The Tribune, Chandigarh, India

Sharper accountability
Punjab’s new Bill may improve govt services

THE unanimous passing of the Right to Service Bill 2011 by the Punjab Assembly on Wednesday is a momentous step towards ensuring greater accountability of the bureaucracy in the provision of services to the citizen. That 67 services, including 20 pertaining to the police department, have been brought under the Bill, which provides for time-bound delivery, is indeed heartening for the common man who currently has a harassing time in getting basic services at the government’s door. If what Deputy Chief Minister Sukhbir Badal said while steering the Bill is taken at face value, any citizen who does not get his document on time can appeal and the government will recover the fine from the salary of the official responsible for delay. If this is scrupulously followed, it would be a big boon for the citizen and would ensure greater accountability of those dealing with the public. But how this will pan out in actual practice remains to be seen because it would entail a whole new culture in governance as opposed to the current casualness of approach in government departments.

That the Congress party cooperated with the Akali-BJP government in getting the Bill through unanimously is heartening. Indeed, some of the apprehensions expressed by opposition legislators deserve to be taken seriously. The counsel that the chairman of the commission and its other members should not be appointed on the basis of their allegiance to the government is a perfectly valid expectation. Another suggestion that the disposal of applications made to the police should be made time-bound and inquiries by the police should also have a time limit will doubtlessly fulfil a crying need to make the police more accountable. Deputy Chief Minister Sukhbir Badal’s assurance that the opposition would be consulted in the appointment of the commission’s chairman was also in the right spirit.

However, the proof of the pudding lies in its eating. Ever so often a seemingly well-intentioned law ends up as being either non-functional or ineffective or partisan. The onus is now on the government to ensure that the impending law is implemented in letter and spirit.

Tablet for the masses
An Akash grounded in reality

AKASH, a new tablet made in India and targeted at Indian students, has made waves internationally since it comes at an astounding low price tag, and has much to offer. For Rs 2,250 you get a seven inch tablet that will run on the time-tested Google Android 2.2 (Froyo) and has an 800×480 resolution, two USB ports, and 256 MB RAM. It also has a flash memory of 2GB, which can be increased later up to 32 GB. Now, none of these is cutting edge, but then, you are getting a tablet at a price that is just a fraction of the cost of a smart phone, let alone any other tablet.

The device has shown that it is adequate for normal computing. In fact, you can see video fairly well on it. Akash should not be compared with any hi-end product like an iPad, a Samsung Tab or a Kindle, as it is not meant to compete with them at all. But it has the potential to open thousands, rather, millions of digital doors for inquisitive young minds. Digital divide is an ugly reality that is normally glossed over, more so in India where an overwhelming majority of people do not have any access to computers or allied devices. As the experience with mobile telephony has shown, the masses take to technology in ways that are difficult to envisage when it is originally introduced. All they want is that it should be affordable, and should function reasonably well.

The new tablet is a good example of how the government and the private sector can work together. Of course, it is a beginning. The product will have to prove its hardware, but that’s the easy part. Any tablet is primarily a consumption device, thus, the content will have to be tailored for the tablet so that it becomes the educational devise it has been envisaged as. New content will have to be created for it, as well, keeping in mind the hardware limitations that the tablet has. Having proved sceptics wrong, now the government and its partners must make every effort to make the device truly useful for students, as well as the general public.

Thought for the Day

Here is the test to find whether your mission on earth is finished. If you’re alive it isn’t. — Richard Bach

ARTICLE

Myanmar towards civil war
Suu Kyi has a major role to play
by Medha Chaturvedi

Myanmar is amidst transition, and is desperately making efforts to improve its image internationally. The country’s pro-democracy movement leader, Aung San Suu Kyi, has again become active with her first political visit across the country and her meeting with the President and the Labour Minister.

