India 2020 Part 16

The scramjet engine will give energy of 3000sec. Compare this with 50sec of cry engines! This is not only for military application. These supersonic combustion engines have application for cruise missiles, launch vehicles and hyper planes of the future.

India's proposed scramjet is designed for operating up to Mach 12. In the long term it could become part and parcel of our jet aircraft too. Currently, only a few countries are working in this area. Based on our experience with LCA and GSLV, India should at least take initiative in the elements of the hyper plane programmed so that India's hyper plane and future Aeros.p.a.ce vehicles can be built around this power plant. The Hyper plane can deliver a payload of above 30 tons for a takeoff Weight of 250 tons, giving a quantum jump for the existing payload / take off ratios of max 3 per cent to 15 per cent through ma.s.s addition.

A future hyper plane mission can have an integrated power plant complex working in three modes. Fan ramjet engine mode in low alt.i.tude, low speed flight regimes. Scramjet engine mode in March number range 3 to 12 along with airliquification and ma.s.s addition. Rocket engine mode till payload launching. In the critical technology areas of scramjet engine, our aeros.p.a.ce scientists start with the design, development and integration of fixed geometry air intakes for a wide mach number range supported extensively by a.n.a.lytical tools like Computational Fluid Dynamics (CFD) and experimental set up like hypersonic wind tunnel. The combustor development including the material, fabrication technology and combustion kinetics has just begun. Test and evaluation facilities are to be planned for prototype and full scale engine testing.

By 2010, commercial jet aircraft, military fighters reusable satellite launch vehicle and the reusable terrestrial payload delivery vehicle will have one common feature, that is, the usage of supersonic combustion engines for flying in hypersonic flight regimes.

The real proliferates Recently I addressed diplomats in Delhi on the subject of nuclear proliferation. I offer an extract: 'during my tenure in Delhi, I made a study of the proliferation doctrine initiated by the five nations. The USA for the last four decades, unto 1990, 194.

acc.u.mulated about 10,000 nuclear warheads and almost an equal number was acc.u.mulated by the erstwhile Soviet Union. And this cruel fanaticism was justified in the name of ideology of Capitalism versus communism! The seeds of nuclear proliferation were thus sown. These two nations used nuclear weapons as a tool to subordinate or influence many national politics by giving socalled nuclear technology for peaceful application or nuclear power stations. For china, nuclear weapon technology was given by the Soviet Union and we have witnessed recently that the same developed countries have ensured that Pakistan will have a certain number of nuclear weapons. A former prime minister of Pakistan has reported this.

The five weapon countries proclaimed that they were the nations solely approved to possess nuclear weapons. They evolved certain international policies. The total number of warheads they possessed was so many that they created Safety and security problems of tremendous magnitude for the world. These two nations driven by the people negotiated START ii (Strategic Arms Reduction Treaty). They signed a treaty for reducing the warheads, including the delivery carriers to 3000.when I asked Dr William Perry, US secretary for defense, during his visit to India, why 3000 and not zero as Pundit Jawaharlal Nehru had put forth the concept of complete nuclear weapons is a dream. He meant that the nuclear weapons should always be with the club of five and be a dream for Others. We can a.s.sume that at no time will the nations come to zero level of nuclear weapons. Nuclear weapons are a strong component of the global strategy they visualize. For them they are weapons of political strength and by propagating a non proliferation doctrine they claim to generate peace. It was a delightful privilege for DAE and DRDO teams. Backed up by the political leaders.h.i.+p, to break this dangerous and self centered monopoly of nuclear weapon states.

Similarly, in the area of chemical or biological weapons or missile systems, the origin of their proliferation is the same. If one opens the Pandora's box of proliferation, one would see USA and the former Soviet Union, with the recent addition of China. If there could be an impartial world body, not driven by the superpowers, the developing countries affected by this dangerous proliferation can seek justice and compensation, Can we dream for such a new and just world?

195.

