REMEMBERING PROF. R.P. SAHI BY HIS LECTURE ON MIDLINE SWELLINGS OF THE HEAD AND NECK

 

Prof. R.P. Sahi was our teacher in the Department of Surgery in King George’s Medical College, Lucknow. He was easily the best teacher in the campus. His baritone voice was renowned for its richness, strength and unmistakable quality, making it a defining feature of his aristocratic persona and a major factor in his enduring and universal popularity. This also made him instantly recognizable and command attention every time.

 

As an undergraduate teacher he was matchless because he could sub-divide the most complex subject into easily understandable bits, and once he taught a topic it somehow got imprinted in our brain for life. There was a method in his teaching which invariably simplified problems for even the back-benchers.

 

As a resident in his unit, I found him to be an inspiring leader and an outstanding post-graduate teacher with priceless qualities of a communicator, a disciplinarian, a conveyor of information, an evaluator, a Unit manager, a counselor, a member of many teams and groups, a decision-maker, a role-model, and a surrogate parent all rolled in one. His umbrella of benevolence was so reassuring that trainees got the best opportunity to express themselves. He understood the strengths and weaknesses of his trainees and steered them towards what would be best for them. Looking back, I can understand today how important this individualized approach was in his unit.

 

Prof. Sahi was a very sought after speaker, whether in surgical conferences or on social occasions. He was invariably our first choice for C.M.E and Conference inaugurations as well as after post dinner speeches. He somehow could palpate the mood of the gathering and say exactly what the occasion demanded. When Prof. P.C. Dubey was the Head of the Department of Surgery, Prof. Sahi was entrusted with the responsibility of resident posting and academic scheduling and the Department of Surgery was the best Department of the Medical College by miles. When I was applying for my Microsurgery training fellowship in St. Vincent’s Hospital, Melbourne, he and Prof. N.C. Misra gave me some glowing recommendations.

 

After his retirement he practiced in Krishna Medical Centre and mostly spent his time in academic pursuits. He stays in Hazratganj in his old bunglow wnd enjoys his retired life to the fullest.

 

I came across a lecture he delivered to our batch in 1978 on ‘Swellings of the Head & Neck’. He taught this vast topic in two lectures ‘Midline Swellings of the Head & Neck’ and ‘Lateral Swellings f the Head & Neck’ and this is the first lecture of this series.

  

Introduction

The deep fascia of the neck splits to envelope the Sternomastoid muscles. All swellings situated superficial to it are superficial swellings and all lying deep to it are the deep swellings.

 

Thus superficial swellings at this site are like any other site:

Skin             Epidermoid or Pilar cyst          

Fat               Lipoma

Nerve          Neurofibroma                          

Vessels        Haemangioma

 

The deep swellings of the neck for the purpose of description are sub divided into midline swellings and swellings in the lateral aspect of the neck.

 

Classification by Duration of lesion

1.      Acute: Cellulites, Ludwig’s Angina, Abscess, Carbuncle, Ac. Lymphadenitis

2.      Chronic:

A.    Cystic: Branchial cyst, Thyroglossal cyst, Cystic Hygroma, Cystic adenoma of Thyroid gland, Cold Abscess, Pharyngeal pouch

B.    Solid: Lymph nodes, Submandibular salivary gland, Thyroid tumours, Cervical Rib, Carotid body tumour, Branchogenic carcinoma, Sternomastoid Tumour

C.    Pulsatile: Aneurysm of Carotid artery / Subclavian artery, Aorta, Exophthalmic goiter.

 

