TENTATIVE STEPS IN KASHMIR AND IN TREATMENT OF XDR TUBERCULOSIS

 

 

 

We are most certainly living in momentous times, the world has changed as never before, the proof being the scrapping of Articles 370 and 35A from the state of Jammu and Kashmir on a single morning of this month. This naturally created a humongous furore both within Parliament as also the entire nation. The prime minister rightly stated from the ramparts of Red Fort that what could not be done in 70 years he did in 7 weeks. Brutal no doubt but the truth. To his credit the BJP manifesto for decades had underlined abrogation of the above Articles. Modiji had the crucial majority in both Houses to push the Bill through, spectacularly assisted by the home minister. The opposition was left both stunned and speechless. Remarkably Pakistan did not haver a clue ; this includes their infamous ISI that repeatedly has staked claims of being the finest in the business and whose very existence is based on ensuring “freedom” to “Indian Held Kashmir.” On closely examining the photographs published of their military high command one thing is obvious, both the army chief and the ISI head look perplexed, almost confused and tense. Only a few days earlier they had returned from a triumphant visit to the United states, with the promise of a big IMF loan and renewal of spare parts for their F16s. Mr Imran Khan was ecstatic declaring that he felt he had won the Cricket World cup once more. In his mammoth public meeting with Pakistani expatriates he had screamed he would ensure that AC’s and televisions of jailed Mr Nawaz Sharif and Mr Zardari were cut off, to loud cheers from the Pakistani American audience. The newspaper Dawn could not help commenting on the stunning success of Mr Imran Khans successful visit. This collective hubris was however short-lived but in the mean time Mr Khan got Mr Sharif’s daughter Maryam Sharif also incarcerated in a cell. In fact right now the apex of almost the entire Pakistani opposition languishes in jail. So when the “selected prime minister” of Pakistan wails about the 2 former chief ministers of Kashmir being put under house arrest he sounds a bit rich. Also most of the media is directly under the control of Pakistani regulators. The Pakistani media is however putting up a robust fight unlike our chaps who excel in toeing the government line. One of the brightest journalist of the subcontinent has had a defamation suit slapped against him by Mr Khan. Mercifully Seth keeps coming up with his excellent takes on matters in Pakistan. His independent day message to his countrymen is a must watch; its on YouTube. He puts great emphasis on Pakistan resetting its relations with India. He cannot but concede that the economic gap between India and Pakistan has become insurmountable. Pakistan as of now remains on Finacial action Task Force (FATF) grey list of countries recognised as laundering money to support terrorist activities. To get the 6 billion dollars loan agreed by the IMF, Pakistan has to get out of this FATF list or face complete fiscal collapse. Pakistan’s foreign exchange is depleting  fast. No wonder Mr Khan finds himself between a rock and a very hard place. He cannot launch a military operation nor a jihadi movement. His mentor the army chief had accompanied him to the USA and knows every line of the IMF deal.

 

But I was bewildered  watching a video of a leading Indian journalist who claims to clear and simplify matters that he cannot talk about the constitution as he is not a legal luminary. Of course he is not, but surely any one knowing basic English can read up on Article 370 and Article 35A. You don’t have to be a Supreme Court Justice or a Jethmalani to realise that the government has rogered the Articles with total disregard of the letter and spirit of the Constitution. Maybe it is confident that in years to come it can not only tinker but change its complexion. They can then rest completely free of any burden on their intrepid shoulders. For now hats off to Mr Modi and Mr Shah, they sure have guts. One cannot and should not forget the role played by their security adviser. Take it from me, Ajit Doval was always considered “brilliant” by his peers. One of them was my patient. The entire process of withdrawing all civilians form the valley, cutting of the internet ( we are the world champions in cutting the internet and hold the world record, Pakistan comes a distant second), blanking out mobile and land phones, in fact placing the entire civilian population of Kashmir (thats in millions) under house arrest, and then torpedoing the Articles enshrined in the constitution with impunity was a master stroke. Rajnikanth is wrong ( I could be lynched for the) the blitzkrieg, which Rommel would have been proud of was ordered by the prime minister and home minister ( Krishna and Arjun) but Mr Doval most certainly is the third component of the Troika.

 

Why do some journalist take the plea that they are on slippery ground where the constitution is concerned? Its because they know deep in their hearts that although just about every Indian wanted Kashmir to be assimilated into India, they would have wanted a less controversial method. Undoubtedly abrogation of Article 370 is a dodgy act to say the least. Its their in plain English that albeit a temporary measure , the slightest modification can only be done after a green signal from the Constituent Assembly. The Constituent Assembly however dissolved it self without a whisper of the slightest alteration way back in the fifties. There is a case to be made that the legislative assembly voted by the people could provide consent for any sort of tinkering. But even that was absent when the deed was done this August. The governor ( appointed by the central government) was considered to be the sole representative of the people, the constituent assembly, and the legislative assembly, and hence his consent was perfectly legal and correct. The president presented the abrogation bill to his own man who in turn gave his solemn consent and voila the Article ceased to exist.

