Indian Pharmaceutical Industry

Slow poisoning is on. It will take time, but end is inevitable. Believe it or not, the world class Indian pharmaceutical sector is subjected to slow poisoning and is under attack by vested interests. The poison is being released into the system aimed at total destruction. It’s a novel way to attack. This sector is relatively small compared to FMCG sector. HUL profits for last year were higher than turnover of Lupin Laboratories. This is just to give an idea of the size of these two sectors. The question is if this sector is so small then why would it come under attack? There are many reasons. Across the world human beings are very sensitive to anything that is related to food and healthcare. India was dominated by MNCs in these sectors. This is now a history. In this sector the top companies in India are of Indian origin and these companies are a threat to the supremacy of MNCs across the world. As far as FMCGs are concerned, their Indian competitors are no threat these giants operating world over. They rule the Indian market. In addition the majority share holdings in these companies are with foreigners. Same is story for auto sector. The market leader Maruti Suzuki has over 56% foreign share holdings and most of the other players are unlisted companies in India making huge profit compared to their Indian counterparts. Electronics is totally dominated by foreign players, be it LG, Samsung, or Sony. Indian manufactures are struggling to survive. Why should these MNCs bother about their Indian competitors? Similar is the story for engineering sector, be it ABB or Siemens. Nestle and Cadbury’s are market leaders in different segments, not Amul. Indian children are growing on noodles, pizza and burgers. Foreign Banking and Insurance operations are growing and have sizable business in India compared to Indian operator’s share in the foreign countries. Indian banks or LIC have neglible presence in the world market, thus no complaints about Indian banks or insurance companies by foreign players. Oil and Gas, IT and Metal sectors also have some foreign players but dynamics of that business is different, and there is no attack on Indian companies. Therefore large foreign holdings in their Indian arm, strong market presence and big profits that are repatriated to country of origin makes India a wonderful destination to operate where their supremacy is not challenged. Why then anyone would bother about Indian manufacturers? The chart below gives a fair idea of foreign holdings of leading listed companies. There are thousands of privately held, unlisted companies who make fortune for the stakeholders that go unnoticed by a common man. Thus there is no cause of worry for MNCs. India is safe heaven for them. But it is not so for pharmaceutical sector, thus it is under attack.

Company	Foreign              Holding                31st March 2013	Last Declared Dividend
Pharma Sector
Sanofi	60.40%	290%
GSK Consumer Healthcare	72.46%	450%
GSK Pharma	50.67%	500%
Pfizer	70.75%	325%
Novartis	75.00%	200%
AstraZeneca	75.00%	175%
FMCG Sector
P & G	68.73%	225%
HUL	52.48%*	600%
Colgate	51.00%	900%
ITC	50.29%+	525%
Nestle	62.76%	125%
Engineering Sector
ABB	75.00%	150%
Siemens	74.71%	300%
SKF	53.58%	75%
Auto Sector
Maruti Suzuki	56.21%	160%
Bosch	71.18%	600%
Cummins	51.00%	400%
IT Sector/Metal Sector
Oracle	80.27%	100%
Sesa Goa	55.13%	10%
Oil & Gas Sector
Cairn	53.66%#	65%
Castrol	71.03%	75%
Source: Published information of/for listed companies *Buyback offer to shareholder to raise holdings to 75% is on (May 2013) +Includes Foreign companies, Foreign nationals and FII #Includes Foreign Promoters and FII There are many unlisted companies operating in India with foreign holdings

Pharmaceutical MNCs are attacking the Indian companies, its guerrilla warfare. Best form of defence is attack. MNCs for their stakes in India cannot go in for direct confrontation, so they have to take help of local gullible persons and institutions, other foreign agencies and even traitors to attack. The corruption in India makes it easy for those who can bribe in hard currency and offer foreign trips, to get what they desire. Attacking Indian pharmaceutical companies is a well thought of, systematic, long-term plan. Attack from foreign entities can be understood. What surprises is the attack by fellow Indians. Some of hospitals from Mumbai and from Delhi have reported to have banned medicines of Ranbaxy. One hospital has asked the company to prove their quality. This reminds me of wolf and lamb story of Panchatantra that mentions a ridiculous justification by wolf to eat the lamb. This is ridiculous; I call someone a cheat and ask that person to prove that he/she is not a cheat, rather than I furnishing the proof of cheating. So any one can charge anybody and the onus will be on the person charged to prove the innocence. The Ranbaxy problems with USFDA are of mid last decade for certain formulations. These hospitals have not used those formulations. If other medicines from Ranbaxy have been used then these hospitals should provide the data of casualties caused by Ranbaxy medicines for last eight years. How come these hospitals woke up so late and are now worried? Is their assessment of patient’s relief/recovery guided by media reports about Ranbaxy? Is it a part of evil design to malign the company image? Unfortunately Indian pharmaceutical manufacturers are turning a blind eye. If one manufacturer is attacked then the others look at it as an opportunity to grow at the cost of the sufferer. Such manufacturers lack foresight. A stage has come when they have to unite and expose the evil designs of multinationals. Showing a top Indian company in a bad taste is no trump card for growth of others. At opportune moment the MNCs will take the joker out of the pack and tell the world that if the top Indian manufacturer is so bad then imagine the condition of rest of the manufacturers. This is dangerous. Not only the top manufacturer would lose the business but it will have a snowballing effect where the entire Indian pharmaceutical industry would lose its credibility and that will take us back to 1960’s. We will be forced to be dependent on MNCs. That will be catastrophic.

