A misguided policy that cuts deep into patient safety
The basic requirement of medical practice is the safety of the patient.
Surgery is a branch of medicine in which poor training can have dramatic and disastrous results.
This is the strongest argument against the ill-advised move of the government of India to allow graduates in Ayurveda to practise surgery.
It is an aphorism in modern medicine that a surgeon needs to know not only how to perform surgery, but when.
Importantly, the surgeon needs to know when not to perform surgery, a skill commonly called clinical judgement.
These skills are difficult to teach and difficult to master.
In India, the Consumer Protection Act serves as an incentive to modern medical practitioners to provide high quality health care.
Safe surgery requires years of training.
In surgery where novel situations are often encountered and a good knowledge base is essential to solve problems which may not have been previously encountered.
Modern medical training consists of a basic degree during which the fundamentals of the functioning of humans in health and disease, and techniques to diagnose illnesses are taught.
Increased knowledge in various domains is obtained through post-graduate training.
All these domains work together in order to ensure safe surgery.
It is impossible for Ayurveda to incorporate surgical techniques while ignoring all the other domains of modern medicine and still perform surgery safely and effectively.
Traditional knowledge in India has become the victim of self-serving apparatchiks who have fossilised it, preventing its development and growth.
The quality of medical care received in India is highly dependent on personal resources.
There is a shortage of trained medical personnel in rural areas.
The only way to address this is to greatly increase the number of government medical colleges.
New Home Ministry guidelines to check further spread of COVID-19 during the winter months starting with December reflect the government’s concern that the gradually reviving economic activity should remain unaffected by ongoing containment measures.
The Centre has mandated that States declare containment zones online, identifying them with micro targeting to minimise the impact.
It has also prohibited any lockdowns at State and city levels without prior consultation with the Ministry.
Encouraging results from vaccine trials and the likelihood of early emergency use authorisation have weakened voluntary caution, and citizens are yielding to pandemic fatigue.
Health authorities must reinforce the message that low-cost interventions such as masks, good ventilation and distancing norms cannot be abandoned.
The prime task before health administrators is to convince the average citizen that there is much to be gained through inexpensive lifestyle modification.
A study of 131 countries published in The Lancet estimated the benefits of restricting group gatherings to 10 people, and how reducing physical attendance at workplaces could bring down the reproductive number by 38% in one month.
Universal masking, with 95% compliance, is projected to reduce deaths dramatically, in another University of Washington study.
Evidently, the entire economy stands to benefit from such painless interventions, while sparing doctors and frontline health workers of deadly risk.
The Central government has rightly prioritised targeted containment, but it should standardise testing protocols across States, and not dilute the message of safe behaviour by labouring over the point of recoveries and low per-million fatalities.
Closer to punishment
12 years of 26/11 Mumbai Terror Attack
While nine of the attackers were shot dead by the police between November 26-29, 2008, one of them, Ajmal Kasab, was apprehended and sentenced to death after a trial that revealed the conspiracy and planning by LeT operatives among others responsible for the attacks.
One among the foreign collaborators is Tahawwur Rana, who conspired with former FBI agent David Headley to assist the LeT in the planning and execution.
Rana, a Pakistani-Canadian citizen, was found guilty by a U.S. court in 2011 of providing material support to the LeT and planning an attack on the offices of the Danish newspaper, Jyllands-Posten, and was later sentenced to 14 years in prison
Unlike Headley, who escaped extradition after entering into a plea bargain with the U.S. prosecutors and was sentenced to 35 years in prison, Rana was acquitted in the U.S. of charges of involvement in the 2008 terror attacks.
An Illinois court commuted his jail sentence that was scheduled to end in September 2021, after he tested positive for COVID-19; this has opened the window for his extradition to India.
Rana, according to Headley, had helped him to open an immigration firm in Mumbai, which was used by Headley to survey targets chosen by the LeT.
An extradition memorandum filed by U.S. prosecutors in a California district court has reaffirmed Rana’s role and provides more detail into the conspiracy and the knowledge shared with him by Headley about the attacks.
This should provide the U.S. court enough reason for Rana’s extradition to India to face punishment.
The trial of Ajmal Kasab exposed the collusion of the Pakistan deep state with terrorist organisations.
Groups such as the LeT and JeM have changed their modus operandi to target security forces since then.
The scrutiny over Pakistan has been accentuated by the FATF’s decision to retain Pakistan on its greylist.
