Wednesday, February 25, 2009

dental education

I wrote the following letter as a letter to the editor, in the decan herald. i do not think that it will be published. since publishing on the blog is in my hands, posted it here for whatever it is worth.

Few days back I saw an announcement in the news papers. Being a dentist who loves the profession and feels proud about it, I felt very sad to see that announcement. It was from the CET cell of Karnataka. It stated that the students who are desirous of obtaining admission to BDS, need not take the CET (common entrance test for professional courses). They may straightaway approach the individual colleges and get the admission. I was expecting it. For the last few years I have been observing that the BDS seats in Karnataka have no takers. The daily declaration of availability of vacant seats made by the CET in the newspapers, during the admission time, always showed BDS seats available. Students with minimum of 50% in the qualifying exam (eligibility to appear for CET) could just walk in to the dental colleges, whatever the CET ranking be. But those seats remained vacant even after the admission process was over. (In the middle of this muddle, the Karnataka government decided to start another dental college in Bellary, where I learn that not even 50% of the seats are filled). Since there are no takers in the group who were eligible to write CET, now the seats are being offered to anyone who has the minimum qualification. I do not know if those who have just passed PUC with 35% are also eligible. The college managements want the seats filled up somehow or the other so that their losses are minimised. And the Karnataka government is always eager to help. The dental council, which has given permissions left, right and center, in spite of knowing that the colleges do not have the requisite faculty or number of patients, necessary for imparting quality training, will obviously remain silent. I am sure that there will be a number of students who have passed the PUC but not eligible/not interested to take the CET, will be tempted to take up these easily available seats in dental colleges and have a glamorous prefix ‘doctor’ in front of their names. My intention in writing this letter is to inform them that the quality of dental education, (in the country in general and Karnataka in particular) and consequently the quality of the dentists coming out, has been very bad and so is the prospects of the profession. That is the reason for the seats being vacant. I believe there are any number of BDS graduates who are forced to decide upon pursuing avenues other than dental practice. I have been meaning to write a letter regarding this situation for the past few years but held myself back as I felt that it is none of my business to offer suggestions when not asked for. The announcement by the CET forced me to write this. I have based my letter on the observations, some of which a layman may not appreciate but anyone who has a faint idea what dentistry and dental education is, surely will.

Let us take the three things, which I consider are important for imparting dental education. (Assuming the student is interested in learning). The teacher, the equipment for training and treatment and most impartant, patients- from whom we actually learn and whom we treat.
I can safely say, even without authentic statistics in my possession, that most of the dental colleges score only on equipment.
Most of the qualified and experienced teachers, if available, are ‘visiting’-varying from two days in a month to once a week or few hours a day. Patients, mostly are missing. With a college in every street, how many patients can a college hope to get? I have seen colleges with various departments equipped with 30-40 dental chairs in impressive rows, 8-10 undergraduate students, 4-6 interns and 2-3 postgraduates waiting for patients. So, two factors out of three are gone.
Students train on plastic teeth because extracted teeth are not available, and start on few available patients in the clinics.
Because of lack of patients students have very little chance of practicing all the treatment procedures and so, training and examination standards have been suitably altered (reduced). Most of the graduates who pass out and start practicing, will not even have got the minimum training and depend up on visiting consultants to attend to even simple cases. The consultants with post graduate qualification will have learnt during MDS, what they should have learnt during their undergraduate BDS course.

I may be forcing the wrath of the profession and criticism from many quarters on myself for writing this ‘baseless’ letter but I felt compelled and having got it off my chest, I feel I have done my bit.

Sunday, February 22, 2009

excitement over sunlight!

In my very first post, I had mentioned about the phenomenon of the sunlight falling directly over the statues of the deities that we have placed in our god’s abode. I had said that it happened as there was an un-planned opening in the far wall through which sun light came in only few days in a year, and we were quite excited about it because it was unexpected in this house. Since the opening is small and at an angle to the path of sun light and also to the place where the deities are placed, the light stays only for a minute. This week when it happened I took a photograph. This is it.

