Published: Monday 15 March 2010

Band-aid for rural health

The Centre and Medical Council of India’s decision to start a new degree course—Bachelor of Rural Medicine and Surgery (brms)—to cater to villages is a retrograde step that will only widen the gap between the rural and the urban people. The health minister’s argument that doctors are reluctant to work in rural areas is correct, but the reasons behind this have to be analyzed before arriving at a decision.

In India there are hundreds of medical colleges. At least 20,000 doctors are churned out of these factories every year. Where do they go? It may be true that in north India there are few qualified doctors in rural areas, but this is not true for the south. Every village, small or big, has qualified doctors.

Doctors in rural areas face several problems. Many villages do not have proper roads, good schools and other infrastructure. The income is far lower than their urban colleagues. Thus, it is natural that they try to shift to towns. Moreover the government, tax officials and local panchayats harass them for various reasons. The government must relax laws to help the doctors working in rural areas.

Many medical colleges are short of teachers, many deemed varsities are on the verge of being de-recognized. A three-and-a-half-year course is definitely not an answer to our health problems.

If the government wants pill-giving doctors, it can train teenagers after class X for a year to become ‘rural doctors’. Then they will not migrate to towns and rural health problem will be solved.

Doctor of medicine practising in Padre village of Kasaragod district, Kerala

Government thwarts solution

Apathy is perennial. Bringing about a change in the way sewage is treated in India might require us to cut through red tape and yet no action might be taken ever. But when the Uttar Pradesh chief minister herself complains of foul odour from open sewage, no formal complaint need be lodged. The problem is attended to (‘Appetite for sewage’, January 1-15, 2010).

Bioremediation is the microbiological approach to treat sewage. Every day, more than 3,000 million litres of untreated sewage is dumped in the Ganga. All fingers point to the government when it comes to taking action. Companies and municipalities have made an effort in this regard but the government is proposing to standardize the technology used. Meanwhile we are losing out on time. While the government takes its time planning and organizing the course of action, we are faced with a paradox. A Union urban development ministry body sets the norms for water supply and sanitation, but it does not include water treatment.

With the latest technologies, the setting up time for sewage treatment plants has reduced. They are more efficient and effective now. All that the private companies want from the government is the go-ahead. No one can tell how long they will have to wait. India has a lot of sewage to treat, but I hope the companies do not look at this as a pot of gold. In fact, companies today should focus on triple bottom-line approach—profits, people and environment.


For whom the bridge?

'A bridge that divides them’ (January 16-31, 2010). Indeed it does. The article raises the asked question often: Development for whom? The bundh on river Kosi certainly doesn’t seem to be going in favour of the 30,000 people who would be displaced if the bridge is built. It would result in loss of livelihood and uprooting people from their homes. What is truly disturbing is the fact that in spite of an alternative proposed by villagers, the National Highway Autho-rity of India has rejected their proposal.

It is also worrisome that the authority seems to have commissioned the project without taking into account the possible impact the bridge would have on the flow of the river. The probable long-term effects of building a bridge which would act as only an artificial means to check the river is almost an invitation to disaster.

Then there is the distrust among villagers regarding the government’s promise of compensation; it throws bad light on the entire situation.


Insurance for the aged

Health insurance is a thriving business. The escalating cost of treatment and the inadequate facilities available in government hospitals have helped its growth by leaps and bounds (‘Run from cover’, December 16-31, 2009).

But it has many setbacks like unnecessary check-ups and treatment that exhausts the insured amount early. The aged are the worst affected as the premiums are high.


Corporate responsibility

It is a welcome step to have a pollution index (‘A measure of pollution’, January 16-31, 2010). The polluters should be made responsible for the damage they do. In addition to compensating those suffering from pollution, they should be made responsible towards community development. Such activities under corporate social responsibility help them get several benefits including business and profits. These aspects should be included while giving the approval.


Brat pack auto industry

The Indian government has been supporting the automobile industry for the past two years and is least bothered about reducing emissions. The government supported the real estate and auto industries with generous bailouts last year. As a result, banks reduced the interest rates on car and home loans. How the government will now direct the auto industry to behave I wonder.


