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THE CONSUMMATION OF DALIT ASSERTION

THE CONSUMMATION OF DALIT ASSERTION

Dr Sandeep Pandey

The rise of Bahujan Samaj Party and Mayawati to power in Uttar Pradesh has been remarkable.

There has been a corresponding rise in political consciousness of dalits which has made a serious dent in the oppressive vertical system of exploitation based on caste hierarchy. This has, of course, been preceded by a similar assertion of backward caste politics in the post Mandal phase. Until 20 years back in Hardoi district an upper caste man could give a call to all Chamars of a village to come to work on his field and it would have been v

ery difficult for any of the Chamars to defy the order. Similarly, the newly married bride in a fisherfolk community of Ballia district, until the previous generation, would have to spend the first night at the upper caste Zamindar's house because the entire community was living on a land provided by the Zamindar.

Once when this community had voted for a political party out of their own choice the Zamindar had passed an edict banning them from using his land for the purposes of excretion. The community had to apologize and promise to vote according to Zamindar's wish in future elections. Such has been the tyranny of the caste system. These inhuman practices are slowly becoming history as Mayawati creates history of her own.

What Mayawati, representing the most vulnerable segment of the society, has been able to achieve is unthinkable in the American democracy or any other country of the world for a long time to come. She has wrested power from the powerful in a patriarchal feudal system entrenched in a casteist framework supported by mafia and criminal. The Congress party was trying its best to woo back its dalit vote bank. It instead lost the Brahmins and Muslims to Behenji as well. Mayawati is on top of an alliance which once formed the bedrock of Congress party, the only truly genuine national party in the country. The only difference is that whereas the upper caste dominated leadership of Congress was controlling the dalits, this time it is a dalit controlling the rest. The Congress party remains a sorry bystander in this upturning of hierarchy. Howsoever progressive Congress might be, it would have never tolerated an independent thinking dalit leader.

With Mayawati's coming to power everyone assumes that law and order situation would improve and atrocities against dalits would mitigate. She has already announced the long overdue increase in minimum wages of unskilled workers from Rs. 58 to Rs. 80 per day for eight hours of work. It is a definitely more progressive step than Mulayam Singh’s dole of Rs. 500 as unemployment allowance per month to the educated youth. Whereas successive pay commissions have typically increased the salaries of service classes, nobody has paid attention to a proportionate increase in daily wages for unskilled labourers. The daily wages continue to be abysmally low compared to the incomes of other segments of society across the country.

However, Mayawati is known to be an idiosyncratic and erratic politician. Her autocratic ways allow little space for democracy within the party. Her methods of distributing election tickets to the largest bidder do not create the sense of loyalty for the party or its ideology which is needed in the time of crisis. Professionals who see politics as an instrument of making money can be easily lured away by a more attractive offer, as Mulayam Singh proved during the last term of UP assembly.

Having acquired political equality the dalits are now hoping to climb the social and economic ladder as well. In fact, most of the benefits meant for poor dalits in the form of various government schemes through the panchayats or through schemes like the PDS or NREGS do not reach them, forcing them to live in situations of extreme poverty and deprivation. BSP must concentrate on these if it seriously intends to carry out upliftment of the dalits. Mayawati must move out of the obsession to indulge in symbolism politics of Ambedkar Parks to more concrete things which will impact the lives of ordinary dalits in the state. There is no denial that politics of symbolism has played an important role in the dalit assertion. The statues of Dr. B.R. Ambedkar in every village have given a sense of identity and self-respect to the dalits. This silent movement for the assertion of dalit rights stands in importance next to the freedom struggle and the JP movement in recent history. There has been a feeling of liberation just like in the other two struggles. But having accomplished the political victory the dalit movement has to now chart a course for the social and economic well being of the dalits. Reservations in educational institutions and jobs can help only a small fraction of dalits. We need a blueprint for the development of the ordinary dalit who is too poor to compete. This is the challenge of the future.

The combination with upper caste, especially Brahmins, which is being hailed as potent, has serious pitfalls. The political class which has always cornered all benefits flowing from the system is working overtime to subvert the BSP agenda. There is a danger of the take over of BSP by contractor-mafia raj working through suave upper caste politicians and bureaucrats. Unless Mayawati and the dalit leadership within the party is extremely careful of this attempt of subversion and can be guided by their absolute commitment to the cause of dalits, BSP is in danger of being reduced to any other opportunist political party.

