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Dhaka to be drowned
   Dhaka is going to be drowned in each monsoon more than once if the Inland Water Transport Authority (IWTA) does not pay heed to the government task force’s decision to dredge the Balu river as per specification to drain floodwater out of the city. The Balu river is the only remaining outlet to drain floodwaters out of Dhaka and if the authority does not adhere to the decision of the government task force, the mega city would be marooned for days in times of heavy rainfall as it happened in 2004.
   The 11-member high-powered task force, formed in 2002, was headed by the then shipping minister and its members included land minister, housing and public works minister, the mayor of Dhaka City Corporation, Professor Serajul Islam Chowdhury, Professor Muzaffar Ahmed, Professor Abdullah Abu Sayeed, Holiday and New Age’s founder editor late Enayetullah Khan, the Daily Star editor Mahfuz Anam, water expert Professor Ainun Nishat and former secretary to the government Engineer Quamrul Islam Siddiqui. The task force recommended that the Balu river has to be widened to its original width of at least 100 metres (over 300 feet) and dredged to be able to carry the excess waters during monsoon when at times it rains for days together.
   Media reports say the IWTA now wants to dredge only 37 metres in width (about 120 feet) because both the sides of the river have been systematically encroached by the greedy land grabbers over the years. The IWTA secretary has reportedly conceded that the encroachers have managed to take out land documents from the relevant government offices. How could they do it? By greasing the palms of the corrupt officials, of course. He reportedly said, ‘If the government should dredge the river as wide as 300 feet, it would be a project requiring a massive land acquisition.’ Obviously he was trying to justify the land grabbers’ misdeeds by suggesting that the land that belonged to the river should now be ‘requisitioned’ by paying compensation to the ‘land grabbers’ instead of taking measures to recover the same from them.
   Incidentally, the government task force included the land minister who was a party to its decision, which was based on a Cadastral Survey (CS) conducted for the period between 1888 through 1940. According to the survey, the width of the Balu river all along its 45 kilometres route was in excess of 100 metres and in some places it was 200 – 250 metres wide. Government documents published recently also corroborate this. The land ministry, which was a party to this decision made in December 2002, should have mentioned that the land along the river banks was encroached and needs either to be recovered or requisitioned, if the land grabbers had acquired legal right over it. Likewise, if the IWTA secretary’s assertion that the banks on both sides of river Balu were encroached and legalised is correct, it also proves that the IWTA officials were not doing their job to protect the rivers and its banks and needs to be disciplined.
   
   It is nobody’s business
   The high-powered task force gave its report in December 2002 and large part of the city was inundated for 72 hours following two days of incessant rains in 2004. The existing drains, sewers and outlets failed to carry off the unusually huge quantity of rainwater. Even now if it rains heavily for an hour or so, a large part of the city’s overpopulated areas get waterlogged for hours affecting normal transportation. And the taskforce’s recommendations to dredge the Balu river and implement other measures to improve the capacity of the drainage system had been gathering dust. It seems that neither the relevant agency nor the government at the centre feels that the quick implementation of the task force’s recommendation is urgently needed to not only provide relief to the city dwellers but also to make the city livable.
   Why is this inertia? There appear to be some good reasons behind this unwillingness of the concerned authorities. For example, while the dredging work would surely benefit those who would do the job, but to do the same following the task force’s recommendations would also mean that the misdeeds of the corrupt officials would be revealed. It is common sense that those who were involved in legalising the riverbanks’ encroachment would try to create hindrance for the project’s implementation. Now the question is: how does the government accept this situation? It clearly means that those who are at the helm of affairs do not care much to ensure accountability and disciplining the corrupt and recalcitrant officials. Instead they tend to look at it as ‘nobody’s business.’
   What the Financial Times in a recent report from New Delhi described as the ‘utopian myth’ of the Indian leaders and policymakers is very relevant to those of Bangladesh. Correspondent Victor Mallet pegged his story on last month’s New Delhi conference of the World Economic Forum (WEF) and the Confederation of Indian Industry (CII) and began with a quote from the exasperating chief minister of Indian capital territory Ms. Sheila Dixit who appeared out of her wits to cope with the bulging problems of mega city New Delhi. She told the conference: ‘I’ve put on some weight merely because I want to drown my anxiety by eating.’
   Her problems are that the 16 million people who live in New Delhi want more water, more power, more wages and more oil. She said if her administration did not meet their needs, Delhi, one of the world’s largest cities, would slide downhill. She seems to care about the problems of the people and does not shy away from sharing it with the people while at the same time letting the people know that she being an elected leader of the territory is well aware of the problems relating to their basic civic amenities. This really contrasts with the thinking pattern of our leaders – ours don’t find the time to think about the people’s problem at all.
   Then the reporter went on to portray the larger scene: ‘It is slowly dawning on Indian policymakers that the country’s much-trumpeted ‘demographic dividend’ – the population surge that will increase the workforce of 800 million by 2016 and India the world’s populous nation – may turn out to be more of a threat than an opportunity.’ The problems that came up during the conference included job creation for 71 million young people of working age over the next five years or 14.2 million annually. This means 1.183 million per month or 38,900 jobs per day. Most of these people, like ours, are poorly educated and a fraction of them will find regular jobs. Now, Sheila Dixit has publicly confessed that she gets frightened just thinking of the consequences of failure to achieve the afore-mentioned goals. And to drown her anxiety she keeps eating more. She should be commended for publicly airing her anxieties because not many Indian leaders dare to share such depressing thoughts with their constituents. That is the reason why the FT correspondent mentioned that the Indian policymakers are gradually coming round to realise the real problems that afflict the nation.
   
