AIIMS report rules out murder or foul play in Sushant Singh Rajput’s death. Let’s admit that he had a mental health issue
Finally, the nation may get closure over the sudden death of actor Sushant Singh Rajput and his family may find peace with confirmation that he did, indeed, commit suicide. An AIIMS panel led by Dr Sudhir Gupta, which has re-evaluated the actor’s post-mortem report, has ruled out murder and has submitted its findings to the CBI. According to the experts, there were no injuries on the actor’s body other than those caused by hanging and there were no marks of struggle or scuffle on the body and clothes to indicate that somebody had forced him into the act. So we have to accept that for all his outer success, he was a deeply troubled and broken personality who couldn’t handle the pressures of living very well and tragically chose to give up on life. Hopefully, we can accept his frailties with as much grace and dignity he deserves as his success. Hopefully, we can honour his work as an actor/social entrepreneur. Hopefully, we can respect his memory enough and not milk it for ruthless politicisation, blame games, running pointless news cycles and spinning conspiracy theories. Most importantly, we need to stop beating around the bush and look at facts as they are — that he had a history of severe depression and though a “hero” in public perception, was too fragile, vulnerable and weak inside. One that made him take an anti-hero plunge into death. This should have been the real conversation all along, that of mental health issue becoming a new pandemic of our times and unsparing in its grip on individuals, from the ordinary to the extraordinary. His death should also open up a debate on performance pressure in the entertainment industry where a slew of actors took the extreme step as they ran into financial difficulties during the lockdown. In fact, the post-millennials are more prone to depression given they are facing the worst doom and gloom of our lifetime. We need a dedicated mental health policy and must think about healing and coping mechanisms in our societal structures.
What was initially reported as suicide — and duly confirmed by the autopsy report given by qualified doctors who are expected to know what they are doing — quickly turned into a murder conspiracy involving the actor’s family, embezzled money, black magic, an allegedly exploitative live-in partner, a political bigwig, Bollywood mafia and nepotism, insider-outsider debate, a media circus and what not. But above all, this tragedy was weaponised by political parties to settle scores among themselves, using his starry aura. For Bihar Chief Minister Nitish Kumar, who has a severe image deficit, the case of a “son of the soil” exploited in faraway Mumbai couldn’t have come at a more opportune time. Since the aam Bihari considers Sushant his “hero”, Sushant was iconised as “the pride of Bihar” though none of these politicians are known to have had an association with him. As for the BJP in Maharashtra, it spares no effort to pull down the Shiv Sena-led alliance Government on some pretext or the other. In Sushant’s case, its troll army played up an alleged association his girlfriend had with Sena scion Aaditya Thackeray, raking up more muck than proof. And finally, we must stop the witch-hunt against his girlfriend Rhea Chakraborty for pushing him over the edge. Let us accept that Sushant may have been a recreational drug user like others in the industry and though her confession and complicity in procuring drugs for Sushant may help trace the drug racket in the industry, there is no need for further character assassination. Let us stop the venom and instead focus on the devil in our minds.
Besides adding evident scientific challenges to the already confusing and out of control global situation, reinfection by Covid-19 has significant social implications which need to be addressed & given serious thought and attention, a cursory approach can only make things worse.
The question of reinfection is directly related to various social factors which would influence it's spread in the society and therefore to the measures that would be required to control it.
Who is prone to get reinfected, what factors facilitate reinfection, when to label a case as reinfection, what should be the therapeutic approach to manage reinfection, does reinfection cause more,or less, severe symptoms, than primary infection, do these patients need to be quarantined and if so for how long? These and many other related questions have to be answered before proceeding to establish a scientific relationship between the cause & effect. When we are still to find definite answers to questions related to primary infection such as "is it shed only in the respiratory secretions? is it found in the urine? is it found in the blood? is it found in the stool, what is infectious, how long is it infectious, how high the viral loads can get, moving on to statements on reinfection could be a premature exercise which may only yield half baked results. The above questions about the primary disease were raised as early as 1st-2nd weeks of January this year by Alex Greninger a virologist at the university of Washington and still remain mostly unanswered. While these things are enabled by the genome certainly, you can't deduce it from the genome.
Finding effective drugs and vaccines are not just scientific questions, everything in medical science ultimately only has social significance, and so does reinfection with Covid-19, as much as it is so for its primary infection. Revising our lessons learnt from SARS epidemic we can recollect that knowing the source of that epidemic helped in its control and therefore it is not the genetic sequence of the virus which will get us there. Epidemiological analysis of the disease is more likely to fetch us the right answers.
A team of doctors from two Mumbai hospitals, BMC (Bombay Municipal Corporation) run Nair hospital, & Hinduja hospital along with researchers from IGIB (Institute of Genomics & Integrative Biology,& ICGEB Delhi (International Centre for Genetic Engineering & Biotechnology, have concluded from their study on four patients of which three were doctors from Nair hospital and one health care worker from Hinduja hospital that " only whole genome sequencing of the viral isolates from different episodes can confirm reinfection and an RT-PCR positive test does not confirm reinfection" (source: Times Of India 23-9-2020 page 17). The topic of the research was comparison of the severity of symptoms in reinfected patients of Covid-19 compared to the first attack. That all four had more severe infection was another of their inferences drawn from the work. Their study appeared as a preprint published in Lancet journal's website. ( I would like to know if the preprint article appeared in the printed copy too and if so in which edition?)
My observation on this news item is that any statement based on a research study of only four patients of a disease which has caused a worldwide pandemic does not present a case of serious study.