 

It is imperative that one reads the actual Instrument of Accession signed by Maharaja Hari Singh on 26th October 1947 and accepted by the governor general Lord Mountbatten the next day on 27th October 1947 (signed in green ink). Hari Singh makes it very very clear in para 6 that he would permit no one to purchase land without his express permission ( this evolved into Article 35A) and in the next para very lucidly puts in a warning that he would not brook any interference by the Indian Constitution ever. I would urge the reader to check out the Instrument, the original has to be on Google. I have been taken aback by the ignorance about Article 370 and the Instrument of Accession (IOA) by almost all people that I know, from professional colleagues to taxi drivers. Also no one seems to understand that in 1947 India was almost a foetus that was fiscally crushed and militarily puny. India could not have with its possession of logistics and provisions forced the Pakistanis to retreat from POK, Gilgit and Baltistan. They may have wanted to do so, definitely had the courage and intent, but they just did not have the armoury, provisions and line of supplies. There was only one runway in Srinagar airport and the road to Srinagar was then primitive and long. Today’s India is far better armed, logistically secure and above all we have an economy rivalling both England and France; almost 2.7-2.8 trillion dollars. Our founding Fathers wanted the world to know that India did NOT subscribe to Mr Jinnah’s “Two Nation” theory, that Muslims and Hindus could never live together. India’s take was different, a Muslim majority state could safely be a part of India.

 

Hundreds of thousands of ordinary Indians have demonstratively rejoiced at the abrogation of 370. I doubt if they know their history or the reasons behind Article 370. But Mr Jinnah too must be dancing in his grave, we have almost proven him right, that Muslims and Hindus are a different people and therefore merit separate nations. But then as I wrote in my book Mr Jinnah had little knowledge of human genetics, to be fair to him little was known in his times. He may have been aghast to be informed that not nearly but all humanity evolved from the African continent. There is little or no difference in the genetic material carried in the Pakistani or Indian, in the Muslim or Hindu.

 

“I have done the deed” said Macbeth to his wife; after murdering Duncan the king (Act 2, scene 2). Macbeth asks his wife did you hear anything; she replies, “I heard the owl scream and the crickets cry.” But we have heard nothing from the people of Kashmir. Their silence now is not of their design. Their moths have been zipped for all practical purposes. They may not have even heard the prime minister speak for all services have been cut off. It is imperative that further moves by the government provides balm to Kashmiris who surely must be shocked, infuriated, scared, terrorised, humiliated and deeply hurt by the events that have overtaken them. Their wounds should not be allowed to become untreatable by the people of India. In the ultimate analysis they willingly albeit grudgingly came over to our side. Never forget the ultimate sacrifice of Mohd Maqbool Sherwani who kept the ferocious Pakistani tribal long enough at bay in Baramulla in November 1947 for the Indian forces to land and secure Kashmir. He was barely 19 years of age, but the boy was a super patriot who scoffed at Jinnah’s Two Nation theory. He was cruelly killed by the Pakistanis whom he had misled by giving wrong directions. Maqbool was crucified and then shot dead, crucifixion is a horrendously painful way to die. Maqbool died for Kashmir and for India. Similarly Operation Gibralter in which the Pakistani army infiltrated Kashmir in 1965 to trigger guerrilla warfare and mass uprising of muslims failed because of a vigorous prompt response by the Indian army who were greatly helped by local civilians in capture and neutralising the enemy. The local civilian were largely Kashmiris. I can vouch for the integrity, commitment and dedication of each and every Kashmiri muslim colleague that I have worked with.

 