Strategic industriesthe future of India We are able to provide only a glimpse of a few important elements of strategic industries to be developed in India. The once described are well within our reachtechnologically, investment wise and schedule wise. If industries and inst.i.tutions, work together with clear vision and goals in mind and with a.s.siduous buildup of markets right from the word go, Indian industries can reap rich commercial benefits. Also let us not forget the fact that a strategic technology or industry today, will have daytoday applications in many walks of life two decades hence. Therefore, it is our duty to build the necessary technologies today so that the future generation of Indians will have new worlds to conquer and not have to struggle with the problems of 'bridging the past gaps' as we are doing today! We owe it to the future generations that we hand them over by 2020 only the excitement and challengers of the future and nit the weight of problems of the past or the crises of the present. Only then will India have truly arrived as a developed country populated with proud people confident of their future.

196.

Chapter 10.

Health Care for all Don't give a place to disease.

Auvaiyyar, Tamil saintpoetess Former Prime Minister I.K. Goral, in his address to the 1998Science Congress at Hydria, made a revealing remark on the state of our basic amenities. 'I see before me the bottled water water kept for the dignitaries on the dais. It reminds me of three cla.s.ses of Indians: one who can afford bottled water others who manage to get some water in their taps or in a near by tap or a pump irrespective of its quality or regularity of supply the third set of Indians are those for whom drinking water is a daily problem and who will be ready to drink any polluted water'. For such a situation to persist after fifty years of independence was a national shame, he added. Unfortunately, if we do not do enough on this front, and the Related one of health care, ten years down the road we might still be saying the same thing. In the ultimate a.n.a.lysis, any society will be judged by its ability to provide universal health care for its people. This does not merely entail the ability to treat diseases and aliments but also to prevent their onset by means of suitable systems and measures. We are aware that not all diseases are entirely, or diabetes. We do not have cures for many genetic disorders. Permanent cures may not be possible even fir many allergies and respiratory problems such as asthma. However, through regular medication and precautionary measures, most patients can lead normal lives.

Disease prevention Most communicable diseases, however, can be prevented by Suitable sanitation systems, control of diseasespreading materials (such as foul water) or vectors (like mosquitoes), and by immunization programmers carried out on a large scale. Paying adequate attention to nutrition and dietary supplements can control a number of diseases.

For example, the use of iodized salt can prevent goiter, which is rampant in many parts of the country. The intake of vitamin A can prevent blindness. Globally, 25 percent of blind and visually handicapped persons are in India! And, of course, among people who can 197.

afford it, a balanced food intake and physical exercise can help prevent several forms of heart disease.

The rich at least have access to information about healthrelated issues in many ways: through journals and magazines, discussions with others and visits to doctors and medical specialists. That is not the case with many lowerincome groups and poorer people. There is a total absence of health education among these sections. And even if they want to, many of them cannot afford a visit to a doctor, or afford regular medication when it is urgently required. More often than not, they end up relying on quacks. Barring a small percentage, most primary health care (PHC) centers do not provide any tangible health care to people. There are many reasons for this: irregular and limited supply of medicines, not enough doctors or paramedical staff, callous and apathetic medical staff, the leverage of influential local individuals, the excessively bureaucratic operation of the system. Despite all this it is creditable that the death rate in India has come down to 9 (per thousand) in 1995 as compared to 14.9 in 1971.

Sanitation Proper drainage of dirty water, disposal of garbage, sewage and human and industrial wastes are crucial for a clean microenvironment, which is a prerequisite for preventive health care. We have simply to visit the slums of Mumbai or Delhi to witness the urgency of such measures. Even in rural India, most women have to wait until it is dark they can relieve themselves in the open. The filth in these places renders them rife with diseases.

