Pollution! Nobody’s Baby!

Recently all of us have heard of pollution issues that are literally choking Delhi and probably this is only the beginning. As usual we go about the issues as if it is Government problem and has nothing to do with us. There are a couple of things that need to be considered. Nobody could have predicted that India will manufacture 3 million four wheelers per year and one million plus two wheelers per month by 2015. Increased car ownership can be considered as effect of liberalization. This improved the economy  at a rapid pace, at the same time growth of IT sector started. Combined effect of these two factors led increase in aspirations of fast growing middle class. But growth of two wheelers is purely because of poor infrastructure of roads and public transport in our cities. A society is considered developed if middle class and upper middle class people in that society travel by public transport.

Consider any city in India. Except for Mumbai, where does public transport carry large number of people daily. What is their other option? People have to move like Sardines packed in the “Local” trains. Ask any Mumbaikar about Metro and he will agree that ALL trains in Mumbai should be like Metros! Why Rs.90000/ crores planned for Shinkansen cannot be used to Mumbai “local” train quality improvement? (I am aware that its a special deal) Millions of Mumbaikars will bless the Government if this is done. What are our governments priorities? What are our society’s priorities? What do we want to achieve? Do we want to become a four/two wheeler dependent society? Do we have the discipline to become individually owned vehicle based society? Are we at all striving to become an advanced nation?

What is really adding to pollution? I am comparing data in general and not for any specific category. During discussions on pollution, we talk only of vehicles like cars, trucks, buses et al but there are other factors too. I am discussing Delhi issues because it has become first city in India to have really suffered. Factors contributing to pollution in Delhi are

  1. Winter/Weather
    1. Winter causes stagnation of cold weather near the earth’s surface  ie inversion due to cool air. This is not new to Delhi and has been an old phenomena
    2. Air flow patterns from Afghanistan and Pakistan, pick up from Haryana and Punjab, smoke created by farmers burning the straw in the fields.
    3. Delhi generates 10000 tons municipal solid waste per day. This is burnt every day.
    4. Pre monsoon dust storm also add to this issue
  2. Industry
    1. Delhi has massive construction projects going on; these add to pollution
    2. There are many industries in Delhi
  3. Power generation plants
    1. Badarpur power plants are 30 to 40 year old. Plants use very poor coal quality and have very old design equipments with almost zero automation. This cause high pollution as well as cost.
  4. Vehicles all types
    • Delhi has 7.5 million vehicles on its roads. Many of them older than 15 years.
    • By sheer volume, we miss out that two wheelers also have equal share in pollution because they are 70% of total vehicle population.
    • Government policies have kept diesel cheaper than CNG for most of the period thereby discouraging the use of CNG
    • Diesel buses which carry 50/60 passengers are taxed more than diesel cars.
    • Large number of trucks going to other destinations  just pass through Delhi though they have no business to be in Delhi.
  5. Dust cleaning from roads
    1. In India road cleaning is done every day using “Zaru”, a broom. With this method maybe 50% of the dust that should have been collected goes into air adding to pollution.
    2. It is seasonal but Diwali fire crackers add to pollution
  6. Delhi has a typical mix of Government authority where Delhi is a state Government but has a very large number Central Government establishments. This causes the clash of authorities so taking decision can be tricky for both!
  7. It is Supreme Court that has been pushing the Government. Supreme Court has now taken actions which best can be described as knee jerk. What is going to happen by not allowing to register say 15000 large diesel SUV/C class vehicles?
  8. Delhi citizens almost pay no money for parking their vehicles on public roads. This leads to indiscriminate buying of vehicles. In cities like New York 30 years back people had pay US$ 300/ per month to park their cars in apartment complexes.
  9. Besides this Governments policies play a major role in vehicle pollution issues. Following two tables show the Indian standards and European Standards for pollution norms.
  10. EuroNorms
  11. BharatNorms
  12. When the policies were declared by European Union, which were then followed by Indian Government, the EU wanted to reach Euro VI standard by September 2014. Whereas Indian goal was equivalent of Euro V by 2017! This is where the real issues start. Pre liberalization there used be Hindu Growth rate of 2.5% per year in India. Probably as we believe in Karma, we are in no hurry to change things. When this rate grew to between 6 & 8%, pollution also started galloping. We just forgot to change our targets  for pollution control which probably would have been ok for Hindu Growth rate! .
    1. Even on decided targets there is a major failure in implementation.
    2. Currently for fuel supplies, Northern India and large cities in other parts of India get BS IV for petrol & diesel. Rest of the country is expected to be BS IV in Jan 2016, BS by Jan 2020 and BS VI by 2023!!  Unconfirmed report says that industry will struggle to meet even BS IV norms by 2017.
    3. Vehicle industry says it will struggle to make BS V by 2020 and  BS VI by 2024!
    4. This proves one thing we are very adept at selecting appropriate names. EURO norms name is converted to BS. I need not elaborate the meaning of “BS”.
  13. Large Industries have money to open new factories but they do not have money to improve their Vehicles for better norms. Our Government owned fuel companies have thousands of crores to spend on marketing and opening new pumps. But they do not have money to improve refineries to make improved quality fuels.
  14. Why Government cannot give stringent targets to Automobile manufacturers and Fuel companies for going straight to Euro VI or Bharat VI norms? All these groups make noise but if they are forced they will do it. It is about putting correct priorities! Is it about the lack of political will? Is it about the clout of these big companies? Is it plain bribery? Why can’t Government push Public sector companies?
  15. Governments work on these issues only when the Supreme Court pushes them, otherwise everything is seems to be hunky dory.
  16. In olden days also I remember very foggy weather in Delhi in winters. Practice of cleaning roads with “Zaru” is an age old practice. Supreme court has already forced Smog caused by burning of straws in fields in Haryana and Punjab is also a very old practice. The factors mentioned were causing problems even in those days but word pollution was not in fashion.
  17. When nations proceeded rapidly towards industrialization they adopt new technologies, new ways of doing things. I am sure people must have been defecating in open in most countries in olden days. But this changed drastically. But in India in spite of Government trying very hard by making laws like “having toilets in home” as a pre-qualification for standing for local elections, people build the toilets but still defecate outside! Oh, we like it that way!! You will hardly see anyone spitting in developed countries. Mind you tobacco chewing was rampant in these countries too!
  18. Unless Governments, Industries, Fuel Companies, People all make concentrated efforts jointly and simultaneously problems of pollution will just remain that, Problems of Pollution, irrespective of whether we have authorities like National Green Tribunal (NGT)