Is Myanmar undergoing a political transition which will make the country more accommodating to different interest groups? Or, in the shadows of a change, is the Myanmar government just buying time before it strikes at the dissidents again? What could be Suu Kyi’s role in this emerging scenario? Are the Myanamarese refugees taking the government efforts seriously? Where do the ethnic minorities stand? Finally, where is Myanmar heading towards?

The government’s efforts are being met with scepticism from international agencies as well as Myanmarese refugees. However, the apparent involvement of Suu Kyi in the political process has caused optimism. Her first political tour outside Yangon to Pegu and Thanatpin town was concluded in August, the first such allowed by the present government since her house arrest. This was followed by her interaction with the Union Labour Minister, U Aung Kyi, and, subsequently, President Thein Sein.

However, with this new-found voice, now the primary agenda for Suu Kyi must be the integration of ethnic minorities of the country. The ethnic minorities have been fighting against the government and have no trust in its intention of bringing about a unified Myanmar. However, their faith in Suu Kyi remains, and the government must capitalise on this to resolve the conflict.

President Sein, in August, declared that his government encouraged refugees to return home. He said the returnees would be treated with leniency for all offences except murder. According to a Refugees International estimate, there are almost 3.5 million displaced persons. The refugees are sceptical about the government’s commitment as over 2,200 political prisoners who were detained during various pro-democracy movements are still incarcerated.

There is also the problem of what the government can offer the returnees if they do decide to come back. Without assurances of safety on return, employment, financial and economic rights and social integration, the refugees will not be safe or productive to the nation-building process.

The President of the All-Burma Students League (India), Kyo Than, echoed the sentiments of most Myanmarese refugees, “This is just a political stand the government is taking. They are not really interested in getting the displaced people back. How can we trust the government without an official ordinance on this issue? Politically, there is not much of a difference, whether the Generals are ruling the country with the uniform or without it.”

The refugees are not in favour of moving back to the country yet. The general sentiment is that of scepticism and fear. While they are still considered citizens of the country, on return, how many constitutional rights they manage to enjoy is unclear. In addition, many of them fear unfair trials and subsequent imprisonment, or, worse still, execution, on return. They are also not convinced that they would be allowed to participate in the country’s political process in any form because of the numerous disqualifications under the seemingly flexible (in favour of the military) election laws.

Myanmar’s ethnic minorities were an integral part of Gen Aung Saan’s agenda for the integration of the Union of Myanmar as they form 40 per cent of the total population. They have been unsuccessfully fighting for greater regional autonomy and political rights. In last year’s union elections, several members of these minorities were excluded from voting because of internal displacement. Also, polling in five major ethnic states was cancelled due to internal disturbances.

Currently, most of the ethnic minorities are fighting the new government through the armed ethnic armies, which the administration calls ethnic rebel groups. These ethnic armies are primarily concentrated along the borders of the country and have been conducting large-scale offensive at the army since the new government’s formation. Most of the ethnic armies rejected the government’s ceasefire agreement and do not seem to be inclined towards having any talks with the incumbent government. This is also because, despite the government’s call for peace talks, heavy offensive by the Myanmarese army continues in Shan and Kachin states.

Moreover, the United Nationalities Federal Council (UNFC), a confederation of the armed groups formed in the beginning of 2011, has rejected the government’s talks on account of non-inclusion of all groups. (The government has offered conditional peace talks with individual armies.) In 1989, too, the government had signed individual ceasefire agreements which the ethnic armies are not looking for now.

In addition, Suu Kyi, despite all her declared intentions, has not been able to convene a common forum for all ethnic armies to come to and discuss their demands with the government. Since her release, she has indicated a willingness to convene a second Panglong-like conference for ethnic minorities, but, so far, no concrete steps have been taken in this direction. The pro-democracy leader’s open letter, issued on July 28, calling for an immediate end to fighting in the country’s border areas, indicate her willingness to work with the government on ending the stalemate. The more time passes by, the more frustrated the ethnic armies will continue to get. Suu Kyi’s restrained actions may lead to disillusionment in the ethnic armies and the fighting is likely to continue until such a meeting is convened.

