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Foisting Hindi is to play with fire
Some other blunders of the new government
Inder Malhotra  ALMOST exactly half a century ago a thoughtless directive by the Union Home Ministry, then headed by Gulzarilal Nanda, on the language issue ignited a fire in Tamil Nadu that scalded the entire country. There already was ample tension in the South over the Constitution's provision under which Hindi was to become this country’s official language on January 26, 1965. Much earlier, recognising the explosive potential of the situation, Jawaharlal Nehru had assured all concerned that together with Hindi as the official language, English would continue to be an “associate official language” for as long as non-Hindi-speaking people wanted it. Nanda's ministry’s detailed directive — evidently aimed at placating Hindi zealots angered by Nehru's concession to the non-Hindi-speaking states — lit the fuse that started the big blaze. Since those who learn nothing from history are fated to repeat it, the self-same Home Ministry in New Delhi, now presided over by the ruling Bharatiya Janata Party’s president, Rajnath Singh, virtually repeated Nanda's blunder. It issued two directives which could have been highly destructive. Mercifully, the glaring mistake was corrected in good time. The credit for this goes less to the leaders of the government and more to those of Tamil Nadu. They promptly and most vigorously protested against the edict issued and warned about the consequences it would have. M. Karunanidhi, patriarch of the Dravida Munnetra Kazhagam, was the first to hit out. The state Chief Minister and supreme leader of the All-India Anna Munnetra Kazhagam, was the next. It was one of those rare occasions when these two rivals were on the same side. Interestingly, the protests of the four smaller Tamil parties might have been more effective because all of them are the BJP’s allies. The Home Ministry's “circular” stipulated that ministries and departments, PSUs and banks should “give preference to Hindi while using English/Hindi to operate official accounts on the social media such as Facebook and Twitter”. A second circular even offered small cash prizes to those who use more Hindi than others in their domain. Obviously, it is a crude device to consolidate support for the BJP in the Hindi-speaking states that have voted for it in a big way. It will succeed, however, only in alienating people in non-Hindi-speaking areas. What the spokespersons of the Modi government did during the interval between the issuance of the regrettable circulars and the eventual declaration that these were confined to the Hindi-speaking states only is even more revealing. The junior Home Minister, Kiren Rijiju, who hails from Arunachal Pradesh where Hindi is hardly understood, extolled the government's directives. “We will give priority to the promotion of Hindi in all communications in our various departments and public life because it is our official language”. He did add: “It does not mean that we are going to discourage the regional languages”. He needs to be told that what he calls “regional languages” are as much national languages as Hindi. The Constitution catalogues 22 of them, something that Hindi zealots don't seem to know. After chastisement by the leaders of Tamil Nadu, Mr Rijiju's bland statement was that the government had been misunderstood. “Our directives are meant only for the Hindi-speaking states”. This may hopefully be the end of one squalid episode. But in the euphoria of a spectacular electoral victory, all kinds of backwoodsmen in the ruling establishment have been trying to push through ideas which are both dubious and dangerous. The BJP Bihar leader who suggested that all those who had tried to stop Mr Modi should be sent away to Pakistan has not been taken seriously. But no BJP national leader has ever remonstrated with him. Nor has anyone disciplined the minister of state in the PMO who lost not a single day in raising a storm over the abrogation of Article 370 that gives Kashmir special status. The reaction in the sensitive state, including that from Chief Minister Omar Abdullah was very sharp. Mercifully, this issue was not mentioned in the President's Address to the two Houses of Parliament but the eviction of “illegal immigrants in Assam” from Bangladesh was. Of course, the BJP has been concerned over this matter for long and wants to do something about it. But an Assamese BJP MP’s demand that this process must be completed within a limited number of days is an invitation to disaster. Sentiments among various sections of Indians are varied and strong. Also, our relations with Bangladesh, an important and friendly neighbour, are involved. And incredible though it may seem, a stalwart of the BJP’s oldest ally, the Shiv Sena, has been propagating that the saffron flag of Hindutva should be flown at the Red Fort, together with the national flag on August 15. There is another act of the BJP-led government that has to be condemned, not just deplored. As it happens, of the 543 newly elected members of the Lok Sabha as many as 53 are facing criminal charges of a serious nature. Of them 24 belong to the BJP and five to its ally Shiv Sena. Union Minister for Water Resources Uma Bharati and BJP patriarch L. K. Advani figure on the list. Charges against them are of such a nature that if convicted, they would be automatically disqualified from membership of Parliament, as Lalu Prasad Yadav was last year. It is a different matter that this did not prevent the Congress from entering into a close alliance with him. All this pales, however, when compared with the lengths to which the entire Modi government is going to erect protective walls around one of its junior ministers, Nihal Chand, accused of the unspeakable crime of sexual exploitation allegedly lasting a decade. A Rajasthan court has summoned him, together with 17 others, including the victim's husband. Most shockingly, the entire Modi establishment is unwilling even to hear the suggestion that he be asked to step down for the duration of his trial and come back only when cleared by the court.
