India 2020 Part 17

Pharynx 41541 11073 56898 15175 73638 19669.

Millions 39981 33496 56539 48099 74838.

64418.

Larynx 18836 1590 23785 1074 28898 346.

Lungs 47634 6963 67969.

9138 90517.

11459.

Urinary bladder 11861 2998 16603 4167 21822.

5456.

TRC 204728 79798.

281354 102168.

365012.

125609.

Breast 99941.

140603.

185677.

Cervix .

83283.

82495.

76963.

Lymphoma 25892 16053 35366 24428 45679.

33958.

Leukemia 19013 14701 25902 21152 33392.

28366.

209.

________________________________________________________________________.

_______________________.

All sites 476308 448482 655787 574181.

851904.

705896.

Devices and diagnostic kits would greatly help in the management of the disease. The projected requirements of insulin for 2010,estimate at about 168 billon units annually, indicates the importance of developing indigenous technology for lowcost human recombinant and other newer forms of insulin. It may incidentally be pointed out that much of this equipments, medicines and diagnostic kits, be it for diabetes, CVD's or other diseases, can be exported. Domestic consumption alone can form a reasonably profitable business venture.

Cancer is another area that would require special attention. Amongst many high level nonmedical decision makers there is a general opinion that cancer is a disease of the rich and they can take care of it. But the facts are otherwise. Cancer is a degenerative disease influenced by age, environment, and lifestyles. Also, increased life expectancy means an increased incidence of cancer! Table 10.2 indicates the incidences of cancer in India and the future and the future projection.

Indian incidences as per the current records appear to indicate that if we look at the common sites of cancer in the population, their proportions and trends, over 40 per cent of cancer in males and 20 per cent of females can be directly attributed to the use of tobacco. Most of these cancer cases are presented only at the last stage of the disease and very few at the early localized stage, increasing the incidence of death by the disease. A relatively high incidence of stomach cancer in the south and gall bladder cancer in the north is observed, thus making studies on cancer etiology and epidemiology imperative.

It is essential to generate information on baseline parameters for different regions of the country in order to a.s.sess the risk factors and develop measures to create awareness. Effective diagnostic and therapeutic facilities are essential all over the country. For example, endoscopes are an essential part of diagnostic services for cancer. They are available only at specialized inst.i.tution. A set of endoscopes costs about Rs.2.5 million now. We believe that the costs can be brought down partly by economies of scale and partly through innovative design to cater to essential 210.

needs. Often the vision of those who plan the programmed is limited to procurement of the equipments in a few urban centers and in a few other areas to prove that we have it elsewhere too! This narrow vision should change.

Yet again, availability of external radiotherapy Cobalt60 units is limited to specialized units. There are only 120 units in the country and these are also not uniformly distributed. With the increasing incidence of cancer, it is estimated that for every one million people, at least one unit will be required. That is about 1000 units, with increasing demands in the future. With out tremendous capabilities in nuclear technologies and many other supporting Indian industries, can this problem not be solved by innovative and inexpensive designs? Experts believe that it can. If there us a mission, a demand will be generated.

If a nuclear technologist is shown foreign equipments and asked if he or she can manufactured it in India, the answer will be 'yes' he will come up with an innovative design and an estimate of the cost which may often be very high. It is a pity, but it is only very rarely that the same technologist would be faced with the project stating that our vision is to reach the whole of India. 'can you sit with doctors , production specialists, businessmen and others to come up with minimum essential features to create technology available at a lesser cost, on a large scale and more speedily? That is a question which is never asked. Over a period, our system has lost the capability to enthuse people to pose challenging problems for our youth to harness a large vision.

Let the coming fifty years be a period of expanded vision for India, faith in ourselves, a bold desire to carve new paths and create an environment for the youth to excel. Such a new developed India will inspire confidence in people of other countries as well. Let us look for a strong, healthy and wealthy India radiating its wellbeing to all people.

Sight for all Even as we speak of vision, it is depression to acknowledge that India has one fourth of the world's blind or visually handicapped. About 12 million 211.

people are fully blind and 20 million suffer from various forms of serious visual handicaps, rendering them virtually ineffective.

At k.G. Hospital at coimbatore, a welltodo person along with a few doctors is providing eye care to many poor people, including those in nearby towns and villages. The vans go for tests and pick up cases requiring treatement.While going on a round of some of the patients , I came to an elderly man and asked him in Tamil what his name was and where he was from. The man replied, 'I have heard about you, kalam sir I am happy to be near you though I cannot see you!' I asked him how old he was. That made the elderly man tearful. He said,' I don't know my age and I don't care about it now. I have been in darkness for so many years that it appears to me that many yugas are over. Losing your vision is much a bad thing because you own children taunt you as a kurudan (a blind man).' Indicating his bandaged eyes he said,' These punyavans (holy souls) appear to care for me. They brought me in a van, examined my eyes and did some operations. Once they opened the bandages to do a check up it looked to me that I was able to see through hazily. They told me that in a couple of days my bandages would be opened and they would give me a gla.s.ses. May G.o.d bless those who will save me from the miserable state of being a kurudan.... Kalam sir, I am confident that I will see you with my eyes and gla.s.ses during my lifetime... my faith in G.o.d has gone up he comes through kind human beings ...

