Friday, April 30, 2010

Education Minister and Television

Today (April 29) was a less busy day compared to yesterday, but there were things to be very happy about. The Deputy Minister for Education wanted me and Juan to meet her at 4 pm. We reached there before time and had to wait for some time to see her. The place was a relatively unimposing building, but there were some security people were posted. But I thought it was so much more accessible than the office of a minister of the Kerala government (which itself is simpler than those of other states). Nicolas Cabellero, who was apparently close to her, and Gladys Canese from MMSL were also present and it was he who mainly talked to her.

The minister turned out to be rather young for a senior politician, but she was very pleasant and informal. The discussion was mainly in Spanish because the Minister apparently was not fluent in English. It was mostly Nicolas and Juan who spoke. Nico put forward some suggestions to the Minster that she apparently favoured. It was all about introducing Free Software in the high schools, something on Free Hardware and about introducing some high level IT. I am not clear about all of them, but Nico is supposed to send me a mail where he will describe the main thrust areas.
Discussing with the Vice Minister of Education. Lucho sits separately, disinterested. Nicolas Cabellero did most of the talking. Gladys is next to him.
The Minister is all attention, and Juan is relatively quiet.
One for the records. The Minister next to me, with Nicolas, Gladys and Juan
The next place was the TV station where they had scheduled a programme with Juan and me. Going to the TV station was just like going to any other place, unlike in India where one has to go through security checks. We just walked in and told them who we were and why we were there, and we were asked to wait till the studio was ready.
Waiting in front of the TV studio. It was rather cold that night.

After some time, a lady invited us inside and dis a minimal make up on us. Though Lucho was person who took us there, he opted not to be in the programme. We then went to the studio where the news was being telecast. We waited on another side where the programme was scheduled to be shot. The programme started after the news and the first item was an interview with an agriculture guy. He was talking about GM crops in a favourable way and Juan was getting angry with him.
The agriculture guy promoting GM crops

After his interview, we were invited and Juan and I sat opposite each other with the interviewer on my left. Since the programme was in Spanish, most of the discussion was with Juan, who was brilliant. He started by saying that it was good to speak after a person who favoured GM food because that was the wrong thing to do. And that seems to have got the favour from the interviewer (who turned out to be quite a senior guy in the TV company, the Executive Director, in fact). His questions to me were mainly about the IT at school programme. But at one point, he asked me why anyone should be afraid of freedom. I couldn't understand why he was asking such a question (I still don't), but answered, after some initial fumbling, that people who come out of a long period of control could be afraid of freedom because there was no one to tell them what they should do, and they were not able to take their own decisions. Later, Juan told me that my reply was good. The interviewer gave us his cards and we left quickly because the shooting of the next programme was to start. Later, Juan told me that there were several mails to the station during our programme and they were all in favour, even wanting to get in touch with us (so apparently our emails were shown on the screen). On the other hand, the mails that they go when the first guy was talking were all negative. Good reason for the Executive Director to feel happy with us.
Juan and I at the TV show
That is me on TV in Paraguay

എന്താണു് ജീവന്‍?

(തേജസ് പത്രത്തിന്റെ നാലാം പേജില്‍ ഫെബ്രുവരി 25നു് പ്രസിദ്ധീകരിച്ച ലേഖനം.)

പ്രിയോണുകള്‍ക്കു് പരിണാമം ഉണ്ടാകുന്നുണ്ടു് എന്നു് ഈയിടെ കണ്ടെത്തിയതായി ആഗോള ശാസ്ത്രവാര്‍ത്തകള്‍ റിപ്പോര്‍ട്ടു ചെയ്യുന്ന വേള്‍ഡ് സയന്‍സ് എന്ന വെബ് പ്രസിദ്ധീകരണം പറയുന്നു (http://www.world-science.net/othernews/100101\_prions). ശാസ്ത്രജ്ഞരെ അത്ഭൂതപ്പെടുത്തിയ ഒരു വാര്‍ത്തയാണിതു്. കാരണം പ്രിയോണുകള്‍ വെറും പ്രൊട്ടീന്‍ തന്മാത്രകളാണു്. ജീവനുള്ള ചെടികളും മൃഗങ്ങളുമാണു് പ്രൊട്ടീന്‍ ഉത്പാദിപ്പിക്കുന്നതെങ്കിലും ഈ തന്മാത്രകള്‍ക്കു് ജീവനുണ്ടു് എന്നു വിശ്വസിക്കാന്‍ ആരും തയാറാവാത്തതില്‍ അത്ഭുതമില്ലല്ലൊ. പ്രിയോണുകള്‍ പരിണാമത്തിനു് വിധേയമാകുന്നുണ്ടു് എന്ന കണ്ടുപിടിത്തം അടിസ്ഥാനപരമായ ചില ചോദ്യങ്ങളിലേക്കാണു് നയിക്കുന്നതു്. പ്രിയോണുകള്‍ എന്താണെന്നും അവ പരിണാമത്തിനു് വിധേയമാകുന്നുണ്ടെങ്കില്‍ അതുയര്‍ത്തുന്ന ചോദ്യങ്ങളെന്താണെന്നും നമുക്കു് പരിശോധിക്കാം.