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Getting to know Begum Akhtar
Padam Rosha
 Early in 1945 I went to Amritsar to attend the wedding of Gaur Kishore Kapur, a friend from our days together at Govt College, Lahore. He belonged to a rich family of wholesale cloth merchants from Dhab Khatikan in Amritsar who had made their pile during the shortages of World War II. The highlight of the celebrations was that Akhtari Bai Faizabadi had been engaged to come from Lucknow to regale the guests. The "baraat" went in a large cavalcade of Phaetons, buggies and other plush horse-drawn carriages — petrol was severely rationed in those days. All I remember about this concert is a petite, flashily dressed Akhtari on a distant dais, surrounded by half a dozen 'sazindas'. And yes, midway through the concert, a tall, middle-aged person who had imbibed quite a bit, got up with a wad of currency notes in his hand, and staggered towards the dais, but stumbled and fell flat to general merriment of the audience.I met Begum Akhtar next in 1971 when she was at the peak of her singing career. As it happened, the renowned poet Faiz Ahmad Faiz was on a visit to India and the Pakistan High Commissioner , Sajjad Haidar, arranged a “Baithak” at his Tilak Marg residence. Sajjad was a family friend from Jalandhar, so my wife and I were also invited. Faiz Sahib would recite one of his compositions and Begum Akhtar would sing it. It was an evening of sublime poetry and music you get once in a lifetime — if you are fortunate enough. We were held spellbound till 2 in the morning. The third and the happiest encounter came in 1974 when Begum Akhtar came for a long stay at Srinagar. She stayed with a dear friend of ours, Agha Ashraf Ali, in his lovely residence in Rajbagh. Agha Ashraf comes from an affluent and influential Shia family of Kashmir. His mother, Begum Zafar Ali, was a pioneer in women's liberation and was the first to come out of the strictest type of purdah you can imagine. She used to tell us how in her childhood girls were allowed to play in their garden enclosed by high walls — only after sunset. When transiting from Jammu to Srinagar, a corridor of sheets had to be erected from the car to the rest house at Batote. Ashraf’s charming wife was from Lucknow and his teenage son, Shahid, who later became a Professor of English poetry at Stanford University, was madly in love with Begum Akhtar. So it was here that we spent many happy hours with Begum Akhtar, entranced by her singing and her stories. She was a wonderful raconteur. One of the stories I remember is about the craving she had for cigarettes while traveling on a slow train in UP. She sweet-talked the train “guard-babu” to run out at a wayside station to get a packet of cigarettes, while she promised to hold the signalling flags for him. Now imagine the engine driver impatient to move and whistling furiously, and Begum Akhtar smiling and wagging the red flag at him. The passengers craned their necks out of the windows to find out what was going on, while the guard-babu fumbled with the change at the pan-biri shop across the road. That was Begum Akhtar. When she died on October 30, 1974, in Ahmedabad, Agha Shahid wrote: “Ghazal, that death-sustaining widow, sobs in dingy archives, hooked to you”.
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Improving quality of life of dying patients
Palliative care is aimed at improving care of the elderly through something called “Active Total Care.” This involves treating pain and other medical symptoms, while at the same time offering social, emotional and spiritual support
Taranjit Singh
With the increasing life-span and growing burden of chronic diseases, the need for palliative care will rise. Kerala and Maharashtra have shown the way. |
It
took 19 years of hard work and persistence by an army of dedicated healthcare professionals, human right activists, and civil and international service providers for the amendment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India to become a reality. The Parliament of India finally passed it on February 22, 2014, just a few months ago. Healthcare providers have long seen the injustice visited upon India's chronically ill and terminal patients suffering until their last second. Thus, this amendment of the NDPS Act comes as a welcome relief; it eases medical access to narcotic drugs by removing barriers that date back to 1985, when the act was first introduced. Care and quality of life Chronically and terminally ill patients— battling cancer, and HIV/AIDS — and elderly patients in particular — have complex medical needs and cannot coordinate their own care. However, care becomes less fragmented when a palliative care team is involved. Because of its patient-centred focus, palliative care is aimed at improving the quality of life by treating pain and other medical symptoms, while at the same time offering social, emotional and spiritual support. Applicable right from diagnosis of a chronic disease up to the end of life, palliative care relieves much of the unnecessary suffering due to pain and other distressing physical and psychosocial concerns with evidence-based interventions. Palliative care is aimed at improving quality of life through something called “Active Total Care,” treating pain and other medical symptoms, while at the same time offering social, emotional and spiritual support. A recent study conducted by the Diana Faber Institute in the US found that key barriers to pain management in India include the role of nursing, opioid misperceptions, bureaucratic hurdles, and socio-cultural/infrastructure challenges. The study concluded that that macro and micro-level policy and practice changes are needed to improve opioid availability and cancer pain management for India’s chronically ill and end-stage patients. New policy The problem now, however, is that the newly formed Pain and Palliative Care policy lacks sufficient teeth. Without adequate funding and implementation, the purpose of NDPS Act of resolving the public health issue of managing pain and symptoms of chronically ill and end-stage patients goes unmet. Consider this: Rural and economically disadvantaged populations suffer poor health outcomes. With seven out of every 10 Indians living in rural areas and 6.5 doctors and 10 nursing and midwifery and 9 hospital beds for per 10,000 population according to WHO’s world health statistics 2013, the general health expenditure on health by government is 28 per cent while private expenditure on health as per cent of total health expenditure on health is 74 to 28 per cent. These numbers are reversed in many countries like France, Hungary, Italy, and Ireland. In urban