In her past stints as Chief Minister, Mayawati has given little attention to the well being of dalits. Dalits found it as tough to get cases registered under the SC/ST (Prevention of Atrocities) Act as ever and state SC/ST Commission provided no relief either. Matters related to violence against women also suffered a casualty in her regime. Neither did the situation of landless dalits, hoping to take possession of their legitimate pieces of land allotted to them by the panchayats, improved. All the other benefits through the panchayats continued to be siphoned-off by the unscrupulous elements. There was no clamp on corruption in the various schemes which could have possibly resulted in more benefits flowing to the dalits. With the possible exception of Ambedkar villages there was no overall improvement in delivery efficiency of the administrative system or justice to the poor.

It is hoped that a more mature Mayawati, having survived the Taj Corridor folly, would probably bring governance and development on her agenda and go down in history as more than a politician who indulged in politics of symbolism.

http://www.indianexpress.com/story/202579.html
Indian Express, 26 June 2007

http://www.newindpress.com/newspages.asp?page=2&Title=Second+Article&
The New Indian Express
26 June 2007

Swatantra Bharat, full page supplement on World No Tobacco Day, 31 May 2007

Full newspaper page supplement
Swatantra Bharat
National Hindi Newspaper
31 May 2007

Published on: 30 May 2007
(AMIT DWIVEDI, Dr Rama Kant and Dr Madhu pathak)

After 20 years, Hashimpura survivors find hope in RTI Act

Published in:

The Hindustan Times, 27 May 2007: http://www.hindustantimes.com/

Rediff News: 25 May 2007
http://www.rediff.com/news/2007/may/25bobby.htm

The Seoul Times (South Korea): 25 May 2007
http://theseoultimes.com/ST/?url=/ST/db/read.php?idx=5353

Pakistan Tribune: 25 May 2007
http://www.paktribune.com/news/index.shtml?179173

Asian Tribune (Sri Lanka and Thailand): 25 May 2007
http://www.asiantribune.com/index.php?q=node/5860

Two Circles.Net: 24 May 2007:
http://www.twocircles.net/2007may24/hashimpura-survivors-file-615-rti-applications-20-years-long-pursuit-justice.html

After 20 years, Hashimpura survivors find hope in RTI Act

Hashimpura survivors file 615 RTI applications after 20 years long pursuit of justice

Bobby Ramakant

Even years after the sordid Hashimpura massacre in Uttar Pradesh, in which Provincial Armed Constabulary (PAC) personnel allegedly gunned down over 40 people on 22 May 1987 (all muslim), justice remains still out of sight.

On 24 May 2007, two survivors and many members of 36 families of those killed on the fateful day of Hashimpura bloodbath came to Lucknow – UP’s state capital - to file 615 applications under The Right to Information Act 2005, at the office of Director General of Police demanding critical information pertinent to the case.

The Right to Information Act which came into force on 12 October 2005, empowers every citizen with the right to inspect works, documents, records, take notes, extracts or certified copies of documents or records, and obtain information in form of printouts, diskettes, floppies, tapes, video cassettes or in any other electronic mode or through printouts in largely all government agencies across the country (except J&K).

The Hashimpura massacre occurred during the communal riots that broke out in Meerut in May 1987. Apparently, the immediate provocation was the Rajiv Gandhi-led Central government's decision to open the Babri Masjid for worship by Hindus. Curfew was imposed and PAC personnel conducted a search-and-arrest-operation in several Muslim localities in the city. On 22 May 1987, they booked hundreds of Muslim youth from Hashimpura, though there was no rioting in that area of Meerut city. Also there were hindu localities in Hashimpura as well, which weren’t affected by PAC’s operations.

About 50 of them, all muslim and mostly daily wage labourers and poor weavers, were taken by PAC in a truck from Hashimpura Mohalla in Meerut to the Upper Ganga canal in Murad Nagar, Ghaziabad, instead of taking them to the police station. They then shot some of them, one by one, and threw them into the canal.

RTI Act gave a beacon of hope to people impacted by Hashimpura massacre who have been relentlessly striving for justice since past 20 years. The triad of police, administration and judicial system made all efforts to delay or even expunge the case in some instance. After 20 long gaping years, out of 164 witnesses, only 3 prime witnesses have given statements so far in the court. How many decades more do the courts need to bring to books those who were responsible for this gory and shameful mass killing of innocent people?

