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US commitment
Threat to dams |
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The more the merrier
Vietnam and Asian balance of power
People for the dogs
Understanding morbid obesity
What is bariatric surgery?
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US commitment
US Secretary
of State Hillary Clinton reiterated on Tuesday in New Delhi what Washington DC had been saying since the 46-nation Nuclear Suppliers Group (NSG) recently announced its new guidelines for the transfer of sensitive uranium enrichment and reprocessing technologies. The US remains committed to ensuring that any NSG rules do not affect India’s right to nuclear trade that it got restored after the operationalisation of the Indo-US civilian nuclear deal. The NSG allowed a special waiver in the case of India, not a signatory to the Nuclear Non-Proliferation Treaty, because of its clean record as a responsible nuclear power. Since there is no change in India’s record, any new NSG regulations for the control of nuclear trade should not take away what India has got as a consequence of the nuclear deal with the US. India understands the US concern, as expressed by Mrs Clinton during her meetings with External Affairs Minister S.M. Krishna and other Indian leaders, at the nuclear liability law enacted some time ago. This law, formulated after considerable debate in Parliament, has been coming in the way of the US companies interested in nuclear trade with India. There is a demand that India should amend the controversial law, described as not being in conformity with international norms. Without sacrificing its own national interests, India is ready to do whatever it can. The US also wants India to sign the Convention on Supplementary Compensation to reduce the effect of the Indian liability law. India has agreed to sign it and get it ratified by November. But, in the meantime, the NSG’s new regulations must be made ineffective in the case of India. It is true that the Indo-US civilian nuclear deal does not clearly address the question of transfer of nuclear fuel enrichment and reprocessing (ENR) technologies, but it does mention that this kind of transfer can be possible. The US, which has been hesitant so far, should declare that it is ready for ENR technologies’ transfer even by its own companies once India redresses its grievance related to the liability law. America’s unqualified support to the civilian nuclear cause of India will help New Delhi in becoming a member of all the nuclear export regimes — the NSG, the Wassenaar Arrangement, the Australia Group and the Missile Technology Control Regime.
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Threat to dams
Ever
since the Intelligence Bureau reported that the 225-metre high Bhakra Dam is on the latest hit list of Pakistan-based terrorist outfits like the Lashkar-e-Toiba (LeT) and the Jamaat-ud-Dawa (JuD), security agencies are in a tizzy. Quite understandable, considering that a strike there can cause immense damage. But forewarned is forearmed. Many loose ends which had been dangling callously all this while are now being taken care of. The most significant result of Tuesday’s review of the arrangements has been that the security is to be put under a single command. That has been the Achilles’ heel for Bhakra considering that so far, it has been shared by all stakeholders. The left side of the reservoir is in Bilaspur district and the right in Una district of Himachal Pradesh while the area downstream as well as some related installations are in Punjab. Punjab and Himachal Pradesh are now to approach the Centre for a one-time grant to procure sophisticated electronic equipment like explosive detectors, sensors and underwater cameras. That will entail considerable expenditure, but in such matters of vital national interest, no cost can be too high. It is also necessary to look into the demand of the Bhakra Beas Management Board (BBMB) that the security of the dam, which is currently with the Indian Reserve Battalion, is handed over to the Central Industrial Security Force, which is providing security to other dams in the country being built by the National Hydroelectric Power Project (NHPC). There is a need for at least 600 persons whereas currently only 150 are employed. While focusing on Bhakra, it is imperative to be alive to the security of other dams also. The element of surprise is a potent weapon in the hands of terrorists. They have lost that in the case of Bhakra. As such, they might want to play their dirty tricks at a less zealously guarded place. Constant vigil is the best antidote against evil designs.
