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No more ‘misery tax’
Testing times for Omar
Buffett for the underprivileged |
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Furore over WikiLeaks
The Bitter PIL
The TB terror
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No more ‘misery tax’
ONE proposal in the Union Budget for 2011-12 which had attracted sharp all-round criticism was the 5 per cent service tax on diagnostic tests and treatment in air-conditioned private hospitals with more than 25 beds. Displaying commendable sensitivity to public feelings, Finance Minister Pranab Mukherjee has rightly agreed to roll back the proposal that would have fetched a Rs 700-crore annual revenue for the exchequer. It is amazing that a seasoned and pragmatic political leader like Mr Mukherjee has to be told that an air-conditioned hospital is no longer a luxury but a necessity, that the National Accreditation Board for Hospitals does not grant accreditation unless a hospital has central air-conditioning and that poor villagers have to mortgage their assets to get treatment during an emergency since government hospitals are often crowded and mismanaged. Had the tax not been axed, a heart surgery would have cost Rs 5,000 to Rs 10,000 more and for cancer patients the cost of treatment would have escalated by Rs 20,000. Hospitals would have passed the tax burden on to patients. Calling it the “misery tax”, Dr Devi Shetty, a Bangalore-based cardiologist, had led a protest by citizens outside the Governor’s residence and observed March 12 as the “Misery Day”. There may be hospitals making hefty profits, tempting finance ministers to grab a slice of these but healthcare in India needs large government and private investment. There is an acute shortage of staff and infrastructure. Government doctors prescribe medicines which patients buy from private shops. There is a risk of getting expired or spurious medicines. Since the cost of treatment is multiplying rapidly, health insurance must cover larger sections of society. Private insurance firms are growing fast and, like private hospitals, tend to indulge in questionable practices. To discipline the health sector, there is need for a regulatory authority. Even as private hospitals flourish, the government cannot abdicate its responsibility of providing access to efficient and affordable healthcare to ordinary citizens.
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Testing times for Omar
THE recent statement of Jammu and Kashmir Chief Minister Omar Abdullah that his government was working on a multifaceted programme for the return of Kashmiri Pandits to the Kashmir valley is heartening. Young Omar’s good intentions have never been in doubt, it is his ability to fight against heavy odds in a murky political environment that has been tested from time to time. As the Chief Minister has recognized, what will convince the Kashmiri Pandits to return will be a sense of security that has been lacking all these years since they were virtually forced out of their homes to flee against terror and persecution by militants with no protection worth the name from successive governments in the state. There is no doubt that the ground situation has improved in recent months. This is therefore an opportune time to reassure the Pandits that the Kashmir government would be with them if they choose to return. An estimated 300,000 of the displaced Pandits have been living in Jammu and Udhampur, most of them in ill-equipped camps as refugees while another 100,000 are in such camps in Delhi established by the Government of India and the UN. So all-pervasive was the fear of torture and elimination in early 1990 that an insignificant number of Kashmiri Pandits stayed on in the valley. Motivating these people to put the unpleasant memories of a decade ago behind them would indeed be no mean task. While security from militant attacks would be an important element in rehabilitating the Pandits, it is equally vital that economic opportunities for their youth including reservation in government jobs go hand-in-hand with personal security. Most of them would need to start from a virtual scratch and would require all the help from the government in getting back possession of their property or in settling in new homes. It is indeed challenging times for the Omar Abdullah government and a test of its ability to fulfill the promises that it has been making. |
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Buffett for the underprivileged
SOON after Warren Buffett visits India, comes an announcement of a Rs 1,540-crore pledge towards charity by GMR Group chairman G R Rao. Call this the Buffett effect. When the chairman of Berkshire Hathaway, one the richest men in the world, asks billionaires, or just millionaires, to open their wallets, they do so. Americans have a saying: “Put your money where your mouth is,” and Buffet certainly has. In 2006, he pledged most of his fortune to charity. The primary recipient of his largesse was the Gates Foundation. He also gave to the four charitable trusts created by his family—the Susan Thompson Buffett Foundation, the Howard G. Buffett Foundation, the Susan A. Buffett Foundation, and the NoVo Foundation. Along with Microsoft’s Bill Gates, Buffet has led the trend of billionaires donating a significant part of their wealth to charity. In India, too, there have been some notable donations recently, like the Wipro chairman Azim Premji who gave over Rs 8,000 crore, and HCL founder Shiv Nadar who gave Rs 580 crore for education. Notable instances of corporate social responsibility include the Infosys Foundation and the Rs 500-crore initiative by Reliance Industries. Traditionally, industrial houses like the Tata, the Godrej and the Birlas built hospitals and educational institutions. Overall, however, India lags behind nations like the US and the UK, which give 2.2 per cent and 1.3 per cent of their GDP for charity. The Indian figure comes to a miserly 0.6 per cent. Many of those who give do not merely give away their money; they monitor its use and even set up institutions that would help to make the change that they want to make. We must realise that it is better to leave our children a better society than to merely leave them with wealth. People clever enough to make billions have done so; it’s high time we did so, too! |