They are asking the State to tell them why these PAC accused have not been suspended from service while being prosecuted for custodial murders? What departmental proceedings and disciplinary action, if any, were initiated against them? Why was there a delay of almost a decade in even charge sheeting the PAC accused? Why were most of those indicted by the CB CID Report let off the hook? They are asking for the CBCID Inquiry Report into the PAC killings to be made public.

Zulfikar Nasser, one of the survivors of Hashimpura Massacre, narrated the blood-curdling experience of seeing two persons being shot and thrown into the canal. "I was the third in line. I was pulled out of the truck and as I fell down, I was shot," he said. The bullet hit him in the underarm. He feigned death by holding his breath. The PAC personnel threw him into the canal, said Nasser. He escaped, concealing himself in bushes. He heard relentless cries for help and sounds of bullet shots. "I could hear thuds after the bodies of 15 or 16 persons were thrown into water."

Another survivor Mohamed Naem, who was of 17 years then in 1987, said that when few people were dragged out of the truck by PAC, shot mercilessly and thrown in the canal, out of utter desperation and hopelessness, they attacked the PAC personnel within the truck. PAC fired aimlessly injuring many. One of them was 22 years old Quamruddin, who got shot in the abdomen and fell upon Mohamed Naem who was 17 years then. Later when Naem was pulled out of the truck, he was thrown into the canal mistaken for being dead. He survived and clung onto the shrubs near by and witnessed the mindless fenzy.

In 1988, the State government ordered an inquiry by the Crime Branch - Central Investigation Department (CB-CID). The CB-CID 's report, submitted to the State government in 1994, was never made public. In 1995, some of the victims moved the Lucknow Bench of the Allahabad High Court to make the report public and to prosecute those indicted in it.

The CB-CID filed the charge-sheet only against 19 of the PAC personnel although 66 PAC personnel were indicted by it earlier.

Between the years 1997-2000 the court issued 23 warrants summoning the accused policemen but none appeared.

Finally, 13 years after the massacre, 16 of the 19 accused surrendered in groups in May 2000. Although their bail applications were initially rejected by the CJM, the accused managed to obtain bail from the court of the District Judge, Ghaziabad.

In 2001, the victims filed a petition before the Supreme Court asking for the case to be transferred from Ghaziabad to New Delhi as the conditions there would be more conducive to the trial. The Supreme Court transferred the case to Tis Hazari in New Delhi. In November 2004, the government appointed Surinder Adlakha as Special Public Prosecutor.

After 19 years of the Hashimpura massacre, finally in May 2006, the Court framed charges against all the accused PAC men for murder, conspiracy to murder, attempt to murder, tampering with evidence etc under Sections 302/ 120B/ 307/ 201/ 149/ 364/ 148/ 147 Indian Penal Code.

Maulana Mohammad Yamin, the President of Hashimpura Legal Advisory Committee, said that “This case is about the first instance in which those who were appointed to keep the peace carried out attacks in cold blood.”

The 18 rifles used by PAC jawans to allegedly mow down over 40 muslims of Hashimpura in 1987 were redistributed among the personnel of the force. The shifting of the case property - vital evidence - from the custody of the investigating agency has put a question mark on the judiciary. Legal experts are calling it a "destruction of evidence" on the part of the investigating agency.

The Hashimpura massacre proves how difficult it is to prosecute police personnel accused of communal crimes. According to Vibhuti Narain Rai, who was then Superintendent of Police in Ghaziabad when Hashimpura massacre took place, and is a senior police official in UP today, most of the police personnel posted in Meerut thought the riots were a result of Muslim mischief. They believed that Meerut had become a "mini-Pakistan" because of "Muslim intransigence" and that it was necessary to teach the community a lesson. This bias is only exacerbated by the State's reluctance to prosecute police personnel as seen in the Hashimpura trial.

The fight against communalisation requires drastic changes in the policy of recruitment, training and syllabi of the police. The percentage of minorities, especially Muslims, is only 5 to 6 per cent in most States. Massacres like those of Hashimpura, are a result of a deep and inherent communal bias in the leadership of the police. Unless we reserve some seats for minorities, this bias may never go.

It is the courage and spirit of the people to strive for the truth and justice that can put a stop to the mindless fake encounters, custodial deaths and communal killings, which pose a grave threat to Indian democracy and human rights.

