Friday, April 29, 2005
Tele-density will be 22% in 2 years: Maran
"By that time (2007) the entire country shall be carpeted by telecom network and all the villages shall be connected by phone," Maran said.
He said the Internet connections would increase from 5.45 million to 18 million by 2007. Broadband connections will go up to nine million in 2007. To enable faster expansion of wireless telephony, and other services, the required spectrum will be made available to the operators.
"With increasing competition, we expect that the tariff rates will fall further, benefiting the consumers," Maran said.
The Minister said India has crossed the 100 million mark in terms of number of phones and has become the fifth largest network in the world after China, USA, Japan and Germany.
India not among top 30 exporters’ list
According to the WTO preliminary international trade report released in Geneva, India's exports amounted to $73 billion in 2004. While the country's average export growth was 7 percent in 1995-2000, it went up to 14 percent in 2002, 16 percent in 2003 and to 27 percent in 2004, though its exports suffered during 2001 when it was just 2 percent.
India's import growth during 1995-2000 averaged 8 percent and this went up to 12 percent in 2002, 26 percent in 2003 and to 34 percent in 2004, though it skid to a negative 2 percent in 2001.
However, as per the trade policy annual supplement released on April 8, the country's exports amounted to $80 billion in the fiscal year 2004-05 (April 2004 to March 2005).
An interesting point is that though India does not figure in the leading 30 exporters of the world, it is ranked 24th among the 30 leading importers in the world, a value of $95.2 billion and a share of one percent in global imports. In contrast, China holds third rank among 30 leading exporters and importers with exports of $593.4 billion and imports of $561.4 billion in 2004. However, India can draw some comfort if intra-European Union (25 countries) is excluded. Then as per the WTO listing, India gets the 20th slot as the leading exporter and 16th slot in leading importer league.
But reflecting the rising share of services in India's gross domestic product and also in some important services sector abroad through exports, India occupies the 22nd slot in the export of commercial services at $32.2 billion and accounting for a share of 1.5 percent in global services exports in 2004. Similarly in the import of services, India occupies the 15th slot as it imported $37.9 billion and accounted for a share of 1.8 percent in global commercial services imports in 2004.
Lowest Internet use and access to PC in India
Despite high tech hotspots in India like Bangalore, Hyderabad, Chennai and Delhi, the bank said it is a case of low access to personal computers and Internet. "Modern information and communications technologies are increasingly recognized for their contribution to the development process and links to growth”.
With less than 10 Internet users per 1,000 people, India ranks well below most European and Central Asian countries (160 users per 1,000), Latin America (106 per 1,000), and sub-Saharan Africa (20 users per 1,000).
Access to personal computers is also low in India compared to other developing nations. With just around seven personal computers per 1,000 people, India is behind East Asia and the Pacific (26 PCs per 1,000), the Middle East and North Africa (38 PCs per 1,000) and sub-Saharan Africa (12 PCs per 1,000).
India retains 4th place in purchasing power parity
The size of the economy is calculated according to what a nation's currency actually buys in goods and services and not on the basis of its exchange rate against the U.S. dollar.
The United States has by far the largest economy in the world worth $10,978 billion, followed by China at $6,410 billion, Japan at $3,629 billion and India with $3,062 billion. Germany comes next with $2,279 billion.
With a PPP per capita of $2,880 dollars, India is above the definition of a low-income country (per capita PPP income of $2,110 or below) but falls below the required $6,000 PPP per capita to qualify for being a middle-income country.
HIV/AIDS out of control in India: Global Fund
Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said "the official statistics show India in second place and South Africa in first place."
But, Feachem said, "The official statistics are wrong. India is in first place."
"The epidemic in India is growing very rapidly. It is out of control. There is nothing happening in India today that is big or serious enough to prevent it."
The U.N. agency UNAIDS' latest official figures for the national prevalence of HIV/AIDS were published in July 2004, giving the estimated incidence as at the end of 2003.
IT spend very low in India: Nasscom
This, in turn, is leading to lower direct contributions to GDP and insignificant labor contributions to GDP, according to the Nasscom report. More revealing is the fact that in terms of domestic IT investment, India ranks lower than countries such as Colombia, Chile and Turkey, which otherwise figure nowhere in the global IT radar.
According to the findings of `Information Technology in the Economy of India' report, conducted by Sallstrom Consulting & Nathan Associates Inc and supported by Microsoft Corporation India, a mere 3.5 percent of total economic capital in India is hardware and software. "This is the lowest vis-à-vis the average IT capital share of 5.7 percent among the other eight countries that are underinvested in IT. While among the 21 economies identified as invested in IT, the average IT capital share is 23.9 percent," said the report released by the Deputy Chairman, Planning Commission, Montek Singh Ahluwalia.
The U.K. topped the list, followed by the U.S. Other countries evaluated include Ireland, Sweden, Netherlands, Belgium, Germany, Austria, Spain, Poland, the Philippines, Argentina, Canada, Italy and France.
The report inferred that in economies invested in IT capital, a 10 percent increase in IT capital increases GDP 3.6 percent, while a 10 percent increase in labor hours increases GDP four percent. In contrast, in economies such as India that are underinvested in IT capital, a 10 percent increase in IT capital increases GDP only 1.6 percent; a 10 percent increase in labor hours has no statistically significant impact on GDP. The conclusion - as IT capital deepens in an economy, it adds more to GDP and labor becomes more productive.
