India's healthcare conundrum

Anbumani Ramdoss, India’s Health Minister recently had occasion to highlight the vast gap in the medical workforce in the country. According to him, while the country had around 700,000 doctors, it needed 800,000 more to meet the standards of the World Health Organisation. He added that the country needed 1.5 million more nurses to achieve, as the Indian Planning Commission has indicated, the nurse-patient ratio of 1:500.

In order to overcome the huge deficit, conditions for establishing medical colleges have been relaxed. Sensing an opportunity for making a killing, poliiticians, their financiers and other influential and powerful business interests have got into the act. Colleges have been and are being opened any and everywhere regardless of the availalability or otherwise of the necessary faculty, equipment, patients and/or hospital-beds. Faculty members of distant institution are hired for few days to meet the needs of inspections, which, too, are rigged. Even fake patients are sometimes made to occupy, on payment, beds lying vacant in the attached hospitals.

A member of the Medical Council of India recently lamented the absence of accredition of medical education in India, the efforts being concentrated more towards securing recognition. The main reason for this aberration, he said, was the “absence of sincerity and moral values in the society”. While the Delhi High Court recently ordered closer scrutiny of Indian medical students graduating from abroad, it is almost time for such a scrutiny even of those who graduate from the mushrooming medical colleges in the country. Being products of an ongoing con-game, they mostly emerge as quacks armed with medical degrees. Instead of providing health care they are more likely to effectively deal with the acute population problem of the country!

Training and education of nurses is no different. Because of shortage of a million nurses, to achieve the ratio of a nurse for every 500 patients colleges have been allowed to be opened with scant facilities of teaching and learning. Producing nurses possessing, at best, rudimentary theoretical awareness with little knowledge or training in clinical applications, such institutions are only fattening their promoters doing nothing for the country or for the noble profession. Only the institutions of excellence that the government proposes to open may redeem to a limited extent the ongoing compromise in the quality of nursing.

The proliferating diagnostic labs are also an area of huge concern. According to the Quality Council of India, although 70% of the modern medical care is based on diagnostic lab tests, 90% of medical laboratories have remained unregulated by any standard. Most of the pathological laboratories do not follow any quality benchmark for want of stringent requirements. Here again, accredition (by government or other recognised agencies) is virtually absent and, hence, quality control is non-existent. Leave alone hygiene or sanitation, even sensitivity towards the need for a sterile ambience is absent. Qualified pathologists or radiologists are frequently unavailable. Inspections are unheard of and the entire system is governed by the hardly relevant Shops and Establishments Act. If this is what happens in urban areas one shudders to imagine the plight of the people in the country’s rural recesses. It is nothing but mockery of healthcare.

Instead of tackling these vital issues, Ramdoss got into avoidable controversies. His personal feud with the former Director of the prestigious institution of All India Institute of Medical Sciences, a cardiac surgeon of great repute, ended up with egg on his face and that of his government. Besides, to benefit a party apparatchik he banned production of vaccines by public sector labs, causing their widespread shortage that continues till date.

He, however, successfully imposed a ban on smoking in public places. He is now poised to move into the areas of drugs and alcoholism. Ramdoss’s strategy of mounting attacks on the lifestyle or habits or substances the pursuit and/or use of which cause deadly diseases necessitating heavy public investments for their treatment cannot but be appreciated. He however seems to be oblivious of the problem of food adulteration and use of toxic chemicals to ripen fruits and vegetables and to impart to them farm-fresh appearance. Health problems caused by water and air pollution are also nowhere on his horizon as yet.

India’s healthcare is a conundrum that would need much more than mere tinkering. To take care of health of a billion people, mostly poor, the immediate need would seem to be ruthless governance and rooting out of the prevailing rampant corruption in the health sector. And, the country is now at such a stage when penalisation of the states, the main instruments of healthcare delivery, for non-performance by blocking off their funding seems to have become necessary.