In conclusion, we can say that following factors are causing pollution in Delhi.

  • Large number of vehicles and incorrect policy on diesel
  • Government apathy on regulations
  • Atmospheric conditions in winter
  • Auto makers & Oil industry taking advantage (gain what?) of lack of political will of Governments
  • Age old practices not being changed, road cleaning by “Zaru” & straw burning in farms
  • General apathy of public in not forcing  Government to pass strong laws. Yesterday’s example of passing of “Juvenile Justice Bill”. Public pressure forced law makers to pass this bill in the parliament.

Good Samaritans!!

Doctors as a group are good Samaritans. Most of them are in the service of humanity, money of course matters but of many doctors that I have met and know of, are good human beings. My friend Vijay sent me a video in which a physician was speaking about heart ailments. This doctor had a very nice way of putting things across in a humorous way. He was putting his thoughts across that heart ailments can be cured without surgery, angioplasty and invasive procedures in general. Vijay asked me if this is really possible. When he asked me this question the whole kaleidoscope of my interactions with doctors, throughout my life, passed by quickly. This made me think of two things, about doctors in general and about getting well with their help.

My first reaction was that, when  doctors treated you as individual doctors they were simply good to superb, as is natural in any group of people. They always cared for you, they would try to give least amount of medicines as possible, and try and allow the nature to take its course; they would intervene only if needed. Over a period I have observed that doctors explain things in details about your ailment. On the flip side I know a doctor who instead of explaining gives you a link to his YouTube presentation about your ailment, which I thought was very impersonal.

The personal attention however changes when you are required to go to hospitals, where you are theoretically in a corporate environment. You would expect quick and efficient actions followed by continuous tracking as would be expected, as patients go to hospitals only when such need arises. I do not know what happens in that environment but things are sometimes at the other extreme. You will see inefficiency galore, delays, late responses, doctors just not being available and so on. (Oh don’t worry the intern will take care of you!) I remember when I was required to take my father to a large hospital due to heart attack. He was admitted under a senior physician. After initial checkups I was promised that the senior physician will shortly come and see my father. After a couple of hours I was coolly told that the doctor will now come the next day as he was now busy in his consulting rooms. For me it was it was simple, if the senior doctor is too busy to see my father then I would rather go to another hospital. When I said this to the junior doctor, he said we should not do that as my father was critical! I said if he is critical then why the senior doctor is not checking him? Within 15 minutes the senior doctor came!

