Saturday, 26 December 2009

What ails health care delivery in India? Part 1- The infrastructure

Aaditya has shot off another angry email to the health minister…knowing fully well that just like the last time, this one would most likely be ignored too. Both times he actually put in an enormous amount of research, expertise and perspective - formulating clear plans and suggesting ways and means to remedy the particular problems he’s been perturbed about. These weren’t a means to rant at the establishment. I suspect the powers that be lost no time in brushing his emails off to the trash bin in one clean sweep without so much as a curious glance. At least that seems the most likely scenario as he has never heard back.
It’s true that the Indian healthcare system inspires dread and frustration in a by and large susceptible population struggling with every bend and curve of the system, unable to find any alternative. Some of the obscene statistics that have now become the hallmark of Indian healthcare system around the globe include the 900,000 Indians that die every year from drinking contaminated water and the more gruesome “5.6 million child deaths” in India every year, making up more than half of the world’s total. In the age of ‘India shining’ and words such as ‘corporate superpower’ being bandied about, this almost seems like an anachronism, doesn’t it? I won’t harp on about more of these ‘numbers’ as generations have sat on these statistics with nothing changing except the hospital walls which now look more beige than red, with successive generations of patients, their relatives and ward boys having spat that ubiquitous ‘paan ki peek’ that is as much a part of the hospital as the flies that buzz above.

As with everything else, Indians of a few thousand years ago seem to have been a lot more proficient and systematic at managing health care problems as well. We all cram lessons in school about Charaka, the ancient physician and Sushruta, the ancient surgeon who were both pioneers in their respective fields. Even before their time, there is some evidence that Agnivesh wrote an encyclopedic treatise under the guidance of the ancient physician Atreya in the eighth century BC. There is some evidence that Emperor Ashoka Maurya (third century BC) was the first leader in world history to attempt to give health care to all of his citizens. Thus it was the India of antiquity which was the first state to give its citizens national health care.

What seems to have gone wrong? The modern Indian system of health care is loosely based on the tiered British system, the National Health Service or NHS. We have Primary health care centres at village/small town levels and district hospitals/referral centres at the district or city level to manage the greater numbers in the city and more complicated problems referred from the PHC’s. But here the similarity ends. The PHC’s, though ideally suited to the needs of a country like India, are hardly functional. In actual effect, the system works with major input from the private sector through corporate hospitals and what are called ‘polyclinics’ where money making takes precedence over all else. The ‘sarkari haspatal’ experience is nothing short of purgatory for most of its users.

The system as it works in the UK (and yes, they have had their own share of problems with a fully state funded system of health care recently) caters to ALL citizens irrespective of their paying capacity. From the most basic level of preventative care to highest level of surgical /interventional care, everything is offered free of cost. This is what the planners in India envisaged. Except that they forgot to make provision for the basic needs of such a system. In India, health care comes under the remit of state Governments with central government providing overall direction and recognizing areas of impetus through the five year plans. The Seventh Five-Year Plan (FY 1985-89) budgeted Rs 33.9 billion for health, an amount roughly double the outlay of the sixth plan. However, the catch is that health spending as a portion of total plan outlays, had declined over the years since the first plan in 1951, from a high of 3.3% of the total plan spending in FY 1951-55 to 1.9% of the total for the seventh plan.

But financial resourcing is only part of the problem. Health care professionals – their attitudes, ethics and respect for self and profession seem to be the major players in what ails this system. In 2005 the World Bank conducted a study and reported that "a detailed survey of the knowledge of medical practitioners for treating five common conditions in Delhi found that the average doctor in a public primary health center has around a 50-50 chance of recommending a harmful treatment". This is the more shameful aspect of how a country of over one billion and a so called emerging economic superpower manages the health of the nation. Note the setting here- the public primary health center. Something about that rankles. It’s as if the country’s polity has decided that the poor/lower middle class Indian can make do with second grade health care. How else do you explain the fetid, non-resourced environs of a primary health care center? A rickety chair and desk, plaster falling off walls, no medical equipment to speak of and no support system in place should a difficulty arise. So by logical extension, the only people you find populating these centres are ones who would rather be elsewhere but find themselves unable to.

The disparity between how core services such as health and education are delivered by the public sector and how things work in the economic/commercial hubs of the nation couldn’t be any wider. There has been a complete failure to integrate health with wider social and economic development. While money flows in certain sectors, health and education end up being the ‘poorer cousin.’ The attitude at the top is that of indifference and apathy. Obviously, people have been dying of poor health for decades and no political party has ever lost an election on this issue. So why bother? And here is where the story of downfall begins for a medical professional. A healthy and motivated workforce only exists where adequate support is available at the top. As with people in the financial sector, give these people proper working conditions, make resources available to them and they would work. At least a majority would.

