Up to 1-in-5 TB deaths attributed to tobacco use

Up to 1-in-5 TB deaths attributed to tobacco use

With 50% of all deaths from lung disease linked to tobacco use, control of the substance is high on the agenda of the 39th World Conference on Lung Health in Paris, France.

“Up to one in five TB (tuberculosis) deaths could be avoided if TB patients were not smokers,” Dr Nils Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease (IUATLD), said during the conference.


Smoking is also associated with recurrent TB and people with the disease who smoke have a higher risk of mortality than non-smokers with TB. The scaling-up of tobacco cessation services for people with TB is therefore a clear priority.


Dr Mario Raviglione, Director of the Stop TB Department under WHO discussed the Practical Approach to Lung health (PAL) with delegates at the conference. The approach focuses on comprehensive treatment for all respiratory conditions and diseases, not just TB.


About 80% of smokers live in low and middle-income countries and 520 million people will die from tobacco-related illnesses in the next 50 years, according to available data. By 2030 the annual number of deaths from tobacco will increase from five million to more than eight million.


The IUATLD has helped raise awareness of tobacco hazards, encouraging its partners to play an active role in tobacco control and recognize the link between tobacco and TB.


It has also promoted effective tobacco control policies through technical resources, training a new generation of managers and practitioners and supporting effective programs through grants.

WHO and the union published a joint monograph on TB and tobacco control in 2007 and key elements of the policy include the identification and offers of counselling for smokers assessed for TB or other respiratory diseases.

The monograph also called for the operation of smoke-free public health centres and the training of health workers to deliver smoking cessation treatment.


Concerns over the high rates of tobacco use among doctors and healthcare providers in high TB-burdened countries were also raised during discussions at the conference. In some regions more than 50% of healthcare workers use the drug, making it difficult for them to play a genuine role in tobacco cessation programs.

Living on the outside: The impact of diabetes-related stigma

Living on the outside: The impact of diabetes-related stigma

"Who will marry my daughter who has diabetes?" asks Ram Anuj, a native of Ganga Jamuni village, Bahraich district in India. Ram Anuj's 14 years old daughter Munni (name changed) has type 1 diabetes and needs daily insulin injections.

The family members stopped sending Munni to school when other children made fun of Munni when she took her insulin. In a village-setting, giving insulin injections to Munni, is a public knowledge. Munni often gets scorned for being a burden on the family. Munni's family doesn't have enough money to take adequate care of her and provide the treatment she needs.

Stigma-related to diabetes, is particularly more pronounced for girls. Stigma in response to illness is not a new issue in some parts of the world. Stigma has long been associated with mental illness, physical disability, leprosy, cancer and tuberculosis. However, diabetes-related stigma is particularly severe as diabetes is a life-threatening chronic condition. Stigma is particularly complex as it operates at many different levels and has both social and psychological aspects. Diabetes-related stigma at the workplace or in the community and self-stigma has adverse impact on the mental health and feeling of wellness of people with diabetes.

Primary definitions of stigma usually refer to Irving Goffman (1963) whose text provides seminal critique: "Stigma can be seen as an attribute that discredits the individual, denying full social acceptance, and where notions of social inclusion and exclusion are firmly brought to the fore."

There are many factors surrounding stigma including denial, shame, blame, fear, rejection and discrimination. For any child or adolescent living with diabetes, learning to cope with it is often a daunting task.

Dealing with a chronic illness such as diabetes may cause emotional and behavioral challenges, at times, leading to depression. The need for high-quality counseling sessions, for the people with diabetes and their family members, is paramount at the diabetes care and treatment centres, which may eventually help combat stigma. It may also help them to adjust to the lifestyle changes needed to stay healthy.

"Counseling and emphasizing that diabetes is not a disease but a metabolic condition and every person with diabetes should be referred to as a 'person with diabetes' and not a 'diabetic patient' will go a long way in reducing the diabetes-related stigma" stresses Dr Sharad Pendsey, a noted expert on diabetes, who runs a charitable trust - Diabetes Research Education And Management Trust (DREAM Trust, www.dreamtrust.org) in New Delhi. This trust provides free insulin, syringes, blood glucose monitoring strips and complete healthcare to the poor children with Type-1 diabetes. "Our centre has an education wing where diabetes educators regularly conduct educational classes, one to one counseling with patient and the family members. We have counselors at our centre and we have noticed a remarkable change in reducing diabetes related stigma" shares Dr Pendsey.

In addition, lack of skilled healthcare staff, apart from the treating diabetes physician, exacerbates the situation. There are not enough nurse educators, diabetes counselors, nutritionists, podiatrists (foot experts) and other health educators to help raise awareness and understanding of unique care and treatment needs of people with diabetes in society. This not only fuels the diabetes-related stigma but also reduces the quality of healthcare for people with diabetes. The treating physician is usually single-handedly dealing with all the different responsibilities of being a counselor, educator, doctor, nutritionist, podiatrist, to name a few. "The patients' inability/ unwillingness to pay for this additional support also hinders the treatment" says Dr Surendra Khanna, a Physician at Diabetes Centre in Kanpur.

