New videos

Two water and sanitation movies that I edited and uploaded recently:

"Better" by Atul Gawande

I just read an excellent book "Better" by Atul Gawande. Gawande is a surgeon in the US and writes frequently and well (books, articles etc.). "Better" is a great general read, but here are two ideas from there that are simple, elegant and should be done in India too:

1.) Vaccine fund: It is well-known scientifically that most vaccines have side-effects (in the worst case, very severe) that affect a very small fraction of the people (children) who take them. Presumably, public health professionals have evaluated these incidences and concluded that the greater good is worth the unfortunate few cases. But society has some kind of obligation to those unfortunate few. In the US this is institutionalized through a small surcharge on the cost of the vaccine, the proceeds of which go to a fund for those who are adversely affected by the vaccine. Surely we should do something of this sort in India too ?

2.) A fund to cover the cost of people who suffer due to errors/negligence/bad luck etc in medical care. This is not there in the US but is there in New Zealand. It comes up in the author's discussion of the medical malpractice industry in the US. If you suffer due to error or negligence of a health care provider in the US, the only recourse you have is through the courts. This is a far from perfect system as it works currently in the US. Only a tiny fraction of people who feel they have suffered from errors or negligence go to court due to the expense and the risks. When someone is awarded damages, they tend to be very large amounts. So the system delivers justice only to a very small fraction of people who have a very strong case of severe harm caused. On the medical professional's side, this system leads to very large amounts they have to pay in premiums for their malpractice insurance. The author argues that it would be much better to have a system where there is a common fund for people who suffer due to a slipup in medical care. The system does not worry so much about finding out who is at fault, rather it tries to remedy the damage done to the patient. Through this system a lot more people benefit, though there is a cap on the amount you can get otherwise the overall cost of the system would be impossibly high.

Again something that we need in India too ?

Gawande ends with a short list of 'recommendations' for medical students for them to be better doctors. One is particular I liked:

Count Something. Regardless of what one ultimately does in medicine - or outside medicine for that matter - one should be a scientist in this world. In the simplest terms, this means one should count something. The laboratory researcher may count the number of tumor cells in a petri dish that have a particular gene defect. Likewise the clinician might count the number of patients who develop a particular complication from treatment - or just how many are actually seen on time and how many are made to wait. It doesn't really matter what you count. You don't need a research grant. The only requirement is that what you count should be interesting to you.

More on the book and Gawande at gawande.com. You can borrow this book from easylib.com in Bangalore, the library service I use.