I also have a query related to the conclusion they have drawn from their research: "are we to presume that infection cannot occur by the same strain or genome after it has done so the first time?" If that is the case then its direct implication is that infection with any particular genome sequence confers lifelong immunity which enables only differently sequenced genomic material to penetrate the host cells and create symptoms a 2nd time (or maybe 3rd -4th also; who knows?) Then we also have to consider the question of rejection a RT-PCR positive test as evidence of reinfection. If RT-PCR is not a correct tool for diagnosing reinfection how can it be so for the first time infection! If the test becomes negative after the control of symptoms from the primary infection and becomes positive again after a certain gap of time why should this positivity not be indicative of infection this time too, and if the RT-PCR has continued to remain positive even after the symptoms from the first infection subsided then what is the proof that this new episode is not just an exacerbation of the original attack of the disease--a situation similar to a relapse in our old disease friend typhoid, which could be attributed to various causes, none of which was related to the genomic sequence of the causative bacteria.
Doing a whole genome sequencing is a costly investigation which if prescribed unnecessarily may be an unjustified burden on a poor man's pocket and if selectively prescribed after assessing the financial status of the patient, it will be misuse of scientific knowledge.
Whole genome sequencing maybe providing adequately precise knowledge of the submicroscopic structure of the virus, helpful in elaborating the differences in the pathogenicity of various strains but it cannot get us to the source of infection or reinfection & only a knowledge of this source can help in controlling the disease and preventing its spread.
From the time the start of the pandemic in February till now, Delhi has consistently maintained it's 3rd -4th position in terms of the number of patients of this disease, as compared to other states, all of which are bigger than Delhi. While the total number of cases here till 21st September' 2020 were more or less 2.5lacs, the average number of daily deaths in the week preceding 21-9-2020 has been around 35/day. If Monday's 32 deaths are added to the previous figures we see a total 5147 deaths till 25-9-2020 in Delhi alone.
On Monday the total number of new cases for Delhi was 2548.
All these figures can be seen as markers for the challenges that corona has put before Delhi. To assess the contribution of Delhi in India's fight against corona the first & foremost point which we have to keep in mind is that Delhi is the only state where people from other parts of the country think it to be their right to come for treatment and investigations.
Though this situation has been present since before the advent of corona, the pandemic has made things much more complicated and difficult for Delhi administrators. During the lockdown period when the entire nation was under strict orders not to step out even on to the road outside their houses, Delhi saw innumerable corona cases being brought here from other states for treatment & investigations. This prompted the state government to try and restrict outside corona patients to central government hospitals and reserve Delhi government's and Delhi's private hospitals for citizens of Delhi only. But this stand of the state government was immediately and vehemently opposed by the governor Mr Anil Baijal, who was representing the central government. The resultant differences of the two sides made headlines of all dailies in greater part of June'2020. Following these related news items, a reader could have drawn two conclusions; one that the governor was acting in his capacity of Chairman National Disaster Management Committee and was thus protecting the constitution's that particular item which gives every citizen of India full right to seek treatment &/or investigations for his or her ailments from anywhere they deem it necessary. As for the chief minister's order for reserving Delhi hospitals' covid beds for its own residents-he issued it after taking public opinion and received a 90% support to his proposal for which there were more than 2lacs answers. Not just that he even formed a joint committee of five highly placed senior doctors for consulting on the effects of such a step and they unanimously approved it.
That time in June, interstate transport was prohibited and had this order been fully implemented it would have given Delhi advantage of restricting entry into its premises, but once again impartiality in applying rules was overlooked, with the result that though patients from other states were frequently and unhesitatingly being brought here for corona management, for Delhi vehicles needing to cross its borders into adjoining states even for procuring life saving oxygen & medicines there were unending hurdles.
Delhi administration's efforts to reserve Delhi hospital beds for Delhi residents was not universal. They were only trying implementation of this rule for corona patients, and had made it clear that the rule was not meant for patients of any other disease, Before the lockdown period, at any given time 60-65% of Delhi hospitals' beds were occupied by patients from outside the state.
In the early days of the pandemic the total number of corona beds in Delhi's private & state run government hospitals was '1000' and exactly the same number i.e. '1000' was the availability of these corona beds in central government managed hospitals which are AIIMS, Ram Manohar Lohia & Lady Hardinge Medical College Hospital. In such a situation the obvious conclusion should have been "no room for disputes" but what we get in this politics studded country is a drag into an unconceivable, mind boggling, unexpected bag of controversies for even the smallest of issues.
While analysing the performance of Delhi government in handling corona cases one should keep in mind another very important point, that is that Delhi being the Capital of India, most international travellers coming to this country, have their first stopover on Delhi airport, and since corona has been gifted to us by foreign nations, especially China and the Middle Eastern countries, we in Delhi had an early influx and exposure to the disease. However some southern states like Kerela & Mumbai too had a sizeable number of direct to & fro of international flights, which is why Maharashtra, because of Mumbai is still above Delhi in terms of corona cases.
Of 100 confirmed corona cases two will loose their lives, a study of Delhi numbers tells us, which is much more than the national average of 1.6/100.
As a warning to its people, the Delhi government has issued an information bulletin saying that of the total 3081 state administered ICU beds in the city 67.4% are already occupied and that in a short period of 24hrs between last Saturday & Sunday 7000 corona patients had to be hospitalized here! One aspect of this news which should scare us is that since the big private hospitals, having full facilities for managing corona cases are getting full, Delhi citizens who prefer going to private hospitals are now rushing towards middle sized and small setups which are not fully equipped to manage these cases. This increases the risk of spread of the disease many fold, here in Delhi. Here again we find a situation where residents of Delhi have had to compromise with their safety and rights. To understand the background of this situation one has to realize that people living in smaller towns of other states have prior information about these big hospitals of Delhi and bring over their corona patients for direct admission to these hospitals. This is a glaring example of impingement of our rights as Delhi residents.
The end result of this situation is that 30% of corona cases admitted in Delhi hospitals at any given time are from other states. So the Delhi government's health department, in order to reduce this imbalance, decided on 21-9-2020 to add '1500' new beds to its corona reserved beds in the next ten days.
However there is another side to this situation which is not as encouraging and that is that the total number of tests being done here for corona has fallen from '58000' per day in the week preceding 21-9-2020 to a mere '33733' in the next 24hrs. Another shocking news related to the disease is that in a short period of less than three weeks the number of patients in home isolation have increased from '8119' to '18910' and that these home isolation patients are not taking their containment orders seriously, therefore the chief minister of Delhi has issued strict orders that any home isolation patient found to be flouting the rules, should be forcibly shifted to the hospital and will remain there till he gets corona negative.