According to International Diabetes Federation (IDF, www.idf.org), over 250 million people live with diabetes around the world. In addition, more than 200 children are diagnosed with type 1 diabetes every day, requiring them to take multiple daily insulin shots and monitor the glucose levels in their blood. Currently, over 500,000 children under the age of 15 live with diabetes. With such an enormous number of people with diabetes requiring attention, it is clearly vital to make the treatment, care and support services for people with diabetes made available in public sector hospitals without any further delay.

"Diabetes-related stigma can block access to existing diabetes-care services. If people with diabetes are felt to not be well anymore, then many mainstream systems do not want to spend their scarce resources on them, when they are fighting to have enough antibiotics and IV fluids to combat infections and diarrhoea, still the leading causes of death in children in the developing world. There are not enough specialists in many regions who are knowledgeable of diabetes to take care of all the children," said Mr Phil Riley, Campaign Director, World Diabetes Day Campaign (www.worlddiabetesday.org).

On this year's World Diabetes Day (14 November), let's hope that governments and other stakeholders will commit themselves to invest resources in mobilizing communities in a radical scale-up of awareness programmes, health education initiatives and treatment literacy efforts directed towards not only those living with diabetes but also their family members and people in the community. To reduce the diabetes-related stigma, and to create an enabling environment where people living with diabetes can live a normal healthy life, it is crucial to spread the message that often with appropriate lifestyle modifications type 2 diabetes is preventable, and that proper, affordable and accessible treatment, care and support programmes for people living with both type 1 and type 2 diabetes exist.

Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS). Email: amit@citizen-news.org)


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Children with diabetes Forum

Whither The Light Of Democracy

Whither The Light Of Democracy
Shobha Shukla

Deepawali is the festival of lights which is celebrated all over India . It marks the advent of the winter season and signifies peace and prosperity and the victory of truth over evil. This year’s Diwali (it falls on 28th October) is a bleak one indeed.

As I peer hard through the darkness of hatred and violence, I struggle to find a single ray of bright hope. The atrocities committed by the British Raj on the Indian citizens during its rule in India are now being re enacted by another Raj - the megalomaniac, self styled leader of the Marathas. He seems to be holding the common people to ransom with nary a soul daring to lift a finger against him. The seeds of hatred (between different Hindu communities) so systematically sown by him in Mumbai, some time ago, are spreading like tenacious weeds throughout the country. His diktats against non-Maharashtrians (perhaps with a view to forging new political alliances) have resulted in large scale arson, stampedes, insensitive rioting mobs and killing of innocents - all in the name of protecting the interests of Maharashtra state.

The recent backlash against him in Bihar has killed more innocents, holding public life and security to ransom. And as trains are being torched, public property being damaged and commoners being attacked in the name of avenging misdeeds of the Maharashtra Nav Nirman Sena, Raj Thackarey is being accorded a hero’s welcome by his goons in Mumbai.


Fiery statements by politicians for and against the Mumbaikars are helping in opening a Pandora’s box, with ‘an eye for an eye’ and ‘two slaps for one slap’. It is no longer just Hindus versus Muslims or Christians. New battle lines have been drawn now with one Indian state pitched against another; one caste targeting another caste; all in the name of achieving new political objectives. But does anyone care for the moral objectives?

All of us seem to have become impotent in not being able to control the actions of one madman. Neither the judiciary, nor the government, nor the executive has done anything ( sans issuing the bail able warrant of arrest against him) to douse the fire of hatred and violence that started from Mumbai and is now spreading to other states. The chief minister of U.P.recently feared for the safety of Maharashtrians in other states, thereby hinting subtly at more retaliations rather than reconciliations. Our prime minister, Dr. Manmohan Singh seems to be more affected by the current financial crisis (the economist that he is) rather than the human crisis ( the non humanist that he seems) engulfing the nation. Violence is begetting violence and no political party, worth its salt, is opposing it. They are busy planning strategies for the winning the forthcoming elections. Why should they care for the common person on the street who has lost his/her property, job or even life in the senseless mania that seemed to have gripped the powers that be?

Let us pray to God to give us some sanity on this festival of lights so that we can dispel the darkness of ignorance and wayward behaviour of a miniscule few who are holding humanity to ransom.


Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

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Care for children and adolescents living with diabetes

Care for children and adolescents living with diabetes

"Diabetes is a deadly disease, and each year, almost 4 million people die from diabetes-related causes. Children, particularly in countries where there is limited access to diabetes care and supplies, die young", according to International Diabetes Federation (IDF) which is an umbrella organization of over 200 member associations in more than 160 countries. IDF leads World Diabetes Day (www.worlddiabetesday.org) which falls on 14th November. The campaign is focusing its efforts on raising awareness of diabetes in children and adolescents.

Diabetes is one of the most common chronic diseases to affect children. Every day more than 200 children are diagnosed with type 1 diabetes, requiring them to take multiple daily insulin shots and monitor the glucose levels in their blood. It is increasing at a rate of 3% each year among children and rising even faster in pre-school children at a rate of 5% per year. Currently, over 500,000 children under the age of 15 live with diabetes, according to IDF.

Since diabetes often requires life-long monitoring, care and treatment, is hospital-based approach better than home-based care approaches or a mix of these two approaches for effectively responding to care needs of those with diabetes?

