When I look back to the time when I began my practice way back in 1982, Bob Dylan’s famous lines "The Times, They are a Changing..." come to my mind and I cannot but help thinking how remarkably true the lines are! One can only echo the thoughts of the Greek philosopher Heraclitus who, in all his wisdom said, "The only thing that is constant is Change..."! Equally well known and important are the words of the French writer Jean-Baptiste Alphonse Karr, who, in all his wisdom informed us – "plus ca change, plus c’est la meme chose" that translates to the famous phrase – "The more things change, the more they remain the Same!" Reflecting back, I feel both wise men were paradoxically right in their own way!

So, first of all, what has changed? Diseases like poliomyelitis and small pox which were the scourge of the last century have been eradicated. Children suffering from malnutrition and presenting with typically pinched facies (and sometimes coin lesions on back as a consequence of being branded in the misplaced hope of cure), wards full of children with severe dehydration being administered fluids through scalp vein cannulas and cut-opens, the tetanus and diphtheria wards (a must for every children’s hospital then), and rheumatic fever, are now largely things of the past. Diseases like Acquired Immunodeficiency Syndrome (AIDS) were unknown then; radiology meant little more than X-rays; and the family physician was still around – treating three generations of the family at the same time with his reassuring presence. Malnutrition was then synonymous with undernutrition and obesity was a condition dismissed laughingly as a problem of the West.

However, equally remarkable are the things that have still not changed. Parents still insist that their child doesn’t eat anything – even when he/she looks obviously obese (I tell them the only likely explanation is that he/she raids the fridge in the night when they are sleeping). The advantage of applying ‘kajal’ still remains a mystery – does it make the eyes bigger, does it ward off evil spirits or is it applied just for cosmetic effect? Ask any mother, and all they say is "I don’t know, everyone does it so do I!." What has also not changed is the reluctance of Indian parents to ‘let go’. Their love for their child and the belief that they know what is best leads them trying to live their child’s life for him/her. However, in the process they forget that the primary aim of parenting is to make their child independent and capable of taking the right decisions. This obsession of Indian parents who wish to influence every decision of their child – from career to marriage – has not changed. Just a few days ago, a young engineering student came to my clinic seeking my help in convincing his parents to allow him apply for a passport as they felt he would leave them alone once he had one. If only, Indian parents could read and appreciate the true worth of the following words from Khalil Gibran, from his poem "On Children:"

"Your children are not your children.
They are the sons and daughters of Life’s longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.

You may give them your love but not your thoughts,
For they have their own thoughts.
You may house their bodies but not their souls,
For their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them,
but seek not to make them like you.
For life goes not backward nor tarries with yesterday..."

In the final analysis, however, one may safely conclude that true to the theory of evolution, change is a fact of life and is always for the better. Very often, although change in attitudes provides the impetus for a much wider change for the better in society as a whole, it comes rather slowly.