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Self-control is the best way to calm the thought-disturbed mind. It brings serenity and allows us to look on the world dispassionately. — The Bhagvad Gita
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Furore over WikiLeaks
THE WikiLeaks “India File” published by The Hindu makes interesting reading. There is perhaps nothing startlingly new in most cases but nuances reflecting pressure, irritation and scorn are evident in certain dispatches. This would be so in most diplomatic correspondence as diplomats are expected to be upfront and frank in their assessments of personalities, events and trends from the perspective of their own national interests and concerns. Thus, the Americans were leaning on India to be more accommodating of US concerns regarding Iran’s nuclear “ambitions”, saying that the fate of the civil-nuclear deal was in the balance. Though India has come through reasonably unscathed, critics at home would wish the Ministry of External Affairs (MEA) to throw all diplomatic caution to the winds in airing India’s bottom line always and every time. These are macho reactions, not calibrated responses that keep the country’s overall interests in mind, but must up to a point be accepted as legitimate chatter within a democratic society. The American belief that India’s West Asia policy and attitudes towards Israel are governed by the Muslim factor, are only partially correct. Every country must cater to domestic sensibilities, something that pragmatically informs India’s stance towards Myanmar. But this apart, there is genuine sympathy for the Palestinian cause and outrage at the brutal manner in which the Israelis have often behaved, with uncaring American connivance. The US Jewish lobby clearly has far more influence on Washington than the Muslim factor does in Delhi. Yet there is admiration for Israel’s achievements here and state relations are cordial and collaborative. There has never been anti-Semitism in India. The US policy towards the Islamic world is problematic, driven as it is by oil and geo-strategic interests. The unholy mess created in Iraq, based on a pack of lies, and Afghanistan (where the Taliban and other Islamist jihadis were spawned with the US support) have kept West Asia on the boil. Washington’s long-drawn flirtation with frontline ally, Pakistan, through another long and continuing saga of unparalleled deceit, has been instrumental in the nuclearisation of that country (with Chinese assistance) and its becoming an epicentre of cross-border terror as a means of state policy. The Kerry-Lugar Act is the latest farce that rewards Islamabad for every breach. The burden of “collateral damage” to India from mistaken US policies is huge and totally unrequited. Yet the US has also been a generous friend and it is good that the Indo-US relations are vastly better than before and are gradually assuming a greater degree of mutual understanding and respect. Those at home who might now raise a hue and cry about WikiLeaks India should not protest too much. The revelation of an election-bribe box by a Congress supporter to a US diplomat does no more than confirm a known and disgraceful practice. But taking the diplomat’s word for it may not be entirely warranted as envoys, like others, are prone to embellish and exaggerate their reports to win kudos back home. The demand for the resignation of the Prime Minister as though he has been found guilty by WikiLeaks is an absurdity and shows how shallow some politicians and impatient power-grabbers can be. And to suggest that the US is wicked to want to promote its economic interests in India and might speculate on cabinet and official level changes that bear on this is equally naïve. Diplomats, including Indian diplomats, are paid to win friends and influence nations. One has this past week also heard excessive protest in India about its nuclear power programme in the aftermath of the Japanese quake-cum-tsunami disaster that has led to near-melt-downs and radiation leaks. These have no doubt been alarming developments. The government has wisely ordered a through review of all existing nuclear power plants and future programmes with special emphasis on safety standards and defensive measures. These consultations must take into account public views and international experience and assessments. This, however, is a far cry from demanding a stoppage of the nuclear programme largely on ideological grounds and uninformed panic based on total misjoinders of facts and events. This despite India’s good nuclear power safety record. The Jaitapur site in Ratngari district falls in seismic Zone III that experiences tremors of far lower magnitude than the massive M-9 earthquake that hit Japan. The nuclear plant to be built there by the French company, Areva, is designed to withstand far Secondly, the Arabian Sea is less prone to tsunamis than the Pacific, and so tsunami waves of just over 10 metres that battered the endangered Fukushima nuclear plants can be ruled out at Jaitapur. Thirdly, whereas the Japanese plants are at an elevation of 10 metres, the Jaitapur plant will be located 25 metres above sea level. The suggestion that the proposed Areva plant is totally untried and untested is challenged by Indian nuclear engineers as several of its parts and components have been tested. The assertion is a bogey intended to frighten the uninitiated. There is always a first time for everything. For India to continue on its coal-oil fossil fuel path would be to court global warming and ignore the imperative of achieving a low carbon footprint. Better demand management can help but it will take time before renewable source like solar power is available in bulk at affordable prices. To arm-chair critics who would ask, ‘what is the hurry’, Keynes replied that in the long run we are all dead — some from natural disasters; others from man-made disasters; and still others in consequence of the anger of the excluded who have waited for generations, have again been asked to wait and then made to wait some more.
