The Nepal Digest - Oct 27, 1994 (24 Kartik 2051 BkSm)

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The Nepal Digest Thursday 27 Oct 94: Kartik 24 2051 BkSm Volume 32 Issue 8

          Table of Contents not available due to time constraints, apologies.
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  ***************************************************************************** From: Rajpal J. Singh To: The Nepal Digest <nepal@cs.niu.edu> Date: October 27, 1994 Subject: Anybody around California?

Greetings!

I am in a business trip to San Diego California this weekend.

     I will be staying at Wyndham Garden Hotel
                          5975 Lusk Blvd.
                          San Diego, CA 92121

Phone: 619-558-1818

from October 27, Thursday to October 30 Sunday.

I do not have the room number yet. I'm catching the flight in next
couple of hours. I will be busy October 28 Friday all day.

      I will have access to a rental car for the entire weekend and I do not
      mind driving few hours (LA or something) to meet some Nepalis living
      in CA. Any get togethers this weekend?

Please call the number above and ask for my name. I would be very
happy to be in touch with some folks from Nepal.

Have a happy Holloween!!!!!!

********************************************************************** Date: Wed, 26 Oct 1994 11:01:28 -0400 (EDT) From: mahesh maskey <mmaskey@acs.bu.edu> Subject: Re: The Nepal Digest - Oct 24, 1994 (21 Kartik 2051 BkSm) To: The Nepal Digest <NEPAL@cs.niu.edu>

Dear editor,

Thank you very much for sending the latest issue of The Nepal Digest.
>From the news, articles and debates published in the bulletin, one can see
that it has a great potential to become a forum for exchange of ideas and perhaps, collective action too.

I am a Doctoral student in the Infectious disease epidemiology in Boston University. Through your bulletin I could get the public and medical community's reaction to the plague scare. Attached herewith is the editorial of 'The Lancet' and a brief comment from my side which I am sending to Institute of Medicine, Nepal, where I work. I hope some of the information contained in these lines are also helpful to the readers of The Nepal Digest who are in health profession. I will be oblised if you could send this mail to them through your network. I would also appreciate your comments about the editorial of The Lancet.
Wishing you an enterprising time ahead.

sincerly Mahesh Maskey 26 oct.1994

[ "But Plague is more than a biological disease. It is a symptom of a more cruel social disease - poverty. Plague in India or anywhere else may never go away because essentially it is man made. There is no vaccine that will protect against poverty."
- The Lancet (ed.) 15th oct. 1994

The return of the dreaded Plague (Black Death/Mahamari) has brought with it many deep seated issues which the world at large and the medical community in particular, prefer to avoid. The Editorial of prestigious medical journal "The Lancet" has done a commendable job of placing these question squarely to the health professionals and policy makers alike. Plague is caused not only by Yersinia pestis and transmitted by Xenopsylla cheopis
- it is more than that. It is rather a symptom of much more cruel social disease - poverty. So are many of the infectious disease such as Tuberculosis, Typhoid, Cholera, ARI etc. accounting for major share of death toll in the underdeveloped countries. The question is - are we content with treating the symptoms or we are prepared to tackle the real disease ?
The panic of Plague is world wide and in Nepal, it is understandably high. The cases reported so far may just have been the tip of the iceburg of the actual problem. People are doing their best to secure few capsules of tetracyclin to safeguard themselves from plague. The rush for tetracyclin is one example of how little people have faith in the ability of government health system for protecting their health. But even here the irony of inequity is operating. Those who may need tetracyclin most may have no capacity to buy the drug or worse, they may not even know tetracyclin exists and is used for the treatment of Plague. On the other hand no matter how effective in combating plague bacillus, tetracyclin is no panacea for the problem that plague is. Tetracyclins can not treat the garbage heaps of kathmandu nor the filthy conditions of marginalized urban population where rat, and therfore, plague bacilli survive and multiply.

