Ross Rabindranath Mission Issue-2

The history of malaria contains a good lesson for humanity. We should be more scientific in ourhabits of thought & more practical in our habits of government. Sir Ronald Ross

BILL GATES MILENDA GATES

ROSS RABINDRANATH MISSIONReal Danger :Mosquito-borne diseases, Ebola etc. can wipe outcivilization. So, think globally, act locally.Urgent Need :Governments & International Community must takeserious commitment to combat these global threats,endangering public health. The earth is in crisis dueto global warming.

SIR RONALD ROSS (1857 - 1932)The discovery of the cause of malaria

a journey in timeSimon Phillips, MPhil MBBS FRGS

Late Co-Director,Institute of Refugee Healthcare Studies,

Post Graduate Medical School,University of Bath, UK

Ronald Ross is rightly renowned and respected forhis discovery of the cause of malaria, possibly one ofthe greatest scourges of the human race. However, itseems right, now that over 100 years have passed, toput this achievement into perspective for the amazingapplication of science and perseverance that thediscovery was. Indeed an example of the change ofscientific and academic mind-set that had occurred inthe 60 -70 years before this.

ERADICATION OF MALARIATHROUGH COOPERATION

Rabindranath Tagore(Presidential address before Anti-Malarial Society,

August 1923 Calcutta)Translated by Dikshit Sinha

At the outset, let me tell you how I met Dr. GopalChandra Chattopadhyay1 during this work. However,I myself am not a physician and the opinion that Ihave about malaria is of little value. You are all awarethat we have an institution called Visva-Bharati; aspart of its work, we are trying to keep contact with thesurrounding villages of Santiniketan. It is true that inthe ashram we are mainly engaged in cultivation ofknowledge but it has always been my view that ifeducation, school, and colleges are separated from

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A PUBLICATION OF SIR RONALD ROSS MEMORIAL CENTRE, KOLKATAEditor : Dr. Ranen Dasgupta, Vol. 2, Issue - 2, October - December, 2014, DL No. 175, Dt. 21.8.2012, Price - Rs. 10/- only

Editorial

Gratitude to Bill Gates - Milenda Gates Foundation fortheir contribution towards Global Public Health

Sir Ronald Ross is the First Nobel Laureate ofIndia (1902) and Rabindranath Tagore is the SecondNobel Laureate of India (1913). Their enormouscontribution in anti-mosquito campaign to eradicatemosquito- borne diseases and promoting sanitation,environment and public health has failed to inspirethe Govt. of India, as evident from the fact that Indiais the Second lowest performing country on healthand survival, ranking 141 (out of 142), just ahead ofArmenia (World Economic Forum Report, 2014).

2 n ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

Recently, Nobel Peace Prize (2014) was awarded to an unknown Indian Kaliash Satyarthi, who devoted his40 years of life to save children through Bachpan Bachao Andolan, along with Malala Yousafzai, who is theleading spokesperson for girls right to education. Thus, the rights of the children in this world have beeninternationally recognized. Mortality among children due to mosquito borne diseases, Ebola etc. is enormous.But, right to health for children and pregnant women, especially, is not a priority, in practical sense.

Almost 40 percent of the population of India (about 1.52 billion) consists of children who are below the ageof 18 years. India has no dearth of money to build a 182 meter statue of an architect of united India at the cost ofRs. 3000 crores but is neglecting public health at the cost of promoting corporate health.

Us Philanthropist Bill Gates has announced he will donate over $500 million to fight malaria and otherinfectious diseases in the developing world, saying the Ebola outbreak is a call to action. Bill Gates also said thatin addition to that pledge, his foundation has boosted its annual funding for malaria by 3% (AFP, The Times ofIndia, 4.11.14)

25 Crore Indians are in great peril due to mosquito-borne diseases. Gujarat (Industrial Capital), Mumbai(Financial Capital), Delhi (National Capital), Kolkata (Cultural Capital), Bengalaru (IT Capital) are plagued withmosquito borne diseases the dreaded terrorist to public health. But there is no serious pro-active actions fromcorporate NGOs and Governments, corporations.

Once Singapore and Cuba were mosquito ravaged but they defeated the mosquito terror and gainedinternational acclaim due to best public health service. They prefer health over petty politics.

India, is yet to understand that Health is wealth, Mosquito-borne diseases should not be taken casually,when Ebola can hit India like U.K. & USA and devastate the whole economy as a bolt from the blue and thusshattering Indias dream to be a global superpower by 2020. Will Govt. of India listen?

Ranen DasguptaGeneral Secretary

[email protected] Sir Ronald Ross Memorial Centre, Kolkata

Ross Rabindranath Mission : Contd. from page 1

Malaria has been known over centuries as a killer, not only in the Far East. In Western Europe it wasvariously know as the ague (UK), the sweating sickness (commonly everywhere), paludisme (France) and so on.I have little knowledge of traditional Indian or Chinese medicine, but I am sure they have specific names for thesame condition. Western Medicine confines its nomenclature of the disease to the symptoms it causes. Aguewas the term used in the Essex marshes and the Fenlands of England. It describes a disease of aches andsweating with general debilitation, and was almost always associated with low-lying marshy ground and standingwater. The Sweating sickness is obviously descriptive of the symptoms, while the French name, paludisme,literally means a disease associated with the marshes (after the Latin palus = marsh). The one thing none ofthese names does is to make any mention of its cause by, or even association with, insects.

This is perhaps hardly surprising. In England by the mid 1800s, medicine had hardly progressed far beyondthe Hippocratic (Hippocrates of Kos (c. 460 c. 370 BCE), considered the Father of Western medicine) view ofmedicine, isonomia, the preponderance of one of the 4 bodily humours - yellow bile, black bile, phlegm andblood with their associated elements and seasons (yellow bile: fire and Summer; black bile: earth and Autumn;phlegm; water and Winter; blood: air and Spring). While such ideas arose from speculation rather thanexperimentation, observation played a large part. The human internal structures were known primarily throughanalogy with animals, inferences from visible external structures, from natural philosophy and function. Whilesuch ideas may seem extraordinary now, they were a great improvement of what preceded them, sacrifices andthe supernatural! However, miracles, sacred magic and the influence of the Church were still practiced inEurope until their influence was rejected by Paracelsus (1493 - 15421).

The Greek Galen was one of the greatest surgeons of the ancient world who performed many major operationsincluding brain and eye surgery. These were not attempted again for almost two millennia. After the Roman era,400 AD approx., the study and practice of medicine went into deep decline. In medieval Europe, Galens writingson anatomy became the mainstay of the medieval physicians university curriculum but they suffered greatlyfrom stasis, intellectual stagnation and the stifling influence of the Church. In the 1530s, however, Belgian anatomist

Sir Ronald Ross (1857 - 1932) : Contd. from page 1

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014 n 3

and physician Andreas Vesalius took on a project to translate many of Galens Greek texts into Latin. Vesaliussmost famous work, De humanicorporisfabrica, was greatly influenced by Galenic writing and form. The works ofGalen were regarded as authoritative until well into the Middle Ages.

The beginnings of what we would recognise as modern medicine were to be found in the 13th century whenuniversities such as Padua and Bologna started teaching on the basis of dissection, but it was not really until theAge of Enlightenment in the 1700s that science began to ascend and physicians became more scientific. Until1696 London had only one major hospital, St. Bartholomews (Rosss alma mater) which dated from the 1200s.This changed with the opening of then Peoples Dispensary and then Guys Hospital in 1721. The practice ofmedicine also changed in the face of rapid advances in science, as well as new approaches by physicians.Hospital doctors began much more systematic analysis of patients symptoms in diagnosis. Among the morepowerful new techniques were anesthesia, and the development of antiseptics. Actual cures were developed forcertain endemic infectious diseases but the decline in many of the most lethal diseases was due more toimprovements in public health and nutrition than to medicine. It was not until the 20th century that the applicationof the scientific method to medical research began to produce important developments in medicine, with greatadvances in pharmacology and surgery.

In terms of medicine in Europe, one of the disasters for its inhabitants was the suppression and destructionof the works of Muslim scientists. The Islamic civilisation rose to primacy in medical science as its physicianscontributed significantly to the field of medicine in all areas (anatomy, surgery, pharmacology and so on). TheArabs were influenced by, and further developed ancient Indian, Greek, Roman and Byzantine medicalpractices.The translation of 129 works of Galen into Arabic by the Nestorian Christian HunaynibnIshaq and hisassistants, and in particular Galens insistence on a rational systematic approach to medicine, set the templatefor Islamic medicine, which rapidly spread throughout the Arab Empire.

Two things come to mind here. The Muslims were using general anesthetics in ~1000 AD. The author has inhis possession a picture (taken in 2008 in the Damascus Museum of Ancient Medicine) of the physician Abu Al-Kasim Al-Zahrawi operating on a patient with a general anesthetic, some derivative of the opium poppy, beingdelivered over the patients face with a sponge. A further photograph shows how the opium was infused into thesponge in a clay vessel, the vessel itself being an original. Al-Zarawi was born in the city of Cordoba in Spain in936 AD. General anesthesia was not used in the Western World until the 1840s.

The next brings us right back to malaria. In a study of the population movements in the Southern Levant,and the adaptation of local population of agriculturists (Fellahin) and nomads (Bedu) - the population dynamicsand exploitation of the ground in this area from VI - XVI Cent1, a key concept is that of the rif which may beconveniently described as the edge of irrigated and cultivated ground where water may stand after the irrigationprocess. The authors postulate that this knowledge was why the Prophet Mohammed forbad his bedouin followersto camp at the bottom of valleys, along the axis of the slopes (run-off slopes) where water was used, the lengthof water sources and paths, all rendez-vous des insects nocturnes (the collecting point for nocturnal insects).Furthermore the poet of the 13th Century, IbnMayyada, reinforced the natural tendency of the calif al-Wahid IIibnYahid II in his preference for the desert over the rif. Le voisinage des sources ne nous convient pas; les moustiquesetles fievres nous y dvorent (Being near to water is not good for us; mosquitos and fevers devour us).

