Doctor de Leon and anti-TB drug resistance

A personal story for the World TB Day (24 March 2010)
Doctor de Leon is a Mexican paediatrician who has dedicated her life to saving other people's lives particularly the youngest and most vulnerable of any society - the children. Nine months ago, she developed a cough that her colleagues diagnosed as an allergy. Overall, her health was deteriorating, she lost weight day-by-day despite her efforts to nourish herself the best that she could. Since she was not feeling well, she ordered the sputum smear exams for herself, and they came back positive. Read more



She started TB treatment but her sputum smears and her health status did not improve and after six months of anti-TB treatment, a first-line drugs sensitivity test (DST) result came back positive for multi-drug resistant tuberculosis (MDR-TB).

On 22 March 2010, two days before the World TB Day, Dr de Leon was admitted to a specialty hospital in Mexico City with haemoptysis, weight of 99 pounds and a chest x-ray which showed 10mm cavities.

On the World TB Day 2010, and every day for that matter, Dr de Leon could be providing care to patients affected by tuberculosis or attending the different events planned for this day in the country. Instead, she is a patient in isolation, waiting and hoping that her TB status is not extensively drug-resistant tuberculosis (XDR-TB).

Dr de Leon wants to be cured and will continue her fight to live, not only for herself and her mission in life but also to be able to see her two young children, three and four years old, grow up.

Alberto Colorado - CNS

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A helpline that reaches out to ‘stressed’ students

The recent spurt of suicides by students in the state is a matter of great concern for everyone. It simply points to something being drastically wrong in the society wherein we live. It points towards a big communication gap between teachers, parents and students. It shows up the hidden pressure and stress the students are carrying all the while like dynamite strapped to our body. Read more




It brings to the surface a maniac depression and desperation that is seething within the young of today. Part of a number race they have been forced into a system that forces them to compete all the time for survival. It results in a total burnout. It forces dynamic, powerful youth to be reduced into a helpless, non-entity. It makes him believe that if he is not a topper he has no right to live. It makes him feel guilty, useless and unwanted. The emotional baggage is so heavy that he succumbs loses all interest in life and the world and takes the extreme step of committing suicide.

"This suicidal trend among the youth distressed us too. We, like many adults felt the need to reach out, to talk, to analyze, and to counsel such students. What was born out of this concern was a helpline aptly named All is well", said Mr. Anshumali Sharma of Childline Helpline Lucknow. A Reader and Head, Geology, J N P G College Mr. Sharma’s work in Childline, a Government of India Project under the Ministry of Child and Women Development that works for abandoned children in 83 UP cities decided to expand the work base and include counseling of stressed students during the time of emotional crisis, especially during examination.

To help such students and to help them stop taking this extreme step some like minded NGOs -namely Human Unity Movement (HUM), Circle for Child and Youth Research Cooperation in India (CCYRCI) joined Childline Helpline Lucknow and started a 24x7 helpline service on toll free number 1098, 9415023121, 9415408590 and 9415189200.

Mr Sharma gave this information while addressing journalists at ‘Media for Children’-the fortnightly media sensitization session organized by Media Nest and UNICEF at the Uttar Pradesh Press Club.

He stressed that if a child gets to talk to someone just five minutes before he decides to take the extreme step of taking his life chances are that he will see sense and will change his mind and not commit suicide.

"All is well is all about reassuring a student a positive approach towards life," said Mr Sharma.
He said that they have discovered during their research and interaction with stressed students that it is over ambitious parents and insensitive teachers who are generally responsible for a child committing suicide. Mr Sharma said we must not make our children the vehicle of our own unfulfilled dreams and ambition.

"As parents we must analyze the caliber of our child and also study his area of interest. We must communicate to him that we respect his individuality and that we will not be disappointed if he does not excel in academics," said Dr Sharma. He thanked the media, specially the Lucknow media for being highly child-sensitive and for raising children’s issues in a big way. He said it will have to be a combination of responsible media, parents and teachers that will help reduce the negativeness from the mind of the youngsters.

Speaking on the issue the second panelist, renowned sociologist, Vice-Principal of JNPG College, Lucknow and Executive Secretary of Circle for Child and Youth Research Cooperation in India (CCYRCI). Dr Vinod Chandra, said that post-examination suicides by students is a new and greatly disturbing phenomenon. Earlier suicidal bids were sometime made by students who failed in examinations but now students are ending their lives even before the results are declared.

He suggested counseling sessions for not just students but also for teachers and parents. Dr Chandra suggested that there should be a Parent-teacher counselling association in every school.

Blaming the elitist schools for starting the ‘number game’ Dr Chandra said that there must be debates and discussions on our education system which will lead to a more student-friendly system where there will be healthy competition.

He suggested that parents of today despite their busy schedules must ensure that they spend quality time with their wards. This will instill a lot of confidence in their child and help build an emotional stable individual.

"We have since we launched the helpline already counseled 350 students online. There are days when we are receiving calls till wee hours of the morning. We get calls from oversees too," said Dr Sangita Sharma of HUM. HUM is a child centric organization basically devoted to the cause of child protection and child rights. A former school teacher, Dr Sharma, who was a panelist on the same programme stressed on a healthy relationship between the teacher and the taught.

Elaborating on the telephone calls that ‘all is well’ has been receiving, Dr Sharma said the basic thing she found was a lack of understanding between a child and the parent.

“There was this boy who called to say that he had scorned 90 per cent in all subjects but only 76 per cent in English and that his parents have been livid with him for this. The boy between sobs told me that now he has lost the will and the confidence to study and is petrified of the final exams. Do you blame the child or the parent,” she asked.

Stressing that it is not always the children who learn from teacher but vice versa Dr Sharma said that a child is a precious gift of God and He has sent him on earth with a special talent and we adults must respect this uniqueness embedded in each child.