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The more the merrier
There
is understandable concern in certain quarters about the way private universities are coming up in Himachal Pradesh. To the present 12 private universities, the tiny hill state is expected to add about a dozen more. The number, already large and growing, is more than the state’s small population needs, say opponents of the wholesale grant of clearances to private universities. Concerns are largely misplaced and stem from an old mindset that views the government as the sole benevolent provider of education and the private sector as exploitative, driven by profiteering. Education is a thriving business as there is a large demand-supply mismatch. It is better to have more universities and colleges than cement plants that pollute the environment. New universities will create fresh jobs and education opportunities. They offer market-dictated courses, which usually are unavailable in government universities or the demand remains unmet. If too many education entrepreneurs are concentrating in a small area, risks are theirs. If they do not attract a sufficient number of students, they would be forced to wind up. Students from outside the state may turn up. Parents in the hot plains may like to send their children to Himachal’s cool climes for education. The government can use its limited resources to provide education in the neglected areas. It is like private hospitals easing the pressure on government institutions. But the government needs to be vigilant. Before giving a green signal it should assess how much burden of an additional population can the fragile hills and infrastructure bear. Traffic bottlenecks and water shortage are common at many places. The credentials of private education providers must be thoroughly checked. Their intention should not be to grab land in the name of education for promoting commercial or real estate ventures. A regulator is a must for educational institutions so that they deliver what they promise. An independent rating agency will be helpful for parents to make a right choice.
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Every production of genius must be the production of enthusiasm. — Benjamin Disraeli
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Vietnam and Asian balance of power
Dr
Henry Kissinger makes some interesting revelations about China’s invasion of Vietnam in March 1979 in his recent book on China. He explains how Deng Xiao Ping made elaborate preparations to invade Vietnam by embarking on a charm offensive, with visits to Japan, South-East Asia and, last but not the least, to the US. In Washington, Deng spoke of the “parallel interests” of China and the US, and the need for the US and China to “coordinate our activities and adopt necessary measures”, following Vietnam’s 1978 Treaty with the Soviet Union. While President Carter paid lip service to peace, he offered “intelligence briefings” to the Chinese even as Deng asserted: “China must still teach Vietnam a lesson”. Kissinger reveals that Deng indicated that China’s plan was to mount “a limited punitive strike, followed by a retreat” in Vietnam, as it had done in the 1962 conflict with India. He, however, fails to acknowledge that the Vietnamese gave the Chinese a bloody nose during their “punitive strike” on their southern neighbour. The wheels of geopolitics have turned a full circle over the past three decades. After “strategic geniuses” like Kissinger and Brzezinski contributed significantly to China’s “rise” by advocating liberal transfers of investment and technology, the Americans are now finding China increasingly “assertive,” with its mercantilist policies designed to corner the world’s natural resources and its propensity to use force to enforce maritime boundary claims with virtually all its neighbours. One sees a similar Chinese “assertiveness” in dealing with boundary issues with India. Not only is the claim being laid to the entire state of Arunachal Pradesh, but also China is now alluding to the length of the Sino-Indian border as 2000 kilometres instead of the actual length to 3488 kilometres, thereby excluding its borders in the western sector with Jammu and Kashmir from the ambit of differences over the Sino-Indian border. Forever apologetic and defensive in dealing with an “assertive” China, South Block has yet to acknowledge that this constitutes a significant change in China’s approach to the issue of Jammu and Kashmir and indeed to the entire border issue. A similar pusillanimity appears to characterise our response to the indications of China, which is not a signatory to the 1997 UN Convention on Transnational Rivers, giving consideration to projects to divert the waters of the Brahmaputra, while adopting an approach akin to its policies on the Mekong basin. Clearly alarmed by China’s growing “assertiveness” on its maritime boundaries with virtually all its neighbours — ranging from Japan, South Korea and Vietnam to the Philippines, Malaysia and Brunei — Hillary Clinton joined ASEAN Foreign Ministers at an ARF meeting in Vietnam in July 2010, expressing concern about the growing Chinese disinclination to work constructively with its ASEAN neighbours, to resolve differences over maritime boundaries. American concern was again expressed at a meeting of Defence Ministers of ASEAN and its partners in Hanoi in October 2010. During the past year China has not hesitated to use force along its maritime boundaries with Japan, Vietnam and the Philippines. Tensions have grown significantly between China and Vietnam in recent months. In May 2011 a Chinese fishing boat escorted by two Chinese naval vessels deliberately rammed into a Vietnamese seismic survey ship. Following protests by both sides and demonstrations in Vietnam, Hanoi embarked on naval exercises off its central coast. China responded with a large-scale exercise in the South China Sea, in which fighter aircraft participated. On June 14 Vietnam’s Prime Minister Nguyen Tan Dung served notice about the possibility of an impending military mobilisation while the Chinese Communist Party