The Bangalore Calendar, Turkey and Secularism

One of Bangalore’s oldest institutions is the Bangalore Press. Their most famous product is the Bangalore calendar. What makes it unique is that in addition to the Christian calendar we all follow (even though Hinduism and Judaism go back further) it also has other calendars on the left side so people know of functions and important dates for other religions such as Christmas Day, Id, Buddha Jayanti, Guru Parab and so forth. It also has government holidays so children knew when to blackmail parents to take them shopping or to the movies. The calendar used to hang in kitchens in homes in the south but now it occupies pride of place on many tables including in offices. It is quite a nifty thing that has survived google and internet – there’s something quite reassuring about a large calendar with large squares where you can scribble.

In Geneva, Paris, Brussles or Stockholm, to name a few European cities, there’s no Bangalore calendar. In other words, school children don’t have puja holidays or Diwali chutti or ramzan celebrations. We celebrate Christmas and Easter and Labour Day in schools which are laic in Europe. We can argue about what laic (laity) means till the cows come home, but that’s the way it is. I live in a Christian continent and I went to Christian schools in India like many of my friends. We had moral science classes that did not blind us from appreciating and understanding other conversations with god, who, I think is a woman.

Clearly the worst part of not celebrating all functions is food – no Id ki sevain, no murukku and sheedai, but lots of other good stuff with almonds and chocolates and cream. Since you can only compare what you know, I think the continent is poorer for not having Diwali holidays or Poojoo.

So many years ago when there was talk of Turkey entering the European Union(EU) people were quite agitated. It would never happen, most people concluded. Too many extra holidays with this Eid thing and imagine a 25th language. Tough – 28 states, 25 languages, over 711 million people. The calendar would go haywire. It was bad enough getting used to the Hungarians!

My friends in India speak glowingly of freedom in Europe. In Scandinavia… is a famous first line. They know a lot about the United Kingdom (UK) and the United States (US) and extrapolate from there to Norway and Portugal. My friends in Europe get perplexed when I tell them the Tamils and Bengalis think Punjabis have no culture, Gujjus are miserly and one one can stand the Mallus who control New Delhi. This has has got nothing to do with religion as difference and diversity is India’s strength. Just like Europeans think Italians are thieves, Scandinavians can’t think of anything beyond sex and everybody hates the Germans. No, it’s the French.

And then there were those questions about why Hindu gods and goddesses have so many heads and arms. Because there are so many people in India and we all need private attention. And then when people ask how India produces fine programmers, I tell them all those heads and all those arms on a body allow us the power of abstraction which can finally be reduced on a chip which is like one body. Phew – close!

This piece was not about the Bangalore calendar nor Turkey or secularism. Most Indians don’t understand what secularism means. Leave us alone.

Chitra Subramaniam Duella

Deny, divert, dupe

Ullekh NP of The Economic Times writes about how bureaucrats respond to genuine questions by informed journalists. Deny, deny, deny, dupe, dunk. Tuberculosis has emerged as a major public health problem in India. Drugs are not available, procurement processes are opaque and the number of patients is on the rise.

When we were discussing this blog, the advisory board was keen that we focus on accountability in public life. The past few posts have been focussed on health. The global burden of disease is on the rise and India’s leadership in this critical area of development has been remarkably feeble, if not absent.

Killing the messenger is a bad idea.

Ullekh NP
Anshu Prakash is worried about what he calls “mischievous propaganda” by “some people” who he thinks are misleading reporters. The joint secretary at the ministry of health and family welfare starts off by flatly denying that the joint monitoring mission (JMM) set up by the World Health Organization (WHO) and the government of India (GoI) discussed the impending danger of a TB drugs stock-out in August 2012.

“There was no such discussion. I am trying to help you, dear friend,” he laughs in an on-the-record phone conversation. He vouches for the fact that Mario Raviglione, director of the Stop TB Department of the WHO, wasn’t present at the August 31 meeting held at The Oberoi hotel in the capital. But when told that documents from the JMM meeting lists Raviglione as one of the participants, Prakash protests: “He is too senior to attend such meetings.” Then he adds: “Not a word on procurement was discussed.”

Official documents, however, tell a different story: they list “limited capacity to procure [drugs]” as one of the challenges in fighting TB, which is no longer a poor man’s disease. One of five TB patients worldwide is an Indian. Prakash then goes on to blame junior WHO officials in the India office for “misleading reporters”. After a brief argument, he concedes that he wasn’t part of the health ministry in August last year. “I joined only on October 15. So I don’t want to give you wrong information. I will check about the JMM meeting and get back.”

Anshu Prakash is worried about what he calls “mischievous propaganda” by “some people” who he thinks are misleading reporters. The joint secretary at the ministry of health and family welfare starts off by flatly denying that the joint monitoring mission (JMM) set up by the World Health Organization (WHO) and the government of India (GoI) discussed the impending danger of a TB drugs stock-out in August 2012.

