Dr Swami, suspecting typhoid, had taken samples of Parkly's stools to the Thiruvananthapuram General Hospital for analysis, unfortunately the results were not conclusive. He had therefore to return to the clinic using a special Cary-Blair medium - a semi-solid alkaline medium used to transport sensitive specimens containing enteric pathogens - to collect fresh samples, which given Parkly's condition were abundant.
The hospital's department of microbiology undertook the standard biochemical tests, but failed to detect the presence of Salmonella typhi. Additional tests were undertaken at which point the laboratory technician observed the presence of what he suspected were vibrios.
In the villages in and around Kovalam, ninety percent of families had no toilets and used nearby fields, riverbanks or the seashore. In Kovalam itself there was no sewer system or sewage treatment plant. For the vast majority of its inhabitants the only toilets were pit toilets, basically a hole in the ground. However the lower area of the town, being at almost sea level with a high water table and a high concentration of buildings, toilets, even those connected to a septic tank, contaminated the nearby wells with human faeces. As a result the risk of diseases such as dysentery, diarrhoea, and typhoid was very high.
*****
Chapter 38
I wouldn't let mum get any ideas of plastic surgery here Sarah,' warned Ryan.
'Don't worry, she's just talking,' she replied.
They sat by the pool drinking beer with Barton passing the time of the day and enjoying the sun.
'You should hear some of the nasty stories about of the dangers of cosmetic surgery overseas, and it's not only the quality of the surgery, there's a good number of unqualified doctors doing this kind of work all over the place, not just here in India. Several of my colleagues have seen patients returning from overseas with all kinds of problems, including bungled breast operations and facelifts. People seem to forget that complications can arise with any surgery, they also forget treatment abroad has no recourse once they get home,' Ryan insisted. 'The problem is all that all the things that go wrong are carefully covered up.'
'I know, it's difficult to find an Internet site that talks of complaints from unhappy patients. In fact it's impossible!' added Sarah
'What people should know before taking a decision is that being able to get back to your treating surgeon is really important,' Ryan continued. 'There's always a risk of infection or some other problem. People just don't realise you can't mix plastic surgery with holidays. Do you know how many medical tourists come to India each year?'
'Quite a lot I would imagine.'
'Over a quarter of a million and that doesn't include casual Ayurvedic cures.'
'I can imagine retired people don't want to wait ten years for the NHS, they want to enjoy their retirement,' Barton said.
'That's only natural,' piped in Sarah.
'In the UK the waiting list for hip replacements is long, so those who can afford a cut rate price will seriously think about coming to India or going to another country where they can get immediate treatment, well looked after, where they're met at the airport on arrival and taken to the hospital or a hotel.'
'What about organ transplants?'
'A thriving business, look at the scandal of villagers and poor labourers tricked into selling their kidneys for a few dollars.'
'You've got to give it to them, they're incredibly well organised. They offer a complete package with visa, medical care during the journey to India if necessary, board and lodging both for the patient and his attendant, maps and guides, plane ticketing, an ambulance at the airport, interpreters not forgetting financing.'
The long waiting lists for operations on the NHS, and the high cost of private treatment in the UK had progressively led a growing numbers of Britons to choosing overseas surgery.
'Sun, sand and instant surgery for the price of a good holiday,' said Ryan laughing. 'It's a great idea, but what happens when you're back home, five thousand miles from the hospital, and complications set in, you've got no recourse, and the NHS won't do much apart from stopping you dying. Then pain and apprehension soon transform the memories of sun and sand into regrets.'
Bangalore, the centre of Indian high technology, was proud of its new hospitals, some of which had links to leading American hospitals and the medical faculties of famous universities.
New techniques were learnt overseas and brought home to India by the country's expatriate doctors to be used in new hospitals equipped with ultra modern operating theatres. These hospitals boasted unheard of comforts for their patients compared to their UK counterparts, including individual rooms equipped cable television, PCs and broadband Internet connections not forgetting catering with English meals.
However, cost mattered and in many cases only three days after surgery many patients were back on their feet with intensive physiotherapy, ready to be transferred to a hotel and soon ready to face the ten or eleven hour flight home.
India's new hospital centres had become part of a rapidly growing profit focused industry with an international network designed to provide a regular supply of paying clients in need of treatment. Certain of the larger of the hospitals also provided on line interpretation and analysis of x-rays and scans, so whilst America slept, India worked analysing medical data and transmitting diagnostics over the Internet for use the next day at an incomparably lower cost.
'The truth of the matter is,' announced Ryan, 'even top class hospitals can't avoid problems, such as surgical errors and accidents for example, not to mind problems of nosocomial and postoperative infections like Staphylococcus aureus.'
'I've read reports that say nosocomial infections are rising and up to thirty percent of Indian patients are infected during hospitalisation compared to less than five percent in the UK.'
'By the way Ryan, what exactly is nosocomial infection?' asked Sarah.
'Well, there are several kinds of hospital infections, including bacterial, viral and fungal infections. They're mostly due to a lack of hospital hygiene and proper housekeeping, though some are caused by human transmission, during either surgical or other interventions, not forgetting airborne, water borne and food borne infections.'