THE MESSAGE THUS COMES OUT CLEAR THAT IF THE CITY'S ADMINISTRATORS SHOW LAXITY IN PERFORMING THEIR DUTIES, THE SITUATION IS BOUND TO GET OUT OF EVERYBODY'S CONTROL.
Author Bio: A medical graduate from the King George Medical College of Lucknow and a post graduate in health administration. Has been interested in Urdu poetry writing and reading from an early age. The Corona pandemic has been a stimulus for her to take up the socio-medical impact of the pandemic and write on the subject both in Urdu & English. Lives a peaceful semi retired life in a South Delhi journalist colony with a clinic of her own to practice clinical medicine.
The entire process of turning actors into marketing agents for selling certain political ideologies must stop after Kangana Ranaut
The Government’s recent decision to set up the country’s “most beautiful” and “biggest” film city in Noida, Uttar Pradesh, has to be read in its wider socio-political context. An attempt to decentralise Bollywood, negate Mumbai as the entertainment capital of this country and control the dissemination of art and creativity is under way. The timing couldn’t be any better. The debate over nepotism, drug use and the proliferation of the so-called “mafia” of film-makers in Mumbai, amid the controversy surrounding Sushant Singh Rajput’s (SSR’s) untimely death, has changed the way we, as an audience, look at Bollywood today. The Hindi film industry is allegedly ruled by a bunch of oligarchs and dynasts who are extremely arrogant, egotistical and self-absorbed in their attitude towards “outsiders.”
Globally, the entertainment industry runs on a nonpareil image that it builds for itself. The insider-outsider debate in Bollywood has tainted the larger than life image of actors and film-makers and has brought the good, bad, and ugly side of the industry out in the open. How much of it is true remains to be seen. However, interestingly, Kangana Ranaut has emerged as the unflinching face of the rebellion against power, albeit in a highly uncouth manner.
Resultantly, it has so happened that much of this controversy has led to a debate between the far-Right and the Left-of-Centre political ideologies. In their attempts at winning the hearts of the urban middle-class, political parties have paved the way for a radical overhauling of cinema, art, and artists. This will be done by creating parallel power structures within the entertainment industry that will be backed by the State. We see that happening almost ostentatiously in the SSR-Rhea-Kangana drama. We have also seen that as a gradual development since the NDA Government came to power.
The likes of Anupam Kher, Paresh Rawal and Madhur Bhandarkar, among many others, have been used to lend their voice to debates on nationalism and religion. However, the nexus between Bollywood and politicians isn’t a new phenomenon. Great politicians understand that politics alone will not get their messages to the masses. So, both the groups have, historically, looked after each other. Film personalities help politicians in their campaigns and similarly, politicians help failed actors become administrators in the name of “cultural diplomacy.” It is almost like a rule. However, what the Kangana saga has revealed is that there is an attempt to forge a parallel entertainment industry which will act as the mouthpiece of Right-wing political parties and the Government. This group will help in disseminating what is known as “fringe cultural nationalism.” The mechanism is simple, involving shifting of power structures and bringing the industry within the control of the State. For the services of such actors, the Government will either provide them with security sponsored from public money or citizenship in case you are Akshay Kumar.
What is ignored during this entire debate is that the democratisation of cinema originally meant the production and promotion of diverse ideas previously not permitted within the industry. It also meant that for an “outsider”, there would be “lower barriers to entry” without any particular pedigree. It meant experimentation with alternative modes of artistic expression and creativity. It meant due recognition for films and works of expression that display counter-culture. Diversified cinema and artistic creativity were the major goals behind the demands for democratising the industry.
The present developments pose a threat to all stakeholders, including the audience, who are the primary and the majority stakeholders in artistic expression. The emergence of newbie politicians, who are regarded as pariah actors, will serve the purposes of disseminating Right-wing nationalism and will do no good to creativity and art. Actors, on the other hand, will lose creative autonomy and will be burdened with social responsibility. Films that challenge majoritarianism or films that are against an idea imposed by the State will not be permitted to go on the floors. Existing norms on censorship will change and become worse than what they already are. Discretion will be exercised almost freely. Turning artists into marketing agents for selling a certain political ideology must stop after motormouth Kangana Ranaut. Jaya Bachchan’s “save the industry” from “gutterisation” remark in Rajya Sabha last week should act as a clarion call and must force prospective cine-goers and film-makers to do some introspection.
(Anurag is from the National Law University and Abhinav is a student of law, Amity University)
Unlike many other medical conditions, treating tobacco addiction and diagnosing its sequelae, like oral cancers, can often be done remotely
The Coronavirus pandemic has prompted billions to seek shelter in their homes as countries across the world have gone into lockdowns at different times and in many phases. Although doing so has checked the spread of the virus to a certain extent, it has not slowed the progression of other diseases. Therefore, the need to find innovative ways to stem and treat such diseases grows daily and for many countries, telemedicine has provided a cheap and practical way to meet this need.
It is a quintessential example of the Fourth Industrial Revolution in action and is an area in which India has already demonstrated its ability to lead. Few interventions are as conducive to piloting ambitious telemedicine in India than tobacco cessation and there are three reasons for this.
First, as the Foundation for a Smoke-Free World’s India Report shows, tobacco use is widely prevalent in the country and its results are devastating. There are nearly 270 million adult users of tobacco in India. Experts estimate that tobacco use is responsible for nearly 10 per cent of all deaths in the country and the resulting economic burden amounts to more than one per cent of the Gross Domestic Product (GDP). This figure rises when we consider the economic toll of tobacco-related disability and other indirect costs. Ultimately, the burden of tobacco use constrains healthcare, particularly for the poor.