In addition, the existing IT capital in India was not found to be widely dispersed. "One cost of being underinvested in IT capital is slower economic growth in India. Throughout economies invested in IT capital, IT industries (producing and using combined) contribute between 28 percent and 57 percent to real growth in GDP. More important, in most of these economies the contribution of IT using industries is stronger than the contribution of IT producing industries. Further, productivity in India is lower than three-fourths the average rate in other economies underinvested in IT. When examining the real GDP per capita, India lags behind China and Sri Lanka, but leads Bangladesh and Pakistan," the report said.
The report points out that policy makers needed to borrow from the success of the commercially based software export sector.
Wednesday, April 27, 2005
Dataquest : Top Stories : Tech Goes Rural
Will global markets survive US bust?
Will global markets survive US bust?PRADEEP KURUP INDIATIMES NEWS NETWORK[ MONDAY, APRIL 25, 2005 12:46:43 AM]
Is the most spectacular global economic boom of last two decades, and particularly last two years, is finally coming to an end? Worries about the rising interest rates, burgeoning trade deficit and an apparent growth slowdown in US economy is driving many leading stock indices around the world into negative territory. What's the reason for the current alarm? There is a fear and speculation of the most severe economic depression that mankind has ever seen. Many doomsday predictions have come out saying the severity of the bear markets of 2005 and beyond will make the bear markets of 2000-2002 look like a dream run and the "Greatest Depression" of 2005-2015 will make the 1930s look like one of the swinging decades of the 20th century. There has been a sharp fall in most of the global equity indices in recent weeks and the early signs of a broad economic slowdown have become all too visible, if one considers the warning signals given by many corporations and the latest economic data emanating from US.
Economists and financial analysts are wary of the impact of inflation, rising crude oil prices and the prospects of a sharp rise in US interest rates in next few months. The orgin of the falling equities are mainly mapped to these factors. The general fear is succored by a dangerous combination of US economic indicators. An expanding trade deficit, rocketing oil and commodities prices, a weak American labor market and, looming stagflation (inflation plus recession) are all creating panic. According to Economist, four big sets of statistics for March, namely, employment, retail sales, manufacturing production and housing starts, suggest that the American economy is losing momentum. The world's finance ministers and central bankers are seriously troubled by these structural problems of American economy. What's happening in the US equity markets? US stocks slid on Friday, as a jump in oil prices, some disappointing earnings news and a report that North Korea could be preparing for a nuclear weapons test gave investors further incentive to sell. Retailer Costco Wholesale and photography icon Eastman Kodak were among companies helping douse sentiment a day after major gains.
Meanwhile, oil prices surged back above $55 a barrel, with crude for June delivery up $1.19 to settle at $55.39 a barrel. Rising oil prices raise concerns that higher energy costs will pinch corporate profits and curb consumer spending. Reuters reported that US stocks extended their slide late in the session, after the Wall Street Journal reported on its Web site that the United States has warned China "quietly that North Korea could be preparing for a nuclear weapons test." "The market was weak before and this just added to it. It's another piece of bad news," said Elliot Spar, market strategist at Ryan Beck & Co. The Dow Jones industrial average was down 60.89 points, or 0.60 per cent, to end at 10,157.71. The Standard & Poor's 500 Index was down 7.83 points, or 0.68 per cent, to close at 1,152.12. The Nasdaq Composite Index was down 30.22 points, or 1.54 per cent, to finish at 1,932.19. The decline came a day after a major rally by all three stock indexes and ended a tumultuous week for investors. On Wednesday, the Dow had almost come below the psychologically important 10,000 level. But on Thursday, the Dow surged by its largest amount in two years.
For the week, the Dow ended up 0.70 per cent, the S&P 500 edged up 0.83 per cent, and Nasdaq was up 1.26 per cent. The earnings outlook of almost all the major companies in America as well as big corporations around the world, which draw a major chunk of their revenues from the US market, opted to add a word of caution to their earnings forecast. The poor earnings outlook had triggered the crash of stock market around the world. The worry was further reflected in the surging volumes. According to Reuters, 1.68 billion shares changed hands on the New York Stock Exchange, above the 1.46 billion daily average for last year. About 1.85 billion shares were traded on Nasdaq, above the 1.81 billion daily average last year. The number of declining shares outpaced those that rose by a ratio of about 5 to 3 on the NYSE. Decliners led advancers by about 7 to 3 on Nasdaq. Reuters reported that Dow Jones has not fallen below the 10,000 level since October 2004. Its lifetime high was 11,750.28, reached in January 2000.
Meanwhile NYSE took a historic leap forward. The New York Stock Exchange, known as the Big Board and floor trading, announced it will merge with electronic market operator Archipelago Holdings in a $400 million transaction. The deal will transform the NYSE, founded in 1792, into a publicly traded company and help it break into electronic trading -- the domain of Nasdaq, its arch rival.
doweshowbellyad=0;
How have the global markets responded to US economic slowdown? Equity markets around the globe tumbled during last week hitting 5-month lows. The Japanese stock market fell by 4 per cent against the violent anti-Japanese protests across China. Japanese economic depression has been a global worry for the past few months. When it looked like the Japanese economy is slowly recovering, the China incident seems to damage the dynamic Japanese-Chinese trade relations, worth $168 billion.
The European high-tech shares fell by 2.5 per cent. In key Asian markets the spillover effect is being felt. Hence, debate in major European financial capitals on Wednesday is about the duration and size of `correction', which has been widely predicted with recessionary trading and economic conditions.