My coauthor Y.S. Raja narrates his experience with a Department of Science and Technology project at Mumbai for setting up a big plant for garbage processing and installation of simple latrines in slums. The latrines had about ten modules built around a central pillar. To decide on their location, Raja visited many slums in Mumbai. An incredible amount of putrid water collected and stood for days around the huts even when it was not raining. Added to this dirty water and excreta were various other forms of garbage thrown out by the slum dwellers. How could they and their children be healthy and free from diseases? Above all, what could be expected of their att.i.tude towards keeping general public conveniences like latrines clean? Many poverty removal schemes are not applicable to the Mumbai slums because the earnings of the people who live there are above the poverty line! They may earn more than they would back in the village.

198.

They have better clothes and more food. But the appalling sanitary conditions negate all other aspects of progress. A similar situation exists in most big cities. The response of elite Indians is to remove the slums from view and send the occupants many kilometers away. Or simply to ignore them by building high walls to block these dirty areas from sight!

Drinking water A recent event demonstrated how technology could a.s.sist in meeting drinking water needs. One of the DRDO laboratories at Jodhpur has developed an electro hydrolysis or desalination process that is used to convert salty brackish water. A similar situation prevails in several districts of Tamil Nadir and Gujarat. The Department of rural Development (DRD) and the government of rajas than promoted the technology development by DRDO labs. Two desalination plants of 20000 and 40000 liters respectively have been installed and production has commenced. More than 100 villages now have potable water. I found the desalination plants. This example is replicable in many parts of the country.

Health for all Better sanitary conditions and an improved microenvironment in the habitat or workplace are the most important requirements for health. In the coming years we also need to pay attention to the working conditions within factories as well as open workplaces, be they coalmines, quarries or roads. Removing health hazards to which our people are exposed is a crucial national mission. It is not enough to consider 'global quality levels' of living or working places only for the well todo. Ordinary Indians too deserve and have a right to live and to work in a good environment.

After a good and clean environment comes the need for better nutrition, with necessary food supplements. Preventive healthcare systemsinoculation, vaccination, immunization, periodic health checks and medical treatment are the next steps. These should be made available and affordable to all Indians. Employers, central, state and local governments should bear the responsibility to a.s.sure people of this health security cover.

But how is this to be implemented? It is true that public health services are under severe strain. There is also a tendency towards the commercialization of medical services, which by itself is not bad if there are countervailing insurance or social security covers 199.

that make them affordable for most. Nevertheless, there are also a number of bright spots.

Many medical professionals, who run expensive medical care systems to cater to the needs and fancies of the Affluent, also subsidize the weaker sections by providing them with good services. The authors have seen such philanthropy being practiced at the L.V.

Pa.r.s.ed Eye inst.i.tute while those who register themselves under the category 'not affordable' receive free treatment. Some of these private initiatives are very efficient and humane. There are also many NGOs and a number of local initiatives that work well.

Even the doctors and the staff in many governmentrun medical centers have a number of good ideas to make the existing systems functional and service oriented. There are also a number of systems using alternative and holistic medicine, which are promoted by well trained specialists some of these can bring down the costs of running the general health care system. Given all this, we do not believe that India cannot take up the challenge of 'health for all'. We can make the systems work we can change them to help people, despite the growth of the population and multiple challenges in the task of removing poverty and accelerating economic growth.

It is with firm and considered belief that we describe some facts about the projected scenario of diseases and disabilities and describes how to combat the problems.

Towards the vision: the two Indies Soon we will have one billion Indians. A few tens of millions of them have lifestyles equivalent to or even more luxurious than the upper strata of the developed world. They enjoy the facilities offered by modern technologies, and simultaneously enjoy the benefits of cheap labor. Another 200 to 300 million Indians, the socalled middle cla.s.s, have a varied lifestyle, often aspiring to copy the developed world but having only limited resources. They face the stress of modern life but often do not have the facilities for good living. The rest of the population is engaged in jobs, which leave it confronted with constant insecurity about making ends meet. This majority does not have economic surplus and has just enough for covering its bare necessities. Investment in health care is an impossible luxury.

A TIFAC survey of the future scenario of Indian epidemiology as perceived by medical pract.i.tioners reflects this reality. India world have the diseases of the developing 200.

worldmany communicable and infectious diseasesas well as the diseases of the developed world!

