India’s cultural pluralism its best defence

By Malini Parthasarathy

To question the patriotism of the Muslim community on the ground that it refuses to “worship” India as a concept is to make a mockery of the real meaning of patriotism and national loyalty. As the anniversary of the cataclysmic event of 26/11 draws near, undoubtedly the country will relive the painful and humiliating memory of its powerful financial capital held hostage for more than 36 hours by a group of murderous terrorists sneaking in from Pakistan, challenging the might and capabilities of the Indian nation. But instead of replaying those dark moments, Indians ought to remember with pride the aftermath of the tragedy. The days after the terror strikes saw a spontaneous nationwide outpouring of sympathy for Mumbai with all communities united in their anger and outrage at the impunity with which Pakistan-based jihadi terrorists had struck at India. Indeed the Indian national spirit triumphed in that dark moment with thousands of citizens of diverse cultural and social identities rallying together to support Mumbai in that traumatic phase. There was a remarkable absence of communal violence with even the Shiv Sena in Mumbai resisting the political temptation of baiting Muslims in that stressful period. As a new generation of Indians made the political class and the political system the targets of their ire, one refreshing change was that there was absolutely no focus on communal and social identities. Projected was a collective sense of “we Indians” against the external intruders. All this showed that the enduring sense of national unity was a solid asset that helped the country tide over what could have been a deeply disintegrative challenge. It is clear that with the United Progressive Alliance government emphasising its commitment to secular governance and the preservation of cultural pluralism, the minorities, especially the Muslim community, find little conflict between their civic identities as Indian citizens and their cultural and religious affiliations. When national identity is defined in cultural nationalist terms, the loyalty of minority groups to the national identity comes under intense pressure. In an increasingly disturbed security environment with terrorism sharpening in intensity in Pakistan, it is imperative that the UPA remain unswerving in its acknowledgment that without secularism and internal communal harmony, it would be difficult to fight terrorism. In a departure from its usual reticence, the election campaign for the 2009 Lok Sabha saw both Prime Minister Manmohan Singh and Congress president Sonia Gandhi asserting that terrorism and communalism were two aspects of the same challenge and that a country divided by communalism could not fight terror. The logic of that argument needs to be sustained forcefully today in the face of renewed challenges to the minority groups’ assertions of their cultural rights. The UPA must not allow the BJP which is battling its own internal demons to resurrect majoritarian Hindutva campaigns mounting pressure on the cultural rights of the minorities especially Muslims. The latest incident in which BJP leaders Murli Manohar Joshi and Mukhtar Abbas Naqvi have sought to put Union Home Minister P. Chidambaram and a section of the Muslim community on the defensive is a case in point. The 30th general session of the Jamiat Ulama-i-Hind at Deoband, western Uttar Pradesh adopted a resolution on November 3, upholding a fatwa of 2006 by the Deoband Ulema, describing the singing of the Vande Mataram as anti-Islamic because some of its verses were against the tenets of Islam. The Deoband clerics apparently took pains to ensure that their objections to the singing of the Vande Mataram were not to be seen as being unpatriotic. The resolution that was adopted said categorically “Patriotism does not require singing of the Vande Mataram. We love our country and have proved this several times but Vande Mataram violates our faith in monotheism that is the foundation of Islam … We love and respect the mother but do not worship her.” It went on to demand that “the issue of Vande Mataram should not be deliberately raised for causing communal discord and threat to law and order.” It was also pointed out after discussions amongst the participants in the meeting that the resolution was necessitated by the fact that the song was being introduced in several government schools in BJP-ruled States. It must be recalled that historically the Vande Mataram song did not become the national anthem precisely for the reason that it had strong Hindu connotations by depicting the Indian nation as Goddess Durga. Not only did Muslims object but virtually every other minority had objected, leading to the Jana Gana Mana being adopted as the Indian national anthem. The essence of the idea of cultural pluralism is to ensure that every religious or social group is allowed its own cultural space in which it has the right to practise its own beliefs and traditions. How would it be right to question the patriotism of Muslims and other minority groups because of their rejection of a song that is by no means the national anthem? To accuse the Deoband Ulema, a critical support group in the fight against terror, given that it issued a fatwa against terror last year, of “a separatist mindset” as the BJP’s Mr. Naqvi did on Wednesday is to needlessly provoke a confrontation. Mr. Chidambaram who had clearly made a special effort to underline the UPA’s commitment to cultural pluralism by participating in this conference did well to assert that “a nation can ignore its minorities only at its peril”, that Islam could not be viewed as “an alien faith” and that India was for Muslims, the land of their “forefathers” and of their “birth”. But subsequent attacks on his participation in the Deoband conference by Dr. Joshi and Mr. Naqvi, asserting that his presence gave legitimacy to the resolution opposing the Vande Mataram song appear to put the Home Minister on the defensive with his stating that he was not present when the resolution was passed. The UPA government, which in its second term has promised that it views communalism and terrorism as two equally dangerous aspects of the same challenge, must not waver in its defence of the rights of minority groups to have their unique cultural assertions. Given that the Indian national identity as defined in the Indian Constitution is anchored to civic and territorial parameters, there is no inherent conflict between loyalty to the Indian nation and a community’s own religious beliefs. To question the patriotism of the Muslim community on the ground that it refuses to “worship” India as a concept is to make a mockery of the real meaning of patriotism and national loyalty. As the framers of the Constitution wisely concluded decades ago, when they rejected the idea of including a reference to God in the Preamble to the Constitution, imposing such a concept would go against the spirit of the Constitution. As H.N. Kunzru told the Constituent Assembly during the debate on the Preamble, “Such a course of action is inconsistent with the Preamble which promises liberty of thought, expression, belief, faith and worship to everyone. How can we deal with this question in a narrow spirit?” For Dr. Joshi and his cultural nationalist colleagues to persist with describing the Deoband fatwa against the singing of the Vande Mataram song as “against the provisions of the Constitution” would be to misread recent Indian history. There can be no clearer assertion of the responsibility of the Indian state to provide for cultural pluralism and also of the rights of the citizens of India to enjoy cultural and religious freedoms, than is set out in the Indian Constitution. Cultural pluralism remains India’s strongest card and its best defence against attempts to wreck its integrity or weaken its national structure from inside and outside. Taken from http://www.hindu.com/2009/11/05/stories/2009110554830900.htm

