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A PUBLICATION OF SIR RONALD ROSS MEMORIAL CENTRE, KOLKATA

Editor : Dr. Ranen Dasgupta, Vol. 2, Issue - 2, October - December, 2014, DL No. 175, Dt. 21.8.2012, Price - Rs. 10/- only

Editorial
Gratitude to Bill Gates - Milenda Gates Foundation for
their contribution towards Global Public Health

BILL GATES

MILENDA GATES

ROSS RABINDRANATH MISSION


Real Danger :
Mosquito-borne diseases, Ebola etc. can wipe out
civilization. So, think globally, act locally.
Urgent Need :
Governments & International Community must take
serious commitment to combat these global threats,
endangering public health. The earth is in crisis due
to global warming.

Sir Ronald Ross is the First Nobel Laureate of


India (1902) and Rabindranath Tagore is the Second
Nobel Laureate of India (1913). Their enormous
contribution in anti-mosquito campaign to eradicate
mosquito- borne diseases and promoting sanitation,
environment and public health has failed to inspire
the Govt. of India, as evident from the fact that India
is the Second lowest performing country on health
and survival, ranking 141 (out of 142), just ahead of
Armenia (World Economic Forum Report, 2014).
Contd. to page 2

SIR RONALD ROSS (1857 - 1932)


The discovery of the cause of malaria
a journey in time
Simon Phillips, MPhil MBBS FRGS
Late Co-Director,
Institute of Refugee Healthcare Studies,
Post Graduate Medical School,
University of Bath, UK
Ronald Ross is rightly renowned and respected for
his discovery of the cause of malaria, possibly one of
the greatest scourges of the human race. However, it
seems right, now that over 100 years have passed, to
put this achievement into perspective for the amazing
application of science and perseverance that the
discovery was. Indeed an example of the change of
scientific and academic mind-set that had occurred in
the 60 -70 years before this.
Contd. to page 2

ERADICATION OF MALARIA
THROUGH COOPERATION
Rabindranath Tagore
(Presidential address before Anti-Malarial Society,
August 1923 Calcutta)
Translated by Dikshit Sinha
At the outset, let me tell you how I met Dr. Gopal
Chandra Chattopadhyay1 during this work. However,
I myself am not a physician and the opinion that I
have about malaria is of little value. You are all aware
that we have an institution called Visva-Bharati; as
part of its work, we are trying to keep contact with the
surrounding villages of Santiniketan. It is true that in
the ashram we are mainly engaged in cultivation of
knowledge but it has always been my view that if
education, school, and colleges are separated from
Contd. to page 2

The history of malaria contains a good lesson for humanity. We should be more scientific in our
habits of thought & more practical in our habits of government.
Sir Ronald Ross

Ross Rabindranath Mission : Contd. from page 1

Recently, Nobel Peace Prize (2014) was awarded to an unknown Indian Kaliash Satyarthi, who devoted his
40 years of life to save children through Bachpan Bachao Andolan, along with Malala Yousafzai, who is the
leading spokesperson for girls right to education. Thus, the rights of the children in this world have been
internationally recognized. Mortality among children due to mosquito borne diseases, Ebola etc. is enormous.
But, right to health for children and pregnant women, especially, is not a priority, in practical sense.
Almost 40 percent of the population of India (about 1.52 billion) consists of children who are below the age
of 18 years. India has no dearth of money to build a 182 meter statue of an architect of united India at the cost of
Rs. 3000 crores but is neglecting public health at the cost of promoting corporate health.
Us Philanthropist Bill Gates has announced he will donate over $500 million to fight malaria and other
infectious diseases in the developing world, saying the Ebola outbreak is a call to action. Bill Gates also said that
in addition to that pledge, his foundation has boosted its annual funding for malaria by 3% (AFP, The Times of
India, 4.11.14)
25 Crore Indians are in great peril due to mosquito-borne diseases. Gujarat (Industrial Capital), Mumbai
(Financial Capital), Delhi (National Capital), Kolkata (Cultural Capital), Bengalaru (IT Capital) are plagued with
mosquito borne diseases the dreaded terrorist to public health. But there is no serious pro-active actions from
corporate NGOs and Governments, corporations.
Once Singapore and Cuba were mosquito ravaged but they defeated the mosquito terror and gained
international acclaim due to best public health service. They prefer health over petty politics.
India, is yet to understand that Health is wealth, Mosquito-borne diseases should not be taken casually,
when Ebola can hit India like U.K. & USA and devastate the whole economy as a bolt from the blue and thus
shattering Indias dream to be a global superpower by 2020. Will Govt. of India listen?
Ranen Dasgupta
ranendasgupta@yahoo.in

General Secretary
Sir Ronald Ross Memorial Centre, Kolkata

Sir Ronald Ross (1857 - 1932) : Contd. from page 1

Malaria has been known over centuries as a killer, not only in the Far East. In Western Europe it was
variously know as the ague (UK), the sweating sickness (commonly everywhere), paludisme (France) and so on.
I have little knowledge of traditional Indian or Chinese medicine, but I am sure they have specific names for the
same condition. Western Medicine confines its nomenclature of the disease to the symptoms it causes. Ague
was the term used in the Essex marshes and the Fenlands of England. It describes a disease of aches and
sweating with general debilitation, and was almost always associated with low-lying marshy ground and standing
water. The Sweating sickness is obviously descriptive of the symptoms, while the French name, paludisme,
literally means a disease associated with the marshes (after the Latin palus = marsh). The one thing none of
these names does is to make any mention of its cause by, or even association with, insects.
This is perhaps hardly surprising. In England by the mid 1800s, medicine had hardly progressed far beyond
the Hippocratic (Hippocrates of Kos (c. 460 c. 370 BCE), considered the Father of Western medicine) view of
medicine, isonomia, the preponderance of one of the 4 bodily humours - yellow bile, black bile, phlegm and
blood with their associated elements and seasons (yellow bile: fire and Summer; black bile: earth and Autumn;
phlegm; water and Winter; blood: air and Spring). While such ideas arose from speculation rather than
experimentation, observation played a large part. The human internal structures were known primarily through
analogy with animals, inferences from visible external structures, from natural philosophy and function. While
such ideas may seem extraordinary now, they were a great improvement of what preceded them, sacrifices and
the supernatural! However, miracles, sacred magic and the influence of the Church were still practiced in
Europe until their influence was rejected by Paracelsus (1493 - 15421).
The Greek Galen was one of the greatest surgeons of the ancient world who performed many major operations
including brain and eye surgery. These were not attempted again for almost two millennia. After the Roman era,
400 AD approx., the study and practice of medicine went into deep decline. In medieval Europe, Galens writings
on anatomy became the mainstay of the medieval physicians university curriculum but they suffered greatly
from stasis, intellectual stagnation and the stifling influence of the Church. In the 1530s, however, Belgian anatomist
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and physician Andreas Vesalius took on a project to translate many of Galens Greek texts into Latin. Vesaliuss
most famous work, De humanicorporisfabrica, was greatly influenced by Galenic writing and form. The works of
Galen were regarded as authoritative until well into the Middle Ages.
The beginnings of what we would recognise as modern medicine were to be found in the 13th century when
universities such as Padua and Bologna started teaching on the basis of dissection, but it was not really until the
Age of Enlightenment in the 1700s that science began to ascend and physicians became more scientific. Until
1696 London had only one major hospital, St. Bartholomews (Rosss alma mater) which dated from the 1200s.
This changed with the opening of then Peoples Dispensary and then Guys Hospital in 1721. The practice of
medicine also changed in the face of rapid advances in science, as well as new approaches by physicians.
Hospital doctors began much more systematic analysis of patients symptoms in diagnosis. Among the more
powerful new techniques were anesthesia, and the development of antiseptics. Actual cures were developed for
certain endemic infectious diseases but the decline in many of the most lethal diseases was due more to
improvements in public health and nutrition than to medicine. It was not until the 20th century that the application
of the scientific method to medical research began to produce important developments in medicine, with great
advances in pharmacology and surgery.
In terms of medicine in Europe, one of the disasters for its inhabitants was the suppression and destruction
of the works of Muslim scientists. The Islamic civilisation rose to primacy in medical science as its physicians
contributed significantly to the field of medicine in all areas (anatomy, surgery, pharmacology and so on). The
Arabs were influenced by, and further developed ancient Indian, Greek, Roman and Byzantine medical
practices.The translation of 129 works of Galen into Arabic by the Nestorian Christian HunaynibnIshaq and his
assistants, and in particular Galens insistence on a rational systematic approach to medicine, set the template
for Islamic medicine, which rapidly spread throughout the Arab Empire.
Two things come to mind here. The Muslims were using general anesthetics in ~1000 AD. The author has in
his possession a picture (taken in 2008 in the Damascus Museum of Ancient Medicine) of the physician Abu AlKasim Al-Zahrawi operating on a patient with a general anesthetic, some derivative of the opium poppy, being
delivered over the patients face with a sponge. A further photograph shows how the opium was infused into the
sponge in a clay vessel, the vessel itself being an original. Al-Zarawi was born in the city of Cordoba in Spain in
936 AD. General anesthesia was not used in the Western World until the 1840s.
The next brings us right back to malaria. In a study of the population movements in the Southern Levant,
and the adaptation of local population of agriculturists (Fellahin) and nomads (Bedu) - the population dynamics
and exploitation of the ground in this area from VI - XVI Cent1 , a key concept is that of the rif which may be
conveniently described as the edge of irrigated and cultivated ground where water may stand after the irrigation
process. The authors postulate that this knowledge was why the Prophet Mohammed forbad his bedouin followers
to camp at the bottom of valleys, along the axis of the slopes (run-off slopes) where water was used, the length
of water sources and paths, all rendez-vous des insects nocturnes (the collecting point for nocturnal insects).
Furthermore the poet of the 13th Century, IbnMayyada, reinforced the natural tendency of the calif al-Wahid II
ibnYahid II in his preference for the desert over the rif. Le voisinage des sources ne nous convient pas; les moustiqueset
les fievres nous y dvorent (Being near to water is not good for us; mosquitos and fevers devour us).
Again, terrorised by marsh fever (malaria) which was unknown in the desert, the scribe Al-Jhith (781 - 868/
869) as a spokesman for the Bedouin, warned Gare au rif! En approchersignifie la mort, la perdition court
term (Beware of the rif. Going near it signifies death, perdition in the short term).
Conversely the reason why this problem was not apparently met, or described in regard to the Crusader,
Ayyubid and Mamluk settlements, and castles is probably simple. They were built on hills.
What relevance is all this to the achievements of Sir Ronald Ross? Ross was born in 1857. In 1832 as part
of the world pandemic, a major epidemic of cholera, King Cholera, hit the United Kingdom. A further major
epidemic arrived again in 1849 claiming twice as many lives (14,137 people). During the pandemic of 1851, a
mere six years before Rosss birth, the world-wide scientific community varied in its belief of the causes. For
instance in France the general belief was that it was related to poverty, while the Russians believed it was
contagious but they were not sure how. In Britain, however, there were still some who thought the disease might
arise from Divine intervention!
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The causes of cholera were not known but the most widely accepted notion was that the disease was due to
air-borne miasma. Similarly the transmission of malaria was thought to be miasmatic. The word malaria comes
from the Latin and means bad air. Because of the cholera/miasmatic theorys predominance among scientists,
the 1854 discovery by Filippo Pacini of Vibrio cholerae, the bacterium that caused the disease, was completely
ignored until it was rediscovered thirty years later by Robert Koch. In 1854, a London physician Dr John Snow
postulated that the disease was transmitted by drinking water contaminated by sewage after an epidemic centred
in Soho, but this idea was not widely accepted. However, the summer of 1878 was excessively hot and London
fell victim to what was called The Great Stink. The Thames and all its subsidiary water courses and supplies
were open sewers. Even the wells and pumps from which domestic supplies arose were contaminated. A massively
expensive scheme was put forward in 1859 by Joseph Bazalgette to improve the sewers in London. It was hoped
that by relieving the stench, according to the miasma theory, it would also rid the city of cholera. Although the
new sewerage system vastly improved the situation, it was not until 1867, after the last epidemic of 1860, that it was
shown that polluted water was still entering the London water system from elsewhere, and by finally eliminating this
source as well, cholera was beaten in London for ever. The water-borne transmission of disease had been proved.
By 1871, Berlin was becoming a leading centre for medical research. Robert Koch (18431910) was a
representative leader. He became famous, among other things for isolating Bacillus anthracis (1877) - the cause
of Wool-sorters lung; the Tuberculosis bacillus (1882) - consumption, phthisis and the curse of the chests of the
population of London aggravated by the evil London smogs; and Vibrio cholerae (1883) - cholera. He was awarded
the Nobel Prize in Physiology or Medicine in 1905 for his findings on tuberculosis, three years after Ross.
To put all this into context, Muslims had posited that mosquitoes, or certainly nocturnal insects, were the
cause of the fevers they associated with stagnant water (the rif) before the end of the first millennium. It took two
and a half millennia for the doctors of Western Europe to begin to accept the theory basically proposed, that
malaria was transmitted by mosquitoes, in opposition to the centuries-old medical dogma that malaria was due
to bad air, or miasma. Although the first scientific idea was postulated in 1851 by Charles E. Johnson, who
argued that miasma had no direct relationship with malaria, this hypothesis was largely forgotten until the arrival
and validation of the germ theory of diseases in the late 19th century began to shed new light. When it was
demonstrated that malaria was caused by a protozoan parasite in 1880, the miasma theory began to subside. It
was not until 1877 that it was proven that the mosquito could transmit parasites to humans, and Rosss discovery
of the means of transmission of the malarial parasite on 20 August 1897 was the proof of what the Muslims
feared two millennia earlier.
It was a long long journey!
Yet truly can it be said thatA prophet is not without honour, save in his own country (Matthew 13:57 - King
James Version). The present author and his wife, who is distantly related to Ross, both trained at St. Bartholomews
Hospital, exactly as did Ross. The name of Ross was not mentioned to us throughout our training, and speaking
with our contemporaries none of them were aware of him at that time, although some became aware of him in
postgraduate work, although not necessarily that he trained at Barts.
Ross does not feature in the Wikipedia internet article on the hospital either as a notable member of staff,
which, of course, he was not, but not even as a notable Alumnus. And yet he was awarded the first Nobel prize
for anyone with any close connection to the hospital and was one of only three Nobel Laureates connected with
the hospital, the others being:- Sir John Vane - Nobel Prize in Physiology or Medicine in 1982 and Prof Sir Josef
Rotblat - Nobel Prize for Peace in 1995. Ross was, however, the only one to have actually trained at Barts. The
other two were both staff members. He does, however, merit an entry in one of the more authoritative books
about the Hospital The Royal Hospital of Saint Bartholomew 1123 - 1973 ed. Medvei VC and Thornton JL 1974
p 276: ..and Sir Ronald Ross (1857 - 1932), who came to Barts in 1875, joined the Indian Medical Service
and was a pioneer in tracing the spread of malaria by mosquitoes. No mention of a Nobel Prize there! The
authors do not even seem to appreciate what it was that Ross actually achieved.
Rosss name was initialled preserved by the founding of The Ross Institute and Hospital for Tropical Diseases,
opened in 1926 on Putney Heath by the Prince of Wales as a memorial to, and in recognition of, Ross work.
However this no longer exists as a separate entity but has been absorbed as The Ross Institute into the London
School of Tropical Medicine and Hygiene. The remaining vestige of Rosss name is in the title of Ross Professor
Emeritus within the School.
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Sir Ronald Ross seems to be slowly being airbrushed out of the English version of the history of medicine.
Most of us can remember historic greats from the medical world; Koch, Marie Curie, Fleming, Florence
Nightingale, Pasteur to name but a few. But Ross . . . .?
Ross is certainly more appreciated now in Kolkata where he carried out the majority of his experimental
work, and in India generally, than he has been allowed to become in the country which trained him.
Long may the Ross Memorial perpetuate his name.
I am indebted to Prof. Claudine Dauphin for her help with this section. Prof. Dauphin is Honorary Professor in Archaeology
and Theology of the Universities of Wales, and a member of the French Centre National de la Recherche Scietifique at
'Orient et Mditerane - Monde Byzantin'in Paris. She kindly gave me a copy of an article based on her lecture (the The
Council for British Research in the Levant (CBRL) 25th Anniversary Crystal Bennett Lecture given at the Institute of
Archaeology on 23 April 2013) and subsequently published in Bulletin of the CBRL: 8, 2013.. The title of the CBRL article
is Fallahinand Bedu between the Desert and the Sown: the population Dynamics of a buffer-zone from Byzantium to the
Mamluks. A fuller version in French is published in the technical journal Gomatique Expert: No. 95; Nov - Dec. 2013
entitled Paysanset Pasteurssur les marched du Levant Sud" pp 30 - 53. The sources for the more esoteric Muslim authors
quoted may be found therein.
Eradication of malaria through cooperation : Contd. from page 1