Kulsum Mustafa
(The author is a senior journalist and secretary of Media Nest)

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The Union to launch international trial of 9-month MDR-TB treatment regimen

World TB Day, 24 March 2010

In this year 2010, which has been declared as Year of the Lung, it is indeed a much-awaited welcome news that International Union Against Tuberculosis and Lung Disease (The Union) is to launch an International trial of 9-month MDR-TB treatment regimen. The need for accessible, effective multidrug-resistant tuberculosis treatment is urgent, as the incidence of MDR-TB continues to rise, and extensively drug-resistant TB (XDR-TB) has been reported in 57 countries. In response, the International Union Against Tuberculosis and Lung Disease (The Union) is launching a trial of a 9-month treatment regimen that has demonstrated cure rates exceeding 80% in a pilot programme. Read more

While tuberculosis has been curable for more than 60 years, drug-resistant strains are far more difficult and costly to treat. Currently used treatment regimens can take up to two years to complete, placing a heavy burden on both patients and health systems.

The Union's evaluation of a standardised treatment regimen of anti-tuberculosis drugs for patients with multiple drug-resistant tuberculosis or STREAM will seek to determine whether a regimen developed and implemented by the Damien Foundation and the Institute of Tropical Medicine, and used with notable success in Bangladesh, can be used in different settings with comparable results.

"Obviously, this regimen represents a significant difference in time and resources for all involved", says Dr Nils E Billo, Executive Director of The Union. "But any treatment strategy must be carefully evaluated to ensure the most effective and feasible approaches are implemented, particularly in low-income settings where MDR-TB is most prevalent."

To prepare for and implement the single-arm, multicentre STREAM study, The Union is collaborating with the Medical Research Council of the United Kingdom. The four-year study will involve close to 600 patients in four different countries, which are in the process of being selected. Selection will be based on the country’s disease burden of TB, MDR-TB and TB-HIV co-infection, as well as other criteria such as ability to provide close supervision of patients, quality of lab facilities and the full support of the national tuberculosis programme..

The STREAM study is part of the USAID-funded initiative led by The Union called Technology, Research, Education and Technical Assistance for Tuberculosis – TREAT TB. Consistent with the goals of TREAT TB, the overarching goal of STREAM is to see that research, technology and education are increasingly used to improve the performance of patient management practices in the countries selected for the trial. The outcomes of the study are expected to provide important evidence to inform MDR-TB treatment recommendations from global technical agencies, including the World Health Organization and The Union and national policy and guidelines for MDR-TB treatment in high-burden countries.

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AIDS and Drug Resistance pose challenges to TB control in India

World TB Day, 24 March

On the eve of World TB Day - March 24, 2010 - the Indian Network for People living with HIV (INP+), in partnership with the ACTION (Advocacy to Control TB Internationally) project and Global Health Advocates have brought out results of the first of its kind study on barriers to accessing TB treatment services among people living with HIV, injecting drug users (IDU) and the general population. This year, 2010, is also declared as Year of the Lung. Read more

The study conducted in Imphal, Manipur and Erode, Tamil Nadu highlights the lack of penetration of TB control services among vulnerable populations. The study lead author Dr Venkatesan Chakrapani, Policy and Research Adviser, INP+, says: "The gap of knowledge among people living with HIV/AIDS of this key co-infection contributes directly to their higher mortality. Early treatment can avert a majority of these deaths. Newer technology is crucially required to diagnose the problem of drug resistance among both the general population and among people living with HIV."

Affordable, faster diagnostics and treatment for TB the most important research and development required, says Dr SK Brahmachari, Director General, Council of Scientific and Industrial Research (CSIR). CSIR says that the combination of an ayurvedic ingredient with the current drug regime have shown enhanced effectiveness of TB treatment in currently ongoing clinical trials.

Among the people who spoke at the release on the need for innovation and research to tackle TB were Dr SK Brahmachari, Director General, CSIR, and Dr Jayanth Banavaliker, Medical Superintendent of the Rajan Babu Institute for Pulmonary Medicine and Tuberculosis (formerly RBTB Hospital), New Delhi.

Releasing the report on behalf of ACTION Project and INP+, Dr SK Brahmachari, DG, CSIR said it is a commendable job done. He added that, "There is a huge challenge, how to develop more specific diagnostics and treatment which is affordable and detects quickly. This is the most important research and development required."

Commenting on the need for more rapid and effective treatment for TB, Prof SK Brahmachari, DG, CSIR said that clinical trials have shown that the combination with Pepperine (an ayurvedic extract) in one of the TB drugs not only makes the treatment more effective with half the current dosage but also cheaper by nearly 23%. This combination is expected to have fewer side-effects and prevent reoccurrence, with specific benefits for women.

"With more and more people reporting drug resistance, it is imperative that newer technologies are adopted to make early diagnosis of drug resistance a reality," says representatives from Global Health Advocates (GHA), one of the advisors on this study. "All the gains from having a national TB control effort can be decimated by the problem of drug resistance. This is the tipping point of the battle against TB in India, and we need new ways of diagnosing people with TB", GHA representative adds.

Discussing the intensity of tuberculosis in India, Dr Banavaliker stressed, "Tuberculosis is curable and the disease can be contained if managed adequately throughout. Early initiation and proper treatment is the best prevention of tuberculosis and resistant TB."

"In-as-much that drugs, diagnostics and research are going to be critical to TB control, we need to have far more involvement of civil society and a greater engagement of political will. TB must be taken on wholeheartedly and comprehensively by society and politicians if we are to avert an MDR crises," said Vivek Dharmaraj of the Advocacy to Control TB Internationally (ACTION) project.

TB remains one of the greatest public health challenges. Paradigm shifts in thinking are urgently needed. Across the world innovative approaches are being initiated to tackle TB. Massive investment in new drugs, rapid and robust diagnostic tools and research is imperative.