What is the genesis of this situation? Lets us take a look at the past. Things changed for Indians in 1970’s when government announced DPCO (Drug Price Control Order). During the same period government brought in some restrictions for pharmaceutical MNCs operating in India. Process patent was in force but not the product patent. All this made the pharmaceutical MNCs uncomfortable and many of such companies either withdrew from Indian market or reduced their exposure. The government support helped the Indian manufacturers to gain strength and they got a chance to prove themselves. The country that was net importer turned in to a net exporter in few decades. World started depending on India for pharmaceutical raw material (API) and finished formulations. Indian manufacturers also went in for manufacturing pharmaceutical equipment and all this has been an eyesore for MNCs.  The MNCs that milked India till 70’s of last century were helpless. Different formulations, innovative fixed dose combinations and penetrating marketing strategies developed by Indian manufacturers left the MNCs high and dry. The hope for MNCs was India’s acceptance to IPR in 2005. There were lots of discussions across the industry to access the future of Indian pharmaceutical industry post 2005. There were different schools of thought. Some felt that India’s dependence on MNCs would increase while others thought the opposite. Post 2005 and even in the era of liberalization the MNCs could hardly do anything. Indian pharmaceutical manufacturers started eroding the bastions of MNCs. Many of them went in for M&A, started their own projects in different countries across the world, gained sizable market share and offered quality products at much lower cost. Many of the MNCs closed their API plants and sourced the raw material from India. And then there was a limit to the patience of MNCs. The overpricing of MNCs was getting exposed. There was advent of generic era that further exposed exploitation by MNCs. Many governments around the world modified their budgets on healthcare because of availability of generics. The profitability of MNCs from yesteryears money spinners plunged. It hurts when you lose the money, it hurts when you see someone overtaking you, it hurts more when you see an Indian company doing this. The MNC profits, their future in the generic jungle is under threat, their ego is hurt. These MNCs are averse to strategic alliances with Indian manufacturers. Their ego prevents them from understanding the reality and taking rational decisions. Such alliances can be a win-win situation, but the MNCs have to keep their aura of supremacy of yesteryears in a closet and then take a step forward. They can’t do it, so attack the Indian players.

Indians have pardoned the cola giants when their products were found to contain pesticides above the desirable limits. Indian parents whose children’s life was endangered due to insects in the chocolates or higher radiation levels in milk powder turned a blind eye towards the MNCs manufacturing such products of questionable quality in India. MNCs manage such situations well. Their PR activities pull them out of the mess that they create. Indian companies are unable to handle adverse propaganda. The pharmaceutical companies may or may not have faulted but there is a malicious attack to spread the venom. When there is a price war MNCs cannot show their superiority unless they play foul. Time has come to understand such evil designs of all those who hate to see India prosper, who dread to see Indian drugs curing the billions around the world at low cost and those who want prosper at the alleged failures of fellow manufacturers. It’s time to tell the world the progress of Indian pharmaceutical industry. Stand together for Indian pharmaceutical industry before it is too late. Solidarity is the only way out.

Nurturing Laziness

The political parties are bent upon providing food grains at subsidized price to those under BPL. In fact the limit of income of less than Rs.27/- can itself be challenged. But that is another story. The intriguing questions are, how one can ride a bike and get a BPL card for himself, or how a female may find some time in between her two favourite serials and rush to get the BPL card.

The media has reported that the government might call a special session of Parliament to pass the National Food Security Bill. The ruling UPA claims that it will solve the hunger crisis on the other hand its critics are certain that it will only increase corruption, and that the public distribution system must be wound up and replaced by cash transfers. The corruption in PDS will never get eliminated and on the other hand the cash transfers will open up new avenues for corrupt officials. Today’s print media has advertisements announcing the launch of similar scheme in Madhya Pradesh, making rice available for Rs.2/- per kg and wheat for Rs.1/- per kg. Making food available at such a low price is big threat to the nation. I am not talking economics but conditioning of mind. Out of the basic needs of Roti, Kapada and Makan, government has taken care of Roti by providing food at near zero prices. Governments in many states provide a piece of land and the cash assistance to build the house. The Makan is also taken care of. Kapada is not of great significance and the same is available, either as new or used one at reasonable price. Apart from this the RTE helps in education, various schemes for minorities offer lot of assistance, healthcare, mother and childcare are also taken care of. Incentives for going to government dispensaries for prenatal check up and delivery are already available. Everything provided by the government to its subjects in communist country is understandable. In communist nations a “common man” cannot influence the politburo and cannot change the government. Situation is different in democratic countries. Such schemes are more for creating a vote bank rather than the consideration for welfare state.  If the governments are of different political ideologies at center and at state level then there are chances of competition. One may offer greater benefits than other to appease and this will lead to rat race. There is no end to it. Now the question that bothers me is simple. If one gets everything from government, than why should people work? What is the motivation? Getting dole can be motivation for those above BPL to fall in to BPL. This is not done. Jobs need to be created and fair wages paid so that the citizens can buy the needs form their earnings. Dole, if I can call all these schemes so, makes one lazy. This is not acceptable. India with largest youth population should not be pushed to be lazy nation. If jobs are difficult to create, which can be debated, then entrepreneurship needs to be encouraged. Let people work and earn then spend rather that subsidizing, or giving free. That is bad for the economy and the nation.