Dr Sonia Kakar, a New Delhi based doctor, said: "hospital-based approach should be for the management of acute and/or chronic complications arising out of diabetes. But as 99% of diabetes care is self-care, empowering people with right information can make home-based care approach more feasible and economical."

She also felt that, "adolescents often have the motor and cognitive skills to perform all diabetes-related tasks and determine insulin doses based on blood glucose levels and food intake. Thus, they must be supervised in their diabetes tasks and allowed gradual independence with the understanding that the independence will be continued only if they adhere to the diabetes regimen and succeed in maintaining reasonable metabolic control."

"During mid-adolescence, the family and healthcare team should stress upon the teenagers the importance of checking blood glucose levels prior to driving a car to avoid hypoglycemia while driving" stressed Dr Kakar.

Managing diabetes in children and adolescents becomes more effective when the entire family gets involved. Families should be encouraged to share their concerns with physicians, diabetes educators, dietitians, and other healthcare providers to get help in the day-to-day management of diabetes. Extended family members, teachers, school nurses, counselors, coaches, day-care providers, and other resources in the community can provide information, support,and guidance regarding skills to cope with the disease.They may also act as resource persons for health education, financial services, social services, mental health counseling, transportation, and home visits.

"Diabetes is stressful for both - the child as well as his/ her family. Parents should be alert for signs of depression, eating disorders or an unexplained loss of weight and seek appropriate medical help. While all parents should talk to their children about avoiding tobacco, alcohol, and other drugs, this is particularly important for parents of children with diabetes. Smoking and diabetes, both increase the risk of cardiovascular diseases and those people with diabetes who are smokers are at an increased risk of heart/ circulatory problems. Hence parents/ family members of children/ adolescents living with diabetes should refrain from tobacco use in order to avoid sending wrong signals to their wards" recommends Dr Anoop Misra, Director and Head, Department of Diabetes and Metabolic Diseases, Fortis Hospitals New Delhi and Noida.

Depending on their age and level of maturity,children living with diabetes should be encouraged to take care of themselves. Most school-age children can recognize symptoms of hypoglycemia and if they are over 12 years old they may be able to take insulin injections of correct dosage by themselves. They can also be involved in planning their diet chart.

Treatment of diabetes in adolescents is complex and should only be handled by experienced physicians. Also, such patients should be looked after by a team consisting of diabetologist, nutritionist, diabetes educator, and psychologist.

Educating people with diabetes about diet, exercise and drugs is the most important part of the initial management of the disease and should be accomplished in several sessions. Insulin management should be discussed and demonstrated to children and parents, so that they can take insulin injections themselves. Parents, along with their children, should be made aware about healthy eating habits, physical exercise, and dosage management of drugs/ insulin.

IDF is bringing together key opinion leaders to push for action to secure care for the thousands of children with diabetes in developing countries without access to care at a meeting in London on October 25. The meeting, Access to Essential Diabetes Medicines for Children in the Developing World will focus on ways to help keep more children alive and healthy with diabetes. Ministries of Health from various developing countries, leaders from the pharmaceutical industry, philanthropic foundations, leading supply-chain management firms, diabetes associations, as well as professional societies in paediatrics and diabetes education have been invited to the meeting.

Close to 75,000 children in low-income and lower-middle income countries are living with diabetes in desperate circumstances. These children need life-saving insulin to survive. Even more children are in need of the monitoring equipment, test strips and education required to manage their diabetes and avoid the life-threatening complications associated with diabetes.

"We are bringing together the people and the organizations that can provide not only the interim humanitarian response to save lives but can lay the groundwork for sustainable solutions that will benefit all children with diabetes," said Dr Martin Silink, President of the International Diabetes Federation (IDF).

Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS). Email: amit@citizen-news.org)

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Not only the rich are at risk of diabetes

Not only the rich are at risk of diabetes

[To listen to the audio podcast of this article, click here]

A media report labeled diabetes as a lifestyle disease. Rightly so, but it doesn't imply that poor and underserved communities are not at risk of diabetes. In fact, the World Diabetes Day (WDD) was created by the International Diabetes Federation (IDF) and the World Health Organization in 1991, to draw attention of the world community towards escalating incidences of diabetes amongst the rich and poor, old and young alike. WDD is celebrated world wide on 14th November, on the birth anniversary of Fredrerick Banting, co-discoverer of insulin.

"Diabetes is affecting all classes of our society, be it rich or poor, high caste or low caste, urban or rural residents. So it is no longer the disease of the rich alone," said Dr Ambady Ramachandran, Director, India Diabetes Research Foundation (IDRF), Chennai, Tamil Nadu. In a recent study conducted by IDRF in the South Indian state of Tamil Nadu, prevalence rates of diabetes were found to at par in rural and urban areas, dispelling the misconception that diabetes is only affecting the rich living in urban areas.

Dr Ramachandran further said that "Diabetes exerts a life-long financial burden for treatment. It is not only the cost o
f medicines but the recurring costs of ongoing home monitoring, laboratory investigations and hospitalizations also add to the financial burden. Also, the changing prevalence of disease patterns is likely to increase the burden of chronic diseases like diabetes in developing countries such as India."

