The Tribune, Chandigarh, India

Regretting a massacre
British PM seeks to undo a wrong

British Prime Minister David Cameron’s visit to Jallianwala Bagh is historic. Not only is he the first British Prime Minister to visit the site of one of the worst massacres in history, by calling the mass killing a ''deeply shameful incident'' in British history and adding “we must never forget it,” he has also atoned for the sin of one of the most infamous British army officers, Brigadier-General Reginald Dyer, who ordered his soldiers to fire on people peacefully gathered in a public park nearby after celebrating the traditional festival of Baisakhi.

The memorial, near the Golden Temple, which the British Prime Minister also visited, is a lasting reminder of the arrogance of a colonial empire that failed in its duties towards the people it had subjugated. The gathering in Jallianwala Bagh on April 13, 1909, comprised thousands of Sikhs, Muslims and Hindus. While it violated the martial law that banned the assembly of four or more persons, it was peaceful. The British Empire could never live down the infamy of killing thousands of innocent people and, indeed, the Jallianwala Bagh massacre fuelled the fire for freedom in Indians, who were finally set free of British rule in 1947.

It might well be argued that Cameron’s visit and his comment are but a logical progression of the visit of Queen Elizabeth II and her husband Prince Philip 16 years ago. While the Queen had not made any comment, the symbolism of her visit was not lost upon the Indian people. Indeed, the British establishment has responded in a correct manner. Mature nations learn to negotiate with their past even as they work on the future. The British Prime Minister’s comment, while short of an outright apology, is an acknowledgement of a terrible deed. Even as we look around at various wrongs committed in the name of governments of the day, the overall grace with which the British establishment has sought to right the wrong committed by Brigadier-General Dyer stands out.

Unrest among workers
Strike offers no solution

The two-day countrywide strike called by 11 trade unions began on Wednesday after the government’s efforts to reach a settlement failed. Unfortunately, the first day saw the strike turning violent at places.

The damage to public and private property, inconvenience to people and a loss to the economy are some of the obvious consequences of the strike. Sympathetic governments usually abandon their primary duty of ensuring an unhindered movement of people and vehicles at such times. In West Bengal, however, Chief Minister Mamata Banerjee took the strikers head on. Her tough talk accompanied by an offer of compensation to shop owners in case of damage had the desired effect.

Though Left parties are losing appeal in West Bengal and elsewhere, the message has not gone across that their socialist ideology and disruptive politics have become irrelevant in the changed economic environment. Today’s urban middle class struggles to improve its living standards and career prospects, and has no time for disruptions in normal life. City youth do come out in the streets but on issues that affect them like corruption and rape. The Left-leaning trade unions enjoy support largely among workers who are exploited by managements indulging in unethical practices. Hence, they demand the implementation of the labour laws.

The organisers of the strike, including the pro-Congress and pro-BJP trade unions, have also raised some larger issues that have wider public appeal. Price rise affects not just the workers but the poor all over the country. The issue of social security net is something Dr Manmohan Singh had himself raised as the Finance Minister. The policy of hire-and-fire, prevalent in developed countries, can become acceptable here if accompanied by social security measures. Those opposing economic reforms like disinvestment in PSUs and merger of banks are not in tune with the times. A broader consensus on reforms has emerged and chances of a rollback are remote. To ease social tensions, the government should try to make growth more job-oriented and inclusive.

Thought for the Day

Our patience will achieve more than our force. —Edmund Burke

ARTICLE

Freight or passengers?
The eternal dilemma for the railways
by R.C. Acharya

Indian Railways is a transport utility whose basic unit for business is a “train load”. The infrastructure such as the track on which these trains run, the signaling system, the stations, the locomotives, the operating staff , etc, does not differentiate between a 24-coach superfast carrying 1500 passengers or a 54 BOXN train carrying 4500 tonnes of coal.

For each is simply a “train” with vastly different earning power, occupying valuable section capacity, needing locomotives to haul it, drivers, guards, station masters, maintenance and hordes of supporting staff to make it run fast, safe and on time !

In 2009-10, the railways' total working expenses were Rs 82,915 crore, when around 11000 passengers (including 6000 suburban or locals ) and 6000 freight involving a total of 17,000 trains originated every day, costing just over Rs. 4.87 crore per train. During the same period, it also earned Rs. 56,911 crore, from freight and Rs. 23,414 crore from passenger business, or Rs. 9.48 crore from freight and Rs. 2.13 crore from each passenger train.

This pattern of earnings is almost the same the world over and, given its vastly superior earning capacity, the hard-nosed management of 14 Class I railroads of the US with over 2,00,000 km of rail network between them have understandably chosen to put all their eggs in the all-important “freight” basket.