Create real jobs. Not jobs on the paper. Fictitious job creation is still more dangerous. I know a sad story of a person who was in fish farming. The labour intensive activity went on for years till one day he found workers abandoning the job on his project. In few months he had no worker to work and was forced out of the business. His enquiries revealed that his ex-employees are on pay roll of some scheme, that provides wages and sad part was the workers may not work if they share the wages with certain individuals and make money even without stepping out of their home. If these kinds of jobs are made available then who the hell will go in for a hard labour on a fish farm? Are we not making the productive population lazy? Work has no substitute. A Latin proverb says, “If there is no wind, row”. Wind will induce lethargy, nobody will row. If one has to reach somewhere, one has to row. Let there be no wind of cheap food, free housing and lots freebies, nobody will row, this will induce lethargy and nation will depend upon the few who work. To ruin the nation nurturing idleness is enough, you don’t need enemies.

The need is for good governance, transparency and no subsidies. The need is to make the population work and not depend upon government dole. If India has to prosper then the politicians have to realize this ground reality. They should strive for the growth and not for just coming to the power. 

Epistaxis II

This is the second part. Cautions for readers are the same as given in the first part. Any critical analysis is for introspection and not to malign image or reputation of any individual, doctor or hospital. Introspection should help all to perform better. No hard feelings. Take it easy. Here we go.....

Shift from Casualty to room was much faster than expected. In the same casualty little over six months ago, I had brought a old lasdy with hip bone fracture. The medical officer forced me to rush to the pharmacy to buy traction. It was indeed needed. I left the patient alone in the emergency, went to the pharmacy and got the traction. For next six hours in spite of repeated coaxing the patient and traction were lying in casualty. Ultimately after a wait of six hours with acute fracture pain the patient was shifted to the room and it took another hour to put the traction in place. With this experience and background, I was happy at my shifting to the room in less than one hour after arrival. The bed had electronic controls for reclining, altering the height of the bed and looked impressive. Unfortunately it was uncomfortable for me as these beds were designed keeping in mind patient’s maximum height to be of six feet. I am more than six two, so fitting in the bed was tricky. I had to sleep diagonally. While in casualty blood samples were drawn, IV cannula was in place at the back of my left wrist and x-ray chest was done. I thought I will have few hours of sleep before I go to the operation theater. However it was not to be so. I just dosed off and nurse walked in to record the ECG. Soon after that a ward boy came with hospital dress. There was a problem again. The largest size available in the hospital was tight for me. With no other option I slipped into what was provided and I was looking like a joker. Pyjamas were three inches short, sleeves were between elbow and wrist, many of the buttons refused to come closer to the button holes. I looked in the mirror and enjoyed my funny look. Then one after other someone kept on coming, from nurses to the anesthetist and surgeon as if there was a conspiracy not to allow me to sleep.

My younger son was travelling, he was called and asked to take next available flight back home. In any case he would not have made it before the surgery. He booked online and was to reach Vashi by 3.00 pm. I did not call my elder son in US as there was no point giving him the tension and in any case he can reach only when the emergency is over. By 9.30 am my wife and brother accompanied me when I was wheeled in to preparation room next to the OT. The final check was on to move me to the OT. The nursing staff was pushing the stretcher when the anesthetist asked me if I could walk to the OT. I said yes, I accompanied him to the OT. I took a good look at the OT. It was OK. I was in for endoscopy and cauterization. The position of the operation table was away from the monitor and thus the table and shadow less lamps were shifted accordingly. Anesthetist asked me usual questions, if I have dentures, addictions etc. He started Ringer Lactate drip, I saw him adding a sedative and in a moment I was fast asleep. I woke up when the procedure was in the final stage and the ENT surgeon was pushing the packs in my nostrils. In fact the pain of pushing 8 cm long packs in nostrils made me wake up from the deep slumber. The ENT surgeon looked to be happy at the job she did. I spent another hour in recovery room and later on was shifted to my room. The oxygen mask was making me uncomfortable. I did not certainly need the oxygen. I asked the nurse to check oxygen on pulse oximeter, it was 100. I asked her to remove the mask. On discharge I realized the need for the same for the hospital, as they had billed me for the oxygen and also for pulse oximeter. I could bought the pulse oximeter for myself with kind of charge billed. Rest of the day I was sleepy and uncomfortable. Nostrils were packed, breathing was through the mouth. With packed nostrils the post operative secretions, discharge was blocking the sinuses. I had to constantly sip water to keep dry mouth moist but even that was painful as nostrils were blocked. Block your nostrils and try to drink, you experience the discomfort. Lips developed cracks due to dryness. I had a restless night. Next morning some secretions dripped down the nostrils. ENT surgeon came for a round and looked satisfied with the progress. She suggested that packs could be removed after two days and I would be normal.

