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Back to square one |
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A right about-turn
All is not well
Iran faces diplomatic isolation
Nostalgic for candle-light era
The rising cost of medicare
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Back to square one
After
the disruption of international flights for 58 days, resulting in a loss of Rs 600 crore, the Air India management and the agitating pilots agreed to settle their dispute in the Delhi High Court on Tuesday. The 101 sacked pilots are expected to be reinstated. If the management were to “sympathetically” consider the pilots’ grievances, why did it take so long? This should have been done before the pilots’ simmering anger erupted. The cancellation of international flights has caused a huge loss of image and credibility to the institution apart from inconvenience and loss to customers. The management first let the situation boil over by not addressing in time what essentially are post-merger human resource issues. Then it adopted a tough stand from which it backed down. If the High Court were to facilitate a compromise, why did it declare the strike illegal in the first place and ignore the brazen contempt of court by the protesters? The 500 Air India pilots flying on international routes lost all public sympathy by suddenly going on strike. Their demand that pilots from the erstwhile Indian Airlines should not be trained on new Boeing Dreamliners as this would hurt their career prospects is illogical. Managements decide who will do what work in larger institutional interest. What have they gained by hurting the airline they are supposed to serve? By putting personal interests above those of the institution, they have emerged as a short-sighted, selfish lot. Air India, which has accumulated losses of Rs 20,321 crore and a debt of Rs 43,777 crore, has been misused by all stakeholders – politicians, bureaucrats, the management and the employees. The airline is incompetently managed. It charges below-cost fares and has 218 staffers per plane compared to Jet Airways’ 116. It flourished in a monopoly situation and shrank as private airlines came up. Given its functioning, the public sector airline cannot survive competition for long. The government should ensure that the airline work culture is overhauled and it sticks to the conditions tied to the Rs 30,000-crore bailout announced recently.
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A right about-turn
UP
Chief Minister Akhilesh Yadav has shown wisdom by withdrawing his miscalculated announcement made in the state assembly on Tuesday. He had declared that the legislators in UP would be allowed to buy a car costing up to Rs 20 lakh from the funds meant for the MLA Local Area Development Scheme. Before allowing this largesse to the legislators the UP government had increased the funds available under the scheme to Rs 1.50 crore from Rs 1.25 crore annually. But the opposition MLAs particularly noticed a serious flaw in the decision and declared that the idea was not acceptable to them because it would send a wrong message to the electorate. People would gather the impression that the funds allocated to each MLA for development work in his/her constituency were being diverted for personal benefits to the legislators. The Opposition in UP had a point. A state which was finding it difficult to pay even salaries to its employees some time ago could not afford to allow largesse of Rs 20 lakh to its legislators. The condition of the state’s coffers is not very comfortable even today. UP, which has a bicameral legislature, has 403 MLAs and 110 MLCs. All of them buying a vehicle from public funds would mean an expenditure of over Rs 100 crore . Voters were bound to feel upset. UP, one of the country’s laggard states, has been faced with an acute power shortage for many years. The condition of roads is also very poor. It has very poor irrigation and agricultural produce marketing facilities. There is, therefore, need for massive investment in infrastructure development with a view to boosting industrial and agricultural growth. In May, the Akhilesh Yadav government came out with a roadmap for development called Samagra Vikas, aimed at initially generating funds for development projects. But with schemes like cars for legislators from public funds, people might draw the conclusion that the government was more interested in the welfare of the MLAs and MLCs than that of the people. This is not what they expected from Akhilesh Yadav when he took over as the state’s Chief Minister.
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All is not well
While
suicides among the young have often set the alarm bells ringing, they are not the only ones prone to suicidal behaviour. Close on the heels of a study published in the medical journal Lancet that pointed out the alarming rate of suicides in India, now comes another report with startling figures. According to the report, “Accidental deaths and suicides in India 2011,” every four minutes one person resorts to the extreme step of embracing death. If the study in Lancet underlined that its younger people who are at risk, the latest report surmises how one in five suicides are committed by housewives. Farmers’ suicides too have been recorded time and again. Whatever may be the circumstance or the reasons — social economic or personal — behind increasing deaths due to suicides, the bottom line is that these tragedies can be averted. Indeed, different social groups and genders have varying reasons for calling an endgame, yet suicide remains an extreme cry for help. If only the warning signals are paid heed to, many precious lives can be saved. Experts’ opinion that often suicide is not an impulsive decision points out that those nursing suicidal tendencies can be helped well in time. While no fixed pattern can be ascertained from the various reports, answers do lie somewhere in the changing lifestyles. The high rate of suicide in metros suggests a link between unfulfilled materialistic aspirations and fatal choices that people make. Suicides, the preventable tragedies, are triggered by environmental, biological and genetic factors. Since the extreme act of ending one’s life is invariably an outcome of depression, the need for mental health care assumes great significance. In a country which has one of the highest suicide rates in the world, suicides can’t be seen as individual acts of desperation. India can no longer afford to ignore a problem that is fast acquiring alarming proportions. A supportive family structure, an alert educational system and a responsive mental health care set-up are all needed to address this problem.
