Sunday, 30 December 2012

Amanat's obituary

Amanat, 23, an ordinary Delhi girl who would ordinarily have remained unknown beyond her family and friends died on 29 Dec 2012 probably of septicaemia and multiple organ failure. She underwent major abdominal surgery in New Delhi, probably a total ileectomy and colectomy, followed by a spell of  intensive care before transfer to a tertiary unit for a last ditch attempt to save her life.

 In her last moments she was surrounded by all the high tech gadgetry of a world-class hospital in Singapore known for its track record in multi-organ transplant surgery. The hospital itself was surrounded by the usual media pack tracking and reporting, even sometimes making it up, every heart beat of the girl and every sob of her family. Back home in Delhi and elsewhere in India the news coverage of her plight, ever since she was found on a flyover beaten (we now know, to death) and raped, rose to a new crescendo.

In life she was content with the anonymity of an ordinary citizen. In death her coffin was met at the airport by the country’s prime minister and the leader of the ruling party. A surreal fame that she did not seek and could not possibly have desired but a status that the media pinned on her like a bravery medal on an unwilling conscript.  

Amanat was of course not the first victim of violence against women nor sadly will she be the last. In a country known for its poor record of equal rights for women, why her case rose to such prominence remains a question that many will ponder and few will adequately explain. But the fact is she did become a focal point for protests in New Delhi and across the country.

What would she have wanted to come out of all this? For her it was a personal tragedy of unimaginable horror, for her family the anguish has become deeper, for the country this was a crime that aroused a whole generation of young Indians demanding change. They would all have wanted a safer, fairer society where such crimes are rare, hopefully even unknown, and where, when they do occur, justice is swift but fair with regard for the due process of law. And yet the portents are not bright that meaningful change will emerge.  

Her alleged attackers have already been identified, tried and found guilty by the High Court of Television and Newspaper. Crowds of protesters were baying for a swift trial followed by capital punishment. Politicians too weighed in with their own demands for and promises of tougher laws and fast track courts. (They probably failed to spot the irony that many among them had more in common with Amanat’s attackers than the girl they appeared to be mourning). The country is a democracy and people usually get what they wish for if they ask loudly enough.

As a future doctor, Amanat would have recognised that prevention is better than cure, that prevention is hard work, takes longer, is less immediately gratifying but ultimately more satisfying since it delivers better results than the quick fix of swift and seemingly decisive action after the event. She of all people would have known this because she experienced firsthand the ultimate futility of high-tech medicine to fix the frailty of torn intestines and mangled viscera.

Applying these principles, she would have asked some searching and uncomfortable questions. Was she just tragically unlucky to have been in the wrong place at the wrong time to have fallen prey to a gang of psychopaths? Or was her’s a disturbingly extreme example of what happens when a whole society tolerates a callous disregard of the rights of women and girls? 

Why is the criminal justice system so inept that cases drag on for years, decades even? Are our judges trained, fair and impartial?   

Can the police be trusted? Are victims safe from the depredations of policemen drunk with the power they wield over ordinary citizens?   Do they have the education, training, and resources to do their job, free of political pressure? And are they accountable for their own actions and misdeeds?  

Are the politicians up to the job of reform? Can they – will they- accept that we are nothing if we cannot be a nation of laws?

Not until these questions are answered will Amanat rest in peace. Not until these questions are answered should any politician sleep easy at night. Not until these questions are answered should the protesters allow those in power to treat this as an isolated case that would be resolved once the accused are tried.

That would in all likelihood be Amanat’s prayer. All the fervent prayers of the protesters who gathered in Jantar Mantar for Amanat to pull through and survive went unanswered. But Amanat’s prayer need not go similarly unanswered if only because the answers for once lie in our hands.  

Amanat (not the young woman's real name), 23, died 29 Dec 2012. The events of the night of 16th december are here  with further commentary from Soutik Biswas

Sunday, 5 August 2012

The Great Indian Blackout of 2012

The unprecedented breakdown in the Northern Grid between 30 and 31 July resulted in 600 million people across the north and east of India losing their electricity supply.

No lights, no fans, no air conditioning. Hospitals, trains, businesses, and schools shut down. Life as many knew it was dislocated.
Those who had them used diesel-powered generator sets. Most people simply sat it out; after all power cuts happen every day in most cities; we had regular load-shedding as far back as the mid 70’s; in any case vast numbers of poor people in thousands of villages are not connected to the grid anyway. That this particular power outage affected half the country’s population at the same time was merely a matter of detail. 