Things were not destined to be so. By 11^th afternoon I started bleeding again. The difference from earlier episodes and the fresh ones was that I was now getting a forewarning of the bleeding. The packs in the nostrils would absorb the blood and then blood would run down the nostrils. I was taken to the OPD to show her, as she did not respond to our request to visit the room. Now the ENT surgeon was worried. She prescribed me those medicines which she had asked me to stop when I met her first.  I had three episodes on that day. Next day the ENT surgeon was to take a look and see if she could remove the packs. She examined and suggested we should remove the packs on 13^th in the OT, so that if need be the cauterization can be again done. Bleeding was increasing on 12^th. The quantity was high and frequency was more. On that evening my brother saw me bleeding for the first time and then he realized the gravity of situation. The chairman of the hospital was informed of the condition, staff from ICU rushed to my room, we were given a choice to get another ENT surgeon of our choice from anywhere and we also made plans to shift if condition deteriorates. The night went by. Next morning on 13^th, bleeding was more profuse.  I went to toilet and nose started bleeding and once again the blood was splattered everywhere in the toilet to the bed. In between the bleeding would stop but things were taking a serious turn. By noon I was in the preparation room and while on the stretcher I once again bled profusely. That was the first time my younger son saw me bleeding. He could not believe that things could be so bad. I was moved to the OT with ice pack over my nostrils. This time the OT was different, but problems were same. The table had to be moved so it was closer to the monitor. The equipment was attached to the monitor. The cable was loose. It worked for a while and then the monitor went blank. I got reminded of AVG cable connecting the laptop with LCD projector not working in the management school that happened to belong to the same hospital group. The problem was somehow fixed. The air conditioning was on full blast. I requested the staff to increase the temperature. The poor fellow did not know how to respond to my request. I told the anesthetist to increase the temperature. He knew the problem and told the staff to switch off the AC. Apparently the thermostat of the AC was not working. Again it was similar to the problems I had in management school. I was readied for the procedure. This time I was not to be sedated but a mild tranquilizer was given. I was in full senses, local anesthetic xylocaine 4% was put in the nasal cavity and the pain was little blunt. In a short while the ENT surgeon walked in. She ordered IV cephalosporin. I stopped her and suggested that she gives amoxycillin and not cephalosporin. It was more than ten days I was on cephalosporin. She agreed but was tense.  I could sense her nervousness when I was in the preparation room and she was frantically trying to get some additional help, another senior ENT surgeon. She had a tough luck. No one was available at that moment. She called couple of her friends who advised her. Fortunately for me we had requested our octogenarian friend, a highly experienced ENT surgeon to be present in the OT. I was positioned for the procedure. She asked the table to be lowered. Unfortunately it could not be done. Then she asked for a stool, that was made available and then she stood on the stool to start the procedure. Eye drops were put in my eyes so that the vision gets blurred and a head towel was placed and tucked so that I could not see anything. She asked for the headlight, placed over her head and here again the connection was loose. The headlight stopped working. The wires were tightened and she was now ready. Our friend who was supposed to be there had still not come. The traffic jam at Airoli bridge had delayed him.  She asked me if she can start the procedure. I wasn't sure how much time my doctor friend would take and he was only an adviser  so I asked her to proceed. She removed the eight cms. long  packs that were placed little over 75 hours back. There was a friction and pain during the removal and soon after that there was gush of blood. The cauterization that she did on 10^th was disturbed and old wounds started bleeding. She was in a shock. She asked for assistance, ‘get the suction, Txxy, jaldi karo, it’s a profuse bleeding”, she applied the suction to suck out the accumulating blood. Either she was tense or was not used to the procedure, God knows. Ideally she should have put saline gauze over the bleeding surface and then used the suction. This minimizes the damage to the bleeding tissues. Putting suction straight on the bleeders is traumatic. Anyway while this was on, my doctor friend walked in and then I had my comfort levels. She put the endoscope in. I could feel the pain, it must be old model of endoscope as the new ones are just 2 mm in diameter.  This time she used RF for cauterization. It took almost twenty five minutes to finish the cauterization. The tip of the instrument emits high frequency waves and raises the temperature to about 70⁰ C that seals the bleeding points. She would cauterize one point and the bleeding would start from another point. At one point she used so much of force that I felt rupture in septum. This was confirmed later by another doctors when the healing process was on and old blood clots were gone. She was working on my nose as if she was playing a video game. She had to look at the monitor and make moves. The battle was over after nearly half an hour. With all these efforts she was feeling warm; she ordered to start the AC that had nonfunctional thermostat. Once again the blast of cold air swept my body. My doctor friend advised her not to pack but place gel foam, a old time tested dressing. The surgeon was not quite impressed with suggestion of an old timer but couldn't refuse and placed it in both the nostrils. I was wheeled out to recovery room. All looked relieved. The ENT surgeon patted me with assurance that all is well and went for another surgery. My wife, son, brother, doctor friend were around the bed with visible sign of relief. I blinked my eyes to assure that things are OK now. That happiness was momentary. I got the feeling that I am going to bleed. I told my doctor friend and asked the nurse to get the gauze. Before anyone could realize my nose started bleeding. The faces turned worried and helpless. The anesthetist and my doctor friends came close to me, ice was brought and once again my nostrils and face was covered with ice pack. The ENT surgeon was informed but was in the OT operating another patient. The two attending doctors and my brother said that nothing can be done at this stage. All that was to be done has been done. We have to wait and watch. Everyone looked helpless. I was wondering if it was a beginning of an end. Is this the way a healthy person has to meet his end. No it can’t, I said to myself and relaxed. The gel foam that my doctor friend had suggested worked. It soaked the blood and packed my nose. With pressure of soaked gel and it’s forming a film over the bleeding area the bleeding stopped. The cold compression was on. The ENT surgeon came after about half an hour and I am sure she must have silently thanked my doctor friend for his suggestion of gel foam. I was in recovery room for next two hours before returning to the room.

