerry Packer was unable to use traditional cricket grounds for his breakaway competition and had to turn to such stadiums as Waverley Park. Where the Sydney Cricket Ground and Brisbane's Gabba boast traditionally grown centre squares that become pitches when the football season is finished, the MCG, Adelaide Oval and Perth's Optus Stadium have drop-in wickets. Critics of drop-ins say there is sameness about them, and that they rob grounds of their individual characteristics. For example, the SCG has traditionally been a spinning wicket.
Concern for M.C.G

 The International Cricket Council in 2017 announced a scheme which aimed to keep venues and curators accountable for doctored and sub-standard pitches and outfields, venues receive public ratings from the ICC match referees after every international game. Venues accrue demerit points for a pitch or outfield that is rated below average, poor or unfit. These demerit points are counted over a rolling five-year period and, if a ground accumulates five points, it loses the right to host international cricket for 12 months.  So one of my favourite cricket ground is in serious crisis of losing its Test status. This is both unacceptable and unimaginable.

Wednesday 18 December 2019

MAROONED ON A FANTASY ISLAND


The Labour party in U.K under the leadership of a pro Pakistan, pro Muslim, Jeremy Corbyn suffered the worst defeat last fortnight to the resurgent Conservatives led by Boris Johnson. This election keeps the Labour out of power since Tony Blair resigned after a decade in power on June 27, 2007.

The Labour Party is a centre-left political party in the United Kingdom that has been described as an alliance of social democrats, democratic socialists and trade unionists. The party's platform emphasises greater state intervention, social justice and strengthening workers' rights. Now if all this sounds too familiar to you it is because this is exactly what the opposition parties in general and the Congress in particular is in India today. Labour’s pro- Pakistan, pro-Muslim line on Kashmir looks very much similar to the Congress stand and its refusal to identify the religion of terror too follows Congress lines. Now as we are living in the same world, with almost the same challenges of terrorism and illegal immigrants, any party which fails to identify these challenges and believes in minority appeasement as its USP to gain votes, is bound to share the same fate.    

Even the successful Labour Prime Minister Tony Blair has warned the defeated British Labour Party it will remain "marooned on fantasy island" if it doesn't change course from Jeremy Corbyn's hard-left socialism, which voters emphatically rejected.
The crumbling of the red wall - seats in the north and midlands, including Blair’s own constituency Sedgefield - was "no ordinary defeat" but "a moment in history" he added.

Both Labour in the U.K and Congress in India have to understand that the voters are against socialism. Congress’s promise of Rs. 6000 per month as Uniform Basic Income, loan waivers to farmers, free electricity and Labour's "wish-list" manifesto filled with unbelievable promises of "everything for free" including fibre broadband connections to everyone's house are dreams which the voters of today simply refuse to see. Both these parties have to leave their “fantasy islands” and eventually migrate to the mainland of reality. 

In a press interview Tony Blair said that under Corbyn, "the takeover of the Labour Party by the far left turned it into a glorified protest movement, with cult trimmings, utterly incapable of being a credible government". Now does that not sound familiar once again? This is what Mamta Banerjee is doing in West Bengal, Arvind Kejriwal is doing in Delhi and Kamalnath and Ghelot in Madhya Pradesh and Rajasthan respectively. Agitating in the streets against the Central Government is not the job of the State Governments and their Chief Ministers. They had representatives in both the houses of parliament and they have made their points and failed to convince the majority. Laws have been passed and States have to implement them without exceptions.

In the same interview Blair likened Labour to a football team, "whose striker was directionally oblivious, its midfield comatose, the defence absent in the stand chatting to a small portion of the fans and its goalkeeper behind the net re-tweeting a clip of his one save in a 9-0 thrashing." And again you see the familiarity, the Congress soft power centres re-tweeting and posting falsehood about Article 370 and Kashmir, about Citizenship Amendment Bill, about the historic legal culmination of the Ayodhya dispute and about Triple Talaq! In fact it is Pakistan which is using their posts to make their case in the international arena!! How do they intend to win back the confidence of their electorate when all they are doing is providing fuel to the enemies of our nation?

