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ISI all
the way Debt
waiver talk, again |
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World-class
row
Corruption
and combat aircraft
NRI’s
dilemma
In India approximately 30,000 Down syndrome babies are born annually. Prenatal screening for chromosomal abnormalities is highly essential for socio-economic growth and development of the country
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Debt waiver talk, again
Going
by her media statement of Monday last, Punjab Finance Minister Upinderjit Kaur does not seem to know that the committee set up to look into the debt problem of Kerala, West Bengal and Punjab has already submitted its report. It has rejected the request of the three states for relief, saying this would encourage fiscal mismanagement and set a bad precedent. Ironically, she had demanded an early submission of the committee’s report. She was supposed to study it and go prepared for her date with the Planning Commission. She also pleaded that the tax holiday to the hill states should not be extended. The tax package expired in April last year and the Himachal leadership is pressing for its revival Instead of focussing on one or two major issues, Dr Upinderjit Kaur made too many demands. Dr Montek Singh Ahluwalia gently advised her to improve the state’s growth rate and enforce fiscal discipline. There is no convincing argument why the Centre should make an exception and write off the state’s debt when there is no effort on the part of the state political leadership to cut wasteful expenditure, raise revenue and undertake austerity measures. The state has failed to benefit from Central schemes where matching contributions are required. While ministers and bureaucrats carry on with their reckless spending ways, it is the common people who suffer the brunt of the fiscal mismanagement. College teachers are hired on contract at pathetic salaries and rural doctors’ meager salary is further cut. When former Finance Minister Manpreet Singh Badal raised the debt issue last year and claimed a conditional debt waiver offer from the Centre, the Badals expelled him from the party because – apart from the succession issue – he questioned the politics of freebies needed to win elections. The Central conditions – cut power subsidy, levy user-charges, impose house tax, disinvest in sick PSUs and CAG audit of local bodies etc – are still relevant and can provide a roadmap for fiscal recovery.
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World-class row
Environment
Minister Jairam Ramesh triggered off quite a controversy by saying that faculty at IITs and IIMs was “not world class”. The minister often says more than necessary, and in this case too, he spoke about education, which is not the portfolio that he holds. Jairam Ramesh did not back his statement with facts, and in fact it was the kind of an off-the-cuff remark that has got him into trouble in the past also. However, to be fair, many would agree with what the minister said, and indeed even Education Minister Kapil Sibal endorsed it, and added that there were, no “world class” educational facilities in India. This is, indeed, the case, and some of the reasons for this state of affairs can easily be seen. No doubt, the students who attend these institutions are top-class, largely because of intense competition they face to get admission. As for the faculty, even though many are the cream of the nation’s teaching staff, they are burdened with teaching many classes. As a result, they do not devote as much time to research. Lack of industry participation in the institutions also negatively impacts research. We do not have a tradition of professionals taking sabbaticals, and moving to industry and back. If they were to do this, it would allow for them to gain a wider perspective that enriches the institutions they are a part of. World class institutions need a vision, guidance and the right people to run them. It was Jawaharlal Nehru’s vision that resulted in the setting up of IITs and IIMs, but that was then. The world has changed now, and when a former alumni of an IIT like Jairam Ramesh speaks out, it should be listened to. Higher education in India needs to take a long hard introspective look in order to identify the ills that plague it, and then it needs to work with the government and industry, to set the wrongs right. The primary function of a wake-up call should not be eclipsed by the noisy delivery.
