I have always believed in the mystery surrounding this world. As a child, I believed in mythological stories, the stories in my textbooks, and the ones I heard on the radio (Television was not avaiable in homes until the 1970s). Then, when I entered the realm of books, I related to the stories there. Only after enrolling in GB Pant University and living surrounded by scientific institutions did rationality dawn on my consciousness. There was a great library there, and I used to spend hours reading books on humanities, driven by an irrational curiosity.

After coming to Hyderabad, the work pressure at the Defence Research & Development Laboratory (DRDL) took me away from books for a while. In 1987, I developed life-threatening ventricular tachycardia and was rushed to hospital in an emergency. When I thought about why I had that medical emergency and how was I treated in an ICU, which included medicines accessed from the U.K. through government channels, my enchantment with the mysterious returned. I met Dr B. Soma Raju in the hospital. Colonel R. Swaminathan, Chief of Management Services at DRDL, emerged as excellent support. In hindsight, that crisis propelled me to a higher orbit.

 Dr APJ Abdul Kalam had chosen me to pilot ‘Civilian Spinoffs of the Defence Technologies’, a programme aimed at developing affordable indigenous medical devices. He created the Society for Biomedical Technology as an interministerial initiative of the Government of India. But as the Indian economy opened up and globalisation swept in, this initiative turned redundant. Dr Soma Raju, by this time a good friend-cum-mentor, established the CARE Foundation and Hospital,and I took a leap of faith, quitting my government job to work there. Dr Kalam was a steadfast pillar, offering constant guidance and support.

In 2004, I suffered a cardiac arrest. Thankfully, as I was working at CARE Hospital (a career path that seemed nearly impossible for a mechanical engineer), I could be resuscitated in time. On the eve of my bypass surgery, Mr Madhu Reddy, CEO of University Press and publisher of ‘Wings of Fire’, visited me and gifted me a copy of ‘Glass Palace’, a novel by Amitav Ghosh about the King of Burma. Later, I visited Myanmar, the new name of Burma, with Dr. P. Krishnam Raju, Cardiologist and Chairman of CARE Foundation. We visited the real ‘Glass Palace’. Our visit paved the way for the training of Burmese doctors in India, which led to the beginning of the healthcare revolution there, similar to the onein India in the 1980s.

After Dr Kalam departed in 2015, I took up reading scriptures and decoding them for young people by writing in simple English. Dr Soma Raju gifted me ‘The Hero with a Thousand Faces’ by Joseph Campbell (1904–1987), which explores how mystery reveals itself in the world of sight and sound to whoever is open to transformation. On my own, I have read, over two years, the collected works of the Swiss psychiatristCarl Jung (1875–1961), published in twenty volumes. Volume 14 is ‘Mysterium Coniunctionis’; he wrote it at the age of 81. He metaphorically said that peace descends only after the ego is discarded, just as the moon rises after sunset.

And then, suddenly, the Shaligram appeared.

The use of the Shaligram Shila in the worship of Lord Vishnu is a well-known Hindu practice. I remember Shaligram Shila as a part of our ‘Thakur Ji’ collection, miniaturised metal idols handed over by our ancestors. When I asked my younger brother Salil, who lives in Meerut, about it, he told me that it had accidentally fallen while children were playing with it, causing it to crack. Therefore, it was immersed in the river Ganga.

Shaligram Shila is a fossilised stone collected from the bed or banks of the Kali Gandaki River in the Himalayas, famous for its course that runs between deep gorges. The hallmark of a Shaligram Shila is its black colour and distinctive fossil marks, representing an ancient creature preserved in stoneover millions of years. Obtaining an authentic Shaligram Shila is not easy, as they are primarily circulated through exchangesamong devoted believers. Of course, fake stones are available in the market.

While studying the Shiva Purana to write my next book, ‘The Lord of Innocents’, I came across the story of Shaligram Shila. Lord Vishnu had to impersonate Tulsi’s husband to take away her chastity so that her husband, Shankhachuda, who was protected by that force, could be killed. WhenShankhachuda died in battle with Lord Shiva, Tulsi discovered that she had been deceived. She cursed Lord Vishnu to live as a stone on Earth. The innocent lady who was wronged, ended her life. Impressed with her, Goddess Parvati, took the body of Tulsi and transformed it into the Gandaki River, and from her hair emerged the Tulsi shrub.  

