The NMJI

Letter

VOLUME 16 NUMBER 6 November/December 2003

Letter from Chennai

BOTTOMS UP
The Government of Madras and its successor, the Government of Tamil Nadu, have always had an ambiguous attitude towards prohibition. It is introduced when finance ministers realize there is money in alcohol and within a few years time, it is withdrawn. However, it is a far cry from permitting the sale of liquor in the private sector to nationalizing it, which is what the government did by promulgating an ordinance amending the Tamil Nadu Prohibition Act, 1937 (Tamil Nadu Act X of 1937). Tamil Nadu State Marketing Corporation (TASMAC) and cooperatives associated with it will hereafter run the retail trade in the state. In a press release, the government said that liquor dealers had formed cartels by means of which they could corner the market. They violated the maximum retail price fixed by the government, and sold spurious and contraband liquor, to the detriment of the consumer. It was in the interest of the consumer that the government decided to take over the trade and run ‘bars in an orderly and hygienic manner’.

Doubts were raised about how the government would find the manpower to run its liquor shops. However, conveniently, for this plan, the workload of ration shops in the state was reduced by the denial of supplies to everyone earning more than Rs 5000 a month. The staff thus made redundant could be diverted to the liquor shops and bars. Meanwhile, there is agitation among those registered with employment exchanges, all of whom think they are best suited for this convivial service.

In the 1960s, I worked in the Government Stanley Hospital that serves an industrial area. I was familiar with many of the families living in a nearby slum. There was a dramatic improvement in the standard of living of the slum dwellers when prohibition was introduced, and the even steeper decline when it was lifted. Children were better fed, better clothed, and generally more healthy and happy when their father could not waste his money on alcohol. I am all for prohibition, and I am dismayed that we have swung from one extreme to the other.

Does not every Indian have a fundamental right to drink or smoke as he/she desires? Let me tell you the views of one of the greatest protagonists of prohibition. On the last occasion when Rajaji was the Premier of Madras, my father was a senior civil servant. When Rajaji introduced prohibition, he left a loophole for well connected people to obtain a permit to purchase and consume alcohol on the flimsiest grounds. My father was a social drinker and had the permit. When some foreign visitors came to Madras for discussions on some project with the government, Rajaji asked my father to entertain them. On one such occasion, my father asked him how he could reconcile his views on prohibition with the fact that he had actively incited him to drink along with the foreign guests. I heard Rajaji’s reply: ‘I am not bothered about people like you. You are affluent and sufficiently well informed to look after yourself. If you choose to ruin your health by drinking that stuff, it is of no concern to the state. My responsibility is towards the poor, who do not know better, and who will seek refuge in drinking for their problems, making those problems worse. It will benefit them if the government enforces prohibition.’ These may not be his exact words, but that was the meaning. When the prohibition was lifted, I was still in Stanley and the nutritional standards of my patients from the neighbouring slum dropped dramatically, and they became prey to ever more illnesses.

Perhaps prohibition has proved to be unworkable. By the same token, the government’s handling of matters which should be left to the private sector has also proved to be inefficient and corrupt. I do not think the drinking public of Chennai will be protected from substandard and adulterated alcohol if the government takes over the trade; a different set of people will profit.

WATER
Our government has enthusiastically arranged to provide us with liquor to drown our sorrows, but it has done nothing to provide us with a more essential liquid, water. Time was when we had a water meter in our houses, and paid the municipal corporation according to our consumption. Many years ago, the corporation took the wise step of disconnecting the meters, and charged us a flat water rate. We have not had a drop of water from the Metrowater pipe for months now, but we still have to pay the rate, since it is not linked to our use of water.

The Veeranam lake in Cuddalore district, some 230 km south of Chennai, is considered as a means of augmenting the city’s water supply. The Veeranam project was inaugurated in 1968. Unfortunately, it has been a political plaything. One government works to implement it, and then yields place to another party, which shelves it merely because it was promoted by its rival. We have yet to see any water from it, or from the more recent Telugu Ganga project to bring us water from the Krishna river, 350 km north of Chennai.