   The Bangladesh scene
   The problems of India that the FT report has focused also apply in the case of Bangladesh, only in a smaller scale. For example, Bangladesh will need to create over 15 million jobs for the young people who would be entering the job market over the next five years or 3 million annually and a quarter of a million per month. This also means over 8,300 young persons will enter the job market each day, 365 days a year. It is a frightening scene to visualise that over 8,300 poorly educated job seekers are lining up for job every day in the country and a substantial part of them are rushing to the capital city of Dhaka. Once they are in the capital, they need to be fed, clothed, sheltered and transported. The pressure on the available civic facilities would be simply mind-boggling.
   Sheila Dixit’s problem is that she thinks of these problems and also of the consequences if the targets are not achieved. She naturally becomes anxious and in her anxiety, she tends to overeat and puts on weight. She would have done better if she had tried to follow the examples of Bangladeshi leaders: they don’t think about any such problem and do not allow them to be bothered about the consequences of failure. If one does not have a head on one’s shoulder, one does not suffer from headache.

Since the ancient times, human beings have been carriers of the germ Mycobacterium tuberculosis that causes tuberculosis. Skeletal remains have revealed that prehistoric humans (4000 BCE) had tuberculosis. Examinations of Egyptian mummies dating from 2400 BCE have yielded definite traces of the disease. There were references to tuberculosis in India around 2000 BCE and it was present in the Americas from about 2000 BCE.
   The Greeks termed it ‘phthisis’ and around 460 BCE, Hippocrates noted it was the most widespread disease of those days which was almost always fatal. He also warned his colleagues to stay away from patients who were at the last stage of the ‘wasting disease,’ his logic being the healers would be held responsible for their inevitable demise.
   Although pathological and anatomical descriptions of tuberculosis began appearing from the seventeenth century, its cure was still not found.
   It was Sylvius who first identified actual tubercles as a consistent and characteristic change in the lungs and other areas of consumptive patients along with the description of their progression to abscesses and cavities in his Opera Medica (circa 1679). In 1702 Manget described the pathological features of miliary tuberculosis. In 1720 English physician Benjamin Marten theorised that tuberculosis may be caused by ‘wonderfully minute living creatures’ (bacteria) which once ensconced inside the body, would continue to spread. He also said one could get it being too close to a TB patient.
   The introduction of the sanatorium cure was the first real treatment of tuberculosis. Hermann Brehmer, a Silesian botanist, who under instruction from his physician, travelled to the Himalayan mountains and returned cured after a period of stay in the pristine atmosphere. At home he devoted himself to studying medicine and in 1854, presented his doctoral dissertation, Tuberculosis is a Curable Disease, and also constructed a sanatorium in Gorbersdorf, in the middle of a forest for TB patients.
   In 1865, French military doctor Jean-Antoine Villemin proved that tuberculosis could be transmitted from humans to cattle and from cattle to rabbits. His theory that a specific germ was responsible finally killed the age-old belief that the dreaded malady happened spontaneously.
   In 1882 Robert Koch discovered a staining method which made it possible for him to see the micro-organism that caused tuberculosis.
   The scientific and medical study of the causes and transmission of tuberculosis within a population continued, as did efforts to identify the origin and development characteristics of the disease. With the discovery of X-Rays it was now possible to accurately follow and review the progress and severity of a patient’s disease could be.
   Although improvement in sanatorium conditions and better nutrition proved a worthy campaign, drug therapy yielded mixed results. The first drug that could kill the bug was still too toxic for human or even animal use. It was in 1943 with the discovery of streptomycin and its subsequent introduction the following year to a patient critically ill with tuberculosis that showed remarkable results. The disease was not only halted, the patient recovered, albeit with some minor side effects.
   And though streptomycin-resistant mutants appeared in the next few years the disease could be busted with the combination of two or three drugs.
   Today, tuberculosis is the most common major infectious disease, infecting two billion people or one-third of the world’s population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.
   Most of those infected (90 per cent) have asymptomatic latent TB infection. There is a 10 per cent lifetime chance that latent TB infection will progress to active TB disease which, if left untreated, will kill more than 50 per cent of its victims.
   The registered number of new cases of tuberculosis worldwide roughly correlates with economic conditions: the highest incidences are seen in those countries of Africa, Asia, and Latin America with the lowest gross national products. The World Health Organisation estimates that eight million people get tuberculosis every year, of whom 95 per cent live in developing countries. An estimated 2-3 million people die from tuberculosis every year.