Second, many of those most affected by tobacco use live in places with few specialists to provide cessation services. The shortage of healthcare providers is acute in these regions where brick-and-mortar clinics are few and far in between. India already suffers from a shortage of healthcare providers, with only one doctor for every 1,400 people and only one hospital bed for every 2,000 people (well below the World Health Organisation’s recommended norms).
Third, unlike many other medical conditions, treating tobacco addiction and diagnosing its sequelae, such as oral cancers, can often be done remotely. Tobacco cessation is predicated on counselling for behaviour, which can be effectively delivered via telemedicine platforms. India has more cases of oral cancer than anywhere else in the world due to the popularity of smokeless tobacco products in the country.
The scale of tobacco use and its resulting harms, its disproportionate toll on those in rural areas and the ability to effectively treat it and diagnose many of its sequelae make it a natural contender for telemedicine. However, some structural changes are required to successfully integrate telemedicine in the healthcare sector’s arsenal. Specifically, the three “Ds” — doctors, diagnostics and data — require redoubled focus in this context. The Ministry of Health and Family Welfare’s recently-notified Telemedicine Practice Guidelines provide a scope for registered medical professionals (RMPs) to familiarise themselves with telemedicine. The guidelines include instructions for RMPs to maintain digital records of patients, including evaluation and management reports.
Doctors may still require guidance to select appropriate software and technology that can help streamline these tasks. Though specialised digital applications to facilitate cessation are available, doctor awareness is the key to unfetter their use-case. Additionally, issues of medical ethics and liabilities need to be addressed, to build patient trust.
The second critical area is investments in diagnostics. Recent experiments with tele-diagnostic services in Maharashtra have enabled the use of photos to detect early cases of oral cancer and identify at-risk patients. This ensures that RMPs can make clinical evaluations to identify early onset of diseases to reduce the time between diagnosis and treatment.
The country requires similar interventions that leverage the combination of widespread smartphone access and state-of-the art diagnostics. But scale requires private sector investments, based on a profitable business model.
Diagnostics capabilities can likely be bolstered through hub-and-spoke telemedicine models to ensure access to larger markets at reduced rates of service distribution. Moreover, the use of Artificial Intelligence (AI) and Machine Learning (ML) to augment diagnostic capabilities of physicians can also reduce healthcare costs. Studies estimated that the use of this model to treat stroke patients can reduce costs by 10 per cent.
India’s fragmented healthcare ecosystem has multiple public, private, and individual healthcare providers. Therefore, it is often a challenge for healthcare professionals to maintain robust medical records. Even when they do, such records are not easily portable, and patients rarely get timely access. Digitisation of health records can help doctors administer appropriate treatment and create a knowledge bank that will help officials understand trends in public health, such as the burden of tobacco use.
It is important that such solutions are designed as open data ecosystems, subject to user audits and not as vulnerable single points of failure. Studies indicate that high, out-of-pocket expenditure on healthcare pushes around 32-39 million citizens below the poverty line every year.
Telemedicine services offer an opportunity to leapfrog traditional constraints to quality healthcare. The three “Ds” offer the means to unlock such potential and reduce the healthcare burden that is a consequence of widespread tobacco use.
(Shah is research manager at the Foundation for a Smoke-Free World and Sharan is, partner, Koan Advisory Group. The views expressed are personal.)
It is high time governments act by adopting mandatory energy-saving codes for new buildings and refurbishing existing ones
Sneha Singh shifted to an apartment in a highrise building with her husband and children in the national Capital two years ago. She has two air-conditioners, a TV, a refrigerator and other electrical appliances in her home. But she has stopped using air-conditioners now and has minimised the use of other electrical appliances because of the economic impact of the Covid-induced lockdown.
“With the mercury shooting up in April and May, it was extremely difficult for my kids to study or sleep. They were restless and unable to focus on their work,” she says. But what she does not understand is that the problem lies with the design and construction of the flat, which was not built keeping the health of its occupants in mind. With the virulent virus forcing Sneha to spend most of the time indoors, she and many other families like hers are now realising the importance of the quality of the environment inside the house.
Experts are of the opinion that green building technologies can help the world prepare for a future in which pandemics will be more common. In fact, the Singapore Green Building Council (SGBC) president Dr Ho Nyok Yong made it loud and clear at a webinar in May this year when he said, “Think of green buildings as giant N95 face masks, protecting you from harmful toxins the moment you step inside.”
Echoing his observation, a study in Singapore said that people who stay in “green” buildings are less likely to suffer from fatigue, headache and even skin irritation, showing that their benefits stretch beyond saving energy.
In contrast, the health impacts of living in energy-inefficient buildings have been studied extensively in some countries like the UK and New Zealand. They have shown that the list of consequences of non-energy efficient houses is long: Increased chances of respiratory infections, cardiovascular disease, gastro infections, asthma, allergy symptoms, poor mental health, arthritis, rheumatism and a higher number of falls — a major safety risk for the elderly. Closer home, in 2018, IIT Bombay and Doctors For You, an NGO, conducted a study in Mumbai’s poorest ward, M-East, that established a co-relation between mortality due to tuberculosis (TB) and housing conditions. It found that eight to 10 per cent of the residents in the denser, less light-filled and more poorly ventilated complexes had TB, compared to one per cent of residents in a better ventilated project. Even within a building, the risk of TB declined on higher, well-ventilated floors.
Veteran architect Ashok B Lall explains, “Most of the time buyers are not aware that housing conditions have an influence on physical health. People must understand that houses are more than the physical structures providing shelter. For example, a warm and dry house can improve general health outcomes and specifically reduce respiratory issues. Children living in crowded homes are more likely to be stressed, anxious and depressed, have poorer physical health, and inattentiveness at school.”
Lall is a supporter of green building design focussing on reductions in energy and water usage, creation of healthy indoor environment and minimisation of environmental disturbances.
Realising the significant co-benefits of improving housing conditions, in 2018, the World Health Organisation (WHO) came out with guidelines on health and buildings. “Improved housing conditions can save lives, reduce disease, increase the quality of life, reduce poverty and help mitigate climate change,” said the WHO, also noting that these can contribute towards the attainment of Sustainable Development Goals (SDGs) related to health (Goal 3) and sustainable cities (Goal 11). As per the guidelines, installing efficient and safe thermal insulation can improve indoor temperatures that support health, while also lowering energy costs and reducing carbon emissions.