Back home, rampant populism during the last two decades has resulted in an addition of nearly 3000 new passengers while less than 500 new freight trains could be introduced. Moreover, successive Railway Ministers, keen to “win friends and influence people”, have also frozen the passenger tariff practically at the same level for the last 10 years.

As a result, the railways lose around Rs 20,000 crore in the passenger fare segment on a yearly basis, and to make up this loss, earnings from freight traffic are increasingly being used to cross-subsidise the passenger business.

Realising the flawed business model, Railway Minister Pawan Kumar Bansal has at last decided to “bite the bullet” by announcing a pre-budget hike of 20 per cent in passenger tariff, a prerogative of the Railway Board not requiring parliamentary approval, but has not been exercised for quite some time.

Against the target increase in the earning of about Rs. 4000 crore consequent to the hike announced in the last budget by Dinesh Trivedi — which unfortunately had to be immediately rolled back — the belated hike would get the railways only an additional Rs. 1200 crore for passenger business.

Added to this, there is likely to be a shortfall in freight earnings since the target loading of 1025 million tonnes may be missed by about 15 million tonnes, resulting in the operating ratio coming down from the present level of 90 per cent to just under 87 per cent.

However, recent initiatives to prioritise linking 122 km from Gevra Road to Pendra Road, and 63 km from Raigarh to Bhupdeopur to speed up the evacuation of coal to be financed jointly by the Railways, the South-Eastern Coalfields and the State of Chhattisgarh would give a boost to freight loading.

So would the proposed doubling of the vital 248 km long track between Palanpur and Samakhiali in Gujarat, which will add to the valuable track capacity and speed up export-import traffic between Bhuj, Kandla, other West Coast ports and the North.

Commissioning of the 1278 km-long eastern leg of the DFCCIL (Dedicated Freight Corporation of India Ltd.), expected to speed up the burgeoning coal traffic from the eastern coalfields to the scores of thermal plants in Bihar, UP, Haryana and Punjab, and the 1515 km-long western corridor, promising faster and assured movement of export- import traffic, is still a few years away.

Till then Pawan Bansal will have to actively pursue every available opportunity to garner more freight and, may be, order a further increase in passenger tariff to offset the escalation in diesel prices to somewhat restore the railways financial health.

Perhaps the recently announced PFT (private freight terminal) policy, promising a better deal for the logistics players, will encourage them to set up their own facilities and contribute to the growth of freight business.

The forthcoming rail budget, the first ever by Bansal and the last by UPA II, will establish if the railways will continue to beat the well trodden populist path or take an entirely different route getting the railways out of the financial quagmire it is fast slipping into. A distinct drop in the number of new trains announced will perhaps signal this change.

Perhaps, the time has also come to take a fresh look at the onward rush for another highly populist measure — electrification. In a power-deficit nation such as India, each electric locomotive on track draws valuable electric energy from the grid, denying power to industries and farmers, who increasingly have to opt for running highly inefficient diesel generators to meet their needs or drive their individual pump-sets!

When each of the 6000 hp electric locomotive hits the track, we could also say goodbye to lighting in about 15,000 middle class homes or villages. The highly industrialised state of Tamil Nadu is reeling from daily power cuts, which is crippling production, hiking costs and making the facilities unviable.

On the other hand, a diesel locomotive does not draw an iota of electric energy from various power grids and is, in fact, a virtual power house on wheels, converting fossil fuel directly to haul a train, eliminating the transmission losses involved in electric traction which can be as high as 30 per cent!

It's no surprise that against a generation of about 22 GTKMs (gross tonne kilometres — a measure of transportation) per million calories of the fossil fuel consumed by an electric locomotive, a diesel unit generates over 30 GTKMs, almost 33 per cent higher.

With thermal power plants increasingly opting for imported coal on account of its higher calorific value and lower ash content, the argument of savings in foreign exchange by changing over from diesel to electric does not appear to be valid !n

The writer is a former Member, Railway Board.

MIDDLE

Postage stamps
by K. K. Paul

Despite the explanations, the recent controversy over a delayed speed post may have delivered yet another and a direct blow to the already shrinking community of letter writers, and an indirect one to the dying art of philately.

That philately, or the fine art of collecting stamps, is almost like romancing a hobby and can be experienced only by a collector. Postage stamps, being very delicate, require a plenty of dedicated time, nurturing, patience and care. One gets hooked on to the hobby usually while at school. I did so.

My father had a very large number of scientist-friends abroad, and indulged in voluminous correspondence on matters of his professional interest. As a fringe benefit, the postage stamps used to be cut out from the covers and retained by me. They had to be soaked in water and then, after degumming, removed gently from the paper and put on a blotter for drying. Usually, they often warped while drying and had to be pressed and kept in a heavy book for some time. Thereafter they were stuck with folded hinges and displayed in albums. Sunday mornings were almost entirely devoted to my collection which continued to grow into several albums till I joined the service.

