Saturday, June 23, 2007

Minority Institutions: Examining the Foundations

In all this debate about St. Stephen’s College and its decision to go and have a Dalit Christian reservation, we have not taken time to unpack the concept of the minority institution. When the constitution guaranteed the minorities the right to start and manage their own institutions, they were not handing out freebies. The liberal climate that prevailed when the constitution was being drafted had the vision of a welfare state. They wanted the constitution to lay the foundation of a secular state where all sections of society would live with their identity and culture intact. It was such a benevolent gesture that made them reserve two seats in parliament for members of the Anglo Indian community, a practice that continues to this day, though the population of Anglo Indians might number in their thousands. Probably the two Anglo Indian members of Parliament represent their constituency more effectively than the elected members if the ratios and the representation formulae are taken into consideration.

The Minority institutions that were typically envisaged to enjoy the state’s protection were those which would actually serve to preserve minority languages, customs and traditions. The feeling was that minorities could get overwhelmed by the sheer mass of the majority community surrounding them and their culture and unique identity could just get subsumed into one large anonymous melting pot. So they needed a helping hand and the benign protection of the state. In this understanding of the concept, if a minority institution is not doing its job of preserving the ethos and culture and traditions and identity of a community, it is not really doing its job. A bunch of Muslims or Christians or Sikhs could get together and run a secretarial institute or a typing college or even a degree college running conventional BA and courses. Would such institutes qualify to be a minority institute ? Not really in the spirit of the constitution.

The Christian Medical College, Vellore has put it well. When asked to explain why it should reserve so many seats for Christians when it was just another medical college , it replied that it wasn’t just another medical college. It put forward the very correct argument that running hospitals and clinics and providing affordable health care to the poor was an important function of the church from its earliest history in India and Vellore was training doctors to continue and preserve that tradition of the church. It was not another commercial minded, doctor generating machine but an instrument to preserve the identity of the Christian community in India which has always been associated with a spirit of service and especially so in the fields of health and education.

Another example one could cite is that of the Jamia Hamdard University in Delhi. Run by the foundation associated with the makers of the famous sherbet Rooh Afzah, the campus has a distinctly Muslim feel to it. It teaches conventional courses all right , but also has an impressive array of courses relating to Islamic theology, Persian , Arabic , Unani medicine and other facets of liberal Islamic culture.

But not every institution is CMC Vellore or Jamia Hamdard. I know of many several church run institutions- (and this is very likely true in the in instances of other communities as well) where there is very little of Christ or His teaching to be seen or heard. What makes it a minority institution is that the Board of Management is headed by some Bishop or Priest or church official. The Bible is seldom referred to or opened, students go to tepid moral science classes and the morning assembly is anemic. When the church is persecuted from time to time , it is common to hear that many eminent people attended such and such Christian school. Well they might have done so but the moot question is whether they were exposed to the teachings of Jesus in their student days or it just happened that the school happened to be run by some religious order or denomination but beyond these legal niceties , it ran as any secular institution would do.

The plumb line to determine if any institution is a minority institution – be it linguistic or religious or ethnic is to examine what minority values and cultures are being imparted there. If after studying in a Christian school for ten years or more, a child comes out with negligible knowledge of the church, its contribution to nation building and the Bible or if a Sikh institution teaches little about the history of the community, the valor and sacrifices of the Sikh Gurus or the Guru Granth Sahib, then in what way is the establishment representative of the Christians or the Sikhs ? They are no more than secular institutes which just happen to be run by a group of people who speak a particular language or profess a particular religion.

Let me end with an example from my own life. I studied in a school run by the Sri Aurobindo Ashram. The Ashram management in no sense of the term attempted to” convert” any one to Sri Aurobindo’s philosophy but in every turn and gesture, they indicated in word and deed , that they cherished Sri Aurobindo and his successor, The Mother and their teaching wasn’t just lip service for them. Sri Aurobindo’s philosophy is not easy to understand ,but in the school assembly where his teachings were unabashedly taught , the school principal and other speakers made every effort to present them with passion and reverence and the atmosphere was live and electric and Sri Aurobindo’s thinking and influence was every where and it wasn’t phony.

My Ashram school of course wasn’t a minority institution of course, but to me it represents all that a minority institution should be. Its mandate was to promote the teachings and ideas of Sri Aurobindo and it did so earnestly and with compassion and grace. In the same way, the definition of what is a minority institution is not to be determined by who owns a piece of property or who sits in the board room but by the larger question ---- is the institution fulfilling its mandate ?

Wednesday, June 20, 2007

Mertitocracy in Education

As over breakfast , I switched on the television for the morning news, the opening headline was about the Symbiosis University in Pune has unilaterally gone ahead and decided to implement an OBC quota in its courses, without waiting for the Supreme Court verdict on the matter. As the TV screen came alive, the anchor was interviewing some aspiring students of the university on their views. One of them was heard saying that ''Reservation must be provided on the basis of scientific measures.

It is not clear what the smooth talking student meant by “scientific measures”. Sociological measures, yes, anthropological measures, yes, but scientific measures? Since when the fissures and the cracks in society manifested themselves along scientific lines.