The man was obviously suffering from a cataract. Probably his children either did not care or he could not afford to go in for an operation.

Almost 80 per cent of blindness in India is due to cataract. The other significant causes are corneal diseases, glaucoma, diabetes and other vitreoretinal disorders. Interlobular lens (IOL) implantation is an ideal method for rehabilitation of cataract patients after surgery. Extra capsular cataract surgery with IOL is one of the most costeffective therapies, in terms of quality of life, since vision with as good as 6/9 is possible. In India mostly intracapsular extraction is practiced .

However, IOL implantation is also becoming increasingly popular. According to a survey, of the cataract operations reported in the country in 1992, 42 per cent 212.

were extra capsular and about half of these received IOLs. The projected requirements for IOLs in the country would be close to 2 million every year.

This necessitates production of better quality IOLs indigenously. Another modern technique of cataract surgery employed in overt 75 per cent of the cases in the USA in phacomulsification, where surgery is performed through a 3 mm incision and the lens inserted through a slightly enlarged incision(5.5 mm). Alternatively, a foldable silicon IOL is implanted through a 3.5 mm incision. Phacomulsification technology needs to be made available in India. There is also scope for development of small incision technologies such as lasers and mechanical endolenticular fragmentation.

The DRDO has made a small contribution to eye care through the development of 'Drishti' eye laser equipment. The DRDO has formed the society for Biomedical Technology (SBMT) with the objective of creating conditions under which costeffective, lifesaving medical products can be indigenously produced and made available to the common man at affordable prices. The spin offs of defense technology are the basic strength of SBMT. The society binds together scientists, engineers, doctors, social workers and administrators in a shared mission. In less than three years time, DRDO/SBMT, along with others, have successfully developed an external cardiac pacemaker which is onethird of the cost of its imported counterpart, an automated cancer detection device for ma.s.s cancer screening, and a lowcost cardiac stress test system to take this important screening tool of diagnosing coronary artery diseases to small towns and community health centers. The technologies for these systems have been transferred to industry for production. The laboratory systems of Drishti and coronary catheters are under clinical validation. The Jaipur foot for polioaffected children developed by Dr P.K.Sethi has been made ultralight by using an advanced composite material that goes into making missile heat shields. The coronary stent is under production. Plans aren afoot to enlarge these efforts, using a spinoff of defence technology for launching indigenous development of a hollowfibre dialyser, coronary stents , drug delivery implants and microproces...o...b..sed inca.n.a.l hearing aids. The mission is enormous. The partners are medical inst.i.tutions and 213.

industries. We desire that all the available technology forces and philanthropists must come together to make it happen.

There are other solid inst.i.tution and industries in India capable of doing more. BARC is not merely devoted to nuclear devices or systems. It has the knowledge and capabilities for many medical technologies. The centre for Advanced Technology (CAT) at Indore has worldcla.s.s capabilities in laser devices and applications. Dr M.S.Valiathan, who led the Health Care Technology Vision 2020 studies, is an eminent scientists and technologist of India. More than three decades ago he came back from USA after his advanced studies to build an inst.i.tution called Sri Chitra Tirunal Medical Centre located at Thiruvananthapuran. Operating from there against heavy odds, he and his team have developed many biomedical devices ranging from blood bags to heart valves, bringing down the costs several fold. These devices are under commercial production in India and some of the devices are also produced abroad under successful technology export contracts. The inst.i.tute has developed several unique capabilities in bio medical devices.

Similarly, the cochairperson of the vision 2020 exercise, the eminent nutritionist Dr Mahtab Bamji, has extensive experience in rural areas. After retirements she spends much of her time in rural areas, contributing towards the vision. There are extremely capable medical personnel, scientists and engineers all over the country.

These are many NGOs and youth in search of challenging human missions. There are many persons like Dr V. Sudarsan of Mysore who combine modern knowledge and scientific methodologies with the inherited wisdom of our people. Also, most experts believe that many older forms of medicines and medicinal plants will have an important role to play in future medicare systems not only in India but in the world. That is the reason many foreign multinational companies invest in research and development of herbal drugs. A few of our experts opine that much of its knowledge has not been fully exploited because of the limited prevalence of Sanskrit and Indian languages. With its ancient knowledge base and excellent biodiversity, India can really become a world leader in herbal and other natural medicare systems.

214.

Maternal and child health Let us end this chapter by addressing a crucial element of the health care system, that is maternal and child health. Women of childbearing age and children under five represent the maternal and child category in any population profile. As per the 1991 census, 56 per cent of the population in India fall under this category. The projected Maternal and Child Health (MCH) population is given in table 10.3. Anaemia , chronic undernutrition and complications during pregnancy and childbirth are the orders of priority for maternal health. In the case of the children, the priorities are diarrhoeal diseases, anemia, perinatal disorders and vitamin A deficiency. Effective antenatal care, prophylactic iron and drinking water facilities, universal immunization coverage are some of the measures which would reduce the problems in MCH.(see table 10.3) In fact, none of the medicare required for maternal and child health demands breakthrough technologies. What is required is a largescale production and distribution system. Even anaemia diagnostics have become simpler, thanks to development in the technologies of advanced sensors. We require a new regarding our children and mothers. The very foundation of our future depends on their health.

