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Tribunal as a remedy
Ominous calm in Assam |
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Pakistan deserved it
Agenda for defence reforms
Demise of ‘chavanni’
Today, celiac disease is neither rare nor necessarily a diarrhoeal condition. Nearly 1-2 per cent of the population suffers from it. Also, no longer is it a childhood disease as a majority of the cases are being picked up between 40-60 years of age
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Tribunal as a remedy
The
Supreme Court has suggested that the Hansi-Butana canal dispute should be referred to a tribunal. Punjab has got some relief as the status quo will have to be maintained until the issue is settled. This will bring to a halt the ongoing construction work on the canal embankment by Haryana. But a large part of the concrete wall along the canal is already there and in case of excess rain, canal water would continue to overflow towards Punjab, submerging residential areas and the fields. There is no immediate relief for the harried villagers, who live in constant fear of floods during the monsoon. In essence, the Supreme Court verdict means the Hansi-Butana canal dispute will linger. The apex court pulled up the Central leadership for keeping quiet as the inter-state water dispute was on the boil. Haryana and Punjab have had a history of water disputes, which have defied legal and political solutions. The Central intervention had not helped much in the past. This does not inspire much confidence in the tribunal proposed by the court. River water disputes can be settled if handled maturely by visionary leaders. Small-time politicians make inflammatory speeches to raise passions over emotive issues and create ill-will among people living in peace as neighbours. Villagers along the canal held a protest recently and deprecated the petty water politics. They blamed the floods on politicians’ failure to clear and repair canals and rivers. Punjab and Haryana leaders are now dragging their feet over the Centre’s Rs 1,130-crore project to tame the Ghaggar. It seems they do not want to delink it from the existing water disputes. Some are even questioning the viability of the project. Their lack of interest or knowledge is appalling. It is perhaps too much to expect such politicians to rise above narrow interests and sort out inter-state issues.
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Ominous calm in Assam
The
use of explosives barely 60 kilometres from the Assam capital Guwahati in a bid to derail the Guwahati-Puri Express on Sunday night is cause for concern. Besides indicating the failure of routine safety measures, it revived the spectre of a return to chronic violence that was a feature of Assam not too long ago. The state,however, had a largely peaceful Assembly election this year and appeared to have made some headway in peace talks with the outlawed United Liberation Front of Assam (ULFA). Sunday’s explosion, which fortunately did not result in any casualty, is however a grim reminder that all’s still not well in the eastern state. While suspicion initially was directed at the National Democratic Front of Bodoland ( NDFB), a barely three-year old outfit styled as Adivasi People’s Army (APA) has claimed responsibility for the subversive act. The NDFB is known to have been sulking for some time. The outfit, which declared a unilateral ceasefire in 2004 but has been ‘active’, has been complaining that it was not being taken as seriously by the government as the ULFA. If the government could negotiate with ULFA and even release its top leaders, who were arrested in Bangladesh and handed over to India, argued the NDFB, the government could also release the arrested NDFB chairman Ranjan Daimary in the same manner. The Adivasi People’s Army came into existence after the long-standing demand of tea garden workers, estimated to be 20 million strong, to be treated as Scheduled Tribes, received no response from the government. The ancestors of these tea garden workers were tribals and migrated from Jharkhand, Orissa and other northern states a century ago. But they were denied the tag of ‘ST’ in Assam. The government does appear both slow and stubborn in dealing with popular and emotive demands. By appearing to ignore relatively smaller and peaceful groups, it has been giving out the wrong signal that only dramatic acts, insurgency and violence are capable of drawing its attention. The explosion, one hopes, would serve as a timely warning for the government to nip the existing discontent once and for all.
