The Tribune, Chandigarh, India

Indo-Russian joint project
Fifth generation fighter will sharpen airpower

Union Defence Minister A.K. Antony’s recent statement that India and Russia have sorted out all issues pertaining to the joint development of the fifth generation fighter aircraft (FGFA) and that the deal is slated to be signed during Russian President Dmitry Medvedev’s visit to India in December is heartening indeed. Considering that the joint development of the multi-role transport aircraft with Russia is also on the anvil and India has decided to go in for long-range maritime reconnaissance aircraft from the US, among other equipment, it is refreshing that the need to upgrade India’s air firepower is being addressed after all. Only last week Air Chief P.V. Naik had sent shock-waves across the country when he admitted that 50 per cent of the Indian Air Force equipment, including fighters, radars, transport aircraft and air defence systems, was either obsolete or obsolescent.

That the Russians have settled for joint development of the fifth generation fighter aircraft and of multi-role transport aircraft is no flash in the pan. It is an index of their faith in India’s technological prowess as borne out by its indigenous development of the Light Combat Aircraft, the Advanced Light Helicopter and by co-production of the BrahMos cruise missiles with them in a cost-effective manner. Though the Indo-Russian FGFA will be based on the Russian Sukhoi T-50, which flew for the first time this January at their facility in Siberia, it will be built to the IAF’s specifications. Significantly, it is being touted as superior to the American F/A-22 `Raptor’, the world’s only operational FGFA as of now.

If there is a flip side to Indo-Russian defence cooperation it is that projects get delayed inordinately and this leads to considerable cost escalation. Not only has the FGFA been delayed, India had bought Gorshkov frigate in 2004 and its delivery, originally fixed for 2008, has now been finalised for 2012-13. In the case of the Akula-II nuclear-powered submarine, the two sides have now reportedly postponed the delivery to March next year, though India was supposed to get it last year after trials. This week’s talks between Antony and his Russian counterpart resolved to cut down delays but the proof of the pudding would lie in its eating.

Facebooked
A cautionary tale

Every day, social networking sites have been throwing up new challenges and shaping how people interact with one another. Social networks like Facebook, MySpace and Orkut enable people who are separated by geographical distances to interact and share each other’s lives, thus strengthening their bonds. Their usefulness can be gauged by the fact that the market-leader Facebook has more than 50 crore active users, 50 per cent of whom log on on any given day. An average user has 130 ‘friends’ to share his comments with.

Sometimes, Facebook’s strengths create situations that throw up new challenges for its users, and the world at large. In a recent case, schoolchildren commented negatively against a teacher in words that were distasteful bordering on obscenity. The remarks were meant to be shared among “friends” and were not for the consumption of the public. The students were subsequently identified and punished for that act. The school’s action has brought to the fore the debate about whether Facebook information should be used to discipline students. How much of the students’ activities outside the campus should their schools monitor? What right to privacy do they have for online activities? There are no clear-cut answers to such questions.

Many issues arise when the cyber reality clashes with the real world, especially since this is uncharted territory as far as rules and regulations are concerned. The young people of today have many new modes of expression that cause anxiety among adults. For them there is no difference between a verbal and an online chat. Sometimes their activities are taken too seriously by administrators. On the other hand, those who use social networking sites, too, have to realise that what they do online has real-world consequences. What is online can never really be private. Thus, all those who spend an average of over 70,000 crore minutes per month on Facebook must be cautions about what they post. At the end of the day, it is the unwritten but widely accepted rules of civil behaviour that govern our social lives, both online and offline.

Thought for the Day

It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm. — Florence Nightingale

ARTICLE

Obama’s Af-Pak drive in turmoil
Tough times ahead for India
by Harsh V. Pant

Bob Woodward of the Watergate fame is back once again with his new book, Obama’s Wars. Despite the hype, there is nothing in the book that is really shocking or revelatory. There is no analysis, commentary or policy assessment in the book. One finds only narrative and an unyielding focus on relationships among its principal subjects. What Woodward lays bare, however, are rifts at the highest echelons on decision-making in Washington over America’s mission and strategy in Afghanistan as well as the vociferous and highly personal nature of policy disagreements.

Woodward’s book is largely a near-verbatim account of US National Security Council meetings last fall where the administration hashed out its Afghanistan policy. It should come as no surprise to learn that the Obama Administration was deeply divided and riven with suspicions. America’s civilian and military leaders were divided on Afghanistan, and the level of distrust between the two was so high that Obama ended up designing his own strategy.

