‘The imprisonment and high-tech torture of dying people in ICUs is a growing Indian disease’

Q&A

‘The imprisonment and high-tech torture of dying people in ICUs is a growing Indian disease’

13.01.2021

Palliative care is a branch of medical care that aims to mitigate the symptoms of serious ailments. It is sometimes offered concurrently with other treatments. WHO estimates 40 million people need palliative care every year. MR Rajagopal, a physician by training and founderdirector of a charitable trust Pallium India, explained its importance to Narayani Ganesh:

What is palliative care?

Palliative care is prevention and management of serious healthrelated suffering. It provides not only relief from pain and other symptoms, but also enables social, mental and spiritual well-being. It tries to understand every fibre of the suffering. The source of suffering could be any of the following: pain, breathlessness, an ulcer, anxiety, depression, issues of relationships, and abandonment by the family, hopelessness or even suicidal thoughts.

At the moment, palliative care is available only to a tiny minority of people in India. At least 98% people are deprived of even basic pain relief. In the context of the growing catastrophic health expenditure which pushes 5.5 crore of Indians into poverty every year, it becomes particularly important to bring in more humanity and compassion to care.

How would you describe ‘healthy ageing’?

When you hear the expression ‘healthy ageing’, what thoughts cross your mind? Preventing lifestyle diseases like diabetes and hypertension, perhaps? You might also think about mobility and financial independence. They are all important. But let me share with you a lesson that a lot of ailing and dying people taught me: Love.

Investment in love and being connected become most important towards the end of one’s life. Remember, no one can be an island. We are social beings. A hand that says with a touch, “I care for you,” becomes all-important.

Is palliative care meant only for geriatric and end-of-life patients or can any gravely ill person, old or young, go for this option?

Palliative care is not only for any particular age group. It is not only for the dying and is not only for any particular disease. If there is suffering, palliative care has to step in, hand-in-hand with treatment of diseases. It is best done if every doctor and every nurse learns its principles and integrates it into their work. But, even then, for difficult issues, palliative care specialists will still be needed. And when the disease becomes incurable, palliative care continues to improve quality of life. Palliative care is also for the family and provides support even during bereavement process.

Most relatives try to prolong the life of a terminally ill patient at great financial cost in an ICU. Is palliative care a more affordable and humane option?

Death is the inevitable consequence of every life. The weeks or months preceding death can become a precious time, rebuilding connections, giving love and receiving love. The medical system needs to understand that it does not have a duty to prolong the dying process, when the disease is advanced and treatment is obviously futile.

Unfortunately, the imprisonment and high-tech torture of dying people in intensive care units is a growing Indian disease. This is clearly unethical. Relatives may want to “do everything” to keep the person alive; they need to be helped to come to a state of acceptance.

Where are we in palliative care and what promise does the future hold for us?

In 2014, the World Health Assembly had asked for integration of palliative care into all health care. In May 2020, it recommended inclusion of palliative care in Covid-19 strategy. Though neither of these has been achieved in India, there are several silver linings. The National Health Policy of 2017 does include palliative care. Several legal restrictions on the use of opioids for pain relief, have been overcome by a law enacted by Parliament in 2014. The MBBS curriculum includes most aspects of palliative care from 2019 onward.

All this lays the foundation for better care. But success will be limited if it is all left only for government action. Everyone in the community has a role to play, to offer a helping hand. Participation of the community is crucial to good palliative care. As the Astana Declaration said in 2018, healthcare ‘for all’ has to be healthcare ‘with all’.

What has been the impact of Covid-19 on palliative care?

Covid-19 has been an amplifier of suffering in every respect. As of now, approximately 1.5 lakh people have died of Covid-19 in India. They all die isolated from the family, most of them breathless and in physical, social and spiritual pain. At least 5 lakh people have been bereaved in the most brutal fashion – a loved one whisked away in an ambulance, never to be seen again with not even a proper farewell to the mortal remains – and they are at serious risk of mental illness.

Moreover, the suffering caused by lockdowns – particularly loss of income and lack of access to healthcare – has been horrendous.

India’s world No. 3 in nano research, but...

HEAR THE PROF

India’s world No. 3 in nano research, but...