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The Bitter PIL
As a child, the task of swallowing a pill was a nightmarish experience. The very thought of falling sick and taking pills every eight hours would shake both my body and soul. I would hide my fever/bad throat or stomach ache from my parents till the very last moment. I could not swallow the pill. I feared that it would get stuck in my throat and suffocate me. My elder brothers, sisters and parents would try their best to allay my fears and offer all sorts of rewards but of no use. “Come on,” the chorus would start, “you are a brave boy. We will count 1, 2, …3; and you swallow the tablet. There will be no problem”. As they counted one, my throat would go dry. On 2, I would take a deep breath and place the tablet on the tongue and on 3, take a big sip from the glass of water and try to swallow. Everyone would clap with joy. Their joy was shortlived as the very next moment the pill was out with a vomit; my face red and the body quivering. Before I could be rescued by my mother, a few tight slaps from my father had already landed on my cheeks. It took several months before I learnt the skills of swallowing a pill. The bad experience was soon forgotten and taking a tablet was never an effort thereafter. Now, having put in more than three decades of tough, challenging police service, the fear of taking a PIL (Public Interest Litigation) has come to haunt me again. Believe me, it is as traumatising an experience as was in the childhood. How often my officers come barging into my office to announce that a PIL has been filed! “What have we done now?” I ask bewildered. Don’t we often deal with the crooked, crazy, disturbed minds? It is easier to face an enemy on the borders than to face violent surcharged mobs. Yet, not a word of sympathy. Only the PILs. “Sir, another PIL is coming,” enters an officer nervously. A dismissed Sub Inspector has sat on dharna and threatening to commit suicide in front of our headquarters. “That will be a slaughter,” I said. No one is going to believe our side of the story. Media will have juicy news and we will be seen as villains --- the old timer Prem Chopra would look like a gentleman. Save him at any cost. Photograph him repeatedly”. As if this was not enough, two of my officers presented applications for five-day casual leave. I was furious. “What is this? We have a crisis on hand and you are proceeding on leave!” “That precisely is the reason, sir. Another PIL, another storm by the media. Another round of investigations by the CBI. You are the boss, you have to suffer anyway; spare us the harassment”. “How often would we be stripped for doing our normal job,” I throw up my hands. “May be, we’ll have the FBI on our backs, next, if PIL writers have their way,” the officer chipped in. “Leave me to my fate and get lost,” I slumped into the
chair.
The writer is Director General of Police, Haryana
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The TB terror The co-morbidity of both these diseases is so alarming that invariably it leads to fatal consequences. This is the most common opportunistic infection among people living with HIV. In 2007, WHO recommended that countries with high co-infection rate should develop TB-HIV collaborative activities through Integrated Counselling and Testing Centers (ICTC). Even today, 129 years after its discovery, tuberculosis remains one of leading causes of death of several million people, mostly in third world poverty-stricken developing countries. The gross estimation of WHO is that two billion persons, one-third of world's population, are infected by this bacterium. The number of cases had become so enormous that in the year 1993, WHO had to declare a state of Global Emergency on this disease. Our country is no exception to this epidemiological data; where 2 per cent population is infected, amounting to about 20 million people. It is one of the leading causes of mortality in India — 330,000 deaths each year — nearly 1,000 every day, which amounts to 2 persons dying every 3 minutes. These deaths can be prevented with proper diagnosis and treatment. Patients can be cured and the battle against this scourge can be certainly won. This is one of the curable diseases if detected timely and managed properly. The standard recommended length of drug therapy is six months, which may be extended in some of the unusual cases. However, if there is delay in establishing diagnosis, irreparable damage takes place. Hence it may not be curable at an advanced stage. Sometimes, even if diagnosis is timely made, the patient may not take the full course of treatment with prescribed doses. It turns into multidrug-resistant tuberculosis (MDR-TB), where first-line drugs (isoniazid and rifampicin) become ineffective. The situation is already so grim and above all there is now an emerging threat of extensively drug-resistant tuberculosis (XDR-TB) since 2006, where patients do not respond to the first line as well as the second line of anti-tuberculous drugs (fluoroquinolones and at least 1 of 3 injectables — capreomycin, kanamycin and amikacin). Such cases are now being reported from India also. The XDR-TB has really posed a big challenge before the medical fraternity and the ailing community. In our country, the National TB Programme (NTP) was started in the year 1962 and the Revised National Tuberculosis Control Programme (RNTCP) in 1997, after pilot testing from 1993-1996. It included Directly Observed Treatment Short course (DOTS), which is being implemented to tackle this menace. The WHO-recommended DOTS strategy was launched formally through the RNTCP. Since then DOTS has been widely advocated and successfully applied. The RNTCP has covered the entire population of the country by March 2006. This programme has achieved the global target of 70 per cent case detection for the first time while maintaining the treatment success rate of more than 85 per cent in our country. The Ministry of Health and Family Welfare, Government of India, has now come up with the DOTS-Plus programme, which refers to DOTS that add five essential components for MDR-TB diagnosis as well as treatment. These are: *
Sustained government commitment; * Accurate timely diagnosis through quality assured culture and drug susceptibility testing; *
Appropriate treatment utilising second-line drugs under strict supervision; *
Uninterrupted supply of quality assured anti-tuberculous drugs; and *
Standardized recording and reporting system. There is full integration of DOTS and DOTS-Plus activities under the RNTCP so that patients with MDR-TB are both correctly identified and properly managed under the prescribed recommendations. In the RNTCP DOTS-Plus vision by 2012, it is aimed to extend these services to all smear positive retreatment cases and new cases who have failed an initial first-line drug treatment and by 2015, these services will be made available to all smear-positive pulmonary tuberculosis cases registered under the programme.