According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 40.9 million people with diabetes in India in 2007 which is about 16.7% of the global number of people living with diabetes. This number is predicted to rise to almost 70 million people by the year 2025. The countries with the largest number of people with diabetes will be India, China and USA by 2025. It is estimated that every fifth person with diabetes will be an Indian. The economic burden on India due to such a high incidence of diabetes is amongst the highest in the world.

India is, therefore, often referred to as the 'diabetes capital of the world'. Several studies have revealed that the prevalence of diabetes is increasing in rural areas too. However, there are no diagnostic tests available at Primary Health Centres for diabetes or diabetes-related complications. Dr Viswanathan Mohan, Director, Madras Diabetes Research Foundation, Chennai, Tamil Nadu said that "there is an urgent need to establish diagnostic centres for diabetes at every ante-natal clinic (ANC) especially in rural areas to detect and reduce the burden of diabetes at an early stage in children and adolescents".

Comparatively, the urban adolescents are more prone to type-2 diabetes than those residing in the rural areas. These urban adolescents have a higher intake of refined cereals as well as high fat and calorie-dense foods. Moreover, they are less likely to engage in regular physical activities. These factors lead to an increased incidence of obesity and consequently a higher risk for the onset of type-2 diabetes at an early age. Overall, patients with young-onset type-2 diabetes are only found in urban areas, and more so in affluent households. On the other hand, type-1 diabetes can occur equally in urban or rural areas. India is a land of famines, floods, local conflicts, large population and a high illiteracy rate. All these factors, coupled with uncertain economic conditions, are likely to impede the diabetes' prevention and awareness programmes.

It may be pertinent to mention here that the theme for World Diabetes Day 2008, (www.worlddiabetesday.org) as envisaged by IDF is 'Diabetes In Children and Adolescents', keeping in mind the increasing incidence of diabetes in youth. This is a matter of grave concern and needs to be tackled. No child should die of diabetes.

Dr Sharad Pendsey ,an expert on diabetes, runs a charitable trust - Diabetes Research Education And Management Trust (DREAM Trust, www.dreamtrust.org) operational in New Delhi/ Noida region which provides free insulin, syringes, blood glucose monitoring strips and complete health care to the poor children with Type-1 diabetes. Dr Pendsey said that "children should be routinely screened for diabetes at diagnostic centres and appropriate follow- up action should be taken , as agreed upon by the primary healthcare providers and the diabetes experts". Dr Pendsey emphasized on the role of boosting up primary prevention strategies to limit or delay the onset of diabetes which will prove cost-effective as well.

Without primary prevention strategies at the public health level, the number of undiagnosed and uncared for people with diabetes will increase, as also the number of complications arising out of this disease, thus requiring a higher technological input. This in turn will limit access to health care for a large numbers of patients.

Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS). Email: amit@citizen-news.org)

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India should strengthen its public distribution system to reduce food scarcity

India should strengthen its public distribution system to reduce food scarcity
Sarika Tripathi

The Food and Agriculture Organization (FAO) of United Nations has recently issued a report which reveals that currently there are 75 million (7.5 crore) people in the world who have fallen victim to famine and if the current crisis of price rise persists this count may reach the total of 920.25 million (92.25 crore).

India too is facing the same harsh situations where poorest of the poor of our country have to go to bed hungry. But at this crucial time when the country expects some stringent steps from the government’s side, it is defending itself by saying that food crisis is a global problem which has already struck over 30 countries, most of which have witnessed food riots. It is not interested in finding and disclosing the root cause of this havoc.

The FAO report further says that in 2007-08 there has been a 52% increase in the price of grains and that of fertilizers has doubled. In India, the retail price of many food commodities have seen a sharp rise in the past six months- pushing te inflation level around 12 at the end of September. Experts have cited various reasons behind this food crisis like increasing population, growing inclination towards bio-diesel crops, weakening of US currency, frequent natural calamities. Even the US president blamed Indians of eating more due to growing purchasing power. But in Indian context the pro market biased policies of the government and “planned weakening” of Public Distribution System (PDS) to benefit corporate sector are responsible for food crisis. Though the signs of the food and agricultural crisis were noticed by the government in its early stage but it continued with its neo liberal policies to benefit corporate sector. All this liberalization has been done under the pressure of US and World Bank who have been constantly pressurizing India to break its tariff walls and open its market for wheat import. It was due to their influence only that India became a wheat importer from wheat exporter. All this was done to benefit major grain corporate companies like Glencore, Cargill India and the Australian Wheat Board. This imported wheat was unaffordable for the poor people of India.

In spite of rising inflation and panic regarding food availability our government still believes that to sustain in world economy we need investment and support of corporate companies. The Economic Advisory Council to the Prime Minister advocates the role of corporate sector in agriculture and says that activities other than food grain production like commercial crops, horticulture etc. have contributed most to agricultural GDP. The council recommends removal of subsidies related to grain procurement and Public Distribution System, making more room for the private sector in agriculture and promoting contract farming. These recommendations were made as per the wishes of US and World Bank who have asked India to shift from subsidy based agro-economy to more diversified agriculture sector so as to allow corporate companies to enter this sector.