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Spill Neither Water Nor Blood: World Water Day (22 March)

Exclusive on World Water Day (22 March 2010)
One gives life, while the other sustains it. One flows in our veins making us living beings, and the other percolates around us, making this planet livable. The possibility of finding water on Mars and Moon excites the scientific community no end. But, Alas! We don’t seem to be caring for either of them. Political leaders have not shied away in giving patriotic slogans like ‘you give me blood and I will give you freedom’, or ‘we want blood for blood’. We do not hesitate to label a non aggressive person as one who has water flowing in her/his veins instead of blood. Rhetoric apart, I really admire George Bernard Shaw for having had the courage to say “Fight if you must, but do not glorify war”. And yet it is being strongly felt that if at all there is going to be a third world war, it will be fought for water. So water, or the lack of it, is likely to spill rivers of blood. Read more


I was really shocked to read recently in a national daily that Thai protesters, including monks, poured several jugs of their own blood on the front gate of the government head quarters in Bangkok, in a symbolic sacrifice to press their demands for early polls in Thailand.. Their leaders vowed to collect 1000 litres of blood (drawing a few teaspoons from each volunteer) and pour it out on the roads. One of the protest leaders proudly claimed that ‘the blood of the common people is mixing together to fight for democracy’.

I do not know about Thailand, but in India there is a perpetual shortage of blood for patients who are in need of it. It is a pity that litres of blood simply went down the drains, when it could have been used to give life to someone in desperate need of it. Wouldn’t that have been a better gesture to save democracy? People are very circumspect about donating blood for others, but they do not bat an eyelid when it comes to wasting it on the streets. I think that all of us should resolve to donate blood (and not spill it) to hospitals on our birthdays and other solemn occasions, thus strengthening human bonds and not pay mere lip service to democracy.

It is equally unpardonable to waste water. It is through our own wicked deeds that water has become such a priced commodity which is becoming scarcer day by day. As a youngster, I remember the taps in our homes never went dry. Now it is a miracle if they trickle for 2 or 3 hours in the entire day. In some cities of India, the condition becomes so bad that water in very limited quantities is supplied through government tankers only once or twice a week during the summer months. People are being forced to buy water, not only for drinking purposes, but also for their daily chores. The public water supply system is almost on the verge of extinction and slowly passing into private hands. People resort to installing water pumps and/or digging tube wells / hand pumps in their houses and feel encouraged to use it more indiscriminately.

Even as we refuse to reduce its consumption, we can at least curb the wastage of water. It is heart rending to see water flowing into drains from over filled overhead water tanks, as the household pumps remain switched on for long. I wish there was some mechanism to stop this criminal waste of a precious thing. I wonder if some study has been carried out to measure the amount of water wasted if a water storage tank overflows at full force for just about 5 minutes. Talks of rain water harvesting seem ludicrous if we cannot switch off our water pumps, when not needed, and prevent this criminal waste of water.

Every year, 1,500 cubic kilometres of waste water are produced globally. While waste and waste water can be reused productively for energy and irrigation, it usually is not. In developing countries 80 percent of all waste is being discharged untreated, because of lack of regulations and resources.. Human and environmental health, drinking and agricultural water supplies for the present and future are at stake. Still, water pollution rarely warrants mention as a pressing issue. An estimated 1.1 billion people of the world rely on unsafe drinking-water sources.

Keeping this dismal scenario in mind, UN-Water has chosen ‘Clean Water for a Healthy World’ as the theme for World Water Day 2010. The overall goal of the World Water Day on 22 March 2010 campaign is to focus on raising awareness about the profile of water quality at the political level so that water quality considerations are made alongside those of water quantity.

In fact potable drinking water should not be a demand or a need, but a basic human right, just like clean breathing air. Yet, it has become a commercial product, like oil, thanks to a lack of political will and abundance of citizens’ apathy. We take it as a sign of upward mobility to buy and drink bottled water (whose purity is also doubtful). Mineral water (what does it actually mean?) is the buzzword these days, thanks to sustained advertisement propaganda by multinationals.

As the UN and other international bodies seek solutions to this crisis of potable water at government levels, let us just be a bit more sensitive and sensible in our daily lives. It would merely require a little bit of conscious effort on our part to turn off the taps while brushing our teeth, and mend the leaking ones; switch off the pumps when tanks are full; use the shower in the bathroom judiciously; do not leave the hose in the garden to water it overnight; and prevent household waste from being thrown in ponds and rivers.

Let water not turn into rivers of blood and let blood not be spilled on roads – figuratively and literally.

Shobha Shukla
(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)


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Right to Choose: Sex reassignment surgery (SRS)

The transgender people should have the option for sex reassignment surgery (SRS). “Not all transgender people might want sex reassignment surgery. So the option should be there for those who want it” said Dr Venkatesan Chakrapani, Policy and Research Adviser, Indian Network of People living with HIV (INP+) at a skill building workshop session on SRS at the recently held State Consultation for MSM and Transgender in Science City, Kolkata (18-19 March 2010). This consultation was organized by MANAS Bangla with support from Voluntary Services Overseas (VSO) India and West Bengal State AIDS Prevention & Control Society (WBSAP&CS). Read more



“Current medical definition of Gender Identity Disorder (GID) is of people who are born of particular sex and feel like the other sex. GID is a broad spectrum term. Transsexualism is when people change sex” said Dr Chakrapani.

“There have been many studies on transsexualism and general consensus is to make transsexualism as a medical condition and not as a GID” said Dr Chakrapani.

“There are two kinds of transsexual people, operative transsexual people are those who go for SRS and non-operative transsexual people are those who don’t go for SRS” said Dr Chakrapani.

The entire process of changing one’s sex can take about one and a half year therapy or more. Apart from other steps, before the actual surgery can take place to remove the sexual organ and perform vaginoplasty, the person goes through female hormone therapy during which female hormones are administered.

“There are many procedures a transgender person may like to go through from head to toe – like some people want to remove facial hair, or want changes in vocal cord, some may want to reduce the face bones, some want to go for breast implants (silicon implants), some want to go for bone correction in the hip area” says Dr Chakrapani. There are many other invasive and non-invasive procedures” said he.

Currently only in Tamil Nadu, free SRS is available in select government hospitals. Only operation and vaginoplasty is covered under this programme in Tamil Nadu.

There is a compelling need to have more competent healthcare staff to provide SRS related services to transgender people. Effectively engaging transgender communities in reducing stigma and discrimination at healthcare settings is another enormous challenge confronting public health system in India.

