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Stuck with reforms
Message from militants |
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Vrindavan widows
Assam’s ominous fallout
Memories of another day
Stealing away your sleep
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Stuck with reforms In his Independence Day address, Prime Minister Manmohan Singh said that growth slowdown should be treated as a national security problem. He means just as during a national security crisis politicians unite, so should they do when growth falters since it affects the economic well-being of all. Given the politics of confrontation, such a call is unlikely to elicit a favourable response. The BJP has already dubbed the speech “uninspiring”.
There are those ideologically opposed to reforms such as the Left, parties unreasonably resisting anything the UPA proposes such as the Trinamool Congress and opportunistic fence-sitters like the Samajwadi Party and the Bahujan Samaj Party. The BJP, by and large, has a similar economic agenda but will not cooperate and let the UPA walk away with credit. The Manmohan Singh government cannot push greater foreign direct investment in multi-brand retail, insurance and aviation. Important Bills, including those relating to the Lokpal and land acquisition, are pending in Parliament. But the Prime Minister can blame political opposition only up to a point. There are issues which do not require a political consensus and can be tackled by administrative orders. What prevents the government from faster environmental, mining and land acquisition clearances? Or speeding up highway construction? Actually, the government is caught between reform and populism. After the BJP lost the 2004 election on the “Shining India” issue the UPA focussed on inclusive growth and launched programmes, including Bharat Nirmaan and the rural job guarantee scheme. Sonia Gandhi’s food security Bill, when passed, requires huge resources. Earlier 8-9 per cent growth could yield enough revenue to support welfare. Now growth has slowed and the 2014 election is approaching. The government can neither cut welfare spending nor slash subsidies. It cannot hike the prices of diesel, the fuel of farmers, during a near drought. As the fiscal and current account deficits bloat, foreign rating agencies threaten further downgrades, which could hit FDI inflows. High inflation holds back the RBI from cutting interest rates to accelerate growth. In these circumstances, the Prime Minister could not have delivered a more “inspiring” speech. |
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Message from militants Despite intelligence reports that militants can strike in a big way before the coming Eid festival, the Pakistan government could not prevent the terrorist attack at its biggest airbase at Kamra, around 70 km from Islamabad, early on Thursday morning.
All the attackers were killed in the gun battle that ensued, but they succeeded in taking the life of one security official besides causing considerable damage to the airbase where 30 fighter jets were parked. This largest airbase of Pakistan in Attock in Punjab was targeted by militants in October 2009 also when a suicide bomber tried to enter the Pakistan Aeronautical Complex in Kamra. Nine people had lost their lives then, including the militant. In 2009, terrorists stormed into Pakistan Army’s General Headquarters in Rawalpindi. In 2011, they had struck at the key naval base in Karachi. This time the terrorist attack came soon after the Army Chief, General Ashfaque Kayani, declared that Pakistan had been involved in the war on terrorism because “it is its own war” and it is “a just war”. A few weeks ago Pakistan had reopened the NATO supply route to Afghanistan following intense US pressure. Pakistan could no longer afford to say “no” to the US as its economy urgently needed US economic aid, which had remained blocked for some time. No militant outfit has claimed responsibility for the Kamra suicide bomb attack. It may, however, be the handiwork of the Tehrik-e-Taliban Pakistan (TTP) because Pakistan’s so-called “war on terrorism” is basically aimed at eliminating the TTP bases in the tribal areas bordering Afghanistan. The extremist elements in Pakistan are unhappy with the government in Islamabad because of its support to the US in the war on terror and the PPP-led government’s undeclared approval for US drone attacks on the Taliban’s bases in tribal areas. But the Kamra Aeronautical Complex has a Chinese connection —- 11 Chinese engineers are associated with it. The base has assembling and overhauling facilities run in collaboration with China for JF-Thunder fighter jets. Pakistan has not only a strong anti-US sentiment but also an anti-Chinese sentiment, particularly among the extremist elements. Whatever the factors feeding terrorism, these elements, it seems, remain a strong destabilising force in Pakistan.
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Vrindavan widows They are called the ‘white rainbows’ to camouflage the ugly reality of their existence. Hindu widows live in a world bereft of colour and hope. It is baffling for a social system that accords almost a God-like status to the elderly to treat some women worse than beggars only because they happen to tolerate their husbands. Like a cruel joke, the poor Hindu widows are abandoned at Vrindavan, the birthplace of Lord Krishna.