Myanmar is now ready to engage the international community despite criticisms. This is evident in the invitation the government extended to Tomas Ojea Quintana, the UN Human Rights Envoy, for a five-day visit in August to assess the developments in the country. Quintana was denied a visa following his last trip to the country in February 2010, when he accused the then ruling military junta under Gen. Than Shwe of gross human rights violations and war crimes.

The government at present seems to be aiming at a system of disciplined democracy with checks and controls in place. However, refugees and the international community have fears that this may end up being a benevolent (or not) dictatorship which will prove to be counter-productive. In addition, government efforts towards a national reconciliation are being scrutinised critically due to its double standards on issues like the return of the exiles, the fight against the ethnic armies and the release of political prisoners.

Suu Kyi’s role is now even more important as she is not only the symbol of democracy in Myanmar, but also the only link to the West. Therefore, showing a lenient and more open attitude by the government towards her will help in building bridges with the West. As a result, it may lead to the revocation of sanctions which will help the country recover economically.

While Suu Kyi is now enjoying greater freedom and visibility, chances of her involvement in active politics are non-existent due to the various disqualifications under the 2008 constitution, preventing her from any active participation in the country’s political processes, even in future. She must now take on the role of a leader in civil society, and engage the government productively for an effective nation-building process. She also must find a way to bring together the ethnic minorities and build trust in them regarding the incumbent government because if the internal fighting continues in the country as it is, Myanmar may be heading for a civil war.

The writer is associated with the Institute for Peace and Conflict Studies, New Delhi.

MIDDLE

Is honesty the best policy?
by Rachna Singh

AS children we were brought up on Aesop’s fables, Panchatantra tales and ‘sakhis’, all of which emphasised the ultimate triumph of honesty and truth. In school, moral science classes also taught values of honesty, humility and goodness.

Not to be outdone, our parents inculcated in us the belief that ‘honesty is the best policy’. It was not surprising then that I carried all these idealistic values to my parenthood as well. I drilled these values into my children like an unsympathetic drill sergeant. The poor mites accepted it as gospel truth. But in my desire to paint honesty in rosy hues I forgot the Biblical Abraham and failed to warn them about the pitfalls of honest-to-god truth.

What happened thereafter was inevitable. One day my son (then all of four years) came home from school in tears because the teacher had punished him for not completing his home work. I asked him what excuse he had given the teacher for not doing his work. He looked at me askance. ‘What excuse?’ he sobbed: ‘I told her the truth’, the truth being ‘I didn’t feel like doing my work’.

My daughter’s brand of honesty was no different. Once I took her along to call on a senior colleague. As a courtesy I carried a box of pastries and flowers. After the usual small talk, I prepared to leave but my four-year-old daughter refused to budge despite my repeated glares and nudges. My amused boss asked her: ‘Beta kya baat hai?’ She responded with a mischievous ‘My return gift’. This earned her a smack from her embarrassed honesty-loving mother.

But as the children grew their questions about honesty came thick and fast. Commenting on my penny-pinching ways they would often point to a colleague’s luxurious living and advise me: ‘Uncle earns a larger pay-packet. Why don’t you get the same post?’ How could I explain to them the nuances of the not-so-honest living that had taken root in our society? So I glossed over it.

But as the years went by the young mites saw their beleaguered parents struggling to survive in a Janus-like society which preached honesty but provided incentives for dishonesty.

When Anna Hazare’s anti-corruption campaign made waves, my children were thrilled. With a naivety born out of idealism and inexperience they believed that like Gandhi, Anna would have his way and corruption would be rooted out. I did not have the heart to tell the ‘Harry Potter’- inspired generation that there was no ‘Elder wand’ to magically remove corruption. It was a long struggle and there was no guarantee that honesty would triumph over dishonesty. But I dread the day when they will turn to me accusingly and ask: ‘Is honesty the best policy?