When students are saying that they want reservations to be made on the basis of ‘scientific measures”, what they are really saying is that that measurable indicators like marks secured should be the basis and that meritocracy should rule. On the face of it there is nothing wrong with it, it looks fair and just. Except that it is a good question as to what is the scientific measure of excellence because presumably that is the elusive Holy Grail that every one is seeking. When St. Stephen’s College in Delhi, decides to lower the cut off marks to accommodate Dalit Christians, they hasten to assure every one that academic standards will not be diluted. When Symbiosis students file a petition in the Supreme Court, they take the same route – that by increasing reservations, academic standards would be diluted.

That leads to the inescapable conclusion that academic standards are all about scoring high marks and the higher the better. So you have students getting ninety five percent or ninety six or ninety seven percent marks. You hear of students getting into depression because they got a few decimal points less than the fellow in the next seat. Which makes people like me who got only seventy five percent or so wonder if these guys and girls are all smart geniuses or what and if so, why we aren’t winning all these Nobel Prizes that they give out every year. This article here is not taking a stand on reservations – for or against. The matter is as they say sub judice. But this piece does take a look at defining what excellence is though because the aim of all education is the pursuit of excellence or so it should be.

Lady Shri Ram College in Delhi has dared to question the prevailing paradigm in education that marks are every thing. They have discovered that the fact that students who scored 100 or 98 percent in English did not necessarily reflect one's knowledge and ability to grasp, understand and critically analyze literature. And to get the ``best'', Lady Shri Ram (LSR) college, has lowered its eligibility criteria from last year's 75 per cent to 70 per cent in English. Similar eligibility condition has been set for journalism honors course.

Among other established institutions, the Armed Forces had always a broader definition of merit and excellence. Though perhaps a bit blemished today, still it was and is an enshrined principle that is sacrosanct to the army that a military officer is somehow a gentleman, too. And it was in line with that concept, that the Army Act actually laid down penalties "for conduct unbecoming the character of an officer and a gentleman."

I do not know whether reservations are good or bad, who should have it and who should not, how much reservations should there be, should the creamy layer be excluded or not. All that I will wait for the Supreme Court to tell me as millions of students and their families in India are doing. But in the mean while, I do know one thing that marks scored in a robotically conducted examination and aided by cram camps like the ones in Kota and else where are no measure of excellence in education. The colonial army definition of an officer and a gentleman, adapted and attuned for today may be a far better one.

Tuesday, June 19, 2007

Religious Hegemony and Human Rights

What would Jesus do is a popular wristband that many Christian youth wear. It is supposed to remind Christians about how they should behave and act in life’s situations in the light of the example set by Jesus. So it is interesting to read about the face off between the Roman Catholic Church and the human rights organization Amnesty International where the Catholic Church has advised Catholics not to fund Amnesty.

AI currently does not receive any funding from church bodies but individual Catholics do give a fairly large sum to AI and if they were to heed the Vatican’s advice, the institution would be affected. As is often the case in the West, the issue concerned that of abortion. The Roman Catholic Church is “pro-life,” which is to say, vehemently anti-abortion as we all know, but no matter what, is it such a great idea — given a) its own long history on the wrong side of human rights, and b) its more recent concern with human rights, including opposition to the death penalty — to go after Amnesty International for promoting abortion choice is a matter of debate.
It is not as if Amnesty International was setting up of abortion clinics all over the place. They are advocating that abortion as and option or a choice be made available to women who are victims of rape and incest and other such traumatizing experiences. The church says that its stance is absolute on the matter – that the taking of human life, no matter how urgent the situation is always wrong.

It is nobody’s case that murder is right, that even the murder of an unborn child is right. But however it is a bit painful to see that the church is so concerned about the rights of the unborn that it is so totally insensitive to the rights of the ones who are living and breathing and will live with the scars of the trauma inflicted on them all their lives.

If the question “what would Jesus do” were to be answered here, Amnesty International, which claims no familiarity or allegiance to Jesus Christ comes through as a more humane, compassionate and caring organization than the church whose head the Pope is presented as the vicar of Christ on earth. The church comes through as cerebral, ideologically correct but aloof and unconcerned about the pain and concerns of those living in the here and now.

After reading about the spat, I could not help wondering about the whole rainbow of human rights and religious rights and the whole gamut of where they converge and where they diverge. This is particularly relevant because most human rights though secular in ethos have their roots in religion but whereas secular human rights seems to have progressed and evolved religious thinks on rights seems to have frozen up in a medieval theologian’s library.

Where human rights bodies with their passion and religious bodies with their reach join forces, they can be a strong agent of change. The Catholic Church and Amnesty International which take such widely divergent views on abortion now are fighting shoulder on issues like the abolition of the death penalty, the elimination of child soldiers with considerable synergy and success. But the divide on the abortion issue seems unbridgeable.