Again, terrorised by marsh fever (malaria) which was unknown in the desert, the scribe Al-Jhith (781 - 868/869) as a spokesman for the Bedouin, warned Gare au rif! En approchersignifie la mort, la perdition courtterm (Beware of the rif. Going near it signifies death, perdition in the short term).

Conversely the reason why this problem was not apparently met, or described in regard to the Crusader,Ayyubid and Mamluk settlements, and castles is probably simple. They were built on hills.

What relevance is all this to the achievements of Sir Ronald Ross? Ross was born in 1857. In 1832 as partof the world pandemic, a major epidemic of cholera, King Cholera, hit the United Kingdom. A further majorepidemic arrived again in 1849 claiming twice as many lives (14,137 people). During the pandemic of 1851, amere six years before Rosss birth, the world-wide scientific community varied in its belief of the causes. Forinstance in France the general belief was that it was related to poverty, while the Russians believed it wascontagious but they were not sure how. In Britain, however, there were still some who thought the disease mightarise from Divine intervention!


The causes of cholera were not known but the most widely accepted notion was that the disease was due toair-borne miasma. Similarly the transmission of malaria was thought to be miasmatic. The word malaria comesfrom the Latin and means bad air. Because of the cholera/miasmatic theorys predominance among scientists,the 1854 discovery by Filippo Pacini of Vibrio cholerae, the bacterium that caused the disease, was completelyignored until it was rediscovered thirty years later by Robert Koch. In 1854, a London physician Dr John Snowpostulated that the disease was transmitted by drinking water contaminated by sewage after an epidemic centredin Soho, but this idea was not widely accepted. However, the summer of 1878 was excessively hot and Londonfell victim to what was called The Great Stink. The Thames and all its subsidiary water courses and supplieswere open sewers. Even the wells and pumps from which domestic supplies arose were contaminated. A massivelyexpensive scheme was put forward in 1859 by Joseph Bazalgette to improve the sewers in London. It was hopedthat by relieving the stench, according to the miasma theory, it would also rid the city of cholera. Although thenew sewerage system vastly improved the situation, it was not until 1867, after the last epidemic of 1860, that it wasshown that polluted water was still entering the London water system from elsewhere, and by finally eliminating thissource as well, cholera was beaten in London for ever. The water-borne transmission of disease had been proved.

By 1871, Berlin was becoming a leading centre for medical research. Robert Koch (18431910) was arepresentative leader. He became famous, among other things for isolating Bacillus anthracis (1877) - the causeof Wool-sorters lung; the Tuberculosis bacillus (1882) - consumption, phthisis and the curse of the chests of thepopulation of London aggravated by the evil London smogs; and Vibrio cholerae (1883) - cholera. He was awardedthe Nobel Prize in Physiology or Medicine in 1905 for his findings on tuberculosis, three years after Ross.

To put all this into context, Muslims had posited that mosquitoes, or certainly nocturnal insects, were thecause of the fevers they associated with stagnant water (the rif) before the end of the first millennium. It took twoand a half millennia for the doctors of Western Europe to begin to accept the theory basically proposed, thatmalaria was transmitted by mosquitoes, in opposition to the centuries-old medical dogma that malaria was dueto bad air, or miasma. Although the first scientific idea was postulated in 1851 by Charles E. Johnson, whoargued that miasma had no direct relationship with malaria, this hypothesis was largely forgotten until the arrivaland validation of the germ theory of diseases in the late 19th century began to shed new light. When it wasdemonstrated that malaria was caused by a protozoan parasite in 1880, the miasma theory began to subside. Itwas not until 1877 that it was proven that the mosquito could transmit parasites to humans, and Rosss discoveryof the means of transmission of the malarial parasite on 20 August 1897 was the proof of what the Muslimsfeared two millennia earlier.

It was a long long journey!Yet truly can it be said thatA prophet is not without honour, save in his own country (Matthew 13:57 - King

James Version). The present author and his wife, who is distantly related to Ross, both trained at St. BartholomewsHospital, exactly as did Ross. The name of Ross was not mentioned to us throughout our training, and speakingwith our contemporaries none of them were aware of him at that time, although some became aware of him inpostgraduate work, although not necessarily that he trained at Barts.

Ross does not feature in the Wikipedia internet article on the hospital either as a notable member of staff,which, of course, he was not, but not even as a notable Alumnus. And yet he was awarded the first Nobel prizefor anyone with any close connection to the hospital and was one of only three Nobel Laureates connected withthe hospital, the others being:- Sir John Vane - Nobel Prize in Physiology or Medicine in 1982 and Prof Sir JosefRotblat - Nobel Prize for Peace in 1995. Ross was, however, the only one to have actually trained at Barts. Theother two were both staff members. He does, however, merit an entry in one of the more authoritative booksabout the Hospital The Royal Hospital of Saint Bartholomew 1123 - 1973 ed. Medvei VC and Thornton JL 1974p 276: ..and Sir Ronald Ross (1857 - 1932), who came to Barts in 1875, joined the Indian Medical Serviceand was a pioneer in tracing the spread of malaria by mosquitoes. No mention of a Nobel Prize there! Theauthors do not even seem to appreciate what it was that Ross actually achieved.

Rosss name was initialled preserved by the founding of The Ross Institute and Hospital for Tropical Diseases,opened in 1926 on Putney Heath by the Prince of Wales as a memorial to, and in recognition of, Ross work.However this no longer exists as a separate entity but has been absorbed as The Ross Institute into the LondonSchool of Tropical Medicine and Hygiene. The remaining vestige of Rosss name is in the title of Ross ProfessorEmeritus within the School.


Sir Ronald Ross seems to be slowly being airbrushed out of the English version of the history of medicine.Most of us can remember historic greats from the medical world; Koch, Marie Curie, Fleming, FlorenceNightingale, Pasteur to name but a few. But Ross . . . .?

Ross is certainly more appreciated now in Kolkata where he carried out the majority of his experimentalwork, and in India generally, than he has been allowed to become in the country which trained him.

Long may the Ross Memorial perpetuate his name.

I am indebted to Prof. Claudine Dauphin for her help with this section. Prof. Dauphin is Honorary Professor in Archaeologyand Theology of the Universities of Wales, and a member of the French Centre National de la Recherche Scietifique at'Orient et Mditerane - Monde Byzantin'in Paris. She kindly gave me a copy of an article based on her lecture (the TheCouncil for British Research in the Levant (CBRL) 25th Anniversary Crystal Bennett Lecture given at the Institute ofArchaeology on 23 April 2013) and subsequently published in Bulletin of the CBRL: 8, 2013.. The title of the CBRL articleis Fallahinand Bedu between the Desert and the Sown: the population Dynamics of a buffer-zone from Byzantium to theMamluks. A fuller version in French is published in the technical journal Gomatique Expert: No. 95; Nov - Dec. 2013entitled Paysanset Pasteurssur les marched du Levant Sud" pp 30 - 53. The sources for the more esoteric Muslim authorsquoted may be found therein.

Eradication of malaria through cooperation : Contd. from page 1

the totality of life, it does not blend well with the inner spirit, it cannot be made part of the life. For this, we aretrying to merge the life process of the villages with the pursuits of knowledge with whatever little resources wehave. This work was going on. Here, in this hall, we discussed about this before. Those who were in the hallbefore, know how we are carrying out our work. When we first took up work, we first found a scene of diseases.We are non-businesspersons; we did not have courage then to appeal to the people of the country who hadexperience in eradication of diseases of the villages to come forward to help us. Whatever we could, we did itourselves. In this connection, we acknowledge with deep sense of gratitude, the help we received from foreigners.We got the support of an American woman in this regard2. She is not a doctor, she acquired knowledge from herdirect hands-on experience by nursing patients during the War. Depending on that, she went from door to door ofthe patients, negotiating knee-deep mud; she nursed the poorest of the poor at their huts, provided nourishmentsto them. Deep festering sores the sight of which even our gentry abhorred- she herself cleaned all these bandaged the wounds of low caste patients, gave them nutritious diet. She is working until today; she did notrelinquish her work even when the intense heat exhausted her. When her health broke down, she went to Shillongfor a few days, on her return, once again she is putting herself to her physical limits. We got her help like this.She will have to go back to her country, but she is continuing to provide nursing and succour to her physical limitsduring the few days that remains.

Another benevolent Englishman, Elmhirst, has come bearing his own expenses, collecting fund from theoverseas without keeping a farthing for himself. No word is sufficient to describe how he is working day in andday out, visiting the surrounding villages, striving hard to alleviate the miseries of the villages. We are workingwith the help and support that we received from these two persons hailing from foreign countries.

This much you should understand that it is a fight between insects and men. The vector that carries ourenemy-disease occupies a long stretch of land. It is not possible to get hold of such a small insect within such avast territory. At least, it is impossible for one or two individuals to achieve anything unless we cannot workcollaboratively. We were groping, merely trying, at that juncture one of my former students, who is a student ofmedical college, came to me and said, Gopalbabu is a renowned Bacteriologist, he is even well-known in Europe.He is a famous man, earns quite a lot. The fight against malaria that you are about to take up, he himself hasbegun this work. He has vowed to work to the extent possible to save Bengal from this formidable enemy evenat the cost of his profession. When I heard this, I got interested. I decided to claim his support in our venture. Notfor the reason that we shall get tool to kill mosquitoes, we realized, we have information about such a rareperson who is involved in the work; not on the basis of anger, envy or excitement, nor was he driven by externalforces but for the sole purpose of saving the people of the country, sacrificing his self-interest, even though itcost him personal loss. Such examples are rare indeed. A sense of piety arose in my mind, I said I want to meethim and discuss this. He himself came to meet me - I heard from him how he has begun this work. Then it came


to my mind that we would remain grateful if we could take part along with him in this work, not for success itwould be a matter of great honour if we could join in a work of such a man.