OPED health

Weight-loss surgery
Myths and facts
Dr Atul N.C. Peters

As with any surgery, weight-loss surgery carries risks. But modern technology has made bariatric procedures relatively safe. In a study of 66,000 obese people over five years, those who elected to have bariatric surgery lived longer than those who did nothing

Weight-loss surgery is in the news almost daily. In my line of work, I often field questions from patients, neighbours, concerned relatives and strangers, and it never ceases to amaze me how little people understand about bariatric surgery (weight loss surgery). In this column, I intend to answer the common misconceptions about this type of surgery.

Obese people get surgery because they’re lazy
On a personal level, this misperception annoys me the most. By the time these people come to my outpatient clinic, they have tried every diet available. They have suffered immense social, emotional and psychological stress, and they want nothing more than to rid themselves of the excess body weight they carry.

Important Considerations

z These weight loss procedures are in no way to be considered as cosmetic surgery. These procedures are done as the only effective way to improve health and reduce long-term risks of developing associated co-morbidities.

z The surgery does not involve the removal of adipose tissue (fat) by suction or excision. Contrary to popular belief the patients do not come out of the OR magically transformed. Liposuction is a body shaping surgery, where the focus is on improving looks rather than losing weight. The most weight loss which can be safely achieved with liposuction is about 5 – 8 kg, and that too from the subcutaneous fat. Bariatric surgery on the other hand focuses on a more gradual but permanent weight loss, with fat reducing from all parts of the body, particularly the visceral component of fat which is more dangerous.

z A decision to elect surgical treatment requires an assessment of the risk and benefit to the patient and choosing the appropriate surgical procedures. Not all patients are emotionally or physically suited to undergo these procedures. A careful pre-operative analysis and education of the patient is essential to have realistic expectations regarding outcome and achievable targets for weight loss.

z The success of bariatric surgery is dependent upon long-term lifestyle changes in diet and exercise. Remember, surgery is only a tool to achieve weight loss. It must be combined with a strict adherence to the prescribed diet and exercise protocols to get the desired results. The major difference between lifestyle changes attempted before surgery and after is that post surgery; the attempts at weight loss are more successful and permanent.

z Problems may arise after surgery that may require re-operations. No procedure is without its downside. The only reason to undergo the surgery should be if the perceived risk to life and health is higher without surgery and with continued morbid obesity, as compared to the risk of getting the procedure done.

z Post-operatively, anastomotic leaks, obstruction, pulmonary complications, or clots in the veins of the legs may happen. Some common minor early complications include regurgitation and dyspepsia, dehydration, or constipation. Later problems that may be seen include vitamin or mineral deficiencies requiring supplementation, sagging skin, and even weight regain if lifestyle modifications are not carefully followed.

Due to an individualised interplay between genetics, environment and behaviour, these patients have realised that their best chance of living a normal life is to resort to a band, sleeve or bypass. This is based upon the scientific facts reached after hard work and prolonged research.

There is a hormone Ghrelin, which is produced by the gastric cells. This hormone rises to a great extent when a person is fasting or dieting. So there is a vicious cycle of fasting episodes followed by overeating and in the long run it results in an increase in weight. Bariatric surgery removes the source of this hormone so that the urge to eat more and more after dieting is gone. So it hardly matters whether a person is active or lazy.

Instead, post-operatively the patient is required to do a lot of hard work and routine exercise with a healthy diet schedule. So, ironically, bariatric surgery helps the lazy lads to attain an active lifestyle.

Weight-loss surgery helps people shed those extra 20 kilos
Many people don’t realise that gastric banding, sleeve gastrectomy and gastric bypass are not cosmetic procedures to be taken as lightly or performed as frequently as botox or nose job. Weight loss surgery is a definitive and final step for people weighing at least 40 kg over their ideal body weight. These people have a BMI of 32.5 to 37 or higher, and have unsuccessfully tried many a fad diet, taken so-called "weight reducing pills" and attempted other means of weight loss. There is consideration, conversation and qualification before a procedure.

