By Rajan Narayan

AND a few stray thoughts for yet another Saturday. For a Saturday following the week when dozens of caretakers at the GMC and virtually every health centre in the country. For a Saturday following the week when we hear the new swanky GMC super speciality hospitality has some nice terraces to celebrate medical milestones as also birthdays for special occasions. For a Saturday following the week when I realized how good news can be bad news, particularly in the case of health.
And a few stray thoughts on the dozens of caretakers at the GMC and virtually every health centre in the country. This has particularly a bad impact on the patients who are not from Goa and do not have extended family staying in Goa. Relatively, Goans because of the Uniform Civil Code, have dozens of cousins, uncles and aunts to look after in their old age. Unfortunately, in my case, both I and my wife are from outside. I am originally from Tamil Nadu and never lived in Tamil Nadu. My wife is from Gujarat though she has never lived or worked in Gujarat. Since we do not have any extended family in Goa we are forced to hire professional caretakers when hospitalized.
The word professionalism is a myth more or less because few of the caretakers we have engaged in the last year have any real caretaking training. If you are a crorepati you may perhaps afford trained nurses who charge up to Rs2,000 or more per day. If you are from a middle-class family you have no choice but to depend on a dozen or more employment agencies who supply caretakers. Then luckily In my case I found an ideal caretaker who has enough experience dealing with fuzzy-aged patients like me. On normal days I have to be very patient but when I am not well my irritation level goes up even further. When my mind starts investigating things and I cannot resist investigating even at 77 years of age, I discovered that these caretaker agencies are primarily exploiting migrants or job seekers from the rest of the country.
Goans by attitude and aptitude have no interest in health care even though the earnings from caretaking a patient is rewarding. Charges are as high as Rs1,000 per shift for 12 hours, so if you want a 24-hour caretaker it costs you Rs2,000 per day to Rs 60,000 per month.
If you don’t have a godfather and if you don’t have a Goan life no middle-class family can afford a 24-hour caretaker on a full-time basis. I depend on the goodwill of friends and my wife’s continuing efforts on my behalf to raise some income. In any case, my wife is passionate about the “Goan Observer” (my baby) and prefers to devote her time to bringing it out online rather than spend 24 hours around the clock at my feet.
The out of Goa job seekers are easy prey for caretaking agencies as they are willing to do any kind of job for an ailing patient who may be bedridden including changing diapers and cleaning up the patient. Most of them are semi-literate and speak in Hindi or broken English. The GMC being Goa’s premier public hospital sees quite a few seekers for a caretaker’s job in its wards. Every time a new patient is admitted, half-a-dozen agents approach the patient and his family to offer their services.
The GMC must regulate these caretaking services which turn into a racket sometimes. There is no milder word for these caretaking services in their present form. There is only one agency which trains people to be good caretakers, that is Caritas, but even Caritas has a capacity to train a small batch of persons interesting in caretaking jobs. It takes only 30 students in a batch for training in nursing care. Moreover the Caritas-trained home nurses like to migrate abroad as earnings are better there.
The risk in hiring the services of half-trained caretakers is that if they are not educated enough they may even contribute to the death of a geriatric patient, especially if no family member is around or abroad. If you don’t have a choice but to hire a caretaker to take care of your needs in times of illness it helps if you install a CCTV camera on the premises (so that everything is recorded if anything untoward happens). At least your daughter or son at work will be able to keep track of you at home where the caretaker is watching out for your wellbeing.

BIRTHDAY BASH AT GMC
AND a few stray thoughts on terrace parties taking place at the new GMC super speciality block hospital courtesy the generosity of Vishwajit Rane, who likes to celebrate his wife’s birthday dramatically. His wife Divya Rane is the Poriem MLA is also a microbiologist we are told by a doctor friend who attended a party at the third floor terrace of the new GMC hospital from where views of the hills in the distance are terrific. A friend from the Preventive Medicine department visited me in G Ward or Geriatrics ward and was acting like an agitated cat on a hot tin roof, he told me that his wife was invited to a party but he was not!
The Rane couple were present for the party at which a lot of neurology department staff and doctors and neurosurgeons past and present were present. All of Baba’s favorites at the GMC old and new were present. In any case, the majority of the Class 4 jobs in the GMC are reserved for residents of Sattari constituency. We dare to think that perhaps Vishwajit’s wife is more comfortable at the GMC than in her palatial home. At home she has to live with the autocratic Vijayadevi and former chief minister of Goa, Pratapsingh Raoji Rane.
This reminds me also that if you want to be guaranteed good service at the GMC, all you have to do is tell them you are from Baba’s village. Baba is how Vishwajit is affectionately known at the GMC in some quarters. The dean of the GMC is Dr Shivanand Bandekar, who qualified for the post by the strict public health service board. In the process, Dr Tiwari of the Nephrology department who served at the GMC selflessly for 20 years, was sidelined. His chance will never come as long as Vishwajit Rane is the health minister of Goa. We only hope VIshwajit Rane is equally dedicated to finding new doctors to replace the older generation of doctors at the GMC.
The last old guard, Dr Sanjay of Radiology department and Dr Sundaram Ponraj of the Neurology department, not to mention Dr Edwin Gomes, will retire in the next few months coming up in the new year. We see the departure of some of the most experienced senior doctors in the GMC in the healthcare industry of Goa.

HOW GOOD NEWS TURNS BAD!
AND a few stray thoughts on when how I realized that good news can be bad news particularly in matters of health. About a year ago my MRI reports suggested that I may have TB of the spine. It was suggested that I may have TB of the spine. The GMC did a range of other tests including several X-rays and CT scans. Also a needle aspiration test to check out a small lymph at the armpit, and a sputum test, but none of these proved positive for TB. However, I was introduced to this TB medicine a year ago even though there was no formal confirmation of tuberculosis. Perhaps I was living in a state of denial for the understanding is that only young men from poor families get TB. I was discharged from the hospital with a summary saying that I had latent TB of the spine although I was unwilling to accept the verdict. Because TB medicine had very horrible side effects on me and I discontinued it after a week’s trial.
But I was still uneasy and went to a neurologist to confirm my belief that I had no TB. The young neurologist who’s very qualified in his field said I had no TB but a chronic cervical problem of the nervous system called a crushed spine. Alas, two weeks ago the TB was diagnosed anew with MRI testing and I felt the left side of my body collapsing and was unable to move my feet. I thought it was a neurological problem and was being treated with physiotherapy at home would improve me…then the fall over the walker happened and the panic button. It was back to the GMC which is like an almar matter for me as a patient. I could barely move my hands or legs and getting agitated over my ability to talk. After an ultrasound-guided needle aspiration of the spine and new MRI it was disclosed that there was a lot of spinal fluid in the neck area, the TB has spread to other parts of my body. The new NAATs test comprehensively confirmed it is TB infection which I kept denying in the absence of conviction.
And so I am mercifully now at the geriatric ward of the GMC with no choice but to take my TB medicine. I do not know whether I have chosen the path of cure. Perhaps if I had started the TB treatment a year ago I would not have been so acutely affected now. I am fortunate now to have found the best medicine doctor in GMC of Goa in Dr Edwin Gomes who is treating me. He clears my mind and says that after three weeks of the TB drug treatment, which is like chemotherapy, they will try to drain out the spinal fluid of some absess and hopefully improve my condition of the spine infection. So I say sometimes that good news can be bad news and if I had latent TB of the spine which is rare, and if I had taken the medicines earlier, I would have been cured and achieved remission of this disease which takes a toll on so many patients in the country.