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The educated killers
It’s raining cash in TN
Smokeless tobacco kills |
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Now we are 1210 million
Daughters of a lesser god
April 7
Antibiotic resistance is main focus
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The educated killers
Haryana
and Punjab have shown a dismal record of child sex ratio. Now Jammu and Kashmir too has gained notoriety. The spread of education or prosperity has nothing to do with ethical living or respect for the rule of law. In fact, both literacy and prosperity contribute to acquiring influence over official machinery and means to get rid of unborn daughters. The conviction rate for female foeticide and infanticide is abysmally low and the better-off often get away with murder. Greed knows no limits. It is a fact of life that a daughter is still seen as an economic burden. What can be more shocking than a judge of the Supreme Court listing her daughter as a liability. Haryana’s poor child sex ratio record, therefore, comes as no surprise. Despite achieving a commendable economic growth rate, the state is weighed down by its social backwardness. Khap panchayats feel no moral compunction or fear of the law in ordering the killing of young lovers whose marriage they do not approve of. In such a state no one can argue that education will improve things. The latest census figures have presented an uncomfortable trend: daughters are particularly unwanted in areas with a high literacy rate. The district of Mewat, which is among the most backward – economically and educationally – has earned the highest sex ratio of 903 in the 0-6 age group in the state. The dismal social scenario apart, Haryana’s population, like its prosperity, is growing unevenly. There are pockets of high growth like areas close to Delhi and along the G.T.Road. Gurgaon is choking with population growth. Unless the trend is reversed, population pressure on limited amenities would keep rising. Those from less developed villages and towns will migrate to fast-growing cities. This will further widen economic disparities, resulting in greater social unrest and more agitations and road/rail blockades. The state’s sleepy political leadership is yet to wake up to such realities. Over the years it has failed to manage social tensions and correct economic growth imbalance.
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It’s raining cash in TN
Reports
of large-scale bribing of voters in the Tamil Nadu Assembly elections are cause for serious concern. Elections will cease to be a level-playing field for all candidates if political parties indulge in such unabashed use of money power. The seizure of currency notes to the tune of a whopping Rs 5.11 crore kept in five travel bags from the roof of a private bus in Tiruchirapalli by a bold lady revenue officer speaks volumes about the extent of electoral corruption in the state. Cash is being ferried through various modes of transport — bicycles, two wheelers, police jeeps and even ambulances. Though the police is yet to catch the people behind the seizure in Tiruchirapalli, these bundles were apparently being ferried for distribution among voters. Last month, officials had seized Rs 3.5 crore in Madurai. Unfortunately, the role of money power has been increasing after every election in Tamil Nadu which is ranked among the highest in election irregularities. But then, this menace is not confined to Tamil Nadu. Reports of cash seizure have come from West Bengal and Assam too. The Election Commission had transferred the entire Air Intelligence Unit staff of the Income Tax Department at Delhi’s Indira Gandhi International Airport for letting off Trinamool Congress MP from Rajya Sabha K.D. Singh carrying cash of Rs 57 lakh on March 24. Chief Election Commissioner S.Y. Quraishi has said that cash seizures were not enough and that tackling the role of money power has become “a big challenge”. The latest seizure enjoins a special responsibility on the officials to step up vigilance. The Commission’s flying squads should intensify searches on vehicles to prevent the use of money power in the elections. Poor gullible voters, who fall an easy prey to the lure of money, need to be educated on the evil of taking bribes for votes. As violating electoral rules to influence voters is punishable under the law, there is a need to spread awareness among the masses. The money to pay bribes comes from the proceeds of fund-raising by political parties. Thus, we need to have tighter laws to regulate campaign finance. If Germany, Japan, the UK and France have laws to govern campaign spending, why cannot we have them? Money-based elections inevitably lead to a political system up for sale, and it is the moneyed who can buy governments. One has to understand its consequences on the system and the quality of governance. It is in national interest that this menace be tackled headlong.