Unlike the U.S.A, both India and U.K operate a “first past the post” electoral system, in which parliamentary seats are awarded to the candidate who wins the most votes in each individual race, rather than by proportion of the total national vote. When you don’t have two parties, the first-past-the-post system is really bad at translating voter beliefs into seats. So while BJP in the 2019 General elections won 303 seats and its NDA alliance won 353, as against Congress’s 52 and its UPA alliance’s 91, BJP’s vote share was only 37.4% and NDA’s 45%. Now the opposition is out there crying hoarse that though BJP has a brute majority and can get all that is in its wish list passed by both the houses of parliament, they only represent 37.4% of the electorate and thereby 62.6% are not with them! By this measure Congress has only 19.5% of vote share and so 80.5% of the electorate are not with them!

This weakness was on display in the most recent U.K election, in which the roughly half of the electorate who oppose leaving the European Union found that their votes had only a fraction of the power that votes for the pro-Brexit Conservatives did.


While in theory the Labour and the Liberal Democrats in U.K and the Congress and the rest of the opposition may have a point but such arguments will not stop the Narendra Modis and the Boris Johnsons of this world from going ahead with their pre announced and well planned agenda. Their voters voted for them knowing fully well what they expected them to deliver, and they are delivering exactly that. The Labour and the Congress have to get their act together and stitch a worthy alternative and tell a believable story.  Right now I will have to give it to Tony Blair, he has made the correct diagnosis – these parties are "marooned on fantasy island". I will go a step ahead and say that they are trying to paint on a white canvas with invisible colours depicting good old days, which are never going to return for them as they have failed to pick the pulse of their nations.

Sunday 8 December 2019

WHY SHOULD WOMEN TRADE FREEDOM FOR SAFETY



You don’t have to be a feminist to understand this hypocrisy. Molestation and rape are committed by men but people invariably try to find a reason to blame the women. Instead of asking the perpetrator why he / they committed the crime we start contemplating as to why the victim got targeted! Is this not a supreme and abhorrent paradox?

The culture to blame the rape victim is almost pathological in our society. What clothes was she wearing? Why was she unaccompanied? Why was she on a lonely stretch of road? Why was she out so late? These are the usual questions that the society asks in the garb of a news reporter, a politician, a policeman or a judge and surprisingly almost all of them are of the mindset that it was the victim who was at fault and she should not have been in the wrong place at the wrong time! By doing so an attempt is made to find an excuse for the perpetrator for his crime and put the blame on the victim.

In today’s day and age if half the population of our country is not free to pursue their dreams, study where they want and work where they get an opportunity then are we not reducing the productivity of our nation by half? If an atmosphere of fear and anxiety prevails for our women then how will they attain their fullest potential and how on earth will our country prosper? If we get the undesirable tag of being unsafe for women then why will tourists and investments choose to come to India?

Our attitude of over-reacting to a few highly publicized rape cases in Delhi, Hyderabad and Unnao is in sharp contrast to the phenomenal under-reporting of sexual violence and rapes perpetrated within the sanctity of a so called ‘family’. The social stigma and the police apathy only adds to the problem of under-reporting and the brainless utterances of the media, the police, the politicians and the judiciary all are tailored against the victim. In which crime is the victim made a target so shamelessly?

Right from the womb the girl child is at threat. Even when schooling is free she is often kept out of school to help the mother with her domestic chores. Her social interactions are grossly curtailed and this constrain is directly proportional to the level of ignorance and lack of education of her parents and the level of caste and communal hierarchy that prevails in her society. Subdued, subjugated and socially stunted such girls are brought up with a precautionary boundary of pseudo-morality, a Lakshman Rekha, which they dare not cross lest the big bad world of wolves is waiting outside to prey on them! In a country which worships Durga and Kail why are their daughters so helpless and vulnerable to demons and asuras?

Which brings us to the question of who are these big bad wolves, demons and asuras? These are the brothers of these very helpless sisters, who are never disciplined by their parents. They are never asked why they skipped school, where did they go, why are they coming home late, whom are they befriending and what are they chewing, smoking or drinking. Total anarchy for the sons and choking of liberties of the daughters keeps not the women but the patriarchy and caste hierarchy safe and turn these unruly sons into rabid elements of the society.