Several other measure are in the air to combat Plague - ranging from rat control to border sealing. Jumping onto closing the border without strengthening its own health system may be more damaging to Nepal than the contrary. Effective monitoring system is a far better alternative but given the spread of border, it can not be accomplished without massive mobilisation of people in plague prevention and control program. Imparting factual conciousness about plague to the people and then forging that popular conciousness into mass action for changing circumstances that breeds plague should be our target. Strenthening isolation ward capacity in the capital and in peripheral hospitals especially in the terai region which may at the same time provide referral support to the front line health posts, updating the knowledge and skills of the health professionals working in the field, maintenance of basic minimum supplies of drug and other equipments are essential steps to prevent the abrupt upsurge of plague in the country. It is also not unlikely that plague may passout without making much trouble for the Nepali population this time. But that would be no excuse for complacency. This is high time we realize that either we brace ourselves up to this seemingly impossible task of overhauling the entire health care delivery system,
of protecting our environment and of eliminating the socio-economic determinants of these infectious disease or be prepared to be condemned to the onslaught of all kind of deadly diseases supposed to be buried in the sands of history. The message is loud and clear - if we care to observe the return of cholera in Russia or schistosomiasis and sexually transmitted disease in China and so on and so forth.
Editorial of The Lancet, though profound and explicit in its content, stops just short of telling us how to treat this social disease poverty. But in these pages, one can surely hear the echos of what Rudolph Virchow had said in 19th century. "Medicine is a social science and Politics is nothing more than medicine in a large scale." Well, if the disease is poverty then arguably, the medicine is politics. But the question remains. When will politics in thought and practice resemble a
'Medicine in the larger scale' and when we, the medical community and the public health practitioners begin to acquire the necessary skills to deal with the disease called poverty?
I have tried to make available the editorial of 'The Lancet' to the email network of Nepalese community in the hope that it may help to clarify many issue regarding the plague scare. Please send your comments to Mahesh Maskey, mmaskey@acs.bu.edu]

PLAGUE IN INDIA: TIME TO FORGET THE SYMPTOM AND TACKLE THE DISEASE

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The Lancet, 15/10/94

Why has an infection affecting some impoverished people in India sounded alarm bell world wide? We know that plague is a disease of the poor--indeed, the poorest of the poor. Until a few years ago you could be rich and get smallpox; you can still be rich and get polio or hepatitis. But when you get plague in the 20 century there is not much further those surviving around you can go without hitting the rock bottom. The chances of being rich and getting plague, India and any where else in the world, are about as remote as the ability of the rat flea to jump from its slum habitat to the distant electronically protected environ ment of the rich the distance between a slum environment and five star comfort is rather more than an inch. The chances of a poor man coughing in the face of a rich man are admittedly, better. But the chances of that cough transmitting the plague bacillus are still negligible.

Now we begin to comprehend the deeper malaise that is plague, the current outbreak in India did not start in the southern state of Kerala, renowned for its system of basic education, literacy , low infant mortality, and move towards a more equal society .It started in the north western area of Beed and spread to the industrial town of Surat notorious for its record of commercial exploitation, fine tuned under British rule, where hundreds of thousands of imported labourers sweat it out daily in such enterprises as cloth mills and gold working. Moreover , plague did not emerge everywhere in Surat. When we finally see spot maps of plague deaths prepared by competent epidemiologists we shall observe that those deaths occurred only among people living in a few clearly demarcated slums.

A little perspective on the size of the plague problem is instructive . Last week(Oct 8, p 972) Prof T Jacob John pointed out that the official figures for plague morbidity and mortality are largely fictitious; he too emphasised the appalling living conditions that gave birth of the epidemic . Yet even if the official figure of 60 confirmed plague deaths is a many fold underestimate the total number of plague related deaths will not amount to a lot for a country with a population of 900 million.. In one small sector of Calcutta, filled with people whose only home is the street, there are 2 or 3 deaths a day from "natural" causes that worry nobody--these causes are mainly starvation and tuberculosis. In a measels epidemic year more children probably die in a month in India than have died of plague during the past two centuries. Yet many health workers in India do not class measles as a serious disease. Cholera kills countless more people each year than plague is ever likely to. And if we compare diarrhea, respiratory disease, and malnutrition as causes of death, plague is a mere speck on the disease threat horizon.

