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Testing time for UPSC Stop the killings |
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Questions about nuclear weapons
Flying through clouds
Viral hepatitis: Tackling a silent killer Prevention & treatment of hepatitis B
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Testing time for UPSC A legacy of the British Raj, the Indian Administrative Service (IAS) remains contentious, not for the legitimacy of its role in building a modern India, but for the processes involved in selections. Every year five to six lakh candidates aspire to clear the highly competitive UPSC (Union Public Service Commission) examinations to get into the elite IAS, IRS (Indian Revenue Service), IPS (Indian Police Service), and IFS (Indian Foreign Service). Lakhs of youth competing for less than a thousand seats every year demand a level-playing field. The fact that the percentage of successful English-medium candidates has risen over the past some years has once again politicised the language issue in the prestigious examinations. This time the candidates demand that the aptitude test, conducted in English, should also be taken in regional languages. Taking cognizance of a PIL petition filed in 2011, the government had restored the status of other scheduled languages by allowing candidates to take their test in any of the 22 languages. Literature of the 22 scheduled languages was allowed as an optional subject, even when the candidate didn't study the language at the under-graduate level. The condition of a minimum of 25 candidates was also dropped in the last notification to provide equal opportunities to all. In this context, the government's stand to "not equate language with skill" is praiseworthy. It has now sought a report from a three-member committee within a week. Along with making the logistics of conducting the aptitude test in 22 languages feasible, the process of selection should not be diluted. The panel must ensure this. The UPSC exams are considered to be one of the toughest in the world as the rate of success in these exams stands at 0.3 per cent. And to get into the IAS, the chances get even thinner. In the name of accommodating all, the UPSC should not become accommodative like the Indian Railways, which stops fast trains in every MP's constituency.
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Stop the killings Even
as Israel, Hamas and other Palestinian militant groups agreed to a UN-inspired pause in fighting each other, Gaza Strip heaved a sigh of relief as people got out of their homes without fear for the first time in days. The cost of this fighting has been high, with Palestinians accounting for an overwhelming number of causalities. Even school children were not spared by artillery shells, including those that fell onto a UN-run school. The Israeli offensive on Gaza has turned into a humanitarian tragedy with hundreds of civilians dead and thousands displaced from their homes. India has supported the UN Human Rights Council resolution asking for a ceasefire. The government has stated it is "deeply concerned at the steep escalation of violence between Israel and Palestine, particularly heavy air strikes in Gaza and disproportionate use of force on ground, resulting in the tragic loss of civilian lives, especially women and children and heavy damage to property." Indeed, India has been a traditional supporter of the Palestinian cause even as it has forged closer ties with Israel since 1992, when the two countries established full diplomatic relations. The growing number of Palestinian casualities is causing concern in many international capitals. Israel needs to weigh the postulated gains from its battle in Gaza on the one side against the real loss of ground, diplomatically and morally, on the other. The world is now a village and the vastly disproportionate casualties, alleged use of banned weapons, etc., all have raised a storm in the social media too. Hardliners in Israel must realise that they can no longer count on impunity when they take military action, even when it is said to be directed against a group like
Hamas. The collateral damage is simply too much. On the other hand, Hamas too must understand that the mounting casualities are robbing it of support from within. The silencing of guns and rockets is the only way there can be a modicum of peace in the region, something that ordinary people on both sides so ardently desire.
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The way to love anything is to realise that it may be lost. — Gilbert K. Chesterton
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A plea for the 'provincials' THE traditional position of the Secretary of State towards Indian public money was once described by Lord Morley as that of a tremendous niggard, who watched over the finances of the country in much the same spirit as the dragon of old mythology did over the golden fleece. As a matter of practice, this traditional attitude, it is to be feared, is often departed from. We had a recent instance of this departure in the comprehensive scheme of better pay that has been allowed to the members of the Indian Civil Service in the Punjab. Thanks to a Liberal Provincial Settlement, the Punjab revenues are no longer in need of being screwed to the extreme point of niggardliness. Why should not the Civil Service men, who have contributed in no mean measure to the prosperity of the province share the fruits of their labour? This was the argument used by Mr. (now Sir M.) Fenton in making out a case for allowing larger emoluments to the Civil Service men. But does not the argument apply pari passu to the provincial men?