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The mass of men lead lives of quiet desperation. — Henry David Thoreau
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Corruption and combat aircraft At a time when the credibility of the Manmohan Singh government lies in tatters thanks to the scandal related revelations it faces on corruption, the recent announcement by the government, narrowing the list of qualified bidders, on the acquisition of 126 Medium Multi-Role Combat Aircraft (MMRCA) has happily not invited any accusations for corruption, cronyism or nepotism. This is unquestionably because of the impeccable reputation for honesty and probity that Defence Minister A.K. Anthony enjoys in India and abroad. But many like former National Security Adviser Brajesh Mishra aver that our defence procurement procedures are “antiquated and excessively time-consuming”. They argue that Mr Anthony’s fixation with his image of impeccable honesty (he is often jocularly referred to as Saint Anthony!) has resulted in serious delays in the procurement of vital defence equipment, ranging from Army helicopters and 155 mm Howitzers to combat aircraft and submarines. Mr Mishra warns that our defence planners have to note that since 2008 the Sino-Pakistan “all-weather friendship” has become a “military alliance directed against India,” for which “we may have to defend ourselves at the same time”. The IAF has a sanctioned strength of 39.5 combat squadrons. Barely 29 squadrons are operational at present. Some of these are equipped with the aircraft of the 1960s and 1970s vintage. Even with scheduled acquisitions, we will reach a level of 39.5 squadrons in 2017. We will then find that given the Sino-Pakistan alliance, the IAF requires a minimum of 45 combat squadrons. Pakistan’s Air Force (PAF) presently has 22 combat squadrons. It is set to acquire 10 to 12 squadrons of JF 17 and a couple of squadrons of J10 fighters from China. The latter is an Israeli variant of the American F16. The Chinese Air Force (PLAAF) already has 350 “fourth generation” fighter aircraft and is set to have an estimated 300 frontline combat aircraft based in the Lanzhou and Chengdu Military Regions bordering India. Despite these developments, we have proceeded at a rather leisurely pace with our defence modernisation, though in its growing fleet of Russian Sukhoi 30s, the IAF has one of the finest contemporary fighters. India has adopted a transparent process of tendering for acquiring the MMRCA. The bids came from Russia (MiG 35), Sweden (Grippen), France (Rafale), the US (F16 IN and FA 18 E/F Super Hornet) and the European Eurofighter Consortium comprising Germany, the UK, Italy and Spain for the Eurofighter “Typhoon”. Over the past two years, dozens of senior IAF officials have gone through each of these bids meticulously to see how far they fulfilled the 643 parameters the IAF had laid down. The aircraft offered have been put through rigorous flight tests in Leh (high mountainous terrain), Jaisalmer (hot desert terrain) and Bangalore, across the coastal belt. A high-level Technical Evaluation Committee laid down guidelines for offsets India expects from manufacturers, with they also required to effect substantial and substantive transfer of the aircraft’s technology, in an effort to boost India’s aerospace industry, which lags seriously behind its Chinese counterpart. Following the earlier rejection of the Grippen and MiG-35 bids, New Delhi recently announced that both American aircraft, the F/16 IN and F/A18 E/F, also failed to meet IAF requirements. The Americans argued that their fighters alone possess the unquestionably superior AESA radar, which gives them a combat edge. More importantly, the Americans have looked at the entire MMRCA acquisition in larger strategic terms. American analyst Ashley Tellis, whose knowledge of Indian defence and nuclear policies is profound, asserted: “The winner (of the MMRCA contract) will obtain a long and lucrative association, with a rising power and secure a toehold into other parts of India’s rapidly modernising strategic industries. The aircraft will play a vital role in India’s military modernisation as the country transforms from a regional power to a global giant”. There is “disappointment” in Washington at the rejection of American bids, more so as President Obama had personally lobbied with Prime Minister Manmohan Singh on this issue. Hopefully, the Americans will understand that on issues like the acquisition of the MMRCA, India will not yield to external pressures. Even the Americans acknowledge that both aircraft they offered are of relatively old vintage and cannot be upgraded any further. On the other hand, both the Eurofighter and the French Rafale are relatively new and can be upgraded substantially in future. With Pakistan already flying F16s for over a quarter of a century, there was little enthusiasm for the F16 IN offered, even though it is a much more advanced version of what the PAF flies. The F/A18 E/F failed in high altitude flight trials in Leh in