Thermal quality refers to whether the indoor temperature is comfortable and healthy. While most evidence relates to the impact of cold environment, overheating can also damage health through dehydration. In cold climates, better and improved energy efficiency can lower rates of excess winter mortality while in hot climates it helps reduce the risk of dehydration and negative health impacts, says Sameer Maithel, Director of research and advisory firm Greentech Knowledge Solutions and Head, Building Energy Efficiency Project (BEEP) Project Management and Technical Unit in India. BEEP is a bilateral cooperation project between the Union Power Ministry and the Federal Department of Foreign Affairs (FDFA) of the Swiss Confederation. Maithel says that the health quotients in energy-efficient buildings are: Thermal comforts, natural ventilation, daylight availability, which serves as a disinfectant as well as the source of Vitamin D, safe drinking water, sanitation and waste management.
Talking about the design principles of building green and sustainable homes in India, Lall says, “If we can devote 60 per cent of the terrace area of a four-storey building to install solar panels, it will meet the energy demand of all its residents.” The height of the building has a direct co-relation with its carbon emissions and is inversely proportional to affordability, he adds.
Refining the ventilation system is another key to minimising disease transmissions while saving electricity.
Unfortunately, in India most buildings are not equipped to establish and maintain healthy indoor air quality and need to be upgraded. The number of buildings conforming to green labels covers only about one per cent of the urban buildings in India. Isn’t there a risk that raising standards will push up costs further? “But in the bargain you cut down medical bills as well as enhance productivity,” argues SP Garnaik, executive director of Energy Efficiency Services Limited (EESL), a joint venture under the Power Ministry.
On its part, with an aim to make workplaces healthier and greener in the Covid-19 scenario, EESL and the US Agency for International Development’s (USAID) MAITREE programme, launched the “Healthy and Energy-Efficient Buildings” initiative to ensure efficiency along with health components at workplaces.
“We hope that this pilot will spur urban planners, architects and property managers to rethink the design, operation and maintenance of the buildings so as to safeguard the health and well-being of the occupants at offices and homes as well,” he says.
It is high time governments act by adopting mandatory energy-saving codes for new buildings and for the refurbishment of existing ones, assert experts. “This is all the more urgent in the light of soaring construction rates. Most buildings lack mandatory building energy codes. By strengthening these codes every three-five years, zero-emission and net zero energy codes could rapidly become the norm,” says Maithel.
(The writer is Special Correspondent with The Pioneer. The article has been published as part of CMS-BEEP Media Fellowship Programme.)
Forcing post-graduate medical students to spend three months in rural areas will be beneficial for the doctors too
In an answer to Parliament in 2019, Ashwini Choubey, Minister of State for Health, had stated that assuming an availability of 80 per cent, there was only one doctor per 1,445 people in India. Of course, if one added up alternative systems of medication, the number would be closer to the World Health Organisation’s mandated one doctor per thousand population but over the past few months, we have seen many alternative medical practices wither away in the face of the pandemic. What these statistics do not reveal is just how skewed India’s medical system is towards large metropolitan areas. It is only when you see thousands of patients from across India crowding the entrances at All India Institute of Medical Sciences (AIIMS) in Delhi that you realise just how bad things must be for families to transport critically ill patients hundreds of kilometers for proper care. The fact is that cities like Delhi and Mumbai, while suffering immensely from the pandemic, have enough beds and facilities. There was a joke, not one of any laughing matter though, that there were more intensive care beds and ventilators in Delhi’s Saket area alone than in some other Indian states.
Part of the reason for the deficiency of healthcare in upcountry India is that young specialist doctors want to work, for rather obvious reasons, in big city hospitals. And it is unfair, given the poor facilities in even smaller towns, let alone rural areas, to expect young doctors to work there for extended periods of time. However, if young medical specialists did spend time in rural areas, they would possibly understand the gravity of the medical scenario a lot better than they currently do and suggest innovations in existing infrastructure. Operating in cities, they are often insulated from the realities of India just as much as “expert commentators” on news television channels. The Government’s mandate that post-graduate medical students spend three months in rural areas is understandable and while some of them might be disappointed, this is a practice that should ideally be spread across disciplines. If we talk about “two Indias,” then the only way to redress that is to ensure that young people from urban India see the problems of rural India and understand why they behave — with their votes and their money — the way that they do. Being a warrior on social media isn’t quite the same thing.
(Courtesy: The Pioneer)
Vaccine nationalism is rearing its ugly head again even as the Coronavirus pandemic rages on. The implications of manipulating access to essential drugs, particularly HIV-AIDS ones in developing countries, due to bulk purchasing power of richer nations and honouring of pharmaceutical patents, are already known. That crisis worsened. Sadly, the trend continues as the race to develop a vaccine for COVID-19 intensifies with five leading candidates currently in phase three clinical trials. Who gets hold of the vaccine and when determines which country stops the caseload from going up exponentially, saves lives, escapes the second and third wave predicted by experts and gets on the path of economic recovery faster. However, with the pharmaceutical industry being largely cartelised, it won’t come as a surprise if developing countries are at the far end of the line. Remember the 2009 H1N1 flu pandemic? Australia, which was the first country to come up with a vaccine at that time, blocked exports while some of the wealthiest countries entered into pre-purchase agreements with several pharmaceutical companies. The US alone obtained the right to buy 6,00,000 doses. It was only when the H1N1 pandemic began to recede that developed countries offered to donate vaccine doses to poorer economies. However, the damage at that time was not as severe as it will be this time round because the Coronavirus is far more infectious and deadlier than the H1N1 and has almost strangled the have-not nations. If a recent report released by Oxfam is to be believed, wealthy nations, accounting for just 13 per cent of the global population, have cornered a whopping 51 per cent of the promised vaccine doses. It is just what poorer nations and the World Health Organisation (WHO) had feared, that while they would be prime picks for vaccine trials, they would get to use doses the last. The inevitable result would be a deepening of the pandemic. Right now, many world leaders, like US President Donald Trump, who is facing a re-election in November, will not listen to the feeble voice of the poor or the WHO. A vaccine is his ticket to the White House, he needs it for his voters. This “vaccine nationalism” has also emerged at a time when global majors are trying to establish their political prowess while using their scientific superiority to validate the claim. Thus, whoever has the first access to the vaccine will end up on the top of the global pyramid of power, apart from reaping the enormous monetary benefits that come out of it.
