Why India does not await her Barack Obama?

Rajdeep Sardesai of CNN-IBN has written a blog titled ‘Who will be India’s Obama?’ He has compared the Indian and American political scenario and ends his article by saying “For the moment, India awaits her Barack Obama.” This is my response to that blog article.

Why are we comparing apples and oranges? America is as different from India as Kerala is from UP. Just b’cos something is seemingly different and packaged beautifully, it doesn’t mean that it will be good for India. Obama is already speaking of Venezuela, Iran and others as the ‘enemy’ (not much different from Bush’s axis of evil). When he comes to power (note the certainty!) he cannot be much different from his predecessors b’cos what finally rules the White House is not the President’s charisma or education, but the dictates of the money bags and cartels who finally decide the American policies. You think nobody saw the US sub-prime problem coming? You think nobody sees the insurance-less Americans dying for healthcare? Yes, they do. But they are all powerless to make a change. As long as profit-mongering (as opposed to making) corporates rule the roost, there will be no change! One might install a black president, a woman president, a democrat as president, a republican as president or even a wooden doll as president, all they can be is mute witnesses to the policies formulated in their names.

Our leaders may not be that savvy or Harvard educated for that matter (tho’ many are educated abroad). They may be corrupt, feudal, dynastic, patriarchal and whatever. But that is just a reflection of our society and its priorities. If today, an entire national party clamours for Priyanka Gandhi’s entry into politics there must be a reason for it. If an entire national party and their supporters root for Narendra Modi’s leadership, there must be reasons for it. Those may not be “right” reasons according to us, but they do have the potential to make a change at the vote-office.

And by the way, how can urban, educated, middle class leaders lay claim to understanding, representing and responding to the needs across the Bharat-India divide. When most of India reaches that level of living, we will see leaders from that strata appearing. Until then, bye Obama, & best wishes to you!

Cancellation of vaccine-manufacturing public enterprises’ licenses: AIDAN calls for a rethink

The All India Drug Action Network (AIDAN) is a national network of organizations that have been working on pharmaceutical policy issues since the early eighties. Reacting to the news of cancellation of licenses of three vaccine-manufacturing public enterprises, namely the 103-year-old Central Research Institute (CRI), Kasauli; the 100-year-old Pasteur Institute of India (PII), Coonoor; and the 60-year-old BCG Vaccine Laboratory (BCGVL) in Chennai, the All India Drug Action Network (AIDAN) has issued the following statement:

While there should be no compromise on the quality of medicines and vaccines produced, the cancellation of the licenses for the three vaccine-manufacturing public enterprises under the Ministry of Health and Family Welfare smacks of arbitrariness, and a planned attempt to kill these institutions and clear the way for private companies to operate in a segment which serves a critical national need – the production of vaccines for the large Expanded Program of Immunization. Recent newspaper reports of alleged nexus between the Ministry of Health and Family Welfare and a private vaccine manufacturing company in blatant disregard of the public responsibilities of their role, use of coercion to effect closure of vaccine production units with a proven record of safety and quality, and the comments in the preliminary audit report of the Comptroller & Auditor General (CAG) [i] point to an unprecedented disregard for public good.

The Minister of Health and Family Welfare, Dr. Anbumani Ramadoss has said that the enterprises were ordered to suspend production for non-compliance with good manufacturing practice (GMP). This gives rise to many issues:

1) Since the public enterprises were under the Ministry of Health and Family Welfare, and had been requesting for assistance to upgrade their facilities since the past many years , what did the Minister of Health and Family Welfare, do over the past 4 years to ensure their compliance with newer norms? While the Government is planning to spend Rs. 300 – Rs 500 crore to develop the upcoming vaccine and medical park in Chengalpattu which will become operational in 2012, why were these three enterprises which were engaged in vaccine production since decades not provided with the Rs. 50-60 crores they required? Who will supply vaccines in the interim, and at what cost?

2) The closure of vaccine production in these units comes at a time, when the demand-supply in vaccines for India’s Expanded Program for Immunization (EPI) is widening, private companies are pushing expensive cocktails of the EPI vaccines with other vaccines in the market, and coverage of immunization against these crucial vaccine preventable diseases is declining.[ii] The closure of production of these vaccine producing units will have enormous implications for the cost and access to these vaccines in the future.