The lowest rung of health care in the UK starts with the GP’s or General Practitioners, who also happen to be some of the best paid health professionals. They have a planned system of referral to the secondary level and a thoroughly self sufficient setup to cater to all health problems that can be managed at primary level. They work with immense pride in what they do and society recognizes them as the key player in improving community health. There is never any question of their being treated as inferior to a doctor in a tertiary hospital. The GP’s have support from well trained nursing and paramedical staff and work with a team rather than in isolation. They have an electronic medical records system and access to national guidelines and protocols for management of the plethora of non-serious conditions that they manage in the community. Above all, they are trained from an early stage to be ‘family physicians’ and are not therefore people who could not be specialists settling in for the compromise of general practice.

And that is precisely what we lack. An adequately paid ‘primary’ workforce that has access to at least basic infrastructure. No one is asking for an interventional radiologist at every PHC but basic medicines, syringes, gloves, antiseptics, wound dressing, local anesthetic in adequate quantities is elementary. Nobody can ever know all about all aspects of medicine and its futile to expect this from our overworked and underpaid band of community medics. In a country like India where roughly 700 million people have no access to specialist care, it is astonishing that there is no recognized training programme in community medicine! So what the world bank report failed to highlight perhaps was that these people who they found lacking in knowledge, were functioning not only without guidelines/protocols, knowledge resources and infrastructure to upgrade their learning but also without any semblance of training for the job they were expected to do. They carry out a job that no one else seems to want to do and morale, motivation, job satisfaction and pride in what they do is nonexistent. They need to be appreciated and recognized, not treated like second rate citizens in the medical fraternity.

Just about a quarter of a million trained doctors come out annually in our country and yet there is a perpetual shortage of medical staff in rural areas. The Government tried a policy of enforcing rural postings but why not invest in rural healthcare instead? If these doctors had a viable career option in the form of rural practice, why would they struggle in the cut throat competition in surplus areas?

While no one would dispute the fact that India has its own set of unique problems and no foreign model can be superimposed on it, the obvious lack of interest in improving grass root level healthcare is a disgrace. While we brag about an ever expanding ‘medical tourism’ industry and healthcare is set to become a $150 billion industry by 2017, this seems like a hollow victory in the absence of any sign of improvement in the health of those that need it most. It’s a slap in the faces of policymakers that less than 40% births in the country are attended by trained birth attendants and maternal mortality still sits at the same level as 60yrs ago. To get a sense of just how far behind we are from the rest of the world , maternal mortality rate i.e. a mother dying in childbirth, which is arguably the most sensitive index of the health of a nation, was still sitting at about 450/100,000 live births compared to about 14/100,000 in the UK. That is a staggering difference. What’s more poignant is that about 800,000 women each year die of the most easily preventable causes possible- anemia, infection and haemorrhage. If Mumtaz Mahal died of haemorrhage after childbirth in the 1600’s, more than three hundred years later, one of our most prominent and promising actresses of recent times, Smita Patil, dies of the same in 1986, telling us that nothing had changed in the interim. It requires the simplest measures to prevent so many unnecessary deaths each year- deaths that leave fragmented families and the spectre of infants without their mothers. We’re perpetually in a race to be as advanced as the developed countries of the west. Why then has no initiative been shown to be at par with these countries in terms of the most basic human necessity- efficient healthcare? The answer lies perhaps in freeing healthcare from corrupt political influence and putting people who really know, in charge of the system. Maybe then we’d be able to make a start towards becoming a healthy nation, which I presume comes before ‘superpower’ nation.

Friday, 11 December 2009

The other side of the story

Rohit’s uncle who lives in Bhopal has two very bright, chirpy, extremely lovable kids, 9 and 14 each. Of late we’ve noticed that they have acquired the look of mini sumo wrestlers, which to me isn’t a particularly good look if you can help it. So Rohit mentioned this to his Uncle one day. And got an incredulous look that translated in to ‘you’re either bonkers or under the influence of a cocktail of unmentionables.’ Followed by a retort “arrey khaate peete ghar ke hain to pata bhi to chalna chahiye.”