The writer is Professor and Head, Department of Microbiology, Govt. Medical College Hospital, Sector 32, Chandigarh
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Key facts
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The strategy of Directly Observed Treatment, Short-course (DOTS) is based largely on research done in India in the field of TB over the past 35 years. *
Since 1997, after successful piloting DOTS has been implemented in India as the Revised National Tuberculosis Control Programme (RNTCP). In the RNTCP, the proportion of TB cases which are confirmed in the laboratory and the cure rate are both more than double that of the previous programme, *
The operational feasibility of DOTS in the Indian context has been demonstrated, with 8 out of 10 patients treated in the programme being cured, as compared with approximately 3 out of 10 in the previous
programme. * Multidrug -resistant tuberculosis (MDRTB) is a result and symptom of poor management of TB patients.DOTS has been shown to prevent the emergence of MDRTB and to reverse the trend of MDRTB in communities in which it has emerged. *
TB is the most common opportunistic infection among people living with HIV. *
Revised National Tuberculosis Control Programme (RNTCP) has covered the entire population of the country by March 2006. *
Every patient who is cured stops spreading TB, and every life saved is a child, mother, or father who will go on to live a longer, TB-free life.
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The 24th of March every year is observed as World Tuberculosis Day all over the globe. This occasion provides an opportunity to the governmental as well as non-governmental organisations to create public awareness programmes highlighting the magnitude of the problems and devising solutions related to the ongoing pandemic of tuberculosis entailing the strengthening of the control measures. World TB Day commemorates the historical date in the year 1882 when Robert Koch announced the discovery of Mycobacterium tuberculosis, the causative bacterium of tuberculosis, in one of the meetings of doctors in Berlin (Germany). This used to be was considered a dreaded disease at that time. It used to kill millions of people, as the case fatality was 1 out of every 7 persons, not only in Europe but other continents as well because neither its cause nor any specific treatment was known. This breakthrough discovery on this day paved the way for diagnosing and later on curing this 'incurable disease' of that era. For the next hundred years, this day was not remembered in any capacity. However, in 1982, while commemorating the 100th year of Koch's discovery, the first World TB Day was observed by the International Union Against Tuberculosis and Lung Disease (IUATLD), which was subsequently joined by the World Health Organisation (WHO). The basic idea of the international event was to educate the public at large about the devastating medical and economic consequences of tuberculosis, its effect on the developing countries and its overall continued tragic impact on global health. Every year a theme is decided for this day focussing on to how to get rid of this disease and throughout that year a concerted worldwide campaign is initiated to achieve the set goal. The theme of this year is 'TB Elimination : Together We Can' which is more than a slogan and its campaign will be sustained focussing on to people everywhere who are doing their part 'on the move against tuberculosis : transforming the fight towards elimination'. It is a reminder of the collaborative efforts on eliminating tuberculosis by educating health care workers and volunteers who play a crucial role in identifying symptoms of this disease. It is about highlighting lives and stories of people affected by tuberculosis: women, men and children who have taken tuberculosis treatment; nurses; doctors; researchers; community workers — anyone who has contributed towards the global fight against this dreadful disease. Every patient who is cured stops spreading tuberculosis and every life saved is a child, mother or father who will go on to live a longer, disease-free life. WHO is working to cut tuberculosis prevalence rates and thereby deaths by half by the year 2015. Eventually by 2050, the global incidence of this disease is expected to be less than or equal to 1 case per million population per year. The day is not far when we will be able to celebrate this occasion, as the disease will ultimately be eliminated from the face of the globe. Our vision is a world free of tuberculosis.
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TB is one of the leading causes of mortality in India— killing 2 persons every three minute, nearly 1,000 every day