HEALTH
SUPPLEMENT
THE WEEKLY OBSERVER THURSDAY, jANUARY 19, 2017
The Race Against Superbugs A new generation of drug-resistant pathogens are testing the defenses against major diseases Rishiraj Bhagawati
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astSeptember a woman died in the United States after being infected by a superbug during a trip to India. Doctors said that the infection was caused by a multidrug-resistant organism carrying an enzyme with an Indian name. The New Delhi metallo-beta-lactamase (NDM-1) has been found to make a pathogen (a microorganism known to carry a disease) resistant to around 26 different antibiotic drugs, rendering the pathogen a superbug. The Times of India reported in September 2015 that NDM-1 has now spread to over 70 countries and has covered most major regions in the world. There are four categories of antibiotics, set in ascending order of their power to act upon pathogens. If a pathogen is immune to a Type-4 antibiotic— which includes those of the Carbapenem family —the pathogen is deemed a superbug. The ability to break antibiotics down and thus remain immune to them is made possible by certain enzymes. NDM-1 is one such enzyme, and not a superbug as some have mistakenly suggested, which when carried by bacteria like E coli and Klebsiella, makes them superbugs. The organism that infected the American woman was also intermittently resistant to tigecycline, an antibiotic specifically developed to treat drug-resistant organisms. Essentially, there were no treatment alternatives left. Superbugs carrying NDM-1 were first identified in a Swedish patient returning from New Delhi in 2008. The Times report says that joint research by scientists
from Rice, Nankai and Tianjin universities had recently found superbugs carrying NDM-1 in wastewater disinfected by chlorination. What this means is that chlorination, the most common domestic method to purify water, does not kill the superbugs carrying NDM-1 and may even help it thrive. The report went on to state that tests at two wastewater treatment plants in northern China had revealed that antibiotic-resistant bacteria carrying the deadly enzyme were not only escaping purification but also breeding
and spreading their dangerous cargo. The implication of this seems to be that we have to redesign the method and equipment used for wastewater treatment. The report also said that in New Delhi, Cardiff University scientists had found that the NDM-1 gene had already spread to the bacteria that cause cholera and dysentery in
India. This means that it will now be more difficult to treat cholera and dysentery with traditional antibiotics, and by extrapolation, may result in the return of these diseases on a significant scale. Additionally, the temperature range at which the superbugs carrying NDM-1 thrive best in coincides with the usual temperature in North India. But that fact is not enough to predict that their numbers will increase significantly in the near future; superbugs need specific nutrients to survive and replicate, and there is no evidence to show that these are adequately available here. However, it is also worth noting that the NDM-1 enzyme is particularly mobile, which means that they do not remain local to the pathogen carrying it. The enzymes that create resistance to antibiotic drugs are carried on mobile pieces of DNA which are called plasmids, and can easily spread on to other types of bacteria. People have pointed to a myriad reasons as to how superbugs took birth at all, the most commonly agreed upon of which is misuse of antibiotics. When doctors prescribe more antibiotics than are required or prescribe antibiotics for non-bacterial infections, pathogens build resistance against the drugs instead of getting wiped out. Over time, they have overcome (almost) all antibiotic drugs ever administered. While it seems like we have a major public problem at hand, research is underway at top laboratories around the world to come up with a new generation of antibiotics to counter superbugs – even if they too ultimately prove as short-lived as their predecessors.