You have noticed that after the war the talent of the people of Germany-Austria was on the decline, this wasbecause of physical weaknesses born out of starvation. When the blockade prevented reaching food, it resultedin death of a large number of people but this was not the biggest thing. The children who needed milk, pregnantmothers who required nutritious food, when they did not get it, children were born on this earth malnourished.The result is that when they would grow up they would not be able to stand up on the strength of that much ofintelligence. Therefore, from this point of view, mere headcount do not constitute population; we have to find outhow much those who have intelligence are effective. Mere physical counting is not proper. In Bengal, we are notaware that everything connected with our sources of health is drying up. By carrying the burden of diseases, webear a permanent source of debility in our blood. How many people are born every year, how many are dying,how the number is increasing is not important; whether those who survived are living like a proper human beingis the moot point. Their effectiveness, whether they have the ability to exercise their mind is the vital aspect. Ifthe majority were, half-dead then the people would not be able to carry this burden. From physical debility,mental weakness arises. Malaria produces ill health in the blood, and with that, we do not also have strength ofmind. Only those who are full of life can make sacrifice in life. Those who somehow survive do not have an iotaof surplus left beyond their own requirements; no generosity is left in them. If there is no generosity then nocivilization can be built. Where there is stinginess in life there is littleness of spirit. In no other civilization suchenormous decay of life has occurred. One has to keep in mind, distress do occur in all countries. But whatconstitutes humanitarianism of a human being? That it is not to accept distress as inevitable, to strive to mitigateany misfortune whenever and wherever it arises, to keep this resolve in mind. Up to this time, we have said,malaria is spreading throughout the country, how can we fight them, how can we drive out million and millions ofmosquitoes; government is there but doing nothing what can we do! That cannot be the plea. When we aredying in hordes many are seemingly dead even though they are not if we cannot solve this by any means,there is no escape. Malaria is the fountain head of other diseases. From malaria tuberculosis, dyspepsia andsimilar diseases arise. The Lord Yama gets through with ease when the main door is open. How can we fight withthem? At first, the door has to be closed, if only that results in saving the Bengali race.

There is another point you need to ponder. If we can drive out the mistrust that we have about ourselves inanyone area all the misfortune that we have so long accepted as our predestined fate, if we can go against thisgrain of thought on any pretext - then great service will be done. Howsoever the great the enemy may be, we willnot accept their dictates, will not keep alive any mosquitoes, by whatever means we will eradicate them if wecan gather this courage then it is not only mosquitoes but we will win over far greater enemy, our own inferiority.

Another point for meeting with people we need various occasions. Many such occasions are necessary sothat people of all ages can come together. Not many understand what does a Country means, and many do notknow what swaraj is. But not a single person is there who does not know the meaning of getting together. But ifin any one village the intensity of the diseases can be reduced to some extent by collective efforts then there isnothing like this as an occasion for coming together of all the educated and the illiterates. Gopalbabu has begunthis work. The name of the Mandals have been mentioned; I am happy to know that this Mandals stood side byside on the same ground and collaborated to kill such a tiny enemy like mosquitoes. Nothing can come close tothis as a good omen. For, welfare of others is the responsibility of all, each one is responsible for the welfare ofeveryone and others welfare is the greatest good - if this lesson, instilled as much as possible through innumerableoccasions in our country, it is so much the better. A road passing through a village, developed a pothole in oneplace caused by the passage of bullock carts not more than 4-5 arms length during monsoon knee-deepmud accumulate in it, men and women, old and young, negotiate this pothole for going to the market. Peopleliving in adjacent two villages who face the hardship most do not say, let us put one or two spades of soil over itto make it level because they are afraid lest they are cheated. They think, It is we who will put in the labour andits benefits will be enjoyed not only by others too, then it is better still that we also suffer. I have narrated beforeyou another incidence - one village used to suffer every year from fire, there was no well in the village, I proposedto them, You dig the well I shall provide the masonry part. They said, Babu, you want to fry fish in its own oil.That is, we will put half of the labours but you derive the whole of the piety. It is better still we die from want ofwater on this earth, but we cannot stomach the salvation that you would reap cheaply in the next world.


There are other such examples in the country. Even it is present among the gentry in various guises, I do nothave the courage to discuss these. People will understand from the kind of work that Gopalbabu is engaged in;the mosquitoes that breeds in the shallow pond next door also sucks my blood without any prejudice, thereforehis work of de-silting ponds also is my work.

Gopalbabu is engaged in a great work; a pure good sense attracted him to this work, devoid of any greed,anger, and jealousy. This example of great humanism is no less important to us than killing mosquitoes. For this,I pay my gratitude and respect to him.[Translators note: This was a public lecture. Hence, the sentences were long, syntactically complicated, with little breaksin paragraphs, giving it an interminable look unlike the poets writings, making the translators job difficult one. However,we have tried to be as faithful as possible to the meaning and spirit of the lecture. Transcription has been avoided as far aspossible.]Notes :1. Dr. Gopal Chattopadhyay (1869-1953), a renowned Physician and bacteriologist by profession, was a pioneer in

instituting Anti-Malarial Cooperative Societies in Bengal from 1917. He began his campaign against malaria from hisown village, Sukhchar, near Panihati, 24 Parganas, and then slowly covered the whole of Bengal, except the hills ofDarjeeling. When exactly the poet met Dr. Gopal Chattopadhyay is not known. Dr. Chattopadhayay delivered lecturewith film show about the depredation caused by malaria in the evening of the Anniversary meeting at Sriniketan on 6thFebruary, 1924 (Santiniketan, [Falgun-Chaitra(Feb.-March),1330] 1924). Rabindranath delivered his first PresidentialAddress before the Annual meeting of Anti-Malarial Society on 29th August, 1923. Therefore, he might have met himbefore this. Collaboration between Anti-Malaria Society and Sriniketan began. The Santiniketan journal in its Vol.4(9)reported that some office bearers of the Anti-Malaria Society and a Doctor visited the villages in 1923.Was he part ofit? In fact, Anti-Malarial work started at Sriniketan from the end of 1922 itself. Santiniketan took up the work evenbefore this, most probably, on its own initiative.

2. Miss Gretchen Green, a nurse of the Baptist Mission Hospital, U.S.A., came to Sriniketan at the end of 1922. At thatearly stage of Sriniketans developmental efforts she provided yeomans service by organizing the health work andalso fought ceaselessly against malaria. She will be remembered for her maternity work and direct medical help to theneedy of the outlying villages. The Sriniketan dispensary at that time was not fully ready. She along with KalimohanGhosh collected medicine from the shops of Calcutta for treating the patients of the villages and was responsible forlaying foundation of the health work ( See Gretechen Green, The Whole World and Company, Reynol Hitchcock, NY,1936). She left on March 1924.

3. Leonard Knight Elmhirst was one of the architects of Sriniketan. He and his wife Dorothy W. Elmhirst provided nearlyall the required fund for running the developmental works at Sriniketan.

LABORATORY DIAGNOSIS OF MALARIADr. Shanaz Latif

Consultant PathologistR. N. Tagore Hospital, Kolkata

Diagnostic procedures for the detection of malariadiffer considerably depending on the aim of evaluation.The current requirements of any laboratory procedurefor general application to the detection and diagnosisof malaria include: sensitivity, specificity, simplicity inapplication, unambiguous interpretation and rapidturnaround time. Presently, the differential stained thickand thin blood smear examined under the microscoperemains the most reliable and definitive test (Goldstandard) for diagnosis of malaria.

However, lack of skilled microscopists, limitedsupply and maintenance of microscopes and reagents,delays in results and inadequate quality control aresome of the factors at the periphery of health caresystem as a result in these areas a clinical diagnosisof malaria is made and early treatment of patients

started, although, this in some cases results in over orunder treatment. WHO recently reiterated the urgentneed for simple and cost effective diagnostic tests formalaria to overcome the deficiencies of both lightmicroscopy and clinical diagnosis.

The routine use of thick and thin films is advised formalaria diagnosis. Thick films should be exposed toacetone for ten minutes, then stained without furtherfixation, using Giemsa or Fields stain. Thin films shouldbe exposed to acetone for one minute and then eitherstained with a Leishman stain (methanol based) ormethanol fixed and stained with a Giemsa stain. Thick filmsshould be examined at least 100 microscopic filedsnecessary to count 200 leucocytes for an adequate periodof time by two observers. If thick films are positive, thespecies should be determined by examination of a thin film.

Whenever, Plasmodium falciparum is detected, thepercentage of parasitized cells should be quantified andreported promptly since the severity of parasitemiaaffects the choice of treatment. Quantification should


be performed using a thin film, a minimum of thousandRBC should be examined in different areas of the film.Only asexual stage parasites should be counted in atleast 25 microscopic fields. Thick films are about eleventimes more sensitive than the thin films; an experiencedmicroscopist can detect parasite levels (or parasitemia)as few as 5 parasites/l of blood.

In recent years it has been found that rapid dipstickantigen capture tests for the circulating Plasmodiumfalciparum specific antigen HRP2 have excellentsensitivity and specificity for the diagnosis of Plasmodiumfalciparum malaria, generally at least as good asmicroscopy of a thick and thin film by a skilled microscopist.

Rapid antigen detection tests (RDTS) cannotreplace microscopy but are indicated as asupplementary test when malaria diagnosis is beingperformed by relatively inexperienced staff e.g., in lowprevalence areas and outside normal working hours.