3) While the Ministry has acted with alacrity and closed down production in public sector units, it has dragged its feet in matters where private pharmaceutical companies are involved, even if the issues are of crucial concern to people and public health. A few instances of these are:

a. Action is curiously lacking in the matter of regulation of drug quality with only 17 testing laboratories in the entire country, and only 7 which can be termed fully functional, as per the Mashelkar report in 2005.

b. Action is also curiously lacking against private companies which continue to manufacture hundreds of formulations which the Drug Controller General has admitted in Court as lacking his approval and are therefore illegal.

c. Action is curiously lacking in the matter of hazardous drugs like Nimesulide, which are freely promoted in India for use in children, while it is banned for use below 12 years in the European Union and not available in USA, Canada, Australia or even in neighbouring Sri Lanka.

d. The Health Ministry also does not seem concerned with the low availability of essential medicines in public health facilities [iii] or the increasing unaffordability of drugs in India.

e. The Health Ministry is not known to have taken any stand or action when competitive medicine brands are sold at an entirely inexplicable 1000% price difference or where drugs are provided to the retailer at even 5-10% of their retail price, or where any attempt at regulating the retail prices are vociferously challenged by the pharmaceutical companies. Even if by a curious anomaly, the pharmaceutical policy is formulated by the Ministry of Chemicals, has the Ministry of Health and Family Welfare ever articulated these concerns, which are creating misery for millions?

In this context, the entire sequence of events over the past few years, with allegations of purchase of raw material for measles vaccines at inflated cost from private companies, providing them raw material from these 3 units at either free or at ridiculously low prices, and further agreeing to give 70 per cent of the profit from vaccine manufacturing to the private company needs an enquiry at the highest level.

The All India Drug action Network (AIDAN) calls on the Government to stop playing games with the health and lives of innocent children and with the pharmaceutical security of the nation, in its attempts to pave the way for private enterprise. The falling rates of immunization are a blot on the functioning of the Government, especially the Ministry of Health and Family Welfare and the state health departments. Efforts must be made to ensure safe and steady supply of cost-effective vaccines and universal immunization of children. To ensure this, the robust functioning of public enterprises like CRI, Kasauli, PII, Coonoor, and BCGVL, Chennai are essential. We call on the Government to reverse with immediate effect its directives on the functioning of these enterprises and to ensure all assistance to make them compliant with newer norms.

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[i] “…the heedless decision by the Ministry/Drugs Controller, without ascertaining all the factors, is not acceptable to audit. BCG Vaccine Lab is not a private company; it is a 100 per cent Government of India department. If there is any deficiency in modernisation of building as per norms of WHO or system change in quality control, the Government should use all its force and concentration so that the unit is revitalised.”

[ii] The immunization coverage of children among 1 year olds in India for 3 doses of DTP has come down from 70% in 1990 to 55% in 2006. In contrast, the global figures indicated an increase from 75 to 79% for the same period. These figures were released by World Health Organisation (WHO) in its latest publication World Health Statistics 2008. The Third National Family Health Survey (NFHS-3) had earlier shown that the percentage of children between 1 and 2 years who had received all recommended vaccines had also come down from 61% to 58% in urban areas between the period of NFHS-2 (1998-99) and NFHS-3 (2005-06).

[iii] In a study done in 6 states and published in the May 2007 issue of the Indian Journal of Medical Research, the availability of essential medicines varied from 0% to 30%.

Marginalisation and the label

Now ‘Marginalisation of Muslims’ in NCERT textbook, screamed the headline (Indian Express web edition, May 28, 2008). The news item was about how the topic ‘Marginalisation of Muslims’ was included in NCERT textbook. If one failed to consider the single quotes, the sentence could be easily misconstrued. Anyway, the article spoke about how the NCERT had introduced a chapter ‘Muslims and Marginalisation’ in the Class-VIII Social Sciences textbook to make students aware about how the Muslims had not got proper benefits of the social and economic development in the country. The chapter also cited the findings of the study on Muslims’ status prepared by Justice Rajinder Sachar in 2006.

While 90% of the readers comments to the article, abused Muslims and asked them to show their loyalty, a few voices discussing the issue of ‘proportional representation’ and other forms of marginalisation was also seen. While I am not reproducing those comments here, I am sharing what I wrote, and some of my response to the comments.

First comment

Marginalisation in any form needs to be condemned. If marginalisation of Muslims is given to highlight the social inequalities with respect to religion, then it should be appreciated. More so in this vitiated atmosphere, where a whole community is often treated with suspicion and contempt. I feel that the marginalisation of Muslims is not just in the arena of economic development, but it spreads to even routine matters such as sharing a neighbourhood, giving a house on rent, and so on. Some of the comments in this space also reflects the deep hatred that people harbour towards an entire community.