Markets
16-04-2005
12-04-2005
% decline
Nasdaq
1908
2005
4.8
Dow
10088
10508
4.0
Nikkei
11371
11670
2.6
Sensex
6248
6397
2.3
DAX
4312
4372
1.4
FTSE
4892
4946
1.1
Table courtesy: India Infoline
The European Central Bank has initiated modest interest rate rise but many investors are wondering for how long low interest rates could be sustained in a highly recession-prone European economy. The European unemployment level, with the sole exception of Britain, remained high and could soon plunge to a double-digit figure. On Friday many markets were upbeat for a while, lead by US market recovery. The FTSEurofirst 300 index of pan-European blue chips was 0.63 per cent higher while the narrower DJ Euro Stoxx 50 index rose around three-quarters of a per cent.
Japan's Nikkei share average closed up 0.6 per cent or 61.56 points at 11,045.95. Reflecting earlier gloom, however, it ended down 2.8 per cent on the week. The broader TOPIX index rose 0.7 per cent on the day to 1,130.89. India Infoline reported that the sell-off in global equity markets was triggered by growing concern of flaring commodity prices, especially that of crude oil would hurt the global economy, which will in turn crimp earnings growth. The International Monetary Fund (IMF) said this week that global economic growth was set to slow in 2005 to 4.3 per cent from 5.1 per cent in 2004, before regaining momentum next year. What is the inflation situation in US? US consumer prices gained 0.6 per cent in March, the biggest increase since October, led by gasoline, airfares, clothing and medical care, the Labor Department said. Bloomberg News reported that the Core prices, which exclude food and energy, rose 0.4 per cent, double the 0.2 per cent economists expected. This was the sharpest monthly increase the core CPI in 2-1/2 years.
The Standard & Poor's 500 Retail Index fell 1.73 per cent, reflecting investors' worries that higher prices were keeping shoppers away. Almost all the retail stocks like Gap and Home Depot lost more than 2 per cent. What world economic experts find most disturbing is the hint of stagflation in the United States posed by rising inflation (caused by spiraling prices of commodities and oil), unemployment and a weak labor market. The most serious aspect of stagflation is that it has no surefire economic cure. US Federal Reserve heads have been combating inflationary pressures by periodically raising short-term interest rates. American labor market figures likewise show only a modest monthly growth of above 100,000 new jobs. This produces a condition where inflationary pressure gets coupled with economic slowdown. So, pushing interest rates up any further could further depress growth. Prices in the US housing market have climbed by 65% across the nation since 1997 and by much more in some areas, and the boom has helped to fuel an increase in household debt and consumption.
How the earnings of big companies have been affected? The inflation fears outweighed a number of strong earnings reports from Dow components and other big companies. Technology stocks and motor vehicle makers were among the top losers as investors dived into safe havens like gilts (UK government bonds), US Treasuries and gold. Many analysts point out that first-quarter corporate earnings have not been especially solid. Though there are many high-fliers like Apple, Yahoo!, Intel, Caterpillar, General Electric and Bank of America, there are several weak spots like IBM, Coca-Cola, General Motors, Ford and Continental Airlines - all index heavyweights. According to economist, investor confidence has touched a rock-bottom with 20 per cent of the 324 global fund managers surveyed by Merrill Lynch saying that growth would fall than that it would rise. This was 11% in March. The survey had similar beliefs corporate profits. This was infact justified by IBM, the biggest weight on the Dow average. IBM has not risen a single day so far this month. IBM's stock fell 4.6 per cent, or $3.47, to $72.01, a 2-1/2-year low.
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Economist quoted Nicholas Colas of Rochdale Research saying that firms have achieved their strong balance sheets and impressive cash balances by underinvesting in their operations, despite the good global growth of recent years. They preferred rewarding shareholders through dividends, special repayments and share buybacks rather than investing in expansion drives. This reluctance to invest has reflected positively on most of the companies' financial ratios like the rate of growth of capital employed. Many big corporations have outgrown their management's capability to manage them. Many are thinking of trimming down by divesting non-core activities. Citigroup, Microsoft and GM are no exceptions to this trend. With this trend has grown the number of reported corporate scandals. The fall of global equity markets could be traced to the falling corporate fortunes.
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Is rising oil prices a cause of worry? Finance ministers and central bankers from Europe, America and Japan, are deeply disturbed by high oil prices. Although oil fell back this week from its record $60 a barrel to below $50, a barrel still costs 50% more than it did two years ago. This poses a real threat to economic growth rates in developed countries led by America, Europe and Japan. Studies suggest that every $10 increase in the price of oil cuts economic growth by between 0.3 and 0.4 percentage points. Adnan Shihab-Eldin, the acting secretary- general of the Organisation of Petroleum Exporting Countries (Opec), warned that supply interruptions might drive prices up to $80. The Opec cartel does not have sufficient excess capacity to cope with short-term spurts in demand such as we are now experiencing as a result of the winter gripping the northeast of the United States and parts of Europe. Saudi Arabia says it is stepping up drilling for new reserves, but it will be some time before that capacity comes on line. All this have prompted Opec to abandon its old price target of about $25-$30 in favour of one in the $40-$50 range.
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What will be the impact of interest rate hike? High interest rates in US tend to pull out institutional money from emerging markets. The Fed has continuously raised short-term interest rate. The Federal Reserve had raised the rate up by 0.25 % on March 22. There are altered expectations of continuing aggressive rises in interest rates - some even estimating the next hike on May 3 to hit 0.5% instead of 0.25% as heretofore. High interest also raises credit prices and so hurts the real-estate markets, which are already overblown in many Western countries. The turn in the interest rate story and the flow of institutional money to emerging markets had sound economic logic. Historically low American interest rates drove investors ambitious for better returns in search of more attractive alternatives, mainly emerging markets.
