Be ready for the next IT revolution— in healthcare

The next information technology revolution will be in health care. However, we are far from ready.

healthtechMost doctors in India still use prescription pads and printed results of diagnostic tests. However, this is changing at least in respect of some big hospitals. Doctors could now access results of diagnostic tests online. Appointments with doctors are fixed online.The prescriptions, made online, instantly land on the desks of nurses and pharmacists. A company offering diagnostic services through a chain of laboratories in Kerala is now offering the results through Internet so that you can access them from home or hospital.

However, bigger things are yet to come. Telemedicine is already in vogue and its practice will get deeper and wider. Electronic health records and personal health records will make communication between patients and doctors as well as doctors and specialists easier. Medical images could be moved on the fly and examined by experts. Mobile platforms will increasingly used for monitoring of patients and communication of medical information.

At the next stage, computer programmes will also undertake analysis of medical images. Algorithms are already being developed for these purposes and they promise to detect problems that doctors fail to identify. CT scans will come with analysis. (The casualty would be doctors who expertise in evaluating images will gradually go into disuse. Programs will not be free of errors, but doctors can put the blame on the machines.)

The vistas that new technology is opening up in the health care sector are tremendous. It will now be possible to ‘scan’ large populations for diseases and accumulated data could be sent for diagnosis and analysis for specialists. For example, local health care technicians could be trained to capture images such as that of the retina using small devices and sent to doctors for detection of various diseases such as diabetic retinopathy. Trials for detection of retinopathy have already been done this way in Australia. The United States is already implementing Health IT program through a National Coordinator for Health Information Technology. Incentives are being offered for adoption of the technology.

The Digital India initiative is to have components that focus on healthcare. Indian IT companies such as Infosys are already working on the design and programming part. Cognizant is also emerging as a major player in the area. So, it is high time that the Centre and State government starting training youth to tap the emerging opportunities. The government also needs to come up with guidelines to hospitals regarding inter-operability and other norms. Legal protection of medical data, encryption and other privacy concerns need to be addressed as we go digital.

Hat trick by Oommen Chandy

Sabarinath with CM

K. S. Sabarinath (Right) with Oommen Chandy

It was a hat-trick victory for Kerala Chief Minister Oommen Chandy and the ruling Front in Aruvikkara Assembly constituency on Tuesday. The United Democratic Front (UDF) had won by-elections earlier at Neyyattinkara and Piravom after Mr. Chandy came to power in 2011.

The result indicates that Mr. Chandy’s mass contact strategy is still working though some might be disappointed by the unchanging face of bureaucracy. It also shows that the corruption charges against the government did not have the impact that the Opposition hoped for. The failure of the candidate put up by UDF dissident P. C. George to garner even one per cent of the votes perhaps underlines this.

The UDF had cleverly fielded a new face in the election instead of a seasoned politician. Now, almost every citizen know that politicians routinely take money from businessmen including bar and quarry owners for doing favours. But UDF candidate K. S. Sabarinadhan could not be grouped with them as he has not been in politics before.

Vote sharesHowever, it is notable that opposition parties, including BJP, and NOTA carried away a vote share of 56.87 per cent while UDF’s vote share dropped by 9.17 percentage points (from 48.78% to 39.61%.). The Opposition Left Democratic Front (LDF) suffered a loss of 7.1 percentage points (from 39.61% to 32.51%). NOTA polled one per cent of the votes. The vote share of BJP increased by nearly four-fold from 6.61 per cent to 23.96 per cent.

It showed that BJP could extend the advances it made in Thiruvananthapuram at least partially to neighbouring constituencies provided that it has the right candidate and political climate. BJP’s O. Rajagopal had won 33.3 per cent of the votes in the Lok Sabha polls from Thiruvananthapuram constituency in 2014. Now, he has won 23.96 per cent votes from a neighbouring Assembly segment.

This does not mean that BJP can duplicate the performance in the Assembly elections in 2016. It simply lacks candidates of the stature of Mr. Rajagopal to be fielded in other constituencies. It is also notable that Mr. Rajagopal’s popularity is not as strong as in Thriuvananthapuram in Aruvikkara. His appeal may have also diminished compared to the time of Modi wave and loss of popularity of Shashi Tharoor (who defeated him in Thiruvananthapuram).