As there was no sedation, I was expecting a peaceful night, of course with the tension of further bleeding. By 11.30 in the night a resident doctor came and started explaining post operative primary and secondary bleeding. His knowledge seems to be from recent reading from some book. I asked him not to explain and let me relax. At four in the morning I heard some saying good morning, I looked at the wall clock it was about four ‘O clock. I lost my cool and fired the intruder, told him to come by eight. My son woke up to see what’s happening. The intruder left without further advance. In the morning my son told me that the person I gave a piece of mind was non other than the resident doctor. I felt bad, but certainly four in the morning is not the time to take a round. Night was otherwise comfortable. I could at least breathe through the nose. There was no further bleeding.

After the first cauterization I experienced nose bleeding may be due constipation. This time I decided to take complete bed rest and be on liquid diet for next three days and take stool softeners  It worked out well. I was doing well with liquids. On day two of operation, I started moving in the room and gained confidence. There was no fresh episode. I took discharge after two days. The ENT surgeon was pleased with her job, but not I. She asked me to see her in OPD after three days. I preferred not to. Two days after I was back home, my doctor friend came to my place and almost set up his clinic to examine me. We sterilized the instruments, got sterile gauze and dressing and removed the obstructing blood soaked gel foam. Net week onwards I went to my doctor friend’s clinic, who extended great help to ensure that I am comfortable.

I had tarry dark stools for over two weeks. My hemoglobin before this problem was over 15 gms. On the day I took discharge it was little above 10 gms. I lost almost 5 gms of hemoglobin in two weeks. One bottle of blood donation reduces the hemoglobin by about one gram. So was it equivalent of five bottles of blood loss?

Few questions are still bothering me. Why I got epistaxis to start with. It was from anterior region. I do not see any apparent cause. I was normal, did not venture in hot sun, did not poke the nose, nostrils were moist, no rhinitis, no coryza, no allergy, normotensive, no diabetes, no stress, nothing yet the profuse bleeding. A big question mark.  Why did the ENT surgeon stopped the coagulants and vitamin K? I just don’t understand. May be that would have helped.

Why did the ENT surgeon put me on third generation cephalosporin? Was it needed? I had no infection when I met her first. I was on IV cephalosporin postoperatively. I was getting hot flushes and had a feeling that cephalosporin is not suiting me. Was the epistaxis due to overuse of cephalosporin?

Was the first cauterization faulty or the packing was not correct? If the packing is right then there is adequate pressure and the chances of bleeding are remote. I was bleeding profusely even with nostrils packed raises doubt about the way packing was done? Why gel foam was not used after the first procedure? I am at loss to understand.

Was the ENT surgeon casual? Generally epistaxis can be a OPD matter. Maximum one day hospitalization if needed. I was in for six days. Was she not gentle in performing the procedures? I could feel her harshness many times during the procedure. Was the equipment not latest? The procedure has destroyed nasal villi. I will have to live with it for rest of my life.

With adequate knowledge of medical science, medicine and surgery, with adequate resources, with fair amount of doctor friends and some standing in the society, I have experienced the treatment related problems. What would have been the fate of common person on the street had this problem occurred to him/her?

I am limping back to normalcy. I am not supposed to bend down, exert, and lift weight etc for a while. Life will be normal again, but it was a phase of loss of mental peace, tension to family and friends and financial loss. The phase of fighting with mediclaim is on the cards, as they are paying only for two days of hospital stay whereas I was in for six days and there are many other unjustified deductions. This is the sad part of being ill.

Epistaxis

Epistaxis, nose bleeding is common in about 20% population, more common in children. A condition that’s considered harmless, easy to treat and simple can turn critical. There is a need for good clinician to understand the problem and then to handle accordingly. Wrong diagnosis or treatment or surgical procedures can be detrimental and patients condition can turn critical. Given below is account of my recent experience. There might be some dramatization due to selection of certain words. Those who do not like to read about medical conditions should not read further. In this first part I am giving the preoperative situation that was experienced. Next part will offer some description of operative procedure, post operative complications, and recovery. The write up on hospital stay and the services offered can be a good material for management students to understand gap analysis. Those in service industry can have some value addition. If you are comfortable then read further, the first part of Epistaxis.

