Letters to the Editor — September 21, 2020

There are definitely ‘miles to go’ in maternal and child health care (Page 1, “It’s miles to go for a safer childbirth in Odisha’s Kalahandi”, September 20). India accounts for a quarter of global maternal deaths during pregnancy, and unless there is strong political will, health sector reforms and focused efforts on improving antenatal services occur, there will still be ‘miles to go’ before we can hold our heads high on the world stage. Increasing the abysmal 1.28% allocation of gross domestic product on health services and improving the slow bureaucratic processes in the government to make funding available at peripheral areas will definitely help in improving maternal health care.

Vellore, Tamil Nadu

The First Bench of the Madras High Court, with considerable statesmanship, has drawn the curtain by refusing to initiate contempt against Tamil actor Suriya. The matter would not have gained so much of controversy had the High Court judge concerned exercised restraint and not written a letter to the Chief Justice of the Madras High Court. It really was a case of much ado but nothing. As the Chief Justice himself said, there is no need to use a sledgehammer to kill a fly.

However the suggestion that the actor could have used a little more restraint is slightly off the mark as his comment was only normal and natural. It is the judiciary which should exercise restraint in such situations. There is a great deal of institutional intolerance which is the antithesis of democracy and rule of law. Courts are not immune from this and have got into such a situation largely on account of themselves.

One recalls the courts initiating contempt against Justice V.R. Krishna Iyer and Justice Markandey Katju. It is that same level of intolerance which overflowed in the case of Prashant Bhushan too. Courts should not resort to the Contempt of Courts Act to caution citizens; rather, they must be cautious in using it against citizens. Physicians heal thyself would be an appropriate adage on this occasion.

Chennai

Chennai Super Kings class batsman Ambati Rayudu sure made a very strong statement with his sizzling, breezy, match-winning innings of 71 in the IPL opener against Mumbai, showing that he is still a very reliable player as he was always before (‘Sport’ page, “Rayudu and du Plessis orchestrate Super King’s victory”, September 20). Faf du Plessis’s crucial innings also contributed to CSK’s emphatic victory. It is still quite baffling as to why the experienced Rayudu was not in the reckoning for the Indian ODI team for the World Cup last year despite his good track record. It takes many years to create a dedicated and successful national-level cricketer. and all it needs is one wrong, poorly judged decision by the team selectors to bury the international career of a promising player.

Chennai

IPL 2020 has started on a winning note for Chennai Super Kings and the result of day one is bound to embarrass the critics and their pre-match analysis. ‘Captain Cool’ has got a variety of players to choose from and he has shown that he has enough tricks up his sleeve to unsettle the competition. Going by the fitness of MSD and the spirit shown by the team, fans are certain to witness some flamboyant action from this team.

A.P. Thiruvadi,

Chennai

Though the crowds will be missing in stadia, IPL cricket fans will look forward to the actions of the dazzling stars in the world of cricket. The two-month-long action-packed programme will indeed be a source of relief for sports lovers.

The gradual and welcome return of sport will give the world a chance to understand the timeless values and lessons of sportsmanship — courage, unity, positivity, patience, perseverance, and the immense hope and spirit that the world shall overcome any crisis.

Thalikavu, Kannur, Kerala

I write this as a research scholar in the Centre of Social Medicine and Community Health, Jawaharlal Nehru University. In health-care spaces, we witness marked emotional outcomes of people when faced with adversities related to a relative’s health. These can take forms of violent expression towards health-care staff. The Indian Medical Association suggests that 75% of doctors have faced some kind of violence in their service. Violent attacks by the public are the extreme form of dissatisfaction, leading to low future trust. There is popular public opinion of the inefficiency of the public health-care sector and overpricing, and ‘fraud’ by the private sector. The private sector is variegated, comprising indigenous healing systems apart from allopathic medicine. NFHS-4 data show the utilisation of public health-care services is less than the private sector. It indicates that the public places more trust in private health-care services. This difference is more visible in the urban areas towards using private sector services resulting from the choices available in both the sectors and as a result of a high income.