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Realizing Right to Health for MSM and Transgender people

It is evident from experiences shared at the State Consultation for MSM and Transgender in Science City, Kolkata that the quality of healthcare that MSM and transgender communities have access to is appalling. Dr Venkatesan Chakrapani, Policy and Research Adviser, Indian Network of People living with HIV (INP+) presented some challenges and what could be done to realize the right to health for MSM and transgender. Read more

“There are barriers at the individual level regarding health. The situation needs to change so that MSM and transgender people have better understanding about health issues and increased access to non-discriminatory healthcare services” said Dr Venkatesan Chakrapani.

“Then there are barriers at the healthcare system level with limited understanding and competency in providing quality healthcare to MSM and transgender people. Attending to health needs of MSM and transgender people is not part of medical curriculum and training so that needs to be done so that healthcare workers have a better understanding and competency in providing quality healthcare to MSM and transgender people” said Dr Venkatesan Chakrapani.

The needs of MSM and transgender communities are not addressed adequately in the present healthcare system. For instance, sex reassignment surgery, gender transition procedures etc are hardly provided in non-stigmatising and non-discriminatory healthcare settings. The competency of healthcare staff for such procedures is also an enormous challenge.

Then there are other challenges that make it difficult for transgender and MSM people to access healthcare from public health system. There is no separate queue for them in hospitals and transgender people aren’t allowed to stand in women’s queue. Transgender people have to put on the male dress when admitted in hospitals, and are forced to stay in male ward. These are clear deterrents that make it difficult for MSM and transgender people to avail of existing healthcare services in public health system, said Dr Chakrapani.

“Among the healthcare provider, in general there is a negative attitude towards both MSM and transgender people” said Dr Chakrapani.

“Homosexuality is not listed as a psychiatric disorder in both guidelines followed by psychiatrists. Even if the psychiatrists are sensitive to MSM and transgender people, still they may not be capable of providing quality care because the mental health issues of MSM and transgender people are not being taught in medical curriculum” said Dr Chakrapani.

“At policy level, focus is on bringing down the HIV prevalence but not on an individual. Currently HIV counselling is not dealing with broader sexual health issues” said Dr Chakrapani. “We need a robust comprehensive national health strategy for sexual minorities to address issues related to physical, sexual, and mental health” added Dr Chakrapani.

“Engaging MSM and transgender communities in the dialogue on what changes can be brought about in the healthcare system and then devising appropriate strategies is essential” said Dr Chakrapani.

“Advocating with the State Directorate of Medical Education and Medical University management to include the health issues of sexual minorities in the medical curriculum is another area where MSM and transgender people can play a lead role” said Dr Venkatesan Chakrapani.

“MSM and transgender people should advocate with local branches of professional organisations to conduct sensitisation and training programmes for healthcare providers in their constituencies” said Dr Chakrapani.

“Advocating for formulation of national strategies for sexual minorities needs to be done in consultation with community groups” said Dr Chakrapani.

The public health system in India has made some interventions to improve healthcare for MSM and transgender. For example, in Tamil Nadu state of India, sex reassignment surgeries (SRS) is being provided free of cost in select government hospitals – although it only covers operating and other hospitalisation related costs. The environment in such settings is also tainted with discrimination and stigma towards MSM and transgender people and much more needs to be done to make these model interventions.

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Mental divide between HIV and non-HIV work should dissolve

The debate related to vertical single-issue interventions versus integrated and comprehensive programmes is not a new one. Tuberculosis (TB) and HIV/AIDS collaborative programmes have borne fruits – and maximised resources too – particularly in one of the most hard-hit regions, although a lot more needs to be done on that front as well. Read more

“The mental divide between HIV and non-HIV work is a topic of subsequent discussion. Mental health issues and other barriers MSM have in accessing services need to be addressed too” said Aniruddh Vasudevan, Director, The Shakti Centre, Chennai. Aniruddh was speaking at the State Consultation for MSM and Transgender, in Science City, Kolkata. This Consultation was organized by MANAS Bangla with support from Volunteer Services Overseas (VSO) India and West Bengal State AIDS Prevention & Control Society (WBSAP&CS).

“In a study done in Chennai where 220 MSM participated, one of the findings was that only 26% respondents had ever accessed HIV services” said Aniruddh. The data may be debated, but the assumption that HIV interventions are reaching out to all MSM and transgender people is probably not right. In the Chennai study, 74% of MSM and transgender respondents had never accessed HIV services. Also the needs of the MSM and transgender community go beyond HIV related services.

“Getting these MSM and transgender people who are not yet reached by HIV interventions, is a challenge” says Aniruddh. And solution might lie in integrating MSM and transgender component in other interventions like those on sexual and reproductive health services, mental health services, and other areas in order to move towards a sustainable community development approach.

Mental health professionals need to be sensitive to MSM and transgender issues. “My work in the past has been around mental health issues of LGBT people. It is a crisis – number of psychiatrist and quacks who are offering therapies to ‘cure’ MSM and Transgender people and number of parents who are seeking out such services is alarming” said Aniruddh.

“The drop-in centres and other AIDS-related healthcare service centres are providing counselling for HIV to MSM and transgender people, but counselling for mental health issues is not being looked upon adequately” said Aniruddh Vasudevan.

“Many transgender people in Tamil Nadu are school drop-outs. Many transgender activists who went for sex reassignment surgeries in Tamil Nadu broke down, cried, due to the trauma and insult they had to face while going through the psychiatric counselling process” said Aniruddh Vasudevan.

“We are not looking at working with parents of MSM and transgender people. The number of parents who have started calling us, or want to know what to do if their children have gender identity related problems has upped remarkably. We don’t have resources to attend to this crisis – parents and siblings are at times don’t know whom to talk to, and they can potentially be very supportive if engaged properly” says Aniruddh.

The need for collaborative and holistic approach to help better the quality of life of MSM and transgender people is undoubtedly compelling, and goes beyond HIV prevention, treatment, care and support programmes. Let us hope that different government and non-government development interventions will listen to these voices coming out of the State Consultation for MSM and Transgender in Science City, Kolkata.