Giving the Gift of Life
Despite knowing their lives might one day depend upon the kindness of strangers, few people are willing to donate their organs after death. Mrigakshi Dixit
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second life is the ultimate gift a person can ever receive. That’s precisely what the donation of a vital organ, a scientific miracle in itself, is and one, moreover, that’s within everybody’s power to give. Sadly, although there are many in need, they find few willing to give them that precious gift. According to the Organ Procurement and Transplantation Network,last year more than 24,891 organs were transplanted around the world. However, there still aremany thousands more awaiting a lifesaving organ transplant. The Mohan Foundation, an NGO, estimates the organ-donation rate in India is just 0.26 per million while the United States and Spain boastdonation rates of 26per million and 35.3 per million respectively. In India Tamil Nadu, Maharashtra and Kerala have registered the highest number of organ donations, the numbers donated standing at 519, 216 and 222 respectively, in 2015. Organ donation can be classified into three types: brain-stem death, circulatory death and living donation. In 1994, the government of India passed the Transplantation of Human Organ Act that allowed for organs to be donated aftera person was declared brain dead. In India, around 3,500-4,000 transplants take place in a year according to World Health Organisation (WHO). “Many people in India are still unaware of the concept of brain death,”says Priyanka Shailendra, director operations at Gift Your Organ Foundation. With the increasing number of cases of kid-
ney and liver failurereported in India, there is a huge demand for both organs.Between 1971 and 2016,just 21,395 kidneys have been transplanted. “In Karnataka, just for kidney transplant there are 200 patients on the waiting list. There is a severe shortage of donorsand over 1.9lakh patients are surviving on dialysis,” says Shailendra. Almost70% of liver transplants are made possibleby live donors and 30% receive cadaver donations. Over the past few years, India has been facing a grow-
ing mismatch between demand and supply of organs. “Hospitals in Bengaluru like Fortis, Apollo and Manipal are licensed for the donation of only specific organs,” said Shailendra.’ In many parts of India there is lack of specialised doctors and infrastructure. Apart from the lack of awareness, these factors also contribute to the shortage of organs. People need to be educated about the benefits of organ donation in order to increase their awareness.Our NGO has conducted surveys that show most people are ignorant about the procedure for donation. Gift your organ foundation organises several seminars to educate people,” she adds. The shortfall in the availability of organs has given rise to a thriving black market. India is a global hub of the kidney racket and many poor people are lured to donate their kidneys for money. Several cases have been reported in Uttar Pradesh where kidneys harvested locally have been taken to the United States for transplant. Althoughthe Transplantation of Human Organs and Tissues 2011 Act provides protection against organ trafficking, many rackets thrive in the country. According to reports by WHO, 2,000 people sell their kidney every year. Many illegal organ donation cases have been reported in the last few yearslike the Indraprashtha Apollo Kidney racket in 2016 and Gurgaon Kidney scandal in 2008. With the great strides that technology is taking today, Shailendra believes that organ donation has a bright future and will be able to save more lives but provided there is greater awareness. After all, one day you may be to live longer because somebody thoughtful and compassionate decided to donate her organs.
SUPPLEMENT
THE WEEKLY OBSERVER THURSDAY, JANUARY 19, 2017
Enlightened Self-Interest Hotels know caring for the environment is good for business Nivedita Naidu
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ourists covet pristine getaways, unspoilt beaches and fresh mountain air but seldom consider the impact of their own actions on the environment. Air travel is often blamed for air and noise pollution but seems positively benign when compared to the mess travellers leave on the ground. The hotel industry is at the frontline of dealing with the problem and a few renowned hotels brands have set out to establish best practices in everything from construction to the maintenance of their properties, their use of resources and the management of waste. Call it enlightened self-interest. Hotels managed by the ITC Group have been promoting green practices at all their properties. Their hotels use only treated, recycled water for their gardens and grounds, cooling towers and miscellaneous cleaning. Their best practice goes well beyond recycling water for their own use. They shareany excess water after recycling with the local community, whether through the municipality or directly to educational institutes or for use in irrigation. Treated and recycled water supports 60 thousand trees on their properties. The group also has self-owned wind farms that it uses to power hotels. By using renewable sources of energy (both solar and wind) they directly reduceuse of fossil fuels and the air pollution they cause. Approximately 25 percent of electrical energy demand of ITC hotels is met through renewable energy sources.