Trust in health-care institutions has become even more crucial now in the COVID-19 pandemic. It is defined as the acceptance of a vulnerable situation where the trustor (patients, relatives, the public) believes that the trustee (hospitals, health-care workers) will not take undue advantage of their situation and will work in their best interests. Trust becomes important as it ensures patient compliance and better utilisation of resources. Yet, there has not been enough extensive research on what augments and decimates trust in health-care systems especially in the Indian context. Researchers have found a history of a lack of trust in the health-care system results in non-compliance, further increasing the risk of spreading communicable diseases. Vaccine hesitancy in the United Kingdom (in the 1990s) for the Measles, Mumps, and Rubella (MMR) vaccine and in California (2015) for the measles vaccine created a fear of disease spread. Boycott of the polio vaccine in Nigeria (2003) caused a resurgence of polio in the neighbouring countries as well which were previously declared polio free. These cases are important in highlighting the need to strengthen public trust in the health-care system. The major factors impacting trust have been categorised as systems-related and information-related. Systems-related factors are formal, informal rules and norms which govern our behaviour through institutional guarantees. Information-related factors are derived from the direct and passive experiences from encounters with the health-care system, and the media.

If given a choice and enough financial security, one would choose the best possible service for their health-care needs. Unfortunately, the public health-care sector is inefficient in serving the population. If we follow the Rangarajan Committee (2014) poverty estimation, in 2010-11, about 30% of the population was below the poverty line. This is when the committee has been criticised for not doing a multi-dimensional estimation of deprivation. This group of the population has only public health-care institutions at their disposal. However, it does not mean that the rest of the population can shop around for choices in private institutions (allopathic). These private institutions are only accessible by people who can afford the high user fee and service charges. The Centre for Monitoring Indian Economy estimated that 122 million people lost their jobs between March and April this year and the pandemic has impacted 555 million workers in the country. This leaves more people in the category who cannot access private health-care services due to financial crunch.

At the beginning of the pandemic, the only institutions catering to the infected patients were public institutions. They were calculably inadequate and the quality of services provided was unsatisfactory. For example, the civil hospital in Ludhiana — the most populated district in Punjab — had to move its ventilators to a private hospital, the reason attributed being the unavailability of technical staff to operate them. The hospital had 30 ambulances and none had the BLS (basic life support) equipment. There are no ICUs in public hospitals in the district. The social media was replete with the horrid experiences of people shifted in quarantine facilities on international arrival. Many of them escaped the facilities, and in some places, the police had to intervene. In May, a social media post by a person whose father-in-law died because they could not find a hospital with a ventilator when he tested positive for COVID-19, was reposted 29,000 times in 30 hours. With the lockdown in place, a huge number of migrants returned home from the cities. A lot of them got down from Shramik trains one station ahead of their destination. The reason they gave was their reluctance to stay in quarantine facilities. There were instances of clashes between inmates and staff of quarantine centres for better food and facilities. In Chhattisgarh, three children of migrant workers died in a span for 48 hours in a quarantine centre in late May. They were reported to be malnourished. The deaths which followed in 10 facilities later were due to electrocution, snakebite, suicide and illness. These facilities were overly packed and the hot weather added to the plight. In a civil hospital in Ahmedabad, the situation was so dire that the relatives of the patients had to manually pump oxygen while shifting them and also change their diapers in the hospital.

The public health-care system has failed doctors and nurses too. Health-care staff are working tirelessly to treat infected patients and yet are being neglected by the government. In Ahmedabad, a resident doctor wrote a letter of grievance to the Gujarat High Court. The High Court, on a suo motu PIL, called the hospital “as good as a dungeon, maybe even worse”. The letter mentioned the unavailability of N-95 masks, personal protective equipment kits and proper gloves. Out of the 700 doctors who stay together in a common hostel, hardly 10% had been tested for the infection. Later, a day prior to hearing COVID-19 related issues, the Bench was reshuffled. There were strikes by nurses in large numbers in all the major hospitals treating infected patients, to demand better life-saving gear, lesser duty hours, better accommodation and salary credited on time. Nurses were terminated in a Faridabad hospital when they demanded insurance before attending to COVID-19 patients.

The health infrastructure is in a shambles. Under the central government’s 100 Smart City development projects, health infrastructure was only 1% of the total projects since 2015. There is a lopsided distribution of ventilators and ICU beds in the public and private health sectors. More beds and ventilators are in the private sector except for Tamil Nadu, Delhi and West Bengal. Most ICU beds and ventilators are concentrated in seven States. The two firms that were paid in advance for manufacturing ventilators from the Prime Minister’s Citizen Assistance and Relief in Emergency Situations (PM-CARES) Fund, failed quality tests. There were reports of a hike in charges for COVID-19 related care in the private sector — a 50% hike in emergency care room charges for virus-infected patients and a 40%-50% hike in non- COVID-19 emergency room charges. There was no cost capping for PPE charges in Maharashtra. As per the guidelines by the Insurance Regulatory and Development Authority of India, insurance firms are not supposed to cover non-medical equipment charges; thus, the burden falls on patients.