Obama comes across as a cold, calculating decision-maker who ultimately decides to pander to his base by including a deadline for withdrawal. He was frustrated with his military advisers who he felt were thwarting his search for an exit plan. In the end, all the US seems to have got is a plan to exit but no strategy to win the war.

Obama has been looking for a way out of Afghanistan ever since he took office. He has avoided talk of victory all along, suggesting that America needs a plan about how it can “hand it off and get out of Afghanistan.” Looking for an exit, Obama took the extraordinary decision in December 2009 of sending 30,000 more US troops to Afghanistan along with the announcement of an American withdrawal from July 2011. It is now clear that this decision has led the US adversaries to conclude that President Obama’s heart is not in the war. He has no will to fight. What is equally confounding is the basis on which Obama made this decision. After repeatedly arguing during elections that Afghanistan was the “good” war, the “necessary” war, Obama started searching for an exit strategy because he couldn’t “lose the whole Democratic Party”. As Woodward argues, “He was looking for choices that would limit US involvement and provide a way out.”

The shadow of Vietnam looms large over the debate on the Afghanistan strategy. The US Vice-President, Joe Biden, is said to be “pessimistic and more convinced than ever that Afghanistan was a version of Vietnam.” The President himself is reported to be so determined to avoid a Vietnam-like morass that he ends up writing his own strategy memo. An administration review of the Afghan war is scheduled for this December and it is unlikely to convince the Obama White House that America needs to win the war in the Af-Pak area.

Though Pakistan remains the key to success in defeating the Taliban and eliminating Al-Qaida’s activities in the region, the Obama Administration has grown impatient with Pakistan for its foot-dragging against the militant sanctuaries in border areas. Fears about Pakistan — a nuclear power with a fragile civilian government, a dominant military and an intelligence service that sponsored terrorist groups - have shaped the trajectory of Obama’s Af-Pak policy. The US intelligence has been warning that not only does Al-Qaida and the Taliban continue to operate from safe havens within Pakistan but terrorist groups have also been recruiting westerners to wreak havoc in Europe and North America.

For Obama the reason to create a secure, self-governing Afghanistan was to prevent the spread of the “cancer” from Pakistan. Pakistan’s main priority has been to take on its home-grown branch of the Taliban, the Tehrik-e-Taliban Pakistan (TTP). But the links between the TTP and other terrorist organisations are much too evident to ignore. The US has also pressured Pakistan with regard to the Lashkar-e-Toiba (LeT). Though the Pakistan government is holding the commander of the Mumbai attacks, he “continues to direct LeT operations from his detention centre” and LeT is now even threatening attacks in the US. Pakistan has been successful in hoodwinking the Americans so far and there is little likelihood that anything will change in the near future.

India will have to fight its own battles. The US will start moving out of Afghanistan next year. As a consequence, the Indian footprint in Afghanistan should increase if it wants to preserve its vital interests. The Pakistani military has become adept at the double game it has been playing with Washington. It recognises that America’s reliance on Pakistan is at an all-time high and it will extract its pound of flesh from the West. As the threat of instability increases, the centrality of the Pakistani military is only likely to grow. And given the well-known anti-India views of the Pakistan Army Chief, Gen Ashfaq Parvez Kayani, New Delhi would be fooling itself if it believes that negotiations with Islamabad and Rawalpindi are likely to lead to any sort of a desirable outcome.

Much like General David Petraeus, the top US commander in Afghanistan, who continues to believe that he could “add time to the clock” and “get what we need” as long as some progress is shown, many in India also continue to believe that the US will retain a substantive presence in Afghanistan as long as the mess in the Af-Pak area is not sorted out. But Woodward makes it clear that this is a dramatic misreading of President Obama. He means when he says that America is not in the business of nation-building over the next 20 years.

India will be facing some tough choices in the coming months. It will have to raise the level of its game if it wants to retain any relevance in the evolving strategic milieu in the Af-Pak area.

MIDDLE

If politicians retire…
by Amar Chandel

POLITICS is one profession in which there is no retirement age (there are some other professions also, but less said about them the better). That is why one has never heard of an ex-politician. At worst, some of them become Governors.