Vanishing tigresses of Panna

That the tiger in the Indian wild is critically threatened is a well-known fact. At the beginning of 20th Century 40,000 of these striped animals used to roam the jungles of the country. Wanton killings, rising human population, economic development followed by shrinking habitat brought their numbers to a perilous low of around 2000 towards the end of 1960s. That is when the country woke up to the need for protection of this magnificent beast.

It was at the initiative of the more pro-active of politicians, the late Prime Minister Indira Gandhi, that the Project Tiger was launched in 1973. Its objective was to, “ensure a viable population of tiger in India for scientific, economic, aesthetic, cultural and ecological values…” Succeeding for a short while, the Project helped in boosting up the numbers to around 3500 in the course of a couple of decades. However, lackadaisical approach to its protection coupled with a raging demand for its body-parts in East Asian countries saw their numbers plummet again. The last census, organised on a more scientific basis earlier this Century, pegged their numbers at around 1400 – a number which is in no way viable for fulfilling the Project objectives.

It is in this context that the reports circulating for sometime of vanishing tigresses in the Panna Tiger Reserve in the central Indian province of Madhya Pradesh (MP) are disconcerting. Sariska, a popular tiger-reserve near Delhi, located in the touristy north-western province of Rajasthan, lost all its tigers to pachers in 2005 and two tigers – a male and a female have had to be introduced in it recently. And, now the same catastrophe seems to have befallen Panna.

Created in 1981, Panna National Park was elevated in 1994 to the status of a Tiger Reserve under the Project Tiger. Situated in the picturesque Vindhyan ranges, close to the World Heritage Site of Khajuraho, the Park is known for tiger habitat that is considered about the finest in the country.

All, apparently, was fine with the Reserve until around 2003 when the slide seems to have commenced. With declining tiger-sightings, the figures dished out of its tiger-population in 2004 were so hotly contested that a re-census had to be ordered. Although the fresh census revealed the presence of 35 tigers, the controversy about absence of tigresses in the Park never really died down. Even the Central Empowered Committee appointed by the Supreme Court, comprising inter alia the well-known Indian “tiger scientist” Valmik Thapar, had commented in 2005 on its mismanagement, predicting that the Park was headed the Sariska way.

The year 2007 saw fresh reports about the vanishing tigresses of Panna. Raghu Chundawat, the famous tiger-researcher of Panna, came out into the open in a national English language news-channel speaking about the absence of tigresses in the Park – an observation that, he claimed, was shared by Park officials. Clearly, poachers were active, as was soon proved by press reports.
The current year, too, witnessed no let up in the incidence of adverse reports. In fact, the prestigious Sanctuary Asia magazine published in its June 2008 issue vehement denials by a senior MP Forest Department official of the Park’s plummeting numbers of female tigers. Asserting that it had not become a “bachelor Park”, he maintained, it had a healthy population of 30-odd tigers.

The same issue of the periodical, however, carried a “Counterpoint” by Raghu Chundawat who, drawing from his technical knowledge acquired during his extended researches on Panna tigers, claimed that “breeding territories” – generally stable and constant in a secure (tiger) population – have appreciably declined in numbers. According to him, loss of seven such “territories” has been documented, suggesting disappearance of 80 to 100 % of Panna’s breeding tigresses.

Whatever might be the official projections, Chundawat’s contentions received support from the fact that in September 2008 the National Tiger Conservation Authority (NTCA), finding an unviable male-female ratio, advised the MP Forest Department to introduce more tigresses into the Park.

Quite obviously, lessons have not been learnt from the Sariska debacle where persistent wrong reporting of tiger numbers resulted in the animal’s disappearance from that popular Reserve. Repeating the same mistakes in Panna in an apparent effort to protect skidding reputation(s) well-meant inputs from experts were being ignored, even rubbished, overlooking the larger interests of the country and significance of tiger’s survival to it. Tiger, after all, is not just a feature in our jungles; it is much more than that – “a metaphor for our ecological foundation”, as Bittu Sehgal, a prominent Indian naturalist, has opined. It also happens to be a “metaphor” for the country’s water, food and economic security besides being its vehicle to fight climate-change with.