One comment was by a person (Sushil Bhardwaj) who said that honest development for every marginalized groups without the label of what group would be the real solution, and not proportional representation. He further added that creating jobs, lifelong learning opportunity, building self esteem, etc. was needed and not divisive projects.
My reponse to him was as follows:

Sub: Marginalisation intrinsically linked to the label

You make a very important point about “proportional representation”. Yes, if one starts going about proportional representation, then there is no end to it. Your points about providing an initial impetus (education) and then letting people take off on their own steam is also well taken. But this would work ideally only in an situation where merit equals opportunity. The assumption in your statement is that if good education is provided, then all are at a level playing field, which enables them to go on and create opportunities for themselves. But this rarely happens, because the impact of marginalisation is not just lack of opportunities; it permeates through the very social fabric of life. Let me give you one example. It is very difficult for a well-educated middle class muslim family to get accommodation in common housing societies in urban cities of India.

The Sachar report highlights many other such glaring facts. So, it is not just the lack of opportunities which is creating these tensions it goes much beyond, especially for castes and religions in India which have been traditionally or systematically marginalised. This is not to say that marginsalisation does not exist abroad. The situation of blacks in the US, or Indians in many other countries is also similar. So, basically marginalisation is often linked to the label of caste or religion or ethnicity, and delinking them would be over-looking that reality. But I totally agree with you that overall ‘honest development (as you call it) for every marginalized groups, creating jobs, lifelong learning opportunity, building self esteem, etc’ would bring down marginalisation to a great extent, and may even do away with the need for label based solutions. But until then…. Probably dialogues like these would help in coming up with newer and more creative solutions.

Cricket, injustice and POTA look-alikes

Many Indians are aghast! And rightly so, because an Indian cricketer (Harbhajan Singh) who was accused of making a supposedly racial remark against an Australian cricketer (Andrew Symonds), was declared guilty by ICC Match Referee Mike Proctor, without any corroborative evidence. The accusers were the Australian team (captain Ricky Pointing and co.) and the witnesses were also from the Australian team (Matthew Hayden and Michael Clarke). The match umpires testified that they had heard nothing. Sachin Tendulkar who was also on the pitch, testified that he had heard nothing. Yet, on the suspicion of having uttered a racial remark, and backed by the witnesses of the accuser’s mates, Harbhajan Singh was banned. [How did the word of some witnesses prevail over the other? Was it the colour of their skin? Well, that's a point for another debate.]

The point I am making is that while newspapers and news channels and Indian citizen groups (in the country as well as outside) are crying themselves hoarse over this alleged unfairness, similar instances are happening in our own backyard. In the guise of fighting terrorism, laws are being promulgated where people can be apprehended and kept in jail on mere suspicion. Even though the Prevention of Terrorism Act (POTA) was repealed by the Dr. Manmohan Singh government in 2004, many states still have draconian laws to deal with “terrorism”. I recently attended a court hearing of a person charged under such a law.

If the case was not serious, one could laugh away the charges being levelled against him as a cruel joke. But unfortunately they were for real. I got to witness the power of the state on that day and how anybody who dared to raise a voice against the powerful interests could be put away behind bars, without even as much as a shred of evidence. I saw the State using uniformed guards to make a mockery of public opinion and create an atmosphere of suspicion by projecting its citizens as dreaded terrorists. I saw how cruelly precious human lives were being held hostage to vested interests.

Where is the public outcry and media outrage at these events? Websites are not clogged with bloggers using their free speech to express anguish. In fact, most of us don’t even know that these things are happening. Such harsh incidents hardly make it to the newspapers and other news media. Even if they do, they are tucked away in the deepest, most invisible news spaces. After all, who wants to bust the booming, zooming India story with such unexciting news?

I was wondering about why a State would want to make such draconian laws against its own citizens. The answer is not far to seek. Recent events such as acquisitions of large tracts of fertile land in the country for Special Economic Zones (SEZs) by corporates, in the name of industrial development and economic growth have dispossessed (and will continue to dispossess) thousands and millions of Indians from their only source of livelihood. Unemployment and hunger will cause great unrest among the people, and they will turn against the State and against the powerful interests which exploited them. How can this be contained? How can this be quelled? That is where draconian laws come into the picture. This political economy understanding has been around for long. Yet, we fail to see the impending danger.

So, let me call upon my fellow-Indians who are protesting against the Harbhajan Singh (Bhajji) episode, to take some time after the Bhajji storm is passed, to look into our own backyard. We will see much more injustices and blatant violations of natural justice.

Let us also stand up together and voice our opposition on these fronts. That could make a difference between life and death for people who are being victimised under these laws.

Here’s wishing all of you a more just and equitable 2008!