After the operation, patients must keep to a rigorous follow-up schedule. People who are 10-15 kilos overweight have a host of tools and approaches available to them that can assist them in regaining health, managing their appetite and keeping weight off.

It’s dangerous
As part of my job, I literally get inside of people and either re-route their digestive tracts or slip a lap band over the top of their stomachs. Sounds dangerous, right? As with any surgery, weight loss surgery carries risk. But modern technology has made bariatric procedures relatively safe. In a study of 66,000 obese people over five years, those who elected to have bariatric surgery lived longer than those who did nothing.

It has been shown repeatedly that it’s far more dangerous to live life morbidly obese than to undergo a bariatric procedure. I’ll put it in perspective: In most programmes, the risk of bariatric surgery is in line with the risk of having one’s gallbladder removed.

You can’t get pregnant after surgery
Many patients have trouble getting pregnant prior to surgery and find that they’re very fertile following surgery. This is good news if you want to have children — or it may be bad news if you don’t! And of course, my words are always supported by scientific facts and reasons. There are many ways in which obesity is leading to infertility. And in the developed world, obesity is emerging as a major cause of female infertility.

Contrary to popular belief, pregnancy following weight loss surgery is very possible. Or in some, weight loss surgery may be the only answer. Patients are much less at risk during pregnancy because their other health problems have lessened or disappeared. After your weight is back to normal, and assuming you don’t have any other health problems, you can expect to have a normal delivery.

If you’re a woman of childbearing age, use two forms of birth control for one year following surgery. During that first year, you aren’t eating enough to nourish yourself plus a growing fetus, so you don’t want to get pregnant then. Besides, you want to concentrate on your own weight loss during that first year. Better safe than sorry.

You’ll never be able to enjoy a real meal again
Patients who undergo bariatric surgery can, in fact, celebrate their birthday with a little cake, they just can’t eat the whole thing anymore! People learn new, reasonable, healthy eating behaviours. Trying to eat too much at one time would make it hard to keep the food down. With those caveats, a person can live an unrestricted life following surgery.

It is also important to know that surgery is a tool to get to the real goal. Just because you have had the surgery, it does not mean now you could eat and drink anything! Remember, the surgery primarily acts by restricting your caloric intake, so high density foods and high caloric foods are to be avoided. With these restrictions the patients can go out to restaurants, take a cooking class and host the family Diwali dinner in a few weeks from now!

Bariatric patients undergoing surgery have a very restricted lifestyle
Bariatric surgery has a significant impact on the patient’s personal life. Men and women who are morbidly obese deal every single day with deep, core issues of self-esteem and pride. For example, there are physical repercussions of being so overweight (like an inability to control the bladder) that can be embarrassing, if not humiliating. Bariatric surgery can help restore dignity.

About 60 per cent of my patients are women. Many obese women have suffered not only emotional abuse because of their weight, but actual physical abuse as well; perpetrated by our society that didn’t respect them and convinced them they were unworthy of love and affection. Dramatic weight loss over time often brings these women a new self-confidence and a new beginning to a more fruitful life.

Surgery prevents proper nutrition
As a bariatric surgeon, it is my duty to inform my patients that there may be improper absorption of certain nutrients and vitamins in the body. But than should it be a concern? Sure! We may need certain nutrients to be supplemented after the surgery but it all again depends on the patient. If the patient is following the proper nutritional advice and adopted a healthy lifestyle, these needs are negligible. And again if I compare it with the benefits of the surgery, these disadvantages are minimal.

The writer is Director, Institute of Bariatric, Metabolic & Minimal Access Surgery,
Primus Super Speciality Hospital, Delhi