Or was it?

India’s image was tarnished worldwide. One of the BRIC economies, a nuclear power, a space exploring and satellite launching nation, India aspired to a seat on the Security Council and Great Power status. And we still can’t meet basic needs for electrical energy; forget about the level of per capita energy consumption of China, never mind Europe or America; a third of the population don’t have access to electricity even for a  light bulb or a socket to charge your mobile phone reliably.

The blackout itself was not the real surprise. What I found astonishing and disquieting was the response of Mr Shinde, the Union Minister for Power. On NDTV his replies to fair and balanced questioning by Barkha Dutt was breathtaking for its arrogance and disturbing for anyone hoping that this would be the beginning of the end of India’s power woes.

No, he did not see anything odd or surprising in his elevation to the Home Ministry. It was all planned weeks ago as part of a cabinet reshuffle because of Mr Pranab Mukherjee‘s election as President of India.

No, he said, it was not the fault of the Government. It was because all these states, you see, they were drawing more energy than their allocated quota. Why? Because, stupid, of the drought and the summer heat. That’s what caused the the grid to collapse, and then the blackout. Simple, don’t you see?,  it’s all the fault of the weather.

And by the way these things happen in America too, he continued. Remember the New York blackout? It took them 2 days to get power back on; we did it in under 6 hours! So there, we can do power supply better than the Americans, no need to beat ourselves up over a minor inconvenience of a few hours of loss of supply.

There wasn’t one word of acknowledgement that the Government was accountable for its part in the complex mix of underlying factors that are responsible for India’s chronic under-investment in power generation and poor management of distribution.  There wasn’t a whiff of an apology for the mess that is energy policy over which his Government had presided for the last so many years. There was not the least semblance of understanding of the changes that needed to be made if things are to get better.  Changes that would involve tough policy choices: from higher prices for those who can afford to pay to greater incentives for new producers to make the long term investments in power generation.

The Grid can be patched up and we can all limp along with a few more hours of load-shedding. But if India is to catch up with the rest of the world it needs to think seriously about fundamental changes to how we approach the most important parts of our infrastructure.  Keeping the lights on has to be a national priority.

And yet this may be the cataclysmic event we needed to shake things up. Things usually have to get pretty bad before everyone agrees that something dramatic has to be done to make things better.

Take for example, the experience of London. Today it is glittering in the glow of a successful Olympic games But in the summer of 1858 a great stink arose from the River in London – a stench so strong that London came to a standstill, Parliament shut down, and the Courts planned to move out of the City.

London, famed as the centre of global commerce, came to be seen as the world’s most filthy city.

But The Great Stench also led to reform. It provided the impetus to spend 10% of the country’s then GDP to build a massive modern underground sewerage system that started the great Victorian Sanitary revolution.

The question for India now is this: Will the Great Power Outage of July 2012 be the impetus for a national energy plan that ensures a secure energy supply for every Indian? 

Thursday, 15 March 2012

India Travelogue - Nagpur

Nagpur, Central India. Some things don’t change.

On the surface a lot has changed in Nagpur since when I was last here as a medical student living in Gokulpeth, regularly taking the No. 3 bus at 715 every morning from Ramnagar stop to Ajni via Sitabuldi..

The buses are better, they now have a central wide door and the conductor has an electronic machine that prints out a ticket. The bus stops, at least in this part of town, have clear notice boards showing the routes served and the timings and frequency of buses. Many more cars and motorbikes and scooters on roads that are no wider than they were 40 years ago.

The cows and their place in the road hasn’t changed either. After all this is Gokulpeth. But somehow they seemed to me to have become even more part of the domestic scene than all those years ago. They were tolerated then, now they appear to be almost venerated. They amble along the streets of this locality, seemingly very much at home; no owner in sight but almost certainly they are well cared for, looked after and exploited by someone who wouldn’t understand if you tried to explain that letting them roam free on the public roads was a good example of a negative externality of the local milk industry.

On an early morning stroll I found this cow apparently returning home after a night out and looking suitably contrite after being put in its place by the owner refusing to get out of bed to let it in. I stood and watched to see what would happen, but the cow had infinitely more patience than I did and so i moved on. 

Of course cows have a special place in India, but in Nagpur they are more than just holy animals.  This is the home of the RSS, for whom the cow is not just a spiritual symbol but also a source of potential scientific breakthroughs in every conceivable field.