Speaking on the issue in unusually candies terms, Amnesty International’s Deputy general-secretary, Kate Gilmore said: "The Catholic Church, through a misrepresented account of our position on selective aspects of abortion, is placing in peril work on human rights." She said Amnesty was not promoting abortion as a universal right but stressing that women have a right to choose abortion when their human rights have been violated, particularly in cases of rape and incest. "We are saying broadly that to criminalize women's management of their sexual reproductive rights is the wrong answer," she added. "We live alongside people's life experiences. We don't run a theocracy. We have to deal with the rape survivor in Darfur who, because she is left with a pregnancy as a result of the enemy, is further ostracized by her community." How true and how sad that the Cardinals of the Catholic Church aren’t showing this kind of empathy that Jesus would have shown.

Economic Power or Military Superpower ?

Two defense initiatives pertaining to India have become victims of uncertainty. Defense Minister A K Antony recently said there were “problems” in the acquisition of Russian-built aircraft carrier Admiral Gorshkov for the Indian Navy. The matter primarily relates to cost escalations partly because of delays in Russia's own naval dockyards. As a result, the induction of the warship has been postponed to at least 2008, when according to earlier plans; this should have joined the fleet by the end of the year or early 2008.

The other initiative that has got stalled is the testing of India’s missile testing program, possibly under American pressure. According to reports, India has put its programme to develop inter-continental ballistic missiles (ICBM) on hold and has capped it to a maximum range of 5,000 km for now. Capping missile capability at 5,000 km sends a message that India is not targeting anything beyond Asia. Sources correlated this move with the Indo-US talks on the civilian nuclear deal being poised delicately. Strategic experts slammed the government for capping the programme.

In India, the muscular variety of militarism has always been popular and the flames of it have been well and regularly fanned by ultra patriotic sections of the population which has equated strength and prosperity with military superiority and machismo. Although historically, military power has been paramount and has determined the equation of power, the definition and balance has begun to change since the end of the Second World War. Although the five big allied powers remain militarily powerful, it is no so much military power that determines their pre eminence in world affairs today. Countries like Singapore and the numerous gulf emirates in the Middle East have little to speak of militarily. But their strategic importance has only grown over the years because of their strong economic and financial might.

That has proved more sustaining than military prowess. In fact, Singapore’s founding Prime Minister; Lee Kuan Yew has in his book “The Singapore Story” as well as in several speeches asserted that the secret behind Singapore’s rapid development was an investment in and an attitude of pursuing excellence in education leading to a culture of meritocracy. Singapore’s military might is negligible.

India ’s recent acknowledgment as a player of some significance on the world stage has also happened because of its economic prowess and not because of its military brawn. In fact, the fact is that with the kind of problems associated with the Admiral Groshkov visible in the Air Force too and the once highly respected army increasingly fatigued and stretched as well as often accused of human rights abuses, the sheen of the military has started going off.

One argument that could be made for Singapore and the Gulf States is that they have prospered because of the protection of the US protection – both nuclear and conventional. While this is true, this in fact was a highly strategic move. By accepting this option, countries like Singapore never surrendered their national sovereignty and identify but rather this allowed them to use the millions of dollars that would have been tied up in defense to be used in health care, education and infrastructure development that allowed them to leap frog over those who were busy tanks and guns. North Korea is an extreme example of a country that sought refuge in the might of arms and ended up in penury.

So is it time that we rethink and redefine nationalism and what constitutes a strong country? The notion of huge armies stiff and starched marching out to conquer and defeat is more an epithet of the imperialism we love to hate than the symbols of a vibrant democracy. May be the rising value of the Rupee against the dollar is a better advertisement of our might than the sonic boom of missiles. And so in that light perhaps our strategists should revisit our understanding and doctrine of defense. As a parting shot, I can not but comment on the irony of the defense establishment investing in intercontinental ballistic missiles when larges swathes of the country face terrorism and insurgency and the primary functional role of the Army today is counter insurgency measures combating the enemy within our borders and not some entity outside.

Thursday, June 14, 2007

Cartelization of the Environment

In the Biblical story of creation, after God creates man, He gives to man (and woman) the mandate to be a steward of the creation which they have been privileged to enjoy and to preserve and care for it. Sadly, this has often been breached and most often by those whose civilization has been shaped by the Bible and what it teaches. The recently concluded Heiligendamm summit of the G-8 nations provided a good opportunity for those nations who have the biggest political influence in the world to address the issue of climate change seriously. It was actually the main item on the agenda, the main course on the menu. It is therefore a pity that that the agenda of the main summit got some what hijacked by the simmering differences between the US and Russia on missile defense and the fact that this was British Prime minister Tony Blair’s last major global conference before he steps down.

While nations who have the power to make things happen and are effectively the globe’s movers and shakers chug along merrily and keep deferring making real choices and decisions , the countries where the climate change is going to hit the most and the earliest have no voice at all to voice their concerns except activist NGO environment groups. Although the methods that many of these groups use to garner attention may arouse distaste, there is no getting away from the facts.

Take for instance, Bangladesh. The media there has been raving and ranting about the effects of climate change and global warming and its effects which the country will feel pretty early. Also, unless action is taken pretty quickly, many of the changes will be irreversible. the impact of the climate change, the sea level use will lift up 100 cm at the end of the 21st century and flood 15 to 17 per cent land of Bangladesh that will make about two crore people in the country homeless.