1984ല്‍ ഇംഗ്ലണ്ടിലാണു് ആദ്യമായി പശുക്കളില്‍ ഒരു പ്രത്യേക രോഗം കണ്ടതു്. രോഗം തുടങ്ങുമ്പോള്‍ പശുക്കളുടെ സ്വഭാവത്തില്‍ വല്ലാത്ത മാറ്റങ്ങളുണ്ടാകുന്നു. പിന്നീടു് ഒരുമാതിരി ``വട്ടുപിടിച്ചതുപോലെ'' നടക്കുകയും തീറ്റ കുറയ്ക്കുന്നില്ലെങ്കില്‍ പോലും പശു മെലിയാന്‍ തുടങ്ങുകയും ചെയ്യും. ക്രമേണ പശുവിനു് എണീറ്റു് നില്‍ക്കാന്‍ പോലും വയ്യാതായി ചത്തു പോകുകയും ചെയ്യുന്നു. പശുവിറച്ചിയും എല്ലിന്‍ പൊടിയും മറ്റും അരച്ചു് പശുത്തീറ്റയില്‍ ചേര്‍ക്കുന്ന ഒരു പതിവു് ഇംഗ്ലണ്ടില്‍ അക്കാലത്തുണ്ടായിരുന്നു. അവിടെ നന്നായി വളരാത്ത സോയബീനിനു പകരമായിട്ടാണു് ഇവ ചേര്‍ത്തിരുന്നതു്. അങ്ങനത്തെ തീറ്റ കഴിച്ച പശുക്കളിലാണു് ഈ രോഗം കാണുന്നതെന്നു് മനസിലായി. രോഗം വന്ന പശുക്കളുടെ ഇറച്ചി ചേര്‍ത്ത തീറ്റ കഴിച്ച പശുക്കള്‍ക്കാണു് രോഗം പകരുന്നതെന്നു് പിന്നീടു് മനസിലായി. ഈ രോഗം ആദ്യം കണ്ടെത്തിയപ്പോള്‍ അതു് ശാസ്ത്രജ്ഞരെ അത്ഭൂതപ്പെടുത്തുകയും വിസ്മയിപ്പിക്കുകയും ചെയ്തിരുന്നു.

ചില രോഗങ്ങളുണ്ടാക്കുന്നതു് ബാക്ടീരിയയോ വൈറസോ അല്ല, വെറും പ്രോട്ടീന്‍ തന്മാത്രകളായിരിക്കാം എന്നു് 1960 കളില്‍ ചില ശാസ്ത്രജ്ഞര്‍ സങ്കല്പിച്ചിരുന്നു. അള്‍ട്രാവയലറ്റ് രശ്മികളേറ്റാല്‍ എല്ലാ സെല്ലിലുമുള്ള ഡി.എന്‍. എ. (DNA, Deoxyribo Nucleic Acid) തന്മാത്രകള്‍ക്കു് ക്ഷതമേല്‍ക്കുമെങ്കിലും ചില രോഗങ്ങളുണ്ടാക്കുന്ന രോഗാണുക്കള്‍ നശിക്കുന്നില്ല എന്ന കണ്ടുപിടിത്തം വിശദീകരിക്കാനാണു് ഇങ്ങനെയൊരു സങ്കല്പം ഉണ്ടായതു്. മേല്പറഞ്ഞ, ``പ്രാന്തിപ്പശു രോഗം'' (Mad Cow Disease) എന്നു പേരിട്ട, രോഗം ഒരു പ്രോട്ടീന്‍ തന്മാത്രയാണു് ഉണ്ടാക്കുന്നതു് എന്നു് സാന്‍ ഫ്രാന്‍സിസ്ക്കോയിലെ കാലഫോര്‍ണിയ സര്‍വകലാശാലയിലെ പ്രൊഫ. സ്റ്റാന്‍ലി പ്രൂസിനര്‍ 1982ല്‍ തെളിയിച്ചു. അദ്ദേഹം തന്നെയാണു് ഇത്തരം പ്രോട്ടീന്‍ തന്മാത്രകള്‍ക്കു് പ്രിയോണ്‍ എന്നു പേരിട്ടതും. കണ്ടുപിടിത്തത്തിനു് 1997ലെ വൈദ്യശാസ്ത്രത്തിനുള്ള നൊബെല്‍ സമ്മാനം സ്റ്റാന്‍ലിയ്ക്കു് ലഭിക്കുകയും ചെയ്തിരുന്നു.

പ്രാന്തിപ്പശു രോഗത്തെപ്പറ്റി ഒരു വാക്കു്. ബൊവൈന്‍ സ്പോഞ്ചിഫോം എന്‍സെഫാലോപ്പതി \eng(Bovine Spongiform Encephalopathy, BSE) \mal എന്നാണു് പ്രാന്തിപ്പശു രോഗത്തിന്റെ ശാസ്ത്രീയനാമം. ഈ രോഗമുള്ള പശുവിന്റെ ഇറച്ചി കഴിച്ചാല്‍ മനുഷ്യനു് ഇതുപോലത്തെ ഒരു രോഗം ഉണ്ടാകും. അതിനു് വ്യത്യസ്തമായ ക്രൂട്ട്സ്‌ഫെല്‍ഡ്റ്റ് ജേക്കബ് രോഗം (variant Creutzfeldt-Jakob disease) എന്നു പറയുന്നു. (ഇതേ പേരില്‍ അറിയപ്പെട്ടിരുന്ന മറ്റൊരു രോഗമുണ്ടു്. അതില്‍നിന്നു് തിരിച്ചറിയാനാണു് ഇതിനെ വ്യത്യസ്തമായ ക്രൂട്ട്സ്‌ഫെല്‍ഡ്റ്റ് ജേക്കബ് രോഗം എന്നു വിളിക്കുന്നതു്.) പ്രാന്തിപ്പശു രോഗമുള്ള പശുക്കളെയെല്ലാം കൊന്നൊടുക്കി തീയീട്ടാണു് ഈ രോഗം ഇല്ലാതാക്കിയതു്.