However, if at all our leaders decide to hang up their boots, they will surely not suffer for want of lucrative avenues. Here are some post-retirement relocation possibilities for them:

Mamta Banerjee may open a chain of hospitals near railway tracks. The way the frequency of train accidents has been increasing, there will never be any shortage of patients.

Sharad Pawar can turn into a successful astrologer and fortune teller. He is a natural in the field. Whenever he said sugar or some other commodity was going to get costlier, it always did.

An out-of-politics Omar Abdullah will surely be lapped up by the film world. I am told he already has an offer to play Emperor Nero in a Hollywood production.

Parkash Singh Badal and Sukhbir Badal can make a fortune by manufacturing power generators and inverters in Punjab.

Mani Shankar Aiyar is my candidate for being the Chairman of the Organising Committee whenever India gets to host an Olympics.

Once Bhupinder Singh Hooda is done with politics, he should become president of a khap panchayat.

Lalu Prasad Yadav is wasting his talent fighting elections and his brothers-in-law. He can be the fodder king of the country whenever he wants. He can make additional millions by being a Visiting Professor at various agricultural universities around the world, and share with them the secrets of how he made his buffaloes give quintals of milk every day, which he and Rabri Devi then used to bring up their children like kings.

Maneka Gandhi should raise a monkey brigade, which will be trained to catch human beings and put them in cages.

Her son Varun will do well joining the police force where his ability to curse, rave and rant will come in very handy.

L K Advani and Uma Bharati can turn into architects, specialising in temple architecture.

Mayawati ought to be a mall builder. The first one of these can be a 100-storey structure to come up in Agra at the exact spot where the famed Taj Mahal now stands. Marble from the dismantled Taj can be used to make elephant statues.

Once out of jail, former Jharkhand Chief Minister Madhu Koda should become a mining magnate while A. Raja can float the world’s largest telecom company if at all he is kicked out of the Union Cabinet.

Our good old Suresh Kalmadi deserves to be a demolition expert, of course.

OPED HEALTH

Whither medical and health care
The government has deliberately allowed its hospitals to go to seed so that private hospitals can flourish
Pushpa M Bhargava

When I was a college student in the 1940s we, like others, had a family doctor - a general physician (GP). He was the best friend of the family. Specialisation in medicine was yet in its infancy.

Even today, with so much specialisation, the backbone of the national health service in the UK is the family doctor - a GP. He decides if you need to go to a specialist. In fact, very few need to, for over 90 per cent suffer from less than 0.1 per cent of known diseases, and the family doctor can take care of such common diseases better than a specialist because he knows the patient very well.

But in our country today, while there is a specialist of one kind or the other around every corner in our urban areas, there are simply no GPs; as a class, they have vanished. Till a few years ago, no medical college gave a M.D. (a post-graduate degree) in family medicine. Following my convocation address to the University of Health Sciences in Calcutta a few years ago, the Government of West Bengal decided to have such a course. Even today it is probably an exception. We need to reinstate the tradition of family physicians or GPs as a first step towards ensuring effective and least expensive medical care.

In the absence of GPs, we all go to specialists, and the specialist generally finds a disease that you are not suffering from and prescribes a cure for it. I was told of a person who saw seven specialists in a major corporate hospital. None of the specialists asked him if he was taking any drugs, and each of them prescribed him a course of different antibiotic. He ended up in the hospital with antibiotic toxicity.

Commonsense tells us that, excepting in the case of an emergency requiring a specialist in a particular area, it would be in the interest of the patient to first go to a GP and then to a specialist only if referred to by a GP. The tragedy is that even multi-speciality hospitals in a country -- that are largely in the private sector - do not have enough GPs, if they have one at all. We need to urgently fill this lacuna.

The second problem is that of increasing commercialisation of medical and health care in the last three decades, during which period the government has been increasingly abrogating its responsibility in this area. Till, the 1970s the government hospitals and those rune by trusts (such as Christian Medical College Hospital at Vellore) were very good. They were the only kind we had and each of them satisfied a minimum requirement. Health care was not a business but social service; it is just that the number of hospitals was very small. Today, health care is big business and the government is a party to it. It has deliberately allowed the government hospitals to go to seed so that private hospitals can flourish.

For example, people being treated under Arogyasri go to private hospitals; so everywhere new private hospitals are coming up to take advantage of this situation. Why didn't the Government, instead of subsidising private hospitals through Arogyasri, spend that money to upgrade its own existing hospitals and open new ones of quality. Further, private hospitals are given all kinds of concessions, for example in respect of cost of land and duty on equipment, on the condition that they will treat a certain number of patients free ; not one is treated free and the Government ignores it.