For the third time in my life on April 10^th 2013, I was admitted to the hospital for an emergency. The first admission was on Oct 18^th 1955, when I had a fall from tree resulting in multiple fractures. Second one was on April 9^th 1984, when the scooter that I was riding was knocked down by a speeding car resulting in injuries and multiple fractures. These events were cyclic and took place in cycle of 29 years. I know the astrological reasons and planetary positions of those days, but it’s not the scope of this article. It all started on April 3^rd 2013. I shut down the desktop by 10 in the night and decided to retire. As I was changing I noticed trickle of blood through my nostril. I dismissed it as minor incidence and attributed the same to hot climatic conditions. In few minutes the trickle turned into a gush and there was blood everywhere from bed to bathroom. I packed my nose with cotton gauze, placed crushed ice over the nose and waited for a while for bleeding to stop. My wife in the meantime checked my blood pressure and it was absolutely normal. I called my cardiologist brother and a surgeon friend but no one could figure out the cause. The common cause at my age can be high blood pressure, but I always had normal blood pressure and there were no issues, physical or emotional that would surge the blood pressure. Bleeding stopped in short while. My throat was experiencing irritation due to trickling down of clotted blood. I involuntarily coughed and this time gush of blood started. When looked at myself in the mirror over the wash basin, I couldn’t believe, I was looking like a vampire without protruding canines.  I repacked the nostrils and decided to held the head straight above the level of heart to reduce the blood supply towards the nose. It worked and the bleeding stopped. I spent a restless night. Next noon I had an appointment with the ENT surgeon. I explained to him what all had happened. He was shocked. He suggested not to remove the pack and prescribed vitamin K injections, some coagulants and nasal drops.  He thought it was posterior bleeding, I thought it was anterior. I volunteered to remove the pack so that he could examine. He was unwilling, yet I removed and asked him examine the septum and internal parts of the nose. Everything looked normal except the raw areas which were bleeding last night. I also got my bleeding time, clotting time and prothrombin time tests done. They all were normal. No injury to nose, no high blood pressure, no headache or dizziness, no infection, no alcohol consumption yet nose was bleeding. 

A day went by with sporadic bleeding. The medications were on.  Next day I decided to have second opinion and went to another ENT surgeon. She was more bold than earlier doctor. She prescribed me an antibiotic and for some unknown reasons asked to stop the medications prescribed by first ENT surgeon. I followed her advice. Due to the blood that had gone down the throat, I had dark tarry stools. This was on  April 5^th 2013. Next twenty four hours were ok, but from subsequent day my nose started bleeding again. I was confined to indoors as the bleeding would start anytime without any forewarning. I was feeling weak with loss of blood. Each episode would result in minimum half a cup of blood loss. It was frightening for family members. My wife being bold handled every episode with care and utmost courage. The female ENT surgeon was repeatedly assuring that the bleeding will stop and we need not worry. On 9^th night I again had a profuse bleeding, just like the one I had on 3^rd. There was blood everywhere, the pillows, the bed sheets, the floor. I packed the nose and kept crushed ice over the face. It stopped in while, but I had a premonition. I could not sleep, I was very restless. There was a constant feeling that something serious is on the cards. Midnight passed by, I was tossing in the bed. By 3.30 early morning I could sense the bleeding and before I could act there was a gush as if tap has been opened. I woke up my wife, she was aghast to see the way blood was pouring out of my nose. I struggled to pack my nostrils, kept my head under the cold shower. It took about 10 to 15 minutes to get the situation under control. I asked my daughter in law to call my cardiologist brother, surgeon friend and the ENT surgeon. They were explained the gravity of situation and we decided to get admitted in hospital. My surgeon friend drove me to the hospital, my brother was already waiting there for me and the ENT surgeon had given instructions to the casualty staff. It was about 4.30 in the morning of April 10^th, the Amavasya day, I was admitted. The procedure was scheduled for 10 am same day. Operation theater was booked; it was available as there were no planned surgeries being Amavasya on that day. From casualty I was moved to the room and the preoperative check up were initiated.

Growth of Retail

During past two of months many advertisements have been appearing in print and electronic media announcing inauguration of jewellery stores in and around Mumbai. Not less than four large establishments with multiple outlets have opened up at least ten new showrooms in Mumbai and Navi Mumbai. There seems to be emergence of organized retail movement in jewellery business. These jewellers give lot of assurances like certifications, buyback, low making charges, insurance, life-time maintenance and what not to lure the customers. When I saw these advertisements, I started thinking about small standalone jewellers situated at every nuke and corner of the city. One may not find a pharmacy but will certainly find a jewellery  shop. Now the question comes up about the survival of these small jewellers. Will these small jewellers withstand the onslaught of organized retail stores? Will these small stores continue to do the business? Will their business practices (be it scrupulous or unscrupulous) continue? Will their business model need a change? Time will perhaps answer these questions aptly rather than my guesswork. The consumer needs are changing fast. The big banners, brands, spacious ultra-modern showrooms, cozy ambiance is the experience that consumer is willing to have. The rising prices of gold may be helping big banners as the consumers are likely to believe more in them than the ‘next corner jewellery shop’. I chanced to be in one such big showroom that offered me to check the purity of the gold ring that I had purchased from my old ‘next corner jewellery shop’.  I was hesitant to get the ring tested on modern machines (Karatmeter) for simple reasons. Suppose the ring fails the test for purity then I would have felt hurt for the cheating and would have suspected every gram of gold that I had bought in the past. It would have shattered the confidence that I had reposed not only in my ‘next corner jewellery shop’ but for all such shops. As luck would have it the ring failed the test. The gold that was claimed to be 22k was actually little over 19k. This of course shattered my decade old confidence in the ‘next corner jewellery stores’. With organized retail outlets coming up at frequent intervals and many persons like me switching the loyalty, I expected the ‘next corner jewellery shops’ to close down, but it was not so. I rather found many more ‘next corner jewellery shops’ coming up at a faster pace and doing good business. These shops also underwent few positive changes and those were welcome changes. May be these changes helped them to retain their customers and perhaps attract some new.