One of the developers of the COVID vaccine is Moderna, which has received $2.48 billion in committed taxpayers’ money. It intends to profit from its vaccine and has sold supplies to rich nations at prices that range from $12-16 per dose in the US to around $35 per dose for other countries, leaving poorer nations out of the procurement loop entirely. However, according to reports, the company’s production capacity is barely enough for 475 million people or six per cent of the world’s population. Even if all five vaccine candidates succeed, which is rather unlikely, it is only by 2022 that two-thirds of the world’s population will have access to them. Also, even if one country does get vaccinated, how will its policy on travelling restrictions change? Will the restriction be limited to those who are yet to get access to the vaccine or will they have vaccines for those entering their land? Remember it’s a global pandemic and just like the WHO warned, creating vaccinated pockets will not be beneficial for long if one is aiming for a stable economy. This is why various organisations are calling for a “people’s vaccine”, free of the monopolistic control of the pharmaceutical companies over its sale and urging nations to share the needed information with others so that it is available to every single human being at affordable rates and can be distributed on a need-based rather than a paid-for basis.
If all the five vaccines work, Oxfam says that would amount to a combined production capacity at 5.94 billion doses, enough for 2.97 billion people, keeping in mind that the vaccines will most likely require two doses. The supply deals already agreed upon are for 5.303 billion doses, out of which 2.728 billion (51 per cent) have already been procured by developed countries including the UK, US, Australia, Hong Kong and Macau, Japan, Switzerland and Israel, as well as the European Union. The remaining 2.575 billion doses have either been bought by or promised to emerging countries, including India, Bangladesh, China, Brazil, Indonesia and Mexico among others. This also includes the 300 million doses of the AstraZeneca vaccine pledged to the Covax Advanced Market Commitment (AMC), the vaccine pooling mechanism, promised to developing countries. It is essential for global powers to understand the gravity of the situation and on ethical grounds work in favour of public health and the global economy.
The sordid reality of the 21st century's portrayal of Indian female celebrities is that it defeats all that feminism has tried to achieve so far
As women have come into their own, do they realise that they continue to be objectified even in changed contexts for purposes of mass consumption? And are projected for the wrong reasons than the right ones? That they legitimise the male gaze as a uniform societal response by falling into a trap of imaging they believe empowers and acknowledges them? Further, if they happen to be celebrities with a fair sweep of popular culture, then they are prone to be more “sextualised” as it were as talking heads. So much so that they are now being itemised for politics instead of the big screen, used for advocacy rather than reason, prized for their appearance than their intelligence, made icons of causes that thousands of faceless women are struggling with and drawing accolades and likes that may not be earned or deserved. And should such unevolved but rapidly recognisable faces happen to represent binaries, then you have a catfight that has become the new prime-time fix. In the end, fighting women make a mockery of all that feminism has tried to achieve so far.
What else would explain the obsessive coverage of Kangana Ranaut, Rhea Chakraborty, Urmila Matondkar and their ping-pong exchanges by the media or their appropriation by political parties of the day to amplify their respective narratives? Let’s begin with Kangana Ranaut. An actor par excellence, she has lived through sordid exploitation and displayed a rare grit to carve her space and more importantly, own it. There have been many outsiders in the film industry, co-opted or rebels, but she was neither. Instead, she challenged a system that was based on nepotism and dynastic privileges and insisted on a democracy that would enrich the creative space. She even did her bit, though not the only one, to push the envelope, choosing flesh and blood roles that made real women protagonists as much a revenue-earner for the film industry as its male stars. And there was a straight-forward honesty and boldness about her approach that endeared her to everybody. Most of all she appeared independently sensible and not just fashionably articulate. And much before #MeToo, she called out her male exploiters in the industry, not denying what she had been subjected to but was frank enough to admit that she spoke when she had equal power and respect.
She did carve out a new constituency among the chatterati and was conscious enough to use it to magnify her own appeal. She became a regular at media summits and talks, thereby developing another facet outside films that would lengthen her shelf life. The media, in turn, used her to grab eyeballs. As she became sure-footed, she sailed with the prevailing political winds, beginning with nationalism and then professing her Right wing loyalties. Every citizen, including actors, is entitled to his/her ideological preferences but Kangana, who took years to craft her own disruptive brand, has been waylaid and absorbed this time around. Using her troll-worthy capacities and no holds barred verbal ammunition, the BJP has just made her a pawn in its grand design, whether it is lampooning the Nehru-Gandhis, taking on its arch enemy, the Shiv Sena in Maharashtra, or stoking fires in the mysterious death of Sushant Singh Rajput. And it is here that Kangana has faltered and given into the prevailing rant and sentiments of the day than calibrating them to her advantage. Undoubtedly, the Shiv Sena leaders are not known for their standards when they decide to shred somebody apart but for Kangana to liken Mumbai to Pakistan-occupied Kashmir was not only politically immature but more hurtful to her own self than the Sena. Of course, the BJP benefitted from the scream fest without dirtying its fingers. And compared to the troublesome Anurag Thakur and Kapil Mishra, it has found a palatable public lobbyist of some repute. The fact that she is from the film industry would work both ways for it, as an asset if she got traction, maybe a liability at times and a salacious aberration at worst if she failed.