Bobby Ramakant

Published in:

The Hindustan Times, 27 May 2007: http://www.hindustantimes.com/

Rediff News: 25 May 2007: http://www.rediff.com/news/2007/may/25bobby.htm

The Seoul Times (South Korea): 25 May 2007: http://theseoultimes.com/ST/?url=/ST/db/read.php?idx=5353

Pakistan Tribune: 25 May 2007: http://www.paktribune.com/news/index.shtml?179173

Asian Tribune (Sri Lanka and Thailand): 25 May 2007: http://www.asiantribune.com/index.php?q=node/5860

Two Circles.Net: 24 May 2007: http://www.twocircles.net/2007may24/hashimpura-survivors-file-615-rti-applications-20-years-long-pursuit-justice.html

HYDERABAD BLASTS: Wake up call for secular India

HYDERABAD BLASTS:

Wake up call for secular India

Bobby Ramakant

The people of secular sovereign India have stood strong and more resolved for peace and amity, even at the wake of repeated attacks on religious places. These have only exposed the nefarious designs of a handful of those behind these terror attacks. Undoubtedly these repeated acts of terror have put us through one of the gravest tests of courage, patience, commitment to peace and humane social order.

Another attempt to thwart the communal harmony in India was made on Friday 18 May 2007 when a crude RDX bomb exploded near the historic Mecca Mosque in Hyderabad. Apart from that, there were two live bombs recovered from the spot and defused.

There have been repeated attempts to instigate different religious communities in the past.

Two explosions that took place in quick succession inside the historic Jama Masjid in Old Delhi when the devout were offering prayers on a Friday evening of April 2006. The first explosion took place at around 5.30 pm, when devotees were preparing for 'Asar' (evening prayer) near a pond used by them for ablutions.

Syed Ahmed Bukhari, the Shahi Imam of Jama Masjid, had then made an appeal to the people of India to “maintain communal harmony and to defeat the designs of those who want to disrupt the peaceful co-existence between Hindus and Muslims”.

On the eve of 2005 Diwali, bomb blasts went off in Sarojini Nagar market, Paharganj and a bus in Kalkaji area of Delhi, killing more than 50 people.

Ajay Sahani, Terrorism Expert of Institute of Conflict Management, had then said, "It is clear that objective was to incite violence within the country. But the good thing about today's event and the event in Varanasi [blast at the temple and railway station] was that people were not reacting in frenzy and people behind the blasts were not succeeding."

Similar sentiments reinforcing secular feelings were expressed. Even media restrained and demonstrated sensitive and responbile journalism, in the wake of ugly events of terror and strife.

An overwhelming majority of people in India have realized the vested interests of handful of those who mastermind these terror attacks on religious institutions and thankfully have refused to be instigated by them. By not spewing venom and hatred, we have made the efforts unsuccessful of those who pull the terror-trigger.

Home Secretary Madhukar Gupta reviewed the national security situation in the wake of the bomb explosion at the Mecca Masjid in Hyderabad during Friday prayers (18 May 2007).

Steps were taken to ensure that the communal violence, which erupted in some parts of Andhra Pradesh, does not spill over to other parts of the country.

The Indian Home Ministry has alerted all the state governments to be vigilant about the anti-social elements seeking to use the Mecca Masjid incident to whip up communal passion and create disturbances to upset peace and harmony.

Noted social activist and Magsaysay Awardee Dr Sandeep Pandey said that “Despite of piercing ache in our hearts, we feel all the more committed to make the voices of the majority heard – majority of us hindus and muslims don't want violence and hatred between people, there is a small minority of people indulging in acts of violence and terror, and they don't represent us.”

Few people have been resorting to such brutal ways to invoke undue hatred and anguish, and undoubtedly cause an irrevocable loss of human life.

We also believe that our response in this grim and sad hour of grief should not be of hatred and revenge - rather our commitments to peace and non-violence should be as determined as possible. The perpetrators of violence want to invoke hatred, we must be resolute to not yield to their demands. This is the time to test our steely resolve - to peace, love and harmonious co-existence.

I consider it as a wake up call for the secular India, and we have been ignoring the blaring sirens for long. The struggle to establish a just social and humane order, impacting the lives of most underserved communities, is indeed a long one. It is the time for all of us to dawn our often-neglected roles of being a responsible citizen of secular India as well.