Needed: ‘basic’ doctors of modern medicine

By Meenakshi Gautham & K.M. Shyamprasad

Opening more medical colleges is not the solution to India’s chronic shortage of doctors in the rural areas.

India is the largest supplier of foreign medical graduates to the United States and the United Kingdom. Yet, its own rural areas have remained chronically deprived of professional doctors. The historical antecedents of these shortages could be traced to a landmark health policy document, the Bhore Committee Report of 1946. That report constructed the concept of a ‘basic’ doctor as one trained through five-and-a-half years of university education. An alternative cadre of Licentiates who were trained over a shorter duration and who formed two-thirds of the country’s medical practitioners then, was abolished, in spite of strong dissent from several members of the committee. These dissenting comments must be revisited in the context of India’s persistently poor health indices and inadequate health services for the majority.

The report

In October 1943, the Government of British India appointed the committee to survey the state of public health in the country, and make recommendations for future development. The committee chaired by Sir Joseph Bhore, a senior civil servant, comprised eight British and 16 Indian members. The Bhore Committee Report, published in 1946, was meticulously drafted and reflected its members’ profound understanding of health matters. They presented statistics on the disease burden and attributed the poor state of health in the country not only to inadequacies in medical services and health personnel but also to the prevailing social ills — poverty, illiteracy, poor nutrition and unsanitary conditions.