Ashutosh.Desai@timesgroup.com

13.01.2021

“India is on the world nanotech map,” says Prof Dipankar Bandyopadhyay, head of the centre for nanotechnology and professor in the department of chemical engineering at IIT Guwahati. “We are doing well in terms of nanoscience and nanotechnology research. In manufacturing and product development, we are doing a cutting-edge job too.”

Nanotechnology is the specialised field of work that’s carried out at an atomic and molecular scale. It doesn’t find as much mention as Indian IT in news coverage. But it is an area where India has ranked third in the number of research articles since 2013, behind China and the US, according to nanotech publication StatNano. And its share has been gradually rising.

But, Bandyopadhyay says, India still has a lot of ground to cover. India’s 9% contribution to research papers in 2020 rests in the shadow of the 41% of contributions by China. And in the application of nanotech, India is even further behind. “We have the best scientists, but we have our traditional weaknesses in industry, in terms of developing new technologies and having a market where the technology can be implemented. Investors will only show interest when they perceive a market for it,” Bandhyopadhyay says.

He says the problem is India is not a big user of technology in products, unlike the US, Europe, China, Japan and South Korea. “One exception is the smartphone, which is a product of multiple nanotech processes, including in the body, screen, processors, built-in sensors. Indian society has shown technological dependence on these devices and that created a market for it,” Bandhyopadhyay says.

Other markets are beginning to emerge. Covid suddenly created a market in India that required investment into the R&D of antigen rapid test kits and vaccines – which requires expertise in nanotech. E-spin Nanotech, a company incubated by IIT Kanpur, manufactures masks made from ‘nanofibres’ through electrospinning.

The professor says there is much to be done in areas like healthcare, waste management, environmental remediation, and energy. The government launched the Nano Mission initiative in 2007. But Bandhyopadhyay says government should do more. Government, he says, should give companies incentives to take on certain projects – such as waste management – to manufacture products and thereby create a supply chain in the space.

He also feels education should be geared towards nurturing not just job seekers, but job creators. Big companies are too entrenched in the ways they function. Emerging technologies require entrepreneurs who think differently.

SC suspends implementation of agri laws, sets up panel

SC suspends implementation of agri laws, sets up panel

Protesting Farmers Boycott Hearing; Some Others Support Laws

Dhananjay.Mahapatra@timesgroup.com

New Delhi:13.01.2021

Undeterred by the boycott of proceedings by protesting farmers’ unions, the Supreme Court on Tuesday suspended implementation of three contentious farm laws and set up a fourmember expert committee to examine the laws threadbare for determining which all provisions passed muster on the count of farmers’ welfare and give a report to the court in two months.

A bench comprising Chief Justice S A Bobde and Justices A S Bopanna and V Ramasubramanian said, “We are suspending the implementation of the three farm laws - Farmers’ Produce Trade and Commerce (Promotion and Facilitation) Act, Farmers (Empowerment and Protection) Agreement on Price Assurance and Farm Services Act, and the Essential Commodities (Amendment) Act.”

It announced setting up of a four-member expert committee to hear all stakeholders including the government and determine “which provisions of the three farm laws required deletion” in the interest of farmers.

The committee comprises agricultural economist Pramod Kumar Joshi (Director of South Asia, International Food Policy Research Institute), Anil Ghanwat (head of farmers’ outfit Shetkari Sangathan), another agricultural economist Ashok Gulati (who served as Chairman of the Commission for Agricultural Costs and Prices) and Bhupinder Singh Mann, who heads Bhartiya Kisan Union and is chairman of an umbrella body, All India Kisan Coordination Committee (AIKCC).

The bench also ordered that “the Minimum Support Price (MSP) system in existence before the enactment of the farm laws shall be maintained until further orders. In addition, the farmers’ land holdings shall be protected, i.e., no farmer shall be dispossessed or deprived of his title as a result of any action taken under the farm laws”.

“This committee shall be provided a place as well as secretarial assistance at Delhi by the government. All expenses for the committee to hold sittings at Delhi or anywhere else shall be borne by the central government. The representatives of all the farmers’ bodies, whether they are holding a protest or not and whether they support or oppose the laws shall participate in the deliberations of the committee and put forth their view points. The committee shall, upon hearing the government as well as the representatives of the farmers’ bodies, and other stakeholders, submit a report before this court containing its recommendations. This shall be done within two months from the date of its first sitting,” the bench said.