the totality of life, it does not blend well with the inner spirit, it cannot be made part of the life. For this, we are
trying to merge the life process of the villages with the pursuits of knowledge with whatever little resources we
have. This work was going on. Here, in this hall, we discussed about this before. Those who were in the hall
before, know how we are carrying out our work. When we first took up work, we first found a scene of diseases.
We are non-businesspersons; we did not have courage then to appeal to the people of the country who had
experience in eradication of diseases of the villages to come forward to help us. Whatever we could, we did it
ourselves. In this connection, we acknowledge with deep sense of gratitude, the help we received from foreigners.
We got the support of an American woman in this regard2 . She is not a doctor, she acquired knowledge from her
direct hands-on experience by nursing patients during the War. Depending on that, she went from door to door of
the patients, negotiating knee-deep mud; she nursed the poorest of the poor at their huts, provided nourishments
to them. Deep festering sores the sight of which even our gentry abhorred- she herself cleaned all these
bandaged the wounds of low caste patients, gave them nutritious diet. She is working until today; she did not
relinquish her work even when the intense heat exhausted her. When her health broke down, she went to Shillong
for a few days, on her return, once again she is putting herself to her physical limits. We got her help like this.
She will have to go back to her country, but she is continuing to provide nursing and succour to her physical limits
during the few days that remains.
Another benevolent Englishman, Elmhirst, has come bearing his own expenses, collecting fund from the
overseas without keeping a farthing for himself. No word is sufficient to describe how he is working day in and
day out, visiting the surrounding villages, striving hard to alleviate the miseries of the villages. We are working
with the help and support that we received from these two persons hailing from foreign countries.
This much you should understand that it is a fight between insects and men. The vector that carries our
enemy-disease occupies a long stretch of land. It is not possible to get hold of such a small insect within such a
vast territory. At least, it is impossible for one or two individuals to achieve anything unless we cannot work
collaboratively. We were groping, merely trying, at that juncture one of my former students, who is a student of
medical college, came to me and said, Gopalbabu is a renowned Bacteriologist, he is even well-known in Europe.
He is a famous man, earns quite a lot. The fight against malaria that you are about to take up, he himself has
begun this work. He has vowed to work to the extent possible to save Bengal from this formidable enemy even
at the cost of his profession. When I heard this, I got interested. I decided to claim his support in our venture. Not
for the reason that we shall get tool to kill mosquitoes, we realized, we have information about such a rare
person who is involved in the work; not on the basis of anger, envy or excitement, nor was he driven by external
forces but for the sole purpose of saving the people of the country, sacrificing his self-interest, even though it
cost him personal loss. Such examples are rare indeed. A sense of piety arose in my mind, I said I want to meet
him and discuss this. He himself came to meet me - I heard from him how he has begun this work. Then it came
ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

to my mind that we would remain grateful if we could take part along with him in this work, not for success it
would be a matter of great honour if we could join in a work of such a man.
You have noticed that after the war the talent of the people of Germany-Austria was on the decline, this was
because of physical weaknesses born out of starvation. When the blockade prevented reaching food, it resulted
in death of a large number of people but this was not the biggest thing. The children who needed milk, pregnant
mothers who required nutritious food, when they did not get it, children were born on this earth malnourished.
The result is that when they would grow up they would not be able to stand up on the strength of that much of
intelligence. Therefore, from this point of view, mere headcount do not constitute population; we have to find out
how much those who have intelligence are effective. Mere physical counting is not proper. In Bengal, we are not
aware that everything connected with our sources of health is drying up. By carrying the burden of diseases, we
bear a permanent source of debility in our blood. How many people are born every year, how many are dying,
how the number is increasing is not important; whether those who survived are living like a proper human being
is the moot point. Their effectiveness, whether they have the ability to exercise their mind is the vital aspect. If
the majority were, half-dead then the people would not be able to carry this burden. From physical debility,
mental weakness arises. Malaria produces ill health in the blood, and with that, we do not also have strength of
mind. Only those who are full of life can make sacrifice in life. Those who somehow survive do not have an iota
of surplus left beyond their own requirements; no generosity is left in them. If there is no generosity then no
civilization can be built. Where there is stinginess in life there is littleness of spirit. In no other civilization such
enormous decay of life has occurred. One has to keep in mind, distress do occur in all countries. But what
constitutes humanitarianism of a human being? That it is not to accept distress as inevitable, to strive to mitigate
any misfortune whenever and wherever it arises, to keep this resolve in mind. Up to this time, we have said,
malaria is spreading throughout the country, how can we fight them, how can we drive out million and millions of
mosquitoes; government is there but doing nothing what can we do! That cannot be the plea. When we are
dying in hordes many are seemingly dead even though they are not if we cannot solve this by any means,
there is no escape. Malaria is the fountain head of other diseases. From malaria tuberculosis, dyspepsia and
similar diseases arise. The Lord Yama gets through with ease when the main door is open. How can we fight with
them? At first, the door has to be closed, if only that results in saving the Bengali race.
There is another point you need to ponder. If we can drive out the mistrust that we have about ourselves in
anyone area all the misfortune that we have so long accepted as our predestined fate, if we can go against this
grain of thought on any pretext - then great service will be done. Howsoever the great the enemy may be, we will
not accept their dictates, will not keep alive any mosquitoes, by whatever means we will eradicate them if we
can gather this courage then it is not only mosquitoes but we will win over far greater enemy, our own inferiority.
Another point for meeting with people we need various occasions. Many such occasions are necessary so
that people of all ages can come together. Not many understand what does a Country means, and many do not
know what swaraj is. But not a single person is there who does not know the meaning of getting together. But if
in any one village the intensity of the diseases can be reduced to some extent by collective efforts then there is
nothing like this as an occasion for coming together of all the educated and the illiterates. Gopalbabu has begun
this work. The name of the Mandals have been mentioned; I am happy to know that this Mandals stood side by
side on the same ground and collaborated to kill such a tiny enemy like mosquitoes. Nothing can come close to
this as a good omen. For, welfare of others is the responsibility of all, each one is responsible for the welfare of
everyone and others welfare is the greatest good - if this lesson, instilled as much as possible through innumerable
occasions in our country, it is so much the better. A road passing through a village, developed a pothole in one
place caused by the passage of bullock carts not more than 4-5 arms length during monsoon knee-deep
mud accumulate in it, men and women, old and young, negotiate this pothole for going to the market. People
living in adjacent two villages who face the hardship most do not say, let us put one or two spades of soil over it
to make it level because they are afraid lest they are cheated. They think, It is we who will put in the labour and
its benefits will be enjoyed not only by others too, then it is better still that we also suffer. I have narrated before
you another incidence - one village used to suffer every year from fire, there was no well in the village, I proposed
to them, You dig the well I shall provide the masonry part. They said, Babu, you want to fry fish in its own oil.
That is, we will put half of the labours but you derive the whole of the piety. It is better still we die from want of
water on this earth, but we cannot stomach the salvation that you would reap cheaply in the next world.
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There are other such examples in the country. Even it is present among the gentry in various guises, I do not
have the courage to discuss these. People will understand from the kind of work that Gopalbabu is engaged in;
the mosquitoes that breeds in the shallow pond next door also sucks my blood without any prejudice, therefore
his work of de-silting ponds also is my work.
Gopalbabu is engaged in a great work; a pure good sense attracted him to this work, devoid of any greed,
anger, and jealousy. This example of great humanism is no less important to us than killing mosquitoes. For this,
I pay my gratitude and respect to him.
[Translators note: This was a public lecture. Hence, the sentences were long, syntactically complicated, with little breaks
in paragraphs, giving it an interminable look unlike the poets writings, making the translators job difficult one. However,
we have tried to be as faithful as possible to the meaning and spirit of the lecture. Transcription has been avoided as far as
possible.]
Notes :
1. Dr. Gopal Chattopadhyay (1869-1953), a renowned Physician and bacteriologist by profession, was a pioneer in
instituting Anti-Malarial Cooperative Societies in Bengal from 1917. He began his campaign against malaria from his
own village, Sukhchar, near Panihati, 24 Parganas, and then slowly covered the whole of Bengal, except the hills of
Darjeeling. When exactly the poet met Dr. Gopal Chattopadhyay is not known. Dr. Chattopadhayay delivered lecture
with film show about the depredation caused by malaria in the evening of the Anniversary meeting at Sriniketan on 6th
February, 1924 (Santiniketan, [Falgun-Chaitra(Feb.-March),1330] 1924). Rabindranath delivered his first Presidential
Address before the Annual meeting of Anti-Malarial Society on 29th August, 1923. Therefore, he might have met him
before this. Collaboration between Anti-Malaria Society and Sriniketan began. The Santiniketan journal in its Vol.4(9)
reported that some office bearers of the Anti-Malaria Society and a Doctor visited the villages in 1923.Was he part of
it? In fact, Anti-Malarial work started at Sriniketan from the end of 1922 itself. Santiniketan took up the work even
before this, most probably, on its own initiative.
2. Miss Gretchen Green, a nurse of the Baptist Mission Hospital, U.S.A., came to Sriniketan at the end of 1922. At that
early stage of Sriniketans developmental efforts she provided yeomans service by organizing the health work and
also fought ceaselessly against malaria. She will be remembered for her maternity work and direct medical help to the
needy of the outlying villages. The Sriniketan dispensary at that time was not fully ready. She along with Kalimohan
Ghosh collected medicine from the shops of Calcutta for treating the patients of the villages and was responsible for
laying foundation of the health work ( See Gretechen Green, The Whole World and Company, Reynol Hitchcock, NY,
1936). She left on March 1924.
3. Leonard Knight Elmhirst was one of the architects of Sriniketan. He and his wife Dorothy W. Elmhirst provided nearly
all the required fund for running the developmental works at Sriniketan.