early 2010. Its acquisition would have put the IAF at a disadvantage when facing the PLAAF. In some flight evaluations, the Grippen performed better than the F/A 18. Moreover, India has found US conditions of “end use monitoring” of the equipment the US supplies irksome, if not demeaning. Serious doubts also remain about American readiness for transfers of technology, which could substantially benefit our aerospace industry. The US has little reason to complain when it loses out in the face of international competition. Defence contracts with India, especially during Mr Anthony’s tenure, have been substantial and included 6 C 130 J Super Hercules, 10 C 17 Globemaster Transport aircraft and 12 Poseidon Maritime Reconnaissance Aircraft, apart from the troop-carrying ship “Trenton”. India is also set to purchase a substantial number of light Howitzers for its Mountain Divisions and consider an offer of 197 helicopters for the Army from the US after having scrapped a deal with Eurocopter following American protests. Equally, there is no cause for our worthy communists, who never tire of espousing the cause of the Chinese, while turning a blind eye to Sino-Pakistan nuclear and military cooperation, to celebrate Mr Anthony’s decision. Mr Anthony has handed out more high value defence contracts to the Americans than any of his predecessors. The Ministry of Defence appears to have understandably decided that cost will not be the primary consideration in the selection of the MMRCA. The Eurofighter was sold to Saudi Arabia at a cost of $ 123 million per aircraft - more than double that of its Americana and Russian competitors. The Rafale, priced at around $ 85 million, is also substantially costlier than its American and Russian competitors. The Eurofighter deal with Saudi Arabia was clouded with serious allegations of corruption and kickbacks. This should not be repeated in its dealings in
India.
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NRI’s dilemma I
walked
over to the autorickshaw. The driver was sprawled on the passenger seat absorbed in a juicy conversation on his mobile phone. He glanced at me and quickly put the phone down. “You Amrikan?” he yelled. I told him in Hindi that I was actually from Canada. The water bottle in my hand quickly became a vital suspect for exposing my NRI identity. I have lived in Canada for the past 26 years. However, I am a proud Indian who refused to shed his Hindi and Punjabi linguistic skills. I always try to blend in with the hoi polloi whenever I am in India. Nevertheless I have been ripped off frequently by crooked shopkeepers and shady autorickshaw drivers. Somehow they always figure out that I am an NRI. Anyone who has been away from India for a long time begins to notice certain irksome peculiarities. A distinct one is the clever queue jumper. I was standing in a line waiting to purchase bus tickets from Delhi to Chandigarh. A mischievous young man attempted to squeeze himself in front of me. There were several people behind me but no one protested. I told the opportunist to get back to the end of the line. His initial reaction was a medley of shock, bewilderment, disappointment and anger. The people behind me who had been quiet so far began complaining loudly. Not even a selfrighteous bully has the guts to face the prospects of getting lynched by a mob of travellers. He sheepishly took his rightful place at the end of the line. Like everyone else I too do not like being hoodwinked or let people taking advantage of me. It is possible that my regrettable NRI aura makes me an easy and soft target. Even the queue jumpers refuse to treat me with due respect. It took a while to realise that I will never be accepted as a hundred per cent unadulterated Indian. I decided it was time to put on my Canadian Maple Leafs tourist hat. I ended up on Palolem beach in Goa. I soaked the sun all day, swam in the ocean and lay down in front of a shack under an umbrella. The beach was littered with foreigners but I could not locate a single NRI. As I had already spent most of my life being around white people I began to feel quite at home. After watching the gorgeous sun set I walked into a busy beachside bar. I observed that I was the only Indian there. A waiter reluctantly walked over to my table. One beer wasn’t enough so I wanted a couple more. The waiters kept on ignoring me. I walked over to the bar after a few minutes. The bartender refused to look at me and kept on providing liquor to the white folks in front of his counter. The truth dawned upon me in a flash. I was an Indian and the bar wanted to restrict its customer base only to white people. Unfortunately, my Canadian passport was locked inside the safe of my resort owner. I would have loved to wave it in front of the bartender and demand a cold beer. I made a rude gesture and exited the bar. I eventually found another bar with a predominantly Indian crowd. I did not want to blend in. For a change I was feverishly praying that someone in the crowd would recognise me as an outsider and an
NRI.
