Artificial Intelligence, Actual Challenges

People in power expectedly seek comfort in the fact that India has more than achieved the World Health Organisation (WHO) recommended doctor to population ratio of 1:1,000, described as the ‘golden finishing line’ in 2018. In fact, the ratio is approaching 1.5. This is, however, taking into account the registered medical practitioners of both modern medicine (MBBS and higher degrees) and traditional medicine (AYUSH, the acronym for Ayurveda, yoga & naturopathy, unani, siddha and homeopathy). The yearly intake of nearly 70,000 MBBS students at institutions regulated by the Medical Council of India may look impressive on paper, but this is to be seen in the context of pathetic state of health services beyond cities in vast expanses of semi-urban and rural areas.

People living in Bharat are the sufferers for the low allocation for healthcare in the Union and state budgets year after year ignoring the sane advice of the world’s leading development economists. Indian leaders nurse the ambition that the country be counted among super powers. Nothing wrong in that. But how can that happen when the country is among the lowest budget allocator of GDP in healthcare in the world. Not to cite instances of developed countries, India is distressingly spending less in healthcare, as a percentage of GDP, than Brazil, Bangladesh and Pakistan.

Outside tier 1 to 3 cities in India, people may get good, if they are lucky, to indifferent services of general medical practitioners and rarely of specialists. But relief is likely to come to the vast majority living wherever they maybe, depending on how soon the healthcare system will be enabled by artificial intelligence (AI) to be of universal service. The challenge then is to go on feeding the computer with enormous amount of data culled from international and domestic sources relating to diseases, their symptoms, identification and diagnosis, the tests to be done and treatment to be followed thereafter.

The problem that will still be there is the lack of equipment and trained doctors and nurses in rural hospitals and health centres. When it comes to India, the major problem, as has been identified by Anandalal Roy of National Institute of Health, Washington and Kunal Sen, global chief information officer of Encyclopaedia Britannica is the lack of reliable health related data. They say most of the data are illegibly handwritten, almost impossible to decipher and therefore, it is difficult to create an appropriate database.

According to Roy and Sen, in the absence of an ideal training data in database, the computer will not be able to diagnose diseases and recommend ways of treating them. The basic premise is if wrong or incomplete data is fed into the computer, then it will generate wrong results. They, therefore, recommend that steps should be taken to centrally digitise all health related records. Once this enormous time-consuming work is done, it will be possible to access any health record from anywhere by using the computer. In course of time, once sufficient records are collated and fed into the computer they are to become part of database. Roy and Sen say though India is making progress slowly in this direction, it mercifully has remained in course.

Health is, however, one of the many areas where AI will work wonders in terms of service improvement, booster of efficiency sparing people from doing routine work over and over again and operational cost reduction. No wonder then a growing number of companies engaged in manufacturing from metals to automobiles, FMCG products and financial groups are doubling down on introduction of digitisation and AI in their systems in the wake of the globally disruptive Covid-19 pandemic.

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From logistical planning to supporting sales without being physically in touch with buyers to scripting overall business strategy, AI is proving to be of major aid. Who did coin the word ‘artificial intelligence’ and when? Stanford University professor John McCarthy was the first to use the word in 1955 when he proposed a ten-man summer research on the subject. In proposing the research, McCarthy wrote: “The study is to proceed on the basis of the conjecture that every aspect of learning or any other feature of intelligence can in principle be so precisely described that a machine can be made to simulate it.” Moreover, his invention of computer programming language LISP remains the universal language of choice for AI.

As AI continues to make inexorable march to perform humongous amount of work, there are concerns not confined to India that machines progressively taking over many tasks routinely performed by human beings will lead to job losses. But H. James Wilson and Paul R Daugherty say in an article published in Harvard Business Review that “while AI will radically alter how work gets done and who does it, the technology’s larger impact will be in complementing and augmenting human capabilities, not replacing them.”