The most obvious responses to the plague epidemic so far has been unthinking panic. A certain amount of national level or Indian state level panic is understandable. But international panic measures, sometimes goaded buy cynical use of the media, are increasingly a euphemism for political and social pressure. Some off the actions directed against both India and Indians are absurd. Before a single case has been confirmed in Calcutta, air links between the city and Bangladesh, Thailand, Pakistan, and all the Gulf States have been severed. Bangladesh has gone further and has sealed off twelve of its border crossings to Indian citizens (Indian rats are unlikely to observe such restrictions. International trading links have been disrupted; thousands of tourists have cancelled their visits; and the Bombay stock exchange share index has experienced the unwelcome sensation free fall.

At the individual as opposed to national level social pressures have been equally powerful and the results equally, if not more catastrophic. Thousands of people fled their workplace . Returning home without means of support, many have been bared from entering their family neighbourhoods and have been forcibly taken for testing in infectious disease hospitals. Virtually all such tests have proved negative. There is, of course, no ready way of diagnosing plague until the disease process is well advanced, but the simplest screening method would be to ask whether the opportunity for disease transmission had occurred. Had the plague suspect been in the right place at the right time, or, more realistically in the wrong place at the wrong time? That fundamental question has not always been considered, with resultant panic and social pressures again. In the eastern state of Orissa, one man is reported to have got himself admitted by faking plague symptoms so that he could obtain tetracycline to sell on the market in exchange for food. A couple and their daughter were murdered by a villager after they were suspected of carrying plague. The point of these stories is not whether they are accurate accounts but that they are printed in newspapers and people believe they are true --yet more fuel for the atmosphere of panic.

What should be done? We should acknowledge that India already has taken measures to control the epidemic of plague. Unfortunately, these measures have been inadequate epidemiologically ; worse, they have been enforced with variable degrees of rigour largely through indecisiveness. Thus the passengers arriving from the Surat were not monitored for at least 3 days after the epidemic was confirmed; isolation wards were not immediately set up in major hospitals; and the Delhi government reopened schools less than 72 hours after having ordered them closed .

One problem is that health care is the concern of individual states and the huge populations involved are in different parts of a vast country. Bureaucratic delays and lack of directions have proved damaging. In particular, the machinery of public health has been shown to be weakest precisely where it is needed most--in the overcrowded and garbage strewn urban slums. Nevertheless, medical teams have been established in Surat , rodent control and counts of dead rats have been started in plague affected areas, attempts areas attempts have been made to monitor populations returning to their homes across India, and central government has provided reserve stocks of antibiotics to some states where suspected cases of plague have been reported. After a few deaths in the capital, New Delhi, control measures to reduce chances for spread of pneumonic type of infection have also been taken.

Second, it is now obvious that such internal measures in themselves are not enough to subdue the momentum of international suspicion against India. The plague epidemic may subside, but not before lasting damage has been inflicted on India and its economy. One way for India to protect its own interests is to encourage international collaboration in controlling the plague outbreak. The World Health Organization has already reported on the overall situation of the epidemic (the Director-General himself has visited ) and has made specific recommendations. The government of India should also consider the advantages in terms of international opinions of accepting the offer from the centers for Disease Control and Prevention, Atlanta to send a team of independent and experienced epidemiologists. Standard epidemiological techniques --definitions of the size and locations of the problem, surveillance and case -reporting, rat-fall counts isolation and treatment of cases and intensified efforts to clear up the rat infested environment at the foci of infection need not only to be implemented but also to be seen by the global community to be implemented. There are precedents. Smallpox was eradicated from India, and subsequently the world by a concerted international public health effort. In public health the effectiveness of an intervention is often inseparable from its credibility. It took over 170 years after the discovery of a vaccine to eradicate smallpox from the face of the earth, largely because enough people did not find the idea of eradication credible.

But plague is more than a biological disease. It is a symptom of a more cruel social disease --poverty. Plague in India or anywhere else may never go away because essentially it is man made. There is no vaccine that will protect against poverty.

The real reason why and outbreak of plague affecting a few poor people in India can cause such wide spread reaction has nothing to do with the threat of plague infection. The stark fact is that the poor are for once being seen as what they are-- a direct threat to the rich. In India it has been said that poor have finally taken their revenge in the only way they know, by dying. Is it chance, or mere nemesis, that this revenge is taking place at a time when India, indeed the whole planet, is moving toward a "free market" economy that benefits some but not all. The epidemic of plague has meant that instead of being marginalized in their socially distant slums, the existence of the poor has abruptly impinged on the consciousness of the rich . Internationally, the same process of awareness, followed by attempted denial of an unpleasant reality, has been at work. Hence the unspoken(and unspeakable) justification for cutting links with India.