'Sounds great!'
'There are guidelines for the prevention of hospital acquired infections, unfortunately they have not been adopted in India, let alone practised.'
'What about resistance to antibiotics?'
'That's a good question, many of the organisms present in the hospital environments are usually more virulent and more and more resistant to conventional antibiotics.'
'I imagine that's why they want people out of hospitals as soon as they're up and about.'
'Correct, but I hate to think of all the things lurking in the dirt on a Mumbai street for a very recently operated person.'
*****
Chapter 39
The pundits described what was happening in the subprime market as an 'unknown unknown'. But once that unknown became known, West Mercian was one of the first to suspend investors' withdrawals.
One small investor, a client of Barton's, had just retired when West Mercian suspended withdrawals from its property fund, blocking the money he had needed to complete the transaction on a retirement home he was buying in Worthing. Fearing for his savings and unable to contact Barton, he suspected the broker had absconded and lodged a complaint with the local police.
It was not long before a couple of officers from the Fraud Squad turned up at Tom Barton's offices in the City, and puzzled by the explanation he was on an extended vacation they turned their attention to his Epping home, which they of course found closed.
A link between Barton and West Mercian Finance was suspected since the mortgage firm had been one of the principal providers of home loans for his clients. In the furore surrounding the mortgage lender, Barton was a handy suspect with the press pointing to brokers and lax lending practices, overstating of house prices or the borrower's capacity to repay their loans.
Barton was just one of many mortgage brokers who had fallen into the habit of abetting such practices and one of the causes why West Mercian's portfolio of loans were less diversified than they or investors thought.
West Mercian was therefore exposed to the risk of borrowers' default and falling prices, which was not exactly the same problem as the US subprime crisis that was undermining markets and where US mortgage based bonds were carved up into collateralised debt obligations, known as CDOs and sold to financial investors. However, West Mercian's portfolio did include a number of contaminated CDOs, which together their failing commercial property fund and risky mortgages added up to a deadly concoction.
It soon came to light that Barton was in arrears on the one and a half million pound loan on his luxurious Epping home, which only increased police suspicions. In his office they had seen a framed photo of him standing before a chartered Gulf Stream business jet hired for a promotional visit with an unidentified group, the only clue to the jaunt was a handwritten inscription: 'Guadalmina Golf and Country Club group'.
Though no charges were formulated or fraud detected, Barton risked being accused of contravening the Financial Services Act by deceiving lenders, falsifying information and inciting borrowers to take out unrealistic loans.
Tom Barton's brokerage had been successful for many years and he was known for his stylish living, driving around Epping and occasionally in the City in his Jaguar or Porsche. It was over the course of the last five years he had drifted into business practices that were to be his undoing, though in his mind he had never abused his customers confidence, those who dealt with him knew exactly what they wanted and the risks they were taking, he did not deal with first time owners or what he perceived as losers.
He often sported a solid gold Rolex watch and wore stylish bespoke suits; they were part of his business. On occasions he had chartered a private jet to fly small groups of selected prospective customers to visit Dublin or Marbella properties. It was not extravagance, but a well honed technique, whereby he maintained total control of his prospects, from the moment they arrived at the City Airport to the moment they returned. At the destination they were driven around in luxury limousines and stayed at the best hotels, and in the evenings he hosted them for diner in the finest restaurants. To his mind there was no hard sell they simply fell like ripe fruit into his open hands.
Barton worked with his own small team as well as a string of smaller brokers to feed him with a steady supply of customers: special cases for large or difficult loans for small business people, potential buyers of second homes in Spain, then much more recently came Dublin.
He personified booming Britain's entrepreneurial mentality, he was a winner. Never in living memory had there been such sustained growth in UK property prices, making the average homeowner rich, or at least feel rich, cultivating an upward property trade-in way of thinking, where there were no losers, only winners like Barton.
It was common knowledge that he despised house price crash style contrarians, in all their forms, from the simply envious to the jealous losers and lame ducks with their dire forecasts. In 2003 they were already predicting disaster, but people like Barton had a natural talent for knowing when they were on a winning streak, forging euphorically ahead. In early 2007 he realized trouble was brewing, but by then he was already in deep and in need of time to disentangle himself, building a fast exit option.
Unrealistic home loan applications had become part of the industry with widespread self-certification of earnings, which in effect falsified income and employment information, ostensibly deceiving mortgage lenders, although lenders had a pretty good idea of the kind of practices they were condoning, turning a blind eye to what had become a charade and concentrating on their own business objectives: growth, profits and quite naturally bonuses.
*****
Chapter 40
Barton was sitting at the bar when Ryan walked in looking worried. He raised his hand in a hallo and made a sign to the empty seat next to him.
'It's never as bad as it seems!' he said as Ryan sat down. 'What'll you have?'
'A beer would be nice.'
Barton made a sign to the waiter and ordered two beers.
'Where's the family?'
'The Ayurvedic centre.'
There was a silence as they sipped their beer.