I live in a country (Scotland) which is second only to the US in terms of the number of Obese. The Americans have been the most obese in the world now for some years. It has been estimated that one out of every four Americans is now frankly obese as opposed to just being overweight – defined as having a body mass index of more than 30. (Body mass index is calculated as the body weight in kilograms divided by the height squared. So, it’s a true measure of how much weight there is in relation to height, in other words, body surface area. So, a shorter person will hit the high BMI mark of 30 with a lot less weight than a taller person.) Looks like the trend is catching up in India faster than anyone imagined.

One of the scariest adverts for me of recent times has been this:
“McDonald's India: As Indian as you and me……..”

This euphemistically worded ad conceals in it, a very deep intent to penetrate the Indian market and inundate it with what has been the undoing of health aspirations of a generation of Americans and more recently Brits. And looks like our folk have lapped it up like there’s no tomorrow. It used to be said that things that were happening in America reached India maybe with an 8-10 year lag. Now of course this gap is a lot shorter and in the case of practices with a serious potential for self harm, this seems to be instant. So upper class Indians have rushed into the race to be ‘fat and merry’. Even more alarming is the trend in children. In the UK, around 27 per cent of children are now overweight and research suggests the main problem is a continual reduction in the amount of exercise children take. Many overweight children have overweight parents - it's often a matter of family lifestyles. Obesity in the UK is now normal in society and someone with a bodyweight within the recommended range, stands out. How much longer before we start to boast of similar statistics? In adults, obesity causes increased risk of cardiovascular events, diabetes, arthritis and so on. The same risks are now beginning to emerge in children. Obesity increases the risk of insulin resistance and type 2 diabetes which is normally a disease seen in later life in adults. However, increasingly children in their teens are presenting with type 2 diabetes as a consequence of being obese. Young girls run the risk of Polycystic Ovarian Syndrome (PCOS) with long term sequelae of cardiac disease, diabetes and even cancer of the womb. Obesity in fact has moved on from being a ‘pre-disposing’ factor to certain health conditions to actually being part of a spectrum of diseases.

Indians when they emigrate to other countries, take their genetic risk, something called syndrome X which is commoner in South Asian populations, with them. They then adapt to the lifestyles and food habits in these countries and are consequently at even greater risk than the indigenous population. In the UK, an organisation called South Asian Health Foundation (SAHF) is working towards spreading awareness of these issues.

It’s a question of changing the outlook to health. Being a little chubby should no longer be seen as a matter of pride or a mark of affluence. On the other hand I am not for one instant suggesting that we should all join the size zero cult. That has problems of its own. In the UK, obsession with size zero has long been the bane of life for every impressionable teenage girl. Of late, there has been a counter offensive of sorts with a new pageant for plus size women. (

While it may just be a backlash against an unholy trend for unnaturally thin women’s bodies, the implications of this sort of ‘glorification’ of what’s essentially a health problem, are grave. It sends the wrong signal to women struggling with their body image. It seems teenage girls are no longer at risk of falling a victim to the epidemic of anorexia –but of obesity. It promotes a culture of overeating and not exercising as these are now considered ‘okay.’ Try telling these girls that in ten years time they would be in and out of hospitals with diabetes or angina and that might be a more realistic picture, albeit one that is bound to raise the hackles of a number of these proponents of ‘curvy’ figures. This is just political correctness gone crazy. In fact it got so bad at one point that a colleague was cautioned by the management when a patient complained about being ‘made to feel guilty’. The doctor in question, who is an obstetrician, had given the woman a fact sheet about the precise number of complications that increase in an obese woman in pregnancy…all substantiated by well validated studies. It is a crime if you so much as hint about losing weight, in order to minimise so many health complications. Of late, the trick I use is to pass on the counselling bit to my nurse who at a ‘plump’ 83 kgs, is seen by a lot of people as ‘one of them’ and is therefore not as unacceptable as me.

While I completely accept that someone who as a result of a medical condition cannot lose weight (women with PCOS, for example need a lot of extra support to shed those extra pounds) should not be blamed for the resulting health conditions, I can absolutely not believe that 30-40 percent of a nations population is destined to be obese and unhealthy and can do nothing about it. People need to take more responsibility for their own health. And this does not necessarily mean having a blame culture in healthcare, which is what many suppose this is all about

Wednesday, 9 December 2009

Bolly Saga: The Case Of The Missing Brain

As I sat watching the very somber moments in the movie Paa, I could hear a couple of sobs around me in the theatre. The atmosphere was generally muted, fraught with sympathy with the protagonist in the movie (namely AB). And then, out of the blue, a chuckle escaped me…attracting a few angry glances. I said a sheepish ‘sorry’ and sank into my seat.