Friday, February 20, 2009

I had no intention of having my hair cut today. I went to the market this morning. To day is the weekly vegetable bazaar and I did not find any place to park my scooter. I went a little ahead and found a place in front of Hadapad’s hair cutting shop. I peeped in and was surprised to see all the chairs empty. Hadapad and his colleagues were watching the TV. Some crazy channel was discussing in detail, the issue of colour combination of the dresses worn by “Team India” for their matches and and it’s effect on the results. Hadapad's assistants are cricket crazy. I have spent anxious moments when they have been cutting the hair over my ears with their eyes fixed on Dhoni's bat. Today there were no customers and they were free to watch cricket discussion in a relaxed mood. It was a very rare sight. Hadapad and his co-workers are usually busy all through the day. Whenever I go there I need to wait at least half an hour for my chance. To day all the chairs were mine! I was tempted. I sat in a chair and handed over my head to Hadapad.
We know each other for nearly twenty years. I have been following his upward movement in the profession from the time he began his career as a helper with another barber. He learnt the trade, was promoted as a qualified barber and continued to work on income sharing basis. He managed to save enough to make a part payment for a shop, obtained a loan and began his own venture. His hands being good and tongue even better, he flourished, and repaid the loan earlier than scheduled. With a fresh loan he started another saloon which he later handed over to his brother to run. Today he informed me in his own very humble way that he has purchased yet another shop worth twelve lakhs rupees and is looking for some reliable person to run it as a franchisee. Hadapad will equip the saloon and put in an appearance twice a week to promote business. With all modesty he told me that god has looked after him well. Having come to Goa with only the clothes on his back, he now owns a house, and three shops. He employs about seven others, who earn approximately 7-9 thousands a month for themselves and pay an equal amount to Hadapad. If he decides to quit working today, he can be assured of an income of not less than fifty thousand rupees a month! If I quit working today, I can continue to live on my pension, eating every alternate day. I would gladly trade my professional qualification, for Hadapad’s foresight and business sense. I told him so. His response was quick. “Please don’t say that sir, education is far more valuable than all these. I wish and pray to god at least one of my children will be a doctor like you”. We yearn for what we do not possess!

Saturday, February 14, 2009

Found this plaque on the external wall of our renovated post office building. We have seen thousands of such plaques all over the country, which, our politicians consider to be one of their trumpets and also, through which they try to make themselves immortal. Our leaders are always willing (very kindly) to grace each and every foundation stone laying or inauguration, be it a building, bridge, bus shelter or toilet, and leave behind a stone announcing their presence, for the benefit of posterity. In spite of their willingness and eagerness, there is a limit to the number of places at which they can be physically present and actually use their golden hands in our service. They have all the time and plenty of planes, cars and people to facilitate their movements but unfortunately have only one body. Hence some of the places may be deprived of the honour of having great names on the walls.
With this new technique, they can keep their only body in one place and use their golden minds to inspire thousands of people and proclaim their service to mankind in thousands and thousands more plaques. Renovated, repaired and repainted structures can also boast of a honoured name on their walls.
Disgusting though it is, the silver lining is that – if only they are content just to be omnipresent and omnipotent like god, causing inspirations, and proclaiming their work through the plaques, we will be spared of the expense and inconvenience of their physical presence!

i am sure that sri DVG had such people in mind when he wrote,

Neladinda moLake oDevaaga tamaTegaLilla
Phala maaguvandu tuttooridaniyilla
beLakaneeva surya chandraradondu saddilla
holi ninna tuTigaLanu – mankutimma

roughly meaning,

when the seed sprouts drums are not beaten

when the fruit ripens trumpets are not blown

sun and the moon illuminate the world -with out noise

shut your mouth

Thursday, February 5, 2009

bird photography

This bird sat there on the telephone cable, lost in it’s own thoughts. May be it was contemplating on some matter important for the birds. It did not bother about the two humans holding a black object in it’s direction and waving it up and down. My son had noticed it first and tried to get a photograph. He was grumbling that he had to zoom in to the full and that it is difficult to keep the camera steady and get a good picture. He said that we have to use a better camera or ask the bird to come closer, both of which were out of question. I told him what we need is a better hand which one can acquire only after meticulously drilling and shaping thousands of teeth. I snatched the camera and got not one but three pictures. A bird with out head, a head with out bird and a telephone cable with out both. By the time I tried to make my performance acceptable, by supporting my elbow on the balcony wall, the bird decided that a bit of action is better than lot of thoughts and flew away.