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Pakistan deserved it
The
US suspension of $800 million military aid to Pakistan has come after a lot of pressure from the American public that the country that has been the breeding ground of terrorism does not deserve this kind of assistance. This is, however, only a part of the promised US aid to Islamabad — $2 billion over five years. As India has been pointing out time and again, the cause of peace in South Asia demands that the entire aid to Pakistan from the US and other Western sources in the name of fighting terrorism be stopped forthwith. A country which has been using terror to achieve its geopolitical objectives cannot be expected to abandon it when its aims remain unchanged. Moreover, this kind of aid has been misused to strengthen Pakistan’s armed forces with their anti-India agenda. Pakistan has deployed nearly 100,000 troops along its borders with Afghanistan. It launched drives against Taliban and Al-Qaida militants in its tribal areas. It also keeps on saying that as a “victim of terrorism” it cannot tolerate the scourge on any pretext. But the truth is contrary to this. Osama bin Laden had a safe haven in Abbottabad, near Islamabad, till he was eliminated by US forces. Pakistan’s soft approach towards some Taliban factions is well known. These pro-Pakistan groups get all kinds of assistance from Islamabad so that they are ready to be used to strengthen Pakistan’s position in Afghanistan after the US troop withdrawal from there. There has also been a Pakistan policy to impress upon the US and the rest of the West that Islamabad is basically fighting their war against terrorism and, therefore, it is their responsibility to fund it. The US move is very upsetting for Islamabad as it may ultimately affect Pakistan’s economy too. Yet the Establishment in Islamabad is putting up a brave face because it wants to use the opportunity to improve its image among the largely anti-US public. Pakistan also hopes that its all-weather friend, China, will come to its rescue. It will be interesting to watch if the US decision remains unchanged in view of the China factor.
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The shell must break before the bird can fly. — Tennyson
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Agenda for defence reforms
The
announcement about the setting up of a task force to review the reforms in the management of national defence has not come a day too soon. Ten years have elapsed since the Group of Ministers submitted its recommendations on “Reforming the National Security System” in February 2001. During these 10 years many recommendations have been implemented, but some crucial ones are either unimplemented or only partially implemented. In the meanwhile, the security scenario has changed dramatically. China’s rise poses a long-term challenge and its growing support for and inroads into Pakistan call for some caution. The Af-Pak region is rapidly descending into chaos. Cross-border terrorism is a real danger. New threats like cyber terrorism, climate change, water, energy and food shortages and militarisation of space are looming on the horizon. Strategic technologies are making rapid advances and lending themselves to new military applications. The proposed strategic and defence review is, therefore, overdue. Given its mandate, what should be the agenda for the task force? There are two key areas crying for reform: One is integration among the three defence services; the other is the integration of Services Headquarters and the Ministry of Defence. One crucial area that the task force should look at is the structure of the higher defence organisation in India. An important finding of the Arun Singh task force of 2000 is that the Chiefs of Staff Committee comprising the three Service Chiefs and chaired by the senior-most Chief has remained ineffective in fulfilling its mandate. As a consequence, firstly, there is no single-point military advice to the political leadership and during crises the government may receive divergent opinions, complicating the decision-making process. Secondly, the defence planning process is dysfunctional with each Service advancing its own capability without taking into account the inter-se priority of projects proposed by the three Services. This greatly mars the efficiency of the planning process and prevents optimal and efficient use of limited resources. Thirdly, modern warfare demands a very high degree of coordination in planning and operations among the three Services. Currently, despite some feeble attempts of the past few years, the Services tend to operate individually, rather than jointly. Thus, “jointness” or integrated functioning, a vital requirement