Monthly Archives: November 2009

Winter Philosophy in Lavasa

We travel, initially, to lose ourselves; and we travel, next, to find ourselves. We travel to open our hearts and eyes and learn more about the world than our newspapers will accommodate. We travel to bring what little we can, in our ignorance and knowledge, to those parts of the globe whose riches are differently dispersed. And we travel, in essence, to become young fools again—to slow time down and get taken in, and fall in love once more.
-Pico Iyer

The age of the hill station mirrored the period when seaside resorts, spas and the great mountain lodges were built in Europe and the United States. In some case, the style and atmosphere of these European or American mountain retreats were consciously copied in the colonies. The Adirondacks influenced a planner of Baguio, in the Philippines for example. But in colonial Asia, the relatively high altitude hill station, usually at 5,000 to 8,000 feet above sea level, always had to be more than just a resort. The hill station was also a genteel fantasyland, a retreat from reality where the homesick colonial could be cosseted by the atmosphere of a European hometown, down to its familiar institutions: the club, the library, the village church. The hill station at its homiest was and is a phenomenon most often associated with the British in India, but the French, the Americans, and to some extent the Dutch also endowed them with similar properties. As Indians, we must now take pride in announcing to the world a completely made by Indians – Hill-station!
If you’re looking for an exotic winter vacation with clouds in your hair and memorable nature trails, Lavasa as a hill-station is hard to beat. Citrus Citrus has pulled together some ideas for adventurous types more interested in exploring the rain forests of Lavasa or the rappelling off Ekaant than hanging out in the shopping malls of cities such as Tokyo, Seoul, Hong Kong, or Singapore. Even so, the Lavasa resort selections offer all the amenities one finds in major urban centers. Here’s a sampling of what Lavasa has to offer this winter vacation season.
The best time of the year for water-sports activities is now! Lavasa is turning out to be the water-sports capital of the country – with personal water jets, speed-boats, pontoon boats, inflatable dinghies and a water-obstacle floating dock! Again the winter months will be the best time to see the almost-extinct fresh-water crabs & the fruit-bats of Lavasa. For the trekking enthusiasts, the nature trails are full of flowers & butterflies the next 4 months! For the adventurous types, go rappelling with the official adventure co of Lavasa – Z-bac! I can bet my last penny that someone who steps foot into Lavasa for the first time will skip a heart-beat! It is a mini-Switzerland in Maharashtra! Its not only tourism that is being promoted – the Lavasa Corporation is also supporting traditional crafts of the villagers around and the first cooperative for bamboo weaving is called Bamboosa!
By now all of us have heard (too often) the old Proust line about how the real voyage of discovery consists not in seeing new places but in seeing with new eyes. Yet one of the subtler beauties of travel is that it enables you to bring new eyes to the people you encounter. Thus even as holidays help you appreciate your own home more—not least by seeing it through a distant admirer’s eyes—they help you bring newly appreciative—distant—eyes to the places you visit. You can teach them what they have to celebrate as much as you celebrate what they have to teach. This, I think, is how tourism, which so obviously destroys cultures, can also resuscitate or revive them, how it has created new “traditional” handicraft outlets, and caused craftsmen in villages around Lavasa to pay new attention to their works. If the first thing we can bring the Indians is a real and balanced sense of what contemporary Lavasa is like, the second—and perhaps more important—thing we can bring them is a fresh and renewed sense of how special are the warmth and beauty of this town or hill-station, for those who can compare it with other places around the globe.
Thus travel spins us round in two ways at once: It shows us the sights and values and issues that we might ordinarily ignore; but it also, and more deeply, shows us all the parts of ourselves that might otherwise grow rusty. For in traveling to a new place, we inevitably travel to moods and states of mind and hidden inward passages that we’d otherwise seldom have cause to visit. The beauty of this whole process was best described, perhaps, before people even took to frequent flying, by George Santayana in his lapidary essay, “The Philosophy of Travel.” We “need sometimes,” the Harvard philosopher wrote, “to escape into open solitudes, into aimlessness, into the moral holiday of running some pure hazard, in order to sharpen the edge of life, to taste hardship, and to be compelled to work desperately for a moment at no matter what.”
Welcome to Lavasa!

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Student Braves Controversy, Refuses to Recite Pledge

“Liberty and justice for all?”

Will Phillips doesn’t believe that describes America for its gay and lesbian citizens. He’s a 10-year-old at West Fork Elementary School in Arkansas, about three hours east of Oklahoma City. Given his beliefs, he refused to recite the Pledge of Allegiance, specifically because that one phrase, “liberty and justice for all,” he says, does not truly apply to all.

