Diarrhea and Rang De Basanti

Today was the final evaluation of a bilateral initiative – the Project for Control of Diarrheal Diseases. The collaborative project had been launched in 1997 between the National Insitute of Cholera and Entreric Diseases (NICED) Kolkata and the International Medical Centre of Japan.

Now, ten years down the line, it was time to take a hard look at how the project had fared. An external evaluation team had completed its work and a presentation was organized at ICMR Delhi. The results were interesting – a two-hour session packed with data, PDMs, LogFrames, and somber speeches... interrupted every now and then by a peppy Rang-De-Basanti ringtone from the chairperson’s mobile phone.

The ringtone was irksome; completely out of place but it did not dilute the seriousness of the problem at hand.

Diarrhoeal diseases kill millions children in India every year – 35.4/1000 live births (Apr.2007) . It is the single largest cause of “infant mortality and morbidity in Third World Countries”. Since its victims are mostly brown and black kids living in third-world hovels, it naturally gets only a fraction of the money that goes for medical research.

WHO requires all countries to report data for only three diseases – cholera, plague and yellow-fever. Few actually do. But, of the three, it is cholera (and allied diarrheal diseases), that can easily be controlled through hygiene and sanitation. This is an embarrassing, inconvenient fact.

So embarrassing that many countries refuse to divulge data. Bangladesh perhaps loses more kids to cholera and enteric diseases than any other country but its officials like to pretend otherwise. Even Thailand too does not disclose data on diarrhea mortality fearing, perhaps, a negative impact on its booming tourism industry.

In India the data is patchy but it is there. More importantly, it is willing to do something about the problem and share whatever it learns. It is an open-mindedness that is born from the friendship of two researchers who met 40 years ago in Osaka, Japan.

Dr. Y. Takeda and Dr. N.K. Ganguly, met on an exchange programme and both grew to be formidable administrators and researchers in their respective countries. Persuading governments is a lot easier when you’re at the top, and that is exactly what Takeda and Ganguly as heads of IMC and ICMR respectively.

It has been a very productive friendship. Apart from sending scores of leading scientists, training hundreds of Indian counterparts and building an International Diarrheal Disease Research Centre at NICED (Rs.85 Cr., 1996), it has persuaded a large number of talented Indian researchers to stay back and seek solutions to a local.

But how to you measure success of a project like this?

A common symptom of diarrhea is “loosies” which, if left unattended, quickly dehydrates and kills children. But the causes are many –


* Bacteria (Vibrio cholerae, shigella, E.coli, aeromonas…over 2500 species)
* Viruses (Noro-virus, sapo, astro, rota, adeno, pico…over 400 types)
* Parasites (hookworm, ascaris, E.hystolytica, etc.,)

So the first step is to identify the buggers, and then to be ready with trained personnel and cures before a pandemic strikes again. This is exactly what NICED has been trying to do – identifying hundreds of strains (Etiology), producing anti-sera for each of them, archiving strains, and training hundreds of scientists.

The training helps create a surveillance network and producing the antisera locally helps save a lot of money – in the world market, 1ml costs about $200! Another measure is the impact of path-breaking medical research – over a 100 papers has been published since 1997.

On the whole, things seem to be on track. Now, if only the chairperson would switch the mobile into silent-mode...

Himba Girl

I just loved this photograph by Go Yamagata:


Himba Girl's Gaze

Small Enterprises and Patronising Bureaucrats

"Put the boy and girl in the park and walk off -- whether they make it or not is not our business!"

This was Mr. Jawhar Sircar's take on government intervention in foreign collaborations for private enterprises. Mr. Sircar is the Additional Secretary and Development Commissioner Ministry of Micro, Small and Medium Enterprises (MSME), a flamboyant satrap who oversees an 'empire' of 13 million micro and small enterprises employing over 40 million people in India.

The numbers are deceptive, of course. The government has no direct control over the enterprises. Each MSME represents an entrepreneur struggling to survive amidst all sorts of constraints and often, the local government itself is one of the problems.

Infighting amongst government departments is another. MSME's turf is constantly usurped by DIPP, an arm of the Ministry of Commerce and Industry. Both claim to be patron saints of all small enterprises.