Classification of Midline swellings

1.      On the face:

·        Median Angular Dermoid

·        Syncipital Meningocele

·        Fronto-nasal Meningo-encephalocele

·        Lachrymal sac swellings

·        Rhinophyma

·        Symphyseal odontomes

·        Gummata

2.      Submental region

·        Sub mental lymphadenitis

3.      Between menton and Hyoid

·        Ludwig’s Angina

·        Sublingual / Midline Neck Dermoid

·        Ranula / Plunging Ranula

·        Thyroglossal cyst

4.      Between Hyoid and Thyroid Cartilage

·        Sub Hyoid bursitis

·        Osteoma of Hyoid bone

·        Chondritis / Perichondritis

·        Chondroma of Thyroid cartilage

·        Laryngocele

·        Thyroglossal cyst

5.      Between Thyroid and Cricoid

·        Lymph node on crico-thyroid membrane

6.       Between Cricoid and Supra sternal notch

·        Thyroid gland – Goitres

7.      At Supra sternal space of Burns

·        Cold Abscess

·         Lymph nodes

·        Ectopic Thyroid

·        Supra sternal bursitis

·        Neurofibroma

·        Aneurysm of Arch of Aorta

 

Median Dermoids: Can be present at the midline either on the vault or on the floor of mouth or neck. They usually contain skin elements – sebum, hairs etc. They may scallop the skull bones and rarely have intra cranial extension through a gap in the skull. Treatment is excision and repair.

 

Fronto nasal Meningocele / Meningo-encephalocele: Meningoceles are brilliantly trans illuminent, cystic swellings, getting tense on coughing, crying or jugular pressure. Meningomyloceles have ectopic brain tissue in them and so are not trans illuminent. The inter orbital distance is widened – hypertelorism and there are cross fluctuations between it and the fontannele. CT scan demonstrates the gap in the skull and the treatment is excision, replacement of herniated contents, and repair of the bony gap by bone grafts and surgical correction of hypertelorism.

 

Lachrymal sac swellings: These are in the medial canthus of eye, usually inflammatory, and cause by blockage of naso-lachrymal duct with resultant epiphora. Treatment is initially conservative and if unsuccessful a DCR is done.

 

Rhinophyma: Sebaceous cyst adenomatosis affecting the skin of nose. There are multiple sessile nodular elevations over the nasal tip. Treatment is aesthetic rhinoplasty.

 

Gummata: These are seen in the midline in the tertiary stage of Syphilis causing erosion of skin, mucous membrane and bone. Midline structures like palate, hyoid, nasal bone, forehead etc. can be involved. VDRL test clinches the diagnosis. It is getting more and more uncommon in this antibiotic age.

 

Sub mental Lymphadenitis: May be inflammatory or neoplastic and so the entire drainage area – the tip of tongue, floor of mouth, incisors, symphyseal alveolus should be examined for focus of infection or primary tumour. Other lymph nodes should also be examined to rule out a primary Lymphoma.

 

Ranula: Myxomatous or mucoid degeneration of sublingual salivary gland. It appears as a blue-grey domed cyst in the floor of mouth, which is brilliantly trans illuminant. It has a tendency to split the mylohyoid and project in the submental region- plunging ranula. Treatment is excision by oral approach or marsupilization.

 

Sublingual dermoid: Sizable swelling filling and distorting the sublingual space, this dermoid is located within the mylohyoid muscle or the intrinsic muscles of tongue. Treatment is excision by sub mental approach.

 

Ludwig’s Angina: This is a form of cellullitis, which starts in the submandibular region and spreads to the floor of mouth. It produces a diffuse swelling beneath the jaw as well as the floor of mouth, often fixing the tongue. The unyielding deep fascia of the neck pushes the oedema up towards the glottis and down towards the mediastinum. Fatal septicemia, airway obstruction and death may result. Treatment is emergency drainage and broad spectrum anti bacterial coverage for Gram +ve, Gram –ve and anaerobes.

 

Thyroglossal cyst: These are cystic swellings mostly infrahyoid but may be suprahyoid as well and they move both with deglutition and tongue protrusion. The Thyroid develops from the foramen caecum and invaginates down as a tract called Thyroglossal tract to become the Thyroid isthmus. The cyst can occur anywhere along this tract. The cyst can become infected and form an abscess, which can be drained like any other abscess and result in the formation of a fistula. Thyroglossal fistula thus formed is never congenital, always acquired. These cysts are lined by squamous, cuboidal or columnar epithelium and may have lymphoid and thyroid tissue. They can turn malignant. Treatment of cyst and fistula is excision in toto along with the entire tract right up to the foramen caecum, taking the middle 1/3 of hyoid along with.