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Smokeless tobacco kills THE adverse effects of tobacco on people’s health, including the link between tobacco use and cancer, have always been known. Now, it has been found that smokeless tobacco contains no less than 28 carcinogens. The latest study also reveals that 30 per cent of the smokeless tobacco available in the market contains heavy metals, far in excess of the permissible limit. With the number of tobacco users in India a staggering 274.9 million, a majority of whom are daily users, the health hazards of tobacco use are to an alarming degree. Tobacco continues to be the leading preventable cause of death and tobacco use kills one in 10 adults worldwide. India alone accounts for 86 per cent of oral cancer cases across the world. Chewing tobacco and gutka contributes to 90 per cent of oral cancer cases in the country. Besides, tobacco addiction involves other health risks like cardiovascular diseases too. Realising the perils of the fatal addiction, India banned smoking in public places and introduced pictorial warnings on cigarette packets and tobacco products. However, these measures have failed to yield the desired results. Even the Union Health Ministry admitted that pictorial warnings have been ineffective. There is now an increasing clamour for banning smokeless tobacco. Undeniably, there is an urgent need to come down heavily upon the unregulated smokeless tobacco industry. But whether a ban is the answer or other measures can help check the harmful contents in tobacco products needs to be debated. The erroneous presumption that smokeless tobacco is less harmful than smoking needs to be dispelled through massive awareness campaigns. Sustained advocacy did lead to fall in tobacco consumption, in the West. The government must keep tabs on tobacco majors too, who continue to flout rules and indulge in surrogate advertising. Pan masala manufacturers whose so-called tobacco free pan masala have been found to contain high levels of nicotine also need to be taken to task. If India needs to avert an impending health catastrophe caused by excessive tobacco use, it must follow a holistic approach.
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Life is far too important a thing ever to talk seriously about. — Oscar Wilde
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Now we are 1210 million THE major outcome of the preliminary results of the 2011 Census of India is not that we are now 1210 million, or more than the US, Indonesia, Brazil, Pakistan, Bangladesh and Japan combined, but that the decadal growth rate is down by 3.9 per cent despite the overall numbers rising by a huge 181 million. Most laggard northern states have shown a welcome decline in fertility and an improvement in female literacy. These are heartening trends but the female child sex ratio has gone down, signifying the continuing tragedy of the unwanted girl child earlier reported even in some of the more progressive northwestern states. Literacy, including female literacy, has markedly improved and we should be able to attain universalisation of primary education by or before 2021, over 60 years after the constitutional promise. The goals must now be universalise secondary education by the same time as emerging India will not emerge if a large swathe of society remains semi-illiterate and unable to imbibe the vocational and professional skills required to move requisite numbers off the land to industry and services with higher farm productivity to boot. The country must add 10 million jobs net annually gainfully to absorb the net incremental growth in the labour force. Steady 9 per cent growth per annum through the decade should enable us to eliminate stark poverty and significantly improve HDI and guarantee the basic services listed under the millennium development goals. But this will require a vast expansion in trained manpower. The demographic gain we foresee from a younger age profile will remain a burden unless quantity translates into quality. Uttar Pradesh has a population just short of 200 million while Maharashtra ranks next with 112 million. Other big states sport numbers in the 75-100 million range. This clearly underlines the case for smaller and more compact states and also the need for another states reorganisation commission to recommend the contours of new units on economic and administrative grounds. Identity and ethnicity can be accommodated through regional autonomy and further empowerment of panchayati raj institutions, which would also make for more participative government and accountability. The census figures for urban growth are not yet available, but urbanisation has clearly seen a marked rise and the country should have a majority living in towns and cities by 2031. This calls for major reforms in urban governance which is today untidily fragmented – with Delhi being a particularly bad case – and some interlocking arrangements to bring metro/ nagar palikas and panchayati raj bodies together for a number of common purposes such as water and sanitation, connectivity and market access, and superior educational and health services. Cities must organically function as hubs and dynamos for the surrounding countryside which they serve even as they are serviced by it. Further action points will emerge as the census numbers are crunched in the months ahead and the first Unique Identification Number of residents is distributed. Meanwhile, the pundits got it totally wrong. The India-Pakistan semi-final for the World Cup in Mohali was no “war” but an enjoyable sporting contest. Neither