Times have changed. The impact of information technology can be felt in all walks of life. The kids do their homework on computer and play video games. Postage stamps seem to be virtually of no use to them as their entire communication is confined to SMSes or e-mails or Facebook. Stories about stamps also do not interest them as they have so many other, perhaps, more useful diversions.

It may come as a surprise to many, but at least on one occasion a postage stamp was able to change the history and geography of a country. The original proposal of linking the Atlantic and Pacific Oceans contemplated a canal through Nicaragua. The rival lobby in 1902, on the day of voting, circulated a Nicaraguan postage stamp with an active volcano. One does not know whether it was entirely due to the stamp or not, but the alignment of the famous canal surely got changed in favour of Panama, and in the process the stamp with a picture of Momotombo volcano overnight turned into a rarity.

Similarly, considerable rarity value is also attached to some of the postage stamps belonging to the countries which had disappeared from the world map. After its absorption in the Austro-Hungarian empire, Bosnia and Herzegovina ceased to exist as a country after 1909; till its revival after the breakup of Yugoslavia.

Similarly, prior to the creation of Israel, the postage stamps showing Palestine with more or less the same map as that of Israel bring out stark historical realities. Some of the very rare stamps these days are also being used by professionals as investment propositions at auctions.

Stamps issued on personalities have their own charm. Stamps on Mahatma Gandhi have been issued by the largest number of countries. India has a healthy tradition of issuing commemorative stamps on illustrious personalities, both national and international. At times, deserving personalities do get left out. For instance, a stamp on Sahir Ludhianvi is to be issued on March 8 about 30 years after his death.

In the present-day technology-driven world, one seems to have no time to keep waiting for the letter to arrive. If at all a letter is to be sent, then the courier happens to be the preferred choice. And as I turn the colourful pages of my albums, I wonder, at the current rate of obsolescence, for how long this fine art would survive.

OPED Health

Little victims, big battle
The Revised National Tuberculosis Control Programme is not age appropriate even though children are included in it. The programme does not provide medicines in syrup form or permit breaking of tablets, making the administration of accurate paediatric doses impossible
Shoma A. Chatterji

Tuberculosis has re-emerged as a major public health challenge in the world. India accounts for nearly one-third of the global TB burden. According to the review of global tuberculosis situation by the World Health Organisation, India comes under a group of high prevalence countries with the Annual Risk of Tuberculosis Infection (ARTI) ranging between 0.6 and 2.0 per cent annually. Although childhood TB has received attention from global health experts, it still remains a major cause for illness and death of children.

Burgeoning burden

India has the highest number of tuberculosis (TB) cases in the world. Each year in India, more than 2 million new cases of TB are diagnosed. Approximately 500,000 persons die of the disease. During the last decade, multidrug-resistant TB has burgeoned in India, resulting in an extremely large number of multidrug-resistant TB cases, second only to the number of cases noted in Latvia. Since 1993, in response to this epidemic, the government of India has implemented the Revised National Tuberculosis Control Programme based on directly observed treatment (DOT).

Akash and Parveen (names changed) are siblings from a small village in North India. Their parents, Meenu and Gyanchand, own a vegetable store. One day, they noticed that their children had a cough that would not go away. The local doctor was not able to find out what was wrong. They took their kids from one health clinic to another till a Delhi hospital diagnosed that both kids were suffering from extensively drug-resistant (XDR) TB. The parents did not know what to do, where to go and how to spend on the children's illness.

Most health facilities in the private and the public sector do not have the tools or the infrastructure needed to diagnose XDR-TB. Though the National TB Programme in India provides most medicines for free, medicines for XDR-TB are not always covered. Global Health Advocates India, an ACTION partner, took up the matter with the government to provide access to free medicines through the government. The cost of medicine was covered and these two children were on the road to recovery.

Social stigma

But the problem did not end there. Meenu and Gyanchand were forced to mortgage their home to fund their children's hospital stay so much was the financial burden. There was also the social stigma attached to TB in India in any form. The children were expelled from the school which deprived them of the right to equality in education. The parents are worried about the future of the children. They feel that the stigma of TB would cloud their opportunities of a better life in the future.

Difficult to diagnose

Sometimes, Indian children, suspected of having contacted TB, find it difficult to respond to early diagnostic tests. They find it hard to cough up the necessary sputum sample from deep inside their chests needed to attempt a diagnosis through microscopy. A solution is sometimes provided by taking an induced sputum test that calls for breathing a saltwater mist through a mask that induces the child to cough deeply from the lungs and helps it produce an adequate sample for analysis.

Another problem that Indian children who are suspected of having contracted TB, face is that many of them are from the lower income groups or from a poor strata and live quite a distance from local hospitals where treatment can be easily accessed. Distance is a big hurdle for poor children whose parents go to work and find it time-consuming and money-consuming to take the child to the local hospital that might be far away.