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Mental health issues of MSM and Transgender need attention

Mental health concerns came up prominently in different sessions of the State Consultation for MSM and Transgender, organized by MANAS Bangla and West Bengal State AIDS Prevention & Control Society (WBSAP&CS) during 18-19 March 2010.

Depression, harassment, relationship problems, loneliness, and social isolation, were among the few pressing mental health concerns that were identified in a skill building workshop for MSM and transgender community. Aniruddh Vasudevan, Director of The Shakti Centre in Chennai, was a key resource person for this session. Mou Bhattacharyya, Psychological Counsellor also participated actively in the discussion. Read more

So what do the MSM and transgender people do when confronted with mental health challenges? “We are referred to our friends or community people. We rarely go to official psychologist or psychiatrist” was the response from the MSM and transgender communities. HIV and STI counselling is more concerned with sexual and reproductive health, and doesn’t adequately address mental health concerns beyond HIV prevention and to some extent care and support issues. There were strong remarks made on the inadequate counselling on HIV treatment, care and support.

“When there is adequate self-esteem and self-respect, there is a natural desire to be healthy, to take care of one self, to engage in safer sexual practice. So none of what we do will be successful if we ignore mental health issues” said Aniruddh Vasudevan.

“Everybody has some problem or the other – depression, etc, but when it becomes so much that everyday life becomes difficult then professional help from psychological counsellor or psychiatrist might be needed” says Aniruddh.

“We speak about behaviour change – there is a big gap between acquiring knowledge and behaviour change, there is a gap between information and practice. This is where good mental health might help reduce the gap. When we are healthy enough, when we have adequate sense of what our worth is and how important we are to ourselves and when we have a tendency to take care of ourselves, behaviour may change” says Aniruddh.

“We have artificially set up a hierarchy that attending to physical health is more important than attending to our mental health. Body and mind are not split, rather they are together. So we better attend to the mind too when we are attending to the body” suggests Aniruddh.

People are often reluctant to accept that they might be needing mental healthcare. “When there is an emotional problem one might be finding it difficult to deal with, somehow we think that taking help is bad, it is a defeat, it is like giving in” says Aniruddh.

“But if there is a physical health issue, we don’t hesitate in taking help and even go to the pharmacy and self-treat at times. But we don’t do this when there is a mental health issue and hesitate to seek help” further adds Aniruddh.

“Even when we have accepted ourselves as we are, there are emotional issues like break-up, or when one of our friends is dying, people will think that we have these issues because we are MSM, transgender. I think we are blaming others in advance even before they say it, because in some corner of our minds, we think we are the source of our problems. Even the best of us who are comfortable with ourselves, in some corner there is a doubt that we are the source of our problems” ponders Aniruddh.

“At times, we think that it is because of us, we are causing so many problems to our parents or to our sister who might not be getting married on time. Sometimes the source of the problem is not us, but because we are concerned about the people around us. It is a sign of humanity that we are concerned about people around us. We have extra mental health problem because we are different and that is causing problems around us” adds Aniruddh.

Another significant comment Aniruddh made was that the members of affected communities need capacity building and must be competent enough to contribute effectively in programmes addressing their community. “Just coming from a community doesn’t mean that the person is automatically equipped to peer counsel – we have to do something to equip ourselves” says Aniruddh.

“At times, it is easier to talk to somebody you don’t know. Professional counsellors or psychiatrists can’t proactively reach out to people and counsel, they can only counsel those who come to them and ask for the counselling. However the peer counsellors can go out to the community and help those who might need help” says Aniruddh.

“Most basic thing in counselling is listening and the person sitting in front of counsellor is most important person. We are not arguing to say that peer counselling can replace professional counselling, but we believe that peer counselling can supplement professional counselling. Peer counsellors cannot handle all cases like suicidal cases at times, so should do referral services to professional counselling” says Aniruddh.

“Peer counselling is not about offering solution – because the message that gets across is the person being counselled is not capable enough of finding solutions” shares Aniruddh Vasudevan.

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HIV counselling doesn’t adequately address mental health issues

“The drop-in centres and other AIDS-related healthcare service centres are providing counselling for HIV to MSM and transgender people, but counselling for mental health issues is not being looked upon adequately” said Aniruddh Vasudevan, Director of The Shakti Centre in Chennai. Aniruddh was speaking at the plenary of the State Consultation for MSM and Transgender on “Confronting Crises: The Situation Today.” Read more

“Many transgender people in Tamil Nadu are school drop-outs. Many transgender activists who went for sex reassignment surgeries in Tamil Nadu broke down, cried, due to the trauma and insult they had to face while going through the psychiatric counselling process” said Aniruddh Vasudevan.

However a Kolkata-based psychological counsellor has another opinion. In AIDS related clinics, by integrating mental health in general healthcare has not only reduced stigma-related to mental health but also increased access to mental and general health services for the men-who-have-sex-with-men (MSM) and transgender communities. “Clubbing medical practitioner and counsellor together in the drop-in centre and other clinics has put off the mental-health related stigma” said Mou Bhattacharyya, Psychological Counsellor with PLUS (partner of MANAS Bangla).

There is no denying to the fact that mental health issues are unique to transgender and MSM people, and are not adequately being addressed.

“Mental health needs are huge for transgender as they are neglected and maltreated by the society, and their own family friends or family in some cases who are source of trauma” said Mou Bhattacharyya. “Earlier experience of trauma comes from your own family and friends. Maltreatment includes teasing, humiliation coming from very closed ones, not even given the minimum respect or importance of what you expect from your family members” adds Mou.

“From the very inception of MANAS Bangla, Mental health issues are very much integrated. In each of the drop-in centres, the main agenda is to let people come in and talk and share things with each other. Every drop-in centre, has one doctor and one counsellor along with other team members like peer counsellors” shares Mou Bhattacharyya.