What should be done. And this time for plague as a manifestation of underlying social disease. Is it too much to ask for slums on the scale of Calcutta or Bombay, where 60% of the population live in such squalid surroundings, to disappear? How can Health for All be achieved by the year 2000 if they continue to exist? We could call in the World Bank and the International Monetary Fund to clear up the mess we have made, or perhaps we could do something ourselves. We should do all these things.

Meanwhile the streets of Calcutta continue to be obstructed with foul garbage. In the streets crows peck aggressively at the dead bodies of large rats. For the festival of Durga Puja, statues of the fortune bringing elephant god, Ganesh, are being prepared along with his semi-divine vehicle--a rat.

The Lancet.

********************************************************************** From: 6500khem@ucsbuxa.ucsb.edu (Khem K. Dahal) Date: Wed, 26 Oct 1994 13:13:02 -0700 (PDT) Subject: Acknowedgement To: Nepal@cs.niu.edu

Dear TND: Namaskar,

Thank you very much for the current copy of Nepal Digest. It is interesting and impressive. Congratulations for accomplishing such a good job. Iwill be sending some materials in the future to include in this Digest. I hope to continue to receive future editions of Nepal Digest. I wish a Happy TIHAR to all the editorial staff of Nepal Digest. Khem Dahal

Tel.(805) 562 5469 (Res.)

********************************************************************** Date: 26 Oct 94 18:31:41 EDT From: Rajendra.P.Shrestha@Dartmouth.EDU (Rajendra P. Shrestha) Subject: KURA_KANI To: nepal@cs.niu.edu

This is a comment on Pramod's article by Hridaya Bahracharya.

--- Forwarded Message from "Hridaya Bajracharya"
<hridaya_bajracharya@sec.educ.ualberta.ca> ---

Subject: Time:13:51
OFFICE MEMO KURA_KANI Date:10/26/94

Subject: Women in Hinduism I am glad that Pramod's recent articles are drawing attention of many readers, some disgusted and some feeling pain, some with concerns for new alternatives and some with hope. His disection of the hindu society is certainly successful. I metaphorically compared his disection to that of disecting a cancerous growth: The disgusting schists, the liquidous "peep", and the fowl smell emanating from the disection seemed offending many casual onlookers (readers) anaware that those are the things that hinduism will be forced to live without such disection. The hopefuls were those who really loved hinduism minus the cancerous schists. If one love someone who has such cancer what should he/she do? Cooperate with the persons who diagnose and disect or blame them for the fowl smell and the disgusting schists? I think the major issue here is the hypocrisy. If someone is ignorant enough to think that the bulging issue of woman is an integral part of "hinduism" endowed by "Brahma" I will respect his/her perspective without agreeing and try to influence with my own idea. However, if someone is aware of the issue as a cancerous development and yet deny the diagnosis and the need for disection (that is only known remedy for the time being) I would say that person is hypocrite who deserve a life with that sort of cancer. Let me give two down to earth experiences of hypocritic instances with my friends regarding the issues of women in Nepali Hindu context. One instance: a friend of mine, who came from hills and was a successful graduate, settled in the valley as a university lecturer. His parents were still in the hills, and he had left his wife and siblings in the hills with the parents to look after the parents. Naturally he was feeling lonely in the valley. In our friendly talk I suggested why don't you bring your family here? I was apalled by his answer. He was saying that his parents cannot live with him in his new found place for they are orthodox Brahmins, besides they had the village property to look after. They needed someone who would to take care, whou would better take care of them than his wife? Nevertheless, his village wife would not be suitable for the type of life he is living in the valley. This friend of mine got married with another woman and enjoyed the double life -- a family in the hill and the other in the city. No regrets! Do any body wonder, if a hindu parent so willingly provided a daughter to become second wife to this professor? I think the law should have acted but where would it be possible for the law to act? Particularly for people like this gentleman who didn't have a standing society in the valley, and therefore no need to be morally accountable, there was not much hassel in becoming a hypocrite. Among the other friends like us he could even pose as a brave with words like: Those who can do it do it those who only comment are
"unmanly"! The second instance was almost murderous drowning of my conscience: another friend of mine with whom I shared this issue said well that is our reality. He questioned me: "What would you do if you were in his position?" and informed me that he himself was looking for some one to marry, an educated one and from decent family to match his own standing. For his liberal standing he was not concerned about the caste, any "clean caste" would do. And he was urgent too since his youngr brother had joined him to study in the valley. And his parents were telling him to marry soon. Some other friends were told by the parent to help him too. Mind you, this friend from another orthodox brhamin family like the previous one was married when quite young and had left his wife to live with the parents (though not very far from the valley). And he had children. I felt hypocrite for not fighting against the "injustice" created in my conscience. But I reconciled. Who knows, the wives being brought up in the local value and belief system are not also seeking their husband to supplement with other ones, better suited to their new positions, so that they could feel fulfilled that someone would be looking after the "swamis' needs" ? I think the war on such situation cannot be at the personal level, both my friends are as friendly as I could imagine and otherwise as humane in our social context as normally one would expect for friendship or social co-existence. There is a need for a bigger mobilization, one that challenges the social norms, values, and beliefs. One that will sweep our society from rotting in the stagnating corner to make it bolder to venture for critically evaluating its own situation and to constantly situate with the emerging conscience. Once again I congratulate Pramodji for taking the bold step of making the problems explicit in this email world. I hope his contribution will also prevail outside this email world. I look forward to reading more of the issues and comments. And I pity on those who are getting impatient with such an important issue that affect directly almost half the population of South Asia including Nepal, and indirectly the whole of the population. I think Pramod's concerns extends beyond our realm to also embody the concerns of the emerging humanity all over the world. Namaste to all readers. Hridaya