Immuno-chromatographic antigen-detection testsuse finger stick or venus blood, the completed testtakes a total of fifteen to twenty minutes and the resultsare read visually as the presence or absence ofcoloured stripes on the dipstick. The threshold ofdetection by these rapid diagnostic tests is in the rangeof hundred parasites/ul of blood (commercial kits canrange from about 0.002 percent to 0.1 percentparasitemia) compared to five by thick film microscopy.One disadvantage is that dipstick tests are qualitativebut not quantitative, they can determine if parasites arepresent in the blood, but not how many.

Rapid diagnostic tests (RDTS) detect eitherPlasmodium falciparum specific or histidine rich protein 2(HRP 2) or species specific parasite lactatedehydrogenase (pLDH).

The main advantage of RDTS is that they providea means for rapid diagnosis, especially in areas wheremicroscopy is not practical (e.g., areas with limitedhealth resources.) The disadvantages of RDTS includethe inability to distinguish between infection and recentlytreated infection. In addition even with a positive RDTa blood film is still necessary for confirmation of speciesand for a parasite count to help guide treatmentspecially in cases of Plasmodium falciparum. PCR isusually available in reference laboratories. It maybeused to confirm the diagnosis of malaria in cases wheremicroscopy is negative but there is high clinicalsuspicion of disease or to determine the species whenit is not possible to distinguish on light microscopy.

Saliva is a promising diagnostic fluid for malariawhen protein degradation and matrix effects aremitigated. Concentrations of Plasmodium falciparumHRP2 in saliva of suspected patients is measured usinga custom chemi luminescent ELISA in microtitre plates.

Systematic quantification of other malaria bio markers insaliva would identify those with the best clinical relevanceand suitability for off the shelf diagnostic kits.

UCLA Biomedical Engineering students areworking to develop a diagnostic tool for malaria wherethe testing is done by using saliva. The idea calledMaliva is for chewing gum to contain small colouredand magnetised particles coated in antibodies that bindto proteins expressed from the malaria parasite.

On chewing this gum, there is salivation this suppliesthe antigen. After a few minutes of chewing the gum isremoved and passed over a small magnet. If malaria bio-markers are present the magnet will concentrate theparticles to form a visible line, much like a pregnancy teststrip. The particular strain of malaria can also be indicateddepending on the colour of the line. However, the goldstandard of diagnosis is microscopy.

LABORATORY DIAGNOSIS OF DENGUE,JAPANESE ENCEPHALITIS AND

CHIKUNGUNYA FEVERDr. Debashis Chakraborty, M.D. (Pathology)

Associate Professor Dept. of Pathology, IPGME&R/SSKM (PG) Hospital, Kolkata

Recently, three viral diseases mainly Dengue,Japanese Encephalitis (JE) and Chikungunya viralinfection, are in top news because of a few frequentsmall epidemics of these diseases in different parts ofIndia in recent past. The present brief account will dealwith laboratory diagnosis of these diseases.

DengueDengue (DEN) and dengue Hemorrhagic fever

(DHF) both are caused by Dengue virus, a virus offlavivirus group. The other important viruses in thisgroup are Japanese encephalitis, Hepatitis, West NileBlue fever, Kyasanur forest Disease, yellow fever etc.

The main symptoms of Dengue are fever, headache,retrobulbar pain, severe muscle and joint pain (Breakbonedisease) and hemorrhagic manifestations.Laboratory diagnosis of Dengue includes1. A rising hematocrit (PCV), due to leakage of plasma

(To remember, PCV may be raised in polycythemia,burn, bleeding etc.). Depending on PCV, fluidtherapy is adjusted.

2. Platelet count may be reduced : It is importantto perform serial platelet count, as singleexamination revealing low platelet count may beconfusing and create undue panic even among thedoctors.


3. White cell abnormalities, usually leucopenia andreactive lymphocytes, (these may be found is otherviral infections also).

4. Coagulation test : Bleeding time (BT) andcoagulation time (CT), though not very specific, areprolonged. PT (Prothrombin time) and APTT(Activated partial thromboplastin time) two testsbasically aiming at abnormalities both in theextrinsic and intrinsic pathways of coagulation are prolonged. It is important to remember that,both PT and APTT rises in DIC (DisseminatedIntravascular Coagulation), a shock-like fatal state.

5. Biochemical tests : These are mainly formonitor ing, include serum transaminases,electrolytes, urea, creatinine and albumin etc.

6. Specific tests : These include i) Virus Isolation : Not practicable except for

research purpose.ii) Viral Nucleic acid detection : By Reverse

transcription-polymerase chain reaction (RT-PCR) : Better than virus isolation.

iii) Immunological response and serological test.There are a) Haemagglutination Inhibition (HI),b) Complement Fixation (CF),c) Neutralisation Test (NT), d) MAC-ELISA (IgMantibody Capture Enzyme-linked ImmunosorbentAssay, e) Indirect IgG-ELISA, f) IgM/IgG ratioOf all these six types, MAC-ELISA is the mostspecific.

iv) Viral Antigen detection : ELISA and dot blot arraysdirected against envelope/membrane (EM)antigens and non-structural Protein-I Antigen(NS-1 Antigen) can be detected in both primaryand secondary dengue infections upto 6th dayfrom the start of illness. Different commercial kitsare available for detection of NS-1 Antigen.

It is important to remember that i) Dengue IgMbecomes positive after 5 days of onset of symptoms,and positive IgM means it is primary dengue infection.The IgM titre rises upto 2-3 weeks, and falls slowly after4th week. ii) Dengue IgG is positive after 14 days andis present in low titre throughout life. iii) Both IgM andIgG kit tests may cross-react with other flavivirusinfections including Japanese Encephalitis (JE). Yellowfever, Western Blue Nile fever, Kyasanur ForestDisease (KFD) etc. So, confirmation of Dengue is tobe done based on Dengue MAC-ELISA.

Japanese EncephalitisJapanese Encephalitis is an arboviral disease,

presenting with Acute Encephalitis Syndrome (AES).So, the aims of diagnosis are basically three

i) To establish the diagnosis of AES. ii) To exclude othercauses of Acute Encephalitis Syndrome (AES). iii) Toconfirm the diagnosis of JE.

The basic treatment protocol for al l AES,particularly viral AES, are same. So, the diagnosticspecificity of JE virus is more important for taking publichealth actions rather than specific treatment, if at all.CSF study :CSF protein, like all viral AES, does not rise. The CSFcell count show a modest rise only.Viral tests :CSF shows at least 4 fold increase in 1gG in pairedsera (with 14 days difference).Specific test :i) CSF shows presence of JE IgM antibody. ii) VirusIsolation from brain tissue. iii) Antigen detection byImmunofluroscence. iv) Nucleic Acid detection by PCR.

For confirming the diagnosis of AES/JE, IgMcapture ELISA (MAC ELISA) is to be done in the sentinelsurveillance network. The virus isolation is to be donein National Reference Laboratory.

Chikungunya VirusChikungunya is a viral disease, caused by CHIK

virus belonging to togaviridae family of genus Alphavirus, characterized by sudden onset of fever, arthritisand rash, and is usually self-limiting. It is, like dengue,carried by Aedes mosquito, namely stegomyiasugenous. Recent outbreak in Indian ocean areas isdue to Aedes albopictus.

Laboratory diagnosis of Chikungunya includes i) Leucopenia, sometimes thrombocytopenia,ii) Increased serum AST (Aspartate Transaminase),iii) Increased CRP (C-Reactive Protein).

For a subset of patients with persistent disease,often presenting with recurrent pleural effusion HLA-B27 testing is very important (These patients are HLA-B27 posit ive, so HLA-B27 test ing has a goodpredictability for chronic disease of Chikungunya.

Chikungunya virus Isolation can be done fromblood of infected patients, inoculated on suckling miceor VERO cells.Conclusion

The diagnosis of the above three diseases aremainly clinical. Laboratory tests, as usual are forconfirmation, monitoring and exclusion. All three areurban; JE and Chikunguya also may affect ruralpopulation. Vector control, improved hygiene and timelyintervention based on good surveillance are needed fortheir control.


MALARIA IN PREGNANCYDr. Sujoy DasguptaMS (Obst & Gynae)

Senior Resident, Deptt of Gynaecological Oncology,Chitaranjan National Cancer Institute (CNCI), Kolkata

(Dedicated to Late Dr. Sundari Mohan Das for hispioneering contribution on this topic in the world)

Among al l vector-borne diseases, malar iacontinues to pose serious public health threat in thedeveloping countries. Malaria affects more than a billionof people worldwide and is responsible for more than amillion deaths1. The name of the disease malaria (badair) was given as far back as 17532. And it is interestingto note that the treatment of malaria became firstestablished (in the middle of 17th century) beforeanything was known about its etiology. Laveran (1880)first discovered the malarial parasite in an unstainedpreparation of fresh blood. It was Sir Ronald Ross fromCalcutta (1898) who worked out the mosquito cycle ofthe parasite2. Four species of the genus Plasmodiumhave been recognized to cause human malaria, viz, P.vivax, P. falciparum, P. malariae and P. ovale. It istransmitted by the bite of infected female Anophelesmosquito that innoculates the sporozoites into humanblood. Apart from this, trophozoite-induced malaria hasalso been described, that is transmitted by bloodtransfusion1.

Pregnancy, on the other hand, is a unique condition.No other physiological events in adult life witness suchmajor changes in all the organ-systems of the body, asthose occur in pregnancy. Any infection occurring inpregnancy may prove fatal for both the mother as wellas the baby. Again, clinical and laboratory parameterschange in pregnancy; so caution should be observedto interpret these results. Treatment is also complicated,because of changes in maternal pharmacokinetics andconcern of effect of the drug on the unborn fetus.