There are also effects expected on the economy. Rising levels of Carbon Dioxide in the atmosphere has begun to affect crop yields. Production of main food crops like rice, wheat and potato will deplete steadily as the climate changes more and more, and by 2015 Bangladesh, along with neighboring countries, may be forced to look for new brand of crops. Food insecurity in a country where famine and starvation deaths are part of the collective psyche is or should be a cause of concern.

Two things disturb me as I read all the literature coming out of the G-8 summit and as I recollect all that I heard about in Bangladesh about the concerns surrounding the whole climate change issue. One is that we in India seem to be intoxicated by the short term goals of high economic growth and are part of the villains in this whole game. Along with China, the USA, Japan and Australia, we appear to be part of a cartel who would like to veto any attempt to adopt a target for emissions cuts, however inadequate. Experts reckon that we need to cut emissions by 80 or 90 percent, and by 2030, to have any chance of keeping global warming at levels where damage can be minimized.

The other disturbing element is that states like Bangladesh and other nations from the two third world do not seem to have a voice in forum of worth. They do not get invited to chats over power lunches in the G- 8 summit or the World Economic Forum and with a weak(and currently care taker) government, the voice of those who are going to be most effected like the fishermen of the Sunderbans is never going to be heard.

What is interesting to me in al this is not that a few industrailaized nations or industrializing nations have ganged up to safe guard their narrower national interests but that India is a part of this cartelization of the environment. Till not too long ago, there was another grouping of nations that was active on the world stage and that was the Group of 77 and here India provided active leadership in this forum of the two thirds world. At that point, we in India loved to identify and sniff out the foreign hand – or more specifically, a particular foreign hand. Now when did we switch sides and become an ally of those very same foreign hands that we so loved to hate. Clearly the world is changing as rapidly as the environment around us.

Wednesday, June 13, 2007

The Child Specialist from Chattisgarh

One would have thought that being a child specialist is a safe, selfless and innocent profession, especially when it is practiced among the poor and the disadvantaged of the country. Not necessarily so, especially if you happen to work among the poor in Chattisgarh and have the rare penchant of matching your walk by some talk. I say, ‘rare’, because most of us would find it far easier to talk rather than match it with some walk.

Dr Binayak Sen, a pediatrician worked in the Naxal-hit villages of Chhattisgarh for many years. He is a rare man as most pediatricians sit in cities and make money or go abroad. But Dr Sen was arrested recently and sent to Raipur central jail supposedly because of his Naxalite convictions. I do not know Dr Sen myself but I have friends who do. And they tell me that his profession was that of saving lives, especially those of children and no one who knew him could accuse him of having gone to someone’s house and shot them down with a gun or commit some other wanton act of terrorism which would deserve such an arrest.

On the contrary, Dr Sen seems to have picked up a calling to serve and work in a place where few would go. Possibly, he picked up the vision from his Alma Mater, the Christian Medical College in Vellore. In Chattisgarh, Dr Sen has been involved in the setting up of the Shaheed Hospital, an initiative of the great trade unionist Shankar Guha Niyogi who was murdered at the behest of rapacious industrialists.

The hospital, owned and operated by a workers’ organisation, remains unmatched anywhere in India as a voluntary venture. It helps the population of a backward tribal area, callously neglected by the state. Dr Sen was on an official advisory committee, which drew up one of the most successful community-based primary healthcare programmes in India, based on the Mitanin, the local barefoot health worker. Besides being actively involved in the Shaheed Hospital, Dr Sen is a very well respected member of Jan Swasthya Sahyog, which is committed to develop a low-cost, effective community health programme in the tribal and rural areas of Bilaspur district of Chhattisgarh. He also donates his service to a weekly clinic in a tribal community in Dhamtari district.

Dr Sen has been contributing theoretical papers to books and journals on public health. He was honored with the Paul Harrison award in 2004 for lifetime work of medical care in the service of humanity. This is an award given annually by the Christian Medical College, Vellore to one of its alumni.

It is not unnatural for such a man with an obvious passion for the poor and who was a civil liberty activist in addition to all the other things that he did, to have strong convictions about what kind of policies and practices would benefit the poor. It is also to be expected that such a man would have the courage of convictions to speak out, which he did. With such a multi faceted personality and vision and a passion and energy to match, he was a trail blazer and a role model for all doctors – especially the deal cutting, commission fed cash cows that many in today’s medical fraternity have become.

Clearly the state government believes otherwise. The myopic and feudal attitudes fuelling the way the government is run there, obviously has decided that if it does not care about improving the manner in which the poor are treated, no else would either, and if they do, then they run the danger of falling afoul of the law as Dr Sen has done. Clearly with people with convictions and concern for the poor like Dr Sen out of the way, the BJP led Naxalite chasing government of Chattisgarh want to prove Jesus right – The poor will always be with us.

The Economics of Contenetment

Jan Grebski, a 65-year-old Pole recently suddenly and inexplicably emerged from a 19-year-long coma. Mr. Grebski fell into his coma after being hit by a train in 1988, the year before the fall of Communist rule. Recently he told Polish television that "when I went into a coma there was only tea and vinegar in the shops, meat was rationed and huge petrol queues were everywhere. Now there are so many goods in the shops it makes my head spin." According to his wife, Gertruda, "Jan was so amazed to see the colorful streets. He says the world is prettier now. These people walk around with their mobile phones and never stop moaning.”