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Average hourly wages in the US when compensated for inflation have risen only moderately. This gave Alan Greenspan, chairman of the Federal Reserve Board, support for his programme of "measured" increases in interest rates. Though emerging economies like the Brazil, Russia, India and China are seen as flourishing economies witnessing high-speed growth, the gainers from a high-interest regime and thereby the closest to a big fall from the current highs are some of the newly-arrived economies like Turkey and Brazil which offer double digit interest rates in the range of 16% to 18%. What is the impact of US trade deficit? The Congressional Budget Office estimates the 2005 budget deficit at about $400 billion, down from $412.55 billion in 2004. Some private forecasts are closer to $375 billion. Cleveland Fed President Sandra Pianalto warned that a persistent budget deficit could lead to a higher equilibrium for interest rates and that the wide US current account deficit was unsustainable. Greenspan urged lawmakers to tackle the deficit by cutting spending rather than raising taxes.
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Greenspan fretted about the demographic crisis expected when the baby boom generation starts to retire and becomes eligible for Social Security and Medicare payments. There is a call to raise the eligibility ages for retirement and Medicare benefits. Irwin Stelzer, business adviser and director of economic policy studies at the Hudson Institute, has said that though the housing, manufacturing and non-manufacturing sectors are expanding rapidly, there is no sign that the US federal budget is being brought under control. The weakening dollar is again threatening to increase the price of imports and reduce the competitive pressure on domestic manufacturers to keep prices down. International Monetary Fund (IMF) heads gathered last weekend in Washington voiced concerns about growth, especially in the United States, under the burden of expensive oil and the soaring US trade deficit, which surged in February to the new all-time record of $61 billion.
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What is the impact of forex and money markets? On the foreign exchange market, the dollar fell to a one- month low against the Japanese yen. It held relatively steady against the euro, holding onto gains made in the previous session after the regional Fed report. Recovery of dollar hurts the emerging markets. It thumps all major currencies, mainly the euro. The euro got a recent jolt with European finance ministers deciding to permit deficits over 3 per cent of gross domestic product in some cases. This decision broke out of the basic tenets of the Maastrict Pact binding all European Union members and the all-euro zone economies. Most big central banks like those of China, India, Korea, Taiwan and Russia remain ever-cautious of dollar movements. They persist in diversifying some of their reserves, switching part of their dollar holdings mainly to the euro. The bond market has tip-tilted in the last two weeks. American 10-year bond yields plummeted from a high of 4.65% to 4.20% during Tuesday April 19 trading. Investors went back to the cozy safety of long-term bonds with the fear of a global slowdown. Long term interest rates dropped sharply in consequence. All financial markets have become more volatile of late, chasing like stampeding cattle from one attraction to another. This manifestation is caused largely by the heavy involvement of hedge funds in financial markets. The hedge funds are excessively leveraged, which means they are financed by as much as ten times their capital value and make frequent acute turns - even in intraday trading.
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Is the fear of another 1930-model depression justified? The reality is it is too early to say whether the current slowdown will translate into global depression. In his writings Milton Friedman has blamed central bank policies for causing the Great Depression of 1930. According to Friedman the Federal Reserve failed to pump enough reserves into the banking system to prevent a collapse in the money stock. But the situation has changed dramatically now. Most economists are adamant that modern central banks know how to counter the menace of a severe recession. The predictions of a worst-case scenario, as predicted by several doomsday commentators like economist & fund manager Marc Faber, economist Mark Watson etc, is that the world economy will slide into depression in next 6 months to one year with the crash of commodity prices triggered by the end of the boom in Chinese demand. Investors worldwide may get sandwiched between equity markets and bond markets. As equity markets fail to give short-term returns, bond markets and forex markets will also succumb to pressures of a high inflation scenario. The fall in US and European bond yields coupled with the fall in dollar value against euro will almost wash away the value of forex reserves accumulated by emerging economies. The fall in bond and forex markets may give a short-time liquidity relief to equities market.
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The fall in commodities market may trigger the fall of emerging markets. The impact of US depression might bee too big for the Asian economies. Rising US interest rates may block the flow of institutional money to emerging markets. The US depression may extend to the long term if the Federal Reserves and government don't take steps to resolve the structural problems of the economy. With globalisation extending capitalism and free markets to almost all the countries, it may take years to get the global economy back into shape. Though these all are indicators, strong enough to have an overall impact on the global economy, the backward and forward integration of markets throughout the world is strong enough to counter any recessionary influence. Central banks and policy makers around the world are well-equiped to meet the depression and all the major financial markets are fundamentally strong to negate the waves of depression. So, no prices for predicting the path of global economy. It is all in the eye of the beholder. (With inputs from Internet sources)
©Bennett, Coleman and Co., Ltd. All rights reserved.
Attention America: 'Indians racing us to top'
US fuelling Indo-Pak arms race: NY Times
Indian leaders are like abused wives
Sunday, April 24, 2005
The incredible story of Lijjat Papad!
Milestones: A Road Map to the Indian Middle Class
Saturday, April 23, 2005
TODAY'S LETTER: An Indian reader asks, “Aren’t Immigrants Just Taking The Jobs Americans Are Too Stupid To Do?”;Norm Matloff Replies
20-city survey of hospitals and medical colleges
Exclusive 20-city survey of hospitals and medical colleges
India’s health care sector is growing astoundingly fast. India has become a hot medical destination for patients in the middle east, Africa and even the west. And word is spreading that Indian hospitals can provide world class care at competitive rates.
