Part 16 (1/2)

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?

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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.

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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.

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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.

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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.