Bobby Ramakant

(The author is a senior health and development journalist, writing for newspapers in Asia, Africa and Middle East. He can be contacted at: bobbyramakant@yahoo.com)

Health Ministry alert on iron-deficiency anaemia

Health Ministry alert on iron-deficiency anaemia

74% children between 6-35 months anaemic

Bobby Ramakant

Union Ministry of Health and Family Welfare gave a high priority to iron-deficiency anaemia. On 23 April 2007, it issued a notification and guidelines to make iron and folic acid (IFA) distribution across India a success.

Iron deficiency remains a major nutritional problem among infants and young children in India. The recent National Family Health Survey III that more than 74 per cent children between the ages of 6-35 months were anaemic.

Vitamin A deficiency is being addressed through nationwide biannual distribution of vitamin A solution to infants, young children, and fortification of foods.

However, little progress was made to eliminate iron deficiency. The Iron continued to remain as most "neglected micronutrient" in spite of its higher magnitude of problem and more serious health consequences.

Regular use of Iron-Folic Acid (IFA) supplements protects a woman's health by helping her body store iron, and preventing a plunge into iron deficiency anaemia (IDA) during pregnancy and delivery. IDA results in low birth-weight babies, morbidity, and maternal mortality. In addition, IFA provides a woman with sufficient folic acid before pregnancy, preventing neural tube defects that can occur during the first few weeks of fetal gestation.

The World Health Organization estimates that 43% of all women of reproductive age living in the developing world have IDA. IDA during pregnancy results in more than 60,000 maternal deaths each year. Folic acid deficiency during pregnancy causes more than 200,000 neural tube defects. Many countries' attempts to combat iron deficiencies during pregnancy with the distribution of iron folate through prenatal clinics has proved less than successful because many women in developing countries do not seek prenatal treatment or do so too late to take advantage of iron folate.

There is strong scientific evidence from community-based studies that iron deficiency anaemia is associated with impaired performance on a range of mental and physical functions in children like mental development, physical coordination and capacity, cognitive abilities, social and emotional development, and loss of intelligence quotient similar to iodine deficiency. The other health consequences are i) poor scholastic performance; ii) reduced immunity; iii) increased morbidity; iv) increased susceptibility to heavy metal (including lead) poisoning. The precise effects vary with the age groups studied. Recent studies have documented that the iron supplementation at a later age may not reverse the effects of moderate to severe iron deficiency anaemia that occurred during the first 18 months after birth.

The recent notification of Union Ministry of Health and Family Welfare gives a high priority to the problem of Nutritional anaemia by including all children and young people for Iron and Folic acid distribution falling in the age-bracket 6 - 60 months, 6- 10 years and 11 to 18 years.

The policy regarding IFA (Iron Folic Acid) supplementation which was approved is as follows:

1) The infants between 6-12 months should also be included in the programme as there is sufficient evidence that IFA deficiency also affects this age group

2) Children between 6 months to 60 months should be given 20 mg elemental iron and 100 micro gm folic acid per day per child as this is considered safe and effective

3) National IMNCI (Integrated Management of Neonatal and Childhood Illnesses) guidelines to be followed

4) For children (6 to 60 months) ferrous sulphate and folic acid should be provided in a liquid formulation containing 20 mg elemental iron and 100 micro gm folic acid per ml of the liquid formulation. For safety reasons the liquid formulation should be dispensed in bottles so designed that only 1 ml can be dispensed each time.

5) Dispersible tablets have an advantage over liquid formulations in programmatic conditions. These have been used effectively in other parts of the world, and in large scale Indian studies. The logistics of introducing dispersible formulation of iron and folic acid should be expedited under the programme.

6) The current programme recommendations for pregnant and lactating women should be continued

7) School children (6-10 years old) and young adolescents (11-18 years old) should also be included in National Nutritional Anaemia Prophylaxis Programme (NNAPP)

8) Children 6 - 10 years old should be provided 30 mg elemental Iron and 250 micro gm folic acid per child per day for 100 days in a year

9) Adolescents 11-18 years old will be supplemented at the same doses and duration as adults. The adolescent girls will be given a priority.

10) Multiple channels and strategies are required to address the problem of iron deficiency anaemia. The newer products such as double fortified salts, sprinklers, ultra rice and other micro nutrient candidates or fortified candidates should be explored as an adjunct or alternate supplementation strategy.

