The Tribune, Chandigarh, India

THE TRIBUNE SPECIALS

50 YEARS OF INDEPENDENCE

TERCENTENARY CELEBRATIONS

Thought for the day

OPINION

Naxalites’ audacious attack on Naidu-I
PWG is even looking beyond Andhra
by P.V. Ramana
ATTACKING the Chief Minister of Andhra Pradesh, Mr Chandrababu Naidu, on October 1, 2003, is most spectacular act that Naxalites of the People’s War (formerly People’s War Group or PWG) have carried out till date. The rebels have not only proved that they have the ability to strike at locations far away from their traditionally known strongholds but also that they were poised to expand their influence beyond the state boundaries.

MIDDLE

The civic sense
by P. Lal
THE doorbell rang. The occupants of the apartment turned apprehensive. Locale: San Francisco. Time: 11.30 in the night; April, 2001. The master of the house, an NRI (non-resident Indian) from Punjab — a turbaned Sikh — peered through the peephole. He froze in his pants. His worst fears had come true. There was a cop at the door.

IN FOCUS

The state of medical institutions — 1
A badly bruised PGI needs a healing touch
Shortage of doctors, nurses adds to patients’ troubles; no cure in sight
by Nirmal Sandhu
UNSAVOURY developments in the recent past have dented the image of the PGI, Chandigarh. For the first time in its history, the Director has been told to proceed on leave. For the first time again, an OSD of the Health Ministry has been deputed at the PGI to monitor its functioning. The PGI is certainly not what it used to be.

Too many patients
No holidays

REFLECTIONS

EDITORIALS

Blow to hate crimes
Roque joins Dara in death row

AN American jury deliberated for a little over a day before deciding on the death penalty for the man who killed a Sikh gas station owner in retaliation for the 9/11 terror attacks in 2001. Frank Silva Roque, 44, will die for killing Balbir Singh Sodhi, 49, a father of five. Last month a court in Orissa had sentenced Dara Singh to death for burning alive an Australian missionary Graham Staines and his two sons in January, 1999. Given the enormity of the gruesome acts, the death penalty for Dara Singh and Roque should be seen as powerful blows against promoting racial and religious hatred. The source of the venom of Staines' killer could be traced to the political viciousness that was brought into the campaign of an essentially religious issue. The source of hatred in America lay in the terrorist attack on the twin towers of the World Trade Center in New York that killed about 6000 persons from diverse nationalities and faiths.

Records of hate crimes during the post-9/11 period in America show a 17-fold rise in anti-Muslim and anti-Arab attacks despite vigorous efforts by officials to contain the wave of violence. Even non-Muslims and non-Arabs were advised to shave off their beard to avoid being attacked by hate groups. Sodhi was mistaken for a Muslim because of his beard by Roque, who shot the immigrant from India in cold blood. He also attacked an Afghan family and a Lebanese-American gas station employee. It is perhaps a combination of historical and geographical factors that has taught Punjabis, particularly the Sikhs, the importance of closing ranks in moments of crisis. Within days of the targeting of Sikhs in several 9/11-related incidents, President George W Bush received a delegation of community leaders to assure them protection against future attacks. More significantly, the Sikh leaders made American lawmakers condemn the acts of bigotry and even managed introduction of an anti-hate crime legislation.

It would be a colossal error to confuse hate crimes with the more organised acts of terrorism. The judiciary of the two greatest democracies has shown ways to tackle hate crimes by awarding the extreme penalty of death for killing fellow human beings for their colour and their faith. But equally important, perhaps a shade more, is the need to create social and community awareness about how to cope with incidents like 9/11 or propaganda that arouse feelings of hatred against others. India can learn important lessons from the school-level initiatives taken by Canada for nipping racial and religious hatred in the bud. The programme is clearly part of a well thought out process of helping Canada become an integrated multi-cultural, multi-ethnic and multi-religious country.

Between 6 and 8
Unwarranted exuberance on the economic front

AN excellent monsoon this year has certainly spread cheer all round, but government officials tend to make exaggerated claims, particularly when it comes to the GDP growth figure. The fact that it is the rain gods that still decide which direction the economy would take and the government has a limited role to play does not deter them from going overboard. While Dr Bimal Jalan, a former Governor of the Reserve Bank of India, has projected a more acceptable growth rate of above 6 per cent for the current financial year, the Chief Economic Adviser, Mr Ashok Lahiri, has scaled up the annual growth rate to 8 per cent, which is rather on the high side. Such exuberance on the economic front may be partly due to electoral considerations. Spreading good economic news does help generate a “feel good factor” among the citizens that is expected to translate into more votes for the ruling party.