   In industrialised countries, the steady drop in TB incidence began to level off in the mid-1980s and then stagnated or even began to increase. Much of this rise can be at least partially attributed to a high rate of immigration from countries with a high incidence of tuberculosis.
   A great influence in the rising TB trend is HIV infection. Chances are that only one out of ten immunocompetent people infected with Mycobacterium tuberculosis will fall sick in their lifetimes, but among those with HIV, one in ten per year will develop active tuberculosis, while one in two or three tuberculin test positive AIDS patients will develop active tuberculosis. In many industrialised countries this is a tragedy for the patients involved, but it these cases make up only a small minority of TB cases. In developing countries, the impact of HIV infection on the TB situation, especially in the 20-35 age group, is of great and increasing concern.
   A final factor contributing to the resurgence of tuberculosis is the emergence of multi-drug resistance. Drug resistance in tuberculosis occurs as a result of tubercle bacillus mutations. These mutations are not dependent upon the presence of the drug. Exposed to a single effective anti-TB medication, the predominant bacilli, sensitive to that drug, are killed; the few drug resistant mutants, likely to be present if the bacterial population is large, will, multiply freely. Since it is very unlikely that a single bacillus will spontaneously mutate to resistance to more than one drug, giving multiple effective drugs simultaneously will inhibit the multiplication of these resistant mutants. This is why it is absolutely essential to treat TB patients with the recommended four drug regimen of isoniazid, rifampin, pyrazinamide and ethambutol or streptomycin.
   While wealthy industrialised countries with good public health care systems can be expected to keep tuberculosis under control, in much of the developing world a catastrophe awaits. It is crucially important that support be given to research efforts devoted to developing an effective TB vaccine, shortening the amount of time required to ascertain drug sensitivities, improving the diagnosis of tuberculosis, and creating new, highly effective anti-TB medications. Without support for such efforts, we run the risk of losing the battle against tuberculosis.
   Mycobacterium tuberculosis is identified microscopically by its staining characteristics: it retains certain stains after being treated with acidic solution, and is thus classified as an acid-fast bacillus. In the most common staining technique, the Ziehl-Neelsen stain, acid-fast bacilli are stained a bright red which stands out clearly against a blue background. Acid-fast bacilli can also be visualised by fluorescent microscopy, and by auramine-rhodamine stain.
   The Mycobacterium tuberculosis complex includes 3 other mycobacteria which can cause tuberculosis: M bovis, M africanum, and M microti. The first two are very rare causes of disease while the last one does not cause human disease.
   Nontuberculous mycobacteria are other mycobacteria (besides M leprae which causes leprosy) which may cause pulmonary disease resembling Mycobacterium, lymphadenitis, skin disease, or disseminated disease. These include Mycobacterium avium, M kansasii, and others.
   Tuberculosis is spread through aerosol droplets which are expelled when persons with active TB disease cough, sneeze, speak, or spit. Close contacts (people with prolonged, frequent, or intense contact) are at highest risk of becoming infected (typically 22 per cent infection rate but everything is possible, even up to 100 per cent).
   Transmission can only occur from people with active TB disease (not latent TB infection). The probability of transmission depends upon infectiousness of the person with tuberculosis (quantity expelled), environment of exposure, duration of exposure, and virulence of the organism.
   The chain of transmission can be stopped by isolating patients with active disease and starting effective anti-tuberculous therapy.
   While only 10 percent of TB infection progresses to TB disease, if untreated the death rate is 51 per cent.
   TB infection begins when MTB bacilli reach the pulmonary alveoli, infecting alveolar macrophages, where the mycobacteria replicate exponentially. Bacteria are picked up by dendritic cells, which can transport bacilli to local (mediastinal) lymph nodes, and then through the bloodstream to the more distant tissues and organs where TB disease could potentially develop: lung apices, peripheral lymph nodes, kidneys, brain, and bone.
   Tuberculosis is classed as one of the granulomatous inflammatory conditions. Macrophages, T lymphocytes, B lymphocytes and fibroblasts are among the cells that aggregate to form a granuloma, with lymphocytes surrounding infected macrophages. The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system. Within the granuloma, T lymphocytes secrete cytokine such as interferon gamma, which activates macrophages and make them better able to fight infection. T lymphocytes can also directly kill infected cells.