Human rights violations by the Indian corporate sector – Case of ICICI bank

ICICI bank is becoming a sort of menace in recent times. They seem to be violating all codes of conduct and established business practices in their pursuit of growth and profit. What is worse is that they have begun to violate basic human rights of many of those who avail of its services. Today’s newspaper (Times of India, Mumbai, Nov 21, 2007, p.13) reports that ICICI bank was fined Rs.1,00,000 by the district consumer disputes redressal forum for sending loan recovery agents to the house of a lady in Pune at night, to seize her car, and for not following legal procedures. In another case, media reported about the bank’s agents in Goa accosting and beating up a man in broad daylight before snatching his car keys. CNN IBN also showed an entire episode of the ICICI bank’s misconduct in loan recovery and the involvement of its officials in a huge car loan recovery racket run in Goa. Earlier the Delhi state consumer disputes redressal commission had levied a whooping Rs.50,00,000 fine on ICICI bank for sending goons to take away a loaned car from a person who had defaulted on paying his loan instalments. The goons sent by the bank had taken the car after beating up the customer’s friend (who happened to be in the car) with iron rods, leading to serious injuries on his skull and other parts of the body. They also asked the bank to pay Rs.5,00,000 to the customer. Newspapers have reported widely about the violation of human rights by the bank, but the officials of the bank remain scot-free and continue to indulge in more violations. The Pune case is only an indictor of that. The Delhi Consumer Commission held the ICICI Bank guilty of “unfair trade practice,” and termed the miscreants as a boorish and a brutal lout, who care a fig for legal and judicial authorities, including the Supreme Court. Its President Justice J D Kapoor said “No civilised society governed by rule of law can brook such kind of conduct,” and added that the violent methods adopted by the recovery agents were serious violation of “human rights”.

Today, privatisation and public-private partnerships are touted as the big mantras of achieving basic human rights and services such as health and education for its citizens. ICICI bank’s practices are only indicative of the practices that an unregulated private sector can indulge in, to maximise their profits, even at the cost of safety of human lives. Relying on the unregulated private sector to achieve human rights will be like entrusting the wolves to take care of the lambs. Let the ICICI bank’s practices be a reminder of this!!!

The shoe-stink of privatisation

If you thought, you had seen the worst of privatisation, think again – Central Railways is going to privatise shoe-shining in 6 zones along the Central and Harbour Railway lines in Mumbai. Those who know the tremendous crowds on Mumbai’s local train stations are also familiar with the shoeshine worker sitting calmly in the surging wave of pushing humanity, waiting patiently for their next shoe to shine. The ‘tick tick tick’ sound of them hitting the shoe-brush against their wooden handy box makes their location known to those who are looking to have their shoes polished.

The regular Mumbaikar may not notice then, because they are as much a part of the local railway station, as the ubiquitous weighing machines in most railway stations. But even they will be surprised to know the shoeshine workers pay the railways Rs.75 every month through their co-operative societies. The railways makes about Rs.75,000 per months from these shoeshine workers considering that there are about 1,000 shoeshine workers on Mumbai’s railway stations.

Now, the livelihood of these 1,000 shoeshine workers are at risk, because in accordance with the national policy (what else!), railways has issues a tender inviting “open bidding” from interested private parties to run shoeshine stalls in six zones along the Central and Harbour Railway lines in Mumbai. The railways expects to make about Rs.15 lakhs per month from the privatisation. The shoneshine workers, some of whom have been in this profession for over 40 years, are willing to pay the reserve price quoted in the tender, through their cooperatives, but they are being outbid because of the open bidding system. The office bearers of these co-operatives, who are shoeshine workers themselves in various platforms of Mumbai’s railway stations claim that none of the private firms who have bid for the shoeshine stalls have anything to do with the shoeshine industry. The Central Railways will finalise the bids on October 28, 2007. Their representative, when contacted by the media, said that “it was an internal matter of the railways”.

India is yet again going to shine for some private moneybag, leaving 1000 more families in the dark.

Bloodshot eyes… year after year

We are now a small and a sick family. We have all fallen victim to Conjunctivitis (commonly called “pinkeye” or “Madras Eye” in India). It started off with my dad, and then spread to the entire family, including our little daughter. Newspapers in Mumbai are full of Conjunctivitis news. It is that time of the year, when Conjunctivitis is rampant in the city. When I called up my colleagues in Bangalore, two of them had also fallen ill and had not reported for work. So, if this is so common all over the country, and if people are not reporting for work, and there is say 2- 3 lost working days per person, imagine the gross loss of productivity. Forget the productivity; what is greater is the suffering and pain that one experiences. In an earlier posting,  I had written about the cost of treatment for diarrhoea in children. Now, treatment of Conjunctivitis is not cheap either. I think more than the medicine cost is the cost of consulting an eye specialist. So, in addition to the lost work days and pain and suffering, is the cost of treatment.