In their research involving 1,500 companies, the principal finding is that companies achieve maximum performance improvements when humans and machines work in harmony. “Through such collaborative intelligence, humans and AI actively enhance each other’s complementary strengths: The leadership, teamwork, creativity and social skill of the former and the speed, scalability and quantitative capabilities of the latter.”

This and many other similar research findings will help in dispelling misgivings about growing AI application. What must also be taken into consideration are the emerging links between AI and creativity. The survey of a large number of global businesses and leaders in information technology (IT) by MIT Technology Review Insights found that nearly half of them agreed that because of AI “we could dedicate more time to thinking creatively about the business challenges we and our clients face.” AI is exactly freeing people from tedious routine work to be able to be engaged in creative and innovative pursuits.

India has a unique advantage in rapidly employing AI in sectors from health to industry to finance to farming. Not only are the world’s maximum number of students are majoring in the subject in Indian colleges, but this country also hosts the globe’s largest number of companies engaged in development and application of AI, ahead of the US and China. Even while India has this distinctive edge in AI education, Roy and Sen, both residents of the US, regret that beyond graduation, the students migrate to foreign countries to pursue further study, including PhD on the subject. As is expectedly the case, once they leave India, they settle down abroad where employment opportunities in the field are growing fast. Roy and Sen recommend the ways to staunch the brain drain of this intelligent kind will be to create condition for appropriate investment in AI higher education, including facilitating research work and assured jobs after completion of education.

Is India Prepared For 3rd Covid Wave?

Indonesia now is in exactly the same terrible and tragic situation as India was during the peak of the second surge. Australia is going for a lockdown, and even New Zealand, hitherto totally safe, is on high alert. With cases rising in thousands every day, Boris Johnson might once again take the UK down the drain if he opens up the lockdown on July 19, even while all is not well in Catalonia/Barcelona in Spain, among other EU nations.

Vice President Kamala Harris led a ‘pride rally’ recently without a mask. Americans in many parts are allowed to come out in the open without masks. However, with 50 per cent fully vaccinated, is the virus really “on the run”, as President Joe Biden so proudly claimed on Independence Day, 4th of July?

There is reportedly a ‘silent surge’ in many parts of America and it is worrisome. It is being largely attributed to clusters of unvaccinated people, including Trump-supporters ‘in denial’. A Georgetown University study reportedly found 30 clusters of counties, of which five are across the Southeast and Midwest, from Georgia to Texas, across Missouri, and parts of Oklahoma, Tennessee, Louisiana, Alabama and Arkansas, where the threat is real and looming large.

So how well is the Indian State with a new health minister at the helm prepared for the ‘third surge’, even as the second wave lingers on, and thousands care a damn in tourist spots, without masks or physical distancing?

Listen to the Covid Task Force head, Dr VK Paul, as reported by the Indian Express: “It is right that the graph (of the decline in the number of cases) has slowed down. It was earlier declining at a faster pace. It only shows that we cannot take the situation for granted. If it is around 35,000-37,000 cases per day, this is almost one-third the number of cases we saw during the first wave peak. The war is not over; the second wave is not over. It is perhaps more visible in some districts and two particular states and the Northeast, but it is still there. As long as this is still rising there, the nation is not safe…With a lot of effort and difficulty, we have reached a situation where cases are on the decline. The situation is bad only in a few districts. But all this can be snatched away from us because we have not contained the virus completely. If we give the virus an opportunity, and chains of transmission are launched…this is something we cannot afford…”

Indians banged thalis, frying pans, pressure cookers at 5 pm on March 22, 2021, following the call of Prime Minister Narendra Modi, even when the virus was just about spreading its wings. Indians followed dutifully with no questions asked, the sudden, draconian and unplanned lockdown last March, which led to the exodus of lakhs of migrant workers. Indians even believed the PM when he said that all will be well in 21 days.

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Meanwhile, the states fought their own battles without any tangible help from the Center. Millions were rendered jobless, the poor were left to their helpless fate, the economy tanked and continues to tank, hunger, starvation, anxiety and depression stalked the unhappy landscape, there was ‘no vaccine policy’ worth its name, and people hoped against hope that 2021 will start with a flicker of hope. Remember the PM’s cathartic speech at the World Economic Forum’s Davos Dialogue in January 2021?