   Importantly, bacteria are not eliminated with the granuloma, but can become dormant, resulting in a latent infection. Latent infection can be diagnosed only by tuberculin skin test, which yields a delayed hypertype sensitivity response to purified protein derivatives of M. tuberculosis in an infected person.
   Another feature of the granulomas of human tuberculosis is the development of cell death, also called necrosis, in the centre of tubercles. To the naked eye this has the texture of soft white cheese and was termed caseous necrosis.
   If TB bacteria gain entry to the blood stream from an area of tissue damage they spread through the body and set up myriad foci of infection, all appearing as tiny white tubercles in the tissues. This is called miliary tuberculosis and has a high case fatality.
   In many patients the infection waxes and wanes. Tissue destruction and necrosis are balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material. During active disease, some of these cavities are in continuity with the air passages bronchi. This material may therefore be coughed up. It contains living bacteria and can pass on infection.
   Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Affected areas are eventually replaced by scar tissue.
   Tuberculosis is the most common major infectious disease today, infecting two billion people or one-third of the world’s population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.
   Most of those infected (90 per cent) have asymptomatic latent TB infection. There is a 10 per cent lifetime chance that LTBI will progress to active TB disease which, if left untreated, will kill more than 50 percent of its victims. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million, and malaria kills 1 million.
   The neglect of TB control programmes, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organisation declared TB a global health emergency in 1993.
   The cause of tuberculosis, Mycobacterium tuberculosis is a slow-growing aerobic bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria, which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of E coli that can divide roughly every 20 minutes). It is not classified as either Gram-positive or Gram-negative because it does not have the chemical characteristics of either, although it contains peptidoglycan in their cell wall. If a Gram stain is performed, it stains very weakly Gram-positive or not at all. It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but, spontaneously, can only grow within a host organism (in vitro culture of M tuberculosis took a long time to be achieved, but is nowadays a normal laboratory procedure).
   In those people in whom TB bacilli overcome the immune system defences and begin to multiply, there is progression from TB infection to TB disease. This may occur soon after infection (primary TB disease – 1 to 5 per cent) or many years after infection (post primary TB, secondary TB, reactivation TB disease of dormant bacilli – 5 to 9 per cent).
   About five per cent of infected persons will develop TB disease in the first two years, and another five percent will develop disease later in life. In all, about 10 percent of infected persons with normal immune systems will develop TB disease in their lifetime.
   Some medical conditions increase the risk of progression to TB disease. In HIV infected persons with TB infection, the risk increases to 10 percent each year instead of 10 percent over a lifetime. Other such conditions include drug injection (mainly because of the life style of IV Drug users), substance abuse, recent TB infection (within two years) or history of inadequately treated TB, chest X-ray suggestive of previous TB (fibrotic lesions and nodules), diabetes mellitus, silicosis, prolonged corticosteroid therapy and other immunosuppressive therapy, head and neck cancers, hematologic and reticuloendothelial diseases (leukemia and Hodgkin’s disease), end-stage renal disease, intestinal bypass or gastrectomy, chronic malabsorption syndromes, or low body weight (10 percent or more below the ideal).
   Some drugs, including rheumatoid arthritis drugs that work by blocking tumour necrosis factor-alpha (an inflammation-causing cytokine), raise the risk of causing a latent infection to become active due to the importance of this cytokine in the immune defence against tuberculosis.
   Ishrat Firdousi is editorial consultant, the Financial Express

Emergency: Bangladesh and Pakistan

Swat province and its environs are a battlefield, people are still reeling from the ‘welcoming massacre’ on Benazir Bhutto’s motorcade, one to two car bombs or terrorist attacks are a normal phenomenon — with all these happening, Pervez Musharraf has declared to end emergency in Pakistan from December 15.
   With the major political parties ‘decapitated’, why the ‘popular’ caretaker government, which has promised us true democracy with honest leaders, needs a life-support like emergency is a million-dollar question.
   Saif
   Dhaka

A ‘victory’ for the ‘untouchables’!
   Syed
   Old DOHS, Dhaka
   

The destroying of the CIA tape adds to the growing suspicion that the US is not the beacon of rights and freedoms that it so vigorously claims to be. This is the latest example to show that the US is no different from the terrorists it rants and raves against.
   Jasmine
   On e-mai

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