Dr Umesh Kapil, Professor Public Health Nutrition, (email: umeshkapil@yahoo.com ) is compiling comments on the recently issued notification of the Health Ministry. So readers are requested to send in their responses.

Bobby Ramakant

(The author is a senior health and development journalist, writing for newspapers in Asia, Africa and Middle East. He can be contacted at: bobbyramakant@yahoo.com)

Medical students need to quit tobacco first

Results of an AIIMS survey on smoking among medical students in Delhi and other parts of the region in North India sends a shiver down the spine – 56 per cent of them smoke.

Furthermore most alarming was the fact that 35 per cent of medical students surveyed were found to be "nicotine-dependent"!

The year-long survey was done by Department of Medicine at AIIMS with students from major medical colleges of North India answering questionnaires based on their smoking habits.

“This survey used the Fagerstrom test for nicotine dependence”, said Dr Randeep Guleria, Professor of Medicine at AIIMS. This test was developed by Dr Karl Fagerstrom, a globally acclaimed authority in tobacco cessation.

“Dependence on smoking was assessed by the quantitative method with questions like number of cigarettes smoked every day and the time of lighting up the first cigarette after waking up,” said Dr Guleria. He further added that "The motivation to stop smoking was assessed qualitatively by direct questions about intentions to quit."

37.5 per cent medical students took to cigarettes after seeing others smoke, a further 32.5 per cent smoked since they felt it was a stress-buster; 8.75 per cent started due to "peer pressure". 11 per cent were found to be "heavy smokers", and 45 per cent had a "family history of smoking".

It is clear that the need to have a strong tobacco control and health education programme within healthcare settings is most compelling. Unless we have a health education programme in place, how else do we plan to reduce the number of medical students who may take up tobacco use during medical schooling?

If public health campaigns cannot bring in a change in medical students who ‘believe’ that tobacco is a stress-buster and smoke because of peer pressure or lifestyle imagery, then how effective will they be in general community?

However an overwhelming majority had tried to quit tobacco use. 65 per cent had made attempts to quit, while 62 per cent were willing to quit if assisted. Are we prepared and geared up enough to provide this ‘assistance’?

That brings us to the glaring gap in tobacco cessation services within healthcare settings. Unless tobacco cessation skills are imparted to mainstream healthcare providers utilizing and building upon existing infrastructure and health systems, how are we going to provide quality assistance to 62 per cent of medical students who want to quit tobacco use?

Professor (Dr) Rama Kant, Head of the Tobacco Cessation Clinics at King George’s Medical University (KGMU), says that "Doctors who use tobacco, endanger their own health, and send a misleading message to patients and to the public. The best way forward is to invest in building training capacities of existing tobacco cessation clinics so that these can impart not only cessation services, but also impart tobacco cessation skills in healthcare staff from different settings. It is also vital to integrate tobacco cessation counseling in routine medical practice.”

The AIIMS survey indicates that the mean age of starting smoking was 18.65 years.

With deceptive tobacco advertising and misconceptions associated with tobacco use, the addiction takes roots before the age of 18, says Prof Kant. By the time tobacco-related hazards begin to manifest, the person, including medical students, is already addicted to nicotine dose. Nicotine is as addictive as heroin and cocaine, stated a US Surgeon General Report in 1988. It is not easy to quit tobacco, but it is also not impossible, asserts Prof Kant.

So far India has about 20 tobacco cessation clinics supported by World Health Organization across the country.

According to the Indian Council of Medical Research (ICMR) tobacco use is responsible for over 10 lakh deaths in India each year, which is about 3000 deaths every day.

The urgency to reduce or decimate preventable burden of life-threatening diseases attributed to tobacco is compelling.

Prof Kant points to a possible way forward – ‘a combination of health education programme with tobacco control in focus to alarm new medical students and encourage them not to use tobacco should be incorporated while we scale up tobacco cessation services across the country’.