“There was no such discussion. I am trying to help you, dear friend,” he laughs in an on-the-record phone conversation. He vouches for the fact that Mario Raviglione, director of the Stop TB Department of the WHO, wasn’t present at the August 31 meeting held at The Oberoi hotel in the capital. But when told that documents from the JMM meeting lists Raviglione as one of the participants, Prakash protests: “He is too senior to attend such meetings.” Then he adds: “Not a word on procurement was discussed.”

Official documents, however, tell a different story: they list “limited capacity to procure [drugs]” as one of the challenges in fighting TB, which is no longer a poor man’s disease. One of five TB patients worldwide is an Indian. Prakash then goes on to blame junior WHO officials in the India office for “misleading reporters”. After a brief argument, he concedes that he wasn’t part of the health ministry in August last year. “I joined only on October 15. So I don’t want to give you wrong information. I will check about the JMM meeting and get back.”

http://economictimes.indiatimes.com/news/news-by-industry/healthcare/biotech/healthcare/why-tuberculosis-is-indias-biggest-public-health-problem/articleshow/20719726.cms

Dossier-Dossier*

It is no small irony that the world’s largest producer of TB drugs doesn’t have enough for its own people, a country also with the largest global burden of tuberculosis. The disease kills two Indians every 180 seconds. There’s a national stock-out which was signalled 10 months ago, somebody forgot to fill in the forms or better still many people were responsible for many forms so no one did. Various departments in India’s ministry of health played dossier-dossier and children were turned away from health centres and dispensaries. If this is not criminal negligence, what is asked The Economic Times making it the only newspaper in India in recent memory to call for heads to roll in the Health Ministry including that of the health minister. The last time he made news was when he said homosexualty was a disease. Worse is yet to come as journlaists and public health activists follow the paper trail backwards to see who dropped the ball and why.

http://www.newslaundry.com/2013/06/et-bites-the-tb-bullet/

*This word picture was coined by Ravinar of MediaCrooks, India’s leading media watchdog.

Sack the minister

In a bold stand that should be welcomed by all, India’s Economic Times has called for the sacking of the Union Health minister for not procuring TB drugs in time to save patients. It is not often that Indian media takes a strong public health stand. This is a welcome departure, one that places responsibility where it should be.

While the country’s disease burden grows, the health minister is busy with other important issues among which is to warn the country of the dangers of other political parties while ignoring India’s health needs.

http://economictimes.indiatimes.com/opinion/editorial/tuberculosis-drug-shortage-calls-for-stringent-penalty/articleshow/20656907.cms

Fake drugs – India and China

Ullekh NP, The Economic Times, India
The World Health Organisation (WHO) has a humble disclosure to make: there is still no accurate estimate of the global scale of counterfeit medicines. Perhaps as compensation, the multilateral body has hung a new name on such products: substandard, spurious, falsely labelled, falsified and counterfeit (SSFFC) medicines.

Various reports by others suggest that the size of the global fake drugs industry could run into hundreds of billions of dollars. Deloitte’s vice-president Terry Hisey says it could be in the range of $50 billion to $200 billion annually. Health economist Roger Bate, who is also the author of the book Phake, which is an outcome of years of research into counterfeit drugs, says countries such as India and China are at the forefront of such a menace, selling fake drugs locally and globally.

http://articles.economictimes.indiatimes.com/2013-06-16/news/39993454_1_anti-malarial-drugs-counterfeit-drugs-fake-drugs

Who will listen?

Dr. Anand Ranganathan is an Indian scientist working on tuberculosis and dengue. He is also a writer – in fact, he is emerging as one of India’s best writers on public health. Here is his plainspeak about what India needs – India, facing the double burden of communicable and non-communicable diseases. India, where 600,000 children die annualy because of pneumonia and diarrhoea. India where one is two child under three is malnourished. http://www.newslaundry.com/2013/06/death-by-another-name/

Excerpts from his piece on Newslaundry, India’s fast-growing webzine.