Lord Vishnu assumed the form of a large rocky mountain,known as Shaligram, rolling over in the Gandaki river. To complete the punishment, worms with teeth as strong as the ‘vajra’ (the thunderbolt, Lord Indra’s weapon) carved out various markings on His stone body. So, whoever worships a Shaligram Shila with a Tulsi leaf bridges the ancient past and connects with the eternal strife between good and evil. Itreflects the complexities of discerning the right course of action in challenging situations, where even God may be required to take decisions that are neither straightforward nor conventional.

I usually share my learnings and interesting readings with Amol, my younger son, as a daily morning ritual, when chai (tea) meets coffee on our balcony. One day, I shared the  story of Tulsi and Shaligram with Amol. Coincidentally, some of Amol’s friends were in Varanasi (Kashi) for a spiritual New Year celebration. He shared this story with them over the phone. The coincidence turned serendipitous as his friends were visiting the Bindu Madhav temple. The three presiding deities of Kashi are Lord Vishwanath, Lord Kala Bhairava and Lord Bindu Madhav, a Shaligram idol of Lord Vishnu. When Amol’s friends expressed the request for a Shaligram before the chief priest of the Bindu Madhav Mandir, he graciously gave away a Shaligram stone that had been housed in the temple for several hundred years. He refused to accept money for the favour and said, “It is going where it belongs.” Ever since I have received it, I daily offer it water and a tulsi leaf and experience a strange peace in performing this little ritual.

Fossil stones are found everywhere in the world. They vary in size from microscopic bacteria to fossils of birds, fish, trees and even dinosaurs, some weighing many tons. As for the Himalayas, they were created when the floating Gondwana landmass collided with another, causing the terrain to lift up. Several forests and animals were buried under the mass and their remains were etched on stones as time passed. When I worship the Shaligram, I feel connected to that distant past and the power of time over which water flowing over millions of years transforms rocks into smooth, rounded stones. Life is as ephemeral as it is eternal.

It is no wonder that life’s enigma attracts truth-seekers, from monks and philosophers to explorers and scientists. The best minds seek to unveil the mystery that governs these phenomena. My belief has grown that the universe is nothing more than a mystery, a benign enigma turned terrifying by our irrational pursuit of understanding it. Let us live purposefully, attending to our duties, and let the rest unfold. Some mysteries aren’t meant to be solved and why I exist is one such mystery.

Two people played a crucial role in my professional life—Dr APJ Abdul Kalam, under whom I worked first from 1982 at the Defence Research and Development Organization (DRDO) and later as his pupil till he departed in 2015, and Dr B Soma Raju, Cardiologist, who I met in 1986 as a patient, then quit my government service to establish the Cardiac Research and Education (CARE) Foundation in 1997 and worked with him for over two decades. I received valuable insights from him, primarily through some of the rare books he gave me.

Finite and Infinite Games: A Vision of Life as Play and Possibility by James Carse is a book he gave me recently. Published in 1987, it is considered a popular book and discussed extensively. A profound book, it offers a different perspective on life. The book is brief and written in simple and direct language. It opens with, “There are at least two kinds of games. One should be called finite, the other infinite. A finite game is played to win, an infinite game to continue the play. If a finite game is to be won by someone, it must come to a definite end. It will come to an end when someone has won.” (p. 1)

As you read the book, the idea becomes more apparent. The format is clear to both sides and those watching whenever a finite game is played—for example, a test match, a one-day international, and a T-20 in cricket. Then there is a football match, which is different. And so on. Even chess is a game, and so are cards. The match ends with one side winning and the other losing. But infinite games continue forever. Take, for example, a marriage, a teacher-pupil relationship, an industry, etc. Generation after generation plays these games, and the idea is not to win or lose but to keep playing. Whether or not we realise it, we are already playing both games. It helps to understand that we don’t go in for ‘win or lose’ in Infinite games and keep playing.