എല്ലാ ജീവിവര്‍ഗങ്ങളിലും ഒരു തലമുറയില്‍നിന്നു് അടുത്ത തലമുറയിലേക്കു് സ്വഭാവസവിശേഷതകള്‍ പകരുന്നതു് ജീവജാലങ്ങളില്‍ അടങ്ങിയിരിക്കുന്ന കോശങ്ങള്‍ക്കുള്ളിലെ ഡി.എന്‍.എ. തന്മാത്രകളിലൂടെയാണു്. ചെടികളുടെയും മൃഗങ്ങളുടെയും മനുഷ്യരുടെയും കോശങ്ങളിലൊക്കെ ഈ തന്മാത്രകളുണ്ടു്. ബാക്ടീരിയ പോലെയുള്ള ഏകകോശ ജീവികളിലും ഈ തന്മാത്രകളുണ്ടു്. വൈറസുകളിലാണെങ്കില്‍ ഡി.എന്‍.എ. തന്മാത്രകള്‍ മാത്രമെയുള്ളൂ. മറ്റു് ജൈവരൂപങ്ങള്‍ക്കുള്ളതുപോലെ കോശമില്ല. കോശമില്ലാത്ത ഒരു വസ്തുവെങ്ങനെ ജൈവരൂപമാകും എന്നു ചിലര്‍ സംശയിച്ചിരുന്നു. എന്നാല്‍ വൈറസുകള്‍ പ്രത്യുല്പാദിപ്പിക്കുകയും ചിലവ ജൈവകോശങ്ങളെ നശിപ്പിച്ചു് രോഗങ്ങളുണ്ടാക്കുകയും ചെയ്യുന്നതിനാല്‍ അവ ഒരു ജൈവരൂപമാണു് എന്നുതന്നെ എല്ലാവരും അംഗീകരിച്ചു.

എന്നാല്‍ പ്രിയോണാവട്ടെ വെറും പ്രോട്ടീന്‍ തന്മാത്രയാണു്. പ്രോട്ടീന്‍ എന്നതു് എല്ലാ മൃഗങ്ങളുടെയും ശരീരത്തിലുള്ള, അത്യാവശ്യമുള്ള, ഒരു വസ്തുവാണുതാനും. അതെങ്ങനെയാണു് രോഗകാരണമാകുന്നതു്? അതു് മനസിലാക്കാന്‍ പ്രോട്ടീന്‍ തന്മാത്രകളുടെ ഒരു പ്രത്യേകത മനസിലാക്കണം. പ്രോട്ടീന്‍ തന്മാത്രകള്‍ വളരെ വലുതാണു്. വലുപ്പം കാരണമായിരിക്കാം അവ സാധാരണഗതിയില്‍ മടങ്ങിയാണിരിക്കുന്നതു്. ഒരു പ്രത്യേക രീതിയില്‍ മടങ്ങിയിരുന്നാലേ പ്രോട്ടീന്‍ ശരീരത്തില്‍ വേണ്ടവിധത്തില്‍ പ്രവര്‍ത്തിക്കൂ. തന്മാത്ര നിവര്‍ന്നു പോകുകയോ മടക്കം മറ്റൊരു രീതിയിലാകുകയോ ചെയ്താല്‍ ആ തന്മാത്രകൊണ്ടു് ശരീരത്തിനു് പ്രയോജനമില്ലാതാകും. ചില പ്രോട്ടീനുകള്‍ വല്ലാതെ ചൂടാകുകയെ തണുക്കുകയോ ചെയ്യുമ്പോള്‍ നിവര്‍ന്നു പോകും. അങ്ങനെ ആയാല്‍ ആ പ്രോട്ടീന്‍ ശരീരത്തിനു് ഗുണം ചെയ്യില്ല.