Are MSM and transgender people who come to these clinics willing to access counselling services? “People who come to these drop-in centres are more than keen to access these services. Every day they are going through several traumatic experiences, when they travel for work or travel for other reasons, or at home or from their partners with whom they may interact sexually or otherwise. Mainly the ongoing problems are with their male partners, family members and other closed relatives and their own confusion and frustration regarding their identity, sexual preferences and other issues” says Mou Bhattacharyya.

“People who have opened up regarding their sexual identities are coming to these drop-in centres. There are lot of people who are not yet open regarding their sexual identity and are difficult to reach. With rising HIV awareness, people are more keen to come in for services” says Mou Bhattacharyya.

Counselling is the main coping strategy counsellors at these clinics resort to. “If the person needs mental health medicines we refer to the doctors. Doctor who comes to drop-in centre is not a psychiatrist, so if we need psychiatric help, we need to refer to psychiatrists. We have a pool of psychiatrists who are sensitive to issues and people can access services with care without any stigma or discrimination at these healthcare settings” says Mou Bhattacharyya.

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MANAS Bangla, an example of partnership between government and affected communities

MANAS Bangla, today, is a network of 13 community based organisations (CBOs), supported by the West Bengal State AIDS Prevention and Control Society (WBSAP&CS) – the Indian Government’s pivotal State AIDS control body. It came into existence in 2003. “It takes two hands to clap. As much as the community was coming forward it was the government too which was supporting networks. We had a dynamic project director supportive of this initiative” said Mahesh Nathan, Technical Support Unit, West Bengal State AIDS Prevention and Control Society (WBSAP&CS). He was speaking at the opening plenary of the State Consultation for MSM and Transgender in Science City, Kolkata on 18th March 2010. Read more


“From government side, we were looking at supporting a network. We thought in terms of a network approach, and goal was empowerment” said Mahesh Nathan.

It wasn’t an easy task to bring different CBOs together as a network. But effective solutions to improve AIDS responses for the men who have sex with men (MSM) and transgender communities clearly warranted an effective network. There were a host of issues to be resolved before that could happen in West Bengal, and one major challenge was identity issues among others. “As we celebrate success of this network, we need to know that there were a lot of issues earlier. First step forward was that seven groups who came together just to have a dialogue in this direction to create a platform” said Mahesh Nathan.

Building networks is certainly not easy. But united and coordinated responses to AIDS, STI, sexuality related issues and other challenges can potentially come from effective networks. “We wanted an approach that would be a role model– we already had effective CBOs in West Bengal. We wanted a network and ownership from communities of this network in a true sense” said Mahesh Nathan. This community ownership is such a crucial element to ensure that the network remains driven by the community and not get drowned by louder voices. The ownership of MANAS Bangla is undoubtedly with the communities – more than 300 MSM and transgender people from all over the state of West Bengal who are convening for the State Consultation for MSM and Transgender organized by MANAS Bangla are the testimony of the effectiveness of this network approach.

“At every step MANAS Bangla was faced with challenges. They had to come up with pragmatic solutions to strengthen the network” said Mahesh Nathan. “Every time MANAS Bangla was confronted with challenges they rose up and build excellent systems. Today MANAS Bangla is looking at many issues beyond targeted interventions (TIs). Other states of India had individual CBOs funded and here in West Bengal we had a network (MANAS Bangla) through which 13 CBOs were funded. MANAS Bangla came up with unique responses, they have looked at processes and they have put systems in place” further added Mahesh Nathan.

“Now the challenge is how to link the network and targeted interventions (TIs)? What role does the network has and what role TI has? There were so many overlaps between roles of TIs and networks. So we put together a TI team for MANAS Bangla. The National AIDS Control Organisation (NACO) – apex Government of India’s agency on HIV/AIDS - has reviewed MANAS Bangla and renewed its contract also. As long as ownership and participation of communities is there, MANAS Bangla will continue to function and serve the needs of the communities” said Mahesh Nathan.

“There are other issues apart from HIV where MANAS Bangla could have a role to play. Empowerment, skill building issues, in terms of vocational rehabilitation, etc will lead to sustainability. MANAS Bangla as a network is on the forefront of change and should set the agenda” said Mahesh Nathan.

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State Consultation on MSM and Transgender in Science City, Kolkata

The State Consultation for MSM and Transgender on the theme of “Celebrating gains, confronting crises, forging future” was inaugurated on 18 March 2010 by Mahesh Nathan from West Bengal State AIDS Prevention and Control Society (WBSAP&CS) in Science City, Kolkata, West Bengal. This consultation was organized by MANAS Bangla with support from Volunteer Services Overseas (VSO) India and WBSAP&CS during 18-19 March 2010. Read more

“The consultation, the first of its kind in West Bengal, had brought together communities of marginalised sexual orientations and gender identities, from across the state of West Bengal” informed Pranai Sekhar Pradhan, President MANAS Bangla. “It has brought together over 300 transgender and males who have sex with males (MSM) from over 12 districts of West Bengal and other important stakeholders including policy makers from government and donor bodies from across the country” said Agniva Lahiri from MANAS Bangla.

“It takes two hands to clap. As much as the MSM and transgender community was coming forward it was also the government that was very supportive of network approach” said Mahesh Nathan from WBSAP&CS. “There are other issues apart from HIV where MANAS Bangla has a role to play. Empowerment, skill building issues, in terms of vocational rehabilitation, etc will lead to sustainability. MANAS Bangla, as a network of 13 member organisations, is on the forefront of change and should set the agenda” added Mahesh.

The consultation opened the dialogue on issues concerning marginalised male to male sexualities and transgender and hijra communities with academicians, students, other development practitioners, activists and human rights advocates from intersecting rights based movements.

This consultation helped build capacities of MSM and transgender communities and community led groups by way of organising various issue-based workshops and discussion forums. This meeting is also the first such interface between MSM and transgender communities and policymakers, government agencies and other stakeholders.

“We do need targeted interventions (TIs), condoms, STI clinics, and other services, but there are other structural issues that we just cannot avoid – education, health, employment, social security, and others. If MANAS Bangla also addresses structural issues, that will also ensure sustainable community development” said Pawan Dhall, Country Director (Programme and Development), SAATHII.