Yet, Pakistan has done little to bring the culprits of the 26/11 attacks to book — a case in point being LeT chief Hafiz Saeed who has been sentenced to prison for terror financing but has eluded justice for his role in the 2008 attacks by never being charged despite being identified by Ajmal Kasab and Headley as a mentor with knowledge of the attacks.
Rana’s extradition would go a long way in bringing justice to the nearly 160 victims of the Mumbai attacks and shed further light on cross-border terror.
Recalibrating India-Nepal ties
When Foreign Secretary Harsh Vardhan Shringla arrived in Kathmandu on November 26 and spoke in fluent Nepali to the media, there was some hope that the visit would go beyond the traditional exchange of pleasantries.
When he departed, the hope was that his visit would be the beginning of a continued dialogue between the two countries that have had a strained relationship since the imposition of a five-month-long blockade in 2015 in Nepal just as the country was recovering from a devastating earthquake.
The Foreign Secretary did not touch upon the issue of the Eminent Persons Group in his latest address. His speech was not different from speeches made in the past, and the joint statement from both the governments was a usual nicety.
Many in Nepal continue to equate being anti-India with being nationalistic.
Politicians and political parties whip up such sentiment and compete with each other on who can be more extreme, especially before an election.
Prime Minister K.P. Oli won the 2017 election partly because he projected himself as someone who stood up to India during the blockade.
He again whipped up nationalistic sentiments when he got the Nepal map amended to add new territory.
This was a good way to deflect attention from the poor management of the COVID-19 pandemic by his government.
His government’s excuse was that after India released its new map in November 2019, Nepal wanted to discuss the map with India but the latter did not provide any time for a discussion.
India continues to think that by providing largesse to Nepal in the form of aid and development projects, it can win Nepali hearts.
But despite pouring billions of rupees into Nepal over decades, it has still not been able to do so.
Indian aid is seen in Nepal as a favour bestowed on a constituency it wants to garner support from rather than a contribution to Nepal’s planned development.
India competes with China in providing aid outside government budgets.
Indian workers in Nepal constitute a big part of the workforce and send about $3 billion to India every year. In terms of remittances to India, Nepal ranks eighth.
Nepalis have migrated in the past 20 years to more than a hundred countries; India is not the only country that Nepalis rely on for jobs or education.
There are some fundamentals that we simply cannot forget: geography will not change, the border will remain open as millions of livelihoods on both sides depend on it, and China is going to be a big global player with varied interests in the neighbourhood.
Moving forward in base areas
The Union government is in the process of deploying five more battalions of the Central Reserve Police Force (CRPF) to Chhattisgarh to scale up anti-Maoist operations, particularly in the south Bastar region.
Despite the present deployment, Bastar still has a security vacuum in many pockets, particularly in the south Bastar and Abujhmad areas.
These pockets, called base areas by the Maoists, not only provide them occasion to wage ‘mobile war’ against the security forces, but also enable their military formations, including the People’s Liberation Guerrilla Army battalion, to move about freely.
Benefits of more forces
The newly inducted battalions could have multiple advantages for the State.
More area will now be dominated by the security forces, the Maoists’ movement will be restricted to a comparatively smaller area.
Consequently, the intensity of war will be reduced and the ‘mobile war’ will come down to its basics, i.e., the ‘guerrilla war’.
Also, additional deployment and frequent movement of the security forces would improve the intelligence network.
New borewells are dug and health services are also extended by the medical staff of security camps.
Once these services are initiated by the forces, the district administration scales them up by providing the required funds.
The dislocated fair price shops (PDS) are restored to their original locations and villagers are not required to walk long distances to fetch their rations.
All other schemes of the governments are also implemented better through these newly established security camps-cum-development centres.
Once the security environment improves, more roads can be laid and mobile towers and electricity poles installed for better transportation, communication and electricity supply.
Financial inclusion can be improved and the MNREGA works started to give impetus to economic activities.
More schools, primary health centres and anganwadis can be opened up to provide basic amenities to the villagers.
Democratic institutions like panchayats may get revived and political activities could increase with the improved security scenario.
However, the security forces need to be more alert to thwart any untoward incident while moving in base areas.
They need to be more watchful of their tactics knowing well that IEDs and iron spikes have been laid all over by the Maoists.
The collateral damage must be reduced to its minimal.
The Maoists usually oppose establishment of new security camps and use villagers as their cover.
Therefore, the villagers must to be taken into confidence and told that the new security camps will act for their welfare as centres of development.
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