പ്രിയോണുകള്‍ എങ്ങനെയാണു് രോഗമുണ്ടാക്കുന്നതു്? ഒരു കോശത്തില്‍ പ്രിയോണ്‍ കടന്നുകഴിയുമ്പോള്‍ ആ കോശത്തിലുള്ള മറ്റു പ്രോട്ടീന്‍ തന്മാത്രകളെ അതു് നിവരാന്‍ പ്രേരിപ്പിക്കും. അങ്ങനെ കൂടുതല്‍ പ്രോട്ടീന്‍ തന്മാത്രകള്‍ ശരീരത്തില്‍ അവ ചെയ്യേണ്ട കര്‍മ്മം ചെയ്യാതാവും. അങ്ങനെ ശാരീരിക പ്രവര്‍ത്തനങ്ങളെ സ്വാധീനിച്ചുകൊണ്ടാണു് പ്രിയോണുകള്‍ രോഗമുണ്ടാക്കുന്നതു്. അങ്ങനെ പ്രിയോണുകള്‍ പുനരുല്പാദിപ്പിക്കുന്നില്ലെങ്കിലും എണ്ണത്തില്‍ വര്‍ദ്ധിക്കുന്നുണ്ടു്. ആ അര്‍ത്ഥത്തില്‍ പ്രിയോണുകള്‍ക്കു് ബാക്ടീരിയ, വൈറസ് തുടങ്ങിയ ഏകകോശജീവികളുമായി സാമ്യമുണ്ടു്. അപ്പോഴും ഒരു ചോദ്യം അവശേഷിക്കുന്നു: എല്ലാ ജന്തുക്കളുടെയും ശരീരത്തില്‍ അടങ്ങിയിരിക്കുന്ന ഒരു രാസവസ്തുവായി പ്രോട്ടീനിന്റെ തന്മാത്രകളെങ്ങനെയാണു് ഒരു ഏകകോശ ജീവിയെപ്പോലെ പെരുമാറുന്നതു്?

പണ്ടൊരു കാലത്തു് ചെടികള്‍ക്കു് ജീവനില്ല എന്നു് കരുതിയിരുന്നു. ജഗദീശ്ചന്ദ്ര ബോസ് ചെടികള്‍ക്കു് ജീവനുണ്ടെന്നു് തെളിയിച്ചു. വൈറസുകളെ ജീവികളായി കണക്കാക്കാമോ എന്നു് പലര്‍ക്കും സംശയമുണ്ടായിരുന്നു. പൊതിഞ്ഞു വച്ചിരിക്കുന്ന ഡി.എന്‍.എ. (അല്ലെങ്കില്‍ ആര്‍.എന്‍.എ.) തന്മാത്രകളാണു് വൈറസുകള്‍. സ്വഭാവസവിശേഷതകള്‍ ഒരു തലമുറയില്‍നിന്നു് അടുത്ത തലമുറയിലേക്കു് പകരുന്നതു് ഡി.എന്‍.എ. വഴിയാണെന്നു മാത്രമല്ല ഒരു ജന്തുവിന്റെ രൂപവും നിറവും സ്വഭാവവും പോലും നിര്‍ണ്ണയിക്കുന്നതില്‍ സുപ്രധാന പങ്കു് വഹിക്കുന്നതു് ഡി.എന്‍.എ. ആണു്. എന്നിരുന്നാലും ഒരു കോശം പോലുമില്ലാത്ത വൈറസിനെ എങ്ങനെ ഒരു ജീവിയായി കണക്കാക്കും എന്നു് സംശയമുണ്ടായെങ്കില്‍ അതില്‍ അത്ഭുതപ്പെടാനില്ലല്ലോ. പ്രിയോണുകള്‍ക്കാണെങ്കില്‍ കോശവുമില്ല, ഡി.എന്‍.എ.യുമില്ല! അവയെ എങ്ങനെ ജീവിയായി കണക്കാക്കാനാകും?

ഇതു് സങ്കീര്‍ണ്ണമായ ഒരു പ്രശ്നത്തിലേക്കു് വിരല്‍ ചൂണ്ടുന്നു എന്നെനിക്കു് തോന്നുന്നു. പ്രിയോണുകള്‍ ജീവികളല്ല എന്നു് സമ്മതിച്ചാലും മറിച്ചു് അവ ജീവികളാണു് എന്നു് സമ്മതിച്ചാലും പ്രശ്നമുണ്ടു്. പ്രിയോണുകള്‍ ജീവനില്ലാത്ത വസ്തുക്കളാണെങ്കില്‍ വൈറസുകളെയും അതുപോലെതന്നെ കാണണ്ടേ? പ്രിയോണുകള്‍ പ്രോട്ടീന്‍ തന്മാത്രകളാണെങ്കില്‍ വൈറസുകള്‍ ഡി.എന്‍.എ. (അല്ലെങ്കില്‍ ആര്‍.എന്‍.എ.) തന്മാത്രകളല്ലേ? രണ്ടും തന്മാത്രകള്‍. പിന്നെ വൈറസില്‍ എവിടെനിന്നു് ജീവന്‍ വന്നു? വൈറസിനു് അധികമായുള്ളതു് ഒരു ആവരണം മാത്രമാണു്. അതിലാണോ ജീവന്‍ കുടികൊള്ളുന്നതു്? അങ്ങനെയെങ്കില്‍, കോശത്തിനുള്ളില്‍ കടക്കുന്ന വൈറസ് ആവരണം ഉപേക്ഷിച്ച ശേഷം കോശത്തിലെ ഘടകങ്ങളുടെ സഹായത്താല്‍ പുനരുല്പാദനം നടത്തുമ്പോള്‍ വൈറസിനു് ജീവന്‍ നഷ്ടമാകുമോ? മാത്രമല്ല, മനുഷ്യന്‍ ഉള്‍പ്പെടെയുള്ള ``ജീവജാല''ങ്ങള്‍ക്കു് ജീവന്‍ എന്നൊന്നുണ്ടോ? അതോ ഇതൊക്കെ നമ്മുടെ തോന്നല്‍ മാത്രമാണോ? ഉത്തരം കിട്ടാന്‍ ബുദ്ധിമുട്ടാണു് ഈ ചോദ്യത്തിനു്.