What are small enterprises? In terms of investment ceiling for plant, machinery or equipment (excluding land & building), the present definition of Micro, Small and Medium Enterprises is as follows:

Micro - >$62,000 (mfrg); >$25,000 (services)
Small - $ 60,000 - $1.25m (mfrg); $25,000- $0.5m (services)
Medium- $1.25m - $2.5m (mfrg); $0.5m - $ 1.25m (services)

By this new definition, MSM enterprises account for $33b+ in exports, 6% of GDP; 45% share of manufacturing output and 40% share of exports.

Annual credit flow to these enterprises is $9.5 billion from PSU banks; $ 3.5b from other banks (foreign, Sidbi, SFcs..) and $3b from 'Emerging Sources (VC/PE, ECBs, Factoring etc.,).

Given the socio-economic imperative presented by the numbers it is not surprising that we have full fledged government departments and ministries to support this section. But are they actually effective? How much do the government officers really know running small-scale enterprises? do they really care about the rough and tumble of cut-throat competition?... I have my doubts.

Design, Style and Functionality

I was catching up with some of last weekend's columns when I came across an interesting piece by Shoba Narayan (TheGood Life, Mint-Lounge), titled, "Where Style and Functionality Converge".

It was a nice update on some contemporary designers:

Naotsu Fukasawa: A recluse who designs everything from hi-tech gadgets to toasters and plates, through his company Plusminuszero. His designs follow Louis Sullivan's dictum, "form follows function" -

His objects don't simply take up space; they don't shout and scream for attention. They simply recline in soft repose and wait for you to discover them...Take for instance his sole bag - a large bag with a canvas shoe-sole bottom that makes it perfect for resting flat on the ground.

Neil Foley in Bangalore - the 'Jellyfish Light'

Lokus Design, Pune and its sleek furniture for Jindal Steel.

Design Direction, Pune for award winning medical equipment, as well as bio-degradable sandals called. "Solemates".

And Kerala's Kumbham range designed by K.B. Jinan, a social activist and designer who is helping revive the traditional terracotta craft.

Hyderabad & HICC

Sometimes you turn a corner and come across something completely unexpected. This is what happened to me this week at Hyderabad.

We had landed from Delhi to participate in an international conference. The venue was called Hyderabad International Convention Centre (HICC) - it sounded grand but drivers from the largest rental-car company in Hyderabad had no idea where it was located.

We strayed for over 5km in Cyberabad before somebody insisted that the venue was actually inside a barren looking trade-fair area. We had been turned away from the gates earlier by guards who told us that nothing was going on inside. There were no signboards or banners anywhere to direct the 1500 people expected to attend the event.

As it turned out, HICC was inside the trade fair area, tucked away deep inside, behind Novotel - a 5-star hotel. Being one of the many exhibitors, we had to enter the large building from the rear, and once inside, the signs were not too encouraging. In a massive hall, people were still creating a podium for an event that was to take place within two hours. The exhibition area was barren, except for a few workers trying to fix electricity connections for the stalls.

Within an hour the scene was completely transformed. Thousands of chairs had been arranged, the podium had become picture-perfect and the sound and lighting system were functioning flawlessly. Obviously we were at no ordinary venue.

I learnt later that HICC was developed and owned by a joint venture between Emaar Properties PJSC, Dubai and Andhra Pradesh Industrial Infrastructure Corporation Ltd. Managed by Accor; world's largest hospitality business operator. It was conceived, designed and created to handle small meetings of 50 people to large scale events for 5000 people. The convention centre formally opened just last year, with the Pravasi Bhartiya Divas convention on January 7th 2006.

The large pillar-free internal hall (6,480 sq. meters) could be partitioned into six halls in an open capacity, holding up to 400 tables in Banquet setting and 6000 in cocktail. The pre function foyer area exceeded 6500 sq meters. The Centre has mobile operable walls, which when expanded accommodates up to 5000 people. The mobile operable walls were soundproof, built in the US and had been covered with Teak and Silk.

On the third and top floor of this complex were exclusive board rooms that remained on 24-hour stand-by. From here you could look through the sheet glass windows and see all the signs of a booming economy - construction of apartment complexes, hotels, and highways in areas surrounding Kukatpally.

The complex was manned by around 200 personnel in neat, color-coded uniforms (black for housekeeping, white for F&B, officers in suits). One of them confided that a few weeks ago, Schneider Electric had booked the entire hotel & HICC for five days and paid a total of Rs. 29 Crores!

He also added with a tinge of pride that the only thing Indian in the entire complex were the carom boards in the staff club!