Nagpur is home also to the politically opposite end of the Hindu spectrum. If the RSS is the last political defender of Hindu belief, then a visit to Deeksha Bhoomi in Ramdaspeth, some 3 Km away, brings you face to face with the counterargument. On this ground, almost 6 decades ago, BR Ambedkar, one of the principal authors of the Indian Constitution, forswore Hinduism and became a Buddhist. He also administered the same 22 vows to a large number of Dalits who followed him to give up their Hindu religion and embrace Buddhism.

At one level the vows are a direct assault on the basic tenets of Hindu belief, and even more directly on Brahminical rituals and practices.  Say similar things about some other religions and you could be in serious trouble! Its a tribute to India's pluralist democratic tradition that Ambedkar is remembered as a national hero. Pity the Government cannot extend the same protection to Rushdie or MF Husain when he was still alive.    

Brahma, Vishnu and Shiva are not Gods and I will not worship them.
There are no gods and goddesses
I will not take part in any ritual performed by a Brahmin.
I will not perform annual shraddha ceremonies (for departed elders)

There are also other vows along the lines of the Ten Commandments, but these, I suspect, are observed more in the breach than in the strict practice.

Deeksha Bhoomi today is a spartan, minimalist monument that is said to attract Buddhists from around the world but more to the point it serves as a focal point for the political activism of people from India’s backward castes.

These castes are listed and defined in one of the Schedules of the Indian Constitution (hence Scheduled Castes). Now the Government wants to set up a database of different castes and communities.

For the downtrodden of India, Deeksha Bhoomi has the same power as the ML King Memorial in Atlanta has for its blacks. I’ve visited both and the symbolism of struggle, survival and emancipation makes your hair tingle

For these people, BR Ambedkar is a God; his framed and garlanded picture, lit up by oil lamps and sanctified with incense, adorns many homes. How ironical that having vowed not to worship Vishnu or Shiva or Brahma, they’ve taken to the worship of Ambedkar.

Maybe the human urge to recognise a God is stronger than Richard Dawkins thinks. Or may be Ambedkar should have made room for one more vow. Or just maybe the people Ambedkar tried to help find themselves, despite, or perhaps because of, the policy of reservations, in much the same plight as before Ambedkar; and so they still feel the need divine help.  

Wednesday, 14 March 2012

India travelogue - No country for old men

Day 3 in Cyberabad

Went to Ramoji film city yesterday. Got a bit late getting ready in the morning and missed the 0825 bus from Paryatak Bhavan  in Greenlands and so we had to take a Meru Cab all the way.

It turned out to be a long drive through Begumpet and Secunderabad to exit the city on the Vijaywada highway. Passed  familiar parts of the city: Sangeet cinema where V and I would often go to see a movie when we lived here some 30 years ago;  Tarnaka and National Institute of Nutrition, and Habshiguda where we lived after getting married. Uppal was the outer limit of the twin cities when I knew it. Beyond that its all new to me. What used to be a road going through empty farm land is now a bustling 4 lane road with shops, malls,  a Big Bazaar and restaurants and hotels on both sides.  And granite/marble outlets.  I come to the conclusion that just like cranes dotting a city skyline are indicative of a buidling boom in progress, in India, the number of outlets dealing in marble or granite gives the best measure of building activity. Counted at least 50 of them before reaching Hayathnagar.

Ramoji Film city is a marvel in its own right; its a theme park, film production facility and tourist attraction all in one 2000 acre campus. Its quite a remarkable achievement of one man's vision.

A large party of girls from St Ann's school in Bolarum, assorted tourist groups from all parts of India and families of various sizes. For a working day, it was good to see so many people out to enjoy themselves and yet the facilities and the infrastructure handled it all easily.

The entertainment was pretty good too. A delay in the start of one of the shows gave the audience, including the St Ann's contingent, the opportunity to provide their own entertainment in the form of impromptu dancing to whatever bollywood song was on the PA system. A semi-competitive spirit seemed spontaneously to emerge with groups in different parts of the huge auditorium trying to outdo each other.

It dawned on me that the vast majority of the audience were under 25. Suddenly I realised first hand the implications of what is a well known demographic statistic; this is a young country with the proportion of under 25s set to rise even further.

No country for old men or women, India.

Its the young you see everywhere, they supply the services and the labour and also consume the product or the service.