 

Subhyoid bursitis: Soft fluctuant swelling below the hyoid, it moves with deglutition and cannot be distinguished from Thyroglossal cyst easily.

 

Lymph node on crico thyroid membrane: A secondary deposit from a primary in the larynx, if present an endoscopic laryngeal examination and biopsy is a must. It also moves with deglutition.

 

Laryngocele: A soft, variable, unilateral or bilateral swelling, arising from the upper part of Thyroid cartilage, this is a herniation of the laryngeal mucosa through a gap in the thyrohyoid membrane. The swelling moves with deglutition and is usually seen in musicians playing wind instruments like flute and bagpipes Treatment is excision and repair.

 

Thyroid: This butterfly like endocrine gland straddles the trachea and its isthmus is situated over the 3^rd.and 4^th. tracheal rings. It moves up with deglutition and may have variable shape, size, consistency and tenderness. Lesions in Thyroid can be inflammatory, neoplastic, autoimmune and idiopathic. Lymph nodes on either sides of the neck and features of hypo and hyperthyroidism should always be examined.

 

Thus ended Prof. Sahi’s lecture on Midline Swellings of the Head & Neck. The diagram that he made on the board, every time pops up in my mind, whenever I see patients with midline head and neck swellings. This was once in a lifetime teaching, which has stayed life-long!

BE A PERSUASIVE SPEAKER

 

 

Persuasion is undoubtedly an art form, but have you ever wondered about the secrets of the world’s most persuasive speakers? They are usually tasked with steering an audience to accomplish an explicit action, or to get it to convert to a specific assumption or opinion. A persuasive speaker is someone who effectively convinces their audience to believe or act in a certain way. They use arguments, evidence, and emotional appeals to influence the audience's beliefs, attitudes, values, or behaviors. If you can recollect Martin Luther King Jr.’s “I have a dream” speech or Jawaharlal Nehru’s “Tryst with destiny” speech or Hillary Clinton’s “Women’s rights are human rights” speech or Winston Churchill’s “We will fight on the beaches” speech you will at once understand what I am hinting at.  So, what makes these speakers different?

 

1. They always appear confident

Although the confidence might not be there in reality, a persuasive speaker will always give the impression of confidence. This is one of the most imperative parts of being persuasive. Unsureness on the speaker’s part will be picked up on by the audience, so it’s crucial for a persuasive speaker to have a confident demeanor.

 

2. They always reinforce who they are

The introduction of a speaker is usually the thing that sells the message to an audience before a speech even commences. It is the thing that makes the audience eager to listen to what the speaker has to say.

 

3. Their body language is strong

In order to maximize their interface with an audience, a speaker must exhibit strong body language. Consider how much emphasis is now made on visuals in our culture thanks to technologies such as tablet computers, smart televisions, movies, video games and smartphones. We come to expect the same visual strength from the people we consider to be persuasive.

 

4. They make eye contact

Rather than looking out at the audience as a collective, a persuasive speaker will go that extra mile to ensure that they make eye contact with as many individuals as they can during their speech. In fact, people in an audience tend to expect a speaker to make eye contact with them, and this is a great way of building trust.

 

5. They use an emotional punch

Many highly persuasive speakers include a “grabber” right at the start of their presentations. Examples of a grabber are a declaration, symbol, image or other tool that is employed to immediately grab the audience’s attention. Furthermore, persuasive speakers also use emotions to gain attention and elicit a positive response from their audience.

 

6. They always answer “why” questions

Another technique that persuasive speakers use is to answer a “why” question at the very beginning of a presentation, such as “why is it essential to discuss this subject at this point in time?” Posing such a question, then having the ability to answer it clearly is a demonstration of strong and effective communication skills.