But it is in the process of cleansing the drug taint from the film industry that she has gone overboard, attacking women colleagues in the industry, unarmed with logic and defeating the very women’s cause that she loves to represent. She locked horns with Jaya Bachchan, actor and Rajya Sabha MP of the Samajwadi Party, an industry veteran and an active parliamentarian who has spoken out on societal issues. Rightfully, she decided to argue for an industry that was being vilified over a few bad apples and drug abuse, generalised as a sin city than the enormous talent it nurtures and made to look like a villain of all societal ills when fact is, it supported jobs and created opportunities. This, she said, despite the “non-support of the Government.” Kangana’s rebuttal for the sake of one not only lacked refinement, it undid the work of several women actors who made it possible for her to make her current space and be heard. Taking a potshot at Jaya’s remark that actors were ungrateful to the industry that fed them, Kangana retorted, “Got one thaali which included two minutes of fame in item numbers and one romantic scene with the hero, that too after sleeping with him. I have taught feminism to the film industry.” Reality check? Jaya Bachchan has been a bigger path-breaker than her because she etched powerful women characters despite a hostile climate set by the movie mafia, the single-hero domination and a less than encouraging commercial logic where strong women onscreen were considered artsy and NFDC material. Jaya tried to mainstream that discourse. Kangana perhaps also forgot her own sensuous numbers on screen before she called actor and now Congress member Urmila Matondkar a “soft porn” star. Apart from a pervert television audience that sees news as entertainment, this discourse did nothing but perpetuate the stereotype that “women are their own worst enemy.” Something that Jaya’s peer and BJP MP Hema Malini realised as she supported Jaya’s speech instead of mindlessly toeing what her party propagandists would have wanted her to do.
Kangana may get a BJP ticket to contest elections in the future but she would again not earn it by her own rules but by conforming to the misogynistic mindset that sees women stars as a whiff of fresh air in the dry world of politics. She should have taken lessons from the late Tamil Nadu Chief Minister J Jayalalitha, whom she is portraying onscreen. Jayalalitha became the respected leader she was by mastering all rules of the political game, working the ground, breaking out of the shadows of her mentor MGR and battling the authoritarianism that had already been established by her male counterparts on equal terms. Kangana, sadly, is in danger of looking like a stooge. Does she realise that for all her headline grabbing acts on social and visual media, she is being used to divert attention from the nation’s more pressing problems like the pandemic mismanagement, the Ladakh incursions or the tanking economy? That she is fuelling exactly what the ruling dispensation wants her to do, namely create a cloud of inconsequential nothingness?
At the other end is starlet Rhea Chakraborty, who is on everybody’s search engine, not because of her films or work but as an exploitative girlfriend of late actor Sushant Singh Rajput. No doubt he was a talent snuffed out too early, but the mysterious circumstances of his death, his troubled history with drugs and mental health, his Bihari identity and his “outsider” status in the film industry have far too many elements to be exploited by politicians and their new hand-maiden, the broadcast media. The conspiracy theory that she might have pushed him to addiction, swindled him, could have diverted funds and in the process pushed him over the edge by entrapping him in a world of debt and drug cartels, has become a credible story that the nation is devouring hungrily. Simply because legal evidence and cold facts of the actor’s death are too dry to be juiced out for news cycles. Simply because a good-looking starlet allows the masses to project their sinful obsessions, aspirations and high crimes to her kind and claim moral righteousness by exclusion. So Rhea’s going to jail becomes a visual that is more satisfying as a portrait of instant justice. Many film personalities have been involved in the drug racket. Yet Rhea’s arrest, for possessing just 59 grams of weed, makes a seething urban sub-culture a sensational discovery. She, too, is aware of the fame that the unfortunate death of her boyfriend has given her. Flashing a victory sign and sporting T-shirts emblazoned with “down with patriarchy” slogans, she, too, could emerge out of this mess as a prime pick for advocacy of women’s rights against the lynch mob trial she was subjected to. She may or may not be a success in films going forward but, like Sushant, has been appropriated as a political tool. If the BJP is fuelling the “justice for Sushant” campaign, the Congress has taken up the “justice for Rhea” crusade. Self-appointed activists shouted slogans opposing the “vilification campaign” against the “daughter of Bengal” and held up placards that said, “We will not stop till she gets justice.” Bengal Congress chief Adhir Ranjan Chowdhury even invested her with casteist respectability, calling her a “Bengali Brahmin.” What Rhea wouldn’t appreciate, if she walks into this trap, is that she is hated mostly by women with a patriarchal mindset over tea and conversations, seen as a woman who made capital out of what is called “easy virtue.” In this sense, both the newsmaker and the news recipient are defeated, simply because neither gets respect nor understanding. But they certainly perpetuate a male construct of how women are.
Sadly, women newsmakers from popular culture around the globe are being chased for their representational rather than their authentic selves. Their activism, therefore, appears to be more and more fake. And as they use social media to build intimate partnerships with their communities and followers, they are shaping a market economy of medievalism, where women are dependable worker bees but are actually living in a shell believing they are the queen bees.
(The writer is Associate Editor, The Pioneer)
The ‘POSHAN Abhiyaan’ seems to have made some headway with an ambitious target of achieving a malnutrition-free India by 2022
It is disconcerting that every second child in India suffers some form of nutritional failure in India. Over the years, Government data have borne witness to how many people, especially women and children, do not get three square meals in a day. Worryingly, the potential disruptions caused by the lockdown may make the varied forms of malnutrition a lasting reality. However, the launch of the Government’s flagship programme ‘POSHAN Abhiyaan’, seems to have made some headway, with an ambitious target of achieving a malnutrition-free India by 2022.
It also aims to reduce stunting in children aged between zero and five years from 38.4 per cent to 25 per cent during the same period, along with reducing the level of anaemia and low birth weight in children.
With inter-sectoral convergence being the key strategy, the programme makes a shift from the existing approach of making planning and implementation the responsibility of one Ministry. Instead, it rightly notes the various critical components of success and makes ‘POSHAN Abhiyaan’ a multi-ministerial initiative. While the Ministry of Women and Child Development acts as the nodal office, the Ministry of Drinking Water and Sanitation is responsible for the Swachh Bharat Mission (SBM) that ensures cleanliness and hygiene and the Ministry of Education is responsible for the Mid-Day Meal Scheme (MDMS).