Among the infectious, maternal, prenatal and nutritional diseases, tuberculosis (TB) is perceived as the one requiring top priority in the short term till the turn of the century followed by AIDS, vectorborne diseases, and diarrhea. Then come nutritional diseases, hepat.i.tis, diseases related to pregnancy and childbirth, diseases preventable by vaccination, acute respiratory infections, prenatal disorders, leprosy and s.e.xually transmitted diseases.

Experts also indicate that the application of new developments in technologies could substantially reduce the incidence of these diseases by the year 2020. Even by 2010, we can substantially reduce the 'diseases of the developing country', except for AIDS, provided we act immediately.

Noncommunicable diseases such as alchemic heart diseases, strokes and female cancers are perceived to be of major concern in the short run, while these are likely to decline considerably by 2020. The decline is expected to be much faster for female cancers, which is particularly good news for a country, which still has an adverse s.e.x ratio for females. However, experts also envisage in suicides and homicides, as also psychiatric disorders and accidents, making these areas of high priority.

Even as India world struggle to eradicate the diseases born of poor living conditions and poverty, some of the stress typical of modern developed countries is expected to increase. Is this something, which can be prevented by reorienting ourselves as we make progress? Can some elements of our cultural heritage and simple living be retained to prevent or avoid some of this stress? Or, as some cynics would say, is it that our simple living and emphasis on values is only a manifestation of our poverty Rather than an affirmation of a fundamental conviction in austerity?

Immediate steps for the new vision One thing is definitely clearhalting the spread of TB, AIDS, diarrhea, etc. must become a priority. Our vision should be to eradicate, before or by 2020, the infectious, maternal, prenatal and nutritional diseases. The action plan can be simple and effective. Let us look at some examples.

201.

Experts opine that the information on TB mortality is quite sketchy despite the considerable number of epidemiological studies on the diseases. There is an immense need to develop a reliable TB database.

At present, polyvalent BCG vaccine, which is vulnerable to interference caused by nontuberculosis, must become a priority. Monoclonal BCG vaccination and the identification of specific clones for development of more efficient vaccines are some of the preventive technologies that have been identified. Guidelines for identifying highrisk individuals and protocols for chemoprophylaxis also need to be developed. Health education programmers need to be undertaken for specific target groups. Many NGOs and youth organization can be fruitfully utilized to fulfill major lifesaving missions. The television and film media could also be tapped to spread the message, and there could be corporate sponsors.h.i.+p for such programmers. In the awareness campaign, let us also invoke some of the fears raised by the recent 'sutra plague'. Let us make all Indians aware that TB is not a disease confined to the lower cla.s.ses. TB is diagnosed by screening for specific symptoms of the disease and by sputum microscopy for acidfast bacillus. Culture facilities facilitating detection of the disease are available only at specialized inst.i.tutions. The diagnostic tools of endoscopies and bronchography are available only in tertiary hospitals. Rifamycin, the mainstay in shortcourse chemotherapy, is produced indigenously but is quite expensive. Some of the future technological requirements for TB diagnosis and treatment are R&D investment for developing Elisa Kits and costeffective process technology for producing Rifamycin, immunoa.s.say of mycobacterium antigens, watersoluble dyes for bronchoscope and bronchography.

Similarly AIDS, another major killer, would need to be tackled frontally.

Fortunately, there is a much greater awareness campaign for AIDS than for TB. To date, a vaccine to prevent HIV infection has not been found, though clinical trials have started.

AZT is the only drug currently in use to inhabit the replication of HIV. It inhibits the enzyme reverse transcripts and thereby the viral genome. However, viral mutations lead to drug resistance within twelve to eighteen months. This occurs when AZT is used in combination with other drugs. The option available for India to contain the AIDS epidemic lies in preventive measures such as the identification of highrisk individuals 202.

through screening, screening blood used in blood transfusion, community awareness about the disease, and so on. We also need to focus on research to produce indigenous drugs based on traditional medicine. Gastrointestinal disorders are responsible for more than Onetenth of the disease burden in India. Much of it can be Tackled by providing sanitary living conditions and good, clean Drinking water to all Indians. In addition, we need to concentrate on finding simple, safe and inexpensive methods of diagnosis.