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In India approximately 30,000 Down syndrome babies are born annually. Prenatal screening for chromosomal abnormalities is highly essential for socio-economic growth and development of the country
Mental
retardation, the commonest form of developmental disability, is a condition in which there is delay or deficiency in all aspects of development, i.e. there is global and noticeable deficiency in the development of motor, cognitive, social, and language functions. It affects about 1-3 per cent of the population. There are many causes of mental retardation, but doctors are able to find a specific reason in only 25 per cent of cases. Ignorance about the causes of mental retardation and social stigma and discrimination generally observed among people add to the suffering attached with it. Mental retardation, the commonest form of developmental disability, is a condition in which there is delay or deficiency in all aspects of development, i.e. there is global and noticeable deficiency in the development of motor, cognitive, social, and language functions. It affects about 1-3 per cent of the population. There are many causes of mental retardation, but doctors are able to find a specific reason in only 25 per cent of cases. Ignorance about the causes of mental retardation and social stigma and discrimination generally observed among people add to the suffering attached with it. Chromosomal abnormalities are one of the leading cause of mental retardation and physical handicap. Most chromosomal abnormalities are due to an extra copy of a particular chromosome. Other causes may be chromosome breakage or arrangement in a wrong order. Abnormal chromosomes are caused by defective development of sperm or egg cells. It is difficult to pinpoint the exact nature of the cause but one thing is for sure. There is no cure for chromosomal abnormalities and for those suffering from such disorders life-long management is required.
Abnormalities About 70 per cent miscarriages in early pregnancy are thought to be the results of chromosomal abnormalities. In some chromosomal abnormalities, the fetus survives and grows up as an individual. Down's syndrome (DS), the most common cause of birth defects, is one such abnormality in which the fetus survives during pregnancy. It is a genetic condition in which a person has 47 chromosomes instead of 46. The presence of extra chromosome is referred to as trisomy. In about 95 per cent of cases of Down's syndrome there is an extra copy of chromosome 21 and hence, Down syndrome is often known as Trisomy 21. This extra chromosome causes problems with the way the body and brain develop. Trisomy 21 presents with a wide range of mental retardation. Several other effects associated with DS include mild to severe developmental delay, heart defects, epilepsy, respiratory problems, susceptibility to infection, celiac diseases, Alzheimer's etc. Throughout the world the overall prevalence of DS is 10 per 10,000 live births. DS symptoms vary from person to person and can range from mild to severe. However, children with DS have widely recognised characteristic appearance i.e. head smaller than normal, inner cornea of eye may be rounded, small mouth, wide short hands with short fingers. Physical, mental and social development may also be delayed in children. Advancing maternal age, having had one child with DS and being carriers of the genetic translocation for DS are some risk factors which increase the risk of having a DS baby. With the advancement of science and technology it is possible to detect these birth defects during the development of fetus i.e. during pregnancy. This is done worldwide through Prenatal Screening Programme.
Biomarkers During the development of fetus there are certain biomarkers produced in the fetus which pass through the placenta and enter into the mother's blood stream. Biomarkers are proteins or hormones secreted by growing fetal parts which pass via amniotic fluid and placenta and enter into the maternal circulation. These include AFP (alpha-fetoprotein), HCG (human chorionic gonadotropin), UE3 (Unconjugated estriol) and PAPP-A (Pregnancy Associated Plasma Protein A). These biomarkers can be measured in the mother's blood during the development of the fetus. Under normal conditions there is a specific pattern of increase or decrease of these biomarkers with the gestational age. Any deviation from this specific pattern helps to recognise pregnancies at higher risk of certain abnormalities. These biomarkers are tested twice during pregnancy i.e. between 9th and 13th week (first trimester) and between 15th and 19th week (second trimester). The test for first trimester is called Dual test and for second trimester is called Triple test. The objective of screening is to segregate the test population into a low-risk group and a high-risk group. Once the baby with DS is born then throughout life the child has to be managed. There is no treatment for total cure or eliminating DS, as it a birth defect. which means that the basic unit i.e. the cells of the body have abnormal number of chromosomes, which cannot be changed. Through prenatal screening we can detect such birth defects during development of the fetus and through genetic counselling we can help the parents understand the disorder and its life-long management. The parents can further decide whether they want to continue the pregnancy or opt for medical termination. One important issue which I would like to highlight is that as per Indian law the medical termination is possible only before the 20th week of pregnancy. Hence, screening and confirmatory tests should be carried out as early as possible and before the 20th week of pregnancy, so that the parents can make an informed choice.