Trump wants very much to withdraw American troops from Afghanistan before his term ends; he has to fight another election. He wants no mess behind and therefore wants the Taliban to come to some sort of agreement with the local government. He wants Pakistan’s assistance in this. Pakistan would love to unleash all Jihadis in its corral, and with them as many from the Taliban into Kashmir, as also the Indian mainland. They obviously will not do this with trumpets blaring. They would like to do it when we least expect it. Right now Mr Khan is seething. He surely must be wishing he should have stayed with cricket. The pitch is unplayable now. He has not only been clean bowled but the bumper ball struck his helmet and then deflected on to his wickets. an unusual but hellish dismissal. Worse he never saw the ball coming, nor did his team and support staff. The hit on the helmet has left a concussion on full display in his rant in Muzaffarabad yesterday. He spoke of Nazis and final solutions. That was gross but it is our shared responsibility that he proves not even remotely correct. We have enough wisdom and strength in our scriptures to do what is right. As Yama told young Nachiketa, “the wise prefers the good to the pleasant.” The foolish man chooses the pleasant ( Ken Upanishad). Crucially it is time that the subcontinent reflects on the advice that young Astik gave king Janamjeya ( the great grandson of Arjun) as the king burnt alive thousands and thousands of snakes for killing king Parikshit his father. Arun Kolatkar writes the air became full of the awful stench of dead snakes; the stench became so omnipresent that fresh air became so little that it was termed ‘antinational’ and ‘unIndian,’ in his poem Sarpa Satra; which in turn is from the Mahabhrata. Astik advised Janamjeya to terminate the yagna or else risk harm to the snake Shesha on whose head stands earth. Imagine what would happen if Shesha were to move an inch. The entire universe in fact sits on Sheshanaga; it would come crashing down. The implication is that cycles of vengeance albeit sweet are unpredictable and quite capable of total annihilation. India along with  sought international intervention in 1948 by going to the United Nation’s Security Council. India after winning the 1971 War laid down the Shimla Agreement that spoke of bilateral negotiations alone minus international interference. Now in August 2019, Kashmir has become a domestic issue, with almost no comment from the international community.

 

There is deep despair and sorrow in Kashmiris. This will be exploited by you know who. It will be a long and solemn vigil from now on. The tunnel is very long this time. Will there be light at the end of it? I honestly didn’t know. It is our moral duty and dharma to wipe out Kashmiri tears. To reassure them while instilling confidence into them. We have the wherewithal to do it; and we must. Do not expect politicians to do it. This is not the time for cliches, ,for settling scores, or chest thumping. Time will tell if we have it in us. These could be exhilarating and charming times.

 

Remarkably Pakistan and India could not figure out a way to handle Kashmir. To have fought 3 wars over it is weird. The temperature is again red hot right now after 73 years of tension. There are other serious problems affecting this planet. In fact there are so many that it would be near impossible to mention them all. Any small flicker of positive light hence provides immense relief. One such beacon of hope is the approval by the American FDA for a new short regimen for treatment of Extensively Drug Resistant tuberculosis (XDR). TB is the biggest infectious disease killer on the planet, it kills more people than AIDS. About 15 lakh people die off TB each year.About one crore people get infected annually by TB, but there are only 30,000 people with XDR TB spread over 100 countries. Almost three fourths die before diagnosis, and only 25-30 % are cured. The treatment itself is a killer, involving 40 pills as day for 2 years. If the disease does not kill the patient, the treatment is quite capable of the same. Treatment can have serious side effects consisting of deafness, kidney injury and severe psychosis. A lot of patients even though staring at death give up on the pills and injections. The new regimen involves only 3 drugs for a period of just 6 months. The 3 pills are bedaquline, pretomanid and linezolid or “BPaL” to remember. The first study using this regimen was done in a Hospital in South Africa. Gandhi ji had volunteered in ‘Sizwe Hospital’ during a plague epidemic. The hospital was originally built by the British in 1895 as Reitfontein hospital. Bedaquiline was approved by the FDA in 2012, WHO followed up in 2012. Pretomanid has been passed for use by the FDA as recently as last June . Importantly Ptretomanid is not owned by a drug company but by a non profit organisation called TB Alliance. The BPaL regimen has a 90% success rate and will be a huge boon for XDR TB patients. Two thirds of XDR TB patients are in India ,China and Russia. XDR TB by definition is resistance to INH, Rifampicin, all quinolone and at least one of the injections ( capreomycin, amikacin, or kanamycin). But here too we have a long way to go with guarded optimism. Randomised trials will near impossible to perform. Reliance will have to made on observational studies. The cost of treating one XDR TB patient in Germany is 160,000 Euros; a lot of money. Pretomanid is only the third drug that has been approved for TB in the last 50 years. Approval for BPaL came yesterday the 14th of August 1947. India has the highest number of multi drug resistant ( resistant to INH and rifampicin) TB patients in the world, about 27,000 patients; and possibly at least 9000 cases of XDR TB. Generic versions of BPaL will need to be produced in India. The first step has been taken by yesterday’s FDA approval, but the task ahead is arduous that chiefly requires affordable pricing of all 3 pills for Indian patients. XDR TB is a matter of life and death, at most times death. The first step is thus in the right direction, not hampered by any debate on methods employed as is the case with Kashmir. They brought out a book on 100 scientists refuting Einsteins Theory of Relativity ; Enstein’s riposte was that if he was wrong only one scientist would be enough. Truth, even in a democracy, may not always be a monopoly of the majority .

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