To give entry to various giant grain corporations, the Indian government slowly and systematically weakened its Public Distribution System (PDS) by slowing down grain procurement, especially wheat. Taking advantage of this situation Multi National Companies like Glencore, Cargill India, the Australian Wheat Board, Indian companies like ITC and Adani group procured 30 lakh tones of wheat as compared to the government’s 9.2 million between 2005-07. Due to this reduced procurement by public sector, a number of families which comes under Below Poverty Line (BPL) and collect subsidized rations from Fair Price Shops were devoid of their bread. The cost of wheat decided by corporate companies is far away from their purchasing power. This disrupted the supply and demand ratio and food insecurity prevailed in the country.

FAO’s Assistant Director General Hafez Ghanem has emphasized on two important points. First, to make available grains for poor countries of the world. Second, to encourage small scale farmers to improve crop productivity. Now, it’s the high time when the Indian government should also realize that those small scale farmers, who are the worst sufferer of liberal agro-economy, can be made a key to the solution of food crisis. The agricultural sector of India is mainly covered by small and marginal farmers, so our government should promote small scale agriculture. Besides, the agriculture sector should be solely covered by the public sector from investment up to marketing and distribution. Even if there is any kind of corporate investment, that should be properly regulated by the public authorities.


Sarika Tripathi

The author is a Correspondent of Citizen News Service (CNS) and also a post-graduate scholar of Public Health Management at Lucknow University in India. She can be contacted at sarikasarika_49@rediffmail.com

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World Food Day (16 October): World food scarcity and the challenges of climate change and bio energy

World Food Day (16 October)

World food scarcity and the challenges of climate change and bio energy

Shobha Shukla


‘Rarely has the World Food Day assumed greater meaning than in present times, as rapidly rising food prices risk increasing the number of hungry in the world,’ according to the Food And Agriculture Organization (FAO).

FAO was founded in 1945 on the 16th of October - a day which is observed as World Food Day (WFD) in about 150 countries all over the world. The theme for this year’s WFD is ‘World Food Scarcity : The Ch
allenges Of Climate Change And Bio Energy’ as there is a strong need to expand global awareness to reduce the effect of severe climate patterns on agriculture and the impact of bio fuels on food production.

Global warming and the bio fuel boom are threatening to push the number of hungry even higher in times to come. During 2007 alone, around 50 million more have been added to the rank of the world’s hungry due to rising prices, thus pushing the number of unfed to about 900 millions. The world seems to be further distancing itself from reaching the U.N. Millenium Development Goal of halving hunger and poverty by 2015. Poor harvests, high oil costs, bio fuels and a rising demand for basic staple crops, especially in fast growing Asian countries, have been cited as examples for the spiralling food prices which have sparked protests, even riots, prompting the U.N.Secretary General Ban Ki Moon to give a wake up call.


Global wheat prices have more than doubled during the past year due to poor weather conditions in some wheat producing areas (droughts in Australia and Europe); a shift by farmers to growing crops used in making bio fuels; and speculation by traders.
. Though India is being touted as one of the world’s hottest economy, nearly 50% of the world’s hungry live in it. It is listed as a low income, food deficit country, with about 25% of its population subsisting on Rs.12 or less, a day and around 77% living on less than $1 a day ( according to the latest report of National Commission for Enterprises In The Unorganized Sector). It does boast of having a burgeoning 350 million strong middle class with improved diets ( which was lamented by Ms.Rice and Mr.Bush to be one of the causes of the global food price crisis). Yet around 35% of its population is food insecure, consuming less than 80% of the daily minimum requirement and it has the dubious distinction of having the highest rate of malnutrition in children below three years of age in the world (about 46%).

Today, India faces an agricultural crisis and hunger, which are due to not only current high prices of basic staples, but skewed up government policies too. Her rapid economic growth and accompanying shortages have also fuelled prices. State support for agriculture and irrigation has been slashed, price support reduced and the public distribution system drastically curtailed.. While the GDP grew at the rate of 8.5% in 2006-2007, the growth in agricultural sector was a mere 2.6%.Also marginal land holdings have increased and total cultivated land decreased, especially as more and more agricultural land is being seized by domestic and international corporations in the form of ‘Special Economic Zones’ for industrialization (as happened in Na
ndigram and to some extent in Singur).

The results have been disastrous as many studies show that agricultural growth reduces poverty and hunger much more than urban and industrial development. A spate of farmer suicides ( about 150,000 during the last decade) is a rude reminder of our agrarian crisis and the grip of cash cropping on poor farmers, bolstered by seed and chemical agribusiness.
India has belatedly sought to control prices by holding back essential commodities, curbing export of non-premium rice and waiving off loans of farmers. Obviously more needs to be done than mere cosmetic changes.

There is an urgent need to improve productivity of dry land farming (as 60% of India ’s agriculture is rain dependent) as well as a better implementation of the National Rural Employment Programme and the Public Distribution System.

The director general of FAO, Dr. Jacques Dious, has called upon governments to pay urgent attention to needs of agriculture and water management and also increased investment in agriculture. At the recent Rome Summit held in June 2008, he pointed out that in 2006 the world spent 1.2 trillion dollars on arms. He asked, ‘Against that backdrop how can we explain to people of good sense and good faith that it was not possible to find $ 30 billion a year to enable the hungry to enjoy the most fundamental human right to food and thus the right to life.’ Yet it has been estimated that there is enough food for all in the world, at least 2700 kilo calories per person, per day.