Back home after a long day I check with the railway reservation website ( to discover that we are still on the waiting list for the journey to Nagpur. No option but to try and book tatkal (Emergency) tickets. These special tickets are open for booking a day before the journey but demand is high and only the first few in the queue have any chance of getting it.
So off I go to Khairatabad station at 7.15.  The counter opens at 8.00 but the queue had already built up with 20 or so people ahead of me already. Doesn't look hopeful. At 7.30 I learn from others in the queue that you need a photocopy of your photo-id to apply for a tatkal ticket. I remember reading something about this but assumed you needed to produce a photo id and so I was carrying my PAN card, but a photocopy? That’s a bit much; what do they want to do with it? Frame it?

But I’m told it is a must, without it my application for tatkal tickets won't even be considered.

My situation looks increasingly hopeless. I went off in search of a xerox shop - at 7.45 am nothing is open except tea stalls and petrol stations.  One stationery shop with a photocopying machine is just about opening but No, he isn’t really open until 8.30; the lad who operates the photocopier doesn’t come in till then. Cant I operate the machine? I ask. He is aghast at the suggestion; No way he says. The guy is clearly getting annoyed at my inexplicable persistence, so I give up..

Then I notice that the Khairatabad branch of ICICI Bank is just about opening but the armed guard shuts the door after letting in a pair of staff members and takes his place in a plastic chair by the door, rifle by his side. I decide to try my luck.  They are just opening up the branch he tells me, the bank itself is open for business only at 8. That's too late for me, so I plead my case for special treatment. Finally I manage to sweet talk him to helping me ('I am an ICICI bank customer with xx lakhs on deposit, a photocopy isn’t asking much'). He must be the first Indian official not to be a job's worth. He agrees to do it himslef, goes back inside, locks the door and goes away with my PAN Card, and returns a few minutes later with the all important photocopy. Quite remarkable I thought to myself even as I invoke god's blessings on him and his kids. He smiles and waves away my gratitude, addressing me as uncle-ji - Ive made his day and learned that there may still be a place for old-ish looking  men in this country.

I may have been pleased with my success of  getting a photocopy of a document at 7.50 am but Indian Railways proves altogether more intractable.  

My place in the queue has been maintained by friendly fellow sufferers who are pleasantly surprised at my triumphant return with the necessary photocopy just as the counter was opening. They agree the pointlessness of the photocopy-of-id requirement but philosophically shrug their shoulders in a gesture that indicates the futility of arguing with it. By the time my turn comes up at the counter, all that is left is a position on the waiting list even in the tatkal quota. That's of little use to me, so I turn down the offer and walk away with a photocopy (of my PAN card) that I did not want and without the tatkal tickets that I did want. You win some, you loose more. 

I cross the road back onto Rajbhavan Road towards home taking advantage of a lull in traffic at the lights that I thought was good  driving behaviour.

No such thing.

All the traffic on Khairatabad cross roads had been held up to allow a motorcade of important looking cars to sweep down Banjara Hills into Raj Bhavan Road. A  Merc with darkened windows, police jeeps with sirens going in the anemic way only Indian police cars do, and a couple of white Ambassadors with guys in impressive military uniforms. No autos in sight but manage to hop into a bus with a couple of seats spare!

Back home I decide to solve the problem of how to travel to Nagpur by throwing money at it.  I went on the net, logged into  and within minutes I had booked flights to Nagpur on Sunday. We'll get there 4 hours later than we would have by train. It took me longer to learn that buying emergency quota rail tickets is not straightforward, while booking a flight, provided you have the means to pay, is relatively simple. Let's not even consider the carbon factor, after flights from and back to England are taken into account, this is a relatively small extra puff.

India Travelogue - cell phones and confectionery

Day 2 in Cyberabad

 I am distraught that we don’t have a cell phone connection in India. I thought we had one but Idea Cellular disconnected us since we had not used it in 3 months!

I know its not vitally necessary  but in India, not having a cell phone means belonging to the 48% of the population who don’t. Its the fastest growing cell phone market in the world, and with the keenest pricing too.  But today after two trips to the Vodafone shop in Smajiguda I succeed in getting one. Its no mean achievement!  

Its all to do with the rules laid down by the Government. No one can get a cell phone connection - at least not legally - until he can establish his identity and an address. So far so straightforward.  

But the way the rule is interpreted makes it almost pointless. I produce my UK passport but it does not have an address in it so it is deemed less than useful. Apparently an Indian passport does show your address though so far as I know it is not illegal to hold a passport with an outdated address on it. I also produce a Hyderabad Municipal Corporation tax bill in my name and showing my local address but that is rejected - it has to be an electricity bill. Why? Who made up this rule?  The fact that this latter piece of paper shows my address but not my name is okay apparently.  Luckily my OCI card saves the day - not only is it issued by the Govt of India but it also shows an address - never mind that its a UK address.