That did not go over well with the substitute teacher in his fifth-grade classroom.

The Arkansas Times reports that he started refusing to say the pledge Mon., Oct. 5. By Thursday, the substitute was steamed. She told Will she knew his mother and grandmother and they would want him to recite the pledge.

Will told the Times the substitute got more and more upset. She raised her voice. By this point, Will told the newspaper, he started losing his cool too, adding: “After a few minutes, I said, ‘With all due respect ma’am, go jump off a bridge.'”

That got him sent to the principal’s office. The principal made him look up information about the flag and what it represents. Meanwhile, there was the inevitable call to his mother.

 

At first, mom Laura Phillips told the Times, the principal talked about Will telling a substitute to jump off a bridge. When pressed, the principal admitted the whole incident was sparked by the boy exercising his constitutional right not to recite the Pledge of Allegiance.

Phillips suggested an apology was in order — from the teacher. When the principal said that wasn’t necessary, Will’s mother started venting to friends via Twitter. Those friends, in turn, told the news media. And what would have been a minor classroom incident has people throughout Arkansas and beyond choosing sides.

As for Will, he continues to exercise his right to remain silent. It can be rough at times, he and his family admit. He has his share of supporters, however, his critics are louder and nastier — especially because he took his stand to defend gay rights.

“In the lunchroom and in the hallway, they’ve been making comments and doing pranks, calling me gay,” he told the Times. “It’s always the same people, walking up and calling me a gaywad.”

Nonetheless, Will told the paper, he is sticking to his convictions. A reporter for the paper asked Will — with all this talk about patriotism and the pledge — what he thinks it means to be an American.

“Freedom of speech,” he responded. “The freedom to disagree. That’s what I think pretty much being an American represents.”

His mother is proud.

“He’s probably more aware of the meaning of the pledge that a lot of adults,” Phillips told the Times.

Watch the CNN interview at http://us.cnn.com/video/?/video/us/2009/11/16/am.boy.no.pledge.cnn

by Tom Henderson (Subscribe to Tom Henderson’s posts)

 

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Cutting Edge in Gynecological Endoscopy – The MOGS Indo-Israeli Live Surgical Workshop & Conference

The MOGS Live Surgical Workshop on the Cutting Edge in Gyneacological Oncology was held on 14 November 2009. Cases were performed at the Tata Memorial Hospital, Parel and relayed live to the ITC Grand Grand Central, Parel, Mumbai. In the morning session, there was a demonstration on Radical hysterectomy for carcinoma cervix by Dr.Rajendra Kerkar.During the course of surgery he especially highlighted the nuances of surgical anatomy with respect to the pelvic vasculature and lymph nodes. This was followed by a demonstration of laparotomy for a large pelvic mass. It turned out to be large degenerating fibroid. This challenging case was skillfully dealt with by the invited Israeli onco-surgeons Dr.Jacob Korach and Prof.Gilad Ben-Baruch.

The next case demonstrated was that of groin node dissection for positive groin nodes in a case of Ca Vulva, which was operated upon by the invited onco-surgeons from Israel. There was healthy interaction between the faculty in the Operation Theatre and the chairpersons and audience at the ITC.

In the afternoon session, the Israeli team demonstrated two cases of laparotomy for ovarian masses. In the first case the performed a debulking/cytoreductive surgery for a cystic ovarian tumor. The procedure was carried out very smoothly and it was much appreciated

This was followed by a secondary cytoreductive procedure. Prof.Jacob Korach and Dr.Gilad Ben-Baruch demonstrated the technique of omentectomy and interacted with the audience about their approach, their surgical technique and their experience in Israel. The operation theatre at the Tata Memorial Hospital was coordinated by Dr Rajendra Kerkar. The sessions were chaired by Dr Belvi, Dr Sanjanwala and Dr Madhvi Pandya in the morning and Dr Reshma Rao and Dr Aparna Prabhu in the afternoon. The workshop was attended by over 100 delegates not only form Mumbai but also from all over the country.

The MOGS Conference on the Cutting Edge in Gynecological Oncology was held on the 15th November 2009 at the ITC Grand Central, Parel, Mumbai. There were 127 registrations for this event. There were 35 delegates from outside Mumbai attending the Conference.The opening session was an Invited Video Session. The faculty demonstrated a variety of open and laparoscopic techniques for the entire gamut of gynecological cancers. Dr Shailesh Puntambekar, one of the invited faculty from Pune, has been recently awarded the Golden Laparoscope Award from the AAGL. As a last minute request, he shared with the audience his award winning video on laparoscopic posterior exenteration.