However, the BJP’s performance is a clear warning to both the UDF and LDF. They will lose votes if people find an alternative, perhaps even NOTA, if they take the voters for granted. People are also not ignoring issues like development. The UDF lost a lead in Aruvikkara panchayat of Aruvikkara constituency over issues of local development. It won because BJP took away votes of LDF also. by-electionRelated Post:
Crucial battle for Oommen Chandy in Kerala

Crucial battle for Oommen Chandy in Kerala

The by-election from Aruvikkara constituency in Kerala is a crucial battle for Ommen Chandy government, beleaguered by corruption charges.
Chief Minister Oommen Chandy has taken it upon himself to win the election by fielding a novice. He has already addressed or interacted directly with half of the electorate in the constituency.

by-election

Finale of by-election campaign in Aruvikkara constituency in Kerala. Photos: Roy Mathew

A victory in Aruvikkara will enable Mr. Chandy to claim that his government still has people’s support. The ruling Front will be winning the third by-election after coming to power in 2011. (It had earlier won by-elections from Neyyattinkara and Piravom).

A defeat would show that support for government has slipped. This would encourage his detractors and he will face increasing pressure over corruption, questionable associations and misdemeanors of his Ministers and his own office. Though challenge to Mr. Chandy’s Chief- Ministership is not as strong as before, a defeat in the by-election can spell serious trouble for Mr. Chandy.

The campaigning is throwing out characteristics of a neck to neck race. However, the chances of the ruling Front (UDF) or Opposition Front (LDF) making a significant advance at the finish line could not be ruled out. The UDF candidate K. S. Sabarinathan, being a novice, has the advantage of being unblemished. The LDF candidate M. Vijayakumar, on the other hand, has to carry his own baggage. He faces an unusual situation of a counter affidavit having filed against his affidavit given as part of his nomination papers.

electionThis may be first time that a counter gets filed against an affidavit filed by a candidate. This could now become a trend in future elections.
The BJP candidate O. Rajagopal is sure to carry away a notable number of votes from the UDF and LDF kitty. He had been runner up in elections from Thiruvananthapuram.

His party’s vote share in Aruvikkara in the Assembly election of 2011 was only less than seven per cent. Mr. Rajagopal, who is popular around Thiruvananthapuram, and his foray into an adjoining area is sure to increase BJP’s votes.

Related links:
Kerala Assembly election database
By-election results: Neyyattinkara and Piravom

Poison in food

If we look at officials records, the banning of Maggi noodles will look as an isolated incident. Maggi was the first instant noodles to be introduced in India in 1982 and the pre-1982 generation had not tasted anything like that before. However, the food item had hardly been examined critically though sometimes perceived as unhealthy having several additives and preservatives in it.

When the dust settles down, Maggi will bounce back. Many Indians would not have even heard of the controversy and they will continue to relish the foreign food. The Maggi incident will not be a lesson for either the authorities or the people. In fact, there are thousands of products in the market which can be worse than Maggi.

The Food Safety and Standards Act was enacted in 2006 with more stringent provisions than the erstwhile Food Adulteration Act. However, during the past nine years, the authorities have not cared to strictly enforce the Act, but for occasional tests and warnings.

The problem is not confirmed to large packaged food manufacturers. Many food items such as vegetables and grains in the market are contaminated or adulterated. Items procured by large manufacturers cannot be free of contaminants and it is not easy to test all the items that go into production. Many smaller operators cannot even afford to do any testing at all.

It has been found that excessive quantities of pesticides are being used in vegetables cultivated in Tamil Nadu and grains in Punjab. Sometime back, all samples of packaged chilly power sold in Kerala were found to

Potassium dichromate used as an adulterant in chilly powder affects resperatory system, liver, kidneys,eyes, skin and blood.

Potassium dichromate used as an adulterant in chilly powder affects resperatory system, liver, kidneys,eyes, skin and blood.

have highly toxic and carcinogenic potassium dichromate in it. Even products of well known brands had it. It turned out that they were procuring chilly powder from North India and was merely packaging and marketing it in Kerala without any testing. (It was more profitable for them to buy the powder than buy the raw material for powdering in Kerala.)