But which of these are world class? All India Institute of Medical Sciences, Delhi, topped our list of 10 best hospitals last year (‘Best hospitals’, Jan. 18). This year, we again commissioned TNS for a follow-up. TNS spoke to 663 general practitioners and 1,013 specialists in 20 cities for the ranking. A hospital entered the roll of honour if at least 10 per cent of the doctors in any speciality rated it as one of the top five. Thus, 22 qualified and the top 10 were chosen on the basis of the proportion of doctors who considered the hospital among the top 5. AIIMS retains its No. 1 position followed by Apollo Hospitals, Chennai; PGIMER, Chandigarh; and CMC, Vellore. Sankara Nethralaya, Chennai, and JIPMER, Pondicherry, have entered the elite club for the first time.
Since the standard of medical education has a direct bearing on health care, we also surveyed India’s medical colleges. For this, TNS spoke to 409 MBBS aspirants. A medical college qualified to be one of the best in the country if it was rated among the top 3 by at least 10 per cent of the general practitioners or students in a city. Like last year, we discuss treatments available for specialities, too. Though we examine in detail only three—trauma care, ophthalmology and prosthetics—we list the best hospitals for 12 specialities.
Many Indians today get good care, but many more—70 per cent of the population—still do not have access to the best. Even as we pat ourselves for all the achievements, let us not lose sight of this stark reality. As Mumbai cardiologist Dr B.K. Goyal says, the primary objective should be to make top class medicare available to the common man.
By Kavita Bajeli-Datt
Prabha, 34, (left) can pass off as yet another plucky working woman as she zooms past on her Kinetic Honda. But what makes her different is that she lost her right leg at 18. And the confidence she exudes is the result of the advances in prosthetics that have given ample freedom of movement to many like her.
Prabha’s right leg, which was turned upwards to the pelvic bone, was amputated after treatments including surgery failed to correct the birth defect. Though she got an artificial leg fitted, she gave it up when she fell on the road three times while crossing and the limb came off. "There was no lock in it," said Prabha. "I felt embarrassed. I decided never to use them and to continue to use crutches. I was really scared."
So she walked on crutches till five years ago when she joined the Indian Spinal Injuries Centre in Vasant Kunj, Delhi, to train physically disabled people in clay modelling and making soft toys. Prabha, who comes to the centre on alternate days, decided to get an artificial limb when she saw people like her at the centre benefit from new prosthetics.
"We have made rapid strides in prosthetic technology," said Dr B.D. Athani, director of All India Institute of Physical Medicine and Rehabilitation in Mumbai, which was the first of its kind in southeast Asia when it was set up in 1955. Dr Dharmendra Kumar of Delhi’s Pt Deendayal Upadhyaya Institute for the Physically Handicapped agrees. "The technology and materials used in India have been rapidly changing in the last few years," he said. "Advanced plastics with increased durability and strength and improved cosmetic appearance have started replacing wood. This has brought down the cost and the weight of the artificial limb, and the time required to fabricate a prosthesis has gone down."
There was a time when artificial limbs were made only in wood. Before Jaipur Foot, there was the British-founded Army Limb Centre in Pune, but the wooden limbs made there were heavy. There was a long waiting list for the limbs, said Prabha Lalji, director of Santokba Durlabhji Memorial Hospital (SDMH) in Jaipur.
Support systems: A patient with spinal injuries at the Indian Spinal Injuries Centre
Jaipur Foot made of wood, rubber and steel proved to be a turning point in Indian prosthetics. Though the Solid Ankle Cushion Heel foot was available then, it was not as flexible as the Jaipur foot that Dr P.K. Sethi first brought out in 1965. "It did not allow the mobility needed to use an Indian toilet and walk on uneven terrain," said Dr Anil Jain, consultant at SDMH. "These were not water-proof so the user had to wear shoes and this didn’t allow the person to go to a temple, mosque and gurdwara. These were not durable, so required frequent replacements and were not easily available. All these drawbacks often forced the user to reject the artificial limbs and revert to crutches. The Jaipur Foot is a culture specific innovation and an answer to all these problems."
Over 1 million Jaipur Foot, which now costs around Rs 400, have been fitted in people from even countries like Afghanistan, Bangladesh and Vietnam. The SDMH’s rehabilitation centre has all the facilities for fitting artificial limbs and low weight thermoplastic calipers in paralysis patients. "Since 1965 the Jaipur Foot has undergone some changes," said Sethi, who trains technicians from across the country and around the world. "It has a new design and is of better quality now. But the major change has been that its wooden forefoot has been replaced by micro-cellular rubber."
New-age prosthetics are lightweight and often incorporate complex electronic and pneumatic mechanisms. "Newer materials have emerged, endoskeletal fitting assemblies have taken the place of conventional wooden structures," said Athani. While prosthetics made of material made in India cost between Rs 400 to Rs 7,000 depending on the body part it replaces, those made of imported materials cost up to Rs 1 lakh. The artificial limb and the procedure of getting it fixed cost Prabha Rs 12,000.
"Imported materials are quite expensive and beyond the reach of poor people," said Kumar. "We are always looking for locally available materials which are strong, durable and are within the reach of Indians." The government is covering the vast amputee population living below poverty line, said Athani, through a scheme of assistance to disabled persons for aids and appliances where the prostheses are given free of cost.