A study in 2007 by Dr Vishwanath K G, Dr Siddaraju M and Jagannatha P covered 112 children of ages ranging from six months to 14 years attending the TB clinic of the paediatric department of Vanavilas Hospital, Bangalore. They were observed for one year. This study was undertaken to evaluate the clinical spectrum of TB among BCG vaccinated and non-vaccinated children. Among the study group 73.2 per cent children were malnourished. Among malnourished children 76.8 per cent of the children were BCG vaccinated. At least 73.2 per cent of children had intra-familial contact and among these 80.5 per cent children were BCG vaccinated.

The BCG vaccine was discovered in 1924 and has been in use for nearly 90 years. It has not made the impact it was expected to make. Several epidemiological studies have shown wide variations in protection offered by the BCG vaccine. Why do children develop tuberculosis despite being vaccinated? What is the alternative? There is no ready response to these questions.

The 15-year follow up of the Indian Council of Medical Research (ICMR) BCG trial in Chingleput district, concluded that "BCG offers no protection against adult-type bacillary tuberculosis. Consequently, BCG cannot be expected to reduce the transmission of tuberculosis."

Another study by Sunil Karande and Sandeep B. Bavdekar points out that TB is developing in more children in Mumbai today than a decade earlier. Moreover, close proximity to adult patients with multi-drug-resistant TB makes children prone to developing primary multidrug-resistant TB. Similarly, disseminated TB is occurring in large numbers in children living in overcrowded slums in Mumbai with a consequent high death rate.

The AIDS epidemic in adults in Mumbai has also adversely affected the epidemic within the population of children with TB.

Lack of proper facilities

Though children are included in the national control programme, they do not receive the benefit of DOT strategy. The Revised National Tuberculosis Control Programme does not provide drugs in syrup form or permit breaking of tablets, making the administration of accurate paediatric doses impossible. Most children with TB are also sputum-smear negative for acid-fast bacilli.

Doctors must rely on clinical acumen when deciding whether or not to start TB treatment. This lack of a method for definitive diagnosis of TB in children makes treatment centres reluctant to enlist paediatric cases; as a result, these children attend general paediatric outpatient clinics every 28 days to obtain their TB medication.

DOT strategy is not followed in the general outpatient clinics. Compliance with treatment depends on the motivation and perseverance of the parents. Often, one or more of the drugs is out of stock. In such cases parents are forced to dig into their own small resources to purchase the necessary medication. To avoid a long wait in the crowded general paediatric outpatient clinics, some parents intermittently purchase anti-TB drugs from local chemists, who supply the drugs without a current prescription. This practice leads to frequent defaulting and inadequate treatment.

A 12-year-old boy in Mumbai with secondary multidrug-resistant TB had received multiple courses of inadequate treatment with various anti-TB treatment regimens for nine years. The TB gradually progressed in severity and was disseminated with the bacterial load increasing sufficiently for multidrug-resistant TB to develop. This case is not unusual and many children in Mumbai are dying of multidrug-resistant TB because DOT strategy regimens are unavailable.

Improved patient care, better BCG immunisation coverage and multi-drug anti tuberculosis regimen have not created a dent in the mortality due to tuberculosis in children. However, certain remedial measures can be taken to prevent the tuberculosis in children.

So, it must be stressed that the most powerful weapons for controlling tuberculosis and altering the epidemiological situation in a community are case finding and case holding. A sincere effort at all levels of health care delivery system is the need of the day.

chilling Facts

In India, nearly 3-4 million children have tuberculosis and another 94 million are at risk for this disease.
Impact of BCG vaccination has demonstrated that classical or generalised tuberculosis meningitis, disseminated TB, disseminated tuberculosis and other serious complications of primary infections continue occurring in malnourished BCG-vaccinated children.
The annual infection rate is about 3 per cent. These figures are not complete as these have not included children under the age of 5 years. The usual sources of infection are adults. An infected individual can transmit the infection to as many as 20 contacts.
(Source: P.M. Udani, Postgraduate Institute of Medical Sciences, Mumbai)
Attention to child TB activities are rarely included in the strategic plans and budgets of ministries of health.
Need for better diagnostics that can detect TB in children.
There is lack of appropriate child-friendly, fixed-dose combination drugs for treatment.
Systematic screening of TB is not undertaken among children living in households affected by TB.
Health workers lack sufficient knowledge about child TB diagnosis and management.
Current TB vaccine protects young children against the most severe forms of TB such as meningitis and disseminated TB disease but it does not prevent transmission from an infectious contact.
Recommendations for provision of isoniazid preventive therapy (IPT) for children under 5 years is rarely implemented.
(Source: StopTBPartnership, WHO)

The writer is a freelance journalist, scholar and author