The Conference was then officially inaugurated. Appreciation plaques were awarded to Dr Rajendra Badwe, Director, Tata Medical Center and Dr Rajendra Kerkar. The Israeli faculty members, Professor Gilad Ben-Baruch and Dr Jacob Korach were thanked for their efforts at the Workshop yesterday and for their visit to India. Dr Puntambekar was felicitated for his recent achievements.

The next session of invited lectures featured dilemmas in borderline tumors by Dr Anita Borges, a celebrated name in the field of cancer pathology. Dr Jacob Korach from Israel gave a balanced view on treating gynecological cancer in the geriatric patient. The concept of cytoreduction for ovarian cancers was expounded by Dr Hemant Tongaonkar.

Before lunch, Dr Amish Dalal conducted a well-planned and informative panel discussion on controversies in gynecological oncology. The panel comprised of surgeons (Dr Jacob Korach, Dr Amita Maheshwari and Dr Murad Lala), radiation oncologists (Dr V Kannan and Dr U Mahantshetty) and medical oncologists (Dr H Menon and Dr Kumar Prabhas). The discussion was fruitful and had -important take-home messages for the delegates.

After lunch, we opened up the newer vistas of minimal access surgery in gynecological oncology. Dr Neeta Warty dealt with the suspicious adnexal mass. Dr Puntambekar spoke about complications and the videos on the problems one can face were engrossing. Interestingly, most of the complications were treated laparoscopically as well. Dr Rajendra Kerkar gave a detailed account of minimal access surgery and future directions in gynecological cancers.The next session was a sponsored session on prevention of cervical cancer. Dr Ashwini Bhalerao Gandhi and Dr Bhaskar Pal from Kolkata spoke on this subject and this was followed by an audience interaction.

The last session was the Indo Israeli Keynote Address. Professor Gilad Ben-Baruch brought with him his immense experience on the subject of his interest, organ preservation and conservatism in gynecological oncology. His talk was peppered with case notes and personal insights which enthralled the audience.On the whole, the scientific content was of high quality. The program ran on schedule with adequate time for the audience to participate. The venue was well-appointed with a sumptuous lunch buffet. The hotel staff extended a great deal of co-operation to make the program a pleasure to attend and organize.

Organizing Secretaries: Sulbha Arora, Parikshit Tank, Rajendra Kerkar

Joint Organizing Secretaries: Rajendra Nagarkatti, Vipin Checker, SN Agrawal

President: Gautam Allahbadia

Secretary: Ashwini Bhalerao Gandhi

Report submitted by: Parikshit Tank

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Moving surrogacy law forward in the UK?

Of all the prospective parents conceiving through assisted reproduction, those in surrogacy arrangements often face the most difficult legal issues. The surrogate and usually also her husband will be treated as the child’s legal parents at birth, leaving the commissioning parents with no legal connection with their child whatsoever, even where both are the biological parents.

There is a special remedy available called a parental order. This is an order made by the family courts which reassigns parenthood after surrogacy, extinguishing the responsibility of the surrogate parents and transferring it to the commissioning couple. The process takes place post-birth: the application must be made within the first six months of the child’s life (though the surrogate’s consent is ineffective until after the first six weeks) and typically takes many months to be processed by the courts. At present, only married couples can apply, but as from 6 April 2010, unmarried and same sex couples will also be eligible.

The Department of Health (DH) is currently consulting on new draft regulations which prescribe the detail of this court process, and which will replace existing regulations that have been in place since 1994. The consultation closes on 23 November.

What is in the draft regulations?

Like the existing regulations, the proposed revised regulations apply provisions of adoption law to the parental order application process, setting out court procedure and giving a surrogate child broadly the same legal status as an adopted child. Adoption law has itself been overhauled substantially in recent years, and this is reflected in the wording of the new regulations. However, as part of the general updating, there are some important revisions being made to the existing parental order system which need to be looked at carefully.

For example, a court considering whether to grant an adoption order now has to first consider the ‘welfare checklist’, a prescriptive list of considerations which includes ascertaining the child’s wishes and feelings and considering his or her relationship with the birth family. The new parental order regulations incorporate this checklist into the parental order process. However, it does not seem appropriate for the court to have to address all these issues in surrogacy cases, given that the child will inevitably be less than six months old, and will be already living with the applicants (at least one of whom is his or her biological parent).