******************************************************************** Date: Wed, 26 Oct 1994 20:44:54 EDT To: The Nepal digest Editor <nepal-request@cs.niu.edu> From: "Pramod K. Mishra" <pkm@acpub.duke.edu> Subject: Western Perspective on Hindu Women?

Dear Editor,

The following is part of a reply I wrote to a letter written to me about my possible Western bias and upbringing. If you find it timely and of interest, please post it.
_________________________________________________________________________

I must say that my aim in writing these letters is to provoke people to think in new ways and entertain better, more liberating, possibilites, that can bring about happiness to both men and women in a changing society and culture. By expressing my ideas I hope I'm helping the long-term interest of Nepali culture and society (wherever they exist), and, of course, that means ultimately the Nepal as a nation itself.

I was not brought up in the West, but I have certainly been deeply influenced by some of the Western ideas. In fact, I was born and brought up (my only home still stands) in a village in eastern Nepal, where we still don't have either 'phone or electricity or paved road. We have to walk over three hours to get to a paved road to catch a bus to get to Biratnagar, my district town. So even though the "frame of reference" of my thoughts can be said "Western," I definitely do not "adore" everything Western. One would have to be blind to do that. But then I ask myself what is Western?

"West" means so many things to so many people. It can mean racism, fascism, sexism, homophobia, Nazism, capitalism, Marxism, anarchism, democracy, liberalism, colonialism, slavery, extermination of the Native Americans, atrocities against the African-Americans, feminism, self-questioning, self-criticism, and so on. The West has its own ugly underbelly, and there are people in the West (both in the United States and elsewhere) who have been exposing this ugly side of the West. So everything about the West is not all milk. And the same can be said about Nepal or any culture. The important thing for me is to understand the nature of the society I'm concerned with and think about it in ways that can make it better and happier and give every individual opportunity to realize full human potential.

So I'm for positive things in every culture. The reason I'm not talking about the positive aspects of Nepali culture is twofold: 1. self-praise exhibits smugness and promotes self-complecency (and if you do it too much you reach the state of the emperor's new clothes, as I think Nepal has reached); 2. there are travel angenceis all over Kathmandu and the official media that indulge in self-praise more than anyone can ever come up with. My upbringing, otherwise, is typically "Eastern"--whatever that means. My father is a practicing pandit, Hindu priest, who quotes Sanskrit left and right whenever and wherever he can; and, as you have perhaps noticed in some of the pieces, I have contracted his bad habit. I studied Sanskrit in college and did pretty good, as my certificate indicates. But I not only memorized those Sanskrit books and their noun forms and verb forms but tried to understand them, as much as I could, critically with whatever resources I had at the time. There were of course numerous questions that I couldn't answer on my own, and in this respect the progressive ideas of the West have certainly helped me understand those questions better.