The search for such inexpensive diagnostic tools and vaccines is combined with other challenges. One is straightforward: the protection of intellectual property rights (IPR). If somebody or some company has already invented a new drug and patented it in India, permission has to be obtained from the party concerned before it can be used. The party may charge heavily for IPR, upsetting our cost calculations. Or a new drug not covered by such patents would have to be discovered this may not always be easy, as research and its Qualifications through various regulatory tests takes considerable time.

There could also be unforeseen challenges. When a smaller company manages to invent and to produce an important Vaccine, a bigger company selling vaccines may try to use Understand means to prevent its rival company from establis.h.i.+ng itself on the market. So genuine companies trying to provide Inexpensive vaccines and medicines may have problems in overcoming such illegal immoral 'compet.i.tive' practices.

This brings us to another important area. Most vaccines would require good delivery and storage mechanisms. They lose their effectiveness or potency when not stored at particular, often low, temperatures. So as with milk or fruit, we need good refrigerator or chilling systems to enable the vaccines to reach Villages. Also, how do we ensure that the vaccines have indeed been Stored at proper temperatures through various phases of Handling, from the factory in which they are manufactured unto the point of the consumer? Here too there are Technologies to help us keep control. There are thermal sensitive Paints, which can change color a strip of such paint can be put on the medicine or vaccine cover. If the instructions Regarding the exact temperature and permissible time without Refrigeration are violated, the color will be change irreversibly.

Fortunately, in India there are groups working on vaccines and irreversible thermal sensitive paints. But when it comes to Stable and reliable electric power supply to the 203.

rural areas and Towns, enabling the operation of good chilling systems in the Rural areas, one is a.s.sailed by doubts.

A reliable refrigeration system presumes a stable supply of electric power. Electric power is a vital component for operating most machines. The entire electronics industry depends on it through moderndays system consume less and less electric power for greater performance. It is time we as a nation learn to appreciate the importance of electric power for industry. The power crisis in the power sector cannot be allowed to Continue. In our march towards becoming a developed country, we need to drastically transform our electric power operations. It is not merely for agriculture or industry, but for the very health of our people. What this suggests is the importance of interlink ages.

In the past few decades, many government departments, agencies and individuals have began to function autonomously. The concept of selfreliance should be for the country as a whole, not for departments, agencies or individuals alone! But in India, many of the agencies do not see beyond their allocated areas. Someone concentrate on the purchase of a vaccine another on development another 'deals with' distribution without trying to understand the special character of the item to be distributed. There is enough ' paper work' to protect everybody. 'I have done my task' the representative of any department might say. Of course there are also problems in such a system for those initiative. On the pretext of Coordination many irrelevant questions are raised and often months pa.s.s before a decision is taken. We have heard many sincere people telling us that they have sent detailed proposals with specific linkages spelt out to the department concerned in Delhi or the state capital. Often Delhi has something to say even the proposals are sent to the state capital. It may take three to six years for the proposals to be cleared often the Clearance comes after the subject matter has become partially or fully obsolete.

If we want to achieve a developed India, we have to learn to get out of this pitiable state of inaction. If laws, rules and procedures have to be changed, this should be done.