 

7. They are passionate about the topic at hand

In order to persuade or convince an audience, a speaker needs to be passionate, or at least convey passion, about the topic at hand. This has an impact on the audience, which will inevitably pick up on the passion, leaving its members with a sense of obligation that they should accept what they are being told for their own good.

 

8. They speak conversationally

A persuasive speaker will always place emphasis on talking conversationally with their audience, as opposed to giving a speech. This creates an honest and trustworthy perception of the speaker in the minds of the audience members. The Indian Prime Minister, Narendra Modi is a brilliant example. He never lectures in rallies, he establishes a dialogue and uses easily understandable language, the language of regular conversation.

 

 9. They build a sense of truth among the audience

The world’s best actors are prized for their ability to completely involve themselves physically, mentally, and emotionally in the role they are playing. Just try to remember Marlin Brando in Godfather or Anupam Kher in Saransh. A persuasive speaker takes on the same role when in the boardroom or at a conference. The more natural the delivery, the more believable the speaker’s message is.

 

10. They will use repetition for emphasis

Recapping certain points a few times throughout the course of a presentation is the perfect way for a speaker to create greater engagement with the audience. This is especially effective when the speaker goes over the points covered in the presentation immediately after it has been given.

 

11. They share their personal experiences

In order to make themselves more relatable, persuasive speakers will share personal experiences when and where they can as they’re giving their presentation. Doing so brings the message to life, makes the presentation pleasant and wins over the hearts and minds of the audience.

What makes a great and iconic speech? There are numerous examples of brilliant orators and speechmakers throughout history, from classical times to the present day. What the best speeches tend to have in common are more than just a solid intellectual argument: they have emotive power, or, for want of a more scholarly word, ‘heart’. Great speeches rouse us to action, or move us to tears – or both.

REMEMBERING PROF. DEVIKA NAG BY HER LECTURE ON NEUROPATHIES

 

Prof. Devika Nag M.D, F.A.A.N, F.I.A.N.Sc. was our teacher of Medicine, in charge of the Department of Neurolgy in King George’s Medical College in Lucknow. She was a very serious academician and a very good teacher, besides being an extremely graceful lady, and a role model for many Georgians.

 

Prof. Devika Nag lost her father, who was in Army, at young age and later her only younger sister (at UK) due to Subarachnoid Haemorrhage due to ruptured aneurysm. She took good care of her mother till she passed away few years ago. As a child she was keen to become a writer but as destiny desired, she appeared in Premedical test on advice of her mother and topped it. She did MBBS & MD (Medicine) from KGMC and won dozens of awards and medals. Her batch was very bright and gave the Alma mater teachers like Prof. T.C. Goel, Prof. Chandrawati, Prof. A.K. Wahklu and Prof. Indu Wakhlu. She was later trained in Neurology at Boston and other USA & UK institutions.

 

She headed the newly developed Department of Neurology and the department made tremendous progress in all fields, patient care, teaching and research under her leadership. Her consistent efforts led to the start of DM Neurology program in the year 1981, first in state of UP. Prof. Nag served as the Head of the Department from 1977 to 1999 and was a very popular teacher. She later became Professor Emeritus, and served the Department and the speciality in innumerable ways.

 

Neurology and Neurotoxicology were her principal areas of interest and in 1994 the National Academy of Medical Sciences decorated her with their prestigious membership. She served as President of various associations to name a few: Indian Academy of Neurosciences, Neurological Society of India, Indian Academy of Neurology and Indian Epilepsy Association. Her students went on to head various Neorology departments all over the India and even ended up heading their respective institutions as Principals.

She was very punctual, meticulous record keeper, a strict disciplinarian but very soft at heart. Interest of patient was of paramount importance to her. She even declined the offer of becoming the Principal of King George’s Medical College knowing that she will get less time for patient care. She used to take detailed history of all her patients and  perform a proper thorough examination every time. She would take regular evening rounds on Tuesday, the day of her OPD & emergency. This would avoid missing any impending emergency in her newly admitted patients. She was so considerate that she brought home made breakfast for residents sometime when she knew the hostel mess was closed for some reason. She is still serving her patients with devotion even today at Dr KP Singh Memorial (Mayo) hospital at Gomtinagar, Lucknow.