Horrifying tales of their sexual
exploitation and humiliating living conditions have been known to the
world for years, thanks to the research-based works of the late Dr
Indira Goswami, who had lived in one of the ashrams after she was
widowed. But somehow major social reforms and schemes of development
chose to leave these widows to their fate. Though their plight
inspired great works of literature by the likes of Sharatchandra,
Rabindranath Tagore and Premchand, renowned photographer Claude
Renault introduced the world of the privileged to the exotica of their
suffering in white. Oprah Winfrey talked with impressive empathy about
their plight on her glittery TV show after she visited Vrindavan,
which resulted in some fund-raising dinners and even celebration of an
international widow’s day on June 23. But the pathetic living
conditions of the widows of Vrindavan continue to remain a blot on our
social structure that looks the other way while they continue to
suffer all kinds of humiliations. The solution to this social
malaise should have come from within our society, through reforms, but
once again the judiciary had to intervene to lend some degree of
dignity to the widows. For the first time a thought is given to their
vocational training and economic empowerment, rather than doing away
with a righteous approach of offering alms to the widows. This new
approach, that involves a few NGOs will lend some degree of
much-required dignity to about 2000 destitute women in Vrindavan. |
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The secret of getting ahead is getting started.— Agatha Christie
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Assam’s ominous fallout TO their credit the Mumbai police controlled Saturday’s horrendously violent protests against the treatment of Muslims in the riot-ravaged Bodo region of Assam rather fast, and haven’t allowed lawlessness to return to the “Maximum City”.
Various Muslim organisations that sponsored the protest have apologised for what happened though it is hard to believe their protestations that the youth that unleashed the reign of violence and arson, including molestation of women constables, had “nothing to do” with them. The police have arrested at least 23 of the alleged culprits, thanks to CCTV cameras that, unlike those in Pune during recent blasts, did work. However, this is as far as the performance of the security authorities can be commended. Their failure to anticipate the scale of trouble, and to make adequate arrangements to cope with it is surprising. Especially because, as admitted by official sources, intelligence agencies had given them timely warning of prevailing anger among the Muslim community and its looming consequences. Maharashtra’s Chief Minister Prithviraj Chavan has stated that the violence was “premeditated” and perhaps there was “outside interference” and a “foreign hand” behind it. While the truth will be known only after the investigations are complete, three unusual features of the gory goings-on merit attention. First, in the prolonged clashes the police suffered more than the rioters. Two men were killed when the police had to open fire to prevent the situation from spinning out of control. But of the 63 persons injured seriously, no fewer than 58 are police personnel. The condition of eight of them is critical. Secondly, along with the police, the media was the special target of the well-equipped goons who complained that it did not give adequate coverage to the Assam outrage. Media persons were thrashed and, OB vans of TV channels burnt, as were a large number of police vehicles, a few of them with policemen locked inside who were somehow rescued. Life in entire South Mumbai ground to a halt and the rampaging rowdies had no difficulty in taking over suburban trains. The third notable element in the worrisome succession of events is significant. On day one all official pronouncements said that the rioters were protesting against the plight of Muslims living in the autonomous district of Assam administered by the Bodo Territorial Council. Only the next day it was revealed that the virulent protest was as much against the killings in Myanmar of Muslims called Rohingas as against the happenings in Bodoland. By this time the gruesome videos and other material circulated through the social networks had come to light. On this score intelligence and security agencies — which are under the care of a Union Home Minister who is entirely new to the job — must pay heed to what a former intelligence past-master and now outstanding security analyst, B. Raman, has pointed out: The month of Ramzan, now on, is the time when Muslims across the world try to consolidate their solidarity and to intensify their protests against the oppression of their co-religionists anywhere. This had begun with the observance of the last Friday of the holy month as the International Day of Quds (Palestine). After the Islamic Revolution in Iran in 1979, at the suggestion of Imam Khomeini, it was agreed by the Umma that Yom-e-Quds should cover all countries where Muslims are subjected to atrocities. In recent days some have asked, pertinently: how did anger against Myanmar’s oppression of Rohingas become so widespread in this country when the Indian media, without suppressing the news, had covered it with restraint? The simple answer is that there is the Internet, the word of mouth, and the images on the TV channels of the Arab countries that can be easily viewed by whoever wants to do so. Moreover, while radicalisation of this country’s large minority has so far been limited, extremist Wahabi and Salafi organisations in some foreign countries have, of late, been busy spreading their tentacles here. Only the other day in the Lok Sabha the Majlis Ittehad-ul-Muslimeen’s Assaduddin Owaisi declared that if the Assam madness remained unchecked, radicalisation of Muslims would follow. Any Hindutva backlash to this would aggravate the situation, not abate it. It should be the job of the security agencies to take care of this