What surprised me when this organized sector was growing, was the absence of any protest from any corner to these large organized retail jewellery showrooms. It seems no one takes cognizance of this retail movement. No one ever talked of socialism, exploitation, attack on our culture (?), government favouring the rich, possible suicide by any jeweller or anything similar. Why this attitude is different from the attitude that is seen for single brand or multi brand retail stores. This attitude is not necessarily for FDI, but even for Indian establishments. Some players in retail withdrew their operations from UP, some dare not enter certain states or cities. If large chains in electronics, footwear, garments, healthcare, diagnostics etc. have expanded and raised the standards of service,  without a noteworthy negative impact on small standalone stores, then why only the grocery (agriculture produce) sector is being singled out? There are few simple reasons that one can easily understand for this attitude. Grocery is a large sector and every citizen is a consumer for this sector. Farmer is a very sensitive issue in our country. Agriculture is the largest private sector in our country that includes small and large, poor and rich farmers. This sector can be used for development or for politics. Unfortunately politicians effectively use this sector for their political objectives. So anything that is associated with a farmer or agriculture has a potential for politicians to launch the agitation. Most of the politicians are from agriculture sector and there is no other sector where one can find such a huge number of exploiting middlemen, mostly supported by politicians. The protests are more to protect the middleman rather than the farmers or producers. None other industry has such a stronghold of intermediaries. Then why would one bother if there is a growth of organized jewellery sector or electronics sector? Accept for leftist no one would ever object for FDI in these sectors. But when organized retail grocery and allied sectors threaten the supremacy of middlemen then the fire starts. Are these unscrupulous elements protesting against the growth of retail or FDI in retail, not responsible to stall the improvement of this sector?

We have protests in India for inward FDI only. There are no protests of the Indian companies who go in for takeovers, for M&A or set up green field projects overseas. Our protesters for inward FDI welcome outward FDI. The IT industry, steel and metal industry, auto industry, hospitality industry are spreading their wings. All those who in principle protest the growth should come forward and attack every sector that gets organized. Singling out agri products and shedding crocodile tears for the farmers will expose these sharks. The Indian consumers are getting smarter and the manipulators have to realize this fact. The politicians have to stop supporting the unscrupulous intermediaries before the citizens make them realize their evil plans. If India has to progress then we first have to say yes to the progress and work on that and it is for the consumers to do it. Indian consumers get the footwear to walk on dirty streets from air-conditioned showrooms and the same consumers get their vegetables from these dirty streets. Can this mindset change? Like a decent electronic or similar showroom, can we not have decent grocery and vegetable stores across the nation? We need to say YES to the progress.

Neglect of natural marvel

A Google search will tell you about ten famous balancing rocks in the world, but these famous ten conspicuously do not include the best in the world that we have in Jabalpur. The great volcanic rock is a wonderful example of neglect. It is sadly neglected by all, the citizens, the local government, the state government and finally the central government. Not many years back the rock was seen from the highway running few meters away from the site, but today I had to search for it. The wonderful natural marvel got surrounded by the mushroom growth of dwellings that seems mostly illegal and if these are legal them I pity the authorities who permitted these structures.

Mighty Narmada through Marble Rocks

Jabalpur has a great history. The city has been bestowed with many wonderful marvels by the nature. The mighty river Narmada flows through the marble rocks, a marvel that’s not seen anywhere in the world. The depth of Narmada at certain points in these ravines is up to 600 feet and distance between the two banks is as little as a monkey could jump over, thus called Bandarkud. Little away is a spot where the river is just five feet deep but makes a huge noise, proving the proverb, shallow water makes more noise. Down the stream is Indian version of Niagara, our own Dhuandhar, a mighty wonderful waterfall in central India.

Dhuandhar Fall

Wild Flowers

Few miles away from this mighty river that flows through the marble rocks, we find a range of volcanic rocks and it is in this area the great balancing rock is situated. Today one has to really struggle to find the place. There is no signage that will guide to this marvel. I stopped over a dozen times to check on the location. I moved little ahead of the rock through the hilly terrain and turned back when I realized that I had left behind the spot. The reason is total neglect, houses in the neighbourhood and no significance given to this magnificent marvel made me miss the place at first sight. I parked the car and entered the place through a trap passage. The wild flowers at the entrance were very pleasing but had I not been careful my next step would have landed on human excreta. What a sadistic pleasure the persons might be getting in turning this marvel in to a public toilet. I was at the rock almost after thirty-five years. I was so pleased to see the place again.

Balancing Rock. Inset: Contact area

The upper balancing stone is inclined at about thirty degrees and the surface area of two rocks in contact with each other is about few square inches. No other balancing rock in the world has this small contact surface area. The earthquake of 6.5 magnitudes on Richter’s scale that rocked Jabalpur in 1997 had no impact on this balancing rock. I tried to get more information about the rock from residents in the surrounding area but they were blanker than me. May be they were the migrants in the area from other parts of the country and had encroached the land. Even on the net hardly any information is available in details about this natural marvel.

The size of this rock is huge and the top balancing rock must be over 18 feet in height. There was no way to measure its girth and no one knows what might be the weight of this rock.