Bobby Ramakant

(The author is a senior health and development journalist writing for newspapers in Asia, Africa and Middle East. He can be contacted at: bobbyramakant@yahoo.com)

Published in:

The Central Chronicle (Madhya Pradesh): 17 May 2007

http://www.centralchronicle.com/20070517/1705305.htm

Medical students need to quit tobacco first

Bobby Ramakant

A recent study gives further evidence that prevalence of tobacco use is more in medical students than in general population. This becomes all the more paradoxical when India’s 25 crore tobacco users look up at existing healthcare providers for assistance in quitting tobacco. Also it questions how serious are we to prevent needless diseases and deaths attributed to tobacco use, ponders Bobby Ramakant.

AIIMS (All India Institute of Medical Sciences) survey among medical students of North India conclusively proves that smoking in medical students increases as their medical schooling goes ahead.

“Tobacco Kills" or “Tobacco causes Cancer” says the new health warning on every tobacco pack. With young doctors and medical students not heeding to this health warning, has the tobacco control strategy went fundamentally awry?

Results of an AIIMS survey on smoking among medical students in Delhi and other parts of the region in North India sends a shiver down the spine – 56 per cent of them smoke.

Furthermore most alarming was the fact that 35 per cent of medical students surveyed were found to be "nicotine-dependent"!

The year-long survey was done by Department of Medicine at AIIMS with students from major medical colleges of North India answering questionnaires based on their smoking habits.

“This survey used the Fagerstrom test for nicotine dependence”, said Dr Randeep Guleria, Professor of Medicine at AIIMS. This test was developed by Dr Karl Fagerstrom, a globally acclaimed authority in tobacco cessation.

“Dependence on smoking was assessed by the quantitative method with questions like number of cigarettes smoked every day and the time of lighting up the first cigarette after waking up,” said Dr Guleria. He further added that "The motivation to stop smoking was assessed qualitatively by direct questions about intentions to quit."

37.5 per cent medical students took to cigarettes after seeing others smoke, a further 32.5 per cent smoked since they felt it was a stress-buster; 8.75 per cent started due to "peer pressure". 11 per cent were found to be "heavy smokers", and 45 per cent had a "family history of smoking".

It is clear that the need to have a strong tobacco control and health education programme within healthcare settings is most compelling. Unless we have a health education programme in place, how else do we plan to reduce the number of medical students who may take up tobacco use during medical schooling?

If public health campaigns cannot bring in a change in medical students who ‘believe’ that tobacco is a stress-buster and smoke because of peer pressure or lifestyle imagery, then how effective will they be in general community?

However an overwhelming majority had tried to quit tobacco use. 65 per cent had made attempts to quit, while 62 per cent were willing to quit if assisted. Are we prepared and geared up enough to provide this ‘assistance’?

That brings us to the glaring gap in tobacco cessation services within healthcare settings. Unless tobacco cessation skills are imparted to mainstream healthcare providers utilizing and building upon existing infrastructure and health systems, how are we going to provide quality assistance to 62 per cent of medical students who want to quit tobacco use?

Professor (Dr) Rama Kant, Head of the Tobacco Cessation Clinics at King George’s Medical University (KGMU), says that "Doctors who use tobacco, endanger their own health, and send a misleading message to patients and to the public. The best way forward is to invest in building training capacities of existing tobacco cessation clinics so that these can impart not only cessation services, but also impart tobacco cessation skills in healthcare staff from different settings. It is also vital to integrate tobacco cessation counseling in routine medical practice.”

The AIIMS survey indicates that the mean age of starting smoking was 18.65 years.

With deceptive tobacco advertising and misconceptions associated with tobacco use, the addiction takes roots before the age of 18, says Prof Kant. By the time tobacco-related hazards begin to manifest, the person, including medical students, is already addicted to nicotine dose. Nicotine is as addictive as heroin and cocaine, stated a US Surgeon General Report in 1988. It is not easy to quit tobacco, but it is also not impossible, asserts Prof Kant.

So far India has about 20 tobacco cessation clinics supported by World Health Organization across the country.

According to the Indian Council of Medical Research (ICMR) tobacco use is responsible for over 10 lakh deaths in India each year, which is about 3000 deaths every day.

The urgency to reduce or decimate preventable burden of life-threatening diseases attributed to tobacco is compelling.

Prof Kant points to a possible way forward – ‘a combination of health education programme with tobacco control in focus to alarm new medical students and encourage them not to use tobacco should be incorporated while we scale up tobacco cessation services across the country’.

Bobby Ramakant

(The author is a senior health and development journalist writing for newspapers in Asia, Africa and Middle East. He can be contacted at: bobbyramakant@yahoo.com)