of contemporary warfare, is sorely lacking. And, finally, India — now a nuclear weapons power — lacks appropriate structures for the management and control of nuclear weapons and strategic forces. Following the Group of Ministers recommendations of 2001, a Strategic Forces Command under a Vice-Chief has been created, but he remains somewhat outside the apex decision-making level. To address these glaring deficiencies, the Group of Ministers had recommended the creation of the institution of Chief of Defence Staff. All major nations, especially those with nuclear weapons, have either a Joint Chief of Staff or a Chief of Defence Staff. He ensures “jointness”, integrated defence planning, inter and intra-Service prioritization, and renders single-point military advice to the government. This crucial recommendation remains unimplemented and needs to be revisited by the Naresh Chandra Committee. In 2001, the Cabinet Committee on Security deferred a decision on it till consultations were held with political parties. But 10 years is a long enough period for such consultations. As many experts speculate, the reasons for this recommendation lying in cold storage may be unfounded fears about the creation of an extraordinarily powerful and high-profile military institution; serious reservations voiced by the Indian Air Force’s leadership; bureaucratic resistance; or all these three factors combined. The second crucial recommendation of the Group of Ministers made in 2001 relates to the integration of the Services Headquarters with the Ministry of Defence by designating them as “Integrated Headquarters”. This recommendation has been implemented but it remains a cosmetic change. When India adopted its Constitution, the President of the Republic became the Supreme Commander. This necessitated changes in the military hierarchy of the erstwhile British imperial command. At that stage, the then Chief of General Staff, Gen J.N. Chowdhary, proposed in a paper for the Chiefs Staff Committee that the three Service Chiefs should be kept out of the government but continue to remain Commanders-in-Chief of their forces. The government accepted this recommendation, which resulted in the Service Chiefs becoming both Chiefs of Staff and commanders of their forces, thus combining the functions of long-term planning with command functions. Naturally, the latter role assumed greater importance and the former role of long-term and operational planning suffered. This arrangement also distanced the Chiefs from the Defence Minister and deprived them of direct participation in decision-making. The Defence Minister then created his own secretariat which has been expanding over time. Since Service Chiefs are independent juridical personalities located outside the ministry, their references are treated as proposals to be scrutinised by the minister’s civilian secretariat. The ministry acts as a check rather than playing a complimentary role. Chronic tension between the civilian secretariat and the staff of the Services is thus inherent in this structure. Jawaharlal Nehru had promised Parliament that for purposes of consultative decision-making, Army, Air Force and Navy councils will be created; but this never happened as Service Chiefs were not inclined to sit with their principal staff officers under the chairmanship of a minister of state. The culture of India’s armed forces headquarters is a legacy of the British Raj and remains essentially a command culture of a theatre command, with Chiefs monopolising the decision-making authority. The Service Chiefs remain preoccupied with administrative chores and the vital task of long-term, future-oriented planning suffers as a consequence. Finally, there is no real integration between the ministry’s civilian staff and the Service Headquarters staff; their roles often become adversarial rather than mutually supportive. The task force on defence reforms needs to address this structural anomaly by recommending complete integration of the Chiefs of Staff with the ministry and the creation of joint theatre commands, directly accountable to the Defence Minister. The much needed integrated planning, inter-Service prioritisation and jointness in the entire gamut of the activities of the Services ranging from doctrines and training to operations should be ensured by creating the institution of Chairman, Chiefs of Staff or Chief of Defence Staff. He should be appointed through a process of deep selection and not reverted to his parent Service. Such an arrangement alone will ensure that he has no parochial commitments and is able to act decisively in the interest of inter-service
prioritisation. The writer is the Director-General of the Institute for Defence Studies and Analyses, New Delhi.