മറിച്ചു്, പ്രിയോണുകള്‍ ജീവികളാണു് എന്നു് സങ്കല്പിച്ചാലോ? അങ്ങനെയെങ്കില്‍ സാധാരണ പ്രോട്ടീന്‍ തന്മാത്രകള്‍ക്കു് ജീവനില്ലേ എന്ന ചോദ്യം ഉയര്‍ന്നുവരുന്നു. ഇല്ല എങ്കില്‍, പ്രിയോണുകള്‍ക്കു് ഏതു് ഘട്ടത്തിലാണു് ജീവന്‍ ലഭിക്കുന്നതു്? പ്രോട്ടീന്‍ തന്മാത്രയുടെ മടക്കു് നിവരുമ്പോഴോ? മാത്രമല്ല, പ്രോട്ടീന്‍ തന്മാത്രകള്‍ക്കു് ജീവനുണ്ടാകാമെങ്കില്‍ മറ്റു് തന്മാത്രകള്‍ക്കും ജീവനുണ്ടാകില്ല എന്നു് എങ്ങനെ ഉറപ്പിച്ചു് പറയാനാകും? കല്ലിനും മണ്ണിനും പോലും ജീവനില്ല എന്നു് എങ്ങനെ ഉറപ്പിച്ചു് പറയും? ആധുനിക ശാസ്ത്രത്തിന്റെ പുതിയ ചില കണ്ടുപിടിത്തങ്ങള്‍ ഇത്തരത്തിലുള്ള ഉത്തരം കിട്ടാത്ത ചോദ്യങ്ങള്‍ ഉയര്‍ത്തുന്നു. %ശാസ്ത്രത്തില്‍ ഒരു കുതിപ്പുചാട്ടത്തിനു് സമയമായി എന്നാണു് ഇതു് കാണിക്കുന്നതു് എന്നു് ചിലര്‍ വിശ്വസിക്കുന്നു.

(ഈ ലേഖനം ക്രിയേറ്റീവ് കോമണ്‍സ് by-sa ലൈസന്‍സില്‍ പ്രസിദ്ധീകരിച്ചിരിക്കുന്നു.)

Wednesday, April 28, 2010

Paraguay

I am writing this from Asuncion, the capital of Paraguay. The first impressions I got when I was travelling from the airport to the hotel by car was the similarity in landscape with Kerala, and the general cleanliness of the environment. There was very little litter on the streets or garbage on the sidewalks. The air was cool and the traffic was light, as it used to be in Bangalore a couple of decades back. Overall a nice place, I thought. I came here for speaking at a Free Software conference, Free Software Asuncion 2010, and I was happy that this was such a nice place. I had collected data on Paraguay for my presentation and it had shown that the literacy was something like 91%. Overall, I thought, this place has similarities to Kerala. The interest the government is showing in Free Software is another factor that confirmed this thinking. I was also happy to see that Asuncion had been voted the cheapest city in the world five consecutive times.

Paraguay is similar to Kerala in other respects also. The country has very few industries, and has to depend on imports even for food, even though it is an agricultural economy. Further, as in any Latin American country, the people talk a lot and do much less. We may find similar characteristics in Kerala too, though saying so would be automatically be very controversial. However, Paraguay is also very different from Kerala in that it has a much larger area (about ten times that of Kerala) but much less population (about a fifth of Kerala) so that the average population density is about 15 per square kilometer whereas it is close to a thousand in Kerala.

But in just a couple of days I started realising that these similarities were superficial. One night about ten of us were walking to a restaurant when a person stopped us full of concern and asked us where we were going. When someone in the group told him, he told us that it was dangerous to go beyond the place where the restaurant was situated. He had thought that we were out just for a walk. The next day, as three of us went in search of a restaurant, we had to beat a hasty retreat from one point because one of us realised that it was dangerous to go further. I was told that a young tough guy could suddenly attack us with a knife or a gun. Well, this is something very unfamiliar in most parts of India.

Later, I learnt that there was a heavy concentration of population in the region around Asuncion. To the north was a large very thinly populated area. And in that area was a small region dominated by German immigrants who have kept the local people as virtual slaves, and the government had almost no control over the region. Well, this again is something not at all familiar in India. To the East of this region, near the border to Brazil, apparently there is a large community that lived on producing marijuana, and they were mostly Brazilian immigrants. In fact, they thought themselves to be Brazilians, and I believe they have even hoisted flags in schools there.

Though the country is basically an agricultural country, the land is held by a very few people. I am told that 90% of the land is with 2% of the people. The statistics on education seems to be suspect. Almost everything is imported. Though the country produces a lot of electricity, it is in collaboration with a couple of other countries, and Paraguay uses only a tiny percentage of the power it produces. People hardly read newspapers, but there are a large number of glossy (that is silly) magazines that are apparently read mainly by the rich. How different from Kerala! How easily appearances can deceive!

Wednesday, April 14, 2010

The Abandoned and the Abused – 1. In Hospitals

(This is the first part of an article I wrote along with Sundar in 2008-09. We failed in getting it published.)