There may not be two opinions about the fact that the economy is picking up. Agriculture is estimated to grow at 7.05 per cent, significantly up from the level of 3.1 per cent last year. While the indirect tax mop-up may meet the target, direct tax collections have crossed last year’s figure. The real good news comes from the sharp rise in the inflow of investments by foreign institutional investors (FIIs) in the stock markets. The Supreme Court’s judgement upholding the grant of tax exemption to Mauritius-based foreign funds is likely to further boost foreign investment in this country. Better-than-expected corporate results in the second quarter and visible signs of recovery in the US and Japanese markets are other positive signs that will keep the investor mood upbeat.

However, everything is not all that optimistic. There are some worrying factors that may upset all calculations and slow down the growth of the economy. Inflation is inching up. The average fiscal deficit to the GDP ratio may decline from last year’s 5.9 per cent to 5.3 per cent, as is estimated by the NCAER (National Council of Applied Economic Research), but it is still very high and a cause for concern. The government’s disinvestment policy stands derailed following the Supreme Court verdict on the selloff of HPCL and BPCL. The government is unlikely to take any bold initiative until the general election next year. That effectively means the next government at the Centre alone would decide on the pace and nature of economic reforms to be followed.

Thought for the day

We do not aim to correct the man we hang; we correct and warn others by him.

— Montaigne

OPINION

Naxalites’ audacious attack on Naidu-I
PWG is even looking beyond Andhra
by P.V. Ramana

ATTACKING the Chief Minister of Andhra Pradesh, Mr Chandrababu Naidu, on October 1, 2003, is most spectacular act that Naxalites of the People’s War (formerly People’s War Group or PWG) have carried out till date. The rebels have not only proved that they have the ability to strike at locations far away from their traditionally known strongholds but also that they were poised to expand their influence beyond the state boundaries.

A preliminary study conducted by this writer on left-wing extremist violence in India as part of an ongoing project of the Observer Research Foundation reveals that the Naxalites have been clearly following a policy of carefully planned expansion into newer areas, consolidation in the existing pockets of influence, and re-emergence in parts from which they have been ejected. At the same time, they have been systematically enhancing their lethality and adding to their finances and cadre strength. The attack on Mr Naidu is part of this strategy. In fact, the attack comes in the wake of the death in an encounter of a top Naxalite leader, Polam Sudarshan Reddy “Ramakrishna”, in April 2003 in Adilabad district.

On many occasions in the past, the PWG has killed important political leaders and senior police officials in well-coordinated and meticulously planned operations. The then Panchayat Raj Minister, Mr A Madhava Reddy, who had served extended terms as the state’s Home Minister, was killed in a landmine blast on the outskirts of the state capital, Hyderabad, in March 2000. A former Speaker of the state, D Sripada Rao, was shot dead in April 1999, in his native Karimnagar district. Assistant Inspector-General of Police Chedalavada Umesh Chandra and the founding chief of the elite anti-Naxalite force, Greyhounds, K S Vyas, were killed in broad daylight in Hyderabad.

Evidently, the rebels carefully choose their target and make a lot of advance preparation before striking. It is believed that preparations for the attack on Mr Naidu commenced at least a year ago. The PWG cleverly chose a bend on the road and planted 17 claymore mines in a steel pipe that would act like a canon when triggered. Of those, eight exploded leaving Mr Naidu’s car in a mangled mess, and damaging the other vehicles in the convoy, besides leaving a thick pall of smoke. A similar attack was conducted in July 2001 on Yeturunagaram police station in July 2001. Furthermore, Mr Naidu’s security officials seem to have been driven into the misconceived notion that the PWG would attack him from close quarters, but not in a landmine blast. Also, Chittoor in the Rayalseema region was never known to be a PWG area of operation, let alone stronghold. The police there was caught napping. Unfortunately, unlike in Telengana, the PWG’s traditional stronghold, the police as well as the civil administration are not adequately sensitive to the rising trend of Naxalite presence and violence in their jurisdiction, as in some other parts of the state.

The PWG has a presence — negligible or formidable — in all of Andhra’s 23 districts. Within the state, the PWG claims that it has established special guerrilla zones in North Telengana, South Telengana, Nallamala and north-coastal regions. Presently, the PWG is battling for survival in its former strongholds, attempting to make ingress into new areas and struggling to revive its activities in areas from which it has been ejected. Within the organisation, weeding out coverts and retaining cadres has been a major challenge to the rebels.