mouthpiece, The Global Times, warned Vietnam that China would answer any “provocation” with “economic or even military counter-strikes”. If China colluded with the US to attack Vietnam in 1979, the Chinese now warn the Vietnamese against “‘unrealistic” expectations of US backing! Vietnam was told: “China will take whatever measures are necessary to protect its interests in the South China Sea”. Vietnam, in turn, is strengthening its defences with the acquisition of 6 kilo class submarines, SU 30 MK 2 fighters and MI 17 helicopters from Russia. Vietnam’s Naval Chief and Deputy Defence Minister Vice-Admiral Nguyen Van Hein visited New Delhi on June 27. Prior to his visit Hanoi had permitted Indian naval ships to berth at Nha Trang Port in Southern Vietnam. Vice-Admiral Hein visited Indian naval dockyards in Mumbai and Vishakhapatnam. Maritime cooperation will be a crucial element in defence cooperation with Vietnam. Both countries extensively use equipment of Russian origin. The Union Finance Minister, Mr Pranab Mukherjee, told Vietnam’s Prime Minister Nguyen Tan Dung on May 8 that India would continue to assist Vietnam in the modernisation of its armed forces, focusing attention primarily on its Air Force and Navy. Mr Mukherjee also spoke of enhanced intelligence cooperation with Vietnam. Unfortunately, given the disgraceful performance and the inability to utilise opportunities for oil and gas exploration that Vietnam provided to the ONGC, India cannot be said to enjoy an image of efficiency or competence in Vietnamese eyes. Moreover, we need to be far less inhibited in dealing with defence cooperation with Vietnam than our mandarins in the Defence Ministry are generally given to being. If we are really serious about developing Vietnam’s capabilities to defend its maritime boundaries, we should be prepared to transfer potent weapon systems like Brahmos cruise missiles to that country. China has, after all, shown no inhibitions in transferring a range of missile systems to Pakistan. Moreover, we should avoid subjecting Vietnam to the inefficiencies of public sector enterprises like the ONGC or the NHPC, which have underperformed in our eastern neighbourhood. India needs to play an active role in building an inclusive architecture for security in the South China Sea and across the Asia-Pacific. We are expanding defence ties with Japan and participating in multilateral naval exercises. Should we not elicit participation by Vietnam in such exercises? While describing the national traits of the Vietnamese, Henry Kissinger notes: “Hanoi was not any other country’s proxy. It fought for its vision of independence, which assigned to Vietnam the dominant role that Beijing had played in East Asia. To these single-minded survivors of centuries of conflict with China, compromise was inconceivable between their idea of independence and any outsider’s conception of stability”. While seeking to build an inclusive architecture for cooperation and security in Asia, no country, least of all India, can or should ignore the importance of Vietnam in building a stable balance of power in the continent.n
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People for the dogs
Several
Britons continued to reside in India post-August 1947 for varied personal reasons. And there was one amongst them who did so out of an indebtedness arising from a lifetimes companionship by his devoted pet, a black and tan Dachshund. This was also the time when the laws prevalent in the U.K. demanded all dogs entering the country to be quarantined in government kennels for six months. Not many owners and pets could pull through the prolonged trauma of such an enforced separation. So, this Englishman would walk his dog on a leash every morning to the Lodhi Gardens, New Delhi. Upon reaching a particular spot, the Dachshund was released and the master would retire to a bench to browse through the newspaper. The dog would bound away (yelping if the morning air was heavy with the scent of his quarry) to a nearby grassy mound riddled with the burrows of field rats. Now the Dachshunds were especially developed and bred by the Nordsmen to ferret out Badgers from their hidings. And no self respecting Dachshund can ever resist that genetic ferreting instinct. How this dog lover induced his pet away from the rat tunnels half an hour later each morning, is a mystery. Then one day in 1948, the gentleman was seen leaving for the UK, bag and baggage. Saddly, the Dachshund had passed away in the natural way, snapping his last link with India. But none has understood and expressed better, the love of man for his dog and the devotion of the dog to his master than Rudyard Kipling did in his epic poem, “The Power of a Dog”: There is Sorrow enough in the natural way From men and women to fill our day, And when we are certain of sorrow in store, Why do we always arrange for more? Brothers and Sisters I bid you beware of giving your heart to a dog to tear. Buy a Pup and your money will buy Love unflinching that cannot lie Perfect passion and worship fed By kick in the ribs or a pat on the head. Nevertheless it is hardly fair To risk your heart for a dog to tear. When the fourteen years which Nature permits Are closing in asthma, or tumour, or fits, And the vets unspoken prescription runs To lethal chambers or loaded guns, Then you will find-its your own affair- But.... you’ve given your heart to a dog to tear. When the body that lived at your single will With its whimper of welcome, is stilled (how still!) When the spirit that answered your every mood Is gone — wherever it goes — for good, You will discover how much you care, And will give your heart to a dog to tear. Our loves are not given, but only lent, At compound interest of cent percent. Though it is not always the case, I belive, That the longer we’ve kept ‘em, the more do we grieve: For when debts are payable, right or wrong, A short-time loan is as bad as a long So why in Heaven (before we are there) Should we give our hearts to a dog to tear? Unfortunate are the people who have not experienced that flutter of the heart from a dog’s unconditional love and that elation of the human spirit which follows from