What is this world but an infinite game? There is a social game within which various other games are embedded, like the family game, community game, religion game, political game, and above all, the economic game. Resources must be harnessed and shifted across the globe, goods manufactured, food grown, and trained and able people are needed to do all these activities. So, children must be born, raised and employed. There must be masters, supervisors, sellers, buyers and middlemen. Then, there are the service providers—maids, cooks, barbers, entertainers—depending on who needs what. We are born into a game and live trying to adjust to what is happening rather than living joyously.

An example of a finite game that’s essential to the infinite game of maintaining a healthy life is making sure you walk for 30 minutes every day. An infinite game includes finite games like employee compensation and recognition of short-term performance targets to ensure employees understand their duties and how they contribute to the organisation’s success. A partnership based on mutual respect and duty is like a series of finite games: getting household tasks done daily, having a proper livelihood, and having no addictions.

In the 1980s, I was introduced to a larger world after coming to Hyderabad. There was no internet facility then, and one had to buy books from shops. There was hardly any spare cash, and I found the second-hand book market in the Abids area, held on the footpaths on Sunday when the main market was closed, to be the most heavenly place. I picked up a 1964 book, Games People Play: The Psychology of Human Relationships, by Eric Berne, from there. It was a ‘bestseller’ in popular psychology (pop psychology), a book that simplifies the concepts and theories about human mental life and behaviour, supposedly based on psychology and widely considered credible and accepted by the populace.

Berne presents his idea of transactional analysis in the book’s first part as a framework for understanding social interactions. He suggests that people permanently inhabit three distinct selves—the child, the adult, and the parent—and keep shuffling between them. His main argument is that most interactions between adults are benign. When people engage in out-of-character roles like ‘Parent-and-Child’ or ‘Child-and-Adult’ in what are adult-to-adult dealings, they can lead to problematic interactions. How can a spouse be dealt with as a ‘baby’?

In the second part, we get a rundown of many ‘mind games’, wherein participants engage in predictable and structured ‘transactions’ based on their ill-suited roles. These exchanges may appear natural at first, but they are a cover for concealed agendas with predetermined results. “See What You Made Me Do”, “Why Don’t You”, “Yes, but” and “Ain’t It Awful?” are a few examples of the funny and informal expressions that describe the games in the book. The first person to return to their Adult ego-state is the ‘winner’ of these mental games.

Religion emerges as the most apparent infinite game. Its ultimate purpose is often the ongoing search for meaning, connection and understanding of the Divine. The practices, community involvement and personal growth associated with faith can foster a sense of continuity and exploration. Religions have evolved, responding to cultural changes and new interpretations. This dynamism is characteristic of infinite games, where the goal is to keep the play alive rather than adhering strictly to unchanging rules.

On the other hand, some aspects of religion can resemble finite games, such as dogmatic belief systems, rituals, or positions of authority that may create divisions or a sense of competition among followers. While not all elements of religion may perfectly align with the concept of an infinite game, many facets—particularly those focused on growth, love, and community—reflect an endless approach to life and spirituality. Ultimately, interpretation can vary based on individual experiences and beliefs.

“No one can play a game alone. One cannot be human by oneself. There is no selfhood where there is no community. We do not relate to others as the persons we are; we are who we are in relation to others. Simultaneously, the others with whom we are in relation are themselves in relation. We cannot relate to anyone who is not also relating to us. Our social existence has, therefore, an inescapably fluid character… this ceaseless change does not mean discontinuity; rather, change is itself the very basis of our continuity as persons.” (p. 37)

Like games, people set personal and/or professional goals and work towards them. Life has its own rules and challenges, and, like a game, it requires strategies to navigate through them. Just as games often involve collaboration or competition with others, life requires social interactions and relationships. Games usually include learning from failures and successes, a principle that can be applied to personal development. We can approach life with the same strategies and mindset we use in gaming. Ultimately, viewing life as a game encourages us to embrace its challenges with curiosity, playfulness, and a focus on growth rather than just winning.