Pregnant women are more susceptible to malariadue to attenuation of malaria-specific immunity. Theimmunity is regained toward the end of the pregnancybut is lost once again in subsequent pregnancies3,4.There is a progressive rise of immunity with increasedparity. Thus, primigravidae are at highest risk5.Parasitaemia peaks during 2nd trimester, followed byhigher incidence of anaemia6.

Also, pregnant women tend to have more severecomplications than nonpregnant counterparts7.Especially, they are prone to develop hypoglycaemiaand cerebral malaria even at very low peripheral bloodparasi taemia. Apart f rom them, al l the other

complications of malaria are common and may provefatal. Examples include- hemolytic anaemia, folatedeficiency, hyperpyrexia, lactic acidosis, disseminatedintravascular coagulation (DIC), renal failure, pulmonaryoedema, circulatory collapse, jaundice, black waterfever and dyselectrolytemia. In severe P. falciparummalaria, case fatality rate in nonpregnant women is15-20% whereas it is as high as 50% in pregnancy8.And non-falciparum species are not totally benign9.

McGregor, 1993 suggested that the malarialparasites, especially P. falciparum have a high affinityfor placenta, probably due to establishment of a newlow-resistance vascular system, which provides a safeheaven away from the host-effector defensemechanism, providing free and unhindered replicationof the parasite in the schizogony phase6. Incidence ofplacental involvement during pregnancy in women livingin endemic areas varies between 16 and 60%7. Heavyplacental parasitaemia may lead to abortion, pretermlabour, still birth, low birth weight, intrauterine growthrestriction (IUGR) and failure to thrive. However,congenital malaria is uncommon, due to passivetransfer of IgG antibody across placenta that providesprotection to the neonate for up to 6 months10.Conversely, in nonimmune women of nonendemicareas, there is increased risk of congenital malaria ofthe offspring7. The Royal College of Obstetricians andGynaecologists (RCOG) defined congenital malariaas malaria in very young infant due to passage of infectedRBC or parasites from the mother in utero or duringdelivery, not due to mosquito bites11. It is characterizedby progressive anaemia, jaundice, slow growth and failureto thrive and is very difficult to diagnose.

So, any pyrexia in a pregnant woman should beinvestigated and malaria must be ruled out, especiallyin endemic area. Microscopic tests are gold standardand are recommended by RCOG for selection of properantimalarials11. Three negative smears at intervals of12-24 hours can safely rule out malaria11. Non-microscopic tests (PCR etc) and rapid tests are alsoavailable but cannot replace microscopic tests11.

Treatment should be prompt and needsmultidisciplinary approach. Any pregnant woman withmalaria should be hospitalized and supportive treatmentshould be initiated. Antipyretics should be given forcontrol of temperature. Blood glucose and electrolytebalance should be maintained. If the patient vomits,one should not rely on oral drugs. Response toantimalarial treatment is multifactorial but is associatedwith the degree of prior immunity acquired fromrepeated exposures in childhood and the backgroundlevel of drug resistance. The higher the transmission

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014 n 1 1

of malaria, the greater the degree of prior immunity andthe more likely the woman will respond favourably to adrug treatment12,13.

Any complicated or severe malar ia needsmanagement in intensive care set up. The criteria forsevere malaria was defined by WHO12. These includeclinical features of organ dysfunction as well aslaboratory features like hyperparasitaemia (>2%parasit ized red blood cel ls), severe anaemia,thrombocytopaenia, algid malaria, lactic acidosis,hypoglycaemia etc. Intravenous artesunate, which issafe in pregnancy, is the drug of choice. It should befollowed by oral artesunate and clindamycin, as soonas the patient is able to eat. If artemisinin is notavailable, intravenous quinine is given, followed by oralquinine and clindamycin. It is to be noted that quinineis safe for the fetus at therapeutic doses but tends tocause more hypoglycaemia in pregnancy14.Complications like pulmonary oedema, anaemia,circulatory collapse, renal failure, coagulopathy andacidosis need proper management11.

Uncomplicated P. falciparum malaria is treated withoral quinine and clindamycin. Chloroquine-resistant P.vivax malaria is also treated in the same way.Otherwise, non-falciparum malaria, if uncomplicated,is treated with 3 days chloroquine therapy, which is alsosafe at this dose14. Primaquine, for radical cure, shouldbe withheld during pregnancy and 3 months thereafter,because the fetus (and the neonate) is relativelyG6PD deficient11.

From obstetric point of view, haemoglobin, plateletand blood glucose should be monitored regularly.Regular growth scan should be considered for earlydetection of IUGR. Before discharge, patient should becounseled about the symptoms of preterm labour andhow to monitor daily fetal movement count. Peripartummalaria needs placental histopathological examinationand cord blood examination for malarial parasite11. Inthose cases, the neonatal blood should be examinedweekly up to 28 weeks to detect congenital malaria11.

We all know the old axiom Prevention is betterthan cure. Regarding malaria, i t needs ABCDapproach15. A stands for Awareness of risk, i.e., travelto any endemic area should be avoided, unlessabsolutely needed, and any fever within one year afterreturn from such area should be immediately reported.B means Bite, prevention by skin repellent, sprays,mosquito-nets etc. C and D respectively stand forChemoprophylaxis and Diagnosis and treatment.Chemoprophylaxis can be given with daily proguaniland weekly chloroquine. In chloroquine-resistant areas,

weekly mefloquine can be used; and for intolerance orresistance to mefloquine, the drug of choice is dailyatovaquone and proguanil (with folate supplementation)15.

In summary, diagnosis of malaria needs high levelof suspicion in pregnancy. Role of early treatmentcannot be overemphasized to avoid potential dangersto both the mother and her fetus. Prevention is ofparamount importance that requires initiative both fromthe health care professional as well as the women.

References1. World Health Organization (WHO) World health

report-1999. Making a difference. Report of theDirector General WHO 2000.

2. Chatterjee KD. Subphylum Sporozoa: ClassTelosporea; Genus Plasmodium. Parasitology2004; 12th Ed:71-86

3. Playfair JHI. Malaria in Pregnancy. Br Med J1992;32:157

4. Brabin BJ. An analysis of malaria in pregnancy inAfrica. WHO Bull 1993; 61: 1005

5. Vieguels MP, Eling WM, Roland R, et al. Cortisoland loss of malaria immunity in human pregnancy.Br J Obstet. Gynaecol. 1987; 94(8): 758

6. McGregor IA,Wilson IA, Billewicz WZ. Malariainfection of the placenta in Gambia. Trans R Soc.Trop. Med. Hyg. 1993; 72: 232

7. Arias F, Daftary SN, Bhide AG. Tropical Diseasesin Pregnancy: Practical Guide to High-Riskpregnancy and Delivery; A South Asian Perspective2011; 3rd Ed: 528-31

8. World Health Organization. Guidelines for theTreatment of Malaria. 2nd ed. Geneva: WorldHealth Organization; 2006 [www.who.int/malaria/publications/atoz/9241546948/en/index.html].

9. Price RN, Douglas NM, Anstey NM. Newdevelopments in Plasmodium vivax malaria: severedisease and the rise of chloroquine resistance.Curr. Opin. Infect. Dis. 2009; 22: 4305

10. Ibeziako PK, Okerangwo AA, Williams AAI. Malarialimmunity in pregnant Nigerian women and theirnewborn. Int. J. Gynaecol. Obstet. 1990; 18(2): 14

11. Royal College of Obstetricians and Gynaecologists(RCOG). Green Top Guidelines No.54B. TheDiagnosis and Treatment of malaria in Pregnancy;April 2010: 2-11

12. White NJ. The treatment of malaria. N. Engl. J.Med. 1996; 335: 8006.


13. White NJ. Why is it that antimalarial drugtreatments do not always work? Ann. Trop. Med.Parasitol. 1998;92:44958

14. Lalloo DG, Shingadia D, Pasvol G, Chiodini PL,Whitty CJ, Beeching NJ, et al. UK malaria

DENGUE ALERT AT CHENNAITN Govt. steps up to tackle fever, launches a toll free number. PTI, on Oct. 14, 2014 reported :

The Tamil Nadu govt. under the leadership of the Chief Minister O Paneer Selvavam reviewed the mosquitocontrol measures being implemented in the state. The govt. has urged the public to inform it about locationsand details through the toll free number 104, so that the state can take prompt action.Health Minister C. Vijaybhaskar said the public could also inform the govt. at 9444340496 and 044-24350496besides the toll free number if they had a fever situation in their towns.On receipt of information, all steps will be taken immediately to control it.

Ross Rabindranath Mission and Sir Ronald Ross Memorial Centre, Kolkata thanks Govt. of TamilNadu for Pro-active measures against the Mosquito-borne viral disease.

Dipanjan Bhattacharya

t reatment guidel ines. J . Infect . 2007; 54 :11121

15. Royal College of Obstetricians and Gynaecologists(RCOG). Green Top Guidelines No.54A. ThePrevention of malaria in Pregnancy; April 2010: 4-8.

SIR RONALD ROSS ANDSIR RABINDRANATH TAGORE :

POETS AND ENVIRONMENTALISTSBiswajit Dutta

Ronald Ross in 1898 discovered the life cycle ofMalaria parasite in the gastrointestinal tract of femaleAnopheles mosquito at the Presidency General Hospital(now SSKM Hospital), Kolkata, for which he receivedthe Nobel Prize in Physiology or Medicine 1902. Hewas a poet too his poem is inscribed in a plaque atthe SSKM (PG) Hospital, Calcutta. Amongst his othercontributions, Dr. Ross preached community hygieneand sanitation to arrest the growth of mosquitoes andother vectors, thereby to prevent Malaria and othervector-borne diseases, an important step towardspreservation of public health and environment.