LABORATORY DIAGNOSIS OF MALARIA


Dr. Shanaz Latif
Consultant Pathologist
R. N. Tagore Hospital, Kolkata
Diagnostic procedures for the detection of malaria
differ considerably depending on the aim of evaluation.
The current requirements of any laboratory procedure
for general application to the detection and diagnosis
of malaria include: sensitivity, specificity, simplicity in
application, unambiguous interpretation and rapid
turnaround time. Presently, the differential stained thick
and thin blood smear examined under the microscope
remains the most reliable and definitive test (Gold
standard) for diagnosis of malaria.
However, lack of skilled microscopists, limited
supply and maintenance of microscopes and reagents,
delays in results and inadequate quality control are
some of the factors at the periphery of health care
system as a result in these areas a clinical diagnosis
of malaria is made and early treatment of patients

started, although, this in some cases results in over or


under treatment. WHO recently reiterated the urgent
need for simple and cost effective diagnostic tests for
malaria to overcome the deficiencies of both light
microscopy and clinical diagnosis.
The routine use of thick and thin films is advised for
malaria diagnosis. Thick films should be exposed to
acetone for ten minutes, then stained without further
fixation, using Giemsa or Fields stain. Thin films should
be exposed to acetone for one minute and then either
stained with a Leishman stain (methanol based) or
methanol fixed and stained with a Giemsa stain. Thick films
should be examined at least 100 microscopic fileds
necessary to count 200 leucocytes for an adequate period
of time by two observers. If thick films are positive, the
species should be determined by examination of a thin film.
Whenever, Plasmodium falciparum is detected, the
percentage of parasitized cells should be quantified and
reported promptly since the severity of parasitemia
affects the choice of treatment. Quantification should

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

be performed using a thin film, a minimum of thousand


RBC should be examined in different areas of the film.
Only asexual stage parasites should be counted in at
least 25 microscopic fields. Thick films are about eleven
times more sensitive than the thin films; an experienced
microscopist can detect parasite levels (or parasitemia)
as few as 5 parasites/l of blood.
In recent years it has been found that rapid dipstick
antigen capture tests for the circulating Plasmodium
falciparum specific antigen HRP2 have excellent
sensitivity and specificity for the diagnosis of Plasmodium
falciparum malaria, generally at least as good as
microscopy of a thick and thin film by a skilled microscopist.
Rapid antigen detection tests (RDTS) cannot
replace microscopy but are indicated as a
supplementary test when malaria diagnosis is being
performed by relatively inexperienced staff e.g., in low
prevalence areas and outside normal working hours.
Immuno-chromatographic antigen-detection tests
use finger stick or venus blood, the completed test
takes a total of fifteen to twenty minutes and the results
are read visually as the presence or absence of
coloured stripes on the dipstick. The threshold of
detection by these rapid diagnostic tests is in the range
of hundred parasites/ul of blood (commercial kits can
range from about 0.002 percent to 0.1 percent
parasitemia) compared to five by thick film microscopy.
One disadvantage is that dipstick tests are qualitative
but not quantitative, they can determine if parasites are
present in the blood, but not how many.
Rapid diagnostic tests (RDTS) detect either
Plasmodium falciparum specific or histidine rich protein
2(HRP 2) or species specific parasite lactate
dehydrogenase (pLDH).
The main advantage of RDTS is that they provide
a means for rapid diagnosis, especially in areas where
microscopy is not practical (e.g., areas with limited
health resources.) The disadvantages of RDTS include
the inability to distinguish between infection and recently
treated infection. In addition even with a positive RDT
a blood film is still necessary for confirmation of species
and for a parasite count to help guide treatment
specially in cases of Plasmodium falciparum. PCR is
usually available in reference laboratories. It maybe
used to confirm the diagnosis of malaria in cases where
microscopy is negative but there is high clinical
suspicion of disease or to determine the species when
it is not possible to distinguish on light microscopy.
Saliva is a promising diagnostic fluid for malaria
when protein degradation and matrix effects are
mitigated. Concentrations of Plasmodium falciparum
HRP2 in saliva of suspected patients is measured using
a custom chemi luminescent ELISA in microtitre plates.
8

Systematic quantification of other malaria bio markers in


saliva would identify those with the best clinical relevance
and suitability for off the shelf diagnostic kits.
UCLA Biomedical Engineering students are
working to develop a diagnostic tool for malaria where
the testing is done by using saliva. The idea called
Maliva is for chewing gum to contain small coloured
and magnetised particles coated in antibodies that bind
to proteins expressed from the malaria parasite.
On chewing this gum, there is salivation this supplies
the antigen. After a few minutes of chewing the gum is
removed and passed over a small magnet. If malaria biomarkers are present the magnet will concentrate the
particles to form a visible line, much like a pregnancy test
strip. The particular strain of malaria can also be indicated
depending on the colour of the line. However, the gold
standard of diagnosis is microscopy.

LABORATORY DIAGNOSIS OF DENGUE,


JAPANESE ENCEPHALITIS AND
CHIKUNGUNYA FEVER
Dr. Debashis Chakraborty, M.D. (Pathology)
Associate Professor Dept. of Pathology, IPGME&R/
SSKM (PG) Hospital, Kolkata
Recently, three viral diseases mainly Dengue,
Japanese Encephalitis (JE) and Chikungunya viral
infection, are in top news because of a few frequent
small epidemics of these diseases in different parts of
India in recent past. The present brief account will deal
with laboratory diagnosis of these diseases.
Dengue
Dengue (DEN) and dengue Hemorrhagic fever
(DHF) both are caused by Dengue virus, a virus of
flavivirus group. The other important viruses in this
group are Japanese encephalitis, Hepatitis, West Nile
Blue fever, Kyasanur forest Disease, yellow fever etc.
The main symptoms of Dengue are fever, headache,
retrobulbar pain, severe muscle and joint pain (Breakbone
disease) and hemorrhagic manifestations.
Laboratory diagnosis of Dengue includes
1.

A rising hematocrit (PCV), due to leakage of plasma


(To remember, PCV may be raised in polycythemia,
burn, bleeding etc.). Depending on PCV, fluid
therapy is adjusted.

2.

Platelet count may be reduced : It is important


to perform serial platelet count, as single
examination revealing low platelet count may be
confusing and create undue panic even among the
doctors.

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

3.

4.

5.

6.

White cell abnormalities, usually leucopenia and


reactive lymphocytes, (these may be found is other
viral infections also).
Coagulation test : Bleeding time (BT) and
coagulation time (CT), though not very specific, are
prolonged. PT (Prothrombin time) and APTT
(Activated partial thromboplastin time) two tests
basically aiming at abnormalities both in the
extrinsic and intrinsic pathways of coagulation
are prolonged. It is important to remember that,
both PT and APTT rises in DIC (Disseminated
Intravascular Coagulation), a shock-like fatal state.
Biochemical tests : These are mainly for
monitoring, include serum transaminases,
electrolytes, urea, creatinine and albumin etc.
Specific tests : These include
i) Virus Isolation : Not practicable except for
research purpose.
ii) Viral Nucleic acid detection : By Reverse
transcription-polymerase chain reaction (RTPCR) : Better than virus isolation.
iii) Immunological response and serological test.
There are a) Haemagglutination Inhibition (HI),
b)
Complement
Fixation
(CF),
c) Neutralisation Test (NT), d) MAC-ELISA (IgM
antibody Capture Enzyme-linked Immunosorbent
Assay, e) Indirect IgG-ELISA, f) IgM/IgG ratio
Of all these six types, MAC-ELISA is the most
specific.
iv) Viral Antigen detection : ELISA and dot blot arrays
directed against envelope/membrane (EM)
antigens and non-structural Protein-I Antigen
(NS-1 Antigen) can be detected in both primary
and secondary dengue infections upto 6th day
from the start of illness. Different commercial kits
are available for detection of NS-1 Antigen.

It is important to remember that i) Dengue IgM


becomes positive after 5 days of onset of symptoms,
and positive IgM means it is primary dengue infection.
The IgM titre rises upto 2-3 weeks, and falls slowly after
4th week. ii) Dengue IgG is positive after 14 days and
is present in low titre throughout life. iii) Both IgM and
IgG kit tests may cross-react with other flavivirus
infections including Japanese Encephalitis (JE). Yellow
fever, Western Blue Nile fever, Kyasanur Forest
Disease (KFD) etc. So, confirmation of Dengue is to
be done based on Dengue MAC-ELISA.
Japanese Encephalitis
Japanese Encephalitis is an arboviral disease,
presenting with Acute Encephalitis Syndrome (AES).
So, the aims of diagnosis are basically three

i) To establish the diagnosis of AES. ii) To exclude other


causes of Acute Encephalitis Syndrome (AES). iii) To
confirm the diagnosis of JE.
The basic treatment protocol for all AES,
particularly viral AES, are same. So, the diagnostic
specificity of JE virus is more important for taking public
health actions rather than specific treatment, if at all.
CSF study :
CSF protein, like all viral AES, does not rise. The CSF
cell count show a modest rise only.
Viral tests :
CSF shows at least 4 fold increase in 1gG in paired
sera (with 14 days difference).
Specific test :
i) CSF shows presence of JE IgM antibody. ii) Virus
Isolation from brain tissue. iii) Antigen detection by
Immunofluroscence. iv) Nucleic Acid detection by PCR.
For confirming the diagnosis of AES/JE, IgM
capture ELISA (MAC ELISA) is to be done in the sentinel
surveillance network. The virus isolation is to be done
in National Reference Laboratory.
Chikungunya Virus
Chikungunya is a viral disease, caused by CHIK
virus belonging to togaviridae family of genus Alpha
virus, characterized by sudden onset of fever, arthritis
and rash, and is usually self-limiting. It is, like dengue,
carried by Aedes mosquito, namely stegomyia
sugenous. Recent outbreak in Indian ocean areas is
due to Aedes albopictus.
Laboratory diagnosis of Chikungunya includes
i) Leucopenia, sometimes thrombocytopenia,
ii) Increased serum AST (Aspartate Transaminase),
iii) Increased CRP (C-Reactive Protein).
For a subset of patients with persistent disease,
often presenting with recurrent pleural effusion HLAB27 testing is very important (These patients are HLAB27 positive, so HLA-B27 testing has a good
predictability for chronic disease of Chikungunya.
Chikungunya virus Isolation can be done from
blood of infected patients, inoculated on suckling mice
or VERO cells.
Conclusion
The diagnosis of the above three diseases are
mainly clinical. Laboratory tests, as usual are for
confirmation, monitoring and exclusion. All three are
urban; JE and Chikunguya also may affect rural
population. Vector control, improved hygiene and timely
intervention based on good surveillance are needed for
their control.