But it is the lack of purchasing power (more than food shortage due to population explosion and inclement weather conditions) which makes so many millions go to bed hungry every day.
Hunger is linked to the denial of a living wage to the working poor. It is about denial of land to the landless. It is caused by socio economic policies that deny people the right to food. Resources are there to end hunger, but they are exploited by a miniscule few to the detriment of others So the real reason for all this hunger and poverty may well be policy and not scarcity; politics and not inevitability. The real culprits are economies that fail to offer everyone opportunities and societies that place economic efficiency above compassion.

As we Indians gloat over our victory in the recently concluded Nuclear Deal and as Ratan Tata and his Nano are hailed as an engineering marvel, let us do something sincere and concrete to put some food inside empty bellies. That then would be a truly Indian Miracle. Till then, let each one of us at least refrain from over eating and throwing away left over food in the dustbin.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

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President and princess on plenary podium

"There is so much more we could do with resources", said Ugandan President Yoweri Museveni, addressing the first plenary session at the XV International AIDS Conference on "Access to resources: commitment and accountability".

Summarising Uganda's achievements in combating HIV/AIDS, President Museveni stressed the reduction in prevalence of HIV there has been the result of a broad-based national effort backed by firm political commitment, including his own involvement.

Uganda, one of the first countries in sub-Saharan Africa to experience and take action against HIV/AIDS, is a rare success in a region ravaged by the epidemic. While the rate of new infections continues to increase in most of sub-Saharan Africa, Uganda has succeeded in lowering very high infection rates.

Since 1993, HIV infections in pregnant women - a key indicator of the progress of the epidemic - have more than halved in some areas, and infection rates among men seeking treatment for sexually transmitted infections have dropped by over a third. Uganda is the first African country to have reversed the spread of the disease, giving hope that the tide can at last be turned.

The political commitment President Museveni identifies has meant the involvement of a wide range of partners, including religious and traditional leaders, community groups, NGOs and many other sectors of society. Key was the forging of a consensus on the need to contain the spread of HIV, and to provide care and support for those affected.

The president used political rallies and public broadcast messages, especially by radio, to educate the Ugandan people.

President Museveni added that through additional funding from the Global Fund and the US President's Emergency Plan For AIDS Relief, supplies and infrastructure are in place to begin treating HIV-positive people with antiretroviral drugs.

Jean-Francois Rischard, vice-president of the World Bank, made an address on the subject "Global problem-solving in the 21st Century: desperate times deserve innovative approaches". He discussed the urgent need for new global problem-solving approaches; the clock is ticking inexorably towards "high noon" - also the title of his book - before time runs out to resolve the world's 20 most urgent problems, ranging from global warming and water shortages to communicable diseases such as HIV/AIDS.

These problems are all interlinked, Mr Rischard said, and there is an urgent need to discuss appropriate responses.

He dismisses the idea of global governance, citing the European Union, which has been trying to become a regional government for the last 50 years. Instead, he proposes "Global Issues Networks", comprising government experts in the relevant fields, international civil society organisations and businesses. Different networks deal with each of the 20 big issues. He suggests that such networks are a real possibility for better and faster global problem-solving. They would be able, he argues, to reach a rough consensus towards the necessary action.

A striking example of effective collective action was the "Montreal Protocol" on ozone-depleting substances, which had seen a rapid reduction in the production of ozone-depleting gases. But this is the exception, Mr Rischard warns. For networks to work, he said, India and China must participate, since these nations represent about one-third of the world's population.

Critical review of funding mechanisms was discussed by HRH Princess Mabel of Orange-Nassau, currently with the Open Society Institute (OSI). The challenges, she said, are to increase available funding for HIV/AIDS in low- and middle-income countries, to improve donor co-operation in support of national plans and frameworks, to develop comprehensive programmes and to make necessary policy changes.

Princess Mabel argued that these objectives can achieved by involving civil society and other stakeholders in program design and implementation, and by streamlining and harmonising donor procedures. Comprehensive programmes should prioritise needs and not be based on ideology. They should also address controversial aspects of HIV/AIDS, and look at tackling structural, political and legal barriers. Underlying health structures should be strengthened, she added.

The "three ones" principles also received endorsement from Princess Mabel, who sees them as a means to achieve the most effective and efficient use of resources, and to ensure rapid action and results-based management. As she explained, the principles are:

    * One agreed HIV/AIDS action framework that provides the basis for co-ordinating the work of all partners.
    * One national AIDS co-ordinating authority with a broad-based multi-sectoral mandate
    * One agreed country-level monitoring and evaluation system.

Princess Mabel went on to mention the new funding initiative from the US: the President's Emergency Plan for AIDS Relief (PEPFAR), which favours a bilateral approach. Canada, France, Germany, Italy, Japan and the UK have also increased their funding, and the increasing contributions of Ireland, the Netherlands, Norway and Sweden are impressive, she said.