Rabindranath Tagore, born at Calcutta is a great poetand for his poetical work, Gitanjali (Song Offerings), thathe translated into English from his Bengali poems,received the Nobel Prize in Literature 1913. But he is alsoconsidered as a pioneer on various fields of Bengaliliterature and songs, himself a painter, an environmentalist- evident from his human development activities atSantiniketan School, rural developments in his familyestates at East Bengal and Sriniketan. He also initiatedvarious movements at Santiniketan, Sriniketan andelsewhere to arrest the growth of mosquitoes towardseradication of Malaria and to preserve the public healththat are evident in his writings and activities.

We, the members of Sir Ronald Ross MemorialCentre, Kolkata feel proud to follow Sir Ronald Ross

and Rabindranath Tagore, both of them worked in thiscity, inspiring us to serve the distressed humanity.

Ronald Ross was born at Almora, United Province,India, on 13th May, 1857. His father Sir C.C.G. Rossserved the British Indian Army and retired as BrigadierGeneral. About half of the army personnel at that timesuffered from Malaria, may be in their field duties, includingGeneral Ross, who suffered from this disease severaltimes and preferred his son to become a doctor. RonaldRoss, a bright young man having passion for poetry,graduated in Medicine in 1879 at St. BartholomewsHospital, London and entered the Indian Medical Servicein 1881. During his posting at Madras in 1884, the vigorousmosquito bites that greeted him and later the same inBangalore, may have prompted Dr. Ross to unveil thelink between Malaria and the mosquitoes, and he devotedhimself towards the experimental investigation of thehypothesis of Lavaren and Mason that mosquitoes maybe connected with the propagation of Malaria. The timeDr. Ross was contributing to the poetry and publishingthem in literary magazines was gradually being absorbedby his studies and experiments on mosquitoes. Laterduring his service at Secunderabad in 1897, Dr. Rosscould identify that female Anopheles mosquitoes were thecarrier of Malaria parasite. Finally in 1898, at thePresidency General Hospital, Calcutta, his discovery ofthe life cycle of Malaria parasite in the intestinal tract offemale Anopheles mosquito and thus Dr. Ross laid thefoundation for combating the Malaria.

Dr. Ross returned to England in 1899, joined theLiverpool School of Tropical Medicine and later servedas the Director of Ross Institute and Hospital for TropicalDiseases, the institution founded on his honour. In 1911,


Dr. Ross was honoured with the Knighthood. Sir Rossadvised the authorities that, if Malaria mostly prevalentamongst the labourers and the poors, by ensuring properhygiene and sanitation in their localities, growth ofmosquitoes could be arrested, thereby Malaria could beprevented substantially, resulting in considerable rise inproduction of the labourers and subsequent savings inthe public health expenditure, but he failed to convincethe authorities initially in this regard. Sir Ross travelledwidely from Panama Canal to Suez Canal, West Africa toMalaysia, tropical Malaria affected zones, Greece, Cyprusand elsewhere, with his mission to fight out Malaria andsucceeded considerably to wipe out this disease, thus heproved his ideas. Sir Ross is also considered as a pioneeron Pathometry, a unique contribution to both pure andapplied mathematics - methodology to survey and assessthe epidemiology of Malaria, which is now considered asa basis of the epidemiological understanding of insect borndiseases.

Sir Ronald Ross again came to India in 1926 andin his honour on 7th January 1927, Governor General,Lord Lytton, unveiled a Plaque at Presidency GeneralHospital (SSKM Hospital), Calcutta, where Sir Rossmade his epoch making discovery and one of his poemswas inscribed in the Gate of Comemoration :

This day relenting GodHath placed within my handA wondrous thing; And Godbe praised at his commandseeking his secret deeds,

with tears and toiling breathI find the cunning seeds

O, million-murdering Death.I know this little thing

A myriad man will saveO death, where is thy sting,The victory, O Grave? 1

Dr. Gopal Chandra Chattopadhyay, a stalwarttowards antimalaria movements in Bengal, foundedvarious Anti Malaria Societies to fight out the mosquitomenace and prevent Malaria in line with Sir Ross. In abefitting ceremony held on 11th January 1927 at AlbertHall, Calcutta, Dr. Chattopadhyay felicitated Sir RonaldRoss in presence of the distinguished citizens ofCalcutta. Sir Ross had admiration for the literary andsocial activities of Rabindranath Tagore.

Rabindranath Tagore was born on 7th May, 1861at Jorasanko Thakurbari, Kolkata. His father MaharshiDebendranath Tagore and grandfather PrinceDwarkanath Tagore, were amongst the pioneers of theRenaissance movement in Bengal and India, when themembers of the family contributed to a good extent onthis context. Rabindranath studied in Kolkata and

England, then left his academic pursuits to devotehimself to literary activities, thus he created a new worldof Bengali literature, comprising his pioneering workson poetry, short story, novel, play, etc., also revolutionizedthe field of Bengali songs, created the national anthemsof India and Bangladesh. Nobel Prize that he receivedon his poetical work, cannot fathom his genius, histhought is revealed in one of his poems:Where the mind is without fear and the head is held high;Where knowledge is free;Where the world has not been broken up intofragments by narrow domestic walls;Where words come out from the depth of truth;Where tireless striving stretches its arms towards perfection;Where the clear stream of reason has not lost its wayinto the dreary desert sand of dead habit;Where the mind is led forward by thee into ever-widening thought and action -Into that heaven of freedom, my Father, let mycountry awake. 2

In 1890, When he was assigned by his father to lookafter their family estates in East Bengal, stationed atShilaidah, Zaminder Rabindranath then could graduallyrealize the hard and distressed life of his subjects, sowas the condition of most of the rural folks in the country.When most of the Zaminders hardly bothered about thedistressed conditions of their subjects, rather they usedto exploit them for their own benefits, Rabindranath wasworried about them, felt to change their conditions andcalled upon the poet within him, who was otherwiseconfined in his dreamland, to serve the distressed, as hestated in his poem Ebar phirao more:

Oh poet then come up if you have the vigour sobring it with you, offer it today.Intense sufferings, severe grief, hard world aheadextreme poverty, emptiness, extremely mean,confinement, darkness.Wanted food, wanted vigour, wanted light, wantedfresh air, wanted strength, wanted health, happybright longevity, daring wide heart. In this poor grave,oh poet, bring once from the heaven the picture oftrust. 3

Rabindranath establ ished new schools foreducation of the children and adults, hospitals fortreatment of the sick, introduced new variety of seedslike potato etc. at that time, as source of food, spinningschools as source of livelihood, in his Zamindary, toadditionally support the livelihood of the farmers andthe subjects. He introduced the first Agricultural bankof Bengal at Patisar, to support the poor farmers, whowere otherwise victims of the greedy money lenders,


despite the losses he had to incur out of those initiatives.For human development, he founded a school atSantiniketan, Bolpur, in an environment friendly hub,where the students are taught close to the nature, underthe shade of tree, sitting on grass mat, still providingthe best of the educations from the East and the West.He founded the Visva-Bharati University for union andenrichment of human cultures. Towards sustainabledevelopment of the rural folks, he founded at Sriniketan,near to Bolpur, a rural development centre, that too anenvironment friendly initiative.

Rabindranath was honoured with Knighthood in1915 by the British Government. On protest against theJalianwalla Bagh massacre by the British forces in thePunjab in 1919, Sir Rabindranath Tagore renouncedhis knighthood, in a letter dt. 30th May, 1919, to theViceroy Lord Chelmsford, though the same was notformally acceded to by the British authorities, butRabindranath refrained from using the Sir before hisname for the rest of life, whereas the British Presscontinued to use the same.

Rabindranath, along with the teachers and studentsof the Santiniketan and Sriniketan, took various initiativesto arrest the growth of mosquitoes in their localitiestowards prevention of Malaria, and to support themovement wrote various articles and joined Dr. GopalChandra Chattopadhyays Anti-Malaria Movement, whenin a meeting of the Anti-Malaria Society spoke:The enemy whatever mighty could be, would notcare for it, shall not keep the mosquito, how canit be shall eradicate - If we have this couragethen not only the mosquito, will win over agreater enemy, our own indigence. 4

With the advancement of medical science, it is nowclear that, besides Malar ia, di fferent types ofmosquitoes act as carriers of Fi laria, Dengue,Chickungunia etc, also flies, pigs etc. act as carriers ofencephalitis and other diseases. Mosquitoes are nowgradually gaining immunity to various insecticidesapplied to arrest their growth. Similarly Malaria parasitesare gaining immunity to different types of drugspresently applied to treat this disease. According toWorld Health Organization, about 300 million peopleworld-wide, annually become victims of Malaria, mostlychildren and out of them about 1.5 million to 2.7 milliondie, which is still, remaining to be of great concern.

Sir Ronald Rosss mission is very much relevanttoday on the context above, as that of RabindranathTagore. We, the members of SIR RONALD ROSS

MEMORIAL CENTRE, are dedicated to the contextsabove - to the cause of the eradication of Malaria andother vector borne diseases, promotion of public health,environment and human rights that are also projectedin our publication Ross Rabindranath Mission.

NOTES AND REFERENCES:1. Ross Rabindranath Mission, Vol. 1, Oct.-Dec. 2012, P/21.2. The English Writings of Rabindranath Tagore, Vol - 1,

Sahitya Akademi, 2001, P/5.3. Ebar Phirao More, Rabindra Rachanabali - Vol.2, Visva-

Bharati Granthan Bibhag, Posh 1417, P/151.4. Samabaye Malaria Nibaran, Rabindra Rachanabali -

Vol.14, Visva-Bharati Granthan Bibhag, Posh 1417, P/389

SURGICAL ASPECT OF MALARIADr. P. K. Mishra

Professor, Department of Pediatric SurgeryNRS Medical College & Hospital, Kolkata

Human Malaria is a parasitic disease caused byprotozoa species of genus plasmodium (P). Out of the 10plasmodia P.Falciparum and P.Knowlesi cause the mostsevere form of the disease. The infection that causemalaria is transmitted by Anopheles Mosquitoes. Itsimplication in surgical conditions is of serious concern.