menace fairly and transparently. This brings us back to the imperative of promptly ending the highly explosive state of affairs in Assam, which is reminiscent of the infamous Nellie massacre of 1983, and restoring normalcy. But this is easier said than done. It is not for nothing that Prime Minister Manmohan Singh’s earlier visit to the victims of the storm did not produce the desired result. Fresh violence erupted to make matters worse. Congress president Sonia Gandhi has rushed to the spot, with Home Minister Sushilkumar Shinde in tow. The bitter truth is that the trust deficit between the two sides to the seemingly unending ethno-religious conflict is too deep to be overcome easily. No wonder, both Muslim and Bodo refugees in 273 makeshift camps, whose number could be anything between two and four lakhs, are reluctant to return to their homes and villages that have been burnt to ashes. Sadly, at a time when the entire national leadership should unite and try to pacify the hatred-filled groups in Assam, the two mainstream parties, the Congress and the BJP, are at each other’s throat. As it happens with every other problem under the sun, the Assam issue has also become an unrestrained Congress-BJP slugfest. For the saffron party the sole problem in Assam is the illegal immigration from Bangladesh, allegedly encouraged by the ruling party anxious to play “vote bank politics”. It doesn’t occur to it that not every Muslim living in Dhubri district next to Kokrajhar, the Bodo domain, is a freshly arrived Bangladeshi immigrant. There are descendants of locally born, Assamese speaking Muslims and of immigrants from East Bengal during the 1901-47 period when India was undivided. To be sure, huge illegal immigration from East Pakistan first and since 1971 from Bangladesh has taken place and yet the Congress pretends as if the change in Assam’s demography has nothing to do with its variegated and overlapping conflicts. Is the Indian political class, even at the highest levels, incapable of doing better than
this? |
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Memories of another day
At
64, I have a good recall of over 50 Independence Days — mostly routine. In 2007, however, what happened wasn’t routine. Independence Days are about flag waving, affected patriotism, much symbolism and a surreptitious look at one’s watch when boring and dishonest speeches about aim, intent and commitment are being made.
Involved in the construction of a university complex whose promoters had given up all hope of starting on time, I was brought in to recover, if possible, a nearly lost situation. My challenge was complex, yet simple. Nearly 1500 male and female labourers from Andhra, Bihar, Rajasthan, Jharkhand, Gujarat and Karnataka had to agree to do in 40 days what hadn’t been done in the past 400, and without compromising on quality — a formidable challenge. I had an Independence Day plan and which, having shared with the head honcho who backed it fully, I unleashed with intensity. Drawn in by the pre-publicity of lavish free eatables followed by lunch/halwa, the labourers trooped in, all 1500 of them, listening to “Saare jahaan se achchha”; “Ai mere watan”; and “Cheen-o-Arab hamara” on the loud-speakers. The lavish buntings, festive air, free toffees and tri-coloured balloons helped. I was in uniform. I spoke of India and Indians as I saw them — world class. I spoke about mental strength, character, “saathi haath barhana”, about “hum panchhi ek daal ke”, about the sanction of an on-site tented labour school with unlimited milk, fruit and teacher shifts for labour kids while mom/dad worked three shifts in rain, hail or sleet. I spoke of free meals served with“tadka maar ke”, about endless cups of “masale wali chai” and the ubiquitous “vada pav” with hot green chillies. They slowly picked up the promises as real, their body language straightening and eyes lighting up. I could not end my inspired talk. A purple sari-clad young woman with her little son by her side snatched my mike. She said her sari was specially bought for Rs 70 — her daily wages — for Independence Day. “The General is right,” she intoned. “We need the school; let’s help raise it! Here is my ‘pagar’ (wage), join me!” A thousand impassioned hands went up holding grubby notes, and she collected them. A professor’s wife gave Rs 500, crying with the joy of giving. A Gujarati carpenter Rs 300; I turned out my wallet and so did so many others — Rs 40,000 in all. Informed on the cell phone, the head honcho delightedly added Rs 1 lakh, sent minutes later in cash. The young woman, probably just class 6 pass, (the standard female norm in rural India) hadn’t finished. “This old man is a ‘Jarnail’,” she said, pointing at me. “He appears to be someone big, but, sir,” she said, ferociously holding up her startled son, “my son will be bigger than you one day; much bigger! Just you wait!” No one clapped. They were all in tears; even the crusty ‘old man’ who did not cry even while hugging his dead soldiers goodbye. And yes, that afternoon onwards, these bravehearts worked all 40 days, through thunder, lightning and rain; through 18-hour workdays. The university opened on schedule. The labour school still exists, though the labour force has moved on, including the feisty young woman who left us richer with memories of another Independence
Day. |
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Stealing away your sleep The most noticeable sign is snoring. Other signs and symptoms include excessive daytime sleepiness, abrupt and repeated awakenings during sleep, accompanied by shortness of breath, observed episodes of breathing cessation during sleep, morning headache and difficulty staying asleep (insomnia). Anyone can develop OSA, but certain factors can increase the risks like being overweight, individuals with thick or large necks. Persons suffering from high blood pressure (hypertension) and diabetes are at an increased risk of being afflicted with OSA. Alcohol abuse, smoking and the use of sedatives also increase the risks of OSA.