It is from this abnormal breed of men folk that we derive our news reporters, our policemen, our politicians and our judiciary. So subjugation of women and the Lakshman Rekha culture is ingrained in their DNA. They fail to think differently and after every case of rape every time they open their mouth they miraculously find their foot in it. How else can they be insensitive enough to ask the unfortunate victim their usual questions – what was she wearing, why was she alone, why did she choose a lonely road, why was she out so late and how? By doing so they show their ignorance towards the feelings of the victim and at the same time, not so subtly, shift the blame of the heinous crime from the perpetrator to the victim. Unless the press, the police, our politics and our judiciary has equal proportion of women this culture of double rape first by the perpetrator and then by the system will not cease to exist.

Slogans like ‘Beti Bachao Beti Parhao’ will not change our country if we are not prepared to change our way of thinking. We have to start asking the right questions – who is the offender, whose son is he, in which school/college did he go, who are his friends, who are his relatives and who are his well wishers?  Reporters, politicians and judiciary should hound all of them with their questions and make them realize that they have failed in his upbringing and he is an insult to their position in the society. While the victim should remain unnamed the perpetrator should be named and shamed with photograph in newspapers and television. He should be ostracized from the society and his friends and family should be looked down upon. Then only will parents start disciplining their sons, relatives disown them and friends desert them.

Our girls and women do not need guardians to chaperon them when they go to study or to work. They should be given the education and the confidence to conquer the world all by themselves and the society should look up to them with respect as equal partner and not as a sex object. Those who do so are sick and should be subjected to the same treatment as rabid dogs. Please do not bother about their human rights because they are simply not human.


The government has to make public spaces women friendly with street lights, proper and efficient policing and 24x7 public transports. They should appoint more women in police and judiciary, open more courts and bring about judicial and police reforms in real earnest. Fewer adjournments, fast track courts and express delivery of justice are the need of the hour. The perpetrators have to be punished without curtailing the freedom of the women.

Thursday 5 December 2019

LEARN FROM CHINA TO SUCCEED





A news report in the ‘Australian Age’ caught my attention, which I felt like sharing with you.
'Alarm bells': Nation's students slide in rankings
Australian students recorded their worst-ever results in an international test of reading, maths and science skills, and are now about a full school year behind where Australian students were at the turn of the millennium. The decline was most severe in mathematics.
Australia's Education Minister Dan Tehan said the results "should have alarm bells ringing". Victoria's Education Minister James Merlino called for an urgent review of the maths curriculum. The average 15-year-old Australian student is now 3½ years behind the average Chinese student and more than a year behind where Australia was in 2003, according to a triennial international test of reading, maths and science skills.
When 16-year-old Nicholas Zhang, was at boarding school in China he spent 20 hours a week studying maths . In Australia, it is only three.

The Indian scenario

Now let us understand this concern in Indian context. The Annual Status of Education Report (ASER) 2018 published by education non-profit Pratham shows the prevalence of learning deficit and the poverty of basic reading and arithmetic skills among students in Indian schools. The latest report derived from the collected data from 596 districts by surveying 546,527 students from 354,944 homes shows:
  •          Indian students, especially those in elementary school (Classes I-VIII), are not learning enough. To cite a metric, only half (50.3%) of all students in Class V can read texts meant for Class II students.
  •          There seems to have been some improvement in learning levels, especially among students of Class III and Class V, in 2018 compared with those of the previous five years. However, the improvement is not visible at a higher level, for example among students of Class VIII.
  •          The deficit is across government and private schools. Traditionally, students in private schools have fared better than their government school counterparts, but that’s a relative situation. For example, while 40% of Class VIII students in government schools can do simple division, the figure is 54.2% in private schools.