She continued by praising the Global Fund for being participatory, and addressing the problems it is experiencing. But, she said, it is at a critical juncture, and will need at least $3.5 billion in 2005, of which only $880 million has been pledged so far. She noted that French President Jacques Chirac and others have suggested that the Fund's needs should be provided on the following basis: one-third from the US, one-third from the EU, and one-third from other countries and private sources. While recipients need to use AIDS funds effectively, international donors must also increase the impact of their efforts, she said.

"The business response to HIV/AIDS" was presented by Tsetsele Fantan, project leader of the African Comprehensive HIV/AIDS Partnership. Since the XIV International AIDS Conference in Barcelona, international focus has increasingly shifted towards addressing HIV as part of a continuum between the workplace and the community. Indeed, a growing number of national business coalitions and industry associations are supporting national responses, and the Global Business Coalition on HIV/AIDS has doubled its membership since 2002.

Speaking about the Debswana mining workplace programme, Ms Fantan added that HIV/AIDS is a business issue requiring effective leadership, adequate resources and a commitment to manage its impact. The programme extends productive lives through the provision of antiretroviral therapy. Debswana encourages voluntary counselling and testing, and employees and spouses who test HIV positive receive treatment. In 2003, Debswana agreed to introduce the government's antiretroviral scheme at their mine hospitals.

A company should not operate in isolation, said Ms Fantan; it is important to engage other stakeholders from the business area and community. She continued by saying that effective monitoring of impacts requires good information management, and this will help inform better decisions.

Ms Debswana concluded by stressing how, in developing countries, sustainable access to healthcare can be provided through public-private partnerships, where the government delivers the minimum standard of care, the private sector brings skills and core competencies and the donors bring funding and other resources. The public and private sectors are complementary, she insisted, and effective public-private partnership is about structured co-operation and collaboration.

Given the examples presented , it appears that such partnership, combined with innovative approaches to funding, can help increase access to essential services based on structures already in place.

Ishdeep Kohli-CNS

People with diabetes lose more than money

People with diabetes lose more than money
Amit Dwivedi

"It is not about money. No amount of money will give back my limb" said a 65 years old woman with diabetes (name withheld on request) who underwent limb amputation at the Gandhi Memorial & Associated Hospitals (GM & AH).

She couldn't have been right in conveying the message in the lead up to the World Diabetes Day, 14 November 2008, to prevent many diabetes-related complications that are extremely devastating.

"Diabetes ups the risk for heart disease and stroke" said Dr Rishi Sethi, who works with Department of Cardiology at CSM Medical University.

"This increased risk to stroke and heart diseases can be lowered by keeping blood glucose (also called blood sugar), blood pressure, and blood cholesterol close to the recommended levels. Reaching your targets also can help prevent narrowing or blockage of the blood vessels in your legs, a condition called peripheral arterial disease" advises Dr Sethi.

"People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness - loss of feeling - in the hands, arms, feet, and legs" informed Professor (Dr) Rama Kant, who heads the diabetic foot unit at CSM Medical University (formerly King George's Medical College) in Lucknow, India.

"Another major diabetes-related complication is related to kidneys. People with diabetes are prone to develop a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease (CKD)" explains Prof Kant.

"Will you be surprised to learn that diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases" says Prof Kant. "Even when diabetes is controlled, the disease can lead to CKD and kidney failure" adds Prof Kant.

However the diabetes-related complication which had devastated the life of the 65 years old woman in GM & AH (who is quoted above), is diabetic foot. "The foot of the patient with long-standing diabetes is often the site of neuropathic and vascular growth which poses a considerable threat, not only to the lower limb but also to the life of the patient" warns Prof Kant.

Relatively diabetic foot is one of the leading causes resulting in long hospital stays for people with diabetes. It demands much care and attention by both the patient and healthcare personnel. Two major problems which predispose the patients with diabetes to amputation are the development of neuropathy due to uncontrolled diabetes over several years while result in damage to the nerves in the feet leading to the loss of sensation. They also develop certain high pressure points under the feet which result in the formation of callus which later turns in to an ulcer. In addition cigarette smoking will lead to nerve damage and reduced blood flow in the feet.

With increasing age, people with diabetes may develop diminished sensation and decreased peripheral circulation in the feet, and thus are at a heightened risk of developing foot infections.

Prof Kant lists some ways people with diabetes can take care of their feet:

1. Keep feet clean – wash them regularly.

2. Use only lukewarm water – no hot water, heating pads, hot water bottles, iodine or alcohol.

3. Keep the feet dry – especially between toes-use unscented lotion or cream to keep skin soft.

4. Use only medicines recommended by your doctor

5. Cut toe nails straight across, not deep into the corners to help avoid ingrown toe nails.

6. Never use razors, knives or corn caps to remove corns.

7. Wear shoes or slippers at all times -never walk bare foot even at home.

8. Wear good fitting shoes/slippers - not tight or worn-out ones. Boots should be used only for short periods.

9. Check your feet daily and see your doctor immediately about foot problems.

"Diabetes costs a lot to the people, much more than money" says Prof Kant.