In the wake of intense anti-Naxalite operations in Telengana, the PWG has moved to coastal Andhra and Rayalseema. Also, the rebels have expanded to Chhattisgarh, southern Orissa and parts of Maharashtra, all bordering Andhra Pradesh. To make matters worse, the PWG is banned in Andhra, while there is no such curb either in Chhattisgarh or Orissa where the activities of the PWG have been spiralling for the past two years and more.

Besides, the police in many Naxalite-affected areas does not have adequate capability to foresee an impending threat or adopt imaginative tactics to defeat the rebels. The state has always been reactive while the Naxalites continue to seize the initiative. Moreover, the authorities think that the Naxalite problem can be managed. Therefore, laxity creeps in while the rebels gradually expand their presence. Once they enter an area, the PWG Naxalites force the structures of civil governance into retreat. Their declared objective is to paralyse and eject structures of civil governance in order to attain and retain unquestioned sway over such regions.

They then indulge in extortion, abductions for ransom and killings, and hold kangaroo courts, feeding upon the grievances the people have against the government — that it has neglected them and has been responsible for their continued deprivation.

Thus, projecting themselves as friends of the people, the PWG rebels entrench themselves in an area. Thereafter, they seek to bolster their cadre strength and coffers. One estimate holds that the PWG earns around Rs 70 crore annually through extortion in Andhra alone. The PWG is active in nine states in India.

The PWG utilises a portion of that money to built its arsenal. It runs its own arms factories in thick jungles. The rebels began their campaign of violence using farm implements. Now, they can actually service an AK series assault rifle and manufacture an SLR. Furthermore, the designs of an RPG were recovered from a PWG dump in the Orissa-Andhra border area a few weeks ago in 2003.

The Maoist insurgents of Nepal, who had looted an RPG from the Royal Nepal Army in September 2002, might have passed on the RPG design to the PWG. The PWG and the Maoists are among the leading members of the Coordination Committee of Maoist Parties and Organisations of South Asia (CCOMPOSA), a group whose formation was announced on July 1, 2001. The CCOMPOSA was formed with the explicit objective to unify and coordinate the activities of Maoist parties and organisations in the South-Asian region. The idea was reportedly floated during the late 1980s-early 1990s.

The writer is a Research Fellow with the Observer Research Foundation, New Delhi. The concluding part of his article will appear on Monday

MIDDLE

The civic sense
by P. Lal

THE doorbell rang. The occupants of the apartment turned apprehensive. Locale: San Francisco. Time: 11.30 in the night; April, 2001.

The master of the house, an NRI (non-resident Indian) from Punjab — a turbaned Sikh — peered through the peephole. He froze in his pants. His worst fears had come true. There was a cop at the door.

Earlier in the evening, the NRI and his wife had taken out their guest from India, to a nearby restaurant for drink and dinner. They had walked up the distance.

On the way back, the guest felt the urge to go for the corner. However, there was no restroom (as public conveniences are known in North America) in sight anywhere. He tried to exercise control, but unable to hold on for long, eased himself by the side of a wall of a house nearby. Being quite late in the night and nobody around there to notice, he thought he would get off an act which he knew was violative of the local municipal law.

The NRI unlatched the door. The cop stepped in.

“Sir, you have a cleanshaven man with you, dark and medium built”, the cop confronted the NRI who could see over the cop’s shoulders, a police patrol car parked on the street.

The guest came lumbering from the adjoining room. His face was ashen.

“Sir a little while ago, you had pissed around the corner while on your way back”, the cop accused him. “Thereby you have violated the local law”, he added.

The guest, after initial hesitation, admitted the guilt and pleaded, “I am to emplane tomorrow evening for journey back to India. If I get involved in a police case, I shall have to miss the flight. I am extremely sorry for what I did, I shall never repeat it.”

The cop checked the papers of the return journey and flashed him a smile. “Okay, guy, I trust you keep your words.”

As the cop turned around to go back to the patrol car, the guest from India stopped him in the tracks.

“But how did you come to know of it?”, he asked the cop. “There was nobody around there at the time”. he elucidated.

“No, sir,” the cop replied, “There was a lady watching you through the window of her fourth-floor-apartment, who called the police control. They, in turn, radioed to our car. And,we followed the leads to be on your heels.”

The cop smiled again at the Indian guest and walked back to the car.