side played up to its potential, but in the result India registered a fairly comfortable win though there were moments when the match seemed to be going away. The atmosphere was charged with excitement, with a number of Pakistani fans in the stands. But there was an air of bonhomie and the “aam admi” on both sides thought that it was a good idea for Dr Manmohan Singh to have invited his counterpart, Mr Yousuf Raza Gilani, to join him in witnessing the event. The usual critics went overboard, characterising the initiative as a diplomatic blunder that let Pakistan “off the hook”, comparing it to the Sharm El-Sheikh “fiasco”. The communiqué then issued did not altogether delink talks from terror. Nor did it allow Pakistan to score a point by permitting reference to Balochistan. Indeed, the addition of Balochistan to the agenda has embarrassed Pakistan as it has been unable to lead any credible evidence about India’s alleged intervention there while giving Indians an opening to question the continuing suppression of the democratic rights of the Balochi people. The Manmohan Singh-Gilani meeting was largely symbolic but it generated the right atmospherics, reinforcing the happy outcome of the Home Secretaries’ meeting which suggests the possibility of some forward movement in the 26/11 case if an Indian commission can meet the other Pakistani accused now on trial in Rawalpindi. Nothing has been lost and something has been gained. As for the match itself, Shahid Afridi had no reason to “apologise” to the people of Pakistan for his team’s defeat. An expression of disappointment was certainly in order but an apology sounds as though the match was indeed a “war” that had been lost, bringing dishonour and disgrace not just to the team but to the country. This was an unintended note that jarred and could have been avoided as it is reminiscent of an earlier Pakistani captain apologising to all Muslims for Pakistan’s defeat, presumably at the hands of of “Hindu India”. It is time to bury the hollow and vicious two-nation theory that has brought grief to the subcontinent and robbed Pakistan of its soul. India too must curb obscurantist and chauvinistic tendencies by indulging in silly acts such as threatening a ban on Joesph Lelyveld’s new book on Gandhi. Finally, one must question the vesting of leadership of the war in Libya to NATO, a Western military alliance outside and beyond the rubric of the United Nations. The world body is being insidiously dragged in as in Afghanistan without accountability to it. This is a worrying trend, More so when Mr Obama is reported saying that US agents are being tasked to undermine Colonel Gaddafi. Regime change is not part of the UN
mandate.
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Daughters of a lesser god IT’S nice and cosy where I am. Six months old in my mother’s womb, I can’t wait to be born. There’s, however, one big problem — I’m going to be born a girl. And, the world, as I see it today, from my mother’s eyes, hardly seems a nice place to come to and open your eyes in. “Hostile” maybe a harsh word for somebody who has barely learnt to change sides in the womb but that’s exactly the kind of place I am headed for. And, that’s probably what my mother is preparing me for as she whispers some bitter truths to me whenever we are alone. Watching her pain of years gone by flows out as tears and drench her soul, me thinks, can the world really be so
hostile? I know my mother doesn’t lie. When she talks to me, she bares her scared and scarred soul to let me in on her vulnerability. Yet, once her tears have dried, she emerges the strong-willed woman and the caring mother whose heart hasn’t learnt to differentiate between a boy and a girl, ready to take on the world with renewed vigour. Careful not to scare me off, she chooses her words with caution, warning me that shouldn’t step out expecting a celebration, the kind that only seems the prerogative of a boy. No sweets, no party, no frills and no laces. Only a mournful silence and lots of long faces. That at least I am alive and kicking the air that surrounds me should be compensation enough as I lie cradled in her arms when visitors pour in as they most often do. But they’ll come to offer consolation to my family. Before they leave, they may even suggest a “there’s-a-next-time” tagline. She will be happy but “they” want a boy. Desperately and madly. But, she also knows, I’m growing into a girl inside her, like mothers sometimes know. Without reason. And, that’s why my lessons in life have begun earlier than real life itself. From the safety zone of my womb, I’ve heard my grandmother’s expletives. My father, very much a part of me, seems an alien as I see him. And, my mother’s family — ah, finally, a breath of fresh air. I think I can breathe easy here. But, wait, what do I see? Her marriage has made her the “outsider”. Even through my closed eyes I see people blinded by bias. So, while men get to carry their demi-god status on their sleeves and are worthy of being looked up to, women are destined to be looked down upon. That’s why every woman has a story she hides from the world. Because there are no real empathisers. Only self-styled gods out to take advantage. So, she’s a fighters — battling her own kind of circumstances at home and at the workplace, in buses and in markets, somewhere and almost everywhere around. Still, in spite of men being men, and despite all this animosity towards me, the girl child, I want to be born — not because I, too, have inherited my mother’s fighter instinct but because we alone make this world a better
place!