According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 40 million people with diabetes in India in 2007 and this number is predicted to rise to almost 70 million people by the year 2025. The countries with the largest number of people with diabetes will be India, China and USA by 2025. It is estimated that every fifth person with diabetes will be an Indian. Due to these sheer numbers, the economic burden due to diabetes in India is amongst the highest in the world.

International Diabetes Federation (IDF) is striving to raise awareness about diabetes, and advocate for standard treatment facilities globally.

With few weeks to go for this year's World Diabetes Day, 14 November 2008, which in India, is also observed as Children's Day to commemorate the birth anniversary of India's first Prime Minister Jawahar Lal Nehru who was known for his affection towards children, let us hope that the awareness related to diabetes can be upped phenomenally.

Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS). Email: amit@citizen-news.org)

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The Wrath Of God

The Wrath Of God
Shobha Shukla

The wrath of gods seems to be descending on the religious Indian masses with perilious frequency as stampedes at pilgrimages kill more people (361 in 2008 alone, and 875 in the last ten years) than even bomb blasts.

The latest in this series was the early morning stampede this month on the first day of Navratra (the nine days religious festivity celebrated all over India) outside the Chamunda Devi Temple on a hillock adjoining Mehrangarh Fort in Jodhpur .

As a 10,000 strong crowd of devotees surged forward in the wee hours of 1 October 2008, a barricade broke and some men lost their balance on the slopy terrain, made slippery by the flowing coconut waters. The resulting mayhem left 150 dead and several more injured.


Similar unfortunate tragedies have struck in the past in different parts of India (and even abroad in Mecca). Of course, a little more foresight and proper management on the part of organizers could have avoided these mishaps. But with every passing year, the sheer increase in the number of devotees, gathering at religious places, is mind boggling indeed.

As we move forward in the new millennium, our blatant show of religious fervor is increasing at the same rate as our tolerance level is decreasing.
The ever increasing number of puja pandals set up in different cities on Ganesh Chaturthi ( a popular festival of Maharashtra) or on Durga Puja ( a popular festival of Bengal) bear testimony to religious practices becoming corporately nationalistic. We seem to be inventing new religious functions and icons every day, perhaps to pep up our drab existence.

In the late eighties, a new, hitherto unheard of, goddess by the name of Santoshi Mata became very popular. Women devotees (even from high brow society) thronged her temples (which suddenly manifested everywhere) every Friday after a day long fast. Some enterprising producer even made a film on the goddess, which became an instant hit, raking record profits at the box office and increasing her following. At that time, we also had Sai Baba (the one with flowing robes and a fleet of cars) devotees who would swear to the miracle of holy ash/water oozing from the walls of their prayer rooms amid the chants of devotional songs. Both these figures seem to have lost their sheen now and have been replaced by new findings on the block.

One of the latest to head the popularity chart is Shirdi’s Saibaba. Temples dedicated to him invite long lines of bhakts every Thursday, holding the traffic to ransom in many Indian cities. Add to this the ever increasing crowds at Hanuman temples on Tuesdays and at the ‘devi jagran’ pandals, set up in the middle of already congested roads, with night long blaring of loudspeakers, during Navratri. Our ingenuity has even made us to temporarily construct the famous Vaishno Devi shrine, in our own city, enabling the gullible to reap the benefits of the pilgrimage without even making it. Fasting during the month long period of Ramadan/ nine days of Navratri/ forty days of Lent, or turning a veggie on certain days is the latest fad.


Such a leap of faith should give us spiritual peace and moral strength to combat explosive situations in a peaceful manner. Instead, it seems to be giving us the immoral sanction to rape and kill innocents. The more we throng temples, the more we patronize religious gurus (even the television channels are brimming with their discourses), and the more we pretend to be pious during certain periods the more fanatical we are becoming in our outlook.

As religion becomes a saleable commodity, filling the coffers of temple owners/priests, it is making us poorer in human values, creating more chasms than bridging differences; making us more intolerant and fearful of each other than compassionate; more hateful than loving. So we do not hesitate to indulge in violence of the mind and the body - killing in the name of family honour/ ethnic cleansing/ defense of religious faith. Anger is becoming a collective energy and religion is giving us a Christian, Hindu or Muslim mindset instead of a humane mindset. Religious bigotry is fuelling the ambitions of the overfed to manipulate the emotions of the underfed for selfish and partisan gains.


We have not only become religion conscious but caste/region/ class conscious as well, thanks partially to a skewed up reservation policy and communal agendas of political parties. The sudden spate of sabhas (congregations) like Agarwal Sabha, Brahmin Sabha, Kayastha Sabha etc. speaks of our ghetto mentality. How often do we find two Bengalis converse in their regional language, unmindful of the presence of the others in their group who do not understand it. In our excitement, we tend to forget even the rudiments of basic civility.

Perhaps God wishes us to not make a false show of our religious sentiments by thronging temples but to make our children and ourselves more compassionate and tolerant in our actions. Violence as an expression of our hurt has led to more mass violence and terrorist strikes. Non violence has to become a practical imperative as ‘an eye for an eye’ is making us blind to the needs of others, to love and peaceful co existence, to the respect for others’ right to life.

Let God’s will prevail upon everything else and let us start worshipping human values in the precincts of our hearts instead of mouthing hollow words in defense of our shallow religious ideologies.
Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

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