But I also need a passport photo. That's easy. I have my laptop and my entire photo collection so I find an official photograph of myself, put it on a memory stick  and take it to a photolab just down the road from the Vodafone shop. The guy reads it into Photoshop and with a series of speedy mouseclicks and key strokes crops it, resizes the cropped version, adjusts the color balance and prints off 6 passpost size photos. This guy knows Photoshop like a violin maestro knows his strings. 40 Rupees he charges me. You couldnt get this service in Jessops in Birminham. He might do 4 passport photos but a)  he'll have to take it himself, b) it would cost 5 pounds.

A little more form filling and signatures and I acquire a Vodafone sim card for 42 Rupees with 28 rupees talk time on it.  Some victory.

The question I am left with is how on earth do  poor, ill-educated folk cope with all this bureaucracy. Clearly they must be managing somehow if you believe the figure of 600 million cell phone connections  in India with 2 million being added every month.

In the evening V and I venture out on the roads again

First stop the Titan watch showroom to see if they can fix V's watch strap which got damaged when she fell and hit the watch against the bedstead. Easy, of course they could; the clasp needed bending into shape and a woman in overalls who was obviously the chief repair technician took a small hammer to it, before handing it back to V with a smile and a flourish. Oops, too tight, once you fastened the clasp it wouldn’t open. No problem.  A few more sharp taps of said hammer this time with a chisel between hammer and watch sorted the problem.

No charge; its a free service. Really! Titan Watches had acquired one satisfied (potential) customer.

On then to G Pulla Reddy Sweets in Greenlands. But that involves crossing 2 roads. The traffic is never ending and no one really stops at the pedestrian crossing.  Looks daunting and almost impossible but there had to be a technique. You need to put yourself in the same frame of mind as a buffalo that slowly ambles across the road in a vaguely diagonal direction, looking guardedly but defiantly and without blinking,  straight into the eyeballs of drivers of vehicles potentially capable of major damage should you happen to collide with them. 

G Pulla Reddy is unlike any other shop in Hyderabad. It has the air of old world charm and quality about it, an ambience that projects service and style. The range of products is almost the same as when I first came across their Nampally Station Road branch in 1980.  The large shop floor is deliberately kept spare and empty. A glass enclosed counter runs along just one wall behind which attentive shop assistants assign themselves to each customer by an unwritten system that involves catching the eye of the sales assistant. As you make your choice the sales girl collects your purchases for you, totals up your bill and accompanies you to the counter to pay and collect your bag of delicacies. Its a kind of old world personalised service you might find in the finest delicatessen. Its all very quiet and unhurried, feeling refined and unpressured.

What a contrast - buying a cell phone connection and buying sweets from G Pulla Reddy. Not quite a clash of cultures but I'm glad they've kept up their practice of selling the finest sweets with their distinctive style of customer service.

India Travelogue - surviving a long haul flight

Feb – March 2012.

V and I recently went back home to India for a short break. No particular purpose such as a family wedding or event – though as it happens we did turn up for a wedding in Chennai – just to visit family,  laze about and yes visit a place we’d always heard about and have always talked about but never visited before -God’s Own Country.

Day 1.
I don’t usually enjoy long haul flights; the stress, the claustrophobic feeling and the sleeplessness giving me a migraine more often than not. But I think I’ve finally discovered the secret to emerging at the other end in good spirits. 

Here’s my tip: don’t look at the watch and keep asking: are we nearly there yet? Instead immerse yourself in carefully selected films and you'll find yourself saying 'are we there already' when they come to collect your head sets just as you're about to discover how it all ends.  

Applying this rule I selected the following  films to watch when i checked in on line.
 1. Margin Call. Its about the experiences of the traders in a big bank and how they experience the financial meltdown of 2007. Jeremy Irons was great when he says to the young guy with a PhD in particle physics – Hey kid, explain this to me in English, and like I am a 5-year old.