Certain words and phrases gain prominence at different times, and this is becoming a fashion in the Internet media world. “Deep State” is currently circulating about the mysterious powers that run the world. When Khoa Hoang, my Vietnamese–Australian friend and Chairman of Amphibian Aerospace Industries (AAI), visited me, we naturally discussed the geopolitical dynamics, how swiftly governments in Bangladesh and Syria were changed, and how Asia and Europe will be affected by government change in the United States next month.

Khoa explained that whatever word and term one uses, business interests have always run the world, and nothing will ever change this arrangement. Europe was a miserable place to live until the early second millennium. The Gaul (French), Lombard (Germans), Latins (Italians), Hispania (Spanish), Dutch and Norse (Scandinavian) people fought wars against each other until ships were invented. They tasted wealth by occupying territories of countries where people did not have guns. They initially looted diamonds, gold and ivory and brought in slaves to work for them.

After the Industrial Revolution, raw materials were needed, leading to large-scale colonisation. Using guns, Europeans became masters of the entire planet. They kept sending material back to their factories and later sold the mass-produced items back in the markets, killing indigenous enterprises. This business was hidden behind terms like Imperialism, Commonwealth, etc. After the Second World War ended in a “drawn match,” the world was divided into two blocs. Those who preferred to float independently were called the “third world.”

Then, around 1990, Germany first reunited, and then Soviet Russia collapsed. For a while, it looked as if the United States was the only power on the planet, but soon, its corporations, out of their greed for profits, evolved a new form of imperialism called “globalisation.” Without armies, they entered every country to take their resources—both material and people—and, in the name of intellectual property and tariffs, converted the world into a giant profit machine for the businesspeople.

China gained the maximum out of globalisation. It became the “factory of the world” and amassed enormous wealth by manufacturing “American and European products” for global markets. The Communist Party of China, perhaps the most powerful organisation in the modern world, invested this unprecedented wealth back into the United States. China captured rights over almost the entire African continent for material resources. However, attitudes changed when Americans and Europeans realised their good lives were fading. The economic slowdown since the COVID pandemic and the lockdowns forced a course correction.

To understand the geopolitics of the modern world and how it will unfold in the New Year 2025, a close look at history will give a clearer picture instead of indulging in the fanciful imagination of Artificial Intelligence, Robotics, and Biotechnology. As technology matured, the definition of resources changed. What started with mining diamonds and gold, later oil, iron ore, copper and coal, became electronic materials such as silicon, lithium, tantalum and cobalt. With unique magnetic, optical and catalytic properties, rare earth elements—a group of 17 metals—elevate electronic device performance, functionality, and miniaturisation. China currently controls much of the global critical mineral marketplace. It is also rewriting the rules of the world economy.

Let us take a different look at the development of electric cars. The idea is to break free from European dominance and excellence in making internal combustion engines. So, if you can’t make good automobile engines, why not make a car that does not need an engine but runs on batteries? More significantly, China has already secured dominance over the material that would make the batteries that would run such vehicles. China will undo a century of European dominance over the automobile industry in this process. Even being a second mover has its benefits!

No one must make the mistake of ignoring the rise of China, which is as much a wounded civilisation as India is. Powerful countries like France, Russia, Japan, Britain, and Germany tried to control China by dividing it like the African continent and the infamous term “Cutting of the Chinese Melon” gained popularity. Japan extracted hundreds of millions of dollars in ransom, and European nations grabbed vast Chinese territories. Worse still, China was flooded with opium for profits by the British. The British grabbing of Hong Kong in 1841 was a thuggery of the most blatant type.

So, what next? The answer to this question leads to another question: Where are the resources? Russia holds the world’s largest proven natural gas reserves, accounting for nearly one-fifth of the global total. The European economy can’t survive without the Russian gas supply, and for China, Russia is the next-door energy supplier. At the root of the Ukraine War is its potential as a significant global supplier of critical raw materials vital for high-tech sectors, aerospace, and green energy, competed for by Russia and Western European countries. India—the country with the most significant number of young people and a vibrant economy—will be the pivot on which the 21st–century world hinges. All economies will need the Indian market and Indian people.