On 8th March, 2008, which incidentally was the International Women’s Day, a daughter visiting her mother at the Pavlov Mental Hospital, Kolkata, was shocked to see everybody in the female ward naked. The reason, apparently, was that the patients have only three sets of dress each and the washerman comes only once in a fortnight. The question remains why the patients do not have more dresses, and why the washerman does not come more frequently. When Anjali, the Kolkata based NGO, and the West Bengal media raised hue and cry, the government ordered an inquiry. The inquiry may come up with answers and the government may initiate some remedial measures. This would soon be forgotten and another Inquiry Committee would be constituted to look into the next blatant human rights violation reported.

This incident is only the tip of the proverbial iceberg. Three years ago, a sweeper of another Kolkata hospital kissed a woman patient and the hospital staff refused to perceive this as sexual harassment. Beating the patients who ‘act difficult’ or ‘refuse to be medicated’ was also perceived to be ‘normal’. Government mental hospitals in India are often run in an irresponsible manner, violating many of the rules stipulated by the government itself, as report after report has shown. Hospitals lack sufficient infrastructure, are under-resourced and overcrowded. Patients are abused, bullied, molested, harassed and physically assaulted and their rights, ignored.

Dehumanising

In most mental hospitals, you would not be allowed inside, unless you are a prospective 'inmate'. No visits to the wards even if you are a journalist; especially if you are a journalist. The hospital authorities apparently want no interference from outside. They apparently don't want the public to know what is happening inside. Every one of us has the right to know what exactly is happening inside hospitals, any kind of hospitals. Not only because they are spending public money, the money we pay as taxes. In the case of mental hospitals, it is also because they are supposed to take care of one of the most vulnerable sections of society. And, we as citizens have a right to know what is happening there. Especially because tomorrow one of us also could be a patient there.

The authorities may say that everything is fine inside. But when someone found that the female patients in the Pavlov Mental Hospital, Kolkata, had no clothes on, they cried foul. Not because the patients had no clothes ("what is wrong in that?" said the nurses), but because someone discovered it! What happens inside the closely guarded gates, apparently, is purely the business of the "authorities".

A hospital with 800 patients may have 400 beds and even fewer mattresses. This may be the situation in most public hospitals. But mental patients are people without voice because no one takes them seriously. So, we have to speak for them. The food is often of low quality. The amount ear-marked for a meal might have been based on an estimate made a decade back, and not revised. There does not appear to be a system for regular revision and adjustment for inflation. The mentally ill are, anyway, it is perceived, not going to know what they are eating. Even if they know, who is going to listen to their complaints? We need to change this notion. Most mental patients do understand what is going on around them. All mental patients are not totally devoid of consciousness or feelings. And they too are humans and have their rights.

The patients are never taken out. Once inside, it is almost forever. Even prison officials at times refuse to take back the prisoners admitted to mental hospitals for treatment. Very few are lucky enough to be discharged and accepted back by society, and there seems to be no reliable data on the number of persons who have been cured but still languishing in the hospitals. Sometimes, the hospital refuses to discharge a patient who has been cured if his/her family is not willing to come and receive him/her. This could mean hospitalization for life. If a person has recovered, (s)he should be discharged voluntarily, on her/his own responsibility. Being mentally ill doesn't mean that they cease to be human beings or that they could be deprived of their human rights. "Few dispute that mental hospitals have long since been dehumanized through neglect, and had failed to meet patients' needs" write Philip Bean and Patricia Mounser (Discharged from Mental Hospitals, Macmillan in association with Mind Publications, 1993). Though written in a somewhat different context, this is valid even today in our country.

Most mental hospitals lack the infrastructure needed to handle the number of patients they get. And they lack the manpower too. Even the employees who are there are often posted as ‘punishment transfers’, says the report Quality Assurance in Mental Health by the National Human Rights Commission, 1999. Electro-Convulsive Therapy (ECT) is used routinely, though it is a controversial treatment and adverse effects have been reported (http://www.issuesinmedicalethics.org/154oa157.html). As per law, ECT can be given only with the consent of the patient, and that too, only under anaesthesia. And it has to be modified ECT, where the so-called peripheral seizure (the epilepsy-like effect that is often frightening) is suppressed using a drug. Most hospitals do not even have an anaesthetist. Patients are hardly consulted. And ECT without anaesthesia is most often used instead of modified ECT, according to the 1999 report of the NHRC.

"The study shows that all relatives signed consents; many reported that the details of ECT were discussed with them and alternative treatments offered and they were happy with the outcome. Yet many relatives also perceived that they were forced to provide their consent. Even the minority of patients who signed the consent form could not recall the details of the procedure. Many patients also reported coercion." report A.P. Rajkumar, B. Saravanan and K.S. Jacob (Indian Journal of Medical Ethics, Oct-Dec 2007). "After much brutal experimentation and research, the developed world banned direct ECT in the early 1960s. Many European countries have phased out even modified ECT, while in the US its usage has come down drastically after the 1980s, following class action." ECT was apparently abandoned after it was found that up to 20% patients suffered vertebral fractures and many of them suffered from terror and trauma. In this respect, India remains a primitive country where 52 per cent of institutions still use ECT without anaesthesia and only eight institutions have facilities for routine electroencephalography monitoring. (Voices of people who have received ECT, by A.P. Rajkumar, B. Saravanan and K.S. Jacob)

Perhaps the overall Indian experience of institutionalized care is far from civilized. "The findings reveal that there are predominantly two types of hospitals," the report by the National Human Rights Commission (cited earlier) evaluates. "The first type does not deserve to be called 'hospitals' or mental health centres. They are 'dumping grounds' for families to abandon their mentally ill member, for either economic reasons or a lack of understanding and awareness of mental illness. The living conditions in many of these settings are deplorable and violate an individual's right to be treated humanely and live a life of dignity. Despite all advances in treatment, the mentally ill in these hospitals are forced to live a life of incarceration."