The China Story

The Chinese realized that they needed to shift from a nation with large human resources to a nation with strong human resources. They needed to create a better education system so that young Chinese grow and mature into productive and innovative adults. Much like the US under the No Child Left Behind programme, they have a state-run system of public education run by their Ministry of Education. All citizens must attend school for at least nine years, known as the nine-year compulsory education, which is funded by the government. Compulsory education includes six years of primary education, starting at age six or seven, and three years of junior secondary education (junior middle school) for ages 12 to 15. After junior middle school, there are three years of senior middle school, which then completes the secondary education. China has put a heavy emphasis on rigid learning systems followed by standardized tests, which are known as “gao kao” in China. Gradually they have transformed their education from memorizing to understanding, from learning formula to deriving solutions by logic.

To ensure that those students who live in rural areas are subject to the same education standards as those children in the larger metropolitan centres China has a uniform primary schooling system and its teaching style and standards are changing with the changing times. There is a policy of rotating teachers’ assignments on a five-year basis to ensure that the best teachers are not found only in the biggest schools. Instead, high-performing teachers would spend some time teaching in the city and then take that expertise to rural China.

Our twin problems

The two problems that we in India are facing are the quality of teaching and the quality of teachers. The students are taught to memorize facts rather than to approach problems critically. Our focus on standardized testing has led to a teaching style that emphasizes memorization and passing exams. For example, maths scores are high when children are pushed to memorize complicated formulas that they could use on problems given to them. Unfortunately, this system fails to equip children with the skills and thought processes to innovate. There is no focus on critical thinking and needless to say, it is uninteresting.

This issue is important especially when moving into higher education and the workforce. A person who has been taught only specific formulas and definitions will quickly find that such textbook logic does not always translate to real-world problems. And of course, once you get into higher education and the real world, you won’t be given a textbook problem but rather a real-world situation. So our system of education leads to a degree no doubt, but ends up producing unemployables!

What we need is a system that creates innovative and unique individuals capable of thriving in the marketplace. To do this, we must find a system that promotes growth and critical thought. Creating this system is not, however, a problem with a single, simple solution. We need to revise our curriculum, our teaching and assessment styles and we need to update and improve our teachers.

Why be concerned about quality of education?

India’s demographic dividend depends on the learning level of students. The quality of education has a direct bearing on any economy. With some 240 million students or nearly 20% of the Indian population in school, their quality of learning or lack of it assumes significance for the competitiveness of the country. It has an impact on the quality of life, efficiency at the workplace, and labour productivity issues. That is the reason why the World Bank said Indians born today are likely to be just 44% productive as workers, way below their Asian peers.

A quantum jump in the education sector is the need of the hour. As the problem has now been diagnosed and public advocacy has got the momentum, the governments and civil society need to focus on three aspects—a bigger spending on education, maybe 6% of GDP instead of the present 2.7%, political willingness to improve education, and a drastic change in the quality of teacher education.

Education and skill development has to go hand in hand after High School so that we are prepared with a vibrant workforce capable of keeping up with the fourth industrial revolution. China has done it in the most exemplary way and it is not surprising that they will soon overtake the U.S to become the technology head quarters of the world. Countries like Australia and India should take a leaf out of the Chinese book of success and start implementing as soon as possible. It is already too late!

Sunday 1 December 2019

THE SCREAM – AN EXPRESSION OF RAW HORROR AND ANGUISH!




The Scream’ painted by Norwegian Expressionist artist Edvard Munch is arguably one of the most famous paintings in the world, undoubtedly more famous than the artist himself. An image of a lone figure standing on a bridge, the only thing that can truly be identified is the unmistakable fear on the figures face, with both hands clasped against the cheek in horror. You can almost hear the bloodcurdling shriek of this terrorized soul who is screaming.   

Despite radical simplification, the landscape in the picture is recognizable as the Kristiania Fjord seen from Ekeberg, with a broad view over the fjord, the town and the hills beyond. In the background to the left, at the end of the path with the balustrade that cuts diagonally across the picture, we see two strolling figures, often regarded as two friends whom Munch mentions in notes relating to the picture. But the figure in the foreground is the first to capture the viewer’s attention. Its hands are held to its head and its mouth is wide open in a silent scream, which is amplified by the undulating movement running through the surrounding landscape. The figure is ambiguous and it is hard to say whether it is a man or a woman, young or old – or even if it is human at all.