IN FOCUS

The state of medical institutions — 1
A badly bruised PGI needs a healing touch
Shortage of doctors, nurses adds to patients’ troubles;
no cure in sight
by Nirmal Sandhu

Patients come to the PGI from far-off places due to poor health infrastructure in the region. — Photo by Manoj Mahajan

UNSAVOURY developments in the recent past have dented the image of the PGI, Chandigarh. For the first time in its history, the Director has been told to proceed on leave. For the first time again, an OSD of the Health Ministry has been deputed at the PGI to monitor its functioning. The PGI is certainly not what it used to be.

The root cause of the problem, as one gathers from talks with senior faculty members, doctors and well-wishers of the institute, is that the Director, Prof S.K. Sharma, and five pillars of the PGI — the Medical Superintendent (MS), the Dean, the Deputy Director (Administration), the Financial Adviser and the Superintending Health Engineer — did not operate as a team. The captain did not carry the team along.

Professor Sharma chose to run the institution with the help of “non-faculty administrators”, distancing senior faculty members. No one accuses him of corruption. But many believed that a relation also working in the PGI was, as a senior doctor put it, “an albatross round his neck”. Powers got centralised in select hands. Transparency was missing. A number of top appointments — that of the Dean, for instance — have been challenged in court. When reached on the telephone, Professor Sharma refused comments, saying he was on leave.

The PGI faced an inglorious moment when unaccounted stocks of stents, pace-makers, balloons etc worth about Rs1 crore were found in the cath lab and a CBI inquiry was ordered. The cath lab in-charge, Dr H.K. Bali, and the Cardiology Department head, Dr Anil Grover, did not display the maturity and dignified conduct expected from senior doctors and went public with their differences. While the CBI inquiry report, yet to be made public, alone will pinpoint the guilt and the guilty, Dr Bali has regained charge of the cath lab after Professor Sharma’s departure from the scene.

The events that followed were no less shocking. In a dramatic incident, a video film was made of a patient, allegedly provoked by the wife of a senior doctor to level serious charges against a colleague of her husband. Then parking lots were allotted on a lower bid of Rs 12 lakh against the highest offer of Rs 18 lakh. As the issue became public, the allotment was cancelled. The demolition of part of a religious place could have led to a serious trouble on the campus, but the controversy died down after a brief blame game.

What has led to Professor Sharma’s forced leave and handing over of temporary charge to Prof N.K. Ganguly, Director-General of the ICMR, was the appointment of a nephew of the Director as a junior engineer and subsequent extensions to him in utter disregard of the rules. Professor Sharma’s opponents — prominent and more vocal among them, Mr Suresh Chandel, a BJP MP and member of the PGI Institute Body — exploited every administrative lapse to get even with him. The ailing PGI can recover fast and avoid falling from grace in future if politicians are kept away from the Institute Body.

The presence of Professor Ganguly did have an immediate sobering effect on the faculty. On Monday (October 6) he counselled the heads to run their own departments. He has made it known that he favours decentralisation of powers. Elaborating on autonomy, he told The Tribune that he would work in consultation with senior faculty members.

Conceived in 1960 by the far-sighted Nehru-Kairon duo, the PGI (Post-Graduate Institute of Medical Education and Research) came into being on July 7, 1963, when the Nehru Hospital was inaugurated. Its growth in terms of patients and infrastructure has been phenomenal. Some 10 lakh patients attend the OPD every year. Five thousand operations are performed each year. On an average, 110 x-rays and 125 ultrasound scans are carried out daily. And 5,109 candidates have so far obtained the M.D., M.S., D.M., M.Ch. and Ph.D. degrees.

Too many patients

The large number of patients that the PGI draws heavily burdens its infrastructure. Dr B.K. Sharma, a former Director of the PGI, attributes the patient rush to lack of dependable health infrastructure in the region: “The medical colleges at Amritsar, Patiala, Jammu and Shimla do not inspire faith and confidence among patients. Once when it was attempted to restrict the PGI to referral cases only, patients started bribing doctors to get referred here. In India it is the patient who decides where he will get the treatment”.

One common problem that attendants of patients voiced was that they have to run around to get lab tests done, collect test reports, buy medicines and locate doctors. Each patient requires at least two attendants. Outside patients are particularly put to inconvenience. Though there is a gurdwara offering langar, a serai and a dharamshala on the campus, attendants stretch themselves wherever they can find space.

In DMC, Ludhiana, if you know just the name of a patient, you will be immediately told where he or she is. That is because of computerisation. The PGI is expected to take at least two years to achieve computerisation, says Mrs Meeta Rajivlochan, DDA. A proposal to this effect is awaiting a financial go-ahead. At least 5,000 employees will be trained and the training will start shortly.