I do not deny that we have some ethical, people-oriented private hospitals but their number and proportion is extremely small. For a vast majority of private hospitals, the primary objective (in some cases, the sole objective) is to make money; cures in these hospitals are mostly incidental. They engage in gross exploitation of a patient (particularly the uneducated and uninformed ones) by total lack of transparency, inflated bills and unnecessary procedures.

Thus, according to a recent report, private hospitals in Hyderabad carry out, per 100 patients, eight times more hysterectomies, two times more tonsilectomies, three times more caesarian operations, and 15 times more appendectomies than are needed or done in govenment hospitals. This is in addition to unnecessary tests!

Not only that, there is a nexus between private hospitals and private doctors on the one hand and diagnostic centres on the other, so that when a doctor or a hospital asks you to go to a particular centre for a diagnostic test (whether it was necessary or not is another question), he gets a commission from the diagnostic centre for this referral.

Many private hospitals and private doctors in urban areas have touts in rural area who bring patients to the doctor or the hospital for a consideration. The tout gets a commission for the referral and also for the unnecessary tests done on the trusting and ignorant rural patients. In one case, we provided incontrovertible evidence for such an happening, with a complete recording of the conversation between the doctor and the tout, to the Medical Council of India (MCI), but nothing happened. We all now know the extent of corruption in the MCI with its Chairman in jail and its Governing Board reconstituted by Parliament.

The pity of it all is that wherever it can get away with it, the government has been a party to all the above happenings. Not that it cannot run first-rate hospitals ; examples would be AIIMS at Delhi, PGI at Chandigarh, and JIPMER in Pondicherry. But their number is extremely small. Most of the government hospoitals are just bad, steeped in inefficiency and corruption.

Sometime back, we found that in one hospital in Bhopal set up to take care of Bhopal gas tragedy victims, all the drugs used were fake and from companies that are known to make fake drugs.

One of the reasons for the situation outlined above is that to get admission in a medical college, most of which are private, you need to pay huge sums (as much as Rs 1 crore) as capitation fee. This money will have to be earned by the individual after getting the degree which, of course, is guaranteed. The quality of medical education in the country is abysmally low, except in less than 10 per cent of the medical colleges ; most of such colleges are run by the government or non-profit-making trusts.

It is true that government doctors don't make as much money as good private doctors do. But good government hospitals, often attached to good medical colleges, provide facilities that private hospitals do not - for example, of research and security. But, then, the system of capitation fees will have to be abolished de facto, not just de jure.

What should, then, be our medicare policy, taking ground realities into account ? As was shown by the late N. Antia (one of India's foremost plastic surgeons), we can have a successful and validated computer programme which can tell trained, bright high-school-pass young persons coming from the village itself, as to what drugs or treatment should be given to a person in 80 per cent of the cases. The programme would also tell him/her to identify the remaining 20 per cent of the reporting patients who should then be referred to the district hospital which should have basic diagnostic facilities.

Out of these 20 per cent over 15 per cent would be taken care of at a good district hospital. The remaining 5 per cent or so should be referred to good private hospitals committed to following a carefully prepared code of ethics, and covered by insurance. Obviously, facilities for transportation from the village to the district hospital, or to the nearest approved private hospital, would need to be provided. This kind of public-private partnership in medical and health care could go a long way in effectively democratising it and building a sound base for further improvement as the economic status of the majority improves.

Dr Pushpa M Bhargava is currently the Chairman of the Sambhavna Trust and The Medically Aware and Responsible Citizens of Hyderabad

Problems

n Even multi-speciality hospitals in the country do not have enough general physicians (GPs).

n Increasing commercialisation of health care.

n The government abrogating its responsibility.

n Exploitation of patients.

n Nexus between private hospitals and diagnostic centres.

n Capitation fees.

Remedies

n Reinstate the tradition of family physicians.

n All medical colleges should give a postgraduate degree in family medicine.

n Have a validated computer programme, which can tell trained, bright high-school-pass young persons coming from the village itself, as to what drugs or treatment should be given to a person in 80 per cent of the cases.

n The programme will also tell him/her to identify the remaining 20 per cent of the reporting patients who should then be referred to the district hospital which should have basic diagnostic facilities.