Daunting experiences of the public and health-care staff account for diminishing trust in the health-care system. The most visible implication could be seen in the form of patients escaping quarantine facilities, increasing the risk of disease spread, and protests by health-care staff for better facilities. The purview of events that took place during this pandemic highlights the need for damage control. There is need for a revival of public trust in the health-care system.

Jyoti Yadav,

New Delhi

I write this as research scholar in the Delhi School of Economics, University of Delhi. The shocking incidents of fire breaks especially during the pandemic highlight the need for a review of safety measures. In the incident in a firecracker factory in Tamil Nadu’s Cuddalore district, where at least seven people lost their lives and many were injured, the report is of most of the deaths having been caused by the inhalation of poisonous gases. The cause of the blast is yet be ascertained, and as is usual practice, a probe has been launched.

In the past few months, there have been frightening incidents across the country — the deaths in a Vijayawada hospital treating COVID-19 patients and the accident at the Srisailam Hydro Power Plant in Telangana are fresh in our memory. According to data by the National Crime Records Bureau, 2015, more than 17,700, or 48 people in a day, lost their lives due to fire in India. The 2019 data of the Delhi Fire Department shows the department having received 85 daily and 31,157 calls annually to extinguish fires. It has increased by about 10,000 calls when compared to 2009. In this context, considering Delhi as a sample site, we can understand the situation in other parts of the country. All these points reflect the disregard of fire safety norms in India, possible arson and evidence of fire susceptibility in urban areas.

Two major factors, direct and indirect, turn fire into a disaster. Short circuits, gas cylinder explosions, and human negligence are the major direct factors. Indirect causes include illegal commercial activities in residential areas, violation of building and fire safety guidelines, shortage of modern equipment, firefighters, fire stations and infrastructure in the fire department. According to a report of the Indian Ministry of Home Affairs, a total of 8,599 fire stations are needed in the country, 5.6 lakh firefighters, 2.2 lakh firefighting equipment and 93,000 fire engines. Other major causes include the delayed arrival of the fire brigade, the contract-based appointment of the fire brigade with less money and life-safety measures, unplanned urbanisation and urban expansion, the number of rising skyscrapers (more than 150 metres), non-availability of fire safety resources with the general public, and the lack of awareness.

Many laws, policy, and guidelines have been issued in India from time to time by the Central, State, and Union Territory governments, such as the Boilers Act 1923, the Cinematograph Film Rules 1948, the Oilfields (Regulation and Development) Act 1948, the Cinematograph Act 1952, the Mines Act 1952, the Indian Electricity Rules 1956, the Coal Mines Regulations 1957, the Indian Electricity Act 2003, the Gas Cylinders Rules 2004, the Explosives Rules 2008, the Mines and Minerals (Development and Regulation) Act 2010, the Explosive Rules 2008, the National Building Code 2016, the Formation of National Disaster Management Authority 2005, the National Disaster Management Authority Guidelines for Fire Protection, etc. At the level of regional governments as well, there are the Tamil Nadu Fire Service Act 1985, the Tamil Nadu Fire Service Rules, 1990.

So the question arises: despite there being many laws, guidelines, and institutions at different levels in this country, why is fire safety so poor? The appropriate answer is the lack of a comprehensive and inclusive plan for fire protection at the individual, social and national levels.

There need to be three-tier measures to control fires. The simplest and most effective solution is to create general awareness about fire disaster. Everyone can make a two-pronged effort to prevent fire destruction. What are the factors which make fire as a resource to disaster? After people understand these, adopting a way of avoiding it comes next.

Second, the media, social organisations, non-governmental organisations, and other sectors can play a pivotal role in conducting awareness campaigns.

Third, major steps can be taken at the level of State and national governments and institutions to have a fire safety audit on an annual basis, regular inspection of a non-objection certificate (NOC), and building safety standards of buildings. Special attention must be paid to the modernisation of firefighters, fire-fighting equipment, and centres. With the use of remote sensing and Geographical Information System (GIS), there must be a fire hazard risk vulnerability assessment and mapping for the whole of India.