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

MALARIA IN PREGNANCY
Dr. Sujoy Dasgupta
MS (Obst & Gynae)
Senior Resident, Deptt of Gynaecological Oncology,
Chitaranjan National Cancer Institute (CNCI), Kolkata
(Dedicated to Late Dr. Sundari Mohan Das for his
pioneering contribution on this topic in the world)
Among all vector-borne diseases, malaria
continues to pose serious public health threat in the
developing countries. Malaria affects more than a billion
of people worldwide and is responsible for more than a
million deaths1. The name of the disease malaria (bad
air) was given as far back as 17532. And it is interesting
to note that the treatment of malaria became first
established (in the middle of 17th century) before
anything was known about its etiology. Laveran (1880)
first discovered the malarial parasite in an unstained
preparation of fresh blood. It was Sir Ronald Ross from
Calcutta (1898) who worked out the mosquito cycle of
the parasite2. Four species of the genus Plasmodium
have been recognized to cause human malaria, viz, P.
vivax, P. falciparum, P. malariae and P. ovale. It is
transmitted by the bite of infected female Anopheles
mosquito that innoculates the sporozoites into human
blood. Apart from this, trophozoite-induced malaria has
also been described, that is transmitted by blood
transfusion 1.
Pregnancy, on the other hand, is a unique condition.
No other physiological events in adult life witness such
major changes in all the organ-systems of the body, as
those occur in pregnancy. Any infection occurring in
pregnancy may prove fatal for both the mother as well
as the baby. Again, clinical and laboratory parameters
change in pregnancy; so caution should be observed
to interpret these results. Treatment is also complicated,
because of changes in maternal pharmacokinetics and
concern of effect of the drug on the unborn fetus.
Pregnant women are more susceptible to malaria
due to attenuation of malaria-specific immunity. The
immunity is regained toward the end of the pregnancy
but is lost once again in subsequent pregnancies 3,4.
There is a progressive rise of immunity with increased
parity. Thus, primigravidae are at highest risk 5 .
Parasitaemia peaks during 2nd trimester, followed by
higher incidence of anaemia 6.
Also, pregnant women tend to have more severe
complications than nonpregnant counterparts 7 .
Especially, they are prone to develop hypoglycaemia
and cerebral malaria even at very low peripheral blood
parasitaemia. Apart from them, all the other
10

complications of malaria are common and may prove


fatal. Examples include- hemolytic anaemia, folate
deficiency, hyperpyrexia, lactic acidosis, disseminated
intravascular coagulation (DIC), renal failure, pulmonary
oedema, circulatory collapse, jaundice, black water
fever and dyselectrolytemia. In severe P. falciparum
malaria, case fatality rate in nonpregnant women is
15-20% whereas it is as high as 50% in pregnancy8.
And non-falciparum species are not totally benign9.
McGregor, 1993 suggested that the malarial
parasites, especially P. falciparum have a high affinity
for placenta, probably due to establishment of a new
low-resistance vascular system, which provides a safe
heaven away from the host-effector defense
mechanism, providing free and unhindered replication
of the parasite in the schizogony phase6. Incidence of
placental involvement during pregnancy in women living
in endemic areas varies between 16 and 60%7 . Heavy
placental parasitaemia may lead to abortion, preterm
labour, still birth, low birth weight, intrauterine growth
restriction (IUGR) and failure to thrive. However,
congenital malaria is uncommon, due to passive
transfer of IgG antibody across placenta that provides
protection to the neonate for up to 6 months 10 .
Conversely, in nonimmune women of nonendemic
areas, there is increased risk of congenital malaria of
the offspring 7. The Royal College of Obstetricians and
Gynaecologists (RCOG) defined congenital malaria
as malaria in very young infant due to passage of infected
RBC or parasites from the mother in utero or during
delivery, not due to mosquito bites11. It is characterized
by progressive anaemia, jaundice, slow growth and failure
to thrive and is very difficult to diagnose.
So, any pyrexia in a pregnant woman should be
investigated and malaria must be ruled out, especially
in endemic area. Microscopic tests are gold standard
and are recommended by RCOG for selection of proper
antimalarials11. Three negative smears at intervals of
12-24 hours can safely rule out malaria 11 . Nonmicroscopic tests (PCR etc) and rapid tests are also
available but cannot replace microscopic tests11.
Treatment should be prompt and needs
multidisciplinary approach. Any pregnant woman with
malaria should be hospitalized and supportive treatment
should be initiated. Antipyretics should be given for
control of temperature. Blood glucose and electrolyte
balance should be maintained. If the patient vomits,
one should not rely on oral drugs. Response to
antimalarial treatment is multifactorial but is associated
with the degree of prior immunity acquired from
repeated exposures in childhood and the background
level of drug resistance. The higher the transmission

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

of malaria, the greater the degree of prior immunity and


the more likely the woman will respond favourably to a
drug treatment12,13.

weekly mefloquine can be used; and for intolerance or


resistance to mefloquine, the drug of choice is daily
atovaquone and proguanil (with folate supplementation)15.

Any complicated or severe malaria needs


management in intensive care set up. The criteria for
severe malaria was defined by WHO12. These include
clinical features of organ dysfunction as well as
laboratory features like hyperparasitaemia (>2%
parasitized red blood cells), severe anaemia,
thrombocytopaenia, algid malaria, lactic acidosis,
hypoglycaemia etc. Intravenous artesunate, which is
safe in pregnancy, is the drug of choice. It should be
followed by oral artesunate and clindamycin, as soon
as the patient is able to eat. If artemisinin is not
available, intravenous quinine is given, followed by oral
quinine and clindamycin. It is to be noted that quinine
is safe for the fetus at therapeutic doses but tends to
cause more hypoglycaemia in pregnancy 14 .
Complications like pulmonary oedema, anaemia,
circulatory collapse, renal failure, coagulopathy and
acidosis need proper management11.

In summary, diagnosis of malaria needs high level


of suspicion in pregnancy. Role of early treatment
cannot be overemphasized to avoid potential dangers
to both the mother and her fetus. Prevention is of
paramount importance that requires initiative both from
the health care professional as well as the women.

Uncomplicated P. falciparum malaria is treated with


oral quinine and clindamycin. Chloroquine-resistant P.
vivax malaria is also treated in the same way.
Otherwise, non-falciparum malaria, if uncomplicated,
is treated with 3 days chloroquine therapy, which is also
safe at this dose14. Primaquine, for radical cure, should
be withheld during pregnancy and 3 months thereafter,
because the fetus (and the neonate) is relatively
G6PD deficient 11.
From obstetric point of view, haemoglobin, platelet
and blood glucose should be monitored regularly.
Regular growth scan should be considered for early
detection of IUGR. Before discharge, patient should be
counseled about the symptoms of preterm labour and
how to monitor daily fetal movement count. Peripartum
malaria needs placental histopathological examination
and cord blood examination for malarial parasite11. In
those cases, the neonatal blood should be examined
weekly up to 28 weeks to detect congenital malaria11.
We all know the old axiom Prevention is better
than cure. Regarding malaria, it needs ABCD
approach15. A stands for Awareness of risk, i.e., travel
to any endemic area should be avoided, unless
absolutely needed, and any fever within one year after
return from such area should be immediately reported.
B means Bite, prevention by skin repellent, sprays,
mosquito-nets etc. C and D respectively stand for
Chemoprophylaxis and Diagnosis and treatment.
Chemoprophylaxis can be given with daily proguanil
and weekly chloroquine. In chloroquine-resistant areas,

References
1.

World Health Organization (WHO) World health


report-1999. Making a difference. Report of the
Director General WHO 2000.

2.

Chatterjee KD. Subphylum Sporozoa: Class


Telosporea; Genus Plasmodium. Parasitology
2004; 12th Ed:71-86

3.

Playfair JHI. Malaria in Pregnancy. Br Med J


1992;32:157

4.

Brabin BJ. An analysis of malaria in pregnancy in


Africa. WHO Bull 1993; 61: 1005

5.

Vieguels MP, Eling WM, Roland R, et al. Cortisol


and loss of malaria immunity in human pregnancy.
Br J Obstet. Gynaecol. 1987; 94(8): 758

6.

McGregor IA,Wilson IA, Billewicz WZ. Malaria


infection of the placenta in Gambia. Trans R Soc.
Trop. Med. Hyg. 1993; 72: 232

7.

Arias F, Daftary SN, Bhide AG. Tropical Diseases


in Pregnancy: Practical Guide to High-Risk
pregnancy and Delivery; A South Asian Perspective
2011; 3rd Ed: 528-31

8.

World Health Organization. Guidelines for the


Treatment of Malaria. 2nd ed. Geneva: World
Health Organization; 2006 [www.who.int/malaria/
publications/atoz/9241546948/en/index.html].

9.

Price RN, Douglas NM, Anstey NM. New


developments in Plasmodium vivax malaria: severe
disease and the rise of chloroquine resistance.
Curr. Opin. Infect. Dis. 2009; 22: 4305

10. Ibeziako PK, Okerangwo AA, Williams AAI. Malarial


immunity in pregnant Nigerian women and their
newborn. Int. J. Gynaecol. Obstet. 1990; 18(2): 14
11. Royal College of Obstetricians and Gynaecologists
(RCOG). Green Top Guidelines No.54B. The
Diagnosis and Treatment of malaria in Pregnancy;
April 2010: 2-11
12. White NJ. The treatment of malaria. N. Engl. J.
Med. 1996; 335: 8006.

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

11

13. White NJ. Why is it that antimalarial drug


treatments do not always work? Ann. Trop. Med.
Parasitol. 1998;92:44958
14. Lalloo DG, Shingadia D, Pasvol G, Chiodini PL,
Whitty CJ, Beeching NJ, et al. UK malaria

t r e a t m e n t g u i d e l i n e s . J . I n f e c t . 2 0 0 7 ; 5 4:
11121
15. Royal College of Obstetricians and Gynaecologists
(RCOG). Green Top Guidelines No.54A. The
Prevention of malaria in Pregnancy; April 2010: 4-8.