dog-loving.n
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Understanding morbid obesity
Over the next decade, as the Indian population enjoys the benefits of a booming economy but battles with lifestyle diseases, health care experts and the government must step up awareness efforts to establish morbid obesity as a disease. Some of the steps which need to be taken to control the rising incidence of obesity and morbid obesity are as follows: Understand the difference between being overweight and being obese: The first step towards managing obesity/morbid obesity is to recognize it. There is marked distinction in being overweight, obese and morbidly obese. Individuals with a BMI between 18-23kg/m² are in the normal range. Individuals with BMI in the range of 23-27.4kg/ m² are considered overweight. Those with BMI of between 27.5 to 32.5kg/ m² are considered as obese. And individuals with BMI greater than 32.5kg/ m² and higher are considered as severely to morbidly obese. Most of the obese patients have obesity related diseases such as diabetes, cardiovascular diseases and hypertension. The factors leading to obesity and morbid obesity are multiple and complex. The contributing factors for this condition include genetic, hereditary, environmental, metabolic and eating disorders and efforts such as dieting and exercise have limited ability to provide effective long-term relief. Recognize that morbid obesity is a disease and not a lifestyle disorder and must be treated accordingly: At present, morbid obesity is not recognized as a disease and is often termed as just a lifestyle condition which can be reversed through lifestyle modification. According to expert estimates, India accounted for close to 60 per cent of the world's heart disease cases as of 2010. Heart disease and Type 2 diabetes are the most common co-morbidities associated with morbid obesity. But not many people suffering from morbid obesity know the exact nature of their problem or how obesity related diseases can be managed. Morbidly obese and obese individuals with co-morbidities seek treatment for the concomitant diseases like diabetes, heart problems, liver disorders etc. without eliminating the root cause for these ailments. Globally, it has been recognized that symptomatic treatment for co-morbidities, without touching the real cause, cannot assure a long-term solution to these problems. In fact, large steps are being taken to ensure that obesity and morbid obesity are recognized as diseases and guidelines are being set to treat obesity and its co-morbidities. During the Metabolic and Obesity Summit (MOSI) - Consensus in Diagnosis, management of Obesity and Metabolic Syndrome, which was held in New Delhi in 2008, several new parameters and guidelines in measurement of BMI or Body Mass Index for Asians, particularly Indians, were debated. Some of the issues discussed were as follows:
According to the consensus reached at the summit, some new definitions and classifications came into existence.
At the Diabetes Surgery Summit in Rome in 2007 and the 1st World Congress in 2008 it was established that obesity surgery (Bariatric surgery) was appropriate for the treatment of Type 2 Diabetes. At the recently concluded 2nd World Congress on Interventional Therapies for Type 2 Diabetes, the International Diabetes Federation (IDF) issued a position statement supporting bariatric surgery to treat Type 2 diabetes in obese patients. The statement was written by 20 leading experts in diabetes and bariatric surgery who have made a series of recommendations on the use of bariatric surgery as a cost-effective treatment option for severely obese people with type 2 Diabetes. The IDF statement adds to the growing momentum of professional organization support for bariatric surgery to be considered in combating weight related metabolic diseases such as diabetes and coronary disease. This is an important step but more work needs to be done to guarantee that morbidly obese patients do not suffer because of low awareness and lead a poor quality life, when treatment for their condition is readily available. There is need to educate the frontline healthcare workers and doctors and adequately equip the healthcare set-ups offering this treatment. It is imperative to establish morbid obesity as a disease and to take up its diagnosis and treatment seriously and equip the primary and secondary, government and private medical care centres adequately. The new guidelines have put into perspective the rising trend of obesity and related metabolic diseases, providing a roadmap for the future. However, it is important to educate the frontline healthcare workers and doctors in India about the same, so that when obese patients seek treatment for co-morbidities, they are referred to the specialists and the patients are treated well in time, reducing health complications and the prolonged medical expenses. It is also important that the institutions undertaking metabolic and Bariatric surgery must offer a multi-disciplinary supporting system, basic facilities and equipment for the safe laparoscopic and open surgery, written information that explains the procedure, possible risks and complications and medical followup following the surgical procedure, long term followup of all post-operative patients, empathetic staff, patient friendly infrastructure. The need of the hour is to educate people and medical practitioners alike about morbid obesity, making them aware of co-morbidities associated with it and establish it as potentially life threatening condition. It's also vital that surgery be looked upon as a safe option to cure morbid obesity and save lives. What's more, the guidelines proposed at the Summit and World Congress should be adhered to in order to maximize the benefits for patients and their families. Both public and private groups should share the responsibility and help initiate a positive change in diagnosing and treating morbid obesity. Dr Pradeep Chowbey is a
Padma Shri awardee and the Director, Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute, Saket, New Delhi.