The report is best known for providing the blueprint for a modern public health delivery system in India, along with the training of its personnel. Foremost among these was the ‘basic’ doctor of modern medicine who would be central to the delivery of primary healthcare. These were far- reaching recommendations and shaped the course of public health and medicine in independent India. But on closer examination, a number of flaws are revealed.

Two classes

There were two classes of medical practitioners of Western medicine at the time of the Bhore survey: graduates who underwent a five-and-a-half-year course in the medical colleges, and Licentiates (LMPs) who underwent a three-to-four-year course in medical schools. Of the 47,524 registered medical practitioners at that time, nearly two-thirds (29,870) were Licentiates and one- third (17,654) were graduates.

The report informs us that in the rural areas health care was delivered through sub-divisional hospitals and dispensaries that were managed mostly by Licentiates. Besides, there were large numbers of indigenous practitioners providing affordable and accessible healthcare to the masses.

The Bhore Committee proposed a three-tier district health scheme. A primary unit would be at its periphery, a secondary unit at the sub-divisional headquarters would provide more specialised services, and a district organisation would be in charge of the overall supervision of district-level health activities.

Though conceptually well-organised, the scheme was designed to cover only a fourth of the population in the first five years (78,080,000 out of a projected 315 million in the report) and less than half (156,200,000 out of a projected 337.5 million) over the next 10 years. The report was silent on how the needs of the rest of the country would be met.

Nonetheless, the committee recommended that the Licentiate qualification be abolished, all medical schools be upgraded to colleges, and all available resources be directed into the production of only one type of doctor. He or she would have the highest level of training — a five-and-a-half-year university training, similar to what the Goodenough Committee had proposed for Great Britain as the gold standard. The committee believed that there was no role in the modern medical scheme for indigenous systems of medicine and its practitioners: these systems were considered “static in conception and practice.”

Six members of the committee, five Indians and one Briton, put up a brave dissent. They repeatedly argued that in view of the manpower shortages, the country should use every possible means, including the shorter Licentiate course, to increase the number of trained medical personnel. They pointed out that England had abolished Licentiate teaching only after 100 years and Russia relied extensively on ‘feldshers’ (medical assistants) to run 48,000 dispensaries. They noted with anguish that since the new scheme would benefit only a section of the Indian population, “Public health over the remaining four fifth to one-half of the country… will atrophy. There will be no personnel like the licentiates even to help the regions and institutions which will come under neglect.”

Prophetic

The dissenters’ views proved prophetic. They said that the “basic doctor would not willingly fit into the rural scheme.” India’s six decades of chronic shortages of doctors in the rural areas are grim testimony to this fact. They argued that “while a majority on the committee can abolish the licentiate, they cannot prevent other practitioners, practising a variety of systems of medicine, taking his place.” Time has proved this also to be a prescient observation. Studies show that since Independence and even today, much of health care at first contact in rural India is delivered not by qualified doctors but by informally trained and unlicensed private practitioners.

What happened to the highly trained basic doctor of the future?

The Bhore Committee estimated that around 15,000 doctors would be needed in the scheme in the first five years, and around 30,000 over 10 years. As the number of medical colleges roughly doubled during this period (from 19 in 1946 to 42 in 1956) it can be estimated that the number of graduates also doubled.

It is difficult to obtain exact data on how many graduates entered the health system over 10 years, but almost all of India’s Five-Year Plans and national health policies since 1947 have lamented the shortage of doctors in the rural areas.

What is definitely known is that around 10 years later, in the early 1960s, nearly 18,000 graduate doctors from the Indian sub-continent migrated to the U.K. in response to Health Minister Enoch Powell’s call to save the U.K.’s rapidly expanding National Health Service (NHS) from a staffing crisis. In November 2003, a BBC documentary “From the Raj to the Rhondda: How Asian Doctors Saved the NHS,” acknowledged the contributions of doctors from the Indian sub-continent to Britain’s most deprived areas, where no British doctor was willing to go.