The scene was a bit bizarre because Mr. Grebski woke up to discover the wonders of this world, on the eve of the G-8 summit in Germany where a gaggle of anti globalization activists were gathering to shout out how the world was a much messed up place in a unipolar world. The story reminds me of the Biblical character whom Jesus healed after years of lying paralyzed on a mat. The intelligentsia gathered to scrutinize his strange experience with a sheaf of questions but the paralyzed man wasn’t bothered. He was too busy celebrating life. He was also like Mr. Grebski contented with life. He had seen the past, a black and grey life full of deprivation and was suddenly saw life in techni color. The numbers and the grim predictions of the activists didn’t connect with him. The protestors had graphs and charts to bolster their spirits; Mr. Grebski had seen life – literally on both sides of the iron content. And from his experience of life, he knew one thing- he was content and happy.

Although I am no card carrying activist, I have many friends who are on the edge. But activist or not, development practitioners like me typically have our eyes trained to spot what is wrong with our governments, their policies and society in general and like to believe that we know which buttons to punch that will alleviate poverty, remove lack and make life easier for everyone.

But the key to contentment and fulfillment does not lie alone with NGOs and charities; or exclusively with governments and their policies. The key lies, as Mr. Grebski shows us is in setting our internal clock so that we learn to be content and know that the secret lies in recognising the good that exists in life unrecognised and unlamented. For good reasons, Mr. Grebski cannot understand why those like his sons and grandsons who do not live in a world of shortages and ration queues and are spoilt for choice, should still moan and grumble about their lot. And indeed why should they really?

The British columnist, Dominic Lawson asks, “Is anyone in the former Eastern Europe (except possibly ex-secret policemen) absolutely worse off, as a result of the collapse of the centrally managed economies? I was discussing the case of Jan Grebski with a friend in Poland yesterday; she said that she knew "no one, literally no one, who has a lower standard of living than they did under the Communists. Some people are less happy, of course: those who see that their neighbour has a bigger car than they do. And of course, it’s worse that you can’t find a plumber now that they’re all working in England." Then she corrected herself: "Actually, that’s not quite right. You could never find a plumber when the Communists were in charge, either: they were all working for the Government.” Clearly, being rich and being content is a matter of perspective and not a matter of having more and more of this world’s goods as the Bible so wisely reminds us.

Saturday, June 9, 2007

Inclusion or Welfare: Choices in Policy

In one of the overseas offices of my company, where probably a maximum of 20 people work, they have two toilets to service the office. One of them is meant for the disabled even though the office has no disabled employees. The folks working there told me that apart from complying with legal requirements and all that, the office did not want to make modifications in his architecture, at some future date, should they need to hire a disabled person making him or her possibly squirm with embarrassment. They wanted their place to be open and welcoming to the disabled, whenever they might turn up, be it in the distant future.

This reminds me of the Biblical story of the prodigal son where the father is ready and welcoming long before the returning prodigal son is any where on the horizon. He is always included in every thing and in every plan, even though absent from the scene. I suppose that is the truest picture of inclusion. Though the son is still absent , though the disabled person is still not present , I still think of him or her , include him or her in my plans, designs and thinking , so that one day when they come , they can merge seamlessly into the picture because the frame has always been ready to include them.

In our attitude to the disabled and most other disadvantaged, we have been welfare driven rather than inclusion driven in our approach. Simply this – inclusion is embracing, welfare is condescending. The inclusive approach has as its paradigm that the disabled are part of us, our family, our society, our community and our hearts, plans; budgets are large enough to include them. Whether they are actually at our door step today or not, we are ready to receive them, to welcome them.

The welfare approach, on the contrary says that, that the disabled (and other disadvantaged) are among us, some how they are here and though they don’t really belong and are in many ways different, we need to do some thing about them driven by partly by pity and partly by the nuisance value that they can be if we don’t do some thing for them. Welfare therefore some how demeans the self worth of the person receiving it even as it tries in its own clumsy way to help. The inclusion approach on the other hand infuses dignity and self esteem because it does not see the disabled as a burden to be borne, but as a resource yet to be explored.

In India, we have a Ministry of Social Justice and Empowerment which looks at issues of disability. It has done some good work. The National Policy for Persons with Disabilities has been adopted under is aegis and it addresses issues relating to social security, disability pension and education. The Government has approved the signing and ratification of the UN Convention on the Rights of Persons with Disability. The Ministry has recently released a ‘Report to the People 2004-07’ on Social Justice and Empowerment. The report was released by the Prime Minister, Dr. Manmohan Singh on 22nd May, 2007.

In the otherwise excellent report available on the Press Information Bureau Website , there is a section titled” Welfare of the Differently Abled” which talks about all that has been done for them. Which is in some ways is a lot. The only problem is that welfare is disempowering. Inclusion is empowering. So why is the Ministry of Social Justice and Empowerment administering a raft of antiquated welfare schemes like providing subsidized motorized tricycles(better done by the Rotary Clubs) instead of pioneering inclusive , embracive and integrative policies, which the government alone can draft and legislate ? Now will some one of our honorable members of Parliament please raise this question in the House?