DENGUE ALERT AT CHENNAI


TN Govt. steps up to tackle fever, launches a toll free number. PTI, on Oct. 14, 2014 reported :
The Tamil Nadu govt. under the leadership of the Chief Minister O Paneer Selvavam reviewed the mosquito
control measures being implemented in the state. The govt. has urged the public to inform it about locations
and details through the toll free number 104, so that the state can take prompt action.
Health Minister C. Vijaybhaskar said the public could also inform the govt. at 9444340496 and 044-24350496
besides the toll free number if they had a fever situation in their towns.
On receipt of information, all steps will be taken immediately to control it.
Ross Rabindranath Mission and Sir Ronald Ross Memorial Centre, Kolkata thanks Govt. of Tamil
Nadu for Pro-active measures against the Mosquito-borne viral disease.
Dipanjan Bhattacharya

SIR RONALD ROSS AND


SIR RABINDRANATH TAGORE :
POETS AND ENVIRONMENTALISTS
Biswajit Dutta
Ronald Ross in 1898 discovered the life cycle of
Malaria parasite in the gastrointestinal tract of female
Anopheles mosquito at the Presidency General Hospital
(now SSKM Hospital), Kolkata, for which he received
the Nobel Prize in Physiology or Medicine 1902. He
was a poet too his poem is inscribed in a plaque at
the SSKM (PG) Hospital, Calcutta. Amongst his other
contributions, Dr. Ross preached community hygiene
and sanitation to arrest the growth of mosquitoes and
other vectors, thereby to prevent Malaria and other
vector-borne diseases, an important step towards
preservation of public health and environment.
Rabindranath Tagore, born at Calcutta is a great poet
and for his poetical work, Gitanjali (Song Offerings), that
he translated into English from his Bengali poems,
received the Nobel Prize in Literature 1913. But he is also
considered as a pioneer on various fields of Bengali
literature and songs, himself a painter, an environmentalist
- evident from his human development activities at
Santiniketan School, rural developments in his family
estates at East Bengal and Sriniketan. He also initiated
various movements at Santiniketan, Sriniketan and
elsewhere to arrest the growth of mosquitoes towards
eradication of Malaria and to preserve the public health
that are evident in his writings and activities.
We, the members of Sir Ronald Ross Memorial
Centre, Kolkata feel proud to follow Sir Ronald Ross
12

and Rabindranath Tagore, both of them worked in this


city, inspiring us to serve the distressed humanity.
Ronald Ross was born at Almora, United Province,
India, on 13th May, 1857. His father Sir C.C.G. Ross
served the British Indian Army and retired as Brigadier
General. About half of the army personnel at that time
suffered from Malaria, may be in their field duties, including
General Ross, who suffered from this disease several
times and preferred his son to become a doctor. Ronald
Ross, a bright young man having passion for poetry,
graduated in Medicine in 1879 at St. Bartholomews
Hospital, London and entered the Indian Medical Service
in 1881. During his posting at Madras in 1884, the vigorous
mosquito bites that greeted him and later the same in
Bangalore, may have prompted Dr. Ross to unveil the
link between Malaria and the mosquitoes, and he devoted
himself towards the experimental investigation of the
hypothesis of Lavaren and Mason that mosquitoes may
be connected with the propagation of Malaria. The time
Dr. Ross was contributing to the poetry and publishing
them in literary magazines was gradually being absorbed
by his studies and experiments on mosquitoes. Later
during his service at Secunderabad in 1897, Dr. Ross
could identify that female Anopheles mosquitoes were the
carrier of Malaria parasite. Finally in 1898, at the
Presidency General Hospital, Calcutta, his discovery of
the life cycle of Malaria parasite in the intestinal tract of
female Anopheles mosquito and thus Dr. Ross laid the
foundation for combating the Malaria.
Dr. Ross returned to England in 1899, joined the
Liverpool School of Tropical Medicine and later served
as the Director of Ross Institute and Hospital for Tropical
Diseases, the institution founded on his honour. In 1911,

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

Dr. Ross was honoured with the Knighthood. Sir Ross


advised the authorities that, if Malaria mostly prevalent
amongst the labourers and the poors, by ensuring proper
hygiene and sanitation in their localities, growth of
mosquitoes could be arrested, thereby Malaria could be
prevented substantially, resulting in considerable rise in
production of the labourers and subsequent savings in
the public health expenditure, but he failed to convince
the authorities initially in this regard. Sir Ross travelled
widely from Panama Canal to Suez Canal, West Africa to
Malaysia, tropical Malaria affected zones, Greece, Cyprus
and elsewhere, with his mission to fight out Malaria and
succeeded considerably to wipe out this disease, thus he
proved his ideas. Sir Ross is also considered as a pioneer
on Pathometry, a unique contribution to both pure and
applied mathematics - methodology to survey and assess
the epidemiology of Malaria, which is now considered as
a basis of the epidemiological understanding of insect born
diseases.
Sir Ronald Ross again came to India in 1926 and
in his honour on 7th January 1927, Governor General,
Lord Lytton, unveiled a Plaque at Presidency General
Hospital (SSKM Hospital), Calcutta, where Sir Ross
made his epoch making discovery and one of his poems
was inscribed in the Gate of Comemoration :
This day relenting God
Hath placed within my hand
A wondrous thing; And God
be praised at his command
seeking his secret deeds,
with tears and toiling breath
I find the cunning seeds
O, million-murdering Death.
I know this little thing
A myriad man will save
O death, where is thy sting,
The victory, O Grave? 1
Dr. Gopal Chandra Chattopadhyay, a stalwart
towards antimalaria movements in Bengal, founded
various Anti Malaria Societies to fight out the mosquito
menace and prevent Malaria in line with Sir Ross. In a
befitting ceremony held on 11th January 1927 at Albert
Hall, Calcutta, Dr. Chattopadhyay felicitated Sir Ronald
Ross in presence of the distinguished citizens of
Calcutta. Sir Ross had admiration for the literary and
social activities of Rabindranath Tagore.
Rabindranath Tagore was born on 7th May, 1861
at Jorasanko Thakurbari, Kolkata. His father Maharshi
Debendranath Tagore and grandfather Prince
Dwarkanath Tagore, were amongst the pioneers of the
Renaissance movement in Bengal and India, when the
members of the family contributed to a good extent on
this context. Rabindranath studied in Kolkata and

England, then left his academic pursuits to devote


himself to literary activities, thus he created a new world
of Bengali literature, comprising his pioneering works
on poetry, short story, novel, play, etc., also revolutionized
the field of Bengali songs, created the national anthems
of India and Bangladesh. Nobel Prize that he received
on his poetical work, cannot fathom his genius, his
thought is revealed in one of his poems:
Where the mind is without fear and the head is held high;
Where knowledge is free;
Where the world has not been broken up into
fragments by narrow domestic walls;
Where words come out from the depth of truth;
Where tireless striving stretches its arms towards perfection;
Where the clear stream of reason has not lost its way
into the dreary desert sand of dead habit;
Where the mind is led forward by thee into everwidening thought and action Into that heaven of freedom, my Father, let my
country awake. 2
In 1890, When he was assigned by his father to look
after their family estates in East Bengal, stationed at
Shilaidah, Zaminder Rabindranath then could gradually
realize the hard and distressed life of his subjects, so
was the condition of most of the rural folks in the country.
When most of the Zaminders hardly bothered about the
distressed conditions of their subjects, rather they used
to exploit them for their own benefits, Rabindranath was
worried about them, felt to change their conditions and
called upon the poet within him, who was otherwise
confined in his dreamland, to serve the distressed, as he
stated in his poem Ebar phirao more:
Oh poet then come up if you have the vigour so
bring it with you, offer it today.
Intense sufferings, severe grief, hard world ahead
extreme poverty, emptiness, extremely mean,
confinement, darkness.
Wanted food, wanted vigour, wanted light, wanted
fresh air, wanted strength, wanted health, happy
bright longevity, daring wide heart. In this poor grave,
oh poet, bring once from the heaven the picture of
trust. 3
Rabindranath established new schools for
education of the children and adults, hospitals for
treatment of the sick, introduced new variety of seeds
like potato etc. at that time, as source of food, spinning
schools as source of livelihood, in his Zamindary, to
additionally support the livelihood of the farmers and
the subjects. He introduced the first Agricultural bank
of Bengal at Patisar, to support the poor farmers, who
were otherwise victims of the greedy money lenders,

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

13

despite the losses he had to incur out of those initiatives.


For human development, he founded a school at
Santiniketan, Bolpur, in an environment friendly hub,
where the students are taught close to the nature, under
the shade of tree, sitting on grass mat, still providing
the best of the educations from the East and the West.
He founded the Visva-Bharati University for union and
enrichment of human cultures. Towards sustainable
development of the rural folks, he founded at Sriniketan,
near to Bolpur, a rural development centre, that too an
environment friendly initiative.
Rabindranath was honoured with Knighthood in
1915 by the British Government. On protest against the
Jalianwalla Bagh massacre by the British forces in the
Punjab in 1919, Sir Rabindranath Tagore renounced
his knighthood, in a letter dt. 30th May, 1919, to the
Viceroy Lord Chelmsford, though the same was not
formally acceded to by the British authorities, but
Rabindranath refrained from using the Sir before his
name for the rest of life, whereas the British Press
continued to use the same.
Rabindranath, along with the teachers and students
of the Santiniketan and Sriniketan, took various initiatives
to arrest the growth of mosquitoes in their localities
towards prevention of Malaria, and to support the
movement wrote various articles and joined Dr. Gopal
Chandra Chattopadhyays Anti-Malaria Movement, when
in a meeting of the Anti-Malaria Society spoke:
The enemy whatever mighty could be, would not
care for it, shall not keep the mosquito, how can
it be shall eradicate - If we have this courage
then not only the mosquito, will win over a
greater enemy, our own indigence. 4
With the advancement of medical science, it is now
clear that, besides Malaria, different types of
mosquitoes act as carriers of Filaria, Dengue,
Chickungunia etc, also flies, pigs etc. act as carriers of
encephalitis and other diseases. Mosquitoes are now
gradually gaining immunity to various insecticides
applied to arrest their growth. Similarly Malaria parasites
are gaining immunity to different types of drugs
presently applied to treat this disease. According to
World Health Organization, about 300 million people
world-wide, annually become victims of Malaria, mostly
children and out of them about 1.5 million to 2.7 million
die, which is still, remaining to be of great concern.
Sir Ronald Rosss mission is very much relevant
today on the context above, as that of Rabindranath
Tagore. We, the members of SIR RONALD ROSS
14

MEMORIAL CENTRE, are dedicated to the contexts


above - to the cause of the eradication of Malaria and
other vector borne diseases, promotion of public health,
environment and human rights that are also projected
in our publication Ross Rabindranath Mission.
NOTES AND REFERENCES:
1.

Ross Rabindranath Mission, Vol. 1, Oct.-Dec. 2012, P/21.

2.

The English Writings of Rabindranath Tagore, Vol - 1,


Sahitya Akademi, 2001, P/5.

3.

Ebar Phirao More, Rabindra Rachanabali - Vol.2, VisvaBharati Granthan Bibhag, Posh 1417, P/151.

4.