Right then! Granted there has been a massive improvement in the quality of movies doled out by bollywood in the last few years. But one thing that has remained consistent is the misplaced ideology surrounding how medical problems should be depicted. Giving rise to several very humorous moments. The precise scene in Paa that caused me to lose the emotional flow of the movie is when Auro is in a hospital and suddenly becomes quite agitated. The doctor rushes in, puts a stethoscope to his chest and exclaims- he’s had a stroke! As to how he reached that conclusion is completely beyond me….no one else has ever been able to do it, even after spending a lifetime in stroke research!

On the way back, another scene came to mind, from the recent release, Kurbaan. Now, I did enjoy the movie and in many ways, the subject treatment was above average. But remember the bit where Saif comes back after being hit by a bullet in a major police encounter? So, here’s the diminutive Ms Kapoor, at his side with a first aid box, hands trembling. Which is all very well. But then, she has a go…. and….hold your breath…gouges the bullet out with eyebrow tweezers! Which of course was very considerately, floating just beneath the skin. She then stitches the impeccable wound with hand held suture (which I presume must be part of every first aid kit in the US just for such an event). And post surgery, everything is instantly well..and the macho Khan goes back to doing his fight sequences..come on guys! I don’t expect you to put in hours researching trauma management, but at least something believable would be good. You don’t have to be remotely connected to medicine to appreciate that you’re being taken for a ride here…a little bit of common sense will do.

Anyway, I’m sure nothing in these movies will ever compare to our classic gems of yesteryears. One scene that instantly comes to mind, and I’m sure every bollywood fanatic will remember this, is from that mother of all blockbusters, Amar Akbar Anthony. Fabulous movie, bollywood drama at its epitome, immensely enjoyable. But then Nirupa Roy gets hit by a car, lands in a hospital where the gorgeous Nitu Singh is sitting at a desk pondering over cosmic events, while her bleeding patient lies in a bed next doors. The even more gorgeous (I always thought that, looking at this pair) Rishi Kapoor comes in for a casual chat, and she says ‘arrey, tumhara blood bhi to wo negative wala hai na?’ and straps him to a charpoy with a needle stuck to his arm. And then the wonder of all wonders happens……three people simultaneously strapped to giving sets, a common line leading to a bottle, and the collective blood being transfused into a, growing pinker every minute, NR. Of course, the other two people happen to be the other two lost sons…hilarious stuff. I can picture some poor hematologist throwing a major convulsion watching this….But then bollywood wouldn’t be the same without some melodrama, tears, lost and found and major medical mishaps.

We’ve seen countless number of movies with identical twins, making you wonder if some extra-terrestrial intervention had caused the rate of identical twinning to suddenly jump up in India by a thousand percent? And then there are scores of movies with the sequence – hit his head, got amnesia, hit it again, got his memory back….Lovely! Or what about the ones where the old woman would lose her eyesight at some point in the movie, and in the climax squeal with delight – ‘beta, mujhe sab kuchh nazar aa raha hai…’ super lovely!

But, do you know which is the unanimous winner, and by a wide margin too? Its got to be Clerk….now I’d forgive you all for a collective case of amnesia on this….it happens to be the most eminently forgettable movie of the last few decades…but a real gem if you consider the entertainment value.

And you’ve got to watch this clip I found on youtube (where else!):

Pitaji having a heart attack, greedy doctor refuses to come. So what do we do? Play patriotic songs of course. And lo and behold, Pitaji starts to stomp around throwing his arms around for special effect. Priceless! It defies not only medical science but common sense, sanity and all those tiny slivers of art and aesthetics that may have escaped unharmed in the rest of the movie.

All said and done, I remain a devout fan of bollywood. There is something quite endearing, even in the most naively shot sequences, something that appeals to the heart, provides an outlet for emotional outburst, lets us all cry and laugh at the same time and brings a touch of hilarity in otherwise glum surroundings. Long live bollywood.

(BTW, you are all welcome to add your own favourite to the list.)

Tuesday, 8 December 2009

Saving the 'Feriwala'

The last trip to India left me slightly troubled and until recently I had no idea what it was that was bothering me. Until that discussion at Manisha and Taral’s place which somehow meandered into the reasons for going back home. “As it is, you find all the high end shops there nowadays and huge shopping malls too…there is no brand that you won’t find in India now”. Manisha was speaking, as usual, at the top of her voice. And then it struck me….India had started looking too much like the west. The same things that you tire of here- shopping malls, restaurants, multiplexes all looking the same, showing off the same merchandise in every city/town, row after row of the same names…..topshop, newlook, warehouse, oasis and so on. In fact if you were to transplant the high street from one city into another, I doubt people will even notice.