Malaria in postoperative patients complicates theresult of surgery by two mechanisms. One is relapseof preexisting disease by arousal of parasite fromdormancy by immunosuppressive action of majorsurgical procedures, trauma, malignant diseases likeHodgkins Disease, NHL, Haemoglobinopathies likeThalassaemia, or the patient may be in incubationperiod during surgery and become symptomatic inpostoperative period. The second mechanism istransmission by blood transfusion in major surgicalprocedures that may cause symptomatic malaria. So,patients requiring elective major surgery and the blooddonors who have moved from (or recently visited) anendemic area of malaria are considered as potentialsources of infection and need be administeredadequate malaria chemoprophylaxis during peri-operative period, the objective being to prevent parasiteinoculation and parasite arousal from dormancy andthe resultant consequences of fever and haemolysis.

Resistance to commonly used anti-malarial drugslike chloroquine and mefloquin have been observedrecently. So, Quinine is preferred as chemoprophylaxis.Treatment with quinine for 15 days, beginning 7 daysbefore surgery and ending 7 days after surgery,including the day of operation, is recommended as thestandard chemoprophylaxis to prevent relapse ofmalaria, particularly in endemic zone, in a patient withhistory of previous episode of symptomatic malaria. In


patients treated for P.falciparum malaria, where theRBCs are distorted and made cytoadherent and causesevere haemolysis, it takes 125 days to get the allexisting erythrocytes replaced with new ones andthereafter major surgery be performed. Injury/Surgerymay convert asymptomatic falciparum malaria tosymptomatic, which increases the risk of post operativewound infection and complicate the recovery process.The severity of injury is directly proportional to the riskof post-injury malaria in endemic zone. It may beexplained by the fact that in malaria endemic areawhere people are repeatedly infected, developacquired-partial immunity to the parasite, thusasymptomatic malaria are common in those areas. Posttrauma immune depression breaks the defenses, thusthe parasites proliferate to become symptomatic.

To quote few examples, Tropical splenomegaly inmalaria leading to splenic rupture by trauma maypresent as surgical emergency. Surgical procedures likeliver transplant, Kidney and cardiac transplants,cardiopulmonary bypass, emergency caesarian sectionin malar ia infected mother, splenectomy inThalassaemia are the common procedures complicatedwith symptomatic malaria.

Awareness of surgical implication of malaria isessential to help management of itsrelated postoperative complication.

Amrish (Lala) Puris untimely tragic death due tohead injury (caused by accidental fall), myelodysplasticsyndrome and subsequently by Malaria at HindujaHospital, Mumbai was a terrible shock to the filmindustry (Bollywood, Hollywood), Indian theatre Industryand people/fans as a whole.

Malaria killed the Mogambo, our Great Actor andTheatre personality at the age of 72 years. A smallparasite, carried by female anopheles mosquito isdeadly than a mighty man. Severe malaria can causedeath in 20% of patients even in a very good hospital.

SALUTE TO VERSATILE AMRISH PURI A VICTIM OF MALARIA

Currently, 80.5% of the 1.2 billion population inIndia lives in malaria risk areas. Mumbai, as a mini-India reflects the disappointing public health featureof the whole country.

Life history of Amrish PuriAmrish Puri was born at Nausera, Punjab on 22nd

June 1932 and he died on 12th January, 2005. He wasa resident of Juhu, Maharastra. Maharastra (Mumbai)is a notorious mosquito den, though it is the financialcapital of India.

Amrish was an activist of Indian theatre movementsince 1960, along with Satyadev Dube and GirishKarnad. He joined Prithivi Theatre and credited him tobe a famous stage actor. He worked in televisionadvertisements and later joined in film industry.

He acted in more than 400 films in Bollywood andHollywood and in different regional Indian languages Hindi, Marathi, Kannada, Tamil, Telugu, Malayalambetween 1967-2005. His dominating presence withbaritone voice endeared him with negative iconic rolesas villain.

Steven Speilberg said, Amrish is my favourite villain the best the world has ever produced and ever will .Achievements : Wins : 1968 Maharastra State DramaCompetition. 1994 Singapore International FilmFestival. Best Actor Award in Suraj Ka Satvan Ghoda.Nominations : 1990 Filmfare Best Supporting ActorAward Tridev. 1993 Filmfare Best Supporting ActorAward Muskurahat. 1994 Filmfare Best SupportingActor Award Gardish. 1996 Filmfare Best SupportingActor Award Dilwale Dulhania Le Jayenge. 1996 Filmfare Best Villain Award Karan Arjun, 1999 Filmfare Best Villain Award Koyla, 2000 FilmfareBest Villain Award Baadshah, 2002 Filmfare BestVillain Award Gadar Ek Premkatha.Awards : 1979 For Theatre, he won Sangeet NatakAcademi Award. 1986 Filmfare Award for BestSupporting Actor Meri Jung. 1991 Maharastra StateGaurav Purashkar. 1994 In the Sydney Film Festival,he won the award for Best Actor (Suraj Ka SatvanGhoda). 1997 Filmfare Award for Best SupportingActor Ghatak. 1998 Filmfare award for BestSupporting Actor Virasat.Filmography : Prem Pujari (1970), Kachhi Sadak(1971), Gandhi of Richard Attenborough (1982), Coolie(1983), Indiana Jones, The Temple of Doom (by StevenSpielberg, 1984), Kasam Paida Karne Wale Ki (1984),Muqaddar Ka Badshah (1990), Phool Aur Kaante(1991), Zindaggi Ek Juaa (1992), Muskurahat (1992),


Damini (1993), Paramaatma (1994), Dilwale Dulhania LeJayenge (1995), On Wings of Fire (2001), Chori ChoriChupke Chupke (2001), Gadar : Ek Prem Katha (2001),Nayak : The Real Hero (2001), Badhaai Ho Badhaai(2002), Aitraaz (2004), Mujhse Saadi Karogi (2004).Other Memorable Films : Love, Hum Punch, PardeshManthan, Vidhata, Hero, Nisanth, Kisna : The WarriorPoet, Reshma Aur Shera, Bhumika, Party, Shakti, ArdhSatya, Naseeb.So many hats : Collecting hats was his hobby. In hisactive life, he wore so many hats, like awards andappreciation. His autobiography "The Act of life" waspublished in 2006.

SICKENING AFFAIRSMANIK SARKAR, TRIPURA'S BEST KNOWN MARXIST, IS ADMIRED

FOR BOTH HIS PERSONAL INTEGRITY AND ADMINISTRATIVEACUMEN, BUT IN THE EVENT OF THE DEATH OF NEARLY 100

PEOPLE DUE TO MALARIA OVER THE PAST ONE MONTHSEVERAL QUESTIONS ARE BEING RAISED ABOUT THESTATE OF AFFAIRS UNDER HIM, SAYS NIRENDRA DEV

Very seldom would governments commit suicidedeliberately although they may do so accidentally. In thecase of the Left Front regime in Tripura, the recenthandling of a malaria epidemic can be a test case of themaxim referred to. The state government has admittedthat at least 67 people, including 55 children, had diedand over 171,200 had fallen ill over the past one month.According to unofficial estimates, at least 120 people havelost their lives. The epicentre of the outbreak lies in Dhalaidistrict, not very far from the border with Bangladesh.Locals say the district has always been highly vulnerableto water- and vector-borne diseases and if the problemhas assumed serious dimension, it raises eyebrows aboutthe efficacy of the Manik Sarkar regime, which has beenreturning to power time and again.

So one question being raised is perhaps there waslack of foresight on the part of the administration and alsoapathy towards the miseries being faced by people, bothtribais and non-tribals. It goes without saying that Tripuraremains the last citadel of the Communist movement,which ironically swears day in and day out about pro-people and pro-poor measures. It is not only that Tripurais firmly in the grip of Leftists, the opposition Congresshas been virtually rendered irrelevant politically In thisstate, low-profile chief minister Manik Sarkar is admiredfor both his personal integrity and administrative acumen.So how does one reconcile to the bitter fact that such amajor calamity was been let loose under his rule?

The answer perhaps lies in Leftist ideology itself.Most often, one has heard about the Communist ideals

of glorifying poverty. As a result, while Marxism hastriumphed in rural Tripura, it is also a fact that in manycentres in the state there is stark poverty. Many villagesin malaria-hit Dhalai district are reeling under extremepoor conditions wherein people do not have electricityor clean drinking water. Thus, malaria is only a clearpossibility. Thanks to convictions about Marxism amonga large section of people, they do not think there shouldbe any complaint about such poor conditions.

As a result, the malady has spread to districts likeGomti, Khowai, North Tripura and South Tripura.According to reports, remote Gandacherra andKanchanpur subdivisions in Dhalai and North Tripuradistricts, respectively are the worst affected. Worse forthe Left regime in the state, many tribais who earn theirlivelihood by practicing shifting cultivation in theKalajhari range in Gandacherra, were among the worstto be affected by the outbreak.

Health department officials said in Agartala thatover 100,000 people had been admitted to the 1,800odd hospitals and dispensaries with fever and stomachailments and more than 15,000 had been confirmed ashaving being smitten by malaria. State health ministerBadal Choudhury also a senior Marxist, has said thatthe government is well prepared to meet the challenge.The administration has pressed into service a chopper,will hold health camps and distribute medicines in ruralareas. In many places, even the Border Security Forcehas been called in to help civil health workers.