The SC asked the committee to hold its first sitting before January 22 and expressed the hope that the agitating farmers would end their protests and go back to attend to their livelihood while awaiting the outcome of the committee report and the court’s decision.

“While we may not stifle a peaceful protest, we think that this extraordinary order of stay of implementation of the farm laws will be perceived as an achievement of the purpose of such protest at least for the present and will encourage the farmers’ bodies to convince their members to get back to their livelihood, both in order to protect their own lives and health and in order to protect the lives and properties of others,” the CJI-led bench said.

When some counsel said the composition of the committee should be acceptable to all, the CJI said, “We are not catering to everyone’s idea of what is a good committee. We will decide the composition of the committee to help us decide the issue.” “Before the committee, do not present arguments on legislative competence of Parliament to enact the laws. The committee will tell us about the ground reality and what the farmers want. We will decide the validity of the laws,” the bench said.

The protesting farmer unions counsel Dushyant Dave, Prashant Bhushan, Colin Gonsalves and H S Phoolka had on Monday welcomed the court’s proposal to stay implementation of the farm laws but sought time till Tuesday to report back to the court with their client’s instructions on two issues - their willingness to appear before the court-appointed committee and on their plan to hold a tractor rally on the Republic Day.

On Tuesday, however, all four did a vanishing act much to the chagrin of the SC. In their absence, it was chronic PIL litigant-cum-advocate M L Sharma who informed the bench that the farmers have refused to appear before the committee.

While appearing to be riled by the discourtesy shown by the senior advocates who did not think it fit even to convey the farmers’ decision to the court, the CJI-led bench said the absence of the quartet would not deter the court from setting up the panel it had proposed on Monday. “No power can stop us from forming the committee. All farmers who want to solve the problem arising from the farm laws would appear before the committee and express their grievances.” “When we suspend the implementation of a legislation, it cannot be an empty suspension,” the bench said.

No symptoms, no Covid test for college students: Guidelines

No symptoms, no Covid test for college students: Guidelines

TIMES NEWS NETWORK

Bengaluru:13.01.2021

With colleges preparing to throw open campuses for all students regardless of year or semester, the government has said Covid-19 tests are no longer compulsory for pupils or staff who show no symptoms. This is a shift from the previous protocol where tests were mandatory.

The relaxation was among the new standard operating procedures (SOPs) announced by the government on Tuesday.

“There should be no more than 50% of students in each class. Those attending offline classes must compulsorily wear masks, carry sanitisers and bring water and food from home. These directions apply even to teaching and non-teaching staff,” the guidelines state.

Those with symptoms must compulsorily get a test done. Institutions have been asked to tie up with primary health centres for tests. Students who wish to attend regular classes must get parental permission. While students have the choice of attending online or regular classes, attendance is compulsory. Social distancing norms must be followed in classrooms. Colleges can conduct teaching, practical and project classes in shifts.

Libraries and canteens have also been allowed to reopen on the condition that all safety guidelines are followed.

Airline told to pay ₹18k to flyer for delaying check-in bag

CONSUMER IS KING

Airline told to pay ₹18k to flyer for delaying check-in bag

B’lurean Had To Wait For 6 Hours, Ended Up Missing Bus, Paying Taxi Fare To Reach Destination

Petlee.Peter@timesgroup.com

Bengaluru:13.01.2021

A consumer court recently ordered commercial airline SpiceJet to pay over Rs 18,000 to a Bengalurean after it failed to load his check-in bag on his flight to  Delhi in 2019, upsetting his work plans. The verdict came after the passenger complained of deficiency in service and dereliction of duty.

Naveen BM, 37, from Hanumanthanagar, a skill trainer who travels extensively on work, landed at Delhi airport on the evening of May 2, 2019, in a SpiceJet flight from Bengaluru. But he realised his bag containing his clothes, medicines, food and work presentation papers hadn’t arrived.

Baggage not loaded on plane

He approached SpiceJet authorities at the airport, who informed him that his bag was not loaded on to the plane as it was oversized and would be transported in the next flight within an hour. However, Naveen had to wait for the next six hours, which resulted in him missing a bus to Solan, Himachal Pradesh, where he was scheduled to attend a meeting the following day.