Painted in the late 19th Century, this picture was the brainchild of a unique era of art, which had transitioned from still-life paintings into expressions of the soul. Artistic talent became a creative outlet for the artist's innermost thoughts, doubts, desires, joys and most relevant, fears.

The story behind the art
The original German title given by Munch to his work was Der Schrei der Natur (The Scream of Nature), and the Norwegian title is Skrik (Shriek). Munch shared the rationale for this title in a poem he painted on the frame of the 1895 pastel, "I was walking down the road with two friends when the sun set; suddenly, the sky turned as red as blood. I stopped and leaned against the fence, feeling unspeakably tired. Tongues of fire and blood stretched over the bluish black fjord. My friends went on walking, while I lagged behind, shivering with fear. Then I heard the enormous infinite scream of nature. EM.”

This poem gives some clarity to the painting. To begin with, the painter speaks of his exhaustion, which is understandable given he struggled with severe anxiety for most of his life, starting at the tender age of 5 when his mother died from tuberculosis. However, he also says he “heard” the scream of nature, so it can be reasonably presumed that he wasn’t the one doing the screaming. So where did the sound come from? 

If you read the poem a second time, perhaps you’ll notice his multiple uses of the word “blood”, to describe the color of the sky and the fading seascape, as he stands on the bridge. According to his diary, there was a slaughterhouse not far from where the picture is believed to have been illustrated. In another cruel twist of fate, the mental asylum where his own sister was a resident was also nearby. Perhaps the artist was haunted by the terrible screams of animals being dragged to their fates. Or worse perhaps, the anguished screams of the inmates of the mental asylum, his sister’s voice drowned amidst all the chaos.

The Scream isn't one piece, but four.
Munch created four versions in paint and pastels. The first painted version was the first exhibited in 1893. It is in the collection of the National Gallery of Norway in Oslo. A pastel version from that year, which may have been a preliminary study, is in the collection of the Munch Museum, also in Oslo. The second pastel version, from 1895, was sold for $119,922,600 at Sotheby's Impressionist and Modern Art auction on 2 May 2012 to financier Leon Black. The second painted version dates from 1910, during a period when Munch revisited some of his prior compositions. It is also in the collection of the Munch Museum.


Critical interpretation
Art critics have claimed for some time now that the ghastly face in this expressionist icon was inspired by Peruvian mummies the artist had a chance to see at the Exposition Universelle in a Parisian museum in 1889. The mummified figure of a Chachapoyas warrior was discovered near the Utcubamba River in Peru's Amazonas Region. With hands cemented in place on either side of a mouth open in an apparent shriek, the mummy bears a striking resemblance to Munch's screamer.
Yet another critic Grovier believes that it was the Munch’s technophobia that inspired the pasty and sallow face of the figure. If you look closer, it isn’t difficult to discern the shape of the light bulb in the shouting face. For some people, it is a painting of sorrow, for some - existential dread. Others see it as liberating or powerful. The fact is, this painting evokes strong emotion, whether positive or negative. 


Twice stolen
The first time it was stolen in 1994.  Bandits placed a ladder up to the window of the National Gallery in Oslo, slunk inside, and made off with The Scream. As if that was not enough they added insult to robbery by leaving a note that read, "Thanks for the poor security." Thankfully, the painting was recovered within three months.  Then in a daring daylight heist, two masked men rushed into Oslo's Munch Museum and made off with The Scream and Madonna. By May of 2006, three men had been convicted for the theft. But despite the city of Oslo offering a 2 million krone (about $313,000 U.S.) reward, the paintings remained missing till August 31, 2006 when they were recovered in good condition in Oslo.


Munch also mass-produced the image.
Once his Scream caught on in the European art scene, Munch made a lithograph of the concept so that he could sell black-and-white prints at will. These prints got a second life of sorts in 1984, courtesy of Andy Warhol. In the wake of its Munch exhibition, the New York–based Galleri Bellman commissioned the pop art pioneer to recreate Munch's lithographs as a screen print. Warhol did the same for Munch's Madonna, The Brooch, and Self-Portrait with Skeleton's Arm.



Great pain and suffering have a way of forcing artists to reach deep within them to pull out creations that make us think, feel, laugh and even weep. This is what differentiates expressionists like Edvard Munch from his peers. He was the creator of more than 1000 paintings, most of which were donated to the Norwegian Government following his demise.