Little patients, big danger Children, too, could suffer from OSA. However, the problem may not be obvious, hence the danger increases manifold. Signs and symptoms in kids include bedwetting, poor school performance, sluggishness or sleepiness (often misinterpreted as laziness by teachers or by parents), snoring, choking or drooling, excessive sweating at night, restlessness in bed and teeth grinding. OSA in children is, sometimes, due to chronically enlarged tonsils and adenoids. Tonsillectomy and adenoidectomy surgeries may cure the problem. In serious apnea cases, the growth is retarded and abnormalities of the right heart may have developed. But even in extreme cases, surgery tends to cure not only apnea and upper airway obstruction, but subsequently allows normal growth and development. Such children need careful assessment jointly by paediatricians and sleep specialists.
Studies & surveys A study conducted by nursing students of Dayanand Medical College & Hospital (DMCH), Ludhiana, and published in a nursing journal in 2011, found a high prevalence of OSA of 8 per cent in the control group and 18 per cent in patients with congestive heart failure. A population-based study conducted by AIIMS in New Delhi in 2006 reported the prevalence of OSA to be as high as 9.3 per cent. Another study on sleep problems carried out in Africa and Asia by staff and students of Warwick Medical School has indicated that 5 per cent of Indians suffer from sleep disorders. Women in India at 6.5 per cent surpass men at 4.3 per cent when it comes to sleep disorders. Approximately 4 per cent of Indian men suffering from acute sleep disorders at night were hit by extreme depression, while 3 per cent complained of severe anxiety. Among women, 3.79 per cent reported of extreme depression and 2.8 per cent reported of anxiety. Research consisted of studying the quality of sleep on 24,434 women and 19,501 men. All subjects were in the age bracket of 50 years and above. The survey was conducted in eight rural places across the globe. The locations were Africa, Bangladesh, Ghana, Kenya, India, Indonesia, South Africa and Vietnam. The study discovered that 16 per cent of the population in the countries under survey was insomniacs, which is not far behind the West’s 20 per cent incidence.
Complications of OSA OSA is considered a serious medical condition and is associated with many complications: Cardiovascular problems: Sudden drops in blood oxygen levels occur during obstructive sleep apnea episodes. These episodes bring an increase in the blood pressure and strain the cardiovascular system. Many people with OSA develop high-blood pressure, which raises the risk of heart failure and stroke. The more severe the OSA, greater the risk of high blood pressure. People with obstructive sleep apnea are also much more likely to develop abnormal heart rhythms (such as atrial fibrillation). If there is an underlying heart disease, repeated episodes of low blood oxygen (hypoxemia) could also lead to sudden death. Daytime fatigue: Normal sleep architecture is completely disturbed due to repeated awakenings, resulting in severe daytime drowsiness, fatigue and irritability. Affected persons may have difficulty in concentrating and find themselves falling asleep at work, or while watching TV or even when driving (increased risk of accidents). Children and young people with obstructive sleep apnea may do poorly in school, have reduced mental development or have behavioural problems. Treatment of obstructive sleep apnea can improve these symptoms, restoring alertness and improving the quality of life. Diabetes: A number of studies have shown that OSA is associated with insulin resistance, glucose intolerance and type 2 diabetes. A study conducted by AIIMS, New Delhi, in 2010 found that the persons suffering from OSA had a four-fold higher occurrence of metabolic syndrome (presence of risk factors — obesity, hypertension, dyslipidemia and insulin resistance) than patients without OSA. The study also revealed that patients with OSA and having metabolic syndrome were also more likely to have higher blood pressure, fasting sugar and waist circumference.