Balancing Rock

I tend to call this marvel a neglected one as no one seems to be interested in preserving and properly maintaining the place. There is no marketing of this great marvel. One spends USD 10 just to see how a coconut is chopped in Hawaii or USD 15 to see Bandar ka Khel in Miami. Walk tour of downtown London about Jack the Ripper for GBP 25 or a SGD 35 worth night safari in Singapore is marketing. I don’t want to criticize or challenge them. These may be good in their own way, but we have something that is far better, it’s natural and not manmade. Why can we not market this marvel and the mighty Narmada? Out of the top ten balancing rocks, none can come closer to the Jabalpur rock. The nearest rival can be the Balancing Rock in St. Mary's Bay on Long Island, Nova Scotia or The Golden Rock (Kyaiktiyo), perched atop a cliff near Yangon. There are many balancing rocks in Zimbabwe, but all these are poor distant cousins of Jabalpur rock.

Mighty Rock

I know there is no use to plead or demand a better status for this marvel with any authorities. Had it been smaller is size it would have been stolen buy now. All I desire that we should propagate for this marvel, we should visit the site, tell our friends and relations to take a vacation to visit this place. More traffic to this place can only wake the sleeping administration. My only fear is when the traffic increases, before the administration wakes up, touts and unscrupulous elements may wake up fast and make it difficult for the tourists. The place needs be beautified, cordoned off, and protected, it’s a marvel and pride for    India.

Can my young MBA friends, especially from Jabalpur and around, take the lead to market this marvel and of course start their own business venture in tourism industry. It’s a gold mine.

(My recent visit to Jabalpur in mid March 2013 made me think about this neglect and thus this blog. The purpose is not to criticize any individuals or organizations [there is no point], but to do some introspection so that this marvel can find a place in world tourism map. Please share this blog. Thanks)

Women's Day

There has been never any doubt about female power. Be it Jhansi ki Rani or Queen Victoria, be it Indira Gandhi or Margaret Thatcher, for that matter be it any mother or a social worker. Many females have done exceedingly well in their chosen field. Some got the publicity and some were satisfied with their achievements. There is no need for any formal education to prove something. For the females who did not attend any formal school, life was the teacher and they excelled in their chosen field. There are thousands of examples that can inspire a female to do something that is considered as an impossible by males. I am sharing personal experience of a female who got in to a job that was never thought be fit for women. It was not an effort to prove something but the actions proved something. It opened newer opportunities for the females and newer heights are scaled.

In late 1960’s and early 70’s Nagpur was still a sleepy town with orthodox views and less freedom for women to do what they desire. Women’s education was never undermined but the females did not venture in to professional fields or business. There are always exceptions, some follow the chosen path with determination and surge ahead and some stay with the stream.

This is a story of young girl, who stayed in a hostel, away from her parents who were in Indian Air Force, to pursue her education. The results for B.Sc. Part 1, (somewhat equivalent of HSSC of today) were out and she was ecstatic about her admission to the medical college. Unfortunately her parents being away and no courier services in that era, certain formalities could not be completed and she was thus deprived of her admission in the medical college. With not much of choice in late 60’s she decided to complete her B.Sc. She had an option to continue post graduation, but she decided against the same and wanted to do something that no female had done so far, at least in central India.

The mundane jobs that were available for females in those days were not of interest for her. Somehow an idea came to her mind that was close to her interest. It was related to medical field. She spoke about it to couple of persons in that field, who were not ready to accept her idea. No one had ever thought of such an activity in the past. As luck would have it, one company dealing with pharmaceutical products for female segment accepted her proposal and she became the first lady medical representative way back in 1972, in central India.  Her job was to meet the gynecologist and promote the company’s gynec range of products. Walking on streets with a medical representative signature bag, waiting with male colleagues at doctor’s chamber, visiting the pharmacies to ensure product availability at retail outlets was watched by everyone with a astonishment. The local press and radio, of course in absence of electronic media that’s available today, took notice of her activities and her interviews were published and broadcasted. The lady doctors were very comfortable with her while discussing clinical issues related to their field of specialization and understanding the pharmacokinetics and pharmacodynamics of the drugs that she was discussing with them. And of course male doctors were happy to see a sweet little face…!

Interview in Hitwada, Nagpur

Interview in Nagpur Times, Nagpur

Becoming a medical representative was not to prove something, but was for self satisfaction. It was not an effort to tell the world what a females can do, but was certainly a signal that even females can do the job that males have dominated for years. In her interview over AIR (All India Radio) she advised the younger generations not to have any inhibitions about a job, not to get bogged down by fear of uncertainty. It’s the efforts that will prove, desire to excel that will help to succeed.

Her efforts were not to challenge anyone but to open new avenues for the females. Today we find a large number of females working as medical representative, on higher positions and even as head of pharmaceutical companies. Someone had to take the lead to enter male bastion and that is what this girl did, not today but forty one years back.

Published in DNA, Mumbai

At a later stage of her life she worked for overall development of children and successfully ran a playgroup, nursery and children development center. Once again the media took cognizance of her efforts and gave the publicity that she deserved.  Working for downtrodden, under privileged is her passion and she is associated with social organizations and clubs like Innerwheel and Lioness.

May her past activities work as a beacon to younger generation and help them to choose the path that has been less travelled by the females. One should not do anything to prove, but one should do the things that prove ones capabilities. Happy women’s day.