Various factors Prenatal screening test and calculations depends upon various factors like:-
n
Sensitivity of test It should be remembered that screening test is different from a confirmatory test. In a screening test we divide the population into low-risk group and a high-risk group, whereas a confirmed diagnosis is obtained in case of a confirmatory test. Low-risk means that chance of the occurrence of a disease is low, while high risk commands further testing to be sure that the fetus is normal. Further testing includes advanced ultrasonography, invasive testing like chorionic villus sampling or amniocentesis. In an advanced ultrasound we look for various softmarkers which are associated with congenital abnormalities and through invasive testing chromosomal number and structure are examined. It is important to note that all the testing procedures under prenatal screening must be completed within 20 weeks of pregnancy since, as per Indian law, medical termination cannot be carried out after this period.
Counselling Counselling to patients called Genetic counselling is another integral part of prenatal screening programmes. It is a continuous process where counselling is provided to all enrolled couples prior to their enrollment into the screening programme and at all stages of progress of prenatal screening to facilitate thorough understanding of the objective and process of screening procedure and the necessity of carrying out any additional testing. All tests are voluntary and informed consent is taken prior to testing. There is an urgent need of our doctors to be aware of prenatal screening programme, its importance and necessity in today's time. It should be known that prenatal screening is not just one single test. It is a complete programme where testing, interpretation of results, ultrasound evaluation, confirmatory tests and genetic counselling must be provided. Maternal and child health forms the backbone of the concept of healthy family and an essential part of the reproductive health package. Prenatal screening already forms an integral part of healthcare in all developed countries. Owing to their prevention-based approach, the mass screening programmes gain significantly over traditional treatment-based management. However, screening-for-all has shown little development in India except in very few selected centres in metropolitan cities and chiefly as private setups. India has a high birth rate and hence a very large number of infants with genetic disorders are born every year. The available data point out that in India approximately 30,000 Down syndrome babies are born annually. Once a child with DS is born, then only management is available. The responsibility of the child throughout life rests with the family of the child. There are no insurance policies in India to take care of the medical needs of the child and provide financial support. Parents often have to take the child to hospital from time to time for treatment of various defects associated with it. A handicapped child is not only a drain on the financial resources of the family but it is also extremely emotionally exhausting for the family members. Thus, physical and mental handicap in a member of the family exerts pressure on the limited resources of the family, society and the country and overall presents itself as a socio-economic burden. However, preventive screening which is an integral part of health care throughout the world offers early information about genetic disorders in the fetus. Prenatal Screening for chromosomal disorders is available since 20th century in developed countries but, unfortunately, Indian health care policymakers have not yet even considered introducing an existing preventive health care facility in our country. The magnitude of numbers and the suffering, social stigma and economic burden that these disorders exert should shake us from our deep slumber of insensitivity and inspire health policy makers to bring into focus preventive health care facilities in our country along with the existing health care programmes. Public health authorities need to organise genetic services in a comprehensive and integrated manner and promote awareness and availability of facilities so as to improve the standard of antenatal care. The success encountered by the government of India in its efforts to control communicable diseases, especially Pulse Polio Immunisation Programme can be easily replicated in case of genetic disorders if the government brings prevention-based screening into its direct focus for improving maternal and child health care. The writer is Consultant Incharge, Genetic Centre; Assoc Professor, Physiology, Government Medical College and Hospital, Chandigarh
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