Diagnosis The diagnosis of sleep apnea is based on the evaluation of clinical symptoms, physical examination and sleep study (polysomnography). Sleep study measures various parameters like airflow, blood-oxygen levels, breathing patterns, electrical activity of the brain, eye and limb movements, heart rate and muscle activity and are conducted by trained sleep technologists in sleep laboratories. This sleep study aims at establishing an ‘objective’ diagnosis indicator linked to the quantity of apneic events per hour of sleep (Apnea Hypopnea Index, or Respiratory Disturbance Index, associated to a formal threshold, above which a patient is considered as suffering from sleep apnea, and the severity of their sleep apnea can then be quantified.
Devices Patients are treated with mechanical devices like continuous positive airway pressure (CPAP). This machine uses a mask that fits over the mouth and nose of the patient or just over the nose attached to a machine that gently blows air into the throat. The pressure from the air helps keep the airway open while the person is asleep. There are many types of CPAP machines and masks. Lifestyle modifications like losing weight, avoiding alcohol, sedatives and smoking, maintaining a good sleep hygiene and control of nasal symptoms with active treatment also help. CPAP treatment may cause side-effects in some people. These include a dry or stuffy nose, irritated skin on face, dry mouth, and headaches. If the CPAP isn’t adjusted properly, one may get stomach bloating and discomfort while wearing the mask. Treatment with CPAP improves both objective and subjective measures of sleep. After using CPAP regularly, many patients report the restoration of normal sleep patterns, greater alertness and less daytime sleepiness, less anxiety and depression and better mood, improvements in work productivity and better concentration and memory. Patients with obstructive sleep apnea can have enlarged and thickened hearts that pump less effectively, but the heart abnormalities improve with use of a device that helps patients breathe better during sleep, according to a study published in the April 2006 issue of the Journal of the American College of Cardiology. A study published in European Heart Journal in 2004 found a reduction in need for hospitalisation in cases of heart failure, acute coronary syndrome or need for coronary revascularisation or cardiovascular death in patients of OSA with coronary artery disease (more than or equal to 70 per cent coronary artery stenosis) treated with CPAP over a period of four years, two months and 10 years.
Surgical solutions Some patient might benefit from surgery. It is generally performed after a trial of CPAP fails to improve the symptoms. The type of surgery and how well it works depend on the cause of the obstruction. Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
Risk factor for accidents Sleep apnea is an important preventable cause of motor vehicle accidents. Various studies have found that treatment for OSA can lower the accident rate. A study in 2010 published in Journal of Occupational and Environmental Medicine, reports that effective treatment lowers healthcare costs and disability rates for commercial motor vehicle drivers with OSA.
Sleep experts OSA is treated by pulmonologists, neurologists and ENT specialists. The facilities for conducting sleep studies exist in many leading government medical colleges and corporate hospitals of the region. Obesity and dietary habits compounded further by alcoholism and drug addiction predispose a significant section of the society to develop OSA. Screening should be considered for OSA in patients with obesity, diabetes, hypertension or coronary artery disease so that treatment can provide better quality of life and outcome.
A case study
Last year in June, a male patient, who was 49-year-old, morbidly obese (119 kg) and
hypertensive, developed blurring of vision. He was investigated extensively for possible blood cancer since his haemoglobin levels were high at 24.1 gm/dl
(polycythemia). A diagnosis of obstructive sleep apnea with obesity hypoventilation syndrome was made and advised use of BiPAP (bi-level positive airway pressure) device to be applied with a mask over his nose while sleeping. Two months later, he had lost 16 kg, has regained his normal activity levels and has no symptoms of daytime drowsiness. A routine check on his blood investigations revealed that his haemoglobin levels were within normal levels and his lipid profile was much better controlled than before.
The writer is Senior Consultant, Pulmonology, Sleep and Critical Care, Fortis Hospital, Mohali
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Apnea
Other tests suggested increased size of liver, spleen, abnormal lipid profile and raised uric acid levels. An
echo-cardiography suggested moderate pulmonary arterial hypertension. In April 2012, a detailed history revealed that he had snoring, repeated awakenings at night, significantly increased daytime drowsiness with difficulty in breathing since the last four-five months. His blood gas analysis showed raised carbon dioxide with low oxygenation. He was managed with supportive medication with oxygenation. After
stabilisation, he underwent a sleep study (complete overnight polysomnography with titration), which revealed severe disturbance of sleep architecture with episodes of severely low oxygenation. And these were significantly corrected with the use of CPAP device during the study period.