Gurdit Singh's defeat SARDAR Gurdit Singh has undoubtedly been defeated. But no one believes that he and his countrymen have been vanquished. Nor is the dismissal of the application on behalf of the Indians by the British Columbia Court taken seriously. Indeed, as the Nation (London) points out a decision of this Court cannot certainly be accepted as the final decision of the highest Court of appeal. Had the venture been properly organized, Gurdit Singh would have carried the case in appeal first to the Supreme Court of Canada, and next to the Privy Council. But it was not well organized. Nor was Gurdit Singh assisted by the mother country. He suffered from lack of funds.
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Questions about nuclear weapons The newspaper is sharply critical of India's efforts to acquire membership of the Nuclear Suppliers Group (NSG). It bases its criticism on a report by IHS Jane's, a US-based research group, that India is in the process of enhancing its capacity to enrich uranium - ostensibly to power the nuclear reactors on the INS Arihant and future SSBNs, but much in excess of the requirement. This, the editorial says, is causing anxiety to the Pakistanis and has raised the spectre of an arms race in southern Asia. It is obvious that the editorial writer understands neither the background to nor the present context of India's nuclear deterrence. As stated in a letter written by the then Prime Minister A B Vajpayee to US President Bill Clinton after India's nuclear tests at Pokhran in May 1998 (in an unfriendly act, the letter was leaked to the media by the White House), the primary reason for India's acquisition of nuclear weapons was the existential threat posed by two nuclear-armed states on India's borders, with both of which India had fought wars over territorial disputes. The China-Pakistan nuclear and missile nexus, including the clandestine transfer of nuclear materials and technology from China to Pakistan, has irrevocably changed the strategic balance in southern Asia. It has enabled Pakistan to neutralise India's superiority in conventional forces and wage a proxy war under the nuclear umbrella. Since then, the nuclear environment in southern Asia has been further destabilised. China's ASAT test, BMD programme, efforts aimed at acquiring MIRV capability and ambiguity in its 'no-first-use' commitment, while simultaneously modernising the PLA and establishing a 'string of pearls' by way of ports in the Indian Ocean, are a cause for concern for India. Similarly, Pakistan is engaged in the acquisition of 'full spectrum' nuclear capability, including a triad and battlefield or tactical nuclear weapons, which invariably lower the threshold of use. Pakistan has stockpiled a larger number of nuclear warheads (110 to 120) than India (90 to 100) and is continuing to add to the numbers as it has been given unsafeguarded nuclear reactors by China. Mujahideen attacks on Pakistan's armed forces recently have led to the apprehension that some of Pakistan's nuclear warheads could fall into Jihadi hands. Some statements made by IHS Jane's in its report are factually incorrect. The research group has assessed that the new Indian uranium enrichment facility at the Indian Rare Metals Plant near Mysore will enhance India's ability to produce 'weapons-grade' uranium to twice the amount needed for its planned nuclear-powered SSBN fleet. The report does not say how the research group arrived at this deduction. Also, the nuclear power reactors of SSBNs require uranium to be enriched only up to 30 to 40 per cent. Weapons-grade uranium must be enriched to levels over 90 per cent. For the record, the Government of India has denied reports that it is 'covertly' expanding its nuclear arsenal. An Indian official told The Hindu (Atul Aneja, "India trashes report on covert nuclear facility", June 22, 2014) that the report was 'mischievously timed' as it came just before a meeting of the NSG. He said, "It is interesting that such reports questioning India's nuclear credentials are planted at regular intervals." The US Government also dismissed the report as 'highly speculative' ("US dismisses report on India covertly increasing nukes", The Hindu, June 21, 2014). The US State Department spokesperson said, "We remain fully committed to the terms of the 123 agreement and to enhancing our strategic relationship…" The 123 agreement signed after the Indo-US Civil Nuclear Cooperation Agreement of July 2005 gives an exemption to India's nuclear weapons facilities and stockpiles of nuclear weapons fuel from inspections by the International Atomic Energy Agency (IAEA). India has agreed to bring 14 nuclear power reactors under international safeguards. Eight military facilities, including reactors, enrichment and