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The opposite of bravery is not cowardice but conformity. — Robert Anthony
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Iran faces diplomatic isolation
Despite
international sanctions and isolation, Iran has shown remarkable innovativeness in developing a wide-ranging nuclear programme. This programme includes a number of nuclear facilities, and the ability to convert the indigenous raw uranium “yellow cake”’ into uranium fuel, together with the capability to produce zirconium. While the Russians have built a nuclear power plant in Bushehr, the Iranians have a 5 MW nuclear research reactor in Tehran and centres for research in nuclear medicine and agriculture. In addition, the Iranians are building a 40 MW heavy water-moderated reactor at Arak, to be commissioned in 2014, and have demonstrated advanced capabilities for uranium enrichment. The main sources of international concern, however, are two uranium enrichment plants which have now gone on stream. The first uranium enrichment plant at Natanz has been built 8 metres underground. Its existence was revealed in 2002. Iran did not violate any international obligation in secretly commencing construction in Natanz, as it was required to report the project to the International Atomic Energy Agency (IAEA) only when its construction was complete. The underground Natanz plant is protected by two layers — 2.5 metre thick concrete walls, with its roof hardened with reinforced concrete and covered by 22 metres of earth. There are an estimated 7000 centrifuges in Natanz producing low-enriched uranium. Yet another enrichment facility, with some 3000 centrifuges in Fordow, was disclosed to the IAEA after repeated inquiries in September 2009. Like Natanz, this enrichment facility has been built underground and is regarded as even better protected from possible air attacks than the Natanz facility. Original designs for uranium centrifuges were provided to Iran by Pakistan’s infamous nuclear salesman, Dr A.Q. Khan. Iran has faced continuing international suspicions regarding its alleged non-compliance with its obligations as a signatory to the Nuclear Non-Proliferation Treaty, in its relations with the IAEA. Since July 2006, the UN Security Council has passed seven resolutions imposing sanctions on Iran’s nuclear and ballistic missile programmes. These measures even authorise inspection and seizures of shipments violating sanctions imposed on Iran. More importantly, led by the US, the entire Western world has imposed banking and financial sanctions against companies and countries exporting finished petroleum products to Iran, or buying oil from Iran. India has been very severely affected by these measures, primarily because of the extent to which Indian companies are exposed to Western banks and financial institutions. Iran’s economy is clearly feeling the heat of these sanctions. Diplomatic efforts to resolve the Iranian nuclear impasse have faced numerous hurdles. The fundamental differences are between those who say that Iran cannot have a nuclear capability and the others who say that Iran would have to agree to restrictions on its nuclear enrichment that ensure it is not heading towards the production of weapon-grade uranium. Those articulating the second view have viewed Iranian efforts to produce uranium enriched to 20 per cent or more with concern. The most constructive effort to end the Iranian nuclear impasse came from Brazil and Turkey, who together with Iran issued a Joint Declaration on May 17, 2010, in which Iran agreed to send its low-enriched uranium to Turkey in return for enriched fuel for a nuclear research reactor. This initiative was welcomed by a number of Arab countries and by France. Russia and China reacted cautiously. It was rejected by EU Commissioner for Foreign Affairs Catherine Ashton. Mrs Hillary Clinton stated the proposals had a “number of deficiencies,” including Iran’s right and intention to continue enriching to higher levels. Talks with Iran on the nuclear impasse continue under the P5+1 format, with Iran being faced by the five permanent members of the Security Council and Germany. The Russians favour a “step by step approach” under which Iran would take steps to increase cooperation with the IAEA in return for a reciprocal lifting of sanctions. The Western countries want the process to commence with a complete end to enrichment at 20 per cent and above. The Israeli position articulated to President Putin is that the international community should call for the cessation of all nuclear enrichment by Iran, removal of all enriched uranium from the country and dismantling of the Fordow nuclear enrichment facility. The US Congress supports the Israeli position. In these circumstances, it remains to be seen if the P5+1 are able to achieve any significant progress after their meetings in Moscow and Istanbul. While Iran could derive some satisfaction from support from the toothless Nonaligned Movement, it cannot ignore the fact that it is intensely distrusted by its Arab neighbours, who are deeply suspicious of its policies towards their Shia populations and its aggressive posturing on territorial disputes with the UAE. In April 2008, Saudi Arabia’s King Abdullah told General David Petraeus and US envoy Ryan Crocker that the US “should cut off the head of the snake (Iran)”. But what has caused Iran the maximum diplomatic damage has been its comments on Israel. On October 26, 2005, President Ahmedinejad shocked the world with his comment: “Our dear Imam (Ayatollah