The Bengalurean questioned the airline staff on the delay, but they simply had no reply. With the bag finally arriving around 1.30am, Naveen was forced to take a taxi to Solan in the early hours after shelling out Rs 2,101.

With SpiceJet not bothering to pay heed to his grievance, Naveen finally approached the Bangalore 1st additional district consumer disputes redressal commission in Shantinagar on February 12, 2020 with a complaint against the airline.

Naveen presented his case through his attorney, while SpiceJet remained ex parte despite notices. After a litigation of over 10 months, judges of the forum held SpiceJet responsible for the inconvenience and monetary loss caused to the customer by delaying his baggage, which forced him to miss his bus and pay taxi fare.

In its verdict pronounced on December 31, 2020, the forum ruled that SpiceJet must pay Naveen Rs 3,200 towards his taxi fare and bus ticket, Rs 5,000 towards his court expenses and an additional Rs 10,000 towards damages caused due to the ordeal, all within 30 days of the order.

Not given proper chance to be heard: SpiceJet

Responding to the case, a spokesperson from SpiceJet said the complainant’s notice was received during the Covid-19 lockdown and the forum pronounced its order ex parte without giving the airline a proper opportunity of being heard. The company has not received certified copy of the order from the forum till date. “We will examine the order upon its receipt and shall take necessary steps as per law,” the spokesperson said.

Vaccination countdown begins: Karnataka receives 6.5L doses

Vaccination countdown begins: Karnataka receives 6.5L doses

Sunitha.Rao@timesgroup.com

Bengaluru:13.01.2021

Karnataka, which is waiting for 13.9 lakh doses of the Covid-19 vaccine, received 6.5 lakh doses on Tuesday when the first consignment arrived in Bengaluru. The second consignment, expected to arrive from Pune to Belagavi, is likely to have 50,000 to 1.5 lakh doses.

By January 16, when the vaccination drive kicks off, the state is likely to have 8 lakh doses and they can be administered to 4 lakh healthcare professionals. Two doses need to be administered 28 days apart.

The priority list will now be redrawn. Also, the drive may not begin on January 16 at all 235 vaccination session sites across the state.

“Now that the quantity of vaccines we received has been reduced by half, compared to what was earlier communicated, we have to redraw the plan. There may not be 235 vaccination sites as planned earlier and we’ll have to redraw the quantity to be distributed to districts and the beneficiary list too,” said Dr Arundhati Chandrashekar, mission director, National Health Mission, Karnataka.

1.2cr may get vax after frontline staff

Estimates by government agencies suggest 20% (about 1.2 crore) of Karnataka’s population is expected to be vaccinated against Covid-19, after early phases covering healthcare workers are completed, reports Chethan Kumar. P 4

Schools for others from January 15?

The education department in the state is holding talks with various experts on reopening schools for other classes starting on Jan 15. Primary and secondary education minister S Suresh Kumar said parents are requesting for early classes. P 6

‘More people will be vaccinated after May’

M ore people will be vaccinated after May as additional vaccines will be manufactured by then, health minister K Sudhakar said.

While chief minister BS Yediyurappa had said 5 lakh people would be vaccinated under the first two priority categories — healthcare workers and frontline workers together, 6.6 lakh health workers had registered till Monday. Tuesday was the last day for them to register.

Dr Chandrashekar said the consignment received is to be used for both first and second doses given to beneficiaries. With each healthcare worker getting two doses, the current stock is enough for not more than 4 lakh healthcare workers in the first phase. Over 6 lakh health workers have been identified.

Besides, it’s an accepted norm in immunisation drives that 10% of vaccines would be considered as wastage, say authorities. “When 0.5 ml is drawn from a vial to a syringe, it’s measured through eyes and it is possible that we miss out on 10 % of the drug as wastage this way. But that happens with all vaccines and it is an accepted phenomenon. During the transportation too, there could be chances of damage,” said Dr Rajani Nagesh Rao, deputy director, immunisation, health and family welfare department.