The need of the hour, therefore, is to set at rest all the controversies of the past and quickly initiate action to organise relocation of a few tigresses in the Park as advised by the NTCA. The best time to undertake relocation of animals, experts say, is winter, which is just round the corner and should be taken advantage of.

Unfortunately, Panna National Park has, of late, made news for all the wrong reasons. The only good news that came in about it was the recent rejection by the National Board for Wildlife of a proposal to further fragment the Park by laying a railway-line through it. Now that the proposed railroad is out of the way, the Central and the MP governments will do well to implement the stalled proposal of the Park’s extension over the, reportedly, “ideal” tiger country. Utmost care will, of course, have to be taken to ensure protection of the carnivore and its prey-base in the extended Park.

123 Agreement - of nuclear wastes and other risks

The controversial Indo-US Nuclear Deal has finally been signed. It was inked the other day by Condoleezza Rice, US Secretary of State and Pranab Mukherjee, the Indian Foreign Minister. Hugely controversial, it had a chequered progression to its eventual sealing after three long years.

During the protracted debate on the Deal whether in India or abroad nuclear power was touted as a clean source of energy though the West does not seem to reckon it as such any longer. In the US nuclear power plants have not been built for decades. France, too, has reduced the contribution of nuclear energy in its total power output. Yet, curiously, never for once was a mention made of the hazardous radioactive wastes that the nuclear power reactors generate. True, these do no emit greenhouse gases, but the wastes generated by them unless safely consigned can imperil life and the environment. Curiously, this was never touched upon even as the US and others are up against the unsolved problem of permanent interment and isolation of nuclear wastes.

Classified into three categories – low level, intermediate level and high level wastes (HLW) – disposal of nuclear wastes has to be managed with great care for protecting people and the environment from their lethal radiation. Around 95% of wastes generated by nuclear power plants are HLW which include uranium, plutonium and other highly radioactive elements. They are low in volume but high in their lethality, if allowed to escape into the environment. Some of these have thousands of years of “half life”, i.e. they take thousands of years to decay to half of their potency. Hence after being stored for around 40-odd years in leak-proof sealed cooling casks, these have to be permanently buried in deep underground geologically suitable repositories – by far an expensive proposition.

The nuclear wastes of the power plants of the US, having been stored above ground for around 40-odd years, are now due for permanent burial. A site in Yucca Mountains in Nevada has been selected for the purpose but the Nevadans are somewhat worried. After all, none can guarantee that the wastes will never leak out. The Yucca Mountains facility is likely to be ready by 2010. But, one doesn’t really know whether the site will ever be used for the intended purpose.

In India Waste Immobilisation Plants have been operating in Tarapur, Trombay and Kalpakkam. Vitrification, a complex technology possessed by only a few nations, has been successfully developed in the country and vitrified wastes are, reportedly, stored in a specially designed Solid Storage Surveillance Facility (SSSF) for about 30 years prior to their disposal in deep geological formations. No one knows whether any such geological formation has so far been identified. Speculations are, however, rife that scientists may eventually pitch in for a site in the deserts of the province of Rajasthan in north-west of the country.

Now that the Nuclear Deal has been sealed numerous nuclear reactors worth billions of dollars are going to be imported from the US, France, Russia and sundry others by an energy-hungry India. It, indeed, has big plans. Currently contributing only 3% of the electricity produced in the country, the government of Dr Manmohan Singh intends to take the share of nuclear power to 33% by 2020. There will naturally be corresponding increase in the waste generated, for permanent interment of which the country will have to find appropriate site(s).

Besides, although so far there have been no accidents like those of Chernobyl or Three Mile Island, for which Indian scientists deserve all credit, yet chances of one occurring cannot be discounted with the rise in general sloppiness in every sphere of activity in the country. Proliferation generally breeds all round compromise in quality and that may well happen with the proliferating nuclear power industry. Besides, numerousness of atomic power complexes will act like magnates for the disaffected and the hostile elements in the neighbouring countries. If infiltration and exfiltration continue with such ease as at present, the country will never be short of prowling bombers.

