The Tribune, Chandigarh, India

Unfair means
Teach, so they may not cheat

THE Punjab and Haryana High Court has asked the Punjab School Education Board to exercise caution while choosing exam centres, so as to prevent copying. Unfortunately, the board is only one ineffectual entity in this mess, which is evident from the scale at which ‘unfair means’ in exams are used. Hundreds of students are booked by the board each year for cheating, which is only a fraction of the actual number that would be indulging in such acts. Haryana this year booked more than 2,000 students. Pictures appear regularly in the media from both Punjab and Haryana of dozens of people hanging from windows at exam centres, supplying answers to students inside. This is visible to one and all, yet the practice continues.

The reason for this is not unscrupulous students but a whole education system that is dysfunctional. Open and blatant cheating takes place because there is complicity of parents, teachers, the police and education officials. None of them complains because they are convinced this is how “the system works”. To an extent, they are right too. Deny students the opportunity to cheat, and you may have the majority failing. That is because they never had any education in their years in school. Now if you deny them certificates too — for whatever those are worth — the youth may lose out in the job market also.

What will thus prevent the symptom that is cheating is removal of the disease, which is lack of education. Make the students competent enough not to need unfair means. As revealed by an official survey of eight blocks in Punjab, nearly one-third of primary students covered by the Sarva Shiksha Abhiyan cannot read a paragraph in Punjabi. The rest won’t be much better either. A report in The Tribune on Wednesday highlighted a school in Muktsar district that has 206 students, but only one teacher. Students there “enjoy” riding cattle that enter the school premises that has no boundary wall. It is hard to say whether students in board exams are using “unfair means”, or are just trying to get by, by whatever means.

Bonded duty
Bitter pill for doctors

IT is one of those ironies that there is a shortage of doctors in India, yet for long India has been a major source of providing doctors to the developed nations, including the US and the UK. The government’s way of tackling this situation is to ensure that Indian doctors who go to the US for further specialisation would be required to fill in bonds promising to return once they have finished their studies.

The Health Minister, Mr Ghulam Nabi Azad, says that 3,000 doctors went abroad for further studies during the last three years and did not return. In itself, this is not an earth-shaking figure, but then we have to keep in mind the abysmal doctor-to-people ratio in the country, which is said to be as low as one doctor for 1,700 people. There is no doubt that India needs more doctors, yet in many parts of the nation permanent jobs are not available in spite of vacancies. In any case, the pay scale of government doctors does not compare in any way with what is available in the private sector. Thus, primary healthcare suffers the most. There is a crying need for doctors to go to rural areas, and the government must find ways of equipping rural doctors with advanced facilities, and also making some component of rural service compulsory for doctors. This would especially be applicable to students of government-aided medical colleges.

However, there is a shortage of seats available for further studies in India and it is estimated that only 10-15 per cent of MBBS students are able to do their MS. Experienced doctors going in for further studies need facilities. Many go abroad later in their careers for specialisations. Some of them may even focus on esoteric subjects that do not have much relevance in India at present. Others may want to come back once they have gained specialised knowledge, and use it here. Surely, it is for individuals to choose the course they want to take professionally and not for the government to determine it.

Thought for the Day

A hen is only an egg's way of making another egg.

— Samuel Butler

ARTICLE

Beyond Zardari’s India visit
Limitations of an elected leader in Pakistan
by G Parthasarathy

JUST before he commenced his ‘yatra’ to India to combine diplomacy in Delhi with pilgrimage and prayer in Ajmer, President Zardari had a long meeting in Lahore with the person who determines his country’s foreign and security policies—General Ashfaq Parvez Kayani. The worthy General, who never tires of telling his American friends about his “India-centric” view of the world, is no slouch when it comes to political intrigue and manoeuvring to keep the elected government on its toes. He has repeatedly sought to clip the wings of a President, the army establishment loves to hate. General Kayani is quite appropriately called by sections of the Pakistani media as “Canny”.

The cigar-smoking General, who has long been the darling of the American establishment, displayed his true colours, after the US raid on Abbotabad that killed Osama bin Laden, as he was unable to explain how the Pakistan Army, the self-proclaimed guardian of Pakistan’s “ideological and geographical frontiers,” could have allowed the most wanted terrorist in the world to be found in one of the country’s most strongly guarded cantonments.

General Kayani responded by manipulating the media and raising anti-American sentiments across the country. The anti-American propaganda became frenzied after American air attacks killed 25 Pakistani soldiers, who opened fire on an Afghan-American joint patrol across the Durand Line. But, determined to keep his personal links open with the Americans, General Kayani passed the buck for determining the future course of relations with the US to the politicians in Pakistan’s National Assembly (Parliament). The National Assembly has tied the country in knots by placing demands on the Americans for reopening supply routes to Afghanistan, which no American President can realistically accept, especially in an election year. These demands include a public apology for the killing of 25 Pakistani soldiers, an end to drone strikes and a nuclear deal akin to that reached with India.