reprocessing facilities, will remain out of the purview of IAEA safeguards. India is at liberty to set up additional military facilities using unsafeguarded materials if these are considered necessary. India has been a responsible nuclear power and has a positive record on non-proliferation. India has consistently supported total nuclear disarmament and is in favour of negotiations for the Fissile Material Cut-off Treaty (FMCT). For both technical and political reasons, it is important for India to keep its option to conduct further nuclear tests open; hence, it cannot sign the CTBT at present even though it has declared a unilateral moratorium on nuclear tests. Non-proliferation ayatollahs should channel their efforts towards identifying and shaming the real proliferators. Influential newspapers like New York Times should review the progress made by the P-5 nuclear weapons states (NWS) on the implementation of the commitments made by them during the 2010 NPT Review Conference (RevCon) as RevCon 2015 is coming up. The commitments made at the 2010 RevCon include progress in the implementation of the New Start Treaty; disposal of HEU extracted from nuclear warheads; steps towards early entry into force of the CTBT, monitoring and verification procedures and its universalisation; efforts to revitalise the Conference on Disarmament (CD) by ending the impasse in its working and, the immediate start of negotiations on a legally binding, verifiable international ban on the production of fissile material by way of the FMCT; and, measures to strengthen the non-proliferation regime. In April 2009, in his first major foreign policy speech, popularly known as the 'Prague Spring' speech that won him the Nobel Peace prize, President Barack Obama had committed the US to work towards a world free of nuclear weapons in line with the growing bipartisan consensus expressed by Henry Kissinger, George Shultz, William Perry, and Sam Nunn, in their famous 2007 Wall Street Journal article. The New York Times should enquire how well that commitment is being
fulfilled.
— The writer is a Delhi-based strategic analyst
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Flying through clouds Having acquired the stiffness of the Army in drills and parades over the years, it was not easy becoming a flyboy and learning to fly by the "feel of pants" rather than the procedures of maneuvers. One also had the distinctions of learning to fly an aircraft and drive a car at the same time. The first solo sortie was an experience that raised the dopamine levels in the body exponentially. When we were awarded the flying badge or the coveted "Wings" at the end of our training, we were confident that no power on earth could now take our wings away from us. It was an apt recognition of our acquired skill of venturing into the third dimension. On joining the squadron we went through the tactical flying training and I remember those golden words of my CO, a fatherly figure, who said: "There are either old pilots or bold pilots and there can never be an Old Bold Pilot". There were others who gave us funny but useful guidance during our formative years in aviation. During one of the exercises in Rajasthan, our boss gave us pearls of wisdom: "While flying here in deserts, whenever you feel unsure of your position just turn due East or else you will return via Islamabad". I did not realise the importance of these words of experience till I got the difficult task of taking the mortal remains of a colleague who had died in a crash on the aircraft I had flown only a day prior. The greatest challenge of flying was experienced at the Siachen Glacier, where the machine, pilots and their guts were tested to the limits. Every sortie here is a new experience and every landing a great relief. The dilemma of whether to attempt a rescue mission in marginal weather was never easy. While the heart went for the dying soldier, our minds at times thought otherwise. Flying through clouds is not at all pleasant and only an aviator can experience sweat run down his temples in sub-zero temperatures at those altitudes. Evacuating the wounded has been another great experience. The sight of hope in the eyes of the wounded man would only toughen our resolve. The smearing of our shoes with the blood of the casuality lying behind our seat would be nauseating, to say the least. When one did get to meet this man after his recovery, his gratitude would be better than being awarded a medal. Today when I am in the process of getting a civil pilot licence, one wonders if one would ever get the same job satisfaction as one got while flying in those green overalls. Will the tonnes of money earned ever equal the words of that dying officer whom we had once evacuated. His last words were: "Thanks for trying".