The government, therefore, needs to prepare in earnest for handling various implications of the expected inrush of nuclear power plants over the next decade or so. Apart from looking for appropriate safe geological sites, the government will , inter alia, have to take care of at least two more serious implications: one is, of course, to ensure zero-tolerance of slapdash way of functioning and the other is about virtual sealing of the Eastern, Northern and Western borders to prevent their facile penetration by terrorists.

Since harnessing nuclear power in a big way for civilian use is a high-risk venture the country and its people would seem to need to pull themselves up by the boot-straps.

A "neta" thrashed

One wouldn’t be way off the mark if one were to say that politicians have increasingly proved to be bane for this country. It is they who are largely responsible for most of the ills that the country suffers from. Whether it is corruption, non-governance, lawlessness or whatever – all can be traced mostly to acts of omission and commission of the politicians.

One, therefore, does not find oneself harbouring any sympathy for the Member of Parliament (MP) from Madhya Pradesh who the other day happened to be at the receiving end of a sound bit of thrashing at the hands of the Government Railway Police and the Railway Protection Force near the Bina Railway Station.

Quite clearly, he had no business to collect a crowd around him in a bid to obstruct the Railway Administration from removing the encroachers from the Railway lands. As a member of the nation’s Parliament he, surely, is aware of the massive problem of illegal occupation of hundreds of thousands of hectares of prime Railway lands by unscrupulous people. The Railways now need these pieces of land for various purposes, including those of further development and generation of revenues. The encroachers had been given sufficient notice to vacate the lands, and yet they did not do so. Instead, presumably at their instance, the MP decided to jump into the fray along with his supporters and came in the way of the authorities who were implementing the government’s directions. As generally happens on such occasions, violence ensued and the MP got beaten up when the police resorted to use of force to restore order.

Objectively speaking, he had no reason to interfere in execution of a government decision which, from all evidences, was taken in public interest. But, this is precisely what our netas (politicians) are wont to do. Self-aggrandisement is what they believe in, regardless of its ill-effects on the general quality of governance in the country. They indulge almost regularly in such acts of indiscretion in pursuit of votes unmindful of the larger interests, fostering pervasive lawlessness. No wonder, laws and rules are seldom enforced, so much so that even the apex court has on occasions given vent to its ire in this regard. The administrative and law enforcement machineries have been rendered effete and powerless – all because of the constant interference of our netas, petty or big.

As the ugly situation was entirely of the MP’s own making, one dares say that it would be travesty of justice if the policemen concerned are brought to book for no fault of theirs. If that were to happen it would further encourage the unruly to breach the laws, demoralise the law-enforcement machinery, prevent development and economic progress and result in undeserved glorification of our self-serving netas.

Playing with plastic waste in MP

“Plastic bags are choking the life out of India”, that is what The Ecologist magazine had said almost eight years ago. It further said, “Non-degradable plastic bags are poisoning and clogging up India’s towns and cities. But solutions are hard to come by largely due to the political influence of India's plastics industry”.

This may mot be entirely true today as many states have imposed bans on the plastic bags of less than 20 microns thickness with varying success. These bags are used in profusion by everybody for carrying edible and non-edible material and have since become a nuisance wherever the authorities have failed to act. They fly around in the breeze, are present in strength in garbage dumps and drains which they choke often resulting in floods causing loss of life and property.

The Government of India sanctioned a huge increase in the national production of plastic in the mid-1980s in pursuit of not only self-reliance but also of the global plastic market. Over 50% of all plastic produced in India is used for packaging. Most of this is discarded once used and has caused a massive environmental problem. The government and the plastics industry claim that between 40 per cent and 80 per cent of all plastics produced in India is recovered. That may be true but the flimsy carry-bags are not attractive enough for recovery and it is these that have now become a menace.

Alive to the problem, the Centre formed in 1996 a National Plastic Waste Management Task Force under the Ministry of Forests and Environment. It, however, achieved little, mostly because of the intransigence of the plastic industry. Nevertheless, on the advice of the Task Force the government issued a ‘notification’, to be implemented in all states, indicating that only bags of 20 microns thickness could be manufactured.