Samabaye Malaria Nibaran, Rabindra Rachanabali Vol.14, Visva-Bharati Granthan Bibhag, Posh 1417, P/389

SURGICAL ASPECT OF MALARIA


Dr. P. K. Mishra
Professor, Department of Pediatric Surgery
NRS Medical College & Hospital, Kolkata
Human Malaria is a parasitic disease caused by
protozoa species of genus plasmodium (P). Out of the 10
plasmodia P.Falciparum and P.Knowlesi cause the most
severe form of the disease. The infection that cause
malaria is transmitted by Anopheles Mosquitoes. Its
implication in surgical conditions is of serious concern.
Malaria in postoperative patients complicates the
result of surgery by two mechanisms. One is relapse
of preexisting disease by arousal of parasite from
dormancy by immunosuppressive action of major
surgical procedures, trauma, malignant diseases like
Hodgkins Disease, NHL, Haemoglobinopathies like
Thalassaemia, or the patient may be in incubation
period during surgery and become symptomatic in
postoperative period. The second mechanism is
transmission by blood transfusion in major surgical
procedures that may cause symptomatic malaria. So,
patients requiring elective major surgery and the blood
donors who have moved from (or recently visited) an
endemic area of malaria are considered as potential
sources of infection and need be administered
adequate malaria chemoprophylaxis during perioperative period, the objective being to prevent parasite
inoculation and parasite arousal from dormancy and
the resultant consequences of fever and haemolysis.
Resistance to commonly used anti-malarial drugs
like chloroquine and mefloquin have been observed
recently. So, Quinine is preferred as chemoprophylaxis.
Treatment with quinine for 15 days, beginning 7 days
before surgery and ending 7 days after surgery,
including the day of operation, is recommended as the
standard chemoprophylaxis to prevent relapse of
malaria, particularly in endemic zone, in a patient with
history of previous episode of symptomatic malaria. In

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

patients treated for P.falciparum malaria, where the


RBCs are distorted and made cytoadherent and cause
severe haemolysis, it takes 125 days to get the all
existing erythrocytes replaced with new ones and
thereafter major surgery be performed. Injury/Surgery
may convert asymptomatic falciparum malaria to
symptomatic, which increases the risk of post operative
wound infection and complicate the recovery process.
The severity of injury is directly proportional to the risk
of post-injury malaria in endemic zone. It may be
explained by the fact that in malaria endemic area
where people are repeatedly infected, develop
acquired-partial immunity to the parasite, thus
asymptomatic malaria are common in those areas. Post
trauma immune depression breaks the defenses, thus
the parasites proliferate to become symptomatic.
To quote few examples, Tropical splenomegaly in
malaria leading to splenic rupture by trauma may
present as surgical emergency. Surgical procedures like
liver transplant, Kidney and cardiac transplants,
cardiopulmonary bypass, emergency caesarian section
in malaria infected mother, splenectomy in
Thalassaemia are the common procedures complicated
with symptomatic malaria.
Awareness of surgical implication of malaria is
essential to help management of itsrelated post
operative complication.

SALUTE TO VERSATILE AMRISH PURI


A VICTIM OF MALARIA

Amrish (Lala) Puris untimely tragic death due to


head injury (caused by accidental fall), myelodysplastic
syndrome and subsequently by Malaria at Hinduja
Hospital, Mumbai was a terrible shock to the film
industry (Bollywood, Hollywood), Indian theatre Industry
and people/fans as a whole.
Malaria killed the Mogambo, our Great Actor and
Theatre personality at the age of 72 years. A small
parasite, carried by female anopheles mosquito is
deadly than a mighty man. Severe malaria can cause
death in 20% of patients even in a very good hospital.

Currently, 80.5% of the 1.2 billion population in


India lives in malaria risk areas. Mumbai, as a miniIndia reflects the disappointing public health feature
of the whole country.
Life history of Amrish Puri
Amrish Puri was born at Nausera, Punjab on 22nd
June 1932 and he died on 12th January, 2005. He was
a resident of Juhu, Maharastra. Maharastra (Mumbai)
is a notorious mosquito den, though it is the financial
capital of India.
Amrish was an activist of Indian theatre movement
since 1960, along with Satyadev Dube and Girish
Karnad. He joined Prithivi Theatre and credited him to
be a famous stage actor. He worked in television
advertisements and later joined in film industry.
He acted in more than 400 films in Bollywood and
Hollywood and in different regional Indian languages
Hindi, Marathi, Kannada, Tamil, Telugu, Malayalam
between 1967-2005. His dominating presence with
baritone voice endeared him with negative iconic roles
as villain.
Steven Speilberg said, Amrish is my favourite villain
the best the world has ever produced and ever will .
Achievements : Wins : 1968 Maharastra State Drama
Competition. 1994 Singapore International Film
Festival. Best Actor Award in Suraj Ka Satvan Ghoda.
Nominations : 1990 Filmfare Best Supporting Actor
Award Tridev. 1993 Filmfare Best Supporting Actor
Award Muskurahat. 1994 Filmfare Best Supporting
Actor Award Gardish. 1996 Filmfare Best Supporting
Actor Award Dilwale Dulhania Le Jayenge. 1996
Filmfare Best Villain Award Karan Arjun, 1999
Filmfare Best Villain Award Koyla, 2000 Filmfare
Best Villain Award Baadshah, 2002 Filmfare Best
Villain Award Gadar Ek Premkatha.
Awards : 1979 For Theatre, he won Sangeet Natak
Academi Award. 1986 Filmfare Award for Best
Supporting Actor Meri Jung. 1991 Maharastra State
Gaurav Purashkar. 1994 In the Sydney Film Festival,
he won the award for Best Actor (Suraj Ka Satvan
Ghoda). 1997 Filmfare Award for Best Supporting
Actor Ghatak. 1998 Filmfare award for Best
Supporting Actor Virasat.
Filmography : Prem Pujari (1970), Kachhi Sadak
(1971), Gandhi of Richard Attenborough (1982), Coolie
(1983), Indiana Jones, The Temple of Doom (by Steven
Spielberg, 1984), Kasam Paida Karne Wale Ki (1984),
Muqaddar Ka Badshah (1990), Phool Aur Kaante
(1991), Zindaggi Ek Juaa (1992), Muskurahat (1992),

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

15

Damini (1993), Paramaatma (1994), Dilwale Dulhania Le


Jayenge (1995), On Wings of Fire (2001), Chori Chori
Chupke Chupke (2001), Gadar : Ek Prem Katha (2001),
Nayak : The Real Hero (2001), Badhaai Ho Badhaai
(2002), Aitraaz (2004), Mujhse Saadi Karogi (2004).
Other Memorable Films : Love, Hum Punch, Pardesh
Manthan, Vidhata, Hero, Nisanth, Kisna : The Warrior
Poet, Reshma Aur Shera, Bhumika, Party, Shakti, Ardh
Satya, Naseeb.

Paying homage to this Great Soul : Mogambo is


known to the entire film world and he is Amrish (Lal
Singh) Puri, will be ever remembered for his significant
contribution. May his soul rest in Peace
Our commitment : Sir Ronald Ross Memorial Centre
& Ross Rabindranath Mission is dedicate to fight
against malaria mosquito borne diseases to safe guard
public health.
Prof. (Dr.) Ranen Dasgupta

So many hats : Collecting hats was his hobby. In his


active life, he wore so many hats, like awards and
appreciation. His autobiography "The Act of life" was
published in 2006.

SICKENING AFFAIRS
MANIK SARKAR, TRIPURA'S BEST KNOWN MARXIST, IS ADMIRED
FOR BOTH HIS PERSONAL INTEGRITY AND ADMINISTRATIVE
ACUMEN, BUT IN THE EVENT OF THE DEATH OF NEARLY 100
PEOPLE DUE TO MALARIA OVER THE PAST ONE MONTH
SEVERAL QUESTIONS ARE BEING RAISED ABOUT THE
STATE OF AFFAIRS UNDER HIM, SAYS NIRENDRA DEV

Very seldom would governments commit suicide


deliberately although they may do so accidentally. In the
case of the Left Front regime in Tripura, the recent
handling of a malaria epidemic can be a test case of the
maxim referred to. The state government has admitted
that at least 67 people, including 55 children, had died
and over 171,200 had fallen ill over the past one month.
According to unofficial estimates, at least 120 people have
lost their lives. The epicentre of the outbreak lies in Dhalai
district, not very far from the border with Bangladesh.
Locals say the district has always been highly vulnerable
to water- and vector-borne diseases and if the problem
has assumed serious dimension, it raises eyebrows about
the efficacy of the Manik Sarkar regime, which has been
returning to power time and again.
So one question being raised is perhaps there was
lack of foresight on the part of the administration and also
apathy towards the miseries being faced by people, both
tribais and non-tribals. It goes without saying that Tripura
remains the last citadel of the Communist movement,
which ironically swears day in and day out about propeople and pro-poor measures. It is not only that Tripura
is firmly in the grip of Leftists, the opposition Congress
has been virtually rendered irrelevant politically In this
state, low-profile chief minister Manik Sarkar is admired
for both his personal integrity and administrative acumen.
So how does one reconcile to the bitter fact that such a
major calamity was been let loose under his rule?
The answer perhaps lies in Leftist ideology itself.
Most often, one has heard about the Communist ideals
16

Editor
Ross Rabindranath Mission
General Secretary
Sir Ronald Ross Memorial Centre, Kolkata

of glorifying poverty. As a result, while Marxism has


triumphed in rural Tripura, it is also a fact that in many
centres in the state there is stark poverty. Many villages
in malaria-hit Dhalai district are reeling under extreme
poor conditions wherein people do not have electricity
or clean drinking water. Thus, malaria is only a clear
possibility. Thanks to convictions about Marxism among
a large section of people, they do not think there should
be any complaint about such poor conditions.
As a result, the malady has spread to districts like
Gomti, Khowai, North Tripura and South Tripura.
According to reports, remote Gandacherra and
Kanchanpur subdivisions in Dhalai and North Tripura
districts, respectively are the worst affected. Worse for
the Left regime in the state, many tribais who earn their
livelihood by practicing shifting cultivation in the
Kalajhari range in Gandacherra, were among the worst
to be affected by the outbreak.
Health department officials said in Agartala that
over 100,000 people had been admitted to the 1,800
odd hospitals and dispensaries with fever and stomach
ailments and more than 15,000 had been confirmed as
having being smitten by malaria. State health minister
Badal Choudhury also a senior Marxist, has said that
the government is well prepared to meet the challenge.
The administration has pressed into service a chopper,
will hold health camps and distribute medicines in rural
areas. In many places, even the Border Security Force
has been called in to help civil health workers.
But there is more to the issue than meets the eye.
For instance, even the security forces deployed in Tripura
are not immune. In fact, old records say that since 200506, the highly efficient BSF, which patrols the 856 km
border that the tiny state shares with Bangladesh, has
lost more jawans to malaria than to militancy.

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

Theres yet another issue that needs closer scrutiny


The Congress had blamed the state health authorities
of using an anti-malaria drug whose efficacy is being
questioned now. On 20 July the Tripura Pradesh
Congress Committee filed a criminal case against three
senior health officials of the health department, blaming
the institution for an increase in the number of deaths
caused by malaria. Reportedly a formal FIR has been
registered in West Agartala police station against SR
Debbarma, Director of health services, Sandip Nameo
Mahatme, Director of the National Health Mission, and
M. Nagaraju, State Health Secretary.
Predictably, Badal Choudhury denied the charge of
wrong medication and also maintained that the state
government was not aware of any anti-malaria medicine
used earlier been banned by the Centre. His response
has, however, been guarded and cautious. The state
government says it has not received any communication
from the Centre or the Union health and family welfare
ministry on whether a second generation drug, previously

Indias Health Is Its Wealth

used for malaria, has been banned. It further showed only


a credit seeking bureaucratic approach typical of the Leftist
style when it said the opposition Congress was free to
bring out details about such drugs and if they had
documentary evidence they could complain to the Centre
against the state government.
The typical Leftist ego-play comes to the fore as
peoples support for the Marxist-led regime continues
unabated. Even in the recent panchayat polls, the CPMled Left Front secured an absolute majority in 563 of
the 591 gram panchayats and all the 35 panchayat
samitis and eight zila parishads. No wonder the
approach revolves around the oft-repeated fallacy: if
people have voted for us, we can do no wrong.
True, one has heard about these arguments in
West Bengal in the past and perhaps to an extent this
is being heard even now, although the Leftists were
voted out of power in Bengal in 2012.
The Statesman, 4.8.2014

Bill Gates

commission of leading economists found a strong


connection between health and national prosperity. Its
report stated that about 11% of the economic growth in
low- and middle-in-come countries over the past
generation resulted just from reductions in adult mortality.

Today the prime minister will stand at the Red Fort


to address the nation. For a generation, the
Independence Day speech has been about Indias
mind-blowing progress and todays will be no different.

That remarkable statistic underscores the fact that


the raw material of a dynamic society is the mental
capacity and labour productivity of its population. And
that is tied directly to investments in health.

As a frequent visitor to India for more than 30 years,


i agree that the countrys future is phenomenally bright.
But if there were one thing you could do to make Indias
prospects even more spectacular, it would be to invest
more in the health of all Indians.

Despite its growing prosperity India has the highest


burden of malnutrition in the world. Malnutrition is an
underlying cause of almost half of all child deaths, and,
for those children who survive, leads to cognitive
impairment that prevents tens of millions of children
from ever reaching their potential.