Thursday 28 November 2019

PROTECTIONISM IS NOT PATRIOTISM


Just like Toyota, Hyundai and Honda cars are present in every road of South Asia, there is an Indian automobile which is also omnipresent. Have you seen the rickshaws and the tuk tuks in Vietnam, Cambodia, Malaysia and Thailand? They are all made in India and they are all made by Bajaj. They have overcome challenges and come out of intense international competition to emerge as the leading exporter in this section. So, if Bajaj can do it why can't others?

India is shying out of signing free trade agreements with individual nations and with regional trade conglomerates because we fear cheap goods from China and cheap dairy products from Australia and New Zealand will flood our market and kill our local industry. While on the face of it, it may sound very noble and patriotic but the fact of the matter is we are gradually isolating ourselves into a cocoon, impervious to both imports and exports.

If a product A manufactured in India and marketed for Rs. 100 comes from China at a discounted price of Rs. 90, we immediately put a 20% trade tax on it so that now it costs Rs. 118, thus protecting the local manufacturer. So whose interest is being protected......the manufacturer's, the guy who is so inefficient that he can not compete without the government's help. But, and a very important but, whose interest are we sacrificing ........the consumer's, yours and mine! We could have purchased product A for Rs. 90, thus saved Rs. 10 and purchased product B, C and D also! So by protecting an inefficient industry the government is not letting other smaller businesses thrive. These businesses could have prospered by our patronage, employed more people, and added to the productivity of the nation! But we are sacrificing all this to help an inefficient industry.

Amul is a multinational company with a diversified product range. Why should it need government protection against dairy imports from Down Under and Kiwi land? Are Harley Davidson and our locally manufactured two wheelers even remotely comparable? They are in different price range, catering to different consumer sections and still we insist on taxing them astronomically. If the world has opened up to our two wheelers it is because they provide excellent value for money. If other industries want to enter the world market they too will have to do the same. How long do they intend to use crutches of trade taxes?

The Regional Comprehensive Economic Partnership (RCEP) trade block is a group of 16 countries and we are negotiating with them since 2012. Do we look like a confident trading nation if even after seven years we are not yet prepared to open up our economy to this group? After the demise of EU and Trump mauling of NAFTA this RCEP is the coming together of the most vibrant economies of the world. Can we afford to miss the economic bandwagon and isolate ourselves from this growth opportunity?



Let us not confuse patriotism. It is not there in protecting the inefficient industries, it is there in giving the best deal to all countrymen