Khoa shared an interesting concept that no single power on Earth can control the seven seas—the Arctic, North Atlantic, South Atlantic, North Pacific, South Pacific, Indian, and Southern Oceans. The future of humanity rests on how oceans are harnessed and kept free for the movement of goods. His mission of reviving the Albatross seaplanes is based on this premise. Khoa’s company is the Type Certificate holder for the Albatross family of aircraft and is updating and improving this exceptional platform with modern technology to achieve the lowest per seat per kilometre cost.

Khoa is in India for two reasons—need and ability. He sees India, with a coastline of approximately 27,000 kilometres, spanning nine coastal states and four Union Territories and comprising twelve major ports and two hundred smaller ports, as the ideal economy to benefit from seaplanes. The Indian blue economy, which accounts for around 4 per cent of its GDP, can easily be made 10 per cent with the deployment of seaplanes. The Indian aeronautical industry has the maturity of becoming the global hub for manufacturing Albatross 2.0 seaplanes.

It is a pleasure to meet young visionaries like Khoa, who have staked their lives pursuing their dreams. It is the passion of people like Khoa, which I consider the most potent force on Earth; the rest is an old story that keeps repeating itself, with or without the intervention of people. And why do I say this? Projects like seaplanes can transform India’s blue economy, create jobs, and protect its vast marine ecosystems. More important than what you do is how your work affects the lives of others. When people discuss how AI and robots will lead to the loss of jobs, Khoa talks about how the blue economy can generate millions of jobs, particularly in coastal and rural areas, providing livelihoods in fisheries, tourism, and renewable energy.

David Deutsch (b. 1953), a British physicist at the University of Oxford, is among the world’s foremost philosopher-scientists alive. He has worked on fundamental issues in physics, particularly quantum computing, quantum information and constructor theory. I learned about him through his books The Fabric of Reality (1997) and The Beginning of Infinity (2011). Though not popular books, they reached me through the invisible hand that keeps people connected in a bizarre and wired manner, if not by design.

Why should an ordinary person bother with questions like reality? My friend and cancer surgeon, Dr Chinnababu Sunkavalli, is also a philosopher-doctor. The other day, he narrated an interesting anecdote. A young TV journalist interviewed people at a busy railway station in a typical global metropolis (which could be Paris, London, New York, Tokyo, or Mumbai), asking what the most absurd fact of the modern world is. People gave different answers – income inequality, urban slums, climate change, crime, cryptocurrencies, etc. When the question was put to a Buddhist monk, he posed a counterquestion instead of answering it.

He asked the interviewer, “Who are you?”

I am so and so, the journalist answered.

“That is your name; who are you?” the monk repeated.

“I am a TV journalist.”

“That is your occupation; who are you?”

“I am a human being,” the journalist answered, a little frustrated at the way the conversation was going. 

“So are 8 billion people on the planet.”

“I don’t know what you are asking,” the journalist finally answered, giving up.

The monk smiled and said, “That is the most absurd fact in the world. You don’t know who you are.”

The yaksha asked a similar question to Yudhisthira in the famous Mahabharata story: What is the strangest fact in the world? Yudhisthira answered that everyone knows that he will die, as whoever is born must die, yet he conducts his affairs as if he is immortal, acquiring possessions that must be left behind.

Adi Shankaracharya declared in the 8^th century, ‘ब्रह्म सत्यं जगत् मिथ्या जीवो ब्रह्मैव नापरः’ This profound statement conveyed three principles – (1) The Ultimate Reality, be it cosmos or even beyond that, is truth, (2) Not this phenomenal mortal world, and  (3) Humans, though mortals, contain Ultimate Reality within them.

Let us consider this profound but strange idea in the context of an AI bot that is given the task of learning from human intelligence. These bots interact with human activity through the ‘senses’ given to them and find patterns using evidence-based reasoning. Taking the purpose of human life as sensory pleasures and worldly acquisitions – name and fame, and fussing about likes and dislikes, hatred and attachments is living a bot’s life. 

But what is bot learning? What does ‘reality’ mean for it? Indeed, a bot does not know why it is doing what it is doing. A bot is created to carry out its assigned purpose. The purpose of human life is to imagine and decipher the significance of human life in the cosmos. The universe is silent in terms of conscious signals and the cosmos outside our biosphere is sterile and depressing. To the Cosmic intelligence, people being born, growing up, ageing, and dying must be meaningless. Mithya is not ‘false’; it means ‘meaningless’.