It took 15 days for Prabha to adjust to her new limb and another 15 with the physiotherapist for gait training. Though she uses a walking stick for balance, she is glad that her exoskeletal SACH foot has a lock to keep it in place. Exoskeletal prosthetics have a firm exterior and are cheaper than endoskeletal devices that are soft on the exterior too, said Kaushal Kishore, Prabha’s prosthetist.
Prosthetists are in great demand what with the high accident rates and increasing amputee population. There are degree courses in prosthetics and now the Spinal Injuries Centre is planning to start a postgraduate course. Major H.P.S. Ahluwalia, chairman of the centre, said experts from the west would take classes. Ahluwalia, who is also chairman of the Rehabilitation Council of India, a statutory body of ministry of social justice and empowerment, said the degree would improve the standards in prosthetics.
Said Athani: "With the amputee population on the rise on account of diseases like diabetes, peripheral vascular diseases, and vehicular accidents this [prosthetics] is emerging as one of the important areas. A lot of research needs to be done to improve the technology."
India was slightly behind the west in terms of quality of materials and technology, said Kumar. "Indian scientists and professionals are on the way to developing electronically/electrically controlled upper limb prosthesis from locally available materials which will be much cheaper," he said. "The demand for strong and lightweight components in aerospace and marine industries has produced a variety of new materials that possess mechanical properties which are suitable in making prostheses."
Prabha’s mother, Kamla, is happy for her daughter. "I am proud of her. She teaches others and drives her scooter so well," she said. "She has gained that inner strength." Said Prabha, who has been riding a scooter for three years now: "I have a new confidence that was lacking earlier."
| What’s new The components of the modern prosthesis are socket, elbow joint unit, forearm sheath with wrist unit, terminal device, harness and the control cable system. Conventional above-knee prostheses had a conical socket, thigh piece, knee joint, shin piece, ankle joint and a wooden foot. This was suspended by a pelvic band or by a shoulder strap. As the fitting of the socket to the stump became more and more accurate, the suspension devices have become less elaborate. |
Ophthalmology: Sankara Nethralaya has many firsts to its credit
By Kavitha Muralidharan
Shanthi Srikanth (Left) of Chennai began losing her vision in 1998. Doctors at Sankara Nethralaya, who found that she had uveitis (inflammation in the eye between the retina and the cornea), put her on steroids because nothing else worked. Though her eyes responded well to steroids, she soon developed glaucoma and had to undergo surgery. As her vision improved, doctors brought down the dosage. "There were two things in getting treated at Nethralaya," says Shanthi, 42. Employed in a private firm, she goes to Nethralaya for regular check-ups. "One is the talent of the doctors. The other is their ability to make quick decisions."
With 60 patients on the waiting list and a record 25 vitreoretinal surgeries (for diseases involving the vitreous humour and retina) every day, the 72 ophthalmologists at the hospital including its founder-director Dr S.S. Badrinath perhaps cannot afford to delay decisions. With facilities like ocular pathology, microbiology, genetics and molecular biology labs, surgery of retinopathy of prematurity (disease of the retina affecting prematurely born babies), ultrasound biomicroscope, summit excimer laser for refractive corneal surgery, GDx nerve fibre analyser and automated DNA sequencer, the hospital attracts foreign patients, too.
Nethralaya—fifth best hospital in the TNS survey—has many firsts to its credit. The hospital was the first in India to introduce YAG laser in 1982, and photo refractive keratectomy in 1993, followed by LASIK. It was the first to study the role of the eye in AIDS in India and the first Indian eye hospital to get ISO 9002 certification.
Today, the hospital has 12 ophthalmology departments. "Even our allied departments like genetics, molecular biology and microbiology focus on eye care," says Dr Lingam Gopal, ophthalmologist and president of Vision Research Foundation of Nethralaya. "That is why Sankara Nethralaya has been able to provide the best in eye care."
Research, another strong point of Nethralaya, complements care. For instance, ever since its researchers discovered the link between congenital cataract and the incidence of German measles during pregnancy, the hospital, says Badrinath, has been telling women to vaccinate against the disease before pregnancy.
All research is scrutinised by three committees before it reaches the public. "We have an in-house committee which approves our research," says Gopal. "The research then goes to a research subcommittee, also called internal review board, for further approval. Then we send it to the ethics subcommittee with a retired judge and social worker among its members who can reject the research if they find it unethical."
Nethralaya, which will soon have branches in Dehradun and Mauritius, started teleophthalmology in 2002. A fully-equipped mobile van goes to rural areas where villagers use the satellite-abled facility to interact with doctors at the hospital. "We go to a village for two days and in the evening give talks on eye transplantation and donations, creating awareness," says V. Murali, teleophthalmology in-charge. In fact, the hospital, which gets around 1,000 eyes and performs around 500 transplants a year, has two medical workers only to talk to people about eye donations.
Telemedicine for the villagers is for free. So is treatment for poor patients at the hospital. "Our doctors never look at the purse of a patient because they do not get cuts," says G. Sivaraman, patients relation officer. "For them a poor patient is as important as any other patient. We do not take more money from foreigners."
Man of vision: Dr S.S. Badrinath
Patients like Shanthi are touched by the hospital’s concern for them. So are its 1,000-odd employees. "This is more than a hospital and we are more like a family," says Sivaraman, who has been working at Nethralaya for 15 years. "I have got offers where I could get three times the salary I get from Nethralaya. But for me, this is more than a job. It is a mission."