There were focussed sessions in this two days consultation on issues like human rights challenges facing MSM and transgender, right to choose: sex reassignment surgery, post-Delhi High Court Judgement on section 377: scenario in West Bengal, emerging identities around male to male sexualities and reaching out, treatment gaps and adherence, mental health issues of MSM and transgender, sexual rights vs HIV/AIDS organising: Dilemmas for community mobilization, among others.

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Mental health issues of MSM and Transgender need attention

Mental health concerns came up prominently in different sessions of the State Consultation for MSM and Transgender, organized by MANAS Bangla and West Bengal State AIDS Prevention & Control Society (WBSAP&CS) during 18-19 March 2010.

Depression, harassment, relationship problems, loneliness, and social isolation, were among the few pressing mental health concerns that were identified in a skill building workshop for MSM and transgender community. Aniruddh Vasudevan, Director of The Shakti Centre in Chennai, was a key resource person for this session. Mou Bhattacharyya, Psychological Counsellor also participated actively in the discussion.

So what do the MSM and transgender people do when confronted with mental health challenges? “We are referred to our friends or community people. We rarely go to official psychologist or psychiatrist” was the response from the MSM and transgender communities. HIV and STI counselling is more concerned with sexual and reproductive health, and doesn’t adequately address mental health concerns beyond HIV prevention and to some extent care and support issues. There were strong remarks made on the inadequate counselling on HIV treatment, care and support.

“When there is adequate self-esteem and self-respect, there is a natural desire to be healthy, to take care of one self, to engage in safer sexual practice. So none of what we do will be successful if we ignore mental health issues” said Aniruddh Vasudevan.

“Everybody has some problem or the other – depression, etc, but when it becomes so much that everyday life becomes difficult then professional help from psychological counsellor or psychiatrist might be needed” says Aniruddh.

“We speak about behaviour change – there is a big gap between acquiring knowledge and behaviour change, there is a gap between information and practice. This is where good mental health might help reduce the gap. When we are healthy enough, when we have adequate sense of what our worth is and how important we are to ourselves and when we have a tendency to take care of ourselves, behaviour may change” says Aniruddh.

“We have artificially set up a hierarchy that attending to physical health is more important than attending to our mental health. Body and mind are not split, rather they are together. So we better attend to the mind too when we are attending to the body” suggests Aniruddh.

People are often reluctant to accept that they might be needing mental healthcare. “When there is an emotional problem one might be finding it difficult to deal with, somehow we think that taking help is bad, it is a defeat, it is like giving in” says Aniruddh.

“But if there is a physical health issue, we don’t hesitate in taking help and even go to the pharmacy and self-treat at times. But we don’t do this when there is a mental health issue and hesitate to seek help” further adds Aniruddh.

“Even when we have accepted ourselves as we are, there are emotional issues like break-up, or when one of our friends is dying, people will think that we have these issues because we are MSM, transgender. I think we are blaming others in advance even before they say it, because in some corner of our minds, we think we are the source of our problems. Even the best of us who are comfortable with ourselves, in some corner there is a doubt that we are the source of our problems” ponders Aniruddh.

“At times, we think that it is because of us, we are causing so many problems to our parents or to our sister who might not be getting married on time. Sometimes the source of the problem is not us, but because we are concerned about the people around us. It is a sign of humanity that we are concerned about people around us. We have extra mental health problem because we are different and that is causing problems around us” adds Aniruddh.

Another significant comment Aniruddh made was that the members of affected communities need capacity building and must be competent enough to contribute effectively in programmes addressing their community. “Just coming from a community doesn’t mean that the person is automatically equipped to peer counsel – we have to do something to equip ourselves” says Aniruddh.

“At times, it is easier to talk to somebody you don’t know. Professional counsellors or psychiatrists can’t proactively reach out to people and counsel, they can only counsel those who come to them and ask for the counselling. However the peer counsellors can go out to the community and help those who might need help” says Aniruddh.

“Most basic thing in counselling is listening and the person sitting in front of counsellor is most important person. We are not arguing to say that peer counselling can replace professional counselling, but we believe that peer counselling can supplement professional counselling. Peer counsellors cannot handle all cases like suicidal cases at times, so should do referral services to professional counselling” says Aniruddh.

“Peer counselling is not about offering solution – because the message that gets across is the person being counselled is not capable enough of finding solutions” shares Aniruddh Vasudevan.

Rahul Kumar Dwivedi - CNS

Do Not Burn The Midnight Oil: Sleep Well And Stay Healthy

Exclusive on World Sleep Day, 19 March
Sleep is a basic human need, much like eating and drinking. It is crucial for our overall health and well being. Research shows that we spend up to a third of our lives sleeping. Good quality and restorative sleep is essential for day-to-day functioning. Studies suggest that sleep quality, as well as quantity, impacts our life. On an average, a normal adult needs 7-8 hours of good sleep. In teenagers this may go up to 9 hours, while the elderly can do with 5-6 hours of it. World Sleep Day is on 19th of March.

According to Dr Manvir Bhatia (click here to listen to exclusive CNS audio podcast), Chairperson Sleep Medicine and Senior Consultant ,Department of Neurology, Sir Ganga Ram Hospital, New Delhi, "sleep is an essential commodity, which should not be dispensed with, as it cannot be compensated with anything else. It has a strong relationship with health. So we need to look after it well." Read more

Ghalib, the famous poet has said in one of his couplets "maut ka ek din muayyin hai, neend kyu raat bhar nahin aati" (the day of death has been fixed by the Almighty, So why spend sleepless nights).

World Sleep Day 2010 is being held on 19th March, under the slogan "Sleep Well, Stay Healthy". It is an international annual event, intended to be a celebration of sleep and a call to action on important issues related to sleep, including medicine, education, and social aspects. It is organized by the "World Association of Sleep Medicine", with the aim to lessen the burden of sleep problems on society through better understanding, prevention and management of sleep conditions by raising awareness through dissemination of information.

Sleep problems constitute a global epidemic that threatens health and quality of life for up to 45% of the world's population. There is substantial evidence that sleep plays an important role in metabolic, cognitive, restorative, immune, and endocrine functions. Hence disruption in sleep affects all these.