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Morbid obesity is a severe form of obesity where a person's weight becomes unmanageable and it becomes almost impossible to lose weight through conventional means such as diet and exercise. Morbidly obese individuals are highly susceptible to obesity-related diseases such as type 2 diabetes, cardiovascular disorders, liver disease, infertility, osteoarthritis and certain types of cancers and for them weight loss surgery is the only viable solution that provides sustainable weight loss. The three main types of surgical weight loss procedures are Gastric banding, Sleeve gastrectomy and Gastric bypass surgery. Gastric Banding Sleeve Gastrectomy Although it is a quite safe procedure, complications may arise if leakage occurs from the stomach due to staple line disruption. But choosing the correct surgeon and facility for the surgery can greatly reduce the risk of developing such complications. Surgery may also result in cramping, acid reflux, nausea and infection all of which can be treated with medication. Gastric Bypass Gastric bypass surgery is a restrictive and malabsorptive weight loss technique. The stomach is first divided into two sections - a smaller upper pouch and a lower larger pouch. A section of the small intestine is then connected to the upper pouch to allow drainage from both sections of the stomach. This not only limits the amount of food intake but also allows the food to bypass most of the stomach and a large part of the small intestine resulting in reduced nutrient absorption. The major problem associated with this procedure is that it may result in nutritional deficiencies but these can be effectively managed by supporting diet with nutritional supplements. Surgery may also result in ulcers, gastrointestinal inflammation and nausea. Traditional methods of bariatric or weight loss surgery required the surgeon to create a large incision in the patient's stomach which greatly increased the chances of developing infection, haemorrhage and internal hernia, but the implementation of minimally invasive laparoscopic techniques have greatly reduced the risk involved in surgery. The surgeon now has to make only one or two small holes in the abdomen thereby reducing the chances of infection and scarring as well as facilitating faster healing because of which the patients can go back to routine work much early. Post-Surgical Care An important thing to understand is that weight loss surgery does not give the patient a license to eat whatever he wants to. Those who undergo surgery need to adopt good eating habits and eat proper nutritional supplements to avoid nutritional deficiencies. This also helps in tracking one's food intake and avoiding unplanned meals. Patients should follow a diet, exercise and recovery plan, therefore setting realistic goals. Post- surgery patients should gradually start increasing the daily physical exercise. One must exercise regularly as it helps maximize weight loss and also helps reduce the risks associated with diabetes, heart diseases, muscle and bone structure and psychological health. Following bariatric surgery patients must make a lifelong commitment to a healthy lifestyle! — PC
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In the gastric banding procedure, the surgeon places an inflatable silicone band around the upper part of the stomach creating a small pouch. Since this pouch is considerably smaller than the stomach, it is able to hold less food and the person feels full after consuming a smaller quantity of food. Thus weight loss is induced by restricting the amount of food intake. This is the least invasive form of weight loss surgery and it is a reversible procedure. The major disadvantage of the procedure is that if food intake is not regulated, the band may become loose negating the effect of the procedure.
Sleeve Gastrectomy involves reducing the stomach to 25 percent of its natural size in order to limit the food intake. A large portion of the stomach along the major curve is cut away and the edges are stapled together to form a banana shaped tube or sleeve. This is an irreversible procedure and is an effective weight loss technique.