Wednesday, June 6, 2007

Reverse Mortgage in Health

India's premier medical institute, the All-India Institute of Medical Sciences, is still grappling with an acute shortage of corneas. Dr. Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS currently has a waiting list of 250 to 300 top priority patients this month who are blind in both eyes and are young. Similarly, over three million people in India suffer from end-stage renal disease, yet only 2,500 people receive kidney transplants every year. Experts who held a brainstorming session on Saturday to find ways to bridge this yawning gap, found a two-pronged solution: a dose of awareness in the community and suitable amendments to the law governing human organ transplants.

The severe shortages which happen due to several reasons including religious belief and superstition leads to at least three things. Firstly it means that many people who need organ transplants, be it corneas or kidneys or any other suffer the consequences, be it perpetual blindness or a chronic death. Secondly, for those who receive transplants, the costs are prohibitive. Thirdly, because of shortages, rackets thrive in organs, especially kidneys for which India, among other is notorious.

Health care in India and globally is daily growing more expensive and it has always been a challenge to deal with these rising costs. Insurance has not penetrated large sections of the population and will not in the foreseeable further even if the industry expands and then not every one is insurable any way. Those who do not have insurance and fall sick. Lack of access to quality public health services and a rapidly growing unregulated private sector have led to a situation where an increasing number of people are getting trapped in debts or slipping into deeper poverty due to the expenses of hospitals. At the national level, at least 25% of hospitalized people are falling below the poverty line only as a result of hospital-related expenses.

Considering that insurance is not going to be the complete answer and that meeting hospital expenses from out of pocket are increasingly pushing people into debt, it is time to do things differently. Considering that so much of health care is getting commercialized any way, it is time to adopt a practice that has just been introduced in India in a small way- the concept of reverse mortgage. Can reverse mortgage, which has thus far been introduced to provide a safe haven of housing for senior citizens be adapted to health. Yes.

Reverse mortgage contracts in health can work for health care institutions, possibly corporate ones in the first place as they are usually the early adaptors. Such institutions can provide free or subsidized health care for individuals, who stipulate that on their death, they would donate their organs for transplant to those who would need it. This could be particularly tried out among senior citizens who are usually not insurable and to ensure that hospitals and clinics are not tied up by contracting to provide treatment to the young for decades. Of course adequate ethical and systems checks and guidelines need in place to ensure that clinical care is not compromised in the race to harvest organs for transplantation but with adequate regulation in place, reverse mortgage can provide a viable health care financing option for those who are not insurable and who would typically find the costs of treatment to be high. Such a route would provide health care for senior citizens; a regular supply of organs for transplant and some what ease the organ racket. An idea worth exploring and whose idea has come!

Tuesday, June 5, 2007

The Old Scourges are back !

Two news items caught my notice this last week, because they were the kind of news that I would normally expect to read in medical thrillers. The first related to an alert relating to a small pox alert in India’s North East based on reports reaching India about possible cases of small pox in Myanmar and Bangladesh. Officially , the disease has been eradicated in one of the most successful of public health interventions and in whose footsteps , the polio eradication program, stuttering and sputtering has been trying to follow. The second item pertained to the US authorities quarantining an Atlanta based lawyer , who was having tuberculosis and nevertheless boarded a trans Atlantic flight to Greece, potentially infecting hundreds of people in the process.

In my school days , the visit of the small pox vaccinator was a dreaded affair. The class teacher would line up all the students , and one by one , we would be called forward to receive a jab on our fore arm , that would artificially induce a small pox sore. Unlike other vaccinations we received , where the pain of the injection lasted only a moment , the small vaccination was an enduring agony

That one tiny sore would over days swell and redden and then as it would begin to dry up and form a scab , it would led to an unendurable itch. The torture was in waiting for the scab to fall off without scratching and in learning to have baths and showers with the arm extended , so as to prevent the sore from getting wet. The consolation was that if we coped with that one sore, we would never experience the real agony of small pox. What that might mean, came through to me in a much milder form when in adult life , I suffered from chicken pox which most contract as children but which some how had escaped me.

Today’s children have never experienced the small pox vaccinator and of course small pox is eradicated or so we think. And in America , Tuberculosis is as good as eradicated and their society is unfamiliar with what it is even though TB kills about 1.6 million people a year worldwide, including more than 1 million in Asia, 400,000 in Africa and 100,000 in the Americas and Europe. India incidentally has the world’s highest TB toll.

One can barely imagine the devastating effect that small pox will cause , if it has really come back to haunt us. Consider this: While vaccination for small pox was in full force , Smallpox was responsible for an estimated 300–500 million deaths in the 20th century. Smallpox epidemics could involve scores, hundreds or thousands of cases – the highly contagious nature of variola and its gruesome possibilities made number crunching relatively unimportant. Indeed, in colonial South Asia the discovery of a few cases was often considered to represent a prelude to the unraveling of a crisis that would inevitably result in further infections and innumerable deaths; while large-scale mortality was usually considered to be an affirmation of the dangers expected of variola, a less dramatic toll on human life was generally celebrated as an instance of good fortune.