Growth of independent India is an amazing story


- empower it by health investment

When i first started coming to India in the 1980s, i


marvelled at the amazing growth of the Indian IT sector
and the entrepreneurial spirit that seemed to reign
everywhere. These two factors have been pillars of the
countrys stunning economic growth.
In the past decade, however, ive started to think
more broadly about what - in addition to gross domestic
product - makes for a healthy and productive society
After my 30 years at Microsoft, my wife, Melinda, and i
created our foundation, which is devoted to improving
the health well-being of the poorest people in the world,
including the poorest in India.
Through my work at foundation, ive learned
learned that health for rich and poor alike is the linchpin
to the positives changes we want to see in all societies.
Heres a striking illustration of that: a recent global

As the economist Dean Spears has written,


Because the problems that prevent children from
growing tall also prevent them from growing into healthy,
productive, smart adults, height predicts adult economic
outcomes and cognitive achievement".
In short, Indias malnutrition crisis is not just bad
for Indias malnourished children; it also limits the
countrys economic progress.
India has shown that in the health arena, it can
accomplish great things when everyone is committed.
Your polio eradication effort is one of the most
innovative large-scale projects of any kind - ive ever
seen. The government of India deserves international
acclaim for engineering this success. The country
turned the tide on the HIV epidemic, cutting new

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

17

infections by more than half in just a decade and


averting the disaster that many predicted.

monitoring and evaluation can help close the gap


between whats possible and whats happening now.

The improvement in child mortality is less


recognised but just as impressive. The number of
children under five years of age who die every year
has gone down by 60% since 1990 and that number
will keep decreasing even faster as a result of the
governments decision to introduce new vaccines to its
immunisation system.

Third, India can make changes to help citizens get


the most out of private sector healthcare. In India, the
vast majority of medical care is provided by the private
sector, but the sector is insufficiently regulated and the
quality of care is often poor.

Moreover, India has the schemes in place to drive


rapid improvements in health. The National Rural Health
Mission was created in 2005 and provides a framework
by which the government can support the health goals
outlined at the sub-district, district and state levels.
But there is more India can do to advance health.
First and foremost, public spending on healthcare in
India is extremely low - 1.1% of GDP. That compares
to 2.4% in China and 4.9% in Brazil, two other rapidly
growing countries that are wisely betting on health as
a key component of growth.
Second, India can invest in the effectiveness of its
health system by collecting and using data to drive
accountability and results. Currently, the system does
not always perform optimally, but investments in

Fourth and finally India can raise awareness among


its citizens about public health. For instance, poor
sanitation is a massive cause of disease and
malnutrition. If more people understood these
connections, they would be better able to protect
themselves and their families.
The Gates Foundation is committed to supporting
Indias progress in health and development. But the
driving force will be the government of India and the
Indian people. The government is investing, but not
enough. A great way to celebrate Independence Day
would be to spur Indian growth by redoubling
investments in health.
(The writer is Co-Chair & Trustee, Bill & Melinda Gates
Foundation).
The Times of India, Kolkata
Friday, August 15, 2014

CLEANLINESS: WITHIN US AND OF OUR SURROUNDINGS


Tushar A. Gandhi
Founder President, Mahatma Gandhi Foundation
Bapu lay stress on cleanliness. He believed that cleanliness was the responsibility of every individual personally and
collectively. In his Ashrams it was the duty of every individual to not only remain clean themselves but strive for the
cleaning of the body, soul, mind and heart as well as their abode and the precincts of the Ashram. But while cleaning
ones self and the precincts of the Ashram they had to also ensure that they did not leave dirt and garbage outside the
Ashram. Bapu equated cleanliness with Godliness, I quote him from the book Bapu ke Ashirvad, dated Jan 8th,
1946, Bapu wrote When there is both inner and outer cleanliness, it becomes next to godliness.
Bapu believed that cleanliness had to be holistic, all encompassing. He believed that a clean and pure soul could not
reside in an unclean body, he believed that clean thoughts could not arise in a dirty and corrupt mind and a pure,
clean, honest person could not exist in dirty surroundings. He believed that for good deeds to be done or happen there
had to be overall cleanliness. And he believed that it was the responsibility of every individual. For persons to appreciate
cleanliness, they must be repulsed by filth and dirt. Those who become insensitive to filth and dirt, whether of their
own making or created by others will never react to the filth or the dirt and will live in its midst without noticing it. Our
creator has also made us thus that our senses get used to our surroundings very soon. Try this experiment - Find the
smelliest substance, initially one feels revolted and repulsed, sometimes one feels nausea initially but very soon we
become immune to the smell and stop noticing it too. Our sense of smell deals subconsciously with that stench and
then we dont notice it and then we stop noticing it and we stop reacting to it. Since we arent reacting to it anymore we
dont feel like doing anything to get rid of it. This is how one also gets used to filthy surroundings. We stop reacting to
them and so we then learn to live with it and dont get bothered by it and hence dont do anything about it.
We pride ourselves about how clean we personally are, many a times we scoff at others who are scruffy and do
not share our own level of personal cleanliness but look at how we lag behind in communal cleanliness. While
travelling on the roads of our cities and towns one notices how garbage is dumped at every opportune place,
18

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

how we litter everywhere without concern, how we spit, blow our nose, pee and defecate in public places. I know
that our cities and metros lack in civic amenities but we must also realise that as long as we consider common
areas of our cities and towns as not of our concern and litter them, we can never achieve cleanliness. Speaking
at a evening Prarthana Sabha during his travels through Bihar, Bapu had once commented about the habit of
carelessly spitting, if all Indians were to spit all together at the same time, India would drown.
Bapu believed that as we were particular about personal hygiene, we had to be responsible about the hygiene of
our neighbourhood, locality, and town or city too. Right from the beginning while in South Africa Bapu took it upon
himself to clean the locality he lived in and did not ever turn a blind eye to filth. He did not like filth or being dirty
and so he took responsibility of both his personal hygiene and for the hygiene of his surroundings and cities. He
performed his civic duties as a matter of regular practice but when an emergency occurred he was even more
particular and volunteered to clean the filthiest of areas. When the Plague erupted in the Indian quarters in
Durban, initially Bapu rushed to the aid of the afflicted people but to prevent the spread of plague he also worked
to clean the quarters. He cleaned the locality cleaned the homes and administered treatment to the patients
even at personal risk of being infected himself. Later on a visit to Rajkot when a similar epidemic erupted there
Bapu took to cleaning the festering cesspits and gutters of the city so that the germs would not bread there and
the epidemic could be contained. On one of his visits, from South Africa he visited Kolkata the Congress Session
was in progress there Bapu went there and was appalled by the filth and unsanitary conditions at the site.
Instead of presenting himself as an important Indian leader visiting from South Africa, Bapu took up the work of
cleaning and ensuring hygiene of the place. He cleaned the drains organised volunteers to dispose off the filth
and personally cleaned and covered the pit latrines. He did not lecture the delegates about the importance of
cleanliness and hygiene he taught the lesson by example, he made it his own responsibility to maintain the
cleanliness of the place. One must realise that the venue of the Congress convention was not his private property,
nor was it the home of a friend, the venue was a civic ground and Bapu could have very well written to the city
council to ensure the cleanliness of the place, but he took responsibility of ensuring the cleanliness of a common
place and ensured that the convention happened in clean and pleasant surroundings. Bapu believed that it
wasnt possible to have good, true and honest thoughts if the mind and surroundings were unclean. Speaking at
the foundation stone laying ceremony of the Kashi Vishva Vidyalaya, Bapu criticised the uncleanliness of the
holy city and expressed anguish that places we considered sacred and holy were so filthy. This was his observation
also when he visited the Kumbh Mela. Bapu was concerned about how we were dumping filth into river and said
that the rivers were like the veins of our country and our civilisation was dependent on the health of our rivers,
but if we continued to dirty them the way we had been doing it would soon be that our rivers would become
poisoned and when that happened our civilisation would collapse. We are at the brink of an ecological disaster
because we have polluted our holiest of holy river Ganga with our filth. Seventy five years later, our new Prime
Minister in his speech to thank the people of Varanasi and the nation, talked about his concern about the filth in
Varanasi and the pollution of the Ganga. Bapu believed that every individual had to be concerned and take
responsibility. Cleanliness would not be achieved by warnings, laws, or edicts, it would be achieved only as a
matter of habit. Writing in Young India in its issue dated November 19, 1925 Bapu said, Cleanliness is next to
godliness. We can no more gain Gods blessings with an unclean body than with an unclean mind. A clean body
cannot reside in an unclean city. What he wrote to an unknown recipient on April 26, 1945, later reproduced in
Bapu Ke Ashirvad Bapu expressed his concern about our habit of hiding dirt, Is it only that unclean which
appears to the eye to be unclean? If there is even a speak of dirt on what is white, we feel annoyed: but the black
may have any amount of dirt on it and we care not at all! a little amount of dirt in an otherwise clean area causes
a lot of concern as well as irritation but many a times we ignore the dirt which accumulates in dark places and in
nooks and crannies. Bapu believed that it was even more important to be particular about cleaning and maintaining
cleanliness in such isolated places. It wasnt only important to clean areas where dirt or filth would be visible, but those
who were particular- about cleanliness should be even more particular about overall cleanliness. Writing in Young
India in its issue dated April 25th, 1929 Bapu commented on our habit of cleaning our homes or ourselves and
dumping the filth in our surroundings without concern We do believe in removing dirt from our rooms, but we also
believe in throwing it in the street without regard to the well being of society. We are clean as individuals, but not as
members of society of the nation of which individual is but a tiny pan. This is the cause of why beyond our doorstep
we find so much filth and dirt. Strangers or outsiders do not come to dirty our neighbourhoods. It is us who live in
those neighbourhoods who dirty it by littering. When we toss a bag containing garbage out of our door or window, we
can be happy our home is clean but our neighbourhood is also part of our habitat and that one seemingly insignificant
act of making it filthy becomes compounded because every inhabitant of the neighbourhood behaves in a similar
manner, unconcerned about how they are making their own neighbourhood, community and city filthy.
ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

19

Corporates too had a responsibility in maintaining cleanliness, writing in Harijan on 16th June 1946 Bapu said,
meticulous sense of cleanliness, not only personal but also in regard to ones surroundings, is the alpha and
omega of corporate life. In their lust for profits companies cut corners and it is generally on the issue of waste
disposal from their production process. Bapu believed that it was the responsibility of every member of the
organisation from top to bottom that they did not dirty or pollute the .environment of the place they functioned
from. Governments and city councils can do upto a certain amount, they have their limitations but if every individual
took it-as their own responsibility and duty, it would-be much more possible to achieve not only a clean India but
also spiritually cleansed Indian? and then they would be proudly able to become examples of a clean nation a
clean civilisation and a clean people. What Bapu wrote in a letter on 22nd January, 1945, later reproduced in
Bapu ke Ashirvad, He who is truly clean within, cannot remain unclean without. This was the cornerstone of
Bapus belief in personal and civic cleanliness. Bapu believed that the habit of cleanliness inside and out had to
be instilled very early in-ones life it had to become part of ones nature and he believed that if one was taught
about the importance of a clean mind, a pure soul and a honest nature then it would automatically ensure the
cleanliness of the body and ensure the cleanliness of ones surroundings too. Writing in Young India in its issue
dated 10th December 1925, Bapu said, Inward cleanliness is the first thing that should be taught, other things
must follow after the first and most important lesson has gone home. If we wish to instil the habit of cleanliness
we must teach our children to hate filth, hate dirt and take responsibility to not only clean the filth but also not to
contribute to the filth. This was how important Bapu believed, both internal and external cleanliness was for
Humans to thrive and progress and for self actualisation and evolution of humans. He did not differentiate
between the self being clean and the cleanliness of the surroundings, he believed that it was essential for a pure
soul to reside in a clean body just as it was essential for a locality, city, state and country to be clean so that
people would in it who were clean and honest. He believed that they were both as important and vital.
We will achieve Swachcha Bharat only after we cleanse our souls and then cleanse our surroundings, this was
the message of Bapus life. The Prime Minister can inspire, but the responsibility is of every Indian.
(Courtesy : Employment News Vol. XXXIX No. 29, 18-24 October 2014)