The distribution of vaccines to all 30 districts is yet to begin. The beneficiary list, doses to be sent to districts and number of vaccination sites in districts will be decided by the Centre and the authorities are waiting for its decision. Each dose contains 0.5ml and each vial contains 10doses. The first dose is to be administered within 10 days from January 16.

No CCTV surveillance

Though there is police security at the vaccine storage unit inside the health department premises at Ananda Rao Circle, there are no CCTV cameras. “They are likely to be set up in 2-3 days,” authorities said.

India’s biggest vaccine rollout begins as SII ships 55L doses

India’s biggest vaccine rollout begins as SII ships 55L doses

Covaxin Shots To Be Flown Today Morning

Joy Sengupta, Umesh Isalkar & Saurabh Sinha TNN

13.01.2021

May all be free from disease” — with this slogan printed on each box, the shipment of Serum Institute of India’s Covishield set out from Pune to other parts of India on Tuesday morning, kickstarting the biggest rollout of a vaccine in the country’s history.

Delhi, Chennai, Kolkata and Hyderabad, the four major regional depots for vaccines, received their quantum of Covishield doses within 10 hours since their dispatch began from the SII premises at 4.30am on Tuesday. Overall, 55 lakh of the total 1.1 crore doses were dispatched from the SII premises till 5pm on Tuesday, officials confirmed. “The transport exercise for the remaining doses will continue till Wednesday evening,” a senior SII official said.

Covaxin doses will reach Hyderabad airport early Wednesday morning after which they will be shipped to around11destinations across the country, including Delhi, Bengaluru, Chennai, Patna, Lucknow and Jaipur, sources in Bharat Biotech and the aviation industry said.

SII CEO Adar Poonawala with the first of the shipments; landing at Ananda Rao circle in B’luru

Recipients won’t get to pick vax, govt hints

Recipients may not have the option to choose which vaccine they want to be inoculated with — Oxford-Astra-Zeneca’s Covishield or Bharat Biotech’s Covaxin — the government has indicated. P 12

On day 1, Pune airport flies 456 boxes of vaccine vials

Among the states that received the vaccine on Tuesday, Bengal topped the list with 10 lakh doses, followed by Karnataka (6.68 lakh doses), Bihar (5.49 lakh doses) and Tamil Nadu (5.36 lakh doses). As many as 9.63 lakh doses of Covishield will be shipped out from Pune to other parts of Maharashtra on Wednesday.

The Centre has placed orders to procure 1.1crore doses of Covishield and 55 lakh doses of Covaxin, which is being produced by Hyderabad-based Bharat Biotech. While Covishield is priced at Rs 200 per dose, the arrangement with Bharat Biotech is such that it is charging Rs 295 per dose for 38.5 lakh doses and providing the rest 16.5 lakh doses free of cost. “Hence, the cost of Covaxin is Rs 206 per dose,” Union health seceratry Rajesh Bhushan said.

Covaxin doses will reach Hyderabad airport early Wednesday morning after which they will be shipped to around 11 destinations across the country, including Delhi, Bengaluru, Chennai, Patna, Lucknow and Jaipur, sources in Bharat Biotech and the aviation industry confirmed to TOI.

The first vaccine consignment of the country, comprising 2.64 lakh Covishield doses loaded in three trucks, arrived at Pune airport’s cargo handling and processing facility at 5.30am on Tuesday and was shipped out at 8.05 am on SpiceXpress flight SG8937.

Currently, SII is manufacturing 7 crore to 8 crore vaccine doses per month. Private players have been roped in for providing refrigerated trucks, vans and cold storage.

Sources at Pune airport said 456 boxes containing the vaccine vials and weighing 15,000kg were transported to different states in nine aircraft of different airlines. “GoAir was the second in line and flew to Chennai with 59 boxes of the vaccine. The flight left Pune airport at 8.45am and reached Chennai at 10.20am,” an airport official said.

Union civil aviation minister Hardeep Singh Puri tweeted: “Air India, SpiceJet, IndiGo and GoAir will operate nine flights from Pune with 56.5 lakh doses to Delhi, Chennai, Kolkata, Guwahati, Shillong, Ahmedabad, Hyderabad, Vijayawada, Bhubaneswar, Patna, Bengaluru, Lucknow and Chandigarh.”