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April 7 HEALTH CARE FOR "AAM AADMI" While cities and towns have witnessed the introduction of huge medical speciality and super-speciality complexes, both in public and private sectors, primary rural health care centres have remained a pipedream M.L. Kataria The rural and the displaced migrants of rural India constitute 70-75 per cent of India's "aam aadmi", spread over nearly six lakh villages. Thirty to 40 per cent of them patiently and quietly suffer the scarcity and frugality that is the destiny of everyone below the poverty line. And yet, 70 to 80 per cent of our meagre budget for health care, both at the Centre and in States, is utilised by 25-30 per cent preferred urban sons and daughters at the cost of 70-75 per cent rural underprivileged step-children of Mother India. Towards the fag end of British rule in India, the Bhore Commission gave a skeleton health plan for India in 1946. Sixtyfive years have since passed and we have had a series of Five Year Plans. We need political will and bureaucratic accountability to give a comprehensive health care to the common man of India. Inspired by UNO in 1977 WHO resolved at Alma Ata to provide primary healthcare to all by the turn of the century. India was a signatory to this resolution and resolved to establish rural primary health centres, including basic investigative facilities for every group of 2-3 villages, within 1-2 km from each health care centre by 2000 AD. Decades have since gone by. Governments have come and gone. While cities and towns have witnessed the introduction of huge medical speciality and super-speciality complexes, both in public and commercial private sectors, primary rural health care centres have remained a pipedream. The Central Government announced yet another scheme in 2005 with a humane face and called it the National Rural Health Mission for BPL masses. In essence it is a promise for free primary health care and health insurance for hospital services for Rs 30, 000 against a premium of Rs 30 for a family of five members. To make it a peoples movement the scheme lays emphasis on maximum encouragement to NGOs at all levels for a public/private participation for primary and hospital health care for the common man.'
Only an apology Hospitalisation for any major surgery costs Rs 50,000 to Rs 1 lakh, Health insurance for Rs 30,000 for a family of five members is only an apology. Documentation for BPL registration is not only cumbersome but also a journey into wilderness. It is almost impossible for an illiterate person to go to several government departments to get registered. There has to be a single-window service. More than five years have gone by, but the National Rural Health Mission launched with a lot of fanfare, is still to find its feet. India needs more than two lakh primary health care centres for six lakh villages. Each PHC needs to cater for 2-3 villages, not more than 1-2 km from each health centre. Each PHC should operate a daily general OPD, supported by a free dispensary, X-ray, lab, ECG and dental services. Each block should have one 100-bed hospital with a medical, surgical, gynae and obstetrics and paediatrics specialist, who should also attend each PHC once a week or twice a month. Each district should have one or two multi-specialty hospitals and one or two super-specialty hospital in each state. Those below the poverty line should have free health care at all levels. Ninety per cent of ailments are within the curative scope of the rural primary health centre and the block hospitals. Hardly 5-7 per cent patients need reference to multi-specialty district hospitals, and 2-3 per cent to super -specialty state hospitals. Obviously we need to revise our expenditure and development priorities for health care accordingly for each level.