Khomeini) said that the occupying regime (Israel) must be wiped off the map and this was a very wise statement.” He went on to condemn Muslim rulers who accept the existence of Israel as “acknowledging the surrender of the Muslim world.” Such comments are now common in the national discourse in Iran. Most recently, Iran’s Vice-President Mohammed Reza Rahimi told a conference in Tehran on drug smuggling that the Talmud, or the canon of Jewish faith, teaches how to destroy non-Jews while accusing Jews of inciting drug smuggling. Such Iranian rhetoric, combined with its support for fringe groups like the Hamas and the Hezbollah make the already complicated Iranian nuclear issue even more complex. Israel and the US seem to have no hesitation in seeing Iranian nuclear scientists killed while proceeding to work in Tehran and in sabotaging the Iranian nuclear programme through measures like the introduction of the Stuxnet Virus. Iran doubtless knows that Israel has the undersea and land-based missile capability to reduce its ancient civilization to rubble. Israel and its Western backers, in turn, have to realise that while Iranians would be ready to accept limitations on their nuclear programme along the lines agreed to with Turkey and Brazil, they are unlikely to agree to irrevocably close their nuclear options. This has become an issue of national pride for most Iranians, who resent what they believe are Western double standards. In the interests of peace and stability, all concerned would be well advised to pull back from the brink.n
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Nostalgic for candle-light era
If
you ask me what sound I like the most, it may put me in a dilemma. For, I may not be able to decide whether to vouch for the crooning of the koel or go in for the morning chirping of birds in general. The sound of a gentle stream of water or the pitter-patter of raindrops may also vie for my vote. I may not be able to decide at once which musical composition is the most melodious music to my ears. Or, you never know, I may even choose the roar of a Royal Enfield motorbike or the background sound which echoes when my favourite movie actor punches a particularly evil villain on the screen. But if you ask me which sound I dislike the most, I won’t have to think twice: It is the whistling sound of an inverter. It’s an appalling – though sure-shot – way of letting the owners know that the equipment cannot take the load or the battery needs to be replaced. Even if you are more particular about watering your inverter battery than caring for your kids, the gadget can still fail you at the most embarrassing moments. And what on earth can you do about the occasional shrieks of your neighbours’ inverters? Or the screaming machines at the homes of your acquaintances? No, sir. There is simply no escape. Cashing in on the consistent inability of our successive governments in providing uninterrupted power supply to their subjects, somebody must have got this brilliant brainwave – to make a device which stores electrical energy while the power is on and utilises the same at the time of outages. I hope that somebody also devises a decent way of issuing the system-overload or low-battery warnings. Nonetheless, the invention proved a turning point in our lives, and objects like lanterns and hand-fans became even more obsolete. Even the emergency lights, which were emerging as possessions of pride, were rendered useless. Thanks to the inverter technology, candles are now largely confined to birthday and anniversary cakes; and matchsticks mainly used to light the incense-sticks in our pooja rooms. So, as of now, newspapers are primarily used for reading. There is no more hankering for candles, matchboxes and hand-fans in the event of power-cuts. Nor is there is any need to jostle with the cumbersome and hard-to-handle power generators or yell at one’s domestic help at odd hours and invite his/her bad wishes. The advent of inverters has helped us save our precious power-cut time which used to get wasted in cursing the government, the electricity department and our destiny as we idly sat with family members, neighbours or visiting relatives. It has also played an instrumental role in ridding us of outdated qualities like patience and tolerance, which have held us back in this fiercely competitive era. If you still miss your candle-light dinners and compulsive walks with not-so-repulsive neighbours in those powerless nights, it’s a small price to move on.n
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The rising cost of medicare “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.” The medical profession has not been able to keep itself aloof from the strong wave of capitalism. Medicine is no longer the domain of the physicians working in their clinics and hospitals, as it is gradually moving into the hands of big corporate houses, which have introduced advanced services in the medical sector. Equipped with modern technologies and management skills and funded by big corporate, business houses and rich investors, these medical centres have pushed the state medical centres to a much lower pedestal. No wonder, those occupying the corridors of power in our country often flock to these corporate hospitals for their health problems, showing scant faith in the state-run services. It is not a coincidence that during the recent Lokpal movement, Anna Hazare’s health was closely monitored by a medical team from a reputed corporate hospital and he was later shifted to the same private hospital for care.