Two other Ministries, that of Health and Family Welfare and the one responsible for Rural Development, are looking after health programmes such as Mission Indradhanush for immunisation coverage and rural income schemes, such as MNREGA, respectively. The LPG distribution scheme by the Ministry of Petroleum and Natural Gas enabled safe and hygienic cooking in underprivileged households.
But will India accept malnutrition as everyone’s problem? The copious fund allocation for the ‘POSHAN Abhiyaan’ and its increase in the past three years have shown the Government’s sincerity in taking the mission to its intended conclusion. From Rs 950 crore in 2017-18, the current allocation for the ‘POSHAN Abhiyaan’ reached a sum of Rs 3,400 crore for the financial year 2019-20. However, the potential challenge can be bringing social and behavioural change towards malnutrition at the community level. Ensuring equitable nutrition to build a healthier nation will require the following.
Eating local and seasonal food: This comprises a part of the trend known as “sustainable eating” and has been proven to be an economical solution to the food crisis globally. This saves time and the cost of transportation while promoting the use of fewer preservatives. Such food items are also suitable to fulfil the nutritional needs of the people in a way that is commensurate with the local environment.
The concept of introducing kitchen gardens in schools to fulfil some part of the requirements under the MDMS is an innovative step. In the coming days, introducing more steps, such as promotion of local, nutritious millet and crop diversification to promote traditional millet will be the right steps to complement this ongoing effort. Recent studies have observed that investing $1 in nutrition-related interventions will have economic gains of about $19 to $22.
Addressing intrinsic social and cultural biases: In his paper ‘POSHAN Abhiyaan: Making Nutrition a Jan Andolan’, NITI Aayog member Vinod K Paul and co-authors observe that despite the Prohibition of Child Marriage Act, 2006 mandating the legal age of marriage at 18 for girls, 30 per cent of them are married before that age and eight per cent are already pregnant by the time they are 15-19 years of age. Facing intra-household deprivations due to their sex and abject poverty, these young girls often forego necessary nutrition, care, and rest even during their pregnancy, thus delivering low birth weight babies. For these babies, the cycle of malnutrition has already begun, they note.
This long-standing social bias deepens with socio-economic nuances. For example, in tribal households, the overall amount of food is anyway low and the men, by tradition, get the larger share of it, considering the physical labour they must undertake. A male child may get less to eat than his father, but is likely to get more than his mother, grandmother or sister. There is a need to free nutrition from the perceived requirement of the receiver. Disseminating a scientifically-validated diet chart according to age and sex to the Panchayat level can help in spreading awareness and help households modify their practices.
Clear and visible measures for better accountability: Owing to the possible institutional leakages, Government initiatives should be monitored by some metric for accountability. For this, an enhanced information and process system is crucial. Monitoring, surveillance, and evaluation remain critical to all Government initiatives not only to firm up the people’s trust but for better outcomes as well. Understanding ground-level realities will not only enrich policymakers’ understanding, it may help in building a positive perspective among beneficiaries about public interventions. Public consultations, surveys among beneficiaries and social audits are some of the most effective ways to do this.
Building a case against hidden hunger: Few realise that malnutrition is not exclusively a rural phenomenon. Many people, especially children, in the cities, too, suffer from malnutrition, albeit of a different kind. Since a good part of their diet is filled with refined and finished items, not to mention the large amounts of salt, sugar and trans-fat they consume, the children lack micronutrients such as iron and zinc. Traditional crops and millet, marked as nutri-cereals that should have been part of our diet, are fast becoming a favourite of the educated and wealthier part of the society. However, as companies producing fast-moving consumer goods look to the rural market to revive from the economic effect of the pandemic, it is important to ensure that rural consumers do not acquire the habits of cities. The onus is on the Government to ensure that the learnings from the cities reach the villages before it is too late.
(The writer is Associate Professor, Health Economist, IIHMR University, Jaipur)
Aerial sightseeing has become very popular as several nations still have travel restrictions on incoming arrivals
It began with some intrepid folks chartering planes to fly around. Then airlines such as Singapore Airlines and Australia’s Qantas caught wind of the idea and ran with it. What are we talking about? The concept of “flights to nowhere in particular” seems to have taken off, literally. Qantas’ recent trip, involving low-flying, aerial survey of the Great Barrier Reef, was sold out. Airlines are happy as this allows them to fly their aircraft relatively full, thus keeping some jobs safe and their expensive assets, the planes themselves, flying. Of course, scenic flights that operate in and out of the same airport are not a new concept. Qantas itself has run seasonal flights to Antarctica for several years every southern summer. But 2020, as we all know, is not like any other year, with several nations still putting travel restrictions on incoming arrivals, some not even allowing non-citizens to return and others instituting strict quarantine regulations, even for travel within a country.
As a result the global aviation business is hurting, thousands of pilots, cabin crew, ground crew and aircraft maintenance engineers have already lost jobs and unless things change dramatically, several thousand more will lose their jobs in the coming months. Many airlines have already shut for good and many more are in deep financial distress. It is not a good time to be an airline or be employed by one. So yes, while these flights of fancy might seem extravagant and a waste of money and resources, even adding pollution, their popularity means that airlines will probably survive as well as regain some overall confidence in flying. Let us not forget, these flights are being bought by people, who after six months of being grounded, want to get back in the air. They want to experience airport security and airline food for better or for worse. The very frequent flyer might have celebrated the first couple of months of no flying but almost every single person in that category misses that experience now and these flights, pointless as they might seem, allow these people to get a fix. There are many willing to take off in India as well and maybe a scenic flight or two around the Himalayas or the wonderful coastal areas may not be a bad idea here.
(Courtesy: The Pioneer)
FREE Download
OPINION EXPRESS MAGAZINE
Offer of the Month