The rate at which technologies offer new solutions and new windows of opportunity is fortunately very high in the current phase of human development. We can make up the lost time and missed opportunities, provided we learn to move fast. Such opportunities 204.

are not waiting around for us. Others grab them. We need to think holistically and innovatively, and not in our closed compartments. And above all, we need to learn to act Fast and protect those who make genuine mistakes. Failure is a part of any venture! The authors can cite from their experience of three missionoriented organizations: the department of Atomic energy, the Indian s.p.a.ce research organization and The Defense research & development organization, which have projectoriented management for time bound achievements in high technology, and also their societal application. Defense Lasers can be used surgically to treat glaucoma or cataract. Atomic energy is used for irradiating, for example, groundnut seeds for higher productivity and s.p.a.ce research has led to an accurate prediction of the onset of the monsoon. The unique characteristic of all these three departments is that their scientists are not afraid of taking decisions and above all are not afraid of failures. But they have indeed succeeded, thanks to visionaries Like Dr Homi Bhabha, Prof Vikram Sarabhai, Prof Satish Dhawan and Dr Nag Chaudhri For example, satellite remote sensing offers a medium to Map out areas where mosquitoes breed or such areas from which other diseases can spread. There have been a few successful experiments over limited areas. We have our remote sensing satellite whose data is being sold commercially worldwide. We have many experts in remote sensing applications! Many entrepreneurial scientists and technologists have started small companies and provide services even to foreign clients. Why don't we deploy these talents to benefit the country as a whole, in the big battle ahead to combat diseases? We are aware that satellite mapping alone cannot solve all problems. It can monitor, and present a quick picture and help us to develop micro plans. Similarly, there are other tools. Also there may be several source of local knowledge available with our tribal communities or village elders about the control of vectors. Why not deploy this after a quick study? DRDO had an interesting experience in the northeastern state Of a.s.sam, where the organization has a Defense Research Laboratory especially devoted to preventing malaria and its treatment. It is a small laboratory with less than fifty members.

It has been established to keep our armed forces healthy. This laboratory has done something unique in health care. It has characterized the vector of the mosquito prevalent in that region based on their own medical knowledge and the experience of the local people. The laboratory, in turn, has treated the people in the villages and helped them to be free of malaria.

205.

TABLE 10.1.

Estimated and Projected Mortality Rates (per 100000) by s.e.x, For Major Causes of Death in India Causes year ________________________________________________________.

1985.

2000 2015.

_____________ ______________ _______________.

M F M F M F.

All causes 1158 1165 879 790 846 745 Infectious 478 476 215 239 152 175.

Neoplasm 43 51 88 74 108 91 Circulatory 145 126 253 204 295 239.

Pregnancy _ 22 _ 12 _ 10 Prenatal 168 132 60 48 40

30.

Injury 85 65 82 28 84 29 Others 239 293 280 285 167 171.

Source: World Bank Health Sect oral Priorities Review Noninfectious diseases Let us now address noninfectious diseases, some of which are considered 'developed country' (posttransitional) diseases! Since these diseases are significant in developed countries, there is also a vast knowledge base utilized to tackle them. Heart diseases are perceived to be the ones, which will receive major attention for many years to come.

Urbanization and altered lifestyles are indicators of socioEconomic development and lead to risk factors for cardiovascular diseases (CVD). At present, pretransitional Diseases like rheumatic heart diseases, mostly the problem of the poor, coexist as a major cardiovascular diseases along with posttransitional diseases such as coronary heart disease and Hypertension. In India nearly 2.4 million deaths are caused by cardiovascular disorders. Smallscale communitybased studies indicate the prevalence of CVD in adults, ranging from 26 percent in rural and 610 per cent in urban areas. The health Sector review of the World Bank projects that CVD mortality Rates would double between 19852015 (table 10.1) Studies of overseas Indians in many countries reveal excess coronary mortality in persons of Indian origin. These studies conducted in several countries and involving different generations of migrants from India/South Asia suggest a 206.

special susceptibility to CVD as persons of Indian origin face the challenges of epidemiological transition. When a community's status changes from being poor to affluent, both genetic, environmental and perhaps nutritional factors appear to play a role in the special vulnerability of people of a particular community, in this case of Indian origin. Other factors include the stresses due to living in a different cultural setting.

Experts believe that an epidemiological transition is therefore likely to result in a major CVD epidemic in India.