Importing the new adoption law without amendment fails to adequately take account of the special nature of surrogacy arrangements, and there may be a risk that this could make the process of applying for a parental order even more onerous than before. While a parental order is similar to an adoption order (in the sense that it transfers legal parenthood from one person to another), surrogacy is very different from adoption. Because a surrogate child (or at least those to which parental orders can apply) is biologically connected to at least one of the commissioning parents and is almost invariably in their care from birth, the dynamic of the family is perhaps closer to donor conception than to adoption. Adapting adoption law is therefore a difficult task, and one which we think could be handled more carefully by the regulations.

The parental order system

Even though a more fundamental review may not be within the power of these regulations, it seems impossible to look at any legislation relating to parental orders without making the point that the whole system is problematic. Parental orders were introduced as a late amendment to the Human Fertilisation and Embryology Act 1990 in response to a specific surrogacy case. At the time, surrogacy was viewed as very rare and something which occurred largely on the fringes of the law and ethical acceptability. The 1990 rules on legal parenthood clearly prioritised donor conception (making the carrying mother the legal mother, and her husband the legal father), and parental orders were designed as a limited remedy – a ‘sticking plaster’ – in respect of the awkward application of legal parenthood rules in surrogacy situations.

As all those working in this field know, things have changed radically since then. Surrogacy as a form of fertility treatment has blossomed, both in the UK and abroad, and no longer affects just a small number of altruistic inter-family arrangements. Indeed, the Human Fertilisation and Embryology Act 2008 itself has endorsed this, by legalising non-profit making surrogacy agencies like Surrogacy UK and COTS and extending the categories of couples eligible to apply for parental orders. We are also seeing growing numbers of fertility patients travelling abroad for surrogacy, which brings even more complex legal challenges.

The current system, which came about by historical accident rather than a concerted policy decision, fails to meet this increased demand, and is inadequate from almost every perspective. The surrogate and her husband (who, in the vast majority of cases do wish to surrender the child) remain legally and financially responsible for the child for up to a year after the birth, and may have no legal redress against intended parents who refuse to assume responsibility. The intended parents often have no status in respect of their child for many months, including no right to make decisions or to consent to immunisations, no right to transmit inheritance or citizenship rights automatically and the intending mother has no rights to maternity leave (though this is the subject of another current campaign), leaving children very vulnerable during the early months of their lives.

The system is not an effective guardian of public policy against commercial surrogacy, since the check on payments comes at the end the process (by which time any payments have already been made) and the only sanction available to the court is a refusal to grant an order, which is almost impossible to enforce since this would prejudice the welfare of a newborn child. And, most importantly of all, these problems mean that surrogate children lack even basic protection. The problems are highlighted most starkly in foreign surrogacy cases. For example, in the landmark case of Re X and Y (foreign surrogacy) [2008], the law left surrogate twins born abroad to a British couple stateless and parentless. Such children risk being abandoned to foreign state care in the absence of complex and expensive legal intervention – surely this is an outcome which the law has an obligation to avoid at all costs.

We need a better and more planned approach to surrogacy. Of course, there are difficult and sensitive issues to be handled in creating new law. Surrogacy arrangements are among the most ethically and humanly complex in assisted reproduction, with three or even four adults involved throughout the process of conception, pregnancy and birth, and possibly third party gamete donors as well. The respective interests, protection and independence from exploitation of all these adults and, most importantly, the resulting child, need to be adequately balanced and protected by the law.
It is disappointing that such issues were not properly addressed during the government’s overhaul of assisted reproduction law last year. Although the Minister indicated that surrogacy was a sensitive issue which would be looked at separately, no firm commitment for this review, or a date, has yet been set – and it seems, given the current ‘status’ of surrogacy – odd to continue treating it separately. In order to ensure that our law can cope with the demands of modern surrogacy practice, and to ensure that vulnerable children are protected, we urge the government to take a fresh look, not only at the regulations, but at the law itself.

By Natalie Gamble and Louisa Ghevaert
Partners with specialist fertility law firm Gamble and Ghevaert LLP

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The MOGS-FPAI Avabai Wadia Indo-Israeli Workshop & Conference on Contraception

The MOGS FPAI Dr Avabai Wadia Memorial Workshop on Contraception was held on 26 September 2009. Cases were conducted at the Lokmanya Tilak Municipal General Hospital, Sion and relayed live to the Regus Convention Center, Bandra Kurla Complex, Mumbai.