That is how the manufacture, trade and use of polythene bags of less than 20 microns thickness came to be banned in states like Maharashtra, Gujarat, Goa, Himachal Pradesh, Uttar Pradesh etc. In Madhya Pradesh, however, the government has been playing footsy with the problem. It seems to have bowed down to the pressure of the plastic industry and has so far failed to impose the ban as required under the directive of the Centre.

On the World Environment Day in 2006 the chief minister had declared that his government was mulling a ban on polythene. After more than two years his government seems to be still undecided. Discarded plastic continues to be ubiquitous, littering the streets, choking up nallas and killing the omni-present stray cattle. This is not the problem of Bhopal alone; all cities in the state face it. Bhopal, however, witnessed heavy floods in 2006 causing loss of life and property. Among many reasons for the unprecedented floods, one that also stood out was plastic waste choking the drains and nallas.

Currently, the government seems to be moving away from imposition of a ban. Last February a report spoke of a memorandum of understanding with a private firm for manufacture of petrol from the discarded plastic. Nothing, however, has materialised so far as contracted firms, reportedly, had not responded positively. A fresh report indicates that under the “polythene-free Bhopal” initiative, the plastic waste will be carted 400 kms. away to a cement factory to be burned with coal. A truck with 10 tons of plastic has already been sent to the factory enabling the Chairman Pollution Control Board to claim that for the first time in the country plastic, a non-biodegradable material, was being destroyed in a “constructive way”.

Nothing could be more absurd than this. Using scarce, imported and subsidised diesel on disposal of a waste material, the creation of which is eminently preventable, seems to be pretty harebrained. Clearly, the plastic lobby has worked behind the scenes and has won the government over with inducements.

Technologically more advanced countries of the West would have opted long back to extract petrol out of the plastic waste or decided to incinerate it in the same manner had these been economically and/or environmentally viable. Clearly, they did not find them so. From the United States to China and even in the supposedly more backward Sub-Saharan Africa, therefore, countries have opted for banning these infernal bags.

Having a touch of uniqueness about them, our politicians, however, think differently. Reason, logic and larger public interests are seldom in their reckoning. The be all and end all of all their political shenanigans is to seek out resources by fair or foul means to fight elections, satisfy their perceived vote bank and sustain themselves in power. It is all so amazing to see the way they live and work for themselves – oblivious of the wellbeing of the country, its people and their future!

Baltal - the land of contention

In September 1968, I happened to spend a few hours in Baltal. I was heading towards Ladakh for annual inspection of our departmental units along with a Major of the Army Signals in his jeep. I was then in charge of postal operations in Kashmir and Ladakh. Ahead of Sonmarg, instead of pushing on and up towards the Zoji-la, we got off the highway and gently descended for a few kilometres into a valley that, I was told, was Baltal. Luxuriously dressed in several shades of green, it was a valley of incredible beauty. The green carpet of grass, tall mountains all around clothed in thick tall conifers in a shade of dark-green, with white patches of snow at the very top below a lapis-lazuli sky in the balmy September sun of Kashmir took one’s breath away.

With no habitation, except a very small Army Signals tented unit, the place was nature’s own preserve. A small green hillock around the middle of the valley had what looked like an abandoned bungalow. The Signals men passed on to us the local folklore about it. It seems, Indira and Feroz Gandhi had honeymooned in the bungalow – an ideal place, in the lap of nature’s extravagant bounty with hardly a soul around.

While lunching on their substantial fare we were told the Amarnath Cave was only eight miles away, high above across the mountains. Only a few adventurous tough jawans had been able to make it to the shrine. The climb, though very picturesque, was stiff, and the going treacherous on ice-sheets that, at places, were thin enough to crumble, often into what could be deep crevices. The round trip of 16 miles had to be completed during daylight hours.