It is critically important to develop relatively inexpensive diagnostic aids for detecting coronary heart diseases (CHD). These include ECG (electrocardiogram), stress ECG, nuclear cardiology, echo cardiology, halter monitoring and cardiac catheterization with coronary angiographies. Technologies like magnetic resonance angiographies of the coronary arteries are still under investigation. ECG records and simple stress equipment are manufactured in India and are easily available. However, if the diagnostic facilities have to be extended to the primary care (ECG) and secondary care (stress ECG) levels, in Response to the coronary epidemic, their manufacture in larger numbers and reduced cost per unit would be necessary. Medical therapy of CHD may involve antiangina drugs (nitrates, calcium channel and beta blockers), ant.i.thrombosis agents (aspirin, Heparin, etc), ACEinhibitors, thrombolytic agents (streptokinase, urokinase, etc) and antioxidants. Primary health care centers are not presently geared to provide emergency Care. Development of treatment protocols for CHD and training of appropriate manpower at primary levels need to be taken up on a priority basis. Let us remember that CHD and CVD is not merely the problem of the very top strata, of a few tens of millions.

(No doubt this strata cannot only afford private treatment in India but also afford periodic checkups and treatment in the UK and USA. It is sad to note that this strata have confidence only in foreign facilities, despite the presence of experts doctors in India and all such imported equipment with which foreign returned Indian specialists are operating worldcla.s.s facilities!) CVD and CHD are going to become a common illness, from the lower to the upper middle cla.s.s and even among many rural people. Therefore, it is not a disease of the affluent it is a disease, which may also attack many Indians, who have just marginally escaped death from serve infectious diseases or nutritional disorders. The Kalamraju stent, used to prevent arteries from closing up, was one such attempt to target 207.

the treatment of this group. We need many more measures for diagnosis. Since most primary health centers (PhDs) may not have access to excellent specialists, advances in modern communication and information technologies also would need to be deployed innovatively to provide such taleaccess (that is, access at a distance). Most readings of the diagnostic equipment, ECG or others are electrical signals. These can be transmitted to the specialists in a very economical form with modern digital technologies. The opinion and advice of the specialists can be retransmitted to the PHC. We understand that many of those who operate costly nursing homes in cities would be willing to provide such advisory services at a nominal cost as a part of their contribution to society. Let us try many such methods to reach out to people. In addition, the advice of specialists regarding dietary habits exercises and practices for mental stress relief (including yoga) may have to popularize in the media.

Another CVD, which is prevalent now in India and arises mostly due to poverty or neglect of illness at a young age, is rheumatic heart disease (RHD). It is a major cause of Cardiovascular morbidity and mortality. The prevention of RHD requires early diagnosis and prompt treatment of streptococcal pharyngitis, especially in children aged 516 years.

Through a streptococcal vaccine is under investigation, clinical trails are yet to take shape. A multivalent, noncross reactive, long lasting and inexpensive vaccine would be idle for prophylaxis, but does not appear to be feasible. Secondary prophylaxis with penicillin is an available technology whose compliance needs to be improved. Clinical trails on the efficacy of immunomodulatory therapy for rheumatic fever are required.

While balloon valvoplasty and surgery are presently available at sot tertiary centers, the equipments and disposals are mostly imported. Indigenously developed prosthetic values must be Promoted and technologies for production of indigenous equipment and disposables must be developed. On all these fronts, given targets and good organization, India can easily Measure up to the problem. Other noncommunicable diseases such as diabetes may be a cause for concern. About 510 per cent of the population in India suffers from diabetes. Preventive measures include genetic counseling and dietary and lifestyle counseling. Blood glucose detecting devices have been simplified and miniaturized. However, a high running cost and the need for changing the Equipment are limiting factors. Standardized glucose measuring 208.

Projected Number Of Cancer Incidences In India Cancer site Year _____________________________________________________________________.

2000 2020.

2021.

__________.

___________.

__________.

M F M F M.

F.

_____________________________________________________________.

_____________________________________________________________.

_____________________________________________________________.

_______.

Oral cavity 44875 23670.

59560 24515 75299.

24261.