It does not add up

The US is a major impediment to a global response and needs to be exposed for what it is (‘The US and us’, February 1-15, 2010). But I am not sure if I agree with the arithmetic that concludes the developing world will deliver more emission cuts than developed countries. This is not my mathematical conclusion and I would hope that you provide the statistical basis on which this assertion is made. I do not know of any developing country committed to absolute reductions but more framed in relative reductions to a business-as-usual situation. Also, hopefully, countries like South Korea, Mexico, Singapore and several others are not considered developing countries—about time they stepped up to the plate and migrated out of the non-Annex 1 camp.


I am convinced that the US, being a super power, is not at all interested in the right causes all the time. And it doesn’t matter as nobody questions it. Might is right. Nothing will ever change for the US unless it wants to change itself. President Barack Obama seemed genuinely concerned and interested till he had not taken over the presidency. The power gives you the extra power, say arrogance, and you too jump in the cesspool.


Your criticism of the US doing little to reduce greenhouse gas emissions may be correct, but the fact remains that clean technologies have mostly been developed in the West, particularly in the US.

Several states in the US have taken measures to control emissions. Even if one assumes that the US is doing little to fight climate change, there is no reason for countries like India and China to run away from their responsibility.

Let us not forget the anticipated temperature increase will hurt them more than the developed countries. Thus, passing the buck is not going to help.


Car parts have asbestos

I recently learnt of import of car parts containing asbestos, which is banned in almost all countries, including Africa. I understand there is no restriction on use of these parts in India.

It is well known that inhaling asbestos fibres can cause serious illnesses, including malignant lung cancer, mesothelioma (a rare form of cancer caused mostly by exposure to asbestos) and asbestosis (a type of pneumoconiosis). Alas! I had to keep my emotions buried because that is what Indians are used to.

How can one forget that it was India who barred asbestos from being included in the prior infor-med consent list at the fourth Conference of Parties of the Rotterdam Convention in Rome. But w hen ships carrying nuclear material can enter India to be dismantled because they are not allowed in other countries, then use of asbestos is a small thing.



The photo credits for the cover story ‘Low pulse’ (February 16-28, 2010) got switched inadvertently. Meeta Ahalawat took the photograph on p24 and Sopan Joshi the one on p25.

We regret the error.

Pick of the postbag

Floodwaters don’t remove arsenic

The Nature Geoscience article mentioned in ‘Flooding out arsenic’ (January 1-15, 2010) appeared in the January 2010 issue and not in the December 13 issue, as reported.

Also, before publishing such studies you should consult those in India who have better knowledge and worked for years on this problem. Just because a foreigner conducted a study which was published in Nature Geoscience does not mean it is accurate.

In fact, the author may not be aware of the agricultural methods practised in India and for that matter the practice is very similar in all the South Asian countries. The authors have not referred to any of the publications that demonstrate the relationship between irrigation practices and arsenic in groundwater in West Bengal.

Traditional paddy cultivation is an age-old practice in India and Bangladesh. It has been demonstrated that the paddy roots accumulate large amounts of arsenic (>169 parts per million) drawn from arsenic rich groundwater used for irrigation. After harvesting, the roots are ploughed back into the soil for the next crop. The rice fields are always flooded because rice plants require 5 cm of water at any given time. Thus, monsoon or no monsoon, the fields are always flooded. The layer below the top soil where arsenic-rich roots lie are subject to anaerobic condition and makes the environment conducive to mobilizing arsenic into the layers below. Water infiltrating into the aquifer carries the arsenic and mixes with the shallow groundwater. Thus a kind of arsenic cycle is established in all the rice fields of West Bengal and this is true in the case of Bangladesh as well. The flooding due to monsoon is a subsequent phenomenon and some arsenic may be removed from the topsoil. Hence it is not a major process in operation in Bangladesh as reported.

It is easy to mesmerize people with beautiful diagram and data, but one has to understand the process involved in traditional paddy cultivation and irrigation that are being practised for centuries in South Asian countries. If the floodwaters are removing arsenic, the problem of arsenic should decline over a period of time. It is not so.

Chairman, GeoSyndicate Power P Ltd, Mumbai

Our correspondent verified that the article was published online on December 13, 2009

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