Not surprising, for it was in answer to a call from the Kanchi Mutt to work for a mission rather than money that Badrinath gave up his plans to move to the US and set up Nethralaya in 1978. "We do not say we will never have failures," he says. "When we have some, it is our human touch which makes the patient understand and accept it, which makes them realise that there are things beyond our control. The human element is an essential part of medicine." Perhaps, it is this realisation that sets Sankara Nethralaya apart.
What’s new Implanting 2.5-5 gm of gold—sorry, you can’t show it off—in the eyelids to get rid of that stare (mostly in people with problems of the thyroid). The dense yellow metal brings the eyelid down. Ultrafast laser that makes clean, high-precision surgical cuts in the human cornea—the first step in the popular LASIK vision correction surgery. |
By Quaied Najmi
There was celebration in the lower middle-class Chauhan household in Chembur, Mumbai, when its first child was born to Jyoti and Sanjay on March 2. But gloom set in a few days later as the baby girl began vomiting and had difficulty breathing. When her condition did not improve with a local doctor’s treatment, they took her to King Edward Memorial (KEM) Hospital’s new emergency medical services department at Parel.
Working with a sense of urgency: A newborn gets emergency care at KEM
After examination, she was moved to the paediatric ICU where she was put on a ventilator. Within minutes a specialist diagnosed the baby’s condition to be the result of a congenital heart defect. "It could require surgery, but that will be decided only after further tests," said Dr Sanjay Mehta, chief of emergency medicine.
Even as the doctors were examining the baby, Philomena Lopez, 55, was rushed in with dropping blood pressure. Since it was too low to be recorded, doctors carried out an emergency procedure of inserting a Central Venous Pressure Line into her heart to record blood pressure. Dr Rajeev Satoskar, associate professor of surgery at G.S. Medical College (attached to the hospital), said that the emergency department got around six cases a day that required the use of CVPL.
Emergency cases like Philomena and baby Chauhan constitute 10 per cent of the 15 lakh patients who come to the hospital’s out-patient department every year. "For us, tackling emergencies, big or small, is a routine matter," said Dr Nilima Kshirsagar, dean of the hospital run by the Brihanmumbai Municipal Corporation. In the TNS survey for specialities KEM stands sixth in trauma care.
With advances in emergency care, the casualty has starting giving way to modern emergency rooms that stock the latest in life-saving facilities. An emergency room gets a variety of cases—cardiac and kidney patients, paediatric cases, food and gas poisoning and accident victims. KEM’s emergency gets even victims of hooch tragedies, riots and bomb blasts. "Anything can happen any time in a huge city like Mumbai and we are prepared for it, 24x7, 365 days, and a disaster management plan is inbuilt in our emergency facility," said Mehta. "Everything works with clockwork precision, there are express procedures to be followed by all. During emergencies, doctors will even pull stretchers or do other menial tasks. No ego hassles."
Things are not too different in the emergency room of Amrita Institute of Medical Sciences, which is ranked the best in Kochi in the TNS city-wise survey of hospitals. "We have a code blue team [consisting of a surgeon, anaesthetist, cardiologist and technician] that responds within two minutes [of an emergency call]," said Dr Geo Gills, head of emergency department at AIMS. "We have all kinds of modern equipment like monitors, central lines for oxygen and air, paediatric warmers and defibrillators."
"The emergency department at KEM has treatment facilities and equipment [comparable to the best], although there have been no significant advances in this sector in the past one year or so," said Dr B.K. Goyal, cardiologist and dean of Bombay Hospital, Mumbai.
"Even private hospitals are trying to catch up; for instance, Bombay Hospital is the only private hospital in India with 110 ICU beds dealing with all kinds of emergency cases."
KEM's Rs 3.2 crore emergency service, equipped with around 70 doctors, works 24x7, 365 days.
The equipment in KEM’s emergency service, which has 30 beds, are exclusively for emergencies. With around 70 doctors, including specialists, the Rs 3.2 crore emergency department is prepared to carry out any surgery, any time. Mehta said that every day the hospital got at least two heart patients who required the streptokinase injection to dissolve a clot in the artery. A police post in the department ensures that the legal and medical formalities can proceed simultaneously in accident cases.
According to Dr V.J. Lahiri, head of the orthopaedic department, the advantage is that all essential services are available in the same area. Speciality doctors come to the patient rather than the patient going to different departments. Said Gills: "An ideal emergency room should have support from different departments like neurology, anaesthesia and gastro, which we have at AIMS."
Many hospitals now offer training to physicians in emergency and trauma care. KEM’s emergency attracts foreign doctors—around 150 every year—who come to study the department and its functioning. In addition, hundreds of local doctors attend three-month-long refresher courses to upgrade their knowledge and for hands-on experience.
KEM is now planning to uplink its facilities with other government hospitals in Maharashtra and offer telemedicine services in collaboration with the Indian Space Research Organisation. On the cards is a poisoning and toxicology centre.
What about flying ambulances? "That’s still far away," said Kshirsagar. "We must first consolidate ourselves at the ground level before we think of helicopter ambulances."
Trauma care: World class emergency rooms give new hope
| What’s new |
By Dr Sumit Ghoshal
Two years ago, the Administrative Staff College of India conducted a prescription audit among doctors at several government hospitals in Maharashtra. It was carried out in the OPDs, which meant that most of the 212 doctors concerned had five to seven years experience after graduation. The findings were as follows.
Details like dosage, strength of the drug and number of days for which it is to be taken were mentioned in just 40 per cent of prescriptions for tablets. In the case of injections, this dropped to 20 per cent. Proper follow-up advice was given in just 18 per cent of cases.