I'm certainly a man, as you've rightly identified me, perhaps, from my name. But as a man, I was without doubt born of a woman; and have gained great happiness from the company of women in various roles--from mother to daughter. But I have also seen them suffer, inhumanly suffer, and I'm not going to let that suffering go in vain. My life would have been much happier if women in Hinduism were freer, more able to understand the nature of their imprisonment and men were able to understand the full humanity of women. So in a vital way, it is in my own interest that I'm writing what I'm writing.

When I talk about women in Hinduism, that means women everywhere, town and village, India and Nepal, and, as you've mentioned, even in the United States. The reason I mention India only in passing is that the condition of women in India is worse, and at this time I'm not concerned with India. What happens to a woman in a village in Nepal is not much different in kind from what happens to a woman in, say, Kathmandu. The difference is only of degrees. I have lived in Kathmandu for quite a number of years, and I can attest to that.

Very often one may have to fight injustice; that's fine. But first the intellectual understanding of the problem is important. Otherwise we would grope with wrong solutions and yet not solve the problems. It's the women themselves who have to be intellectually strong and understand the nature of women's problem and fight the injustice. People like me, as men, can only help and join the struggle. It's the women who have to be on the forefront of the movement.

So you see even if you came to the United States at young age, that fact is not at all a liability or a problem. On the contrary, you are in a better position to help those who don't have the resources nor the intellectual training to help themselves. It all depends on whether one chooses to identify and empathise with others. In this respect, you are right when you say that you identify with women, whether in the towns or the villages in Nepal, "not much and very much at the same time."

I'm glad that you wrote and are concerned with these issues. If all the Nepali men and women show concern like this, things will certainly change and life for both men and women will be better. But that's a long way away, and we must work to make that happen.

Sincerely, Pramod

********************************************************************** Date: Thu, 27 Oct 1994 05:12:04 -0400 (EDT) From: RA3371@ALBNYVMS.BITNET Subject: Kura-Kani To: nepal@cs.niu.edu

The Nepal Digest publication through e-mail is such a good idea and has a very bright future. I would like to see this expand and have as many members as possible. The Nepal Digest could form a link with all other Nepelese, not only in the U.S. but also U.K., Japan, Korea , Malasia etc. This method of publication is a lot more efficient than print media. As access to computer are getting cheaper, I would think that
a lot more people would be able to communicate through this. It would also be a lot cheaper. I would thus advocate all Nepal Digest people to be the salesperson for this electronic magazine and thereby enhance the number of members. Each person could give the E-mail of friends to the editor. I am sure there are lots of Nepalese who do not know about ND. I myself did not until very recently. So please make sure you do this. We can all work towards a better means of communication amoung ourselves.

Date: Thu, 27 Oct 94 13:42:37 EDT From: Nirmal Niroula <NNIRO00@UKCC.uky.edu> Subject: Re: The Nepal Digest - Oct 20, 1994 (17 Kartik 2051 BkSm) To: nirmal <NEPAL@cs.niu.edu>

yes, i knew the existence of this paper.. but they have not sent it to me yet d espite repeated requests. About cooperatives, I personally have no idea, but th ere is a fellow in Akron Ohio, doing his degree course, who might be familiar
with this. His name is Surendra Adhikari and he is an economist.. so he should
know something about cooperatives. His e-mail address is SBA@AKRONU. Good luc k.

************************************************************** Date: Thu, 27 Oct 1994 14:33:17 EDT From: pramod@UFCC.UFL.EDU To: Nepal@cs.niu.edu Subject: overfed

Aren't you people tired of this "Women in Hinduism" stuff? Come on give us some break, even women in hinduism get some break(during monthly period). It seems to me that Mr. Mishra is writing his thesis in The Nepal Digest, can i do it too? mine will be on "groundwater remediation".

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