 

There is no better way of remembering a teacher than by remembering what she taught us. This is a one her lectures, on the difficult topic on Neuropathies, which she delivered to our class.

 

The term Neuropathy is short for 'peripheral neuropathy'. It relates to nerve damage suffered by the peripheral nervous system, which is in charge of our nerves outside the brain and spinal cord.   

Causes

Neuropathy is a complication that can be caused by a number of various conditions:

·        Physical trauma

·        Repetitive injury

·        Infections

·        Metabolic diseases

·        Exposure to toxins and some drugs

All these can all lead to peripheral neuropathy. 

 

Signs and symptoms of neuropathy

Neuropathy usually starts as a tingling or burning sensation at our extremities, such as fingers and toes. There is also a loss of sensation at the edge of the nerves that patients have reported feeling like they are wearing a thin stocking or glove on their hands. They can say that the feel pins and needles or ants crawling on their feet. The precise symptoms differ from patient to patient based on the types of nerves affected and how they choose to express themselves.

There are three types of nerves that may be affected by neuropathy, namely sensory, motor and autonomic.

Sensory nerves: Sensory nerves are responsible for collecting sensory information for the body, such as touch, temperature, pain, pressure and vibrations. Neuropathy of the sensory nerves can be expressed as:

·        Spreading numbness and tingling in hands and/or feet (which can spread to the arms and legs)

·        Burning, sharp or electric-like pain

·        Extreme sensitivity to touch

·        Problems with coordination

Motor nerves: Motor nerves are the nerves responsible for activating our muscles and control movements. The involvement of motor nerves present as:

·        Muscle weakness

·        Paralysis

Autonomic nerves: Autonomic nerves are responsible for autonomic functions of the body, such as regulating digestion, heat and blood pressure. Their involvement can present as:

·        Intolerance to heat

·        Problems with digestion, bladder and bowel control

·        Dizziness - brought about by problems with blood pressure.

 

A common cause of neuropathy is Diabetes

Among diabetics, about 50% have minimal neuropathy presenting in some form or the other. They often won't notice the symptoms, and it will stay on a very low level. For the other 50%, however, the symptoms will be unavoidable.

Pain is the most common complaint, usually a 'prickling', 'stabbing' or 'burning' pain, that happens mostly at night. This, along with a numbness that feels as if the limb is 'asleep' - occurs predominantly in the toes, feet and legs. A proper history of the patient’s past illness is mandatory, lest we miss diabetes. Today we end up treating these neuropathy patients with drugs like anti-depressants, anti-convulsants, steroid and cortisone injections, lidocaine and pain killers. These are powerful drugs that address the painful sensations for short and long term relief. However, they have a host of side-effects and must be administered very carefully. Some medical practitioners recommend electrical stimulation of the pain area and of the spine. A lot of research is going on in this area, but progress has been very slow from the medical and drug industry so far.  

 

Natural solutions to neuropathy 

If your patient is suffering from Diabetic neuropathy then you must advice the following:

·        Give up smoking

·        Cut down on alcohol consumption or give it up altogether

·        Maintain a healthy weight

·        Exercise

·        Wear clothing that causes less irritation, such as cotton, covering the sensitive areas with wound dressing or cling film and using cold packs. 

·        Stress relief is also a big help when it comes to neuropathy, and so relaxation techniques such as yoga, and meditation will come in handy.

 

Vitamin therapy

Clinical studies have shown that certain supplements can have a cumulative effect on the symptoms and causes of neuropathy.

1.      Vitamins B1, B2, B6 and B12 Vitamin B deficiency is one of the major causes of neuropathy, and also one of the best natural solutions.

2.      Vitamin B1, usually in its common form of thiamine is helpful. 

3.      Recent natural medications have reverted to using benfotiamine, which has been found to be significantly more effective (almost 3 times) in delivering vitamin B than thiamine.