Kayani has also used Chief Justice Iftikhar Mohammed Chaudhury, for whom he had shown consideration, when Musharraf sacked the Chief Justice in 2007, to pressure the elected government. The Chief Justice has reopened corruption cases against Zardari on his Swiss bank accounts and embarrassed him on the “Memogate” affair, involving his former ambassador to the US.

With tensions rising on his country’s borders with Afghanistan, necessitating the move for several Pakistani military formations to be deployed on borders with India to its western borders with Afghanistan, Kayani’s strategy is not to allow escalation of tensions on Pakistan’s borders with India, when his resources are deployed elsewhere. He has, therefore, given President Zardari’s government space to make some token moves, purporting to represent a “change of heart.” Kayani knows there is no dearth of Indian “bleeding hearts”, given to holding “Candle Light Vigils” at the Wagah border who will see all this as a “genuine change of heart” in the Pakistani establishment. Zardari has, therefore, evidently been given the go-ahead to slowly remove some restrictions on trade and for some movement on people-to-people relations. But his government has been put on notice not to get out of line by the Defence of Pakistan Council, a group of Pakistani Islamist radicals, led by Hafiz Mohammed Saeed and backed by the military. Predictably, the Council has alleged that India is starving Pakistan of river waters, and asserted that jihad in Kashmir is the only way forward. Zardari was thus forced to make ritual references to Kashmir when he was in Delhi.

Despite being under siege domestically, President Zardari has shown considerable skills in political management. The ruling People’s Party of Pakistan and its allies recently swept the elections to the Pakistan Senate. He also appears to be working on a strategy to split opposition votes between Nawaz Sharif and army-backed Imran Khan, who’s party Vice-President has been prominently present at meetings addressed by Hafiz Saeed. Zardari has also backed the demand for splitting the dominant Punjab province by supporting the caving out of a Seraiki-speaking province in Southern Punjab. This issue resonates strongly in Southern Punjab, where people feel discriminated against by the dominant Punjabi speakers. Southern Punjab is the home of Prime Minister Gilani, who resents the domination of the Punjabi speaking Sharif brothers.

Zardari has also played the “Sind card,” highlighting Sindhi grievances against Punjabi domination. In a fiery speech at the “mazar” of his grandfather Zulfiqar Ali Bhutto, in Sind, Bilal Bhutto Zardari lashed out at the Punjabi Chief Justice of the Supreme Court, drawing attention to how the late Benazir Bhutto was still being defamed by the court, which had “freed terrorists and rapists” in the Mukhtaran Mai case. “How can there be enough evidence to attempt to try the grave of Shaheed Benazir Bhutto, but terrorists and rapists are set free?” Bilal Bhutto asked.

Accusing the Supreme Court of being a tool of the military, Bilal Bhutto added: “The courts should resist the temptation to obey the dictation of the establishment”. Lashing out at Punjabi domination, he noted: “While a former Prime Minister from Punjab, a self-confessed, convicted accused is vindicated, Shaheed Benazir Bhutto is put on trial from her grave. A (Punjabi) Prime Minister (Nawaz Sharif), who ransacked the Supreme Court, is given a better treatment, while our Seraiki-speaking Prime Minister (Gilani), who obeys the Constitution and presents himself before the Supreme Court, is stripped of his constitutional rights”.

Zardari came to India at a time when the political battle for his re-election as President and the forthcoming general elections next year had commenced. He has fought a hard battle to deal with the manoeuvres of the Army and the Supreme Court to oust him and has shaped the contours of his strategy for the forthcoming electoral battles. There appears, however, little doubt that the ruling coalition cannot retain the decisive majority it now has in the National Assembly. The next elections could well produce a fractured verdict. Given his genuinely friendly and non-confrontational approach to India, it was only appropriate that President Zardari was warmly welcomed in India. His visit has won high praise for him from both the US and China. But this does not mean that we should proceed on the path of diplomatic adventurism, undertaking a poorly planned Prime Ministerial visit to Pakistan.

It is obvious that the Zardari government does not have the power to deliver justice to families of the victims of the 26/11 Mumbai carnage, or rein in its military’s supporting terrorist groups in India and Afghanistan. The lessons of history should not be forgotten. The Kargil conflict followed the hurriedly arranged Lahore visit of Prime Minister Vajpayee. The attack on out Parliament followed the visit of President Musharraf to Agra, undertaken with virtually no advance planning or preparations.

