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Thursday, February 7, 2019

FDA blocks Walgreens and Circle K tobacco sales



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Ahead of budget, K'taka farmers question slow implementation of loan waiver scheme

Farmers’ issues
The coalition government has written off loans worth Rs 1,611 crore borrowed by 3.28 lakh farmers till January 30.
In the first budget announced by the coalition government, Chief Minister HD Kumaraswamy announced the details of a loan waiver scheme to counter the agrarian crisis in Karnataka. The total expenditure for the scheme was pegged at Rs 34,000 crore with loans from both cooperative and commercial banks being waived off. The announcement followed an election promise made by Kumaraswamy.  Six months on, the coalition government has written off loans worth Rs 1,611 crore borrowed by 3.28 lakh farmers till January 30, as per Governor Vajubhai Vala's address at the beginning of the Assembly session on Wednesday.  That’s less than 5% of the total expenditure announced for the scheme in the 2018 budget.  The slow pace of the implementation of the loan waiver scheme has come into sharp focus ahead of the second budget to be presented by Kumaraswamy on Friday. It also comes at a time 100 out of 175 taluks in Karnataka have been affected by drought in the kharif season (June to October) while 156 taluks have been affected by drought in the rabi season (October to January). This means that currently only 20 taluks in the state are not affected by drought, further aggravating the crisis plaguing farmers in the state.  What farmer leaders say Kurubhara Shantakumar, a farmer leader from Mysuru said that the farm loan waiver scheme had benefited a fraction of the famers it was intended for in Mysuru and its neighboring districts.  "The conditions applied on the loan waiver scheme meant that around 20% of the farmers in our area are able to avail the scheme. It is also moving along at a very slow pace so we don't know when the waiver will actually be implemented," he says. Meanwhile Inamathi YB, a farmer leader from Hubballi told TNM that the loan waiver has been implemented for customers of two banks so far  - State Bank of India and Canara Bank. "In Dharwad, two banks have waived off loans worth Rs 50,000 so far but the rest of the waiver is yet to come through. In the past, the Siddaramaiah government had announced a similar waiver of Rs 50,000 from cooperative banks. If you combine both, my debt reduces but there is still a deficit of 2 lakhs. So can you really call it a loan waiver?," Inamathi asks.  The situation is similar in other parts of the state. The delay in the disbursing of the loan waiver scheme has been linked to delay in collecting data about farmer loans. The process was initiated in July 2018 but it was only in January that the loan-waiver implementation began. The information about the scheme has also been made available online. Several other states including Rajasthan, Madhya Pradesh and Chhatisgarh have followed up with loan waiver schemes of their own. The ‘Pradhan Mantri Kisan Samman Nidhi’ scheme, a direct income support scheme for small farmers, was also announced by the central government last week.    But in spite of the urgency injected by the state government into implementing the loan waiver scheme in the past month, questions have been raised against the scheme, particularly since the rate of tax on petrol and diesel was hiked when the scheme was announced.  This time around, Kumaraswamy has indicated that he wants to announce a budget directed at all sections of the society. All eyes will be on the budget on Friday to see whether it lives up to the promise. 
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Karnataka temple prasadam poisoning: The need for emergency readiness mechanisms