My memories of shopping back home invariably drift to the little shops selling everything from cosmetics to jewellery, the tiny shops with shelf after shelf of garments and dress material which offered free alteration services – yeah, try asking for the price of alteration in one of the UK shops, it might just turn out to be more than what you’ve paid for the dress…but that’s beside the point.

As a kid, I’ve seen my mum buy fresh vegetables from the ‘thele wala’ who’d come to the door and implore ‘lauki, kaddoo, tamatar le lo….’ until either my mum or the kam wali bai opened the door and told him off for being too loud. But this would always result in some purchase being made, even if just a stack of coriander or a bunch of chillies. Organic vegetables, delivered to your doorstep, without the hefty premium on being ‘organic’…

Then again there were these numerous ‘feri wala’ guys who brought merchandise from far and wide- Kashmiri shawls, Saris from Orissa, jewellery from Rajasthan and went from one doorstep to another. A different world altogether. And the social side of all this is rarely appreciated….my mum would call on her friends who’d all come over for an afternoon of chit chat, purchasing and cups of tea. In my heavily blockaded and compartmentalised world, these memories seem to belong in some distant past. And one of the reasons is that our society, in a bid to copy everything western, has turned its back to these quaint little rituals and these people who now themselves seem to be an anachronism .

In the last few years we’ve seen corporate giants like Tesco and Marks and Spencer make a bid for the Indian market which of course is quite a lucrative thing to do, given the size of the Indian consumer-force. The sad bit though is that these peculiar, curious shops each selling something different and original will all be replaced by giant stores all selling factory produced goods that we are so sick of seeing everywhere. Jai Ho!

Tuesday, 24 November 2009

'Going Rogue'

Power corrupts and absolute power corrupts absolutely……….these words ring true of not only the entire socio political setup of this world that we live in but also of things on a much smaller stage…everyday living and issues surrounding who rules who?

It would be an interesting experiment to give power in the hands of the downtrodden of today….the ones who curse the system and wish politicians dead. Would they then establish a just world order or fall prey to the very temptations and machinations they abhor today??

Would this then answer the quintessential question? Chicken or egg? What came first?
Is it the wrong kind of people who go into politics, accumulate wealth and become powerful and then perpetrate the hideous culture that has become the hallmark of politics across the globe?
Or is it normal people …people like you and me, but maybe with a dash more of ambition thrown in, who get into politics, wake up to the immense thrill and kick that power gives and then start on the journey of corruption to maintain that power ?

Two old political scandals, or shall I say mishaps, have returned to the fore in the public arena this week. They belong in two different continents but the undertones are similar….
As the Chilcot enquiry begins its work to look into the legality of the war in Iraq, the most palpable sentiment around is hatred for Blair. Yet this is a man who could do no wrong a few years ago. A darling of the masses, twice elected to power, with a huge halo round his head and the glow of his charismatic personality radiating far and wide.

Did Tony Blair start off as a well meaning Prime Minister who seriously wanted to do the right thing, defend democracy around the world and establish a just world order? Few believe this today but in the heydays of Labour supremacy in Britain, he did have people enthralled by his sharp oratory and the look of earnestness about him. Did he start off as a smarmy, sly man or was it years in politics that made him cynical to the extent that many now are ready to believe he took the country into an illegal war? How cynical do you have to be to do something you know will cause immeasurable death and destruction, reduce an entire nation to a rubble and ruin the lives of generations to come?

Opponents of the war hope the inquiry will establish that the decision to invade Iraq was illegal and based on flawed or deliberately misleading intelligence about the risks posed by Saddam Hussein. Whatever else the enquiry achieves, simply by being in the news the past few months, it has played a major role in Blair losing out in the race to be EU President.

The other case in point is our very own L K Advani. In a dramatic turn of events, -the Liberhan commission report, which was 17 years in the making, was tabled after details of its conclusions – apparently implicating top leaders of the Hindu nationalist opposition in the Babri masjid destruction – were leaked on monday, triggering uproar in the lower house. Personally, I have always found it extremely difficult to digest that Advani and co had at any point acted out of ‘Ram bhakti’. It never was a campaign of moral outrage against historical acts of vandalism or a campaign to reignite religious sentiments in the hearts of the non believers. It always was a cynical political act directed towards exploiting the extreme naivety of the electorate, wasn’t it? Yet at the time, even the intelligentsia was divided about whether to celebrate or lament their growing influence.