MIDDLE

Practical lessons
by K.K. Paul

WHILE at the Mt Abu Police Academy, a probationer asking for leave meant asking for trouble. In matters of leave, it was not only difficult but almost impossible to get even a sympathetic glance from the training staff. We dreaded putting in an application, as when one was marched in, before the Adjutant or the AD (outdoors), virtually the entire academy would hear, loud and clear, their dressing down, in a booming voice.

Words most frequently heard outside were “a sissy” and “a malingerer” and, on top of it, when the poor probationer came out, he had to face the sniggers of his course-mates. It was, as such, with some trepidation that I submitted an application for leave, sometime in August 1971. Though I had fortified my application with grounds of Ph.D viva voce at Chandigarh, one could not predict the mood of the training bosses. Having attached the official call letter, I did not expect a dressing down. Nevertheless, leave was not sanctioned. Another application was put in on the same grounds and after a hearing before the acting Director, S.N. De Silva, I was sanctioned leave only for the day of the viva.

Travelling at short notice and without a reservation over long distances could be a harrowing experience now, but those days one roughed it out, and journeying back home was always an exciting preposition. As such, when I reached Chandigarh, fatigue was in abundance and sleep in considerable arrears. Luckily, the viva had gone off very well, and I was confident of getting the Ph.D. at the next convocation.

Despite the temptation of at least spending a night at home, promises made at the academy had to be kept. This meant leaving the same day I had come, except that the train left Chandigarh technically after midnight. I was supposed to arrive at Delhi by 6 a.m. and get the connecting train to Abu Road at 9.30 a.m. It was not yet first light when the train made an unscheduled halt at Narela. Suddenly, there were loud “jai karas” being made by Sikh sangat in the train, which had been, by now, surrounded by the GRP, Delhi. None was allowed to move out as the police rounded up the “Jatha” of a few hundred led by Sant Fateh Singh, who was coming to Delhi to ‘liberate’ the gurdwaras.

Anxiety gripped me as the train could leave only after a delay of over two hours. There was enough time but for another unscheduled stoppage. I finally reached Delhi only at 9.30 a.m. and ran for the meter gauge platform located some distance away. As I was approaching, I could see the rear of my train move away. My immediate reaction was to get into a taxi and reach Sarai Rohilla before the train. But it was not my day, and I again missed the train by a whisker. The taxi driver then told me that it would be impossible to catch this train now at Delhi Cantt or even at Gurgaon. I was advised at Sarai Rohilla to wait for Chetak Express, which would have reached me at Ajmer by 7 p.m. and then by a night bus to Abu, still very much on schedule. Accordingly, I got into Chetak Express and reached Ajmer in time, but found that the night bus services had been stopped. It was quite a desperate situation as I was forced to wait at Ajmer railway station for the night. The morning train was on schedule and I reached Abu Road in the afternoon. A taxi took me to the academy office, where I reported before closing time, but eight hours late. Throughout the night I prepared mentally for the ordeal, and next morning as I was marched up to the Acting Director, there were a lot of apprehensions, but I was well prepared with my defence.

Surprisingly, the Acting Director had a calm and soothing expression and did not appear to be annoyed at all. I then narrated the effort made by me to reach in time and also showed him a copy of the newspaper report on the detention of Kalka Mail outside Delhi by the GRP. De Silva only smiled and said, “Congratulations on your Ph.D. I am not aware of any IP or IPS officer who has done a Ph. D.”

I thanked him and as I came out, there was a feeling of strange lightness, and the travel fatigue, the anxiety, the apprehensions all had just vanished. I think it was his one-line appreciation which did the trick. And in it I found a practical lesson, which no amount of police training could ever impart.

OPED — HEALTH

When robot plays surgeon
Robotic surgery is gaining ground in India as there is less pain, shorter hospitalisation, faster recovery, lesser blood loss and risk of infection as well as minimal scarring. In this minimally invasive surgery, the surgeon is assisted by a robotic surgical system
Dr Sudhir Srivastava

What is robotic surgery?

Robotic surgery is the most advanced minimally invasive surgery (MIS). It is typically performed through small (fingertip-size) incisions. The surgery is done by a surgeon using a robotic surgical system called Da Vinci, which enables surgeons performing these surgeries to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery.

In short, the robot serves as an instrument for the surgeon. The Da Vinci system replicates the surgeon's movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical manoeuvre without the surgeon's control. Robotic surgery utilises the most advanced technology allowing surgeons to perform complex surgical procedures that may not be feasible through laparoscopic/endoscopic procedures.

How is it performed?

During the surgery, the surgeon sits at a console a few feet from the patient. The Da Vinci surgical system then translates surgeon's hand movements into corresponding micro-movements of instruments inside the patient's body. The Da Vinci system also provides better visualisation, dexterity, precision and control as compared to open surgery, while enabling the surgeon to perform procedures through tiny, 1-2 cm incisions.