Healthcare
Unless lessons are learnt and the system gears up, these kinds of incidents are likely to recur and more lives will be unnecessarily lost.
On December 14 last year, 110 people were hospitalised after consuming prasadam at the Kichugutti Maramma temple in Sulwadi village of Chamarajanagar district in Karnataka. This was a case of deliberate poisoning, confirmed to be Monocrotophos, an organophosphate insecticide, classified as highly toxic and banned in many countries but still available in India. The diagnosis of poisoning is made on the basis of clinical suspicion, the characteristic clinical signs, smell of pesticides or solvents, and reduced acetylcholinesterase activity in the blood. Apart from stimulating secretions in the body, it can cause muscular weakness, twitching and neurological symptoms. The main drugs for treatment are atropine, pralidoxime (PAM) and benzodiapines. Seventeen of the 110 affected people died, although almost all received medical care. The district administration and general public demonstrated a remarkable response in terms of arranging transport,  shifting patients to the secondary and tertiary facilities, identifying those exposed to the poison and making manpower available during the crisis. There should, however, be some introspection within the system on how these kinds of poisoning related emergencies could be prevented and managed better – one cannot depend on goodwill to respond to a crisis of this magnitude. Preparation for a disaster should be done much before a disaster actually takes place. Health system response The first point of treatment for a majority of those affected was the 100 bedded Holy Cross Hospital in Kollegal, which has 132 staff, an ICU facility and 7 ventilators. When the first few seriously ill patients began arriving, the hospital authorities realised the scale of the incident and an emergency situation was announced. The hospital initially received 64 patients of the 110 who had consumed the contaminated prasadam. The hospital had adequate quantities of PAM and atropine which are lifesaving and possibly contributed to the reduced fatality of an otherwise largely fatal poisoning. It is, however, ironic that this hospital is not empanelled under the Arogya Bhagya scheme because it does not meet some of the criteria. Facilities at Holy Cross Hospital, Kollegal The public health systems seem ill-equipped and unprepared to handle isolated emergencies, leave alone an outbreak, an epidemic, a natural or man-made disaster and so on. As far as the healthcare system is concerned, there is very little focus in the existing healthcare related schemes and programmes on how to deal with cases of chemical poisoning. Instead, most of the focus seems to be on the more procedure based models of curative care. The district administration and the state government will have to map the healthcare system so that there is seamless communication and referral with the first primary point of care being strengthened substantially. First-aid and disaster management training should be an essential component of training for all healthcare personnel. Functional ambulance facility should be upgraded. At the secondary and tertiary facility level, it is important that there are staff who have received specialised training in toxicology with close contact with poison information centres. The communication should be two way, with the secondary and tertiary level facilities sending updated information to the poison information centres so that a national level database can be maintained. This helps to plan interventions and particularly to screen those poisons that need to be banned at a national level. Since organophosphate poisoning has some long-term side effects, the affected patients should be followed up over a period of time to look for neurological changes, poor concentration, memory and post-traumatic stress disorder. Proper records of their health status have to be maintained. Currently there is no system of long-term follow-up and care for those affected by poisoning. Guidelines and protocols for public distribution of food In India, there are several situations where large quantities of food is prepared – schools, colleges, centralised kitchens, marriages, funerals, religious spaces and others. There should be strict guidelines for food procurement, storage, preparation, serving, etc. Licenses should be issued only to those agencies which meet the required criteria. Adequate resources should be provided for inspecting these facilities and the monitoring reports should be put up in a public domain. Cooking area at the Maramma temple, Sulwadi Any violators should be banned from distributing food to the public. The undue influence of the regulator should be strictly penalised so that an informal nexus between the regulator and the agency should not be formed, as is usually the case with regulation in India. Poisoning management The systems in place for handling chemical poisoning in India is very poor. Vital time is wasted by healthcare staff in identifying the poison based on history, signs and symptoms, and then consulting experts on management. Standard treatment guidelines and markers of common poisons should be displayed in health facilities and also included as part of the regular training. There is a need to urgently revise the medical curriculum to focus on rural health issues and those of public health importance in the Indian context. Knowledge about large-scale poisoning management may be required at the community level itself. Certain members of the community, such as local police, teachers, anganwadi workers, ASHA workers, ANMs and gram panchayat members, may be the first point of contact and should be able to identify, decontaminate and offer basic first-aid. This training for disaster or large-scale emergency preparedness should be made part of all trainings and curricula. The local PHC medical officer or general practitioner should have basic training in emergency care as well as emergency referral options. It is important that the government responds quickly to a large-scale poisoning. Constant updates of helplines, media releases, public education messages, emergency contact numbers and precautionary measures have to be made widely available. This is only possible if these systems are put in place before an emergency. In Karnataka, these systems occur in retrospect or after an emergency has occurred. Poison information centres It is important that poisoning by highly toxic chemicals is not seen as just a case management issue but in terms of prevention, and environment damage and legal enforcement. Although Monocrotophos is classified as a highly hazardous pesticide and recommended to be banned, India still doesn’t follow the international code of conduct on the distribution and use of pesticides. There should be at least one well-functioning poison information centre with the required skilled staff and resources to quickly diagnose poisoning as well as maintain long-term data. Those poisons that are most fatal and banned in other countries should be quickly phased out in India. While exposure to poisons are often brought to attention when it is large-scale and affects many people, chronic exposure to small quantities of poisons and chemicals is hardly on the radar. These are invariably treated as isolated cases, because of which larger patterns and trends are missed and unsuspecting communities in certain occupations or geographic areas face disastrous consequences for years, without any recourse to rehabilitation, appropriate treatment or compensation. There is almost no monitoring of the chemicals used in small-scale industries, pharma companies, home-based manufacturing, and these are often released into the domestic water supply systems. Larger industries often have a level of impunity and can get away in spite of violations, the Bhopal gas tragedy being a case in point. Research on poisons, antidotes and long-term consequences and side effects have to be done on an ongoing basis, and the poison information centres should function on updated field level information rather than theoretical knowledge from other countries. Information about poisons in the country has to be developed in an organic manner based on real experiences and outcomes rather than theoretical ones. For this, it is important that the link between peripheral facilities and the toxicology centres is ongoing and bi-directional. Availability of antidotes In the case of the Sulwadi poisoning, the Holy Cross Hospital had adequate supplies of atropine and PAM for the management of cases and is quite likely to have helped save the lives of several of the 110 who had been poisoned. Antidotes have to be listed among the essential drugs and made available quickly. Their lifesaving value cannot be underestimated, particularly relevant in areas that are remote and where emergency life support is at a distance. If a patient has received an antidote and then transported to a tertiary facility, the outcome is likely to be better and the overall burden on the health system reduced. Good first-aid procedures and the appropriate use of antidotes may not only be lifesaving but also economically sound. Although antidotes are sometimes expensive, their use may prevent death, prolonged hospitalisation, or permanent sequelae. The benefits of their use thus outweigh the costs. Primary care physicians should be trained in the use of antidotes and these should be made readily available. In India, many poisons are readily available but the system is not adequately equipped to deal with a large-scale poisoning as happened in Sulwadi. Unless lessons are learnt and the system gears up, these kinds of incidents are likely to recur and more lives will be unnecessarily lost. The writer is a public health doctor and researcher, who was part of a six-member fact-finding team from the People’s Union for Civil Liberties (PUCL) that visited Sulwadi. Views expressed are the author’s own.
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Bengaluru airport inaugurates solar-powered rooftops