The news about the occurrence of small pox is still not confirmed but the story of the Atlanta lawyer who had a virulent form of tuberculosis is true. While typically in India , we worry about “multi drug-resistant'’ TB, which can withstand the mainline antibiotics isoniazid and rifampin, the quarantined man was infected with something even worse - “extensively drug-resistant'’ TB, also called XDR-TB, which resists many drugs used to treat the infection.

Rich nations have typically ignored diseases like tuberculosis as diseases of the developing world and little funding has typically been made available to the “diseases of the poor”.Government funding for public health campaigns (TB, AIDS prevention, sexually transmitted diseases and obesity) pales by comparison with the billions spent by pharmaceutical companies on disease mongering intended to increase the markets for their products like Viagra. As the developed world discovers that in a border less world , no society is ever fully insulated and grapples with a case of XDR-TB for which there is no treatment because the existing antibiotics don’t work and no new antibiotics exist because no research has been done in what was always considered a poor man’s disease , it can only be hoped that rich and prosperous nations will be forced to visit and take into account the poor man’s world.

Monday, June 4, 2007

When the Caretaker Stays On !

Bangladesh is being governed by a caretaker government since the time Begum Khaleda Zia resigned as Prime Minister in October 2006 when her term settled down.…… after initial hiccups the caretaker government has settled down now since January under the leadership of Fakhruddin Ahmed , an economist and a technocrat , a sort of Bangladesh’s answer to Manmohan Singh. Like our Prime Minister, the Bangladesh Chief Advisor (the nomenclature for Prime Minister in the care taker government vocabulary, is widely respected. The care taker government’s role typically in previous incarnations is to hold free and fair elections to the national parliament, much like holding elections to state assemblies in India under President’s Rule in India.

This is all fine except that Bangladesh has been under caretaker government rule since October 2006 and the elections that are the main mandate of the care taker government have been announced in the end of 2008, with the specific dates still not yet announced. Surely a long time to do baby sitting! A fact worth noting is jus as Manmohan Singh is believed in many aspects of governance to be beholden to his Party High Command, Bangladesh’s Chief Advisor , Fakhruddin Ahmed, is believed by many to be equally beholden to his high command , General Moeen U Ahmed, the Chief of the Bngladesh Army.

It sems that the reticient general loaths the politicans of the kind that are available in bangladesh at the moment and wants to lend as much teeth and time to the care taker government to not just conduct elections but clean up the political scene, hopefully for good. in a enviornment where the Chief Advisor and the Army Chief are apolitical and largely neutral , they have gone after the leaders of both the political parties in the country with equal vigor by jailing leaders from both sides. Though , none of the two Begums Khaleda and Hasina , by disempowering their inner coterie, the government hopes to render them ineffective. The care taker government seems to have learnt its lessons from Pakistan, where exiling Nawaz Sharif and Benazir Bhutto did not lead to any significant lessening of their influence. Here the strategy seems to be wakening the widely party hierarchs perceived to be widely corrupt from with in.
Many of the reforms that the care taker government are carrying out are good and laudable and should typically have been done by a regular elected government with a mandate to do so. It is a pity of course that they did not. Now the question facing Bangla and the larger global community is this : Does the fact that the current regime is acting with the best of interests to all intents and purposes and doing things that seem to have poular sanction provide it with legitimcy to stay in office indefinitely. Is being democratically elected the sine qua non of legitimacyor is there any other? As Bangladesh's own history proves and examples will be available from India too, the so called democratically elected governments can be ruinous and benevolent despots like Lee Kuan Yew can be tarnsformational. As the story from Bangaldesh proves , a nation some times has to confront the question – Is a country better off under a benevolent caretaker manager than a tyrannical democrat ?

Saturday, June 2, 2007

Aam Border for the Aam Aadmi

Those of us who bemoan long immigration queues at Delhi or Mumbai airports should try out the experience of a land border crossing and savor the experience. I would recommend the Changrabandha- Burimari land port on the Cooch-Behar – Lalmonirhat sector of the Indo-Bangladesh border. Most of those who use this border are from the lower socio-economic class though a few wealthy Bangladeshi people on their way for a vacation to Nepal or Darjeeling. The Siliguri – Dhaka bus uses this route and some people use that bus. Most use the run down buses from Siliguri, cross the border on foot and then resume their journey in the some what better maintained Bangladesh buses. A few arrive by air from Bagdogra and then change into a taxi at the airport and then trundle into the border village. And there the fun starts.

The first official point that one encounters at Changrabandha – the Indian side of the border is the customs outpost. Except that you have to first go through immigration. And the immigration at the Changrabndha border is a preview of hell hole. The immigration operates from a thatched hut tucked away in a corner. The staff has out grown the hut and currently half the staff operates from the open air out side the shack. Without any fans and electricity, in the stifling 40 degrees heat, with crowds milling every where, luggage piled up in every available vacant space, the place is the very definition of chaos and yet things happen.

The West Bengal Police, who man the counter, collect a bunch of passports at a time. As the passport disappears into one cavernous hole, one is forced to keep two eyes and one ear open. One eye on the passport in case you can distinguish it from among a mass of others, another eye on your luggage and an ear open for when the immigration clerk will call out your name. Once in a while, a white man walks in and the crowd parts like the Red Sea once did for Moses. The pecking order for immigration seems to be European and US passports, then Indian passports and at the bottom of the pole are those with the Bangladesh passports.