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Demise of ‘chavanni’ Though the 25-paisa coin together with its junior siblings had laid in coma now for many years with zero purchasing power, the formal announcement by the Reserve Bank of India about its official demise has saddened me a good deal. The 21st century has seen a drastic fall in the value of currency worldwide. It would have been better if the government had also simultaneously announced the death of its senior sibling, the 50-paisa coin which too had been for long in a comatose state. Manufacturers of consumer goods and even neighbourhood grocery stores give MRP only in rupees, barring some newspapers which still mention their cover price as Rs 2.50 or 3.50. A rupee today cannot even purchase a small candy. Beggars too would give one a disapproving look if a rupee coin was given. Its pre-decimal avatar i.e. four anna coin, popularly called ‘chavanni’, was one of my most cherished possessions during my childhood and adolescent years. During the college days too, the ‘chavanni’ carried considerable purchasing power. The pre-decimal era rupee had 16 annas and 64 pice or paise. In our younger days, the 4-anna coin was much in demand. In fact, it was my daily pocket money when I went to school in Lahore, and bought me enough of snacks and lassi or milk that would be my lunch and still leave enough balance to buy a cream roll, ice cream soda and even a cup of ice cream at Nisbet Road’s Crystal Restaurant. Even the pice or paisa in the pre-1947 era enjoyed considerable value. I could buy a plate of chhole with kulcha or a pocket full of peanuts for one paisa. A tandoori roti would cost 1 paisa at a dhaba with complimentary dal. During World War II when the then British Indian government had introduced rationing, I bought five sers (1 ser = 0.93310 kg) of sugar for just one rupee. That meant that a ser of sugar would cost less than a ‘chavanni’. Almost until 1950s, the 4-anna class in picture houses was the most popular among the hoi polloi, including students. The success or otherwise of a movie too was judged by the response it got from the 4-anna fans. The louder the whistling, clapping and shrieking, the greater was the deemed response from the fans. Once, our group of students decided to see a popular movie “Ek thi Ladki” in 4-anna class and used our muscle power to book all the seats. Other 4-anna movie goers were sorely disappointed and our group collected five rupees from amongst ourselves in order to pacify the protesters and told them to see the next show. Needless to say, our group was the noisiest of the lot that day in the cinema hall to the annoyance of the rest of the picture goers. Even in 1950s and up to mid 60s, ‘chavanni’ carried much value. We paid four annas for a cup of coffee or tea (per head) and another Chavanni for a king size samosa in the upscale restaurants such as Kwality. Interestingly, post-Independence, I paid a tuition fee of eight annas in my college. It was a special refugee concession, though I claimed Rs 5 from my father which was the regular college fee at that time. Those of us who have lived through the cheap and cheerful days of ‘chavanni’ today mournfully bid adieu to its successor, the 25-paisa coin. May its soul rest in
peace!
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Today, celiac disease is neither rare nor necessarily a diarrhoeal condition. Nearly 1-2 per cent of the population suffers from it. Also, no longer is it a childhood disease as a majority of the cases are being picked up between 40-60 years of age
Believed
to be a rare diarrhoeal disease of childhood, given no more than half a page in medical textbooks, the face of celiac disease has changed radically — a revelation which came as a consequence of my personal experience. The journey to confirming gluten-intolerance in my elder son was unusual and long. As he grew from a chubby, “picture book” baby (up to 3 years) into a tall lanky child with sunken cheeks, I became concerned about his fussy eating habits and borderline low haemoglobin. While most family and doctors felt I was overly concerned about “nothing” as a mother (and a nutritionist), I felt I needed to find out why my exceptionally tall son did not eat as well as others of his age. By the time, he reached age 10, I suspected “mal-absorption” and tossed the idea with my colleagues. Celiac disease is a common cause for mal-absorption, but no one seemed to think of it as a possibility. This, however, need not deter me from getting the basic tests for gluten intolerance available in those days (1995-96). The “anti-gliadin” and “anti-gluten” antibodies tested positive but these results were dismissed by experts as being non-specific markers. As time went by and my concerns unabated, during discussions with colleagues sometime in 2002, I was informed of two new serological markers — tissue trans glutaminases antibodies (tTg,IgA) and anti endomycelial antibodies with 99 per cent reliability. I promptly went ahead for these and this time too the results were positive. Finally, without any resistance, I was advised to go ahead with the “gold standard” –the endoscopic biopsy, which confirms gluten intolerance. The confirmation came almost as a relief, as I seemed to have found answers to my worries. It was then that I entered the gluten-free world and realized how little all of us knew about it….If I being a health professional had to go through so much to reach this far, what would be the fate of the others less literate. I discovered that celiac disease was like a hidden epidemic.