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Viral hepatitis: Tackling a silent killer
Global burden Hepatitis A is the commonest cause of acute viral hepatitis in young children. Over 99 per cent of these children recover fully, acute liver failure can occur in a very small percentage of patients. Hepatitis A has the highest global burden at over 5.5 billion. The mortality of hepatitis A increases with increasing age. With mortality rates of 1 per 1,000 in children and 2 per 100 in adults. Treatment is largely symptomatic and supportive. Hepatitis E shares the same mode of transmission as hepatitis A. This virus affects both older children and adults. Hepatitis E is a more serious infection than hepatitis A, with incidence of acute liver failure exceeding 20 per cent in late stages of pregnancy. Globally hepatitis E causes annual mortality of over 300,000. Hepatitis E has a global burden of 2.5 billion. Both hepatitis A and E have similar clinical presentation such as fever, loss of appetite, body, muscle and joint pain, weight loss, skin rash and jaundice.
Acute liver failure Combined hepatitis A and E are the commonest cause of acute liver failure in India. When should one refer a patient to hospital? Rapidly increasing jaundice, severe headache and vomiting, bleeding from the nose or mouth, drowsiness, irrelevant talk and decreased urine output are symptoms that should require hospitalisation. Boiling and chlorination of water effectively kills hepatitis A & E viruses. We must ensure a 24 x 7, safe drinking water supply, repair of leaking sewerage pipes, which are often the main cause of faecal contamination of drinking water. Hepatitis A can effectively be prevented by two doses of hepatitis A vaccine, spaced six months apart. Hepatitis E vaccine has been available in China for almost two years now but this vaccine is still unavailable in India.
Common causes Hepatitis B and C viruses are common causes of liver cirrhosis and liver cancer. Both are blood-borne viruses with a similar mode of transmission as the HIV/ AIDS virus. Hepatitis B and C rank as the ninth commonest cause of global mortality. Over 1.4 million people across the world die each year from hepatitis B and C. Hepatitis B is a hundred times more infectious than HIV/ AIDS virus. In Asian countries, mother-to-baby transmission (vertical transmission) is quite common.Because of a shared mode of transmission, co-infection of hepatitis B, C and HIV/AIDS virus is not uncommon. India and China combined have well over half-a-billion people chronically infected with hepatitis B; between 15 and 30 per cent of these will develop liver cirrhosis and/ or liver cancer during their lifetime. Hepatitis B causes over 50 per cent of all cases of liver cancer and over 30 of all cases of liver cirrhosis. Hepatitis C infects 2 per cent of the world's population, with India having more than 14 million people infected with this virus. This is almost twice the burden of hepatitis C in Europe. to 20 per cent of all patients of hepatitis C will develop liver cirrhosis and/ or liver cancer in 20 to 30 years. Combined hepatitis B & C, contribute to 70 per cent of 750,000 new cases of liver cancer diagnosed globally. Liver cancer is a very serious disease with over one-third of patients dying within one year of diagnosis. However, if liver cancer is diagnosed early, curative treatment may be offered by surgery, radio frequency ablation or liver transplantation. Hepatitis B and C are often referred to as “The Silent Killers”, because symptoms of liver disease appear at a very late stage. These symptoms include jaundice, swelling of feet and abdomen, vomiting of blood or passage of black stools, fatigue, anaemia, memory disturbances, decreased urine output, fever etc. Both these can be diagnosed through appropriate blood tests. In chronic hepatitis C, the risk of liver cancer increases 17-fold, with maximum risk in an elderly male patient who takes moderate to large amount of alcohol. Hepatitis C is responsible for maximum number of liver-related deaths, and is the leading indication for liver transplants in USA and Europe.