"The second type of 'hospitals,” the NHRC report continues, "are those that provide basic living amenities. Their role is predominantly custodial and they provide adequate food and shelter. Medical treatment is used to keep patients manageable and very little effort is made to preserve or enhance their daily living skills. These hospitals are violating the rights of the mentally ill persons to appropriate treatment and rehabilitation and a right to community and family life".

Not that there aren't well-run mental hospitals in the country, but they are too few and too far apart. One such is the National Institute of Mental Health and Neuro Surgery in Bangalore. Another is the Institute of Human Behaviour and Allied Sciences (IBHAS) in New Delhi, the only mental hospital where the public can enter and take a look around, like most other ordinary hospitals. So, not that it is impossible. Mental hospitals can be run just like any other hospital, and maintained clean. If only there is a will.

There have been changes in some of the hospitals in the country after the report came out, which have been discussed in the updated 2008 publication Mental Health Care and Human Rights from NHRC and NIMHANS. There are some positive changes in some hospitals, but a tremendous lot remains to be done.

"It resembles like a jail (sic). There are two closed wards. The rest are barracks and cells." says the NHRC report about the hospital in Varanasi. "Surprisingly, there is not a single nurse posted in the hospital, or nurse's post." says the report about the Bareilly hospital. "The attenders use long lathis to control the patients (who) often get beaten up." This is about the Agra Manasik Arogyasala. According to the report, the nurse-patient ratio here is 1:225, instead of the stipulated ratio of 1:3!

The updated report of 2008 says: “Insufficient seating, no drinking water or toilet facilities for out patients and their families. There is no proper facility for registration and recording of out patients. No separate MRD. … No managing committee to oversee day to day management of the hospital and to take decisions. No PSWs, Clinical Psychologists, Psychiatric Nurses.” The report doesn't say whether more nurses have been appointed, or whether the patients are still locked up in cells.

Remember the Erwadi incident where mental patients chained to their beds died in a fire not long ago (see Box 1)? Some action was taken at that time, but matters seem to be becoming as bad as before. As in any other, in the case of mental hospitals also, we need to keep a constant vigil.

But that is not enough. “According to NIMHANS, there are over two crore persons in our country who are in need of treatment for serious mental disorder and about five crore people who are affected by common mental disorder. About 30 to 35 lakh persons need hospitalisation at any time for mental illness. In contrast, there are about 29,000 beds available.” says Sri Akhil Kumar Jain, IAS, Secretary General, NHRC, in his preface to the report Mental Health Care and Human Rights published by NHRC and NIMHANS in 2008. As per an estimate, around 12% of all patients in India are mental patients, yet only about 1% of the health budget is allocated for mental health. There is a ten-fold shortage of psychiatrists in India. There are only 3,000 psychiatrists in India as against a demand for over 32,000.This means that mental hospitals are under-staffed and lack sufficient infrastructure, reflecting our society's lack of concern for mental patients.

Mental patients, being what they are, are extremely susceptible to abuse and exploitation. A mental patient who is on the streets can deliver a child every ten months. Even women in a hospital may not be safe: they can be sold for a night, for a consideration, in cash or kind. Or be exploited by the hospital employees. There have been allegations of boys being sodomised. There were allegations that men were surreptitiously allowed into the women's ward in a government mental hospital at night. That was a quarter century ago. In 2003, a young schizophrenic in-patient at NIMHANS was raped by an out-patient while she was sitting outside. The rapist happened to be HIV positive. The hospital refused to take the responsibility for the incident. Recently, it was reported locally that a patient who asked for some more curry was beaten. Remember Oliver Twist?

There was a case in which a person was admitted to a mental hospital and given treatment for four years to make his sexual orientation "normal". "During counselling therapy sessions, the doctor explicitly told the patient that he needed to curb his homosexual fantasies, as well as start making women rather than men the objects of his desire. The doctor also administered drugs intended to change the sexual orientation of the patient, providing loose drugs from his stock rather than disclosing the identity of the drug through formal prescription. The patient reports experiencing serious emotional and psychological trauma and damage, as well as a feeling of personal violation, due to these actions. This form of psychiatric treatment, reflecting an understanding of homosexuality as a disease, represents a serious contravention of internationally recognized psychiatric guidelines and human rights standards." (see here) The case was raised before the NHRC in 2001.

Pathetic, to say the least, was the case of Machal Lalung of Mikir Chuburi in Morigaon district, arrested in 1951 for voluntarily causing grievous injuries. Since he was mentally unfit to stand trial, he was sent to the mental hospital. He remained there, as the case never came up for trial. His release in July 2005, after more than 50 years in prison, came after the National Human Rights Commission intervened.

In 2007, Mr. Deenadayalam, 54, was admitted to the Institute of Mental Health at Kilpauk in Chennai on an order by the Tambaram Judicial Magistrate, although he had no mental illness. He was illegally detained for 30 days. In this instance, the person could escape through a habeas corpus petition filed in the High Court. Else, the story itself would not have come out.