4.      Stabilized R-Alpha Lipoic Acid (R-ALA) This powerful antioxidant is one of the few, rare materials that can pass through the brain's blood/brain barrier to enter the brain and go directly where it is needed the most.  Most importantly, it has a specific effect on the nerves that eases the pain and numbness associated with neuropathy, and promotes better blood flow and oxygen to the nerves. Recent studies have reported that just by using the R-ALA alone, orally, symptoms of neuropathy were reduced.

Neuropathy support formulas These days, it is common for those suffering from neuropathy to take both medical and vitamin therapies, combining short-term treatment with the cumulative effects of correct nutrition.  The best formulas include vitamins B1, B2 and B12, as well as Vitamin D, R-ALA and materials that relax your nervous system, avoiding over-stimulation.  diabetes patients, this would be a good way to perhaps prevent the onset of neuropathic symptoms.

 

Friends, this was a lecture delivered in 1978-79. Many new things have happened in the field of Neuropathies since then and this field has been much enriched by recent advances. From emerging therapies leveraging stem cells and gene editing to holistic approaches encompassing mind-body techniques and nutritional interventions, the landscape of neuropathy management is rapidly evolving, but the foundation that was laid down by Prof. Devika Nag in our MBBS days has only helped us to understand these recent advances, and not get overwhelmed by them. I have to thank my batch-mate, Prof. Atul Agarwal, who is a retired professor of Neurology from the Department Madam Devika Nag chaired, and an eminent neurologist and epilepsy expert of our country, to help me with this blog.

CASTE CENSUS – SCOPE AND CHALLENGES

 

Now that the story is old and dust has settled over it, it is worth revisiting the issue of caste census with a cool head. One may think that talking about caste in modern day India could re-legitimize, reinforce and reestablish an institution that progress and modernity has rendered irrelevant and the Constitution has made illegal, but honestly, have we ever left it behind as we progressed?

 

Caste is a living reality in India, among all religions and in all states.Yes, Muslims in India too are divided along caste likes. They are stratified into three main castes. At the top of the pyramid are the Ashrafs (literally, the ‘nobles’, who trace their ancestry to inhabitants of the Arab peninsula or Central Asia or are converts from Hindu upper castes), Ajlafs (literally, the ‘commoners’, who are said to be converted from Hindu low castes) and Arzals (literally, the ‘despicable’, who are said to be Dalit converts). Even among Christians, after conversion from Hinduism the stigma of caste stick with them and Dalits become Dalit Christians and cannot marry Syrian Christians in Kerala. Similarly in Tamilnadu Christian Nadar would enter into a marital alliance with a Hindu Nadar but never with a Christian of another caste!

 

There are villages after villages which don't cast their vote but simply vote for their caste. We live with caste all the time. So many family names are caste identifiers. We still are uneasy with inter-caste marriages. Members of subaltern caste still suffer discrimination in villages and at work, even across seven seas. Caste based social oppression, though illegal, is overtly or covertly practiced. 

 

The irony of not knowing the caste numbers is profound. This caste invisibility has produced strange paradox, we debate about reservations from the streets to the parliament without knowing the real distribution of the disadvantaged. We deploy caste neutral tools in deeply stratified society, and well meaning government policies miss their mark because we are unaware of the real numbers.

 

 

Why is a caste census necessary?

So, why do we want to again scratch the old festering caste wound which our society carries? This is a necessary surgery, which can no longer be ignored, lest it turns cancerous. Critics fear that caste counting may harden identities or fuel populist demands of increasing the reservation quota. Such concerns are not without merit, but fear of its misuse cannot justify a National statistical blindness. What the government does to address these problems will depend upon its political statecraft and many such political time bombs, kept safely in the cupboard for many years, have been defused in the past by the present government. 