Power
KIAL is hopeful and confident that they will be able to achieve its goal of becoming 100% powered by renewable energy by 2020.
Bengaluru’s Kempegowda International Airport unveiled its rooftop solar powered plant on Wednesday morning. According to a press release issued by BIAL, the solar plant has been installed across 8 rooftops and has been speculated to generate roughly 47 lakh units of clean electricity per year. It is estimated that 3800 tonnes of carbon dioxide emissions will be reduced annually as a result of the newly set up solar plants. “BIAL’s solar project was commissioned across two phases. During the first phase in 2017, 503 KW of rooftop solar, 2.5 MW of ground mounted solar and 425 KW of car parking solar power installations were undertaken. During the second phase, in addition to the 3.35 MW installation by Sunshot, BIAL purchased 20 MUs of solar power through open access from Bosch plant of capacity 14.4 MW solar power plant commissioned at Belagavi. In addition, BIAL has also purchased 20 MUs of solar power through open access from Cleanmax. BIAL has adopted a holistic approach and sustainability principles to ensure integrity of economic viability, operational excellence, conservation of natural resources and social sustainability,” stated BIAL in its press release. At the inauguration, Vice President of the Engineering and Maintenance Department of BIAL, Lakshminarayanan S said to media, “As a role model for sustainable progress, the BLR Airport is well on course towards achieving its goal of becoming 100% powered by renewable energy by 2020. To that end, these solar projects will help BIAL reduce the carbon footprint and achieve energy neutrality. The airport’s consumption from solar power stands at 50 million units through on-site and off-site solar Power Purchase Agreements (PPA) to meet 67% of its annual energy requirements.” The airport administrators are hopeful and confident that they will be able to achieve energy neutrality by the year 2020.  
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BJP MLAs disrupt Karnataka Assembly, but don’t move no-confidence motion