David Deutsch’s books, mentioned here, are, therefore, essential for addressing these existential questions. The gist of The Fabric of Reality is a rational, scientific approach to understanding reality, emphasising the interconnectedness of knowledge and the universe. It confirms Adi Shankaracharya’s assertion astonishingly. Quantum mechanics leads to a cohesive theory that explains the universe as one ground of the entire cosmos and life on Earth (Advaita).

Deutsch emphasises the importance of knowledge as the basis for understanding and problem-solving, viewing it as a creative force that shapes our reality. The questions that emerge in the mind and the explanations generated in the quest for answers define the role of human beings in the cosmos. There may be many planets like Earth and many creatures like humans in the cosmos about whose size and extent we have yet to learn, driving us to expand our consciousness by asking questions and seeking answers.

In The Beginning of Infinity, Deutsch argues that pursuing knowledge is limitless and that our understanding of the universe can continually expand. There are no ultimate limits to what can be understood or achieved. Deutsch highlights humanity’s capacity to solve problems and overcome challenges through creativity and critical thinking. He suggests that every problem has the potential for a solution, reinforcing an optimistic view of the future. Mankind will continue to evolve as it has been.

Just as no one in 1900 could have foreseen the consequences of innovations made during the twentieth century – including whole new fields such as nuclear physics, computer science and biotechnology – so our own future will be shaped by knowledge that we do not yet have. We cannot even predict most of the problems we shall encounter or most of the opportunities to solve them, let alone the solutions and attempted solutions and how they will affect events. (p. 197)

Dr Sunkavalli did not leave the monk’s answer to the TV journalist’s question open-ended. He showed me his iPhone and said, “This is ‘my iPhone’ by all means; it connects me to all my contacts. Anyone can reach me through this, and I can search for whatever knowledge I seek and store gigabytes of information I choose. But I don’t have the faintest idea of how an iPhone works, both as a device and the network that backs it, and yet I enjoy it.” This is the reality of a human being, a mere device in the world, with its unique ownership, contact details and information loaded but connected to the One Source. Human life aims to find explanations for the world’s mysteries not from the outside but from within, like Newton’s imagining of gravity, Einstein’s relativity and Kekule’s benzene ring. They did not observe them; they imagined. Their knowledge did not come from outside – how could Einstein have seen space-time bending or Kekule, the six carbon atoms of benzene making a ring? Their knowledge had come from within.

I am a mechanical engineer who worked for 15 years at the Defence Research & Development Laboratory (DRDL) in Hyderabad. There, I developed the Trishul and Akash missile airframes and Titanium Airbottles. In 1992, Dr APJ Abdul Kalam, then Chief of the Defence Research & Development Organization (DRDO), decided to develop civilian spinoffs of defence technology. I came out of the mainstream to interact with doctors and learn from them to indigenously develop medical materials and devices as affordable import substitutes.

The success of developing a unique variety of 316L stainless steel led to the development of an indigenous coronary stent that became famous as the Kalam-Raju Stent. Cardiologist Dr B. Soma Raju, who guided this effort, invited me to leave the confines of defence research and development. We created the Cardiac Research and Education (CARE) Foundation, a biomedical research platform recognised by the Department of Scientific and Industrial Research (DSIR), Government of India.

The importance of indigenous development cannot be overstated. Innovation—a new method, idea, or product—is at the root of creation. Innovation involves creative brilliance and a particular type of people who think differently from the typical and conditioned ways of life. Using the vast infrastructure of defence R&D for civilian spinoffs was a historical innovation. We were driven to address the cost prohibitiveness, and our little initiative prepared the ground for many multinationals to open their factories in India.

By the turn of the new millennium, I found myself stranded, working with doctors and with little government support forthcoming. The advent of broadband connectivity saved the day for me, and we remained relevant by developing teleradiology, which became the basis of the Pan-Africa e-Network launched by the Government of India to connect African hospitals and universities with their Indian counterparts. The concept of delivering medical images directly from where they are generated to expert radiologists at their locations addressed the issue of a shortage of radiologists in the country. For a while, radiology became the most sought-after medical speciality, but as imaging machines became intelligent, the role of radiologists was reduced to verification. 