The immigration officer’s cross examination is cursory. I am asked my profession and when I say doctor, he says that his mother in law has high blood pressure and what would I advise. I suggest a salt restricted diet and he looks happy and waves me on to the counter where the passport would be stamped. Most of the work here seems to be done here by unemployed local youth who act as facilitators for many of the travelers who are illiterate, helping them fill the immigration forms.

The official staff is there to sign and stamp and with their outsize stamps, they take up a lot of space on the passport. How the immigration function without any fans, forget air conditioning and how they might be functioning in the monsoon is any one’s guess. The immigration process is all manual, so there are heaps of ledgers and notebooks and rubber stamps all around, plenty of stuff to take care of in case of a sudden down pour.

After immigration is the customs and they have their own out sized stamp. The customs operate out of a room which is a little airy and it has a fan. A local boy informs that they don’t have an official connection either but they have made “arrangements” with the local electricity board and pay their bills with the” offerings” that come their way. Again the customs stance seems to be tougher on the Bangladeshis than on the Indians.

Finally, there is the Border Security Force, the land border’s version of the airport’s CISF. No X Ray machines or scanners here of course, so every thing is searched physically. The earthy hands of the BSF jawan will string out your underwear, toiletries and any other thing that you might be carrying looking for contraband or bombs or grenades or what not.

Some where in this process, you have to change your money and you have to make your way to the money changers. No Thomas Cook or Amex here, just tin roofed shacks with bespectacled munshi type characters wearing soiled vests with holes in them for exchange rates that are all their own. They may be sitting in the one horse village of Changrabandha but they deal not just with Bangladesh currency but with Dollars, Pounds and Euros and their exchange rates are all put up with a stick of chalk on a faded black board.

Finally, after dealing with immigration, customs, BSF and the money changer, you cross the border on foot. No luggage trolleys here , so you put the luggage on your head and cross the no man’s land or get some help from the Bangladeshi coolies , who have some how the permission to come to the edge of the no man’s land , pick up the luggage and carry it into Bangladesh. And once you are in Bangladesh, drenched in sweat by the nearly hour dealings with one set of officials, you wipe your brow and begin again with another set of officials – this time, the Bangladesh set. A memorable border crossing indeed… an Aam border for the Aam Aadmi!

Democracy and Violence : The Indian Paradox

I wonder some times why there is so much of violence in a democracy like in India. Expression of dissent by violence is understood in contexts where there are totalitarian regimes where the iron fisted rule of the dictator allows only one view to be expressed and all others are ruthlessly suppressed. We see that in Nepal, Pakistan or Bangladesh in our own neighborhood. But in India, flawed or not, we do have a functioning democracy and there is freedom of the press, and yes, even the freedom to express is available to the common man to a large extent. Strikes, Bandhs and other agitations are happening day in day out and it is certainly not the norm for the government in India to suppress peaceful protest.

Then why do we have the kind of incidents as in Dausa recently, where Gurjar protestors were killed for their demands or the one at the Bhutan border where Bhutanese refugees from Nepal wanting to get into India were stoned or the one in Uttar Pradesh recently where a bunch of lawyers in Agra a group of lawyers got together, tied up a young man to a tree and beat him black and blue. The Agra incident where U.P lawyers instead of litigating for justice , decided to take the law into their own hands in the most crass way possible, and earlier , not too long ago, lawyers beat up Nithari serial killings accused Moninder Singh Pandher and Surendra Koli a few months ago in a Ghaziabad court

I seem to see two patterns here. Democracy is based on the pillar of majority opinion prevailing and the minority submitting to the will of the majority even if they do not fully endorse the policies, directions and the over all direction that may be set. Democracy presupposes tolerance and an acceptance where one group of people set aside their opinions and views and cooperates with the majority that wins. The run up to the campaign during elections may be vicious , but once the results are out, there is a gracious acceptance of the results and honest cooperation. This does not happen in India , we are not prepared to sub serve our opinion and thinking to the wishes of the majority, democracy in the Indian psyche is good and helpful if my view prevails, it is scarred , if I have lost. This is witnessed best in the Uttar Pradesh elections, where the victorious Bahujan Samaj Party congratulated the election commission on holding fair elections and the losing Samajwadi Party castigated the same Commission for holding flawed ones.

It is also incumbent on the majority , to make suitable compromises and give heed to the opinions of the side that lost and see if there is merit in any thing that they have done or in their policies. This too , requires a benevolence that most do not display. The tendency of most is to over turn every thing that has been done before with the wrong assumption that a majority in the election gives them temporary omnipotence. 517

In an atmosphere of intolerance , the essence of democracy is killed. Democracy is after all more than holding elections every five years or so , even if it is done with machine like efficiency, though by no means, should this achievement be negated. Democracy is also about listening, participation , and creating space for others and in these areas we as a democracy have still a long way to go. And till that time, we have to be used to those voices go unheard and whose pleas go unheeded take again and again to the streets committing avoidable acts of violence