I remember a case of one of our relatives; he was admitted to a major hospital due to stroke. He had diabetes, he was on dialysis, and he had high blood pressure. For two days doctors would just not share details hence I was called to talk to them. Hospital was trying to force a brain surgery on the patient (had put him on ventilator) but as layman I could see that it was meaningless. I took a young doctor to side and asked him his blunt opinion; he said the patients’ brain is 85% damaged and he has no hopes; he gave a sad smile and said well looks like commercial aspects have taken over the case! We managed to remove him from that hospital to another one where we knew the doctors well. Doctors gave the same opinion and advised that he should be allowed to die peacefully! We did!

But I know of a physician who treated a friend of mine for heart ailment; my friend did not have sufficient insurance coverage to have bypass surgery. This doctor explained to my friend how this can be handled without surgery but he needs a drastic life style change. This was 20 years back; my friend and I had coffee last week!

This reminds me of a story told to me by a young doctor. He was working for a small hospital. He checked a patient and felt that no tests were needed. So he let the patient go. When the hospital owner came he asked the details. When he shared details about this patient, the owner said “Is my father going to pay installments for the new test machine?” Our friend simply said “looks like it” and calmly resigned and walked out!

A student hurt himself while playing badminton. His friends took him to a large hospital. When his parents reached the hospital this student was very upset and said “Dad lets go elsewhere”. His father told him to let the doctors handle the basics then they can move. The student said that they took x ray of his ankle and later found out that the doctor had forgotten to put the film in the machine!

The stories can go on and on! But as in life there are good doctors and there are not so good doctors. There will always be some black sheep. But why the basics change in large hospitals is beyond my understanding. Are doctors not good managers? Are good managers incapable of handling intricacies involved in running a hospital? Well hospitals these days have software to handle their administrative work. What a hospital system does is to provide services required by patients. This is very similar to running a hotel or running an automotive workshop. These two also provide services. Did you ever find that garages and hotels took 3 to 4 hours to give you or your vehicle a discharge? Why is that hospitals take so long to discharge a patient? On the other side, I have experienced an extremely efficiently run pathological lab. They are very efficient and at stipulated time you get your reports by email! But the norm is inefficiency.

Coming back to the video, the doctor aptly said that if you want to get well then the patient has to follow ALL things told by the doctor.  He gave an example saying that if a tank has 15 holes, how can you fill it up completely? It is obvious that ALL 15 holes need to be blocked to fill up the tank. A patient with liver issues says what is going happen if I take a peg or two of whiskey? Then the patient is asking for trouble. A senior physician once told me that in diabetes, most of the patients keep on having issues as they do not follow the basic discipline of diet, medicine and exercise! He said a very small percentage of patients have really erratic body responses and have a tough time as diabetes remains erratic even after following ALL instructions. He also told me a story of a disciplined patient who in yearly checkups found that he had very high diabetes. But by following the regimen to the last dot on I’s and slash on T’s, in three years’ time the patient has become non diabetic, with medicines!

Friends I wrote this blog to suggest how health issues are handled and need to be handled. These thoughts come to mind probably because I am a senior citizen now!! I will add a few more points. All “Pathys” are as good as the doctor who uses them. Each pathy has its own benefits and down sides plus limitations. When you are having jaundice there is no known cure available in Allopathy! You have to take Liv 52. Similarly other pathys also have limitations. But we should not be very rigid in our thoughts about up & down sides. That Allopathy has certain side effects is a known fact but that does not mean there are no good sides! Allopathy is the best researched pathy and offers cures to many ailments, even the toughest of the ailments. Homeopathy and Ayurved have their own advantages and limitations. What happens is after reading something about side effects of Allopathy, some people tend to just ignore it, to me at least, and it is to their own peril. There are diseases like cancer, dementia and many such tough ones. Very strong Allopathy medicines are also not able overcome such ailments. In such cases people should NOT experiment! I will share with you an anecdote about a patient with blood pressure problems. He went to the doctor and got himself checked. His BP was 200/120! Doctor suggested that he get himself admitted to a hospital or take 100% rest at home for at least four days and then prescribed to him strong medicines. The patient probably did not understand the meaning of 200/120. He asked the doctor, “I am worried about Allopathy side effects. Can you tell me the side effects and try to reduce the dose”. Doctor said, “Let us experiment later, and at this stage let us act fast”. Patient still insisted on knowing about side effects before starting the treatment. Doctor gave him all the details and said, “As against these side effects, if you do not take medicines there is only one side effect”. Patient said “what is it?” Doctor said, “You may die”. Amen!!