'You live in town, I mean in London?'
'Battersea?and you?'
'Epping.'
'Nice, what do you do?'
'The City, finance,' he said carefully.
'Interesting, you know I'm a doctor,' it was a statement, 'internal medicine.'
The conversation was awkward, Ryan's thoughts were elsewhere.
'Not looking too good in the City at the moment,' he ventured.
'No, it'll probably get a lot worse.'
That's encouraging thought Ryan.
'You know the subprime crisis, housing and all that.'
'Hmmm.'
'The problem is no one really knows whether a slowdown in the USA will affect everything else.'
'I don't know, perhaps the Americans will have to go without imported flat screen TVs or Starbucks coffee,' Ryan said with a grin.
'Perhaps, the problem is whether a slump in the USA will hurt us or not.'
'What will happen here or in China and Japan if there's a recession?'
'If you look at what happened in 2000, when the dotcom bubble burst, no one could have predicted the present boom.'
'That's true.'
'Perhaps something new will come up,' said Ryan hopefully.
'Well it better come quickly!' laughed Barton.
Barton was old enough to remember the three previous booms. The first was that of the early 1970s presided by Barber, the second was Lawson's boom of the late 1980s, and now Gordon Brown's - the architect of British economic growth over the previous ten years, now slowly grinding to a bleak end with Brown seeming more and more like a used car salesman in his defence of government plans to save Northern Rock, an intervention that would doubtlessly be a landmark in British financial history.
Past booms had shared the same common characteristics: runaway borrowing, surging house prices and a yawning balance of payments deficit. People, both individuals and companies, believed, as always during such heady times, that the good times would roll on forever, while investors disillusioned themselves into thinking returns on assets had limitless growth.
As to the politicians, from Lawson to Gordon Brown they believed they were infallible, like the Pope, the difference being was the Pope had a direct line to God, which was why the Catholic Church had survived so long, it was unfortunately not the case with British Chancellors, who always made the mistake of believing they were in the presence of a new economic model and what was even worse one of their own creation.
'Would you invest in the City at the moment?'
'What do you mean?'
'Well if you had some capital, you know if you sold a house for example and wanted to put the money in a safe place.'
'Like the Northern Rock?'
Ryan's face dropped so quickly that Barton, suspecting the hypothetical question was in reality a real one, hastily added: 'I'm only joking.'
*****
Chapter 41
The guru was a follower of the late lamented Malladihalli Swamiji, who had been a renowned yoga and Ayurvedic guru, who had boasted of treating more than three million people for various diseases with natural medicines and yoga, and without having to resort to surgery.
'My Ayurvedic clinic and educational institution is totally non-profit making,' he said dismissing the luxuriously appointed centre behind them with the wave of a heavily ringed hand.
The fact that his clinic was worth a fortune in India, or anywhere else for that matter, was explained it away by the need to provide for his loyal followers. The bearded guru planned to build a centre in the UK to back up his nascent network of outlets across Europe, promoting and selling his Ayurve
dic care and products that included an extensive range special massage oils, dietary products, books, courses on yoga and meditation.
A woman appeared, it was Barbara Parkins. She made a sign to the guru who waved her over.
'Please join us Barbara' he said rising. 'This is Doctor Ryan, Mrs Kavanagh and her daughter Sarah.'
There was a gushing round of hellos and hand shaking.
'Barbara is establishing one of my centres in the UK.'
'Oh, that's interesting,' said Nicole. 'Where?'
'In Smethwick.'
'How nice,' replied Nicole, not to sure where Smethwick was.
The guru was counting on Barbara. Her import business was thriving, she ran courses in mediation and promoted the sale of Sree Dharma Jayanthi Guru's Ayurvedic products, a brand name she had registered and sponsored on her Internet site.
Dharma Jayanthi regularly provided her with a listing of clients he gathered not only from his own clinics but also from the smaller, less high profile, clinics in and around Kovalam and Varkala.
Each week charter flights filled with new converts and adepts to Ayurvedic science returned to their homes in the cold, damp, UK winter. Each one of them bearing a collection of souvenir oils, soaps, creams and lotions, and even candles made from essential oils extracted from exotic plants, smelling of lemon, Damask rose, jasmine, patchouli and neem, aromas which would trigger their senses for weeks and months to come - as only perfumes and aromas can, bringing back vivid memories of the warmth of southern India's climate and how their aches and pains had been relieved by a masseur's skilled hands and the power of mystic oils.
Internet sites told of teachings based on the thousand year old tradition of Ayurvedic medicine, persuading the guru's followers of its all embracing healing power.
The message was clear, accusing those who denied the teachings as being ignorant of ancient Ayurvedic studies and traditions. The importance of traditional medicinal plants was vaunted and their amazing powers, capable of healing cancer and a multitude of lesser diseases.
'You know Sir,' he said turning to Ryan, 'the State Government of Kerala has awarded us for outstanding achievements to society. Not only that, people from all over the world donate freely to our projects. You should take a moment to read my books on yoga and Ayurvedic medicine, they explain everything.'
Death of a Financier Page 12