GENOMES GALORE
Two papers published on 27 November in Science
announced the completion and preliminary analyses of
the genomic sequences of 16 species of mosquitoes,
including those that are vectors for the malaria parasite.
The sequences, which were around 200 million base pairs
each, revealed that mosquitoes were rapidly evolving,
exhibiting high degrees of gene gains, losses, shuffling
and even transmission between closely related species.
Both papers provide really powerful information on
the evolution of different malaria mosquito species, wrote
James Logan of the London School of Hygiene and
Tropical Medicine in an e-mail. Comparisons between
the (species) are likely to reveal the reason why some
mosquitoes are better at transmitting malaria than others,
(which is) vital for the future control of malaria, he added.
Each year, hundreds of millions of cases of malaria
are reported globally that cause hundreds of thousands
of deaths. In 2002, as part of an ongoing effort to
understand mosquito biology and ultimately reduce
disease transmission, the genome sequence of
Anopheles gambiae the major malaria vector of subSaharan Africa was published.
Having one genome is a great start, but its not
enough, said Nora Besansky malaria vector researcher
at the University of Notre Dame, Indiana, who led the
20

latest sequencing effort. There were about 450 species


of Anopheles mosquitoes and roughly 60 of them
transmitted malaria, but they were not all closely related,
Besansky explained. Therefore, she said, If our interest
is in trying to control malaria by targeting the mosquito
itself in some way, we need to understand what they
(the malaria mosquitoes) all have in common.
The Statesman, Kolkata, Wednesday 03, Dec., 14

BACTERIA WEAPON IN MOSQUITO BATTLE


Suman Chakraborti
Kolkata: The New Town Development Authority
has started spraying the biological insecticide
containing the bacteria called bacillus thuringiensis
israelensis (BTI) in the waterbodies of Rajarhat New
Town to control breeding of mosquitoes and destroy
the existing larvae, said NKDA and HIDCO chairman
Debashis Sen. It was in April this year that the NKDA
authorities had commissioned a study by a professor
of zoology of Burdwan University for suggesting ways
to check mosquito breeding. After field trials and
surveys in the area, a set of recommendations was
given as to how the mosquito menace in Rajarhat New
Town could be tackled. The recommendation consisted
of short and long-term solutions. The long-term actions
included the use of BTI as a biological insecticide.

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

The report submitted had specifically mentioned


that spraying mosquito larvaecidal agents like BTI,
which is a naturally-occurring bacteria that kills
mosquito larvae, is a very effective solution to control
mosquitoes from breeding. These bacteria kills only
mosquitoes, fungus gnats and blackflies and does not
harm other insects or fish.
Times of India, 9.8.14

GM MOSQUITOES TO HELP WIPE


OUT MALARIA: EXPERTS
Kounteya Sinha
London: Mosquitoes that only gives birth to male
offsprings are the new weapon in the global fight against
malaria. British scientists announced on Tuesday that in
what will be a massive boost against the worlds deadliest
vector-borne disease, they have successfully wiped out
malaria-carrying mosquitoes in the lab.
Scientists modified mosquitoes to produce sperm
that only create males, pioneering a fresh approach to
eradicating malaria. For the first time ever, in the lab,
the method created a fully fertile mosquito strain that
produced 95% male offspring.
Scientists from Imperial College, London have tested
the new genetic method that distorts the sex ratio of
Anopheles Gambiae mosquitoes, the main transmitters
of the malaria parasite, so that the female mosquitoes
that bite and pass the disease to humans are no longer
produced. The scientists introduced the genetically
modified mosquitoes to five caged wild-type mosquito
populations. In four of the five cages, this eliminated the
entire population within six generations, because of the
lack of females. The hope is that if this could be replicated
in the wild, this would ultimately cause the malaria-carrying
mosquito population to crash. This is the first time that
scientists have been able to manipulate the sex ratios of
mosquito populations.
Times of India, 11.6.14

WHO: INDIA HAS 12.8CR


SUSPECTED MALARIA CASES
Kounteya Sinha
London: As many as 111 crore Indians are at risk of
getting infected with malaria and of these, 28 crore have
been found to be at highest risk. The World Health
Organization on Tuesday said that India has 12.8 crore
suspected malaria cases,
India recorded 8.81 lakh confirmed cases. This
means that only 7% of malaria cases are being confirmed
in the country. The country also faces the most deadly
threat of the malaria strain becoming resistant to the most
advanced drugs available till date, thanks to unregulated
selling of banned malaria therapies.
The most dangerous malaria carrying vector
P. falciparum has been found to have become resistant

to the drug artemisinin in five countries - Cambodia, Laos,


Myanmar, Thailand and Vietnam. WHO has banned the sale
of oral artemisinin based monotherapy medicines and
replaced them with artemisinin combination therapies. The
use of monotherapy medicines threatens the long-term
usefulness of artemisinin because it fosters the spread of
resistance to the drug. The number of countries that allow
the marketing of oral artemisinin-based monotherapies has
dropped tremendously since the World Health Assembly
adopted a resolution supporting the ban in 2007.
But as of December 2014 the WHO confirmed that
24 pharmaceutical companies continued to market oral
artemisinin monotherapies, half of them located in India.
WHO also said India and Thailand are on track to achieve
a decrease of 50-75% in malaria cases.
Theme of World Malaria Day (25 April) 2014
Invest in the future : Defeat Malaria

DISEASE FUND UNUSED


OUR BUREAU
Aug. 5; Bengal has allegedly failed to utilise over Rs
24 crore of the funds the Centre allotted to it in the 201314 financial year for the control of vector-borne diseases.
The revelation, in a letter to the Bengal programme
officer by the central official over-seeing the National
Vector Borne Disease Control Programme, coincides with
a Japanese encephalitis outbreak in north Bengal that
has killed over 100 people.
Funds under the programme are given to counter
vector-borne diseases such as Japanese encephalitis,
malaria and chikungunya.
Asked about the allegation of unspent funds, Bengal
junior health minister Chandrima Bhattacharya said:
Speak to officials of the state health department.
Director of Health Services B.R. Satpathy denied that
funds were lying unused, The funds were allocated by
the Centre but it was disbursed late. We did not receive it
in 2013. We got the funds only in February and March
this year, a few days before the last financial year ended.
We used our own funds for preventive measures, he said.
A senior health official in Siliguri said the state sent a
utilisation certificate in January. More funds are not issued
unless the certificate is sent.
The letter was sent by A.C. Dhariwal, the Director of
the National Vector Borne Disease Control Programme,
on April 17. According to an annexure, the Bengal
government spent only Rs. 12.21 crore of the Rs. 36 crore
available with it under the programme.
The Bengal government sent the last utilisation
certificate in January, which indicates that no major work
was done to prevent an outbreak from January to April,
a health official in Siliguri said.
The Telegraph, 6.8.14

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

21

SPURT IN DENGUE CASES, DELHI


REPORTS 409 TILL 1 NOVEMBER
PRESS TRUST OF INDIA, New Delhi, 04 November
There has been a spurt in dengue cases in the
national capital which reported a total 409 cases till
1st November.
However, according to the civic bodies the number
of cases reported this season is much lower as
compared to last year which had recorded about 4,402
dengue cases during the same season in the city.
According to an official report released by South
Delhi Municipal Corporation yesterday, the number of
dengue cases in Delhi and its adjoining areas like UP
and Haryana has increased to 438. Changes in weather
mainly contributed to this occurrence, said officials.
Till now, two deaths due to dengue have been
officially reported in the city which does not include the
death of an eight-year-old boy Rishi Qaddafi from
Srinagar, who died of dengue at Sir Ganga Ram
Hospital on 28 September.

SIR RONALD ROSS MEMORIAL CENTRE,


KOLKATA
Governing Body 2013-2014
President

: Biswajit Dutta

Vice President

: Dr. Arati Dasgupta


Dr. Debashis Chakraborty

General Secretary : Dr. Ranen Dasgupta


Assistant Secretary : Debasish Chaudhuri
Aniruddha Das
Treasurer

: Debolina Chaudhuri

Executive Member : Dr. Tapan Das


Swapan Kr. Chattopadhyay
Purbasha Dasgupta
Dipanjan Bhattacharjee
Phullotpal Chaudhuri
Ranjana Gupta

Honorary Advisers
Ms. Jenniefer Phillips, Dr. Benu Bhushon Chaudhuri,
Dr. Badal Paul, Dr. Kanchan Das, Dr. Parimal
Bhattacharjee, Nilanjana Rakhit, Dr. Ranen Chatterjee,
Dr. Subhas Chandra Dasgupta, Prof. Satyabrata
Dasgupta, Prof. Biswapati Mukherjee, Prof. Amitabha
Nandy, Dr. H. K. Mazumder, Dr. Manaspratim Das,
Adv. Rana Dasgupta, Debashis Nag, Md. Abdullah,
Dr. A.Q.M. Serajul Islam, Dipa Sen, Dr. Hannana Begum,
22

Usually after Diwali, there is a fall in dengue cases.


But then there has been a spurt in dengue cases as
the temperature is conducive for the breeding of
mosquitoes, a senior municipal official said.
The Statesman, 5.11.14

EBOLA EASIER TO AVOID THAN MALARIA


Monrovia, 26 August: The head of the US Agency
for International Development today said poor
understanding of Ebola was undermining the fightagainst the epidemic, pointing out that the fever is
harder to get than malaria.
USAID director Jeremy Konyndyk, in Liberia to
support the fight against an epidemic which has claimed
the lives of almost 1,500 west Africans, told AFP
educating people on how to protect themselves was
the best way to beat Ebola.
Compared to something like malaria, it is much
harder a disease to get. But obviously must worse when
you do get it, he said.
The Statesman, 27.8.14
Adv. Ranjit Dasgupta, Dr. Indira Basu, Dr. Ananish
Chaudhuri, Dr. Atish Ranjan Barua, Hirak Sen,
Prof. Dikshit Sinha, Ranen Mitra, Er. Salil Kr. Mukherjee,
Madhabi Roy.

ROSS RABINDRANATH MISSION


(A Quarterly publication of
Sir Ronald Ross Memorial Centre, Kolkata)

Chief Adviser : Utpal Chaudhuri


Editor
: Dr. Ranen Dasgupta
Editorial Board : Dr. Pranab Kr. Sahana, Dr. Pranab Kanti
Dutta, Dr. P.K. Mishra, Dr. Syamal Kr. Ray, Dr. Sanghita
Dasgupta, Dr. Mohsin Manzoor, Supriya Sen, Mosiha
Khatoon, Dr. Shahnaj Latif (Mohiuddin), Swapan Kr.
Chattopadhaya, Debashis Chanda, Saptarshi Bose, Sujit
Biswas, Tapas Bhowmik, Dr. Debjani Chowdhury, Paritosh
Das, Ranjana Gupta, Subrata Bhattacharya, Phullotpal
Chaudhuri, Monalisa Rakshit, Rajarshi Dasgupta, Sandip
Banerjee, Purabi Das, Priyanka Das, Himika Das,
Sushanta Dutta, Sukomal Chaudhuri, Swapan Kr.
Chattopadhaya, Paritosh De, Babulal Sengupta, Dr.
Chanchal Das, Dr. Mukut Roy, Ranajit Dastidar, Kingsuk
Ghosh, Dr. Tapan Das.
Acknowledgement
Sudhin Roy, Ashoke Kr. Ghosh, Ujjal Roy, S. C. Ghosh,
H. K. Saha, Sumit Sen, Prantosh Bandyopadhaya,
Kamal Kr. Das, Purnima Chakraborty.

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

With Best Compliments From

EAST INDIA
PHARMACEUTICALS
WORKS LIMITED
KOLKATA - 700 071

ROSS RABINDRANATH MISSION VOL. 2, ISSUE - 2, OCT. - DEC., 2014

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