Four-tier care This four-tier health care system will channelise the patient inflow with a regulated referral system and considerably reduce primary health care workload on district and state hospitals. Private health care entrepreneurs who have only commercial interest and goals and are escalating cost of medicare need to be controlled both the by the Centre and states, to make them fit with the overall national and state healthcare plan and layout of facilities. Health care is essentially state subject, and also its budget planning, which is an exercise by itself. Nevertheless, a revolutionary outlook to raise the priority for health care is imperative, both at Centre and state levels. Dr (Brig) M.L. Kataria
(retd), Chairman cum Managing Director of Chandigarh Rural Health Care Mission that has established 20 rural health care centres in UT Chandigarh and adjoining districts of Punjab & Haryana during the last 25 years.
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Antibiotic resistance is main focus THE Theme of World Health Day 2011 is "Antibiotic resistance: No action today, no cure tomorrow". The health of people today is threatened by a growing phenomenon: bacteria that cause common and life-threatening infections are becoming increasingly more and more resistant to antibiotics -- the very drugs used to treat them. This is due to the widespread use and misuse of antibiotics in both humans and animals. WHO has called on the public, prescribers, policy-makers, the pharmaceutical industry and the food animal production sector to prescribe and use antibiotics responsibly, monitor and track antibiotic usage and resistance and promote the development of new antibiotics. We live in an era in which we depend on antibiotics and other antimicrobials to treat conditions that decades ago, or even a few years ago in the case of HIV/AIDS, would have proved fatal. When antimicrobial resistance -- also known as drug resistance -- occurs, it renders these drugs ineffective. WHO has called for intensified global commitment to safeguard these drugs for future generations. Antimicrobial resistance is not a new problem but one that is becoming more dangerous. There was much hue and cry when one of the leading medical journals, Lancet Infectious Diseases Journal, published a story about the resistant strains of bacteria and named these variants after New Delhi i.e. New Delhi Metalo-beta-lactamases. This feature in medical science is not new but when it was linked with medical tourism, it became a very hot issue for our country. Recently in February, a formal proposal to create India's first-ever antibiotic policy has been submitted to the Union Health Ministry. A high-level panel of experts, including the Drug Controller-General of India, Dr Surinder Singh, Additional Director General of Health Services, Dr H. Jani and Health Ministry Joint Secretary Mr Arun Panda, for the first time made a formal presentation of the draft antibiotic policy to Union Health Minister Ghulam Nabi Azad. Utmost importance will be given to the antibiotic policy and how to stop third and fourth generation antibiotics from being misused or used in bulk. This is a very significant milestone in our country. Under the draft policy, several drugs will now be sold only against prescription while several others would be available only for hospital use and not in pharmacies. The policy calls for the creation of a new schedule under the Drugs and Cosmetics Act called Schedule HX, which will be mentioned on the label of the drug itself as a direction to consumers and physicians. Schedule H will denote those drugs which would be given only on prescription while Schedule X denotes those drugs which will have to be kept under lock and key in hospitals. A Schedule HX drug would come with a label warning, "Dangerous to take this preparation except in accordance with medical advice and not to be sold on retail without prescription of a registered medical practitioner." As the antibiotics are the most important drugs to fight various infections of bacterial, fungal, parasitic and viral origin, it is of paramount importance that they are prescribed judiciously or else Indians would become resistant to them. The time has now come to curb irrational use of antibiotics. The draft policy will now ensure both rational and restricted use of antibiotics. The writer is Professor & Head, Department of Microbiology, Govt. Medical College Hospital, Sector 32, Chandigarh
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WHO is an "aam aadmi" in India? He is a remote rural rustic. When he grows up, he is forced to migrate to sprawling cities and towns, mainly for food, clothing and shelter. He lives in humble, inhospitable and, at times, inhuman urban periphery. He and his family are seen constructing roads, bridges, buildings and as domestic aids and engaged in various so-called class IV and III pursuits.