Politics
BJP MLAs protested that the coalition government in power in Karnataka do not have the support of the requisite number of legislators.
BJP MLAs disrupted proceedings in the Karnataka Assembly for the second day in a row on Thursday by chanting slogans and staging a walkout during Governor Vajubhai Vala's speech. BJP MLAs protested that the coalition government in Karnataka do not have the support of the requisite number of legislators after as many as 9 Congress MLAs and 1 JD(S) MLA skipped the joint Assembly session at the Vidhana Soudha on Wednesday.  "We do not support the Governor's speech since this coalition government does not have the support of its MLAs. Congress MLAs are saying their Chief Minister is Siddaramaiah and not Kumaraswamy," Leader of Opposition BS Yeddyurappa claimed.  "Step down, step down. Chief Minister, step down!" BJP legislators screamed, alleging that the JD(S)-Congress coalition government is in power despite not having majority. However, Yeddyurappa stopped short of seeking a no-confidence motion against Chief Minister HD Kumaraswamy.  In the Assembly, Speaker KR Ramesh Kumar adjourned the proceedings till Friday as the BJP members continued their protest and refused to return to their seats to allow Assembly proceedings to continue. The nine missing Congress MLAs include four MLAs who have been absconding since mid-January when Congress herded its legislators to the Eagleton Resort accusing the BJP of trying to poach them. The four missing MLAs are Ramesh Jharkiholi, Mahesh Kumatalli, Umesh Jadhav and B Nagendra. This was in spite of a whip issued by Chief Whip of the JD(S)-Congress coalition government Ganesh Hukkeri asking all MLAs to be present at the Assembly session beginning on Wednesday.  The coalition government is set to present its second budget on Friday. At the same time, Leader of Opposition Yeddyurappa is set to address the media from the Vidhana Soudha's Opposition Leader's office.  In the 225-member Assembly, including one nominated from the Anglo-Indian community, the Congress has 80 legislators, including the Speaker, JD (S) has 37 MLAs, the BJP has 104 and there are two Independents and one from the BSP. With IANS inputs
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Bengaluru lecturer caught with ecstasy drug concealed in notebooks

Drugs
He was arrested on Thursday and officials are investigating if he was part of a larger drug-peddling network operating out of Mumbai.
A lecturer in Bengaluru was caught by the Narcotics Control Bureau on Thursday after he received parcels suspected to conceal methamphetamine (MDMA), a psychotropic drug popularly known as ecstasy, inside notebooks. The 27-year-old suspect holds an M.Tech in Civil Engineering and is an assistant lecturer at a Bengaluru college. He was caught on Wednesday with two parcels containing 16 grams of white crystalline MDMA in his possession after he received the package shipped from Mumbai through a courier service. NCB officials detained the lecturer and seized the drugs when he came to collect it after receiving a tip-off. The value of the drugs seized is around Rs. 60,000. He was arrested on Thursday and officials are investigating whether he is part of a larger drug-peddling network operating out of Mumbai. Officials are now following up on his contact person in Mumbai who sent the drugs concealed in notebooks.   The lecturer was previously an addict who is now peddling drugs in small quantities. This is another case in a growing trend of small-time dopers turning into dealers.  Read: When dopers turn dealers: How India’s party drug users are peddling for a quick buck Ecstasy sold on the streets is frequently mixed with other additives, which increases the risk of nausea, blurred vision and muscle tension.  The effects of MDMA or ecstasy can last from 3-8 hours and include euphoria, heightened emotions, heightened sense of mental clarity, hallucinations, decreased appetite and thirst.  A gram of MDMA costs around Rs. 6,000 while ecstasy pills are sold for around Rs. 1,500 under different names like 'Sprite' and 'Facebook'. MDMA is also the drug of choice in psychedelic parties.
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