Nothing was heard of prosecution in these cases. And it is not known whether chilly power sold in Kerala still has potassium dichromate. Pesticide residues and contaminants sometimes become undetectable after processing. All these point to the need for stricter food safety enforcement covering the source to final product.

 

Rahul Gandhi’s ‘war over sea’, a misplaced adventure?

Congress vice president Rahul Gandhi is reportedly planning an outreach programme in Chavakkad in Thrissur district next week to take up the cause of traditional fishermen. The most pressing issue there is described as the woes of fishermen resulting from the Central Government’s decision to impose ban on fishing for 61 days. He is ill-advised to take up this issue as a shorter ban on fishing is not actually in the interests of traditional fishermen.

It may be recalled that the traditional fishermen had launched a series of agitations for three-month ban on bottom trawling during monsoon led by persons like Fr. Thomas Kocheri and Sr. Philomin Mary in the eighties. The mechanised boat owners were strongly opposed to the ban though it was aimed at conservation of fish resources.

Fishermen's agitation

Fishermen blocking the highway at Alappuzha in 1985 demanding, among other things, ban on trawling.      Photo: Roy Mathew

Congress leader K. Karunakaran was not in favour of the ban and had used police to suppress the agitation when he was the Chief Minister. However, even Congress supporters in the Dheevara Sabha were forced to take a stand in favour of the ban. The agitation led to appointment of various committees to study the issue. Finally, the government decided to have a shorter ban of about 45 days though this was not a scientifically sound decision. Expert committees had called for a longer ban during monsoon to cover the entire breeding season of fishes.

What has changed between now and then is that more of the traditional fishermen have become owners or workers of mechanized fishing boats. The same forces which opposed the ban for quick returns and lobbied with Karunakaran are now behind Mr. Rahul Gandhi’s move. The only difference is that more ‘traditional fishermen’ are now with them. However, this assessment would depend on whether someone is ‘traditional’ by birth or by use of the fishing gears.

Scientifically, the only thing that has changed is confirmation of the fact that all (economically valuable) fishes do not breed during monsoon. Experts in the eighties have either discounted this fact or did not have adequate data to come to a conclusion. This may necessitate deeper look into the recommendation and possibly modification of the ban on a regional basis. More important may be the need to declare marine reserves like wildlife sanctuaries.

A shorter ban will not fully serve the purpose and a two month ban is reasonable considering all the factors. However, stricter enforcement of ban on net types and mesh sizes will be more crucial to conservation of marine resources. Fishlings ought to be allowed to grow to certain sizes before they are harvested.

Related Report:

After land, Rahul to wage war over sea

India opposes ban on pollutants

Stockholm Convention

TO VOTE OR NOT TO VOTE: Delegates to MoP of Stockholm Convention vote on whether to take a vote on listing, by raising flags, in Geneva on Saturday. Photo: Secretariat of BRS Conventions

India has been blocking moves at the Conference of Parties of the Stockholm Convention on Persistent Organic Pollutants to list more chemicals for elimination from worldwide use. This precipitated a division for the first time in the history of the Conference— which used to take decisions by consensus, at Geneva on May 16, 2015.

The vote was for listing of pentachlorophenol, an organochlorine compound used as pesticide and disinfectant, for elimination (which will lead to ban on their production and use by member countries). Residues of the pesticide have been detected in the environment in wildlife and human biomonitoring studies.

Switzerland pressed for a vote on listing of pentachlorophenol after efforts to reach a consensus failed. The Conference first took a vote on whether matter should be decided through division. Then it voted 94 against two in favour of listing with eight abstaining. The decision is not binding on India.

The Conference this time was part of combined meetings of Basel, Rotterdam and Stockholm conventions. India opposed listing of trichlorfon at the Conference of Parties of the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade also, leading to deferment of decision for want of consensus. India was the only country to oppose the proposal.