Correct prescription writing skills form the basis of medical practice, and it is quite natural to assume that a qualified MBBS doctor has these skills ingrained in him during his years of study. This is an indicator of the malaise that has affected the medical education in India. According to the Medical Council of India, there are 233 medical colleges in the country, but almost all the new ones that opened in the past five years or so are private. A vast majority of these are nothing but teaching shops, designed to enable their owners to rake in the moolah as fast as they can.
There are a few honourable exceptions: the Manipal Group in Karnataka; Sree Chitra Tirunal Institute for Medical Sciences & Technology in Kerala, Sri Ramachandra Medical Institute in Chennai and some others. But the fact that these are exceptions only proves the rule.
According to a media report, the Karnataka government has decided to start six medical colleges in district hospitals that do not even have proper buildings for the purpose! While the Bidar district administration is struggling to find land to build upon, the foundation stone for Shimoga’s college has been removed. The foundation stones for Bidar and Raichur colleges would be laid in April while the academic session is scheduled to commence after three more months!
Let us come to Gujarat. In Vadodara Medical College, plans to introduce at least seven super specialties—cardiology, urology, burns and plastic surgery, CT surgery, neurosurgery, neurology and nephrology—are in limbo because suitable teachers cannot be found. Of 21 sanctioned posts for professors, associate professors and assistant professors in various super specialties created by the government, only 10 have been filled.
Great reputation: AIIMS, Delhi
"Most PG students are at the mercy of part-time and honorary teachers. This hampers expansion and upgradation of the institute and affects the quality of education," says a senior teacher at the medical college.
Many consider 2003 as annus horribilis with regard to medical college admissions. It actually began the previous year with a spate of litigations. In October 2002 the apex court ruled that the earlier system of 85 per cent merit-based admissions and 15 per cent management quota was to be discontinued and college managements could decide how they wanted to allot seats. Since the ‘management’ quota was the golden goose, this verdict set off a series of wrangles between private medical colleges and the state governments. These continued and admissions were delayed indefinitely.
"The court cases are bound to happen every year," says Dr Sudhakar Sane, a senior professor of surgery in Mumbai. The 2004 round of litigations is still going on. Now the parents associations have gone to court over the fee structure, and the teaching schedule has gone haywire. The Maharashtra Common Entrance Test will take place next month, and the next spate of petitions is expected soon after the results are out!
But there is a more fundamental question that parents and students must ask themselves. Why does someone want to become a doctor? Is it to practise medicine? To get rich in the shortest possible time? To enhance one’s ‘value’ in the ‘marriage market’? Or perhaps to just increase one’s ‘family prestige’ in the community? Ask a sufficient number of people and you will hear all these reasons. And this gives the politicians and money bags the opportunity to exploit the situation.
It seems that for a large segment of the populace, the medical profession is no longer an attractive option, not just in India but also in the UK and the US. People entering the medical profession in several western countries are not of ‘high calibre’ according to a Swedish executive of GE Medical Systems.
The Association of Medical Consultants in Mumbai conducted an informal survey among its 4,000-odd members a few years ago and discovered that a considerable number of them did not want their children to follow them into the medical profession! With that, I rest my case.
Dr Sumit Ghoshal is a doctor-turned-medical writer, working with a PR firm in Mumbai.
Medical education: Colleges become teaching shops for owners to make a fast buck
Guest column
By Dr Umesh D. Parashar
Coming from a family of doctors, I was determined from a very young age to follow the same career. As both my elder brothers had studied medicine at AIIMS, there was pressure on me to become one of the 35 candidates who succeed in the entrance examination attempted by more than 20,000 applicants. I studied diligently and was thrilled to see my name in the list of selected candidates in 1989.
Right from the start, I could see why AIIMS had such a great reputation. Our professors were selected from the best and the brightest in the country and, despite the responsibility of providing clinical care to a large number of patients, devoting time to train students was high priority for them. The small size of each batch allowed all of us to receive personal attention and we always had ample access to training resources, including a high-class medical library with a huge collection of medical textbooks and journals. The quality of clinical bedside teaching was excellent and because AIIMS is a tertiary referral hospital, we saw patients with both common medical conditions and unusual pathologic manifestations. What truly attests to the quality of AIIMS education is the fact that even in the US many medical residency programmes gladly accept AIIMS graduates primarily because of their positive experience with previous graduates from the institute.
While the quality of teaching and availability of resources at AIIMS were excellent, what elevated the training experience was the interaction with other students. All of us were motivated and strived hard to excel. Most of us stayed in the hostels on the campus, which allowed us to bond.
While we all worked hard, we also played hard. Our annual medical festival, PULSE, attracted large crowds of students from medical colleges across the country and often they were surprised to see these ‘studious AIIMSONIANS’ having such a good time!
Despite its high quality, certain aspects of medical training at AIIMS can be improved, particularly based on my experience in the US. For example, the curriculum can better integrate pre-clinical and clinical training. Also, examination of medical students should focus more on assessment of clinical implications, patient evaluation and clinical management skills rather than on textbook knowledge.
On the whole, however, I have many fond memories of my medical school training and feel that it was a world-class experience. I am proud to be an AIIMSONIAN.
The writer is lead medical epidemiologist, SARS Task Force, Centers for Disease Control and Prevention, Atlanta, US.
Wednesday, April 13, 2005
Decent Dozen: Indian Cos on best BPOs list- The Times of India
Fortresses Europe, America set to fall to cheap Indian labour