Risks involved

Though risks involved in robotic surgery and thetraditional method of surgery are similar, some complications in certain surgeries are lesser or can completely be avoided during the use of the robotic system. For example, impotence and incontinence are the most common side-effects of radical prostatectomy (procedure performed to remove prostate cancer). However, if the procedure is performed with robotic assistance, this side-effect is completely eliminated. In cardiac surgery, in the 1,300 robotic cardiothoracic cases performed by a surgeon, the mortality rate was 0.3 per cent as compared to 2 per cent to 3 per cent in case of conventional methods of performing cardiac surgery.

Pros and cons

The pre-surgery care is the same as in traditional surgery. The patient is taken to a recovery room immediately after the procedure. The patient has to stay in the hospital for two to three days, unlike five to seven days in case of a traditional surgery. There is minimal rehabilitation and one can resume normal activities within 10 days, or even sooner. The patient is not bed-ridden for months.

Advantages

Faster recovery and early resumption of normal routine.

Less blood loss and reduced risk of infection.

Lesser pain and trauma.

Increased range of motion for the surgeon.

Improved dexterity of the expert.

Enhanced visualisation for the doctor peforming the surgery.

Better access to the surgeon, enabling him/her to perform complex procedures.

Procedures or operations

Robotic surgery can be performed for cardiac, thoracic, urology, gynaecology, general, head and neck and orthopaedics procedures. Especially in urological cases, the robot-assisted approach has become the number one method to perform prostate cancer surgery.

General cost

An average robotic surgery costs nearly Rs 2 lakh, though it depends on the kind of surgery being undertaken.

First robotic surgery

Dr Loulmet is one of the world's leading pioneers in robot-assisted cardiothoracic surgery. He performed the world's first totally endoscopic robotic coronary artery bypass in 1998 - an operation that employs several pencil-size incisions between the ribs - as well as the first totally endoscopic robotic pulmonary vein isolation in 2002. He also assisted in the first robotic mitral valve repair procedure in 1998. His robotic surgical practice focuses on endoscopic coronary bypass (TECAB and MIDCAB), mitral valve repair, and procedures to remove adhesions behind the sternum prior to repeat open-heart surgery.

Hospitals and institutes

Fortis Hospital, New Delhi, Medanta Vattikuti Institute of Robotic Surgery, Gurgaon, AIIMS, New Delhi, KIMS Vattikuti Institute of Robotic Surgery, Hyderabad, Manipal Vattikuti Institute of Robotic Surgery, Bangalore, Asian Vattikuti Institute of Robotic Surgery, Mumbai, Sir Ganga Ram Hospital, New Delhi and Rajiv Gandhi Cancer Institute, New Delhi.

The writer is the Chairman, CEO and Managing Director, Fortis Healthcare and International Centre for Robotic Surgery, New Delhi

Case study 1
Dharampal Singh (81, from Palwal village underwent a single-vessel bypass through robotic surgery. He was diagnosed with a coronary artery disease with blockages, usually caused by atherosclerosis, the build-up of cholesterol and fatty deposits on the inner walls of the arteries. This leads to reduced blood flow to the heart muscle by physically clogging the arteries or by causing abnormal artery tone and function.
Major heart surgeries, like the one above, are performed through three to four tiny incisions. Unlike the traditional method of surgery, the chest is not split open to access the heart. There is less pain, shorter hospitalisation, faster recovery, lesser blood loss and risk of infection and minimal scarring. Dharampal Singh was admitted to the hospital on the January 15, 2012, and was discharged from the hospital on January 20, 2012. Within 10 days, he resumed his normal routine.
Case study 2
Deepa Vaid from New Delhi underwent a robot-assisted hysterectomy. She was having this surgery as she was suffering from heavy bleeding which was causing pain, discomfort and weakness. Vaid was scared of lifelong scarring, and was worried about her recovery period. Her biggest fear was that there would be a big cut on her stomach for the surgery. But the moment she heard about robotic surgery as an option, she was relaxed.
Case study 3
Aditya Khandelwal (18 months) was suffering from Grade 5 left vesicoureteral reflux (VUR). This occurs when the valve between the ureters and the bladder doesn't function properly. Because of this, his urine flow was abnormal. Whenever he would pass urine, some part of it went back to the kidney, causing infection.
No cut was made on the infant's body and robotic surgery was performed through four tiny incisions. Normally, when a cut is made on the body, it leaves a scar, which grows along with the body's growth. However, in this case, only four minor incisions were made which left only a few tiny scars, which could be easily removed later. Thus, there was no lifelong scaring on the child's body.
Also, it was easy to access the small baby structure which made the surgery precise and easier. This would not have been possible with rigid laparoscopic instruments. The procedure was performed in just two hours and the patient was discharged in three days.