Conjunctivitis is highly contagious and quickly spreads from one to the other, so, just like in our family, the whole household usually gets infected very soon. We were very careful about not touching our eye and then touching each other, washing our hands often, not sharing towels and pillow cases, and so on; yet we all fell ill. So, one can only imagine in the slums where living spaces are so crammed and people have no other option but to share common resources, how easily it can spread.

The fact that Mumbaikars and people in other places around India suffer due to Conjunctivitis EVERY YEAR, around this time of the year (monsoon and post-monsoon) is almost like a foregone conclusion. Nobody even bats an eyelid (no pun intended) when hordes of people fall prey to this infection. In spite of having enough knowledge about the infection and knowing precisely when it strikes, we are unable to do anything to prevent it from happening year after year. So much for public health in our country! 

I had an interesting experience during the treatment of this infection. A drug which is commonly used in Mumbai (and other places also I presume) as first-line treatment for Conjunctivitis is a drug which contains corticosteroids, while the recommended treatment for bacterial Conjunctivitis (the most common, I think) is non-steroidal anti-inflammatory medications and antibiotic eye drops or ointments  I was told that schools here routinely stock the drug containing corticosteroids during monsoons, because of the high number of children who go to school with the infection. In fact, even I was advised by a friend to get this particular drug for Conjunctivitis. I did not not know about its contents. He said that anybody with Conjunctivitis vouches for the efficiency of this drug, and in fact this was most commonly prescribed drug by doctors everywhere. So, I went to the nearest chemist and asked for the drug. He laughed and said, that this drug was out-of-stock and I would have to procure it in black (paying almost double the cost) since there was huge demand for the drug. I walked away from the chemist in anger and went to another one. There, the same story was repeated. Finally, I decided to buy this drug, by paying that extra cost because my eye was hurting badly and I could not walk any further in the hot sun. Just after I had bought the drug, my wife called me to say that I should not use the drug as it contained corticosteroids and that it was usually used in the worst cases to reduce the discomfort from inflammation. On reading the label, I found that drug contained corticosteroids, and the warning said “indiscriminate and prolonged use of the drug could lead to glaucoma, cataract and fungal infections”. In fact, it can even cause permanent eye damage by inducing central serous retinopathy (CSR). Needles to say, the drug was a Schedule H drug (which was to be sold only on the prescription of a Registered Medical Practitioner), but I got it without even a single piece of paper. What is even more shocking is that, it is being used indiscriminately in schools and slums where people go and buy this from the Chemist across the counter at a price that the Chemist decides, because for most of the slum-dwellers, the Chemist also doubles up as their only “doctor”. 

I have uploaded some snaps of my Conjunctivitis-ridden eyes to show you the signs and symptoms. The first one shows the redness and watering from both the eyes, while the second one shows the swelling around the eyes, especially in the mornings. For more snaps, click here.

This textbook is in the public domain and may be copied without permission

“This textbook is in the public domain and may be copied without permission”

In this age of intense patent and copyright protection, is it possible to imagine a statement like the one above? Well, wikipedia has shown that it is possible (though the license terms are slightly different). In the field of health and public health, it seems a little more improbable, but it is true. There is a text book, which is online, and it actually states the magic words “This textbook is in the public domain and may be copied without permission”.

The text book on “Public Health Management & Policy” has a history attached to it. Duncan Neuhauser, Ph.D., Professor of Health Management and Co-Director of Health Systems Management Centre at the Case Western Reserve University in Cleveland, Ohio began teaching a course on “Public Health Policy and Management” (MPHP 439) as part of the new Master’s degree program in Public Health in the winter 2000 session. As part of the course, the students were required to write a chapter for the on-line textbook for the class, following standard publishing guidelines (no plagiarism, no quotations without permission, etc.). Subsequent batches wrote new chapters, edited old ones and rewrote some portions. Interestingly, many of the old students continue to edit their chapters. Today (Aug 2007), the online edition is in its Eighth Edition. It can be accessed at An On-Line Textbook on Public Health Management & Policy.

The website caught my eye, while reading The Journal of Health Administration Education, Vol 23 (1), Winter 2006. The article by Dr. Neuhauser is titled “A Student-Written, Faculty-Reviewed, Free, On-Line Textbook of Public Health Management and Policy.