There must be expedited hearing of arson-related cases in fast track courts, so that victims can get compensation and justice quickly. Implementation of the 13th Financial Commission’s fire safety suggestions must be done on a priority. The inclusion of fire safety in school courses, awareness campaigns at local, State, and national levels and an emphasis on fire safety practice are mandatory. Infrastructure-related changes in which emergency lanes on roads, provision of a smart control room for emergency coordination of various departments and institutions and preparation of a National Digital Fire Database are other crucial steps.

India’s population is growing every day and there is more urbanisation, so this is an important time when we should focus on the fire safety of the nation. At the same time, there is a need to be strict against the violators of safety instructions. It is only then that a self-sufficient and safe India can be built.

Shubham Kumar Sanu,

New Delhi

I write this as Associate Professor in the Department of Computer Science and Engineering and also as the Principal, University College of Engineering, Adikavi Nannaya University, Rajamahendravaram. Gone are the days of a dishevelled parent running with her children to board a school bus whose driver sounds the horn incessantly. Gone too are the days of smiles and smirks on the faces of teachers seen in the corridors as they rush to class. The novel coronavirus pandemic, or COVID-19, has indeed altered the way we function, live and conduct our activities.

And, the most impacted sector is education where change has swept across it like a shock wave. The present normal of e-learning has shattered the age-old methods of education and teachers across the globe are now pondering over their role and responsibility in this changed world. At the same time, many academicians have welcomed this change as a breath of fresh air into the stagnant model of education.

The time has come to change our age-old classroom to a 21st century technology-centred resource room. However, the challenge is to facilitate a smooth transition from a traditional class room setup — a stage from which a teacher can look at students — to a technological virtual room setup; a gauge that can widen the gaze of teachers and students with an unprecedented flexibility in the mode of education. Despite a strong, almost orthodoxical opposition to virtual classrooms, it is true that any teacher can reach an infinite number of learners in any place at any pace, on any device and in any mode. Seen as an opportunity rather than a hurdle, online education has a potential to solve many gaps in our pre-pandemic education model.

When the Internet was introduced for the first time, people were surprised to learn that an email can reach its destination within a fraction of a second. Now, we are happily accustomed to all sorts of online activities — from booking a ticket on the website of the Indian Railway Catering And Tourism Corporation Limited, or IRCTC, to transferring hundreds of rupees via an app, to buying a second-hand ‘Aerofit’ on OLX. The same is to happen now in the field of education. People who are reluctant about online education till now will, in no time, become earnest tech users; as an educationalist noted: “Technology is not going to replace teachers but teachers who do not use technology will be replaced by those who do,”

Therefore, at the crossroads with no one around, a teacher has to get up, get himself ready and go for a gamut of challenges. In these unsure situations, a teacher will find a place in educational technology like other fields have found their haven in technology. While it is acknowledged that no amount of technology can predict the future with precision, it is nevertheless present to aid in the impending paradigm shift that is to take place in the field of education. Technology, like always, will continue to connect people, bridging the gaps and providing solace to both student and teacher till normalcy is restored or a new normal is established.

With time, technology will become more intuitive to academic needs and become an indispensable resource at the hands of educators and learners. A host of premium organisational tools are available with exciting features and smoother interfaces. Educational technology kits come in different designs and shapes, and as a perfect mix and match based on the requirements to serve the purpose. At its basic level, a smartphone and a blackboard to record the class and release it serve the purpose of reaching the learner community. For small-scale class room management, the Google classroom comes with a set of rich but free features such as sharing and scheduling, online class with meet, assessment through quiz, evaluation through rubric, and a multitude of extensions that can be gracefully integrated into it. Open Broadcasting Software is an open resource platform for recording and live streaming with a combination of sources such as screen, ppt, and video and window capture, without any limitations on the recording time. For further originality, it is recommended to have a pen tablet that really offers a natural blackboard experience with a digital screen.

Other online educational resources for exploration are audio recorders, screen recorders, software that facilitate video recording, animation, video conferencing, creation of wiki pages, interactive webpages, interactive videos and classroom management systems incorporated with assessment and feedback tools.

Educational technology will continue to evolve to put both learner and instructor at greater ease, but the keys to successful online academic transition are not embedded in technology, but within us. It is through these keys one can unlock their potential as a true teacher. Let me give you keys here: passion, patience and practice.

Persis Voola,

Rajamahendravaram, Andhra Pradesh