I looked in the camera and found that though my son was grumbling about the quality of the pictures, he did get a full bird and that there was no need of a ‘spot the bird contest’. So I decided to rob his picture and post it here. While looking through, I found that he had captured our banana raiders too. The Bulbul pair. Incidentally they have bettered their taste. They select just ripe fruits with a uniform yellow hue and never continue on the same fruit the next day. They are getting spoilt.

By the way, the green little bird is the ‘Small Green Bee Eater’ and the pair, ‘Red whiskered Bulbul’ mr&mrs.

Monday, February 2, 2009

Praanaayaama for toothache?

In the course of my work and since many people feel that I have some knowledge of medicine, I find quite a few of my patients, friends, relatives, and even casual acquaintances discussing about their ailments and treatments (other than dental) with me. I have known a number of them who, having lost their faith in the allopathic system of medicine, have tried alternate systems like the well known ayurveda- homoeopathy, or the present ‘yogic’ hits like sudarshankriya-kapalbhati etc. The more gullible amongst them reach up to the relatively lesser known methods like pranik healing, oilpulling, juice therapy, wheatgrass therapy, magneto therapy and whatnots. The ailments that they try to get rid off range from the ubiquitous diabetes-bloodpressure-asthama to arthritis, gastritis, sinusitis, spondylitis and hairfall to name a few. I have seen them embrace the chosen alternate system with a lot of hope and enthusiasm and follow the procedures religiously. I have expressed my wonder and delight while they have described the miracle of the system and have observed their euphoria on getting ‘cured’.
During my subsequent interactions, I have sensed a hint of skepticism creeping in - following the reappearance of the ailment, noticed the lack of enthusiasm in getting along with the healing system and have witnessed the disappointment and abandoning of the process in due course.

Earlier, we were heavily dependent up on the allopathic system to get frustrated with. Now we have a choice of other systems to get frustrated with. Human body is a very complex thing which no one has been able to understand completely. Add a mind to that and it gets ten times more difficult. As far as I am concerned I depend on a system which has been able to analys the structure and functioning of the body and the effects of the drugs to the maximum extent. AND I also practice kapaalabhaati!

My feeling is that SOME of these treatment methods MAY BE of SOME BENEFIT for CERTAIN TYPES of ailments IF practiced AS THEY SHOULD BE over a CONSIDERABLE time. I have neither the qualification nor experience to dwell up on these systems in detail and give a judgement, and so, I just watch these things with amusement. I am happy that my field is comparatively immune to the onslaught of these alternate systems. Till date I have not come across any of my patients trying out ayurveda, oilpulling or aromatherapy to get rid of a toothache, OR magnetotherapy to make a shaking tooth firm. But the home remedies like application of salt or clove to the tooth and packing the cavities with toothpaste or amritanjan abound. After bearing with the toothache and finishing all the remedies suggested by colleagues, friends, neighbours and co passengers, my patients end up with root canal treatment or extractions and have helped me survive.

Recently one of my senior colleagues experienced severe pain when he rinsed his mouth one morning and was flabbergasted and distressed to find a “very deep and probably pulp involved cavity in the right lower six” as he put it over the phone. ( a badly decayed lower grinder). He wanted me to attend to it immediately but it was a holiday for my clinic. He told me that the holiday is only for the clinic and not for the dentist and ordered me to go over to HIS clinic and attend to his cavity. It was difficult for me to work in a different set up and with out the equipment which I am used to, but I managed. He called me after three days to say that there is no improvement and so I requested him to come over to my clinic. I X- rayed the tooth and found that there was a bit of gap between the filling and the cavity wall. I told him that I would re do it, and since I was working with my equipment and with the aid of the x-ray and magnification, managed to do an effective filling. I took considerable time and care as I had to answer to his queries like,
“ have you removed ALL the carious dentine?”
“can you see the borders of the cavity clearly?”
“is the pulp clinically open?”
“have you covered the pulp completely with calcium hydroxide?” etc etc.
I did not hear anything from him for more than a week. So, I called him yesterday to enquire whether my treatment has been useful.
“Oh, Raghu, nice of you to have called. I am absolutely comfortable. There is no pain or sensitivity what so ever. I think it is going to be OK. It was good that I started doing praanaayama the same day. I am sure it has helped. Thanks anyway.”
My assiduous work of nearly an hour was kicked aside. Praanaayaama was the winner.
I had never thought that one of my own tribe would set fire to our profession.