And, allegedly, at least some hospitals have become dumping grounds for aged people who are no longer needed by their families. And not just the elderly. It was not long ago that Tehelka exposed a doctor who was willing to certify a woman as mentally ill without even seeing her. The deal was settled for just Rs. 10,000, so that a journalist could get rid of his "undesirable wife". While this was only a story used by Tehelka to expose the racket, who knows how many women would have spent their "married" lives in the several mental hospitals in the country! Remember the story of Anjana Mishra!

The question naturally arises, "How come, if things are so bad, no one has been complaining?" The question, unfortunately, is based on a wrong premise that no one has complaints. Remember what a patient told one of the authors (Sundar) about the condition of their cell. Patients do have complaints. But who will listen to them? They are, after all, "mad". Their relatives, in most cases, are not bothered. They would like to somehow get rid of the “lunatic” in their family, delete them from their lives.

Box 1: The Erwadi incident

Mental patients are often locked up, chained and sometimes even beaten. They are treated like criminals. See what happened in a mental hospital in Erwadi. “The chain is blackened and the ring is horribly twisted but still fastened to the charred stump – of a leg. Mentally challenged and physically shackled he was, yet Murugaraj had desperately tried to free himself. Twenty seven more mentally ill people died with him in the early hours of August 6, 2001, when a fire engulfed the thatched roof of the Moideen Badhusha Mental Home at Erwadi, a fishing village 27 km south of Ramanathapuram town in southern Tamil Nadu in India. They were stripped of dignity when they lived - chained, confined and ill treated. The manner of their death was even worse.” wrote Asha Krishnakumar in Frontline (Vol. 18, Issue 17, Aug. 18-31, 2001) about the incident that suddenly brought the issues of the mentally ill into public conscience.

As usual, the hullabaloo died out soon after and people forgot everything about it; perhaps they thought that everything would be taken care of. Yet, when the Punjab and Haryana governments submitted affidavits to the Supreme Court stating that no one in the state was kept chained, the Tribune showed that there were still persons with mental illness kept chained in various places, though may not be in hospitals. In 2007, NDTV visited a famous dargah in Hyderabad only to find that the mentally ill still continue to be chained in gross violation of human rights

The Erwadi incident did make a difference. Enquiries were conducted. The licences of mental hospitals in the private sector were examined and some were cancelled. But "violation of human rights is committed in hospitals where basic amenities and services are not provided, inhuman and degrading treatment is very common and patients are subjected to ill treatment and abuse." says a report.


Box 2: Hell on Earth


Conditions in mental hospitals have been intolerable always. “A total of 200 women. Some in dark cells. They have to piss and shit into a small pit…In front of a cell, a plate full of shit. There are no toilets in the cell. Everything has to be done into a pit. A woman might intelligently have done it in a dish and shoved it out of the grill and could have gone to sleep. Or else she would have to sleep on the floor. The stench is unbearable. No one will remove that plate. It would be the plate from which she eats…In one cell a man lay hugging another. ‘You should have come before 10 a.m. You won’t be able to stand anywhere. Shit will puddle everywhere. They will pour a bucket of water over it. Then it will have a unbearable stench!’, says a patient.’ This was what one of the authors (Sundar) saw in one of the hospitals that he visited in the mid 1980s. (Ee Bhraanthaalayathinu Naavundaayirunnenkil (Malayalam), Mathrubhumi Publications, Kozhikode, 2007).

Things did improve, certainly. But not necessarily everywhere, and never as much as it should have. "As one approaches the wards, a strange stench hits the nostrils. The sight is even more horrifying and nauseating. To the wooden railings of the long verandah are tied — actually tied with ropes — the patients diagnosed as violent, sitting on their own human waste. On either side of the verandah are located the two toilets – unusable and filthy. The toilets have absolutely no water, either running or stored." wrote Anjana Mishra in Manushi (No. 120) about the Central Institute of Psychiatry, Kanke, Ranchi, where she was forcibly admitted by her husband. "Fortunately, I came out of that hell alive but the nightmarish memories continue to torment me, constantly reminding me of other women, young and old, whom I have left behind, probably doomed for life, and whose desperate letters, pleading to be rescued, remain unanswered." she wrote. This was in late 1990s.

The way food is served to mental patients in hospitals leaves much to be desired. Look at what Anjana Mishra (real name) has to say: "The dining hall, situated a little away from the wards, constitutes the most unhygienic part of the entire establishment. Dirty wooden tables line the wall, with the remnants or leftovers of earlier meals, especially, rice and dal particles. Almost a dozen dogs loiter around. The afternoon meal consists of coarse, half-cooked rice, watery dal and a tasteless, odourless curry. All of this put together can kill the appetite of even the hungriest human being. Again, privileged patients, like myself, were entitled to a piece of fried fish, a little curd and a pappad. All the patients eat in a child-like fashion, hogging a mouthful and then taking a walk, then coming back for a second mouthful. The dogs happily lick the plates in this interval. ... Some of the very ill patients even put their food on the floor and have it along with the dogs, while the ayahs in charge exchange gossip." (Manushi, No. 120)

Recently, in a mental hospital in West Bengal, a woman who asked for an extra serving of curry was beaten with the ladle by a woman employee! The unionized militant employees of the hospital apparently believe they have every right to do that.

The names of all persons mentioned in the article are changed to protect their identity.

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