 

This will be the first caste census of independent India. The main opposition party avoided it like plague in the 65 years it ruled for it was unsure about the consequences. Their model of 'caste blind development ' failed to curb inequalities and Garibi hatao remained a slogan.  But it succeeded in ensuring caste is deeply entrenched in the political system. They feared that caste enumeration would mobilize political realignment and consolidation of depressed caste communities into electorally powerful vote bank, whose aspirations were left unmet. This caste census will be the first step towards understanding the composition of our society and a giant leap towards evidence based inclusive governance. 

 

The results will have to be implemented with care, clarity and purpose, without bothering about the seismic changes it might usher. For decades our planning and development has moved ahead with a critical blind spot. We were all along chasing parameters like GDP but ignoring such an important factor like caste, which continues to decide access to education, employment, healthcare, housing and delivery of justice!

 

 

How will caste census help?

After every census we are able to interpret data under headings like age, gender, geography, language, but not caste! Why did we continue with this huge umbra region in our national understanding? The caste census will offer an opportunity to correct this misalignment. We will know how our society is truly composed, not only their population size, but their social and economic conditions. This caste census will not be about reinforcing identity but about identifying structural inequalities.

 

Caste enumeration is not about division, it is about design. It will help designing a fairer system, target our interventions more accurately and create more inclusive India. Cast census is not about looking backwards but it is about moving forward with a clear and just plan, with wisdom and with eyes wide open. The numbers we gather today will shape the justice we deliver tomorrow. 

 

Expect a seismic change

Political parties, both in government and in opposition, may be out for a rude shock not only in relative numerical strength of a particular caste in a given region but today's leaders may realize that their caste following is much less than they had projected and anticipated so far! Data could reveal presumed armies of caste supporters to be much smaller or much larger than the leaders and followers had assumed. This could lead to a scramble of realignment within and across parties. Who knows whether the Congress President and leader of the opposition will still enjoy the presumed caste dominance in Gulberga, Karnataka after the caste census!

 

Even more significant political fallout of caste census may be the loss of luster of caste and religion in politics and the predominance of performance, decision making and good governance! After all, caste leaders like Sri Lalu Prasad in Bihar and Sri Mulayam Singh in U.P did precious nothing to improve the conditions of their caste and everything to enrich their own families! Armed with caste census, with detailed knowledge of not only their numbers but their education, employment, health, housing and financial status, will there not be a revolt within these family ruled regional parties? After all, this is the true empowerment of the subaltern groups. Raw data from this census will verify or negate the notion that whether mobilization in the name of caste, or for that matter religion, brings deliverance and prosperity.

 

 

The logistical challenge

The logistical challenge of census in India is formidable but including caste will multiply the challenge manifold. Well designed questionnaire to know not only their numbers but their living conditions, their educational qualifications, their employment status, their housing, banking and credit facilities, their position in society and their delivery of justice is a must. The task will be a technical nightmare. 

 

You may be thinking of caste amomh Hindus as 4 varnas- Brahmin,  Khatriya, Vaishya and Shudra. But each varna has multiple castes or jatis and each caste has multitudes of sub-castes or upjatis. There are more than 3000 jatis in India and countless upjatis. Borders between these castes and sub-castes are petty porous for opportunists to slide in and out to get maximum benefits in government schemes and reservations. Add to this the parliament approved EWS or extremely weaker section category and the oft repeated agitation in almost every state for inclusion in OBC category. As if that was not enough, we have the Muslim Dalits, the Christian Dalits, and the Muslim OBC (Pasmandas), once counted in the census do they too get qualified for affirmative actins like reservation? And now you have an idea how gigantic a problem awaits our political system. 

 

 

Caste is not just a part of our past for most Indians, it is a crucial dimension of our present. If we want caste to matter less tomorrow, we must now understand how much it matters today, and draw a baseline. To pretend that caste has become irrelevant is like ignoring the elephant in the room. To exclude caste from the census is to continue policy making in the dark. To include it, thoughtfully and responsibly is to shine long overdue light in this dark corner and solve the problem of delivering education, employment, healthcare, housing, banking, trade and delivery of justice purposefully. It is the real road to last mile delivery.