Well, 830 million of us live on 20 rupees a day.
Amid all this, who else but WHO to the rescue! Those CFLs at the United Nation’s World Health Organisation have chalked up a “country cooperation strategy” for India for the next five years. Hopefully it will yield better results than the world cooperation strategy the UN had adopted for the eradication of poverty by 2015. The importance of the UN cannot be overestimated. In any case, here is their prescription:
1. Supporting an improved role of the Government of India in global health and ensuring the implementation of International Health Regulations and similar commitments.
2. Strengthening the pharmaceutical sector including drug regulatory capacity and trade and health.
3. Improving the stewardship of the entire Indian health system.
4. Promoting access to and utilisation of affordable, efficiently networked and sustainable quality services by the entire population.
5. Promoting universal health service coverage so that every individual would achieve health gain from a health intervention when needed.
6. Properly accrediting service delivery institutions (primary health care facilities and hospitals) to deliver the agreed service package.
7. Helping India to confront its new epidemiological reality.
8. Scaling up reproductive, maternal, newborn, child and adolescent health services.
9. Addressing increased combinations of communicable and non-communicable diseases.
10. Gradual, phased “transfer strategy” of WHO services to the national, state and local authorities with the sine qua non condition that no erosion of effectiveness occurs during the transition period.
If you managed to live through reading those Ten Commandments, congratulations! You have great potential to become a country cooperation strategist who can advise third-world and third-rate governments to – what was it again? – yes, Promote access to and utilisation of affordable, efficiently networked and sustainable quality services by the entire population.
There is a reason why we pay taxes, and the reason is this: Hey, you – Head of State! Listen up! Forget all that gobbledygook you just heard from strategists who sit around round tables and dream up commandments. You listen to me now. Spend my money on the following, you hear?
1. Give medical insurance to every Indian.
2. Set up 2 AIIMS and 2 Safdarjungs in every state. And don’t just lay the foundation stone and scoot. Make them functional.
3. Set up private-public medical centres. Do not discount the contribution of the private sector – it has a critical role to play. You keep on sanctioning tens of government hospitals and only nine out of them will ever emerge as navratnas, the rest landfill sites.
4. Prohibit politicians to go for treatment abroad.
5. Make generic drugs available at all hospitals at minimum cost.
6. Set up hundreds of train-hospitals, specialising in, among other things, ophthalmology and dentistry.
7. Set up medical clinics with access to modern ambulances near every village cluster.
8. Encourage R&D at medical centres, ask doctors to teach and train.
9. Don’t make it compulsory for medical undergraduates to spend a year in a village. Make it beneficial for them to do so, instead.
10. Carry out the above and you won’t need the tenth.
To hell with cricket, time to fix the nation.

Tobacco Kills – Don’t be Duped

In 2000, Dr. Thomas Zeltner, one of the world’s best known public health and tobacco control experts led an enquiry into tobacco industry tactics to undermine the efforts of the World Health Organisation (WHO) as it prepared to begin negotiations on the Framework Convention on Tobacco Control (FCTC). The report was a bombshell and it blew gaping holes into tobacco industry’s claims that they were good and responsible citizens of the world.

In an interview to The Economic Times (India’s largest circulated economic daily) today, Dr. Zeltner talks about how a leopard can never change its spots, how the industry works like a secret service and more.

http://economictimes.indiatimes.com/news/news-by-industry/cons-products/tobacco/tobacco-industrys-bets-on-india-china-may-lead-to-surge-in-lifestyle-diseases-thomas-zeltner/articleshow/20386727.cms

http://economictimes.indiatimes.com/news/news-by-industry/cons-products/tobacco/zeltner-committee-report-in-2000-a-bombshell-on-tobacco-industry/articleshow/20386862.cms

Spuriosity

There’s a tide in the affairs of global pharma. Ranbaxy, an Indian pharma company, was recently fined $500 million by a US court on charges of selling spurious drugs.

Spuriosity got the better of them! That term was coined by Ravinar, India’s most read media watchdog http://www.mediacrooks.com in another context. But it fits beautifully when one seeks to describe the marketing tactics of pharma companies, big and small, Indian and international. Sections of the Indian media tend to blame it all on the west with the latter accusing the former of large scale cheating not only in marketing but also producing sub-standard drugs and foisiting them on unsuspecting patients and doctors.

This debate, as the article in the Firstpost indicates, is not about to go away. As drugs come off patents in the next two years and as the disease burden grows in developing and developed countries, governments have a role to play. In India, for example, the Health Ministry has to take the bull by its horns and propose solutions that are innovative, visionary and robust. Playing Ostrich is not going to work anymore. It is disingeneous to point to some dark and demonaic western conspiracy for India’s incapacity to deal with diarrhoea, tuberculosis and pneumonia. Or for that matter, any other disease.

http://www.firstpost.com/business/ranbaxy-debacle-big-pharmas-target-is-indian-drug-industry-827071.html

Tuberculosis and the journalist

In part two of a three part series, Anand Ranganathan tells the story of how journalists write or do not write about tuberculosis and his own encounter with the disease with his immediate family. In international health circles, stories that scare, especially if they are perceived as articles on diseases of the “poor” are unwelcome. Donors too shy away from such diseases because they want to put their money where they can show success or atleast some form of success which too is defined in a narrow way.

The most gut wrenching thing about TB is that in a majority of cases, you don’t have to die of the disease – cure is available and it is affordable. The responsibility for this lies squarely with national public health authorities.

Celebrities do not want to associate with tuberculosis, the disease has no brand ambassadors. One journalist even said it was not a “sexy” disease. Journalism has failed public health and tuberculosis is a fine example of why.

http://www.newslaundry.com/2013/05/tuberculosis-the-journalist/