Rare condition
Celiac disease is believed to be a rare condition, both by health professionals and the general public. While in the Western world it is beginning to get more attention than before, in India it is just getting recognized. Today, it is neither rare with 1-2 per cent of population suffering from it, nor necessarily a diarrhoeal condition. Also, no longer is it a childhood disease as majority of cases are being picked up between 40-60 years of age. Nearly, 25 per cent cases are diagnosed in individuals over 60 years of age. The disease occurs globally, has no socio-economic boundaries and can occur at any age. Celiac disease is a condition where individuals cannot tolerate gluten, a protein found commonly in grains, including wheat, oats, barley (also rye, triticale and spelt, not grown in India), where gluten damages the intestinal lining and reduces the ability of the body to absorb food. Typical symptoms of celiac disease include diarrhea, gastrointestinal disturbances like abdominal distension, flatulence, pain, constipation; nausea, vomiting, growth problems, stunting, anemia, but not everyone presents with these. In fact, only 50 per cent cases may present with diarrhea. Other symptoms include weight loss, lethargy, tiredness, bone problems like osteoporosis and cramps; skin problems, infertility, mouth ulcers, numbness and behaviour problems like depression, anxiety, irritability and poor school performance. Absence of typical symptoms makes the diagnosis difficult and often leads to ill health and life threatening maladies.
Causes are unclear
The cause for celiac disease is unclear and there are no simple answers. It is clearly a complex interaction of genetics and the environment. Some specific genes have been identified and some are yet to be identified. Some of the environmental risk factors associated with the development of celiac disease, particularly in children include absence of breastfeeding, repeated infections and early introduction of cow’s milk, wheat, and egg. The type of wheat being consumed these days is also believed to be genetically different from the one in earlier times and has been implicated as a probable cause for increasing prevalence. In India, the prevalence of celiac disease is certainly more common than previously appreciated and since it is largely an undiagnosed condition, the real numbers may be much larger.
Diagnostic challenge
Generally speaking, celiac disease is a diagnostic challenge. It may present itself in many ways — typical, atypical, and even silent (with very mild symptoms), which can make diagnosis difficult. Often, I see patients who have been considered for growth hormone therapy for short stature, been through rounds of hospital admissions due to debility and ill-health, and even on anti-tubercular treatment for unexplained diarrhea and weight loss, only to worsen their suffering. Nearly 60 per cent have no diarrhea and may have completely atypical symptoms — which could be as diverse as neurological problems, ataxia (loss of coordination), bone and joint pains, in women there could be miscarriages, infertility or bone and joint problems like arthritis and osteoporosis. Final diagnosis is done using serological markers (blood tests) and endoscopy. Left undiagnosed, celiac disease can increase the risk of developing a severe form of malnutrition, non-specific ill health and can prove fatal. Celiac disease can increase the risk to disorders like type-1 diabetes mellitus, autoimmune diseases, liver diseases, thyroid disorders, pulmonary diseases such as asthma; ulcerative colitis, crohn’s disease as well as cancer.
Permanent condition
It is a permanent condition and requires lifelong strict restriction to gluten along with nutritional supplements to correct deficiencies. Gluten-free diet usually helps restore normal health. Living with celiac disease in developed countries is easier as food labeling is better, conveniently packed food is available and restaurants and fast foods provide gluten free choices. The same however is not true for India, so far. Food options in India are restrictive and food labeling inadequate. Clearly, the need to raise awareness is urgent. My book ‘Is Wheat Killing You?’ aims to demystify the condition and also puts the condition in complete perspective by providing insights into gluten-free living. To raise awareness about this condition the first Celiac Society in the country, has also been formed with doctors, academicians and people from food industry.
The writer is Clinical Nutritionist & Director, Whole Foods India, Founder President of Celiac Society for Delhi and author of “Is Wheat Killing you?” published recently
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Celiac disease: A hidden epidemic