The shortage of nurses contributes to the inconvenience caused to patients and attendants. Dr A.K.Gupta, Medical Superintendent, says the PGI has 1,200 nurses and 200 posts are vacant due to absenteeism and resignations. Applications are being processed for new appointments.

Lack of awareness is behind many misgivings that patients or their attendants have about the medical fraternity. A few patients complained of multiple tests, but doctors said for multi-dimensional treatment requires such tests. Partiality is alleged in the allotment of rooms. However, the MS says there are 80 rooms excluding those for the staff and 50 per cent allotment is done on merit and 50 per cent to deal with emergency (read VIP) cases.

Another wrong notion prevalent is that patients are taken care of by junior doctors only. To this junior residents said whatever they do is in consultation with seniors and the level of supervision is as high as anywhere. A patient can withdraw at any stage if he is not satisfied with the treatment. Professional ethics are strictly followed.

No holidays

The resident doctors constitute the backbone of the PGI and it is they who face the maximum pressure of patient care. According to the Association of Resident Doctors, the members have a 14-hour working day on an average and they have no holidays. The hectic work schedule leaves them with hardly any quality time for themselves. No time for hobbies, not even for yoga. Due to the high level of stress and exposure to patients, the incidence of TB among the junior doctors is double the national average.

And yet their salary is inadequate (Rs 14,000 pm), lower than that in the AIIMS (Rs 17,000), where their counterparts enjoy holidays and have an easier work schedule. Doctors recall the Bakshi committee, which recommended the salaries of technocrats be on a par with that of bureaucrats, but the bureaucracy not only got the report spiked, but also ensured a punishment posting for the committee head.

The virus of red-tape has also hit the PGI efficiency. Complaints of delayed supply of equipment and material needed urgently for research are common. A department head can buy material worth Rs 2,000 on his own and worth Rs 10,000 by inviting quotations. These amounts hardly serve any purpose because of the high cost of medical material and instruments. More financial autonomy is what many demand, but hardly believe it would happen.

That the tiresomely dilatory procedures have continued for years despite the Directors themselves having suffered these is what is surprising. A sophisticated equipment committee first assesses the genuinness of a department’s expressed need for material. Then there is a lower purchase committee and another higher purchase committee. The purchase rules are not practical. MNCs insist on following their own sale procedures which sometimes conflict with PGI rules resulting in delays. The authorities make do with other suppliers and compromise on quality.

Civil project delays cause much more damage due to cost overruns. An advanced cardiac centre was the first project sanctioned in the Ninth Plan and Rs 45 crore was earmarked. Six years later the project is yet to be completed. Fund shortage is often cited as a reason for project delays.

However, Dr B.K. Sharma does not accept this excuse and asserts: “Let me state with a full sense of responsibility and as the head of a department for 20 years that funds have never been a constraint in undertaking a project. Actually, funds often remain unutilised and lapse for want of right initiatives. The processing of projects is slow”.

Sounding a cheerful note, the head of a department said there was no need for feeling pessimistic. It was not that the PGI has “lost its glory”. “But at the same time I want that merit must be honoured. Today’s middle level will constitute tomorrow’s top”, she said and added “The long-term consequences of ignoring merit will be disastrous for the institute.”

Despite problems, the PGI still remains one of the finest institutions of medical education and research that also provides reliable tertiary care. PGI doctors have won top awards: Padma Bhushan: P.N. Chhuttani; Padma Shree: P.L. Wahi, K.S. Chug, R.R.Choudhary, RVS Yadav, Amrit Tewari. Prof N.K. Ganguly has won the G.D. Birla and Ranbaxy awards. The B.C. Roy Award has gone to at least 15 doctors.

The Medical Superintendent claimed that the PGI has an efficient waste management system in place. Each patient generates 2.1/2 kg of waste, 80 per cent of which is non-infectious. Waste is segregated at the source, collected in yellow, red, blue and black bins kept in different departments and toxic waste is treated before disposal.

The PGI functioning has actually improved in some areas. For instance, the level of sanitation has gone up. A number of new projects are coming up: an advanced eye centre, a trauma centre, an advanced urology centre, a bone marrow transplant centre, a drug de-addiction centre, a multi-level parking for the new OPD, a new mortuary and a new convention centre.

Well-wishers of the PGI demand that the atmosphere of uncertainty and ad hocism that breeds rumour-mongering, affecting study and research, should be put to an end and a healing touch be given to the institute by immediately beginning the process of selection of the new Director since Professor Sharma retires in March next year.