Reforms & liberalisation
The health sector reforms and liberalisation policy in India have brought in new profit-making opportunities in the healthcare market. In India, state-run healthcare providers could not look after the medical needs of the fast growing, prosperous middle and affluent upper class. India has a vast middle-class population which is educated, prosperous, aware, health conscious and is ready to pay for better medical facilities. Having been exposed to world-class healthcare practices during their travels across the globe, they want similar treatment facilities in India as well. Earlier, this population was being looked after by next-door small clinics and nursing homes. Now, it has gradually shifted to corporate hospitals even for common services like normal birth deliveries and regular childcare. Corporate healthcare is being supported by big business houses, rich investors, insurance companies, expatriate Indians, politicians and senior bureaucrats. Equipped with the most modern technology, highly-skilled medical and paramedical staff and better governance, corporate hospitals have carved a formidable place in the health sector. Encouraged by the response and growth of the corporate hospitals, many local entrepreneurs have also come up with specialised chains of the medical centres. In view of the advancement in medical practice in India, foreigners and non-resident Indians, too, flock to India for their treatment. Now these corporate-run hospitals are gradually moving from bigger cities to smaller towns and even to the community health services.
Business-driven model
In a business-driven medical model, output, productivity, sales, earnings, profits, product promotion and packages are the commonly used words. Nowadays, people hardly talk in terms of good or bad doctors. They prefer to visit a ‘busy’ doctor, as they visit a ‘busy shop or a restaurant’. It is not the quality but the quantity that has overtaken. Big private hospitals regularly circulate data about number of diagnostic and treatment procedures done by their faculty. Such an exercise is bound to produce a sense of unhealthy competition among the faculty members. In such hospitals, it is the self-interest that drives the profit and a specialist’s take-home pay-package is linked to his performance and output and not to his qualification, knowledge, and skills. It is a professional’s marketability, media management and business skills which help him to climb on the ladder of success. Many of our medical professionals from the government sector are joining the private sector. They find it difficult to adjust to a business model of medical care, where they are completely devoid of administrative decisions and their clinical decisions are also judged only on the basis of economic parameters. The ethical and moral implications of fast growing commercialisation of healthcare have become a matter of controversy.
Social responsibilities
One of the major criticisms of corporate hospitals has been that these hospitals are being given a host of concessions and subsidies by the government, but these function on a pure business model for profit making without any social responsibilities and sensitivities. The treatment cost in these hospitals is absurdly high. Since a majority of their clients are heavily insured, these hospitals tend to inflate the bills, as these clients are not going to pay from their own pockets. Many of these corporate hospitals are often blamed for openly flouting their commitment of providing free or subsidised healthcare to economically weaker sections of the society. In 2002, the Delhi High Court had ordered that those private hospitals, which had been provided subsidised land, should provide 10 per cent indoor beds and 25 per cent outdoor cases, free of cost, for patients from the economically weaker sections of the society. The court dismissed the plea of owners of private hospitals that they were not given land on the basis of the new norms set by the government. The Supreme Court, in a recent judgment this year, has already said that hospitals, which have been provided land at subsidised rates, will have to provide free treatment to poor patients. Privatisation, in general, has been known to increase the gap between the rich and the poor, leading to the survival of the richest. Wider the gap, higher is the social unrest. The policy of excessive privatisation and state abdicating its responsibility of universal healthcare will limit the underprivileged from accessing the medical services. If the state’s limited resources have to be consumed by the bigger and private players of healthcare industry and state's funding of the general and community healthcare has to suffer, one can imagine the emerging scenario of health services. The health for all by 2020 will remain a utopian idea only. The basic guiding principles of medicine like service, empathy and altruism will be given a silent burial at the altar of corporatisation and
globalisation. The writer is Ludhiana-based psychiatrist and de-addiction specialist
Sops to business houses
Corporate care
Globalisation
Philanthropic care
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