Then came the era of generative AI, and machines started learning from radiologists’ work. Major equipment manufacturers integrated machine learning features into their machines, enabling imaging machines like CT and MRI to instantly identify patients’ apparent health issues. Today, machines can deliver highly accurate results, not only in imaging but also in laboratory tests. Blood is still needed, but in minimal quality—a drop rather than a vial—and soon, even that may be replaced by non-invasive methods.

Saying that COVID-19 was a watershed moment in modern times may sound like a cliché, but the fact remains that it has changed the way the world works. The way in which primary healthcare was abandoned during that period and private hospitals made money, is an embarrassing testimony to the fact that healthcare has become a commercial business. The medical profession has almost destroyed itself, being controlled by big money; most hospitals function with profit-making policies and how things will change is unclear. 

So, the focus shifts back to innovation; its purpose is now redefined as delivery rather than mere availability. How do we take intelligent machines to needy people? They cannot access expensive hospitals because of a lack of money, nor are they always welcomed, as their presence is often viewed as spoiling these hospitals’ clean, polished ambiences that outshine even five-star hotels. This situation is untenable and, unless corrected, will lead to another healthcare crisis sooner rather than later.

Over a decade ago, I met Dr Bharat Veeramachaneni, an Internal Medicine specialist. The grandson of legendary leader Smt. N.P. Jhanshi Lakshmi (1941–2011), Dr Bharat is conscious of his responsibility towards primary healthcare. We create unsolvable issues for ourselves if we neglect to serve the poor and fail to address their issues. Once a pathogen develops anywhere, it becomes impossible to stop it. Today, the biggest problem is the need for more doctors in primary healthcare settings. Before the NEET system, state governments used to deploy doctors to work in such settings before granting them a PG seat, but now, no one goes there. What is the remedy?

I shared the famous story of Belling the Cat with Dr Bharat. In it, a group of mice agrees to attach a bell to a cat’s neck to warn them of its approach in the future, but they need help finding a volunteer to do the job. Technology, funds, and people are available; political will needs to be improved. I asked Dr Bharat if he would bell the cat. He surprised me by saying, “The time to bell the cat has long since elapsed. Our inability to mount a combined and concentrated effort, which included the screening and triage of patients at the primary healthcare level, adversely impacted and overwhelmed our secondary and tertiary healthcare response to the COVID pandemic, causing morbidity and mortality on an unprecedented scale. It is time to deal decisively with a difficult or dangerous situation or live burdened with chronic diseases.”

The productivity of a nation directly depends on the health of the country. With the existing secondary and tertiary healthcare infrastructure, which has neither the required manpower nor the physical reach, it is impossible to cater to the healthcare needs of 1.42 billion Indians. This challenge is compounded by the financial burden of accessing secondary and tertiary care centres for health issues that can often be managed at the primary healthcare level at a fraction of the cost. The responsibility for healthcare delivery cannot rest solely with corporate hospitals and private health insurers, who would manage it for their profits, which is a no-brainer.

There is an urgent need to develop a robust primary healthcare infrastructure: a formidable force of specialists fully vested with knowledge, power, and authority tasked with protecting our nation’s health. Further strengthening our primary healthcare with government policies and new-age tools such as AI would help improve surveillance, delivery and service efficiency and provide an opportunity to educate people on maintaining good health and preventing diseases. AI can bridge the six cardinal information gaps in receiving treatment in the hospital – first contact, longitudinality, comprehensiveness, coordination, person or family-centeredness, and community orientation.

Yes, the time to bell the cat has long since elapsed. The bull is running amok in the shop of fragile glassware, and the only way to prevent further damage and destruction is to take the bull by the horns, wrest control of our great nation’s health from the clutches of private and for-profit players and place it firmly back in the hands of capable, empowered primary healthcare providers. The question is not who will allow it but who will stop it. Life is all about taking the right actions at the right time.