It was after much remonstrance that India agreed to the resolution on elimination of endosulfan in 2011 with riders (specific exemptions that included use on multiple crop-pest complexes). Though the Convention came up with alternatives to endosulfan as decided at its 2011 Conference, India is yet take steps for ratification of the decision through approval of Parliament. This was despite findings of serious harm caused by the pesticide in Kerala and Karnataka, and possibly in West Bengal and Tamil Nadu also.

Observers had alleged that representatives of the pesticide lobby were present in the Indian delegation at the 2011 Conference of Parties to prevent the listing of endosulfan. It is not yet known whether similar situation arose this year also with new government in power. However, it is very clear that India’s opinion at the International fora is dictated by the interests of pesticide companies rather than its population or the world at large.

Regulation is lacking or unenforceable (for want of proper enforcement machinery, laboratories and political will) in India though a substantial portion of the food consumed in the country is contaminated to various levels. Pesticides are often applied unnecessarily and in excess of recommendations in agriculture fields as well as godowns in most States. A national level analysis by government of more than 16000 samples of vegetables, fruits, spices, grains and other food items showed that more than 500 samples had pesticide residues above the limits prescribed by Food Safety Standard Authority of India.

Kerala’s vulnerability to earthquakes: action lacking

Kerala is yet to take steps for reduction of vulnerability from earth quakes though the issue had come to the fore several times during the past two decades.

As many as 45 earthquakes had been recorded in Kerala during the 20th century. On the basis of assessment of about 65 earthquakes recorded in the 19th and 20th centuries, the Centre for Earth Science Studies here had stated that there was possibility of earthquakes of the magnitude of up to 6 on the Richter scale occurring in the State. (Sensitive instruments have recorded around 200 mild tremours in Kerala from 2001 besides a few of magnitude of less than 4.)

Earthquake chart

Historic earth quakes: from 19th century to 2001

The most vulnerable areas were in Kochi and Alappuzha where buildings sit on 400-metre-deep alluvial soil. These soil formations could get fluidised in the event of even moderate earthquakes leaving to devastation as hardly any of the buildings there are designed to withstand earthquakes.

The Kerala Assembly Committee on Environment had called for enforcement of national building code as back as in 2001. It had suggested that the strength of buildings in earthquake prone areas should be tested using the services of experts and measures taken to strengthen weak buildings. The quality of materials used for construction of multi-storeyed buildings should be ensured. Use of wood and bamboo should be encouraged in the construction of houses for the poor.

Though BIS standards exist, they are not being followed for building construction. Houses for even tribals were being built with concrete though many tribal communities liked to live in thatched homes. Though a five-year, UNDP-funded earthquake vulnerability reduction project was taken up in Thiruvananthapuram, Kochi and Kozhikode from 2003-04, nothing much was of heard of its results. The disaster management policy, drawn up in 2010, also remains largely on paper.

Now, it is hoped that the expert committee which is considering changes of to Kerala Municipal Rules would look into matters connected to seismic safety. It is high time that Kerala moved to quake-resistant constructions and retrofitting of buildings for safety, especially in risk prone areas of Kochi and Alappuzha.

Governor redeems

Finance Minsiter K. M. Mani

Kerala Finance Minister K. M. Mani presenting the Budget for 2015-16 in the Assembly on March 13, 2015 amidst vandalism by Opposition

Kerala Governor P. Sadasivam has at least nominally redeemed the prestige of Kerala legislature by warning legislators about their conduct.

A former Chief Justice of Supreme Court of India, Sadasivam will not have failed to notice the obvious break down of not only Constitutional norms but also gross violation of democratic principles by the Opposition. There is no place for vandalism in legislative bodies in a democracy. However, reaction from opinion leaders was generally muted while the ordinary people on the social media could do nothing more than lampooning the politicians.

The Governor’s remark that the happenings on the floor of the Assembly on Friday (March 13, 2015) may even justify submission of a report by the Governor to the President under Article 356 of the Constitution of India is a rebuke to both the ruling and Opposition fronts. What the Governor hints is the vandalism of the kind in the House amounts to Constitutional break down warranting dissolution of the Assembly.