The current government of Dr Jayalalithaa has decided to resuscitate the Veeranam project at a cost of Rs 7.2 billion, to supply 180 million litres per day to the city. Experience makes us sceptical about this. We are used to the sight of massive pipes lying by the roadside, sometimes put to use as a shelter by slum dwellers, and wonder whether the Veeranam project is the origin of the expression ‘pipe dream’. There are two clear sources of water available to the city from within itself. One is ground water, and I feel the government was wise to make it compulsory for every building in the city to install rain water harvesting so that the supply could be replenished. Unfortunately, one must first have rain to harvest water, and with the rains playing truant yet again our wells are running dry. The other, and this time inexhaustible, source of water is the Bay of Bengal which laps our shores. Experts predict that global warming will lead to a rise in sea levels in the years ahead, so we will not run short of this commodity. I have long felt that desalination of sea water is the only feasible method to maintain the city water supply when the rains fail. I am glad the government has at last considered this option seriously. The chairman of the Metrowater project said recently that desalination plants with a capacity of 300 million litres a day were planned at the cost of about Rs 15 billion. These massive figures are beyond my simple mathematical abilities, but it does not seem much more expensive, litre for litre, than the Veeranam scheme, and would probably be much more feasible, especially as it can be left to the private sector, and does not involve long conduits which can be tapped all along their course. Tenders have been called for. The last date was November 14, and the contract will be finalized within 4 months.

THE TAMIL NADU STATE MEDICAL COUNCIL AGAIN
The Tamil Nadu State Medical Council (TNSMC) continues to make noise. It recently announced that it was in the process of compiling a fresh code of ethics for doctors, in keeping with the changed circumstances. I see no point in making code after code when there is no will to implement the directives, and doctors continue to flout them with impunity. Perhaps the new code will remove all the old restrictions, so that we can do what we will and still call ourselves ethical practitioners.

DYING WITH DIGNITY
Some years ago, I wrote about the abominable condition of the city’s cremation grounds. They are filthy and the staff is corrupt, demanding money from helpless mourners at every stage. In 1998, the municipal corporation invited bids from the private sector to run some of these grounds, and at least one of them, the Jayadasa Trust in Tiruvanmiyur, a relatively new part of the city, has done a fine job. The three-acre site has been transformed into a tree-lined garden. Coconut, bamboo and Casuarina have been planted to provide wood for cremation. Iron grills have been installed for the fires, and toilets and other amenities have been provided. I was happy to see a news item that the corporation has decided to improve the cremation grounds it owns and runs. A start has been made in one of the oldest, in Mylapore. Antisocial elements have been evicted and 24-hour security staff provided, the place has been cleaned and the scrub cleared, and adequate lighting has been installed. Not a day too soon. The least we can do for our dead is to enable them to quit this earth with dignity.

EXERCISE AND LONGEVITY

I must confess to having been a couch potato for most of my life. I have always felt that an hour spent in exercise could be better spent in improving my meagre knowledge of medicine. Some of my friends have unkindly implied that the real reason is that I am incurably lazy. I have always sought scientific justification for my views, for example the paper from the USA1 which, while lauding exercise, said ‘the amount of additional life attributable to adequate exercise, as compared with sedentariness, was one to more than two years.’ Given the life expectancy of the average American, an hour of vigorous exercise a day for say 50 years as an adult would add up to 760 days, so one would prolong life by just about the number of hours one exercised. I did not think it worthwhile.

Having lived happily for three score years, I fell into the hands of doctors who insisted on my walking every day, and so I joined the ranks of my fellow citizens who trudge the roads each morning, and I am now a walker of many years experience. The proliferation of diabetic centres in Chennai, and the profusion of cardiologists, has led to ever more of us turning out. I have made a few observations. There are more women walkers than men. The majority of us are overweight, and over the years the exercise does not seem to have made any of us shed even a kilogram of fat.

Some people exercise their dogs along with themselves. There is the mournful gentleman with the hangdog look, who walks with an equally mournful-looking cocker spaniel with its long face and drooping ears. There are the aggressive young lady whose companion is a fierce-looking boxer, the lanky gentleman with his great dane loping beside him, and the sprightly young lady doctor with her pony tail bouncing as she jogs, and the pomeranian prancing with pride beside her. Do human beings take on the characteristics of the animals they associate with or do they select animals akin to themselves? What a wonderful subject for a controlled trial!

REFERENCE

  1. Paffenbarger RS, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986;314:605–13.

 

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