Most sleep disorders are preventable or treatable, yet less than a third of sufferers seek professional help. Sleep medicine is a recent speciality which deals with various problems related to sleep, ranging from obstructive sleep apnoea - with predominant symptoms of snoring, to insomnia (30-45% adults suffer from it) or reduced and poor quality of sleep. Narcolepsy is another cause of excessive daytime sleepiness. Very often, persons suffering from these complaints are not aware of the health hazards associated with them.

Persons with sleep disorders may suffer from insufficient sleep at night and wake up listless, spending the day poorly, with little concentration and more aches and pains. Or they may have loud snoring and also wake up tired. In both cases there are periods of irresistible tendency to take a nap or doze off during work. This affects day time concentration, and hence productivity. It also increases the chances of having other diseases like high blood pressure, diabetes, stroke, heart attack etc. Apart from this, hundreds of people lose their lives unnecessarily every year due to sleep-related traffic accidents, including airlines and railways accidents.

Dr Bhatia laments the 'junk sleep syndrome' prevalent in the modern day teenagers. They are prone to using a whole lot of gadgets like I-Pod, internet, video games, television, or simply studying till late in the night, thus pushing their sleep time too late. Obviously they have difficulty in waking up in the morning and concentrating on their studies in school. They reach home tired, take a nap and the pattern repeats itself. It is not very uncommon to find such students having a 'black out' during examination time. These children are likely to develop a poor memory and low scholastic aptitude, and also an impaired immune function, thus inviting a host of diseases.

It must not be forgotten that poor sleep is a symptom of a cause like obstructive sleep apnoea, poor life style, anxiety, depression etc. Very often the sufferer resorts to the use of sleeping pills, which causes more harm than good. This self medication often becomes addictive in the long run, resulting in more problems.

More must be done to completely understand sleep and to understand better the cause of sleep disorders. We need to increase awareness about sleep related disorders particularly in students, and those working in BPO industry, railways, airlines and road transport services.

Early diagnosis and appropriate treatment of these disorders can prevent serious health conditions and improve the quality of life.

SIR GANGARAM HOSPITAL and NEUROLOGY AND SLEEP CENTRE have taken a step in the direction of increasing awareness among general public about sleep disorders by organizing free Sleep Camps, under the guidance of Dr Manvir Bhatia. These camps provide free consultation by sleep specialists, besides offering dietary advice, yoga training, and psychological counselling related to sleep with provision for blood investigations and sleep studies.

A good night's sleep takes care of many of the physiological and metabolic parameters of our life.

So look after your sleep and enjoy a good health. Wake up every day feeling refreshed to face the challenges of life with renewed vigour.



Shobha Shukla(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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World Tuberculosis (TB) Day is on 24 March in Year of the Lung (2010)

The World TB Day is just a week ahead of us. This year 2010 is the year of the lung. In the lead up to the World TB Day, CNS is reproducing an exclusive article written in December 2009 (Cancun, Mexico) where 2010 was announced as year of the Lung. Read more



2010 is Year of the Lung

The Forum of International Respiratory Societies (FIRS) convening at the 40th Union World Conference on Lung Health in Cancun, Mexico, declared the year 2010 as the Year of the Lung. This was done to recognize that hundreds of millions of people around the world suffer each year from treatable and preventable chronic respiratory diseases. This initiative acknowledges that lung health has long been neglected in public discourses, and understands the need to unify different health advocates behind one purpose of lung health, informed Dr Nils Billo, Chair of FIRS. The FIRS partners include the International Union Against Tuberculosis and Lung Disease (The Union), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Asociacion Latinoamericana de Torax (ALAT), European Respiratory Society (ERS), Pan African Thoracic Society and American College of Chest Physicians (ACCP).

The New York Times carried a series of articles on different parts of human body, but forgot the lungs! It is difficult to remain alive without lungs for more than few seconds!

The Declaration signed by the partners of the Forum of International Respiratory Societies (FIRS) read as following:

[Begin]
WE NOTE WITH GRAVE CONCERN THAT:
Hundreds of millions of people around the world suffer each year from treatable and preventable respiratory diseases, including tuberculosis (TB), asthma, lung cancer, H1N1, pneumonia, chronic obstructive pulmonary disease (COPD).

WE RECOGNIZE THAT:
Despite the magnitude of suffering and death caused by lung disease, lung health has long been neglected in public discourse and in public health decisions.

WE CALL UPON OUR PARTNERS TO:
Enact smoking cessation legislation and programs to reduce the prevalence and stigma of tobacco-related lung diseases.
[Ends]

There are a range of health and environmental factors that affect our lung health. This includes tuberculosis (TB), tobacco smoke, biomass fuel smoke, chronic obstructive pulmonary disease, asthma, pneumonia among other respiratory infections. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach among health programmes at all levels.

Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds, 1 child dies of pneumonia every 15 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming.

More than 2 billion people or a third of the world's total population, are infected with mycobacterium tuberculosis. Tuberculosis is now the world's seventh-leading cause of death. It killed 1.8 million people worldwide last year, up from 1.77 million in 2007. It is one of the three primary diseases that are closely linked to poverty, the other two being AIDS and malaria.

Tobacco smoking is unquestionably the primary risk factor for COPD. More than 5 million deaths are attributed to tobacco use every year. Smokers have two fold higher risk of developing active TB disease. Tobacco smokers have 2 times more risk of dieing of TB. Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis. The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.

Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.

Asthma is yet another major lung health challenge. It is a chronic disease that affects airways. When people have asthma, the inside walls of their airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that they are allergic to or find irritating. When airways react, they get narrower and lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night. When asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that vital organs do not get enough oxygen. People can die from severe asthma attacks.

More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies. The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met. Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.

According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. Effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.

Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and effective treatment is both inexpensive and widely available.

Host of other conditions that affect the lungs, are preventable, and often treatable.

Let us hope that 2010 Year of The Lung initiative of FIRS puts the spotlight on the long neglected part of human body which New York Times missed, the lungs.

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