Tuesday 19 November 2019

RULES OF THE WINDOW SEAT




I am a window seat flyer and I insist for it every time I book a flight. I have, in the past, written about  the pleasures of the window seat in https://surajitbrainwaves.blogspot.com/2018/02/the-window-seat.html
But today I will dwell on a different aspect of flying in this privileged seat, the responsibilities that come with this privilege. I know that when it comes to the best seat on a flight, travellers are split between the aisle and window. My reasons for preferring the window are the views and avoidance of drink-cart knee-bonking; while the aisle traveler is looking for more breathing room, convenience for lavatory trips and exiting the plane before me.
The view from 30,000 feet in the air, soaring through the clouds at high speed to get to destinations near and far is simply breathtaking and unique every time. The magic of the sun rising from behind the Himalayan range or melting into the Arabian Sea as it sets in the evening change every time I get an opportunity to witness from the comfort of the window seat
Window-seat-seekers often see the romance in that scientifically supported magic, seeing this perch as a coveted treasure. It brings the chance to see the Earth's majesty from a rapidly changing vantage point. You soar like a bird over the landscape of our diverse planet, its flora and fauna and fast-casual chains and freeways below. Mountain ranges rise and fall as your plane hums along its invisible path. And if you happen to land in Paro, Bhutan or Queenstown in New Zealand you will never forget the thrill of the window seat!
I am often aghast when I see some frequent flyers occupying the window seat but ignoring the experience, preferring to sit there not for the scene but for its nook-like comfort. You can hole up, sleep relatively undisturbed and deal with the rest of life upon landing. These folks keep the shade shut, opting to catch up on emails, TV shows or shut-eye without a glare beaming into devices or their eyes. I feel that is a waste of the window seat!
No matter what camp you fall in, here are the unofficial rules for both breeds of window-seat passenger.
Rule No. 1: You are the ruler of the shade.
The window shade breeds contempt and conflict among plane passengers. Some could never imagine shutting the thing, blocking the window's best feature: the ability to see outside. Others prefer to keep it down, opting for better sleep and better views of entertainment systems. Both parties have a point.
Because you selected - and perhaps even paid extra - to sit at the window, you have the final say in whether the shade stays up or down (excluding times flight attendants instruct you otherwise). That being said, just because you're the boss doesn't mean other people will respect your authority. Flying is generally a communal activity, and unless you're one of the incredibly lucky souls to get a row to yourself, neighbours may ask you to adjust from your own shade preference.
Some questions to keep in mind before you make that decision: Is the person asking you to change its status a child? A parent with a child who's trying to sleep? A person who has never flown before? An anxious flyer? Also consider your route. Are you flying into a new time zone, especially overseas? Controlling the window shade may have an effect on fellow passengers' internal clocks, as well as yours.
Ultimately it's up to you, the occupant of the window seat, to decide whether you'll be a benevolent or omnipotent ruler.
Rule No. 2: Limit trips out of your seat.
Our human bodies are not always easy to control. There's nothing unethical about needing to use the restroom frequently on a flight, or wanting to stand up and stretch. But if you're a person who fits either of these travel styles, don't book a window seat. If you have a prostate problem then the window seat is not for you.
Sometimes requests to exit your row have nothing to do with bodily functions. If you pack your carry-on bag strategically so you have everything you need within reach when you're locked in by the window, you can avoid making everyone stand while you grab your headphones/neck pillow/laptop/jacket packed in the overhead compartment.
Particularly given the tiny nature of seats in economy, it's a hassle to squeak in and out of airplane rows these days. Don't plague your row-mates with a barrage of requests to leave your seat every now and then.
Rule No. 3: Time bathroom breaks with the middle seat or aisle.
Per the rule above, the way to be the most considerate window-seat passenger is to follow your neighbours' lead. Watch for the opportune time to make a break for the lavatory: when the middle is exiting, too. That's your queue to get up, capitalizing on everyone having to rise, anyway.
Rule No. 4: Lean into the window.
This rule is ordained with the middle-seat passenger in mind. While you're tucked deep, deep into the row as the window-seat holder, you're also often blessed by a little alcove between your armrest and the window. Take advantage of those extra inches by leaning into that nook when possible. You'll alleviate some of your squished neighbour's misery in the process. Remember if you have the window then the aisle side arm rest belongs to the middle seat passenger!
Rule No. 5: Overcome claustrophobia.
If you're claustrophobic, this position is not for you. The window is for people who don't mind huddling up in a confined space for long periods; people who understand that with great power (controlling the shade) comes great responsibility (not getting up unless everyone's getting up).
The view from the window may be comforting if you're claustrophobic, but once you look ahead or to your side to see how you're crammed like a sardine, you could lose that sense of relief. Opt instead for the aisle, or, if your phobia is stemming from a general fear of flying, turn to apps that help nervous flyers.
Rule No. 5: Be generous with ‘excuse me’ and ‘thank you’.
If you're in the window seat you may be the object of envy of your neighbours, so be a wee bit extra polite. A generous dose of Excuse me /  excuse moi / Pardon /  Por favor / Sumimasen and thank you / gracias / merci / arigato / danke sher / do jeh / obligado / shukriya goes a long way in befriending the less privileged and moving in and out of the row.
Rule No. 6: Be patient.

If you're in the window seat there is no way you can get off the plane early. You have enjoyed the view and the thrill and now on arrival at your destination be patient and let others deplane first. Be careful while pulling down your cabin baggage and don’t try to do so from acrobatic positions thus hurting your fellow passengers.

A window seat gives you both - the view and the experience, but along with this dual privilege comes certain responsibilities. We must appreciate this when we opt for the privileges.