2. Aarakshan - Caste is a dangerous subject to explore in public in India and no wonder this film got banned in some states where caste has the same implications as race or color has in some parts of the world. But it turned out to be a good film; a social commentary on all that is wrong with an education system that is all about commercial opportunity, and where learning has been sacrificed in favour of a race towards exam grades. The poor kids who are caught up in the mad world of the Indian educational system seem to fall into two camps: those no one cares about – whether they turn up at all, and if they do whether they learn anything useful; and those who are constantly under pressure to achieve higher and higher grades. Both groups sacrifice their childhood, the former as a result of neglect, and the latter, paradoxically, of too much attention, all of it on the wrong outcome.  
3.  And a chance find: 'The Sound of Mumbai' a 70 minute long docudrama about kids from Mumbai’s slums training for a choir performance in the city’s National Centre for Performing Arts of the songs from The Sound of Music. Uplifting yet depressing but altogether unmissable.
11 year old Ashish from the slums gets to perform a small solo piece and takes up the challenge at some personal cost. The contrast between his life in the slum and that of a 10 year old parsi girl in her middle class apartment is stark.  It’s probably true of any city in the world that 10 and 11 year old kids a few  miles apart can have very different lives, but in Mumbai they might as well be living in separate worlds of hope and expectation while sharing the same if unequally realisable dreams.  I’d give it 5 stars, Catch it here on the net if you can, or get the DVD
Hyderabad, Rajiv Gandhi International Airport.
A gleaming marvel of architectural class and technological efficiency, set in arid fields 30 miles south of the city, like an oasis with broadband and air conditioning in a dusty desert of settlements without sewerage or piped water. Pity they didn’t think to connect it to the city with a rail or metro link yet. Instead they built an 18 kilometer long elevated expressway that has the remarkable feature that you can only go from one end to the other; there are no entry and exit points en route. The road goes through villages that were always there and townships that have sprung up since the airport opened a few years ago. But all the development and economic opportunity seems to be only at either end of the expressway, not along it.  Lopsided priorities but that’s what you get when the decision makers think of the needs only of the class they represent. After all the expressway allows the denizens of Banjara Hills and HiTech city to get to the airport without the inconvenience of negotiating the bastis beneath it.

Saturday, 21 January 2012

Welcome to general practice 2012

At McDonald’s they say, ‘Hi, can I help you please?’ The smile may be trained but its not hostile. 
At airline check-in desks they’re usually polite even if they don’t look overjoyed to see you. 
Even Royal Mail post offices have sharpened up their act. When its your turn at the counter they smile and then, after dealing with you they try and sell you their latest credit card deal.
None of these service outlets is ever as unremittingly unwelcoming as a GP’s surgery. 
The receptionist looks positively displeased to see you. You’re lucky if they merely glum, sometimes they can be grim indeed. The doctor or nurse are fine; they welcome you, smile and are polite. Its the general get up of the waiting area that I am complaining about.
The place is permeated by a culture of sullen tolerance, a forbidding lack of those finer elements of human exchange that is the stuff of a warm welcoming reception when a customer enters a shop.
Take the reception / waiting area, for instance. It  is full of stern sounding admonitions. The gentler ones tell you things they've decided you need to know but in a tone that says ‘ accept this or else’; the more forbidding ones are positively finger- wagging. They threaten consequences for acts you might never commit, but are assumed perfectly capable of contemplating.
Like this one.
Blood tests
If you have been told to come fasted for a blood test but have not fasted then your test will be cancelled and you will have to make another appointment.
Or this one (its still up in my GP's clinic - years after the scare was over)
Important notice about swine flu
If you think you have swine flu then you must not come to the surgery. Telephone the help line for advice on how you can treat yourself with simple remedies. Think about staff and other patients.
This one is plainly intended to put you in your place
Mobile phone use
Don’t use your mobile phone in the surgery. If your mobile phone goes off you will be asked to leave the surgery and take the call outside.

I can quite see the staff enforcing this rule with particular vigour when it is wet and cold outside. 
Even minor transgressions are not tolerated. This notice has no understanding of the legal concept of proportional response or of reciprocal rights.
If you are more than 2 minutes late for an appointment then there will not be time for the doctor or nurse to complete the consultation. Your appointment will be cancelled and you will have to make another one
And just as the needless unfairness of it all gets to your blood pressure and you start tspoiling  for a fight, you see this little notice that tells you how not to respond:
Our staff have the right to work in a safe environment. Aggressive behaviour towards staff will not be tolerated and may even be prosecuted.
Why isn’t there one simple sign that said, even if it was not sincerely meant, that said
to our surgery. We’re sorry that you’re not feeling well or in need our medical services.  We can’t promise an instant cure but we’re glad to serve, and with your co-operation, we’ll do our best to solve your problem.
General practices claim to be businesses but that seems to apply only to their billing procedures. When it comes to culture and attitudes towards us - their ‘customers’ -  they behave like the worst of Soviet-era state run bureaucracies.