I could hear army trucks a few thousand feet above groaning while laboriously working their way up the tortuous road to Zoji-la at around 11,000 ft. To get to the Cave one had to go across mountains of the same, if not greater, elevation on the south-easterly side. According to some, this route to the Amarnath shrine has been used for centuries. If that was so, the Army men would have known. Maybe, some adventurers would occasionally take the route. The regular route has, however, always been via Pahalgam and that, in fact, is also the route of pilgrimage. The valley was in its pristine state as it had not till then become the alternate route to the Shrine.

Forty years ago the Yatra was managed by the J&K government. The Chief Minister used to be personally involved in the arrangements. A few thousand pilgrims would accompany the Chhari Mubarak, the Holy Mace, taking the well-trodden route via Pahalgam. The pilgrimage would be over in a fortnight or so. Of course, there were stragglers who would make it to the Shrine on their own. But they wouldn’t get the same facilities as those who accompanied the Chhari.

Tourism – whether wildlife, beach, religious or whatever – strives for unrestricted growth. In the process, it creates vested interests that treat the activity as mere commerce and try to make a killing. Even governments and public bodies succumb to the temptations, seldom displaying any concern for such niceties as ecology – whether fragile or otherwise.

Apparently, to accommodate the fast growing traffic – now in lakhs – for the Shrine the authorities, instead of regulating and restricting the numbers, opened the alternate route from Baltal. Worse, the Yatra was later made a two-month long affair. And the result is there for all to see. The pictures that come across through the electronic and print media are those of a once-beautiful valley utterly ravaged, with the green of the meadows stripped, trees felled, structures erected, huge gatherings of people, numerous buses and helicopters in flight.

Shorn of all religiosity and the politics over the transfer of the contentious land, one cannot but pity the loss of the once-idyllic valley that was a gift of nature for us to cherish and nurture. Alas, it was sacrificed at the altar of (religious) tourism that, from all evidences, appears to be increasingly becoming environmentally unsustainable.

The seditious allies of UPA

Ms. Mehbooba Mufti, President, Peoples’ Democratic Party of Jammu and Kashmir (J&K), recently led in Srinagar a violent crowd of traders and others in a bid to breach the Line Of Control, the de facto international frontier, for crossing over to Muzaffarabad in Pakistan-held Kashmir. Kashmir has been engulfed in agitations over an alleged economic blockade of the Valley by Jammu’s Amarnath Yatra Sangharsh Samiti. The Samiti is agitating against the reversal of order of allotment of land to the Shri Amarnath Shrine Board in Baltal in Kashmir Valley. The violent demonstrations in the Valley resulted in police firing that claimed two innocent lives.

What is noteworthy in this regard is that there has been no economic blockade of Kashmir. This was proved by the aerial video footage of vehicular movements on Jammu-Srinagar highway telecast by an English language news channel. Even the Home Minister of the Government of India, who is generally considered more sympathetic to the Muslim minority, informed the Prime Minister after his return from the all-parties meet in the state that there was no economic blockade whatsoever.

Ms. Mehbooba is the daughter of a former Central home minister. She also heads a party that until recently jointly ran the government of Jammu and Kashmir and continues to be an ally of the government at the Centre. She, therefore, should have known that, whatever might be the provocation, the state could not have directly carried out trade and commerce with Pakistan without the approval of the national government. By her act, indiscreet as it was, she not only played into the hands of the Pakistani Intelligence-backed separatists, she also needlessly instigated the people of the Valley against their own country spreading calumny and disinformation.

That the father-daughter duo running the PDP is separatist at heart has been suspected for a long time. They have been making weird statements which, inter alia, included the one relating to making Pakistani currency legal tender in the Valley. They did so even when their political outfit was running the J&K government jointly with the Congress. The ongoing agitation fuelled by them about the alleged non-existent economic blockade fully exposes where their sympathies lie.

Strangely, however, PDP continues to be a constituent of the United Progressive Alliance (UPA) that runs the Central government. One recalls how before the confidence vote in the Parliament on 22nd July 2008, the UPA government had Ms. Mehbooba flown over to Delhi in a special Indian Air Force aircraft in the effort to muster every single vote in its favour. That the UPA has in its fold the corrupt and the criminal is well known. In its bid to be more inclusive, it seems, it now also includes the seditious and the secessionist.