Blood tests & treatment Hepatitis B and C can be diagnosed by blood tests. Chronic hepatitis B is diagnosed if hepatitis B virus persists over six months. Timely and appropriate antiviral therapy will improve patients’ survival, decrease liver-related deaths and improve the quality of life. Therapy for chronic hepatitis C has undergone a paradigm shift. The standard of care which included prolonged injections with PEG interferon and daily ribavirin has been replaced by all-oral therapy where this standard therapy cannot be given or is ineffective. These all oral drugs are called DAA's (Directly acting antivirals). These drugs are highly effective, given for a short duration, but are costly and are still unavailable in India. Sofosbuvir and ledipasvir are examples of such new drugs. Hepatitis B can be prevented by three doses of an excellent vaccine given at day 0, 1 month and six months’ interval. These three doses give a 22 to 25 years protection against hepatitis B. Safe surgical practices, avoidance of reusable syringes and needles, proper testing of blood and blood products to be transfused, banning of professional blood donors and taking universal precautions are some of the methods to control the spread of hepatitis B and C. Delta hepatitis is a defective virus which is only seen in patients infected with hepatitis B. This is an extremely difficult-to-eradicate virus and leads to significant liver-related morbidity and mortality. Fortunately, delta virus is uncommon in
India. The writer is Director, Gastroenterology, Fortis Hospital, Mohali
High-risk groups that must be tested and vaccinated against hepatitis B are
ABCDE of the silent killer
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Prevention & treatment of hepatitis B Hepatitis B virus affects over 40 million Indians, with a prevalence rate of 2 to 7 per cent. It shares the same route of transmission as HIV and hepatitis C virus. Hepatitis B can cause acute hepatitis with a 1 per cent mortality rate. Over 95 per cent of the people clear the virus from their blood, unlike 95 per cent infants and children who are unable to do so. Persistence of hepatitis B for more than six months is defined as chronic hepatitis B. Both vertical and horizontal modes of transmission occur with this virus. About 15-30 per cent of all cases of chronic hepatitis B will develop liver cirrhosis and/or liver cancer. Liver cancer is the most-dreaded complication of chronic hepatitis B. Liver cancer is invariably fatal as it is often diagnosed at a late stage. If it is diagnosed at an early stage, it may be cured by liver surgery, liver transplantation or radio-frequency ablation (RFA). Hepatitis B is truly an oncogenic (cancer-causing) virus. The devastating complications of hepatitis B virus can be most effectively prevented with three doses of hepatitis B vaccine given intra-muscularly, in the arm, in three doses of 20 mcg on day zero, one month and six months. The third dose gives a protection of 20-25 years. In India, less than 50 per cent of all vaccinated people receive their third dose. Globally, only one out of five babies will receive the third dose of this vaccine. A titer of 10 IU/ml is protective. Hepatitis B immunoglobulin (HbIg) is also used for prevention of hepatitis B in special circumstances — In babies born to hepatitis B positive mothers, after needle-stick injury, and after liver transplantation to prevent re-infection of graft. Other methods to prevent hepatitis B include testing of all blood and blood products, avoiding reused needles and syringes, practising safe sex, avoiding the roadside barber, etc. This infection is not spread by casual contact. Goals of treatment of hepatitis B include the reduction or slowing down of disease progression and prolongation of life. This includes the delaying or prevention of developing the dreaded complications of liver cirrhosis and liver cancer. Two types of therapies are available The first includes injections of pegylated interferons given for 48 weeks to patients with early liver cirrhosis and a moderate viral load. About one-third of patients respond to this therapy. The other therapy used includes oral drugs like entecavir, tenofovir, adefovir, lamivudine and telbivudine. The first two drugs have a high genetic barrier and are preferred in clinical practice. Therapy is generally continued for few years. Over all, these drugs are safe but may cause lactic acidosis, kidney toxicity and bone changes.
Keep these in mind:
The writer is Director, Gastroenterology, Fortis Hospital, Mohali
Guard your liver
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IN a partisan and condescending editorial in early July 2014, New York Times wrote: "If India wants to be part of the nuclear suppliers group, it needs to sign the treaty that prohibits nuclear testing, stop producing fissile material, and begin talks with its rivals on nuclear weapons containment." 
Surds
Both