The Speaker N. Sakthan could not maintain even a semblance of order in the Assembly because of his reluctance of use force. Normal practice in the House is to use the watch and ward to cordon the podium of the Speaker as soon as the Opposition starts disruption of proceedings. On Friday, the Opposition had started their protest even before the House was called into session. Speaker probably hesitated because he was new to the Chair and did not want to start with a direct confrontation with the Opposition and become a direct target of the Opposition in the coming days.

The Opposition leaders had gone to the Governor saying that the presentation of the Budget was not in order, after creating all the disorder. The Governor has indirectly rebuffed them by accepting the Speaker’s stand that the Budget was duly presented. The Speaker could not be seen as conducting the business of the House during the bedlam created by the Opposition who had also practically gheraoed the Speaker and thrown his chair off the podium in gross disregard to the prestige of the House and its privileges. (The procedures adopted in the House for presentation of the Budget could be irregular but could not be challenged in a court of law. The House is the final arbiter of its own procedures).

The Governor, who himself is part of the Assembly as head of the State, has hinted that the further proceedings on the Budget including passing of the demands for grants on account and Appropriation Bill should be done in an orderly fashion. He may not condone total absence of order and decorum.

 

Moving NGT on Mullaperiyar can boomerang on Kerala

Kerala’s move to approach the National Green Tribunal against raising of the water level in Mullaperiyar dam is likely to boomerang on Kerala.

Environmental arguments similar to those against raising of reservoir level can be raised against lowering the reservoir level also.

In fact, changes to the ecosystem created by the dam and its water will be more pronounced while lowering the water level.

Kerala’s argument is that the raising of water level in the reservoir submerged nearly four decades old vegetation just above 136 feet level in Periyar Tiger Reserve. Lush vegetation including some specialised species have grown in the local environment created by lowering of the water level.

Now, let us look at what will happen if water level is reduced to 132 feet as demanded by Kerala at one point of time, or eventual phased decommissioning of dam. Lowering of the water level will result in the water table going down in many parts of Periyar Tiger Reserve. This would cause a relative drought conditions in many parts of the Sanctuary compared to the present situation and will loss of biodiversity and density of vegetation. The specialised species will not survive in its original location.

Legal position:
Environmental impact argument is something rejected by the Supreme Court in its 2006 verdict itself. However, Kerala tried to raise it again when Tamil Nadu challenged Kerala’s dam safety legislation before Supreme Court. For doing this, it commissioned a scientist from West Bengal, who produced a study report within a matter of weeks. The report had several errors and it was essentially a reproduction of arguments made by KFRI over which Kerala had argued its case earlier. Though these mistakes had been pointed out, Kerala went ahead with producing the author as a witness before the Court. During cross-examination, he admitted he had copied from the KFRI report. This meant that Kerala had no new argument or point to be presented before the Court. Now, Kerala is trying to revive its lost cause by approaching NGT.  It is not even considering the fact that Supreme Court is above NGT.

In any case it will be a win-win situation for TN. If the NGT rejects Kerala’s prayer, TN will have another handle. If it upholds Kerala’s argument, TN can use it in future against lowering of the water level or decommissioning of the dam.

Kerala’s argument goes against what the State itself is proposing to do. The new dam it is proposing to build at Mullaperiyar will submerge some areas of Periyar Tiger Reserve. It is also seeking Central clearance for raising the height of Peppera dam near Thiruvananthapuram by at least three metres submerging about 80 acres of forest. Though the area submerged by increased water level in Mullaperiyar dam is larger than these, the forests that would be submerged by the new Mullaperiyar dam or augmentation of Peppara dam are part of ecosystems that are hundreds of years old. Obviously, much more value is to be attached to the latter.

Moreover, Kerala has done the same thing that TN is doing. Water level at Idukki reservoir had remained low for about three decades. Kerala carried out augmentation scheme under Idukki project to improve inflow. None batted an eyelid, when vegetation that grew over the period was submerged by increasing water level. Besides, the area being submerged at Mullaperiyar was leased to TN much before the enactment of environmental laws.

If we really care for environment (instead just using environmental arguments with the wrong belief that it will win a case in which the key issue is safety), we should demand environmental flows downstream of Mullaperiyar dam, abandon the proposal for new dam and seek phased decommissioning of the old dam.