areas, particularly in the northern parts of the subcontinent, many large medical centres, even the most modern ones, do not offer palliative-care services to any patients, regardless of their status as end-of-life or chronically ill. Third world countries In short, while India likes to compare itself in this arena to the USA, UK, and China, the reality is that with its ratio to expenditure spent on health, it matches the other third world poor countries like Sudan, Nigeria, and Uganda. Healthcare expenditures for chronic diseases eat 70 per cent of the average monthly income for people in low-income groups, and 45 per cent for those in the highest income group. More than 30 million Indians each year find themselves pushed below the poverty line due to high out-of-pocket payments for healthcare. To ensure the most effective care for patients, palliative care must begin at the point of diagnosis, continue throughout treatment, and include bereavement for families after the patient’s death. Many studies have shown that early palliative care, which begins at diagnosis and includes bereavement for families after the patient’s death, coupled with standard cancer treatment extends survival when compared to standard cancer treatment alone. A survey by Centre of Advance Palliative Care has shown that palliative care decreases length of hospital and ICU stays, eases transitions between care settings, and increases hospital compliance with care-quality standards. The WHO has recognised palliative care as an urgent humanitarian need, as an integral and essential part of comprehensive care for cancer, HIV, and other health conditions and recommends that all countries adopt a national palliative care policy. At the 67th World Health Assembly last month on May 24, WHO’s decision-making body adopted the first-ever resolution urging all countries to develop, fund, support and implement appropriate palliative-care policies, to include palliative care as an integral component of the ongoing education and training, It also requests the Director-General of WHO to ensure that palliative care is an integral component of all relevant global disease control and health-system plans. This resolution has the potential of changing the outcomes for every human being around the world as at some time in our lives, we and our loved ones will face a health situation that will require palliative care during a time of intense suffering that most people find themselves ill-prepared to cope with. The Kerala model In India, most state-level healthcare policies do not recognise palliative care as a discipline, and thus, neither public nor private health delivery systems include provisions for palliative care. Except Kerala, the first state to implement a state-wide policy in 2008 supporting the provision of palliative care through the public- health system. Kerala serves as a model for other states to incorporate the simple principles of palliative care in the government public health care programmes at each level. The Maharashtra State Government followed suit, announcing in June 2012 its Pain and Palliative Care policymaking, the second state to do so. Allaying suffering “People in pain and suffering have no vote bank. They and their families are too weak and tired for collective bargaining,” says Dr M.R. Rajagopal, the father of palliative care in India and the tour de force behind Kerala’s robust status. “The huge burden of disease-related suffering in the country is ignored by the arrogant healthy. Most of this needless suffering has easy and inexpensive solutions. We cannot call ourselves a cultured society if we turn our backs and allow the dying and chronically ill to continue to suffer.” Outside Kerala and Maharashtra, most Indian states still remain without a single centre for palliative care service provisions, and this includes urban areas that work hard to foster themselves as medical tourism destinations. Growing disease burden With the increasing life-span and growing burden of chronic diseases, the need for palliative care will rise, and funding the amendment will enable the nation’s healthcare delivery sectors to strengthen its capacity to provide a strong support for the palliative care strategy, the least costly of medical specialties. The provision for palliative care within the National Programme on Prevention and Control of Non-Communicable Diseases (NCDs) was proposed for the 12th Five-Year Plan. It has been successfully integrated into Central Government health programme like NRHM in states like Kerala. The lack of funding, bureaucratic hurdles and a political will, however, prohibits the nation’s fledgling health care infrastructure from establishing the urgently needed palliative care programmes and interventions. People only die once. They (and their families) don't always know what is available, and can't always express preferences. Who will speak for their needs and preferences at the end days of life? Will it take another 19 years to secure funding to implement the Pain and Palliative Care policy?
WHO definition of palliative care
 This type of care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment. It involves treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care provides relief from pain and other distressing symptoms
- Affirms life and regards dying as a normal process
- Intends neither to hasten or postpone death
- Integrates the psychological and spiritual aspects of patient care
- Offers a support system to help patients live as actively as possible until death
- Offers a support system to help the family cope during the patients illness and in their own bereavement
- Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
- Will enhance quality of life, and may also positively influence the course of illness
- Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical
complications.
Adding life to years
- With the increasing life-span and growing burden of chronic diseases, the need for palliative care will rise.
- Outside Kerala and Maharashtra, most Indian states still remain without a single centre for palliative-care service provisions, and this includes urban areas that work hard to foster themselves as medical tourism destinations
- It took 19 years of hard work and persistence by an army of dedicated healthcare professionals, human right activists, and civil and international service providers for the amendment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India to become a reality. The Parliament of India finally passed it on February 22, 2014
The writer earned a MSc in palliative care from Cecily Saunder’s Institute, King’s College, London.
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