The Vision The vision for health for all Indians is realizable well before 2020. We have discussed some details with a few examples.

TABLE 10.3.

Projected Maternal And Population At Different Points Of Time ________________________________________________________________________.

_______________________.

Year Children Adult Female 215.

(04.

years) (1544 years) ________________________________________________________________________.

_______.

Number Per cent of total Number Per cent of total (millions) population (millions) populations ________________________________________________________________________.

_______________________.

1991 111.4 13.2 186.3.

45.8.

2001 114.5 11.3.

231.8.

47.2.

2011 106.4 9.1 275.7.

48.6.

2021.

108.5 8.3 302.3.

47.5.

________________________________________________________________________.

_______________________.

216.

While one needs numbers and statistics, technical evaluation and investments, we believe that a change in thinking would lead to a miraculous transformation. The richer and more powerful sections of our society should realize that the health of their lessprivileged countrymen is their problem as well. They can go to the USA or UK for a cardic examination or surgery but they cannot escape an infectious epidemic in India very long.

Enlightened selfinterest should make businessmen realize that a sick worker cannot give his or her best even with the most modern equipment. High productivity requires a healthy as people's pain and agony, not as files. Similarly, politicians at all levels should learn to look at removal as a part of their duty.

I would like to conclude this chapter with a quote from a convocation address I delivered at the Tamil Nadu Dr M.G.R. Medical University, Madras, on 21 March 1996.

I conclude by recalling the great saying of the Jesuit St Ignatius Loyola to St Paul.

St Paul asked for a message from his guru before taking up the a.s.signment of preaching. St Ignatius Loyola said,'Go to all parts of the earth and ignite their minds and give light.' Dr M.G.R. Medical University gives the message : My young children, Go to all parts of the country, particulary beyond remove the pain of mind and body. Indeed, a health mission is ahead of you. My best wishes.

217.

Chapter 11.

__________________________________.

The Enabling Infrastructure Indeed one's faith in one's plans and methods are truly tested when the horizon before one is the blackest.

Mahatma Gandhi The various chapters so for flesh out the vision of a developed India: poverty being eradicated by about 2010 and the building up of a robust and fastgrowing economy through our core competencies. We have ill.u.s.trated possible trajectories through a few interlinkages between various sectors. Agriculture and agrofood processing will require some of the finest inputs from engineering industries, materials sectors and even sensors and electronics, in addition, of course, to the life sciences and biotechnology. In the modern world every usable product or service is based on a blending of multiple technologies, which are shaped to one or several end uses. Design capability is integral to this and without it we would remain merely at the level of licensed producers. In the long run, that would be a form of enslavement to the developed world.

There are other types of linkages too, that of trade, for example. It is not much use having higher productivity, say of crops, fruit, vegetables, fish and eggs, if these cannot be supplied in time to the consumers. They cannot all be consumed at the place where they are produced. Traders have to sell the products outside and buy other products with the money made. The world today, thanks to the technologies of transportation and telecommunication, has become connected in a much more complex way. The time taken to fly around the globe can be less than a day. Messages, including images of people, can be transmitted almost instantaneously. Compet.i.tiveness in such a complex world can be sustained only at a high level of the knowledge and skill bases at all levels. Many resoures have to be usefully deployed to generate and utilize such knowledge and skill levels. Also, those who have such knowledge and skill levels aspire for better living conditions. We have observed that persons enjoying a better standard of living are able to work more. A simple truth is that a modern developed economy cannot be built on a large number of 218.

people living just above the poverty line, producing agricultural products alone and cut off from the rest of the manufacturing and business centers. This means that every production centre in the country should have speedy economic connectivity with other parts of the country. At every centre there has to be more and more value addition.

Value addition is simply enhancement of the value of material with process attached. It means doing something more to satisfy the ultimate user or consumer.

Innovation can add more features to kindle the imagination of a user or consumer. For example, a farmer can grow a particular variety of mango that is in great demand. There can be value addition if he can provide consistency in taste, shape, size people would be ready to pay more for such an a.s.surance. Value addition can be done through selection, sorting and packaging of mangoes at the production centre. If such a value addition has to be achieved on a large scale, then some forms of semimechanization, testing, etc.

are involved. These are technological inputs.

Nowadays, there are packages designed through computer simulation which consider the types of shock, vibration and thermal conditions the contents and the packages are likely to undergo in transit. We carry out such simulations and design for military equipment, satellites, launch vehicles and missiles. With the increasing presence of computers these techniques are being applied to ordinary civilian life. That is the beauty of technology. As it grows and matures, it spreads to more and more people and provides benefits to all, thus bringing down the costs of application of technologies.

Coming back to our example of value addition, in addition to good sorting and packaging, transportation in containers with controlled atmospheric conditions, or where necessary under chilled conditions, keeps the mangoes fresh. This too is value addition.