The Forbes Global 500 list for 2015 recognised the Hilton group of hotels in the top 50 green brands of the year. One of the main strategies that the group follows is to accurately measure and manage resources. As part of their practice to promote efficient use of resources they developed Project Repurpose, a comprehensive wastemanagement programme. The hotel has recycled items from mattresses to soaps. An interesting example is their
soap-recycling programme which began in 2011. The groupconverted over 2.7 million kg. of used soap into 1.6 million new bars, and donated them to a ‘public health through sanitation’ initiative. Some initiatives require no capital outlay, just common
sense. Toreduce food wastage, one of the hotelsin the Hilton group simply removed all bins from the staff cafeteria for one day. The result was a considerable drop in food wastage. Soon other hotels of the group adopted the ‘No Bin Day’ practice to great effect. Bangalore’s growing water crisis is causing grave concern to the city’s hoteliers who cater to tourists from all over the world. To cater to their guests’ needs in the best possible manner while being responsible a corporate citizen, chief engineer Arvind at the Leela Palace says the hotel has its own water recycling plant that treats around 300 kilolitres of water every day. When managing ITC’s hotel in Port Blair on Andaman Island,Niranjan Khatri, founder of green NGO iSambhav, introduced metal containers to pack picnic lunches for his guests and at one stroke eliminated the problem paper and plastic trash that littered the island’s beautiful beaches. However, there is a concern over the lack of standard practices for hotels. Complains Khatri, “All hotels do not work for sustainability in a systematic manner, though there are a few basic rules applicable for all hotels.”As an example, he points to inefficient water-management practices such as drinking water being used for cleaning and flushing. But as ITC, Hilton and Leela demonstrate, the idea of best practice clearly resonates in the industry. It’s a matter of time before these innovative and cost-effective methods to manage valuable resources becomes standard practice..
A Dog’s Life The ability to care for animals is a true test of our humanity Sandra Branger
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wning a dog has become increasingly common in middle class homes, especially good-looking breeds like the Golden Retriever, Labrador, Dalmatian or Spaniel. People buy them for their looks and sometimes for their intelligence. But they rarely learn to respect them. Animals feel the way we humans do; they feel loved and they can sense hatred and anger and fear. Though completely dependent on us (that’s why we call them pets) they aren’t in constant need of help or support. They want what humans want:autonomy, empathy, and care -- but never neglect. Animals test the limits of our humanity. Whenwe choose to we coddle them or hurt them, we treat them as playthings. And we discard them when we get bored with them.
Vijaya has 32 cats at home, all of them rescued from the streets or from unhappy homes. She fosters them until she can find them new homes. She is a member of the Cat Squad, a volunteer animal-rescue group, who gets 5-6cases of abused animals each day. Earlier this month she found 4 abandoned kittens, 1½ months old, in a plastic bag dumped in a dustbin. According to Vijaya, cats are considered unlucky and thought to be aloof and unfriendly. The fact is cats are shy and independent by nature. It is not right to blame a creature for its instincts. Buddy was gifted by a friend. Initially the kitten was much loved because he was cute. But his owners soon lost interest and Buddy spent his adult life chained in the balcony under a blazing sun and in severe cold, fed a diet exclusively of curd rice (his owners were vegetarians). One day, a young woman who lived across the street saw an animal that she took to be a large rat on her neighbour’s balcony. Out of curiosity she went closer and was taken aback to behold a strange creature,as large as a bandicoot but which mewed! It had red spots on its skin and eyelids completely glued with rheum. It dragged its chain along as it crawled towardsher, probably hoping for food. She promptly called Vijaya, who took Buddy away and gave him a new life. Prince was a cute Labrador bought from a breeder. His initial days with his new family were special, everybody cuddling him and wanting him all day long on their
laps. He was the happiest creature alive. But 6 months later, it was a different story. Prince was a big boy now, so needed no more pampering. He was caged and gradually became an untouchable. The family had appointed a man who could visit twice a month to bathe him. The owner shooed him if he showed any excitement. The kennel stank of poop and pee. Prince cried for affection and attention but his owners were irritated by his constant whining and barking.He was rejected only because he had done what all creatures do: he had grown up. And that was unacceptable.