But there is more to the issue than meets the eye.For instance, even the security forces deployed in Tripuraare not immune. In fact, old records say that since 2005-06, the highly efficient BSF, which patrols the 856 kmborder that the tiny state shares with Bangladesh, haslost more jawans to malaria than to militancy.

Paying homage to this Great Soul : Mogambo isknown to the entire film world and he is Amrish (LalSingh) Puri, will be ever remembered for his significantcontribution. May his soul rest in PeaceOur commitment : Sir Ronald Ross Memorial Centre& Ross Rabindranath Mission is dedicate to fightagainst malaria mosquito borne diseases to safe guardpublic health.

Prof. (Dr.) Ranen DasguptaEditor

Ross Rabindranath MissionGeneral Secretary

Sir Ronald Ross Memorial Centre, Kolkata


Theres yet another issue that needs closer scrutinyThe Congress had blamed the state health authoritiesof using an anti-malaria drug whose efficacy is beingquestioned now. On 20 July the Tripura PradeshCongress Committee filed a criminal case against threesenior health officials of the health department, blamingthe institution for an increase in the number of deathscaused by malaria. Reportedly a formal FIR has beenregistered in West Agartala police station against SRDebbarma, Director of health services, Sandip NameoMahatme, Director of the National Health Mission, andM. Nagaraju, State Health Secretary.

Predictably, Badal Choudhury denied the charge ofwrong medication and also maintained that the stategovernment was not aware of any anti-malaria medicineused earlier been banned by the Centre. His responsehas, however, been guarded and cautious. The stategovernment says it has not received any communicationfrom the Centre or the Union health and family welfareministry on whether a second generation drug, previously

Indias Health Is Its WealthGrowth of independent India is an amazing story

- empower it by health investmentBill Gates

Today the prime minister will stand at the Red Fortto address the nat ion. For a generat ion, theIndependence Day speech has been about Indiasmind-blowing progress and todays will be no different.

As a frequent visitor to India for more than 30 years,i agree that the countrys future is phenomenally bright.But if there were one thing you could do to make Indiasprospects even more spectacular, it would be to investmore in the health of all Indians.

When i first started coming to India in the 1980s, imarvelled at the amazing growth of the Indian IT sectorand the entrepreneurial spirit that seemed to reigneverywhere. These two factors have been pillars of thecountrys stunning economic growth.

In the past decade, however, ive started to thinkmore broadly about what - in addition to gross domesticproduct - makes for a healthy and productive societyAfter my 30 years at Microsoft, my wife, Melinda, and icreated our foundation, which is devoted to improvingthe health well-being of the poorest people in the world,including the poorest in India.

Through my work at foundation, ive learnedlearned that health for rich and poor alike is the linchpinto the positives changes we want to see in all societies.Heres a striking illustration of that: a recent global

used for malaria, has been banned. It further showed onlya credit seeking bureaucratic approach typical of the Leftiststyle when it said the opposition Congress was free tobring out details about such drugs and if they haddocumentary evidence they could complain to the Centreagainst the state government.

The typical Leftist ego-play comes to the fore aspeoples support for the Marxist-led regime continuesunabated. Even in the recent panchayat polls, the CPM-led Left Front secured an absolute majority in 563 ofthe 591 gram panchayats and all the 35 panchayatsamitis and eight zila parishads. No wonder theapproach revolves around the oft-repeated fallacy: ifpeople have voted for us, we can do no wrong.

True, one has heard about these arguments inWest Bengal in the past and perhaps to an extent thisis being heard even now, although the Leftists werevoted out of power in Bengal in 2012.

The Statesman, 4.8.2014

commission of leading economists found a strongconnection between health and national prosperity. Itsreport stated that about 11% of the economic growth inlow- and middle-in-come countries over the pastgeneration resulted just from reductions in adult mortality.

That remarkable statistic underscores the fact thatthe raw material of a dynamic society is the mentalcapacity and labour productivity of its population. Andthat is tied directly to investments in health.

Despite its growing prosperity India has the highestburden of malnutrition in the world. Malnutrition is anunderlying cause of almost half of all child deaths, and,for those children who survive, leads to cognitiveimpairment that prevents tens of millions of childrenfrom ever reaching their potential.

As the economist Dean Spears has written,Because the problems that prevent children fromgrowing tall also prevent them from growing into healthy,productive, smart adults, height predicts adult economicoutcomes and cognitive achievement".

In short, Indias malnutrition crisis is not just badfor Indias malnourished children; it also limits thecountrys economic progress.

India has shown that in the health arena, it canaccomplish great things when everyone is committed.Your polio eradication effort is one of the mostinnovative large-scale projects of any kind - ive everseen. The government of India deserves internationalacclaim for engineering this success. The countryturned the tide on the HIV epidemic, cutting new


infections by more than half in just a decade andaverting the disaster that many predicted.

The improvement in chi ld mortal i ty is lessrecognised but just as impressive. The number ofchildren under five years of age who die every yearhas gone down by 60% since 1990 and that numberwill keep decreasing even faster as a result of thegovernments decision to introduce new vaccines to itsimmunisation system.

Moreover, India has the schemes in place to driverapid improvements in health. The National Rural HealthMission was created in 2005 and provides a frameworkby which the government can support the health goalsoutlined at the sub-district, district and state levels.

But there is more India can do to advance health.First and foremost, public spending on healthcare inIndia is extremely low - 1.1% of GDP. That comparesto 2.4% in China and 4.9% in Brazil, two other rapidlygrowing countries that are wisely betting on health asa key component of growth.

Second, India can invest in the effectiveness of itshealth system by collecting and using data to driveaccountability and results. Currently, the system doesnot always perform optimally, but investments in

CLEANLINESS: WITHIN US AND OF OUR SURROUNDINGSTushar A. Gandhi

Founder President, Mahatma Gandhi FoundationBapu lay stress on cleanliness. He believed that cleanliness was the responsibility of every individual personally andcollectively. In his Ashrams it was the duty of every individual to not only remain clean themselves but strive for thecleaning of the body, soul, mind and heart as well as their abode and the precincts of the Ashram. But while cleaningones self and the precincts of the Ashram they had to also ensure that they did not leave dirt and garbage outside theAshram. Bapu equated cleanliness with Godliness, I quote him from the book Bapu ke Ashirvad, dated Jan 8th,1946, Bapu wrote When there is both inner and outer cleanliness, it becomes next to godliness.Bapu believed that cleanliness had to be holistic, all encompassing. He believed that a clean and pure soul could notreside in an unclean body, he believed that clean thoughts could not arise in a dirty and corrupt mind and a pure,clean, honest person could not exist in dirty surroundings. He believed that for good deeds to be done or happen therehad to be overall cleanliness. And he believed that it was the responsibility of every individual. For persons to appreciatecleanliness, they must be repulsed by filth and dirt. Those who become insensitive to filth and dirt, whether of theirown making or created by others will never react to the filth or the dirt and will live in its midst without noticing it. Ourcreator has also made us thus that our senses get used to our surroundings very soon. Try this experiment - Find thesmelliest substance, initially one feels revolted and repulsed, sometimes one feels nausea initially but very soon webecome immune to the smell and stop noticing it too. Our sense of smell deals subconsciously with that stench andthen we dont notice it and then we stop noticing it and we stop reacting to it. Since we arent reacting to it anymore wedont feel like doing anything to get rid of it. This is how one also gets used to filthy surroundings. We stop reacting tothem and so we then learn to live with it and dont get bothered by it and hence dont do anything about it.We pride ourselves about how clean we personally are, many a times we scoff at others who are scruffy and donot share our own level of personal cleanliness but look at how we lag behind in communal cleanliness. Whiletravelling on the roads of our cities and towns one notices how garbage is dumped at every opportune place,

monitoring and evaluation can help close the gapbetween whats possible and whats happening now.

Third, India can make changes to help citizens getthe most out of private sector healthcare. In India, thevast majority of medical care is provided by the privatesector, but the sector is insufficiently regulated and thequality of care is often poor.

Fourth and finally India can raise awareness amongits citizens about public health. For instance, poorsanitat ion is a massive cause of disease andmalnutr i t ion. I f more people understood theseconnections, they would be better able to protectthemselves and their families.

The Gates Foundation is committed to supportingIndias progress in health and development. But thedriving force will be the government of India and theIndian people. The government is investing, but notenough. A great way to celebrate Independence Daywould be to spur Indian growth by redoubl inginvestments in health.(The writer is Co-Chair & Trustee, Bill & Melinda GatesFoundation).

The Times of India, KolkataFriday, August 15, 2014


how we litter everywhere without concern, how we spit, blow our nose, pee and defecate in public places. I knowthat our cities and metros lack in civic amenities but we must also realise that as long as we consider commonareas of our cities and towns as not of our concern and litter them, we can never achieve cleanliness. Speakingat a evening Prarthana Sabha during his travels through Bihar, Bapu had once commented about the habit ofcarelessly spitting, if all Indians were to spit all together at the same time, India would drown.Bapu believed that as we were particular about personal hygiene, we had to be responsible about the hygiene ofour neighbourhood, locality, and town or city too. Right from the beginning while in South Africa Bapu took it uponhimself to clean the locality he lived in and did not ever turn a blind eye to filth. He did not like filth or being dirtyand so he took responsibility of both his personal hygiene and for the hygiene of his surroundings and cities. Heperformed his civic duties as a matter of regular practice but when an emergency occurred he was even moreparticular and volunteered to clean the filthiest of areas. When the Plague erupted in the Indian quarters inDurban, initially Bapu rushed to the aid of the afflicted people but to prevent the spread of plague he also workedto clean the quarters. He cleaned the locality cleaned the homes and administered treatment to the patientseven at personal risk of being infected himself. Later on a visit to Rajkot when a simi

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