Even today, the second largest proportion of doctors registered with the U.K.’s General Medical Council, by country of qualification, is from India: they number 25,720, or 11 per cent of the total. India also provides the largest pool of international medical graduates to the U.S.

Turf protection

Medical historians point out that the Indian doctors who collaborated with colonial rule were the ones who stepped into positions of power after 1947. Their socialisation into the western model meant that the “development of medical practice in India did not follow the pattern that was being advocated for developing countries at the time. Indian degrees were quite suitable for working in England, but probably totally irrelevant for working to the benefit of the vast majority of the Indian population.” (Professor Aneez Esmail, 2007)

Ironically, even less-trained providers can efficiently deliver primary care. However, efforts to revive a Licentiate type of cadre, as recommended by the National Health Policy 2002 and outlined by a Task Force on Medical Education in 2007, have been non-starters. This is due to resistance from a section of the country’s medical fraternity which carries a turf protection mindset, supported by obstructive legislation contained in the Indian Medical Council Act of 1956.

An alternative

In view of the obvious deficiencies in India’s overall rural infrastructure, it is unlikely that the rural areas will have a sufficient number of doctors over the next several decades. Thus, the solution to India’s doctor shortages does not lie in building more medical colleges. A better alternative would be to draw from other countries’ experiences of developing mid-level practitioners: Clinical Officers and Medical Assistants in Africa, Physician Assistants in the U.S., Nurse Practitioners in Canada, and the rural doctors in China who number more than a million. These cadres are typically trained for three years and empowered to provide clinical services. Studies so far suggest that their performance and outcomes are in no way inferior to that of doctors trained for longer periods.

In the short term, India must also upgrade the skills of existing unlicensed rural practitioners and empower government nurses and pharmacists to take on additional tasks. An alternative to the IMC Act is the Drugs and Cosmetics Act that empowers States to recognise practitioners other than MBBS-holders to provide a limited range of medical care services. Chhattisgarh has invoked this power to create a three-year diploma course for Practitioners of Modern and Holistic Medicine.

(Meenakshi Gautham, PhD, is a public health specialist ( gautham.meenakshi@gmail.com);K. M. Shyamprasad, M.Ch., FRCS, is a former vice president of the National Board of Examinations, MoHFW, India ( shyamprasad@nlhmb.in). Legal inputs have been received from Indira Unninayar, Supreme Court Advocate.)

Taken from http://www.hindu.com/2009/11/05/stories/2009110554760800.htm

Taliban denies Peshawar blast role

The Taliban and al-Qaeda have distanced themselves from Wednesday's deadly market blast in Peshawar that claimed 105 lives, saying "their main targets are the security forces, and not innocent civilians".

The Tehreek-e-Taliban Pakistan (TTP), in a statement sent to the media on Thursday, condemned the car bomb attack that tore through a crowded market and denied any involvement in the explosion.

Taken from http://english.aljazeera.net/news/asia/2009/10/2009102995252334582.html


Taliban Chief Blames Blackwater for Peshawar Blast

Pakistani Taliban chief Hakimullah Mehsud has claimed that the controversial American security firm Blackwater was behind the deadly bomb attack on a market in Peshawar that killed over 100 people.

Hakimullah questioned why the Taliban should target the public when it was capable of carrying out attacks in Islamabad and targeting the army's General Headquarters.

In an interview with BBC Urdu, he claimed Blackwater and "Pakistani agencies" were involved in attacks in public places to discredit the militants.

A powerful car bomb exploded at a crowded market in Peshawar yesterday, killing more than 100 and injuring 200 more. No group has so far claimed responsibility for the attack.

The Tehrik-e-Taliban Pakistan had earlier said it was behind an attack on the army's headquarters earlier this month.

About 15 people were killed during that attack. A group of militants took nearly 50 people hostage before they were gunned down or blew themselves up.

Reports in the Pakistani media have claimed that Blackwater has established a presence in the country by tying up with local security firms but these allegations have been rejected by the US administration.

Taken from http://news.outlookindia.com/item.aspx?668599