The Workshop was held in two sessions. In the morning session, there was a demonstration on puerperal tubal ligation. Two different techniques of tubal ligation were shown – the Pomeroy’s and Madlener’s techniques – on either tube. This was followed by a demonstration of a laparoscopic tubal ligation. Special attention was paid to safe entry techniques in laparoscopy and instrumentation in terms of the band applicator. These surgical procedures were demonstrated by Dr Y S Nandanwar and Dr V R Ambiye.
This was followed by the Inauguration of the Workshop. The Workshop was Inaugurated by Dr Sandhya Kamat, Dean, Lokmanya Tilak Municipal General Hospital and the Chief Guest was Dr Asha Advani, Officer on Special Duty, Department of Family Planning, Municipal Corporation of Greater Mumbai.
In the afternoon session, Dr Nandanwar and Dr Ganpat Shinde demonstrated puerperal sterilization by Wood’s technique – a technique which has the maximum chances of successful recanalization. Kroener’s fimbriectomy procedure was shown in another case. Dr Asha Advani demonstrated Non Scalpel Vasectomy under local anesthesia. She also gave a lucid account of the rules and regulations around taking consent for sterilization and the correct forms to be used for this purpose. Dr R P Soonawala demonstrated the insertion of the Levonorgestrel intrauterine system with practical tips on making the procedure easy and comfortable. History of sorts was created at this Workshop with the first ever demonstration of the Essure device in the country. The Essure device for hysteroscopic sterilization was demonstrated by Dr Asher Shushan, one of the Israeli faculty members. The procedure was carried out very smoothly and it was much appreciated.

There was healthy interaction between the faculty in the Operation Theatre and the chairpersons and audience at the Convention Center. The operation theatre was coordinated by Dr Niranjan Chavan and Dr Shailesh Kore. The sessions were chaired by Dr V D Patkar, Dr Mukesh Gupta and Dr Abha Bhat in the morning and Dr Asha Dalal and Dr Vipin Checker in the afternoon. The organizing secretaries were Dr Sulbha Arora, Dr Raju Nagarkatti, Dr Vipin Checker and Dr Parikshit Tank.

The MOGS – FPAI Avabai Wadia Conference on Contraception was held on the 27th of September 2009 at ITC Grand Central, Parel. There were 100 delegates for this event including 12 postgraduate students. The Israeli Faculty included Dr Asher Shushan and Dr Motti Hallak. Dr Gautam Allahbadia, MOGS President welcomed the Israeli Faculty, the MOGS members and delegates from all over India. The national anthems of both the countries ie India and Israel were played to commemorate the MOGS Indo-Israeli year of Academic Exchange. Dr Usha Krishna, President FPAI and Dr Anjali Sen, Regional Director International Planned Parenthood Federation, addressed the audience. The program began with the Avabai Wadia Video Film Festival on Reproductive Health Technologies, where 8-minute videos were presented on Tubal Ligation and its reversal, Vasectomy and its reversal, Manual Vacuum Aspiration and Hysteroscopic Permanent Sterilization. This was followed by a Panel Discussion on Repositioning Family Planning Leading to Population Stabilization. The panel was expertly moderated by Dr Usha Krishna. The panelists included the Israeli Faculty as well as renowned doctors & family planning practitioners from India. The Indian Demographic scenario, the role of the Government & NGOs, factors having positive & negative influence, and advantages / disadvantages of the available methods were discussed. The Avabai Wadia Memorial Oration was delivered by Prof RP Soonawala on The Indian Contraception Story: Lessons Learnt and Future Challenges. The wonderful talk outlining the evolution of contraception over the last 3000 years with fascinating stories and personal experiences was enjoyed by all. Post Lunch we had four sessions of Invited Lectures on four different aspects of Family Planning. The Hormonal Contraception Session was sponsored by Wyeth, and covered lectures on Low Dose Oral Contraception, Modern Trends in Contraception and Injectable Contraception. The MTP Session included Medical Methods, Implications and Amendments of the MTP Act and Emerging Trends in Second Trimester MTP. The session on Surgical Approach covered the areas of Non Scalpel Vasectomy, Trials & Tribulations of Female Sterilization and Hysteroscopic Sterilization. Lastly we had a session on Contraception in Special Groups such as Adolescents, the HIV Positive and women with Medical Disorders. The day concluded with the MOGS Dr Bhanuben Mahendra Nanavati Golden Jubilee Oration, which was delivered by Prof Suneeta Mittal from New Delhi on Contraception Acceptance: Gaps and Promises. This excellent oration was founded on years of experience, data, images and personal insights. The tireless efforts of the Organizing Committee ensured that the conference was a success in all aspects – the acquisition of knowledge, free exchange of ideas with audience interaction and experts’ opinion on all aspects of family planning.

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