Who knows if these two men started out believing in a just cause and simply ‘went rogue’. (Ha ha….could not keep our darling Ms Palin put of this…). Time will tell.

Wednesday, 18 November 2009

The (Sur)real world of Indian television.

Have any of you recently tried to watch the soap operas telecast on Indian television channels ? If so, you will probably have complete empathy and sympathy with me and understand why I’m still tortured by the memories of what happened.

Here’s what happened: We’d driven off to London for the weekend (on one of our-‘let’s just drive off somewhere’whims). I have to say the weekend went by very well – we managed to catch ‘We will rock you- the musical’ and had some fabtastic Indian food which is always the attraction on a trip to London (God bless the Gujjus).

Then on the way back, we decided to stop by at one of Rohit’s old friends, Neha. Now it so happens that Neha is not just a devout fan of Indian TV soaps but in fact eats, talks and breathes television.

So she told us of this exciting new reality(?) show which has a bunch of guys staying together (No, don’t let your imagination run wild- that just does not happen on Indian television, yet!), a bunch of girls staying next doors with their mothers (the guys’ mothers, silly) and they are supposed to assess each others’ compatibility- the guys and girls with each other and the girls with their prospective mothers in law.

Needless to say there was a lot of bitching, sobbing, outrageous statements a la Big Brother (or is it Big Boss?) and generally everyone seemed to be terribly stressed about coming out of the TV show, having made a lifelong commitment or found their soul mates. Watching it, we went through a complete whirlwind of emotions in rapid succession - disbelief, amusement, puzzlement, frustration, and then downright rage… Rage at the way producers of these shows take the Indian audience to be made up of part cretins and part masochists. There is this complete dumbing down of TV shows and the audiences don’t know to expect any better.

What’s particularly frustrating is the portrayal of female characters: if she’s not running a corporate powerhouse in a sexy mini, she must be a stay at home bahu, indulging in politics of the most complex nature (Move over Mayavati and Rabri, the Indian Bahu is soon going to overtake you), all the time bedecked in tons of jewellery with, of course, a pallu over her head. She wakes up in the morning with more jewellery than most of us manage to wear in a lifetime.

We thought we’d had enough when she insisted there was this other reality show (!!!!) featuring the newly engaged Rakhi Sawant and her partner showing their parenting skills….with other people’s children! Seems the idea is to have celebrity couples staying in a swanky Goa resort with successively older children every week, starting with toddlers. To judge what? How these smooth actors and actresses cope with the stress of being around other peoples’ kids for a few weeks?

I would not even like to venture into what the repercussions could be of one of these ‘celebrity’ parents abusing their proximity with other peoples’ children (Yes, despite 24 hr camera surveillance). What kind of parent leaves his/her child with some fake TV parent to have a showdown on national television?

Tell you what, one good thing to come out of the ordeal was that it reaffirmed our views that we do not need television for entertainment. Looks like the news is all I can watch anyway…as long as its not Star News reporters screaming down my throat, that is!

(P.S.- Interestingly my spell check suggested changing Mayavati to Amravati (didn’t know that was part of MS word repertoire) and Rabri to Rabbi (If only!)

Friday, 6 November 2009

Nick Griffin on BBC question time

Didnt watch the actual program but saw the video clips a couple of days later. (available on youtube, above).
Somehow, just came out with this acute sense of anticlimax. I had rather imagined Nick Griffin to at least know, well read, erudite in his specialised field(!) and a good orator. Whereas he just came across as wishy washy, evasive and in places I simply felt aghast at his assumption that he could come to a national platform, expecting people to believe in his statements simply by sharing patronising smiles and nodding his head. I couldnt decide whether he is supremely stupid or attempting to be supremely smart. In any case, anyone who may have harboured delusions of sympathy for any one of his poilicies, I'm sure switched off his/her television thoroughly disillusioned. So in that sense, we all ought to congratulate the BBC for airing this. All the half baked truths about his party's policy that seemed attractive to some people (they nust have been, for his party to have won seats in an election) were unsheathed for what they were. A truly illuminating episode.

Of the panel, looks like Sayeeda Warsi was well coached in the art of political one-upmanship. She managed to get Jack Straw on a back foot and generally managed to win approval of the audience. So if this was political hara kiri for Mr Griffin, it would probably be a highlight on Baroness Warsi's political portfolio.