“Today, Covid cases are declining rapidly in India… India’s stats cannot be compared with one country as 18 per cent of the world’s population lives here and yet we not only solved our problems but also helped the world fight the pandemic… In these tough times, India has been undertaking its global responsibility from the beginning. When airspace was closed in many countries, India took more than 1 lakh citizens to their countries and delivered essential medicines to more than 150 countries…” 

Significantly, the PM said India’s role will increase with the rollout of more ‘Made in India’ Covid-19 vaccines. Clearly, this was chest-thumping in its most glorious form at the world stage.

Then arrived the deadly second surge, even as the PM and his Union home minster were obsessed with capturing Bengal at any cost, while welcoming millions at the super-spreader Kumbh. The PM was delighted to see huge crowds in one of his last rallies in Bengal. While sections of the stooge media played along, the international media published front page pictures of mass cremations, accompanied with highly critical text putting the entire blame on Modi. And they were on the spot, on the dot. Surely, the mass tragedy was a public spectacle for the world to see!

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Lest we forget, there were tens of thousands dying due to the acute scarcity of hospital beds, oxygen, life-saving drugs, with cremation and burial grounds unable to find space for the dead bodies, while parking lots, pavements, open spaces and public parks in some places were converted into cremation grounds. Some electric crematoriums refused to work because their ‘internal organs’ had melted due to the relentless heat, huge make-shift walls were created to block journalists to report on the relentless mass cremations (in Lucknow), and the data of deaths were allegedly fudged or censored, even while the obituary pages were full of tributes to the dead (as in Gujarat). 

So, is India prepared for the third wave?

On June 19, said Dr Randeep Guleria, Director, All India Institute of Medical Sciences, Delhi:  “We don’t seem to have learnt from what happened between the first and the second wave. Again crowds are building up… people are gathering. It will take some time for the number of cases to start rising at the national level. But it could happen within the next six to eight weeks… maybe a little longer.” He said that unless the population is vaccinated, the country will remain vulnerable in the coming months.

The Hindu reported in early May that that the principal scientific adviser to the government of India has warned that the third wave of Covid-19 is inevitable. “There is, however, no clear time-line on when this third phase will occur. We should be prepared for new waves, and Covid-appropriate behaviour and vaccine upgrades is the way forward,” he said.

Modi has made the promise on live television of total and free vaccination in India after June 21. Hoardings have come up with the PM’s mug shot profusely thanking him for free vaccines. If Rahul Gandhi as much as tweets: ‘July has come. Where are the vaccines?’ some central ministers suddenly emerge from the shadows and Rahul gets a good tongue-lashing.

The situation is as fuzzy as it gets. Noida apparently stopped vaccination from June 30 for a week – reasons not known. Gujarat suspended vaccination recently for unknown reasons – there were no vaccines, according to sources, it was reported. Vaccination was stopped in Mumbai due to lack of vaccines, but restarted again. Almost all the big states reportedly have vaccination shortfalls; Bihar has a shortfall of 71 per cent, while West Bengal, Jharkhand and UP are not far away. Even Kerala and Delhi, who have done the best, will not be able to achieve a 60 per cent target by December.

Is the current scenario optimistic? Not really.

Apparently, about 20 per cent plus have got their first dose, and 5 per cent plus have been fully vaccinated. Surely, at this rate, no one knows when a country of India’s size will ever get ‘fully vaccinated’. And the bitter truth is that less the level of vaccination in the population, the more there are fears of multiple mutations of this killer virus. India, therefore, is as vulnerable as ever.

Nursing Our Health Care System

At all times in India before the outbreak of Covid-19 pandemic, government hospitals and other health centres in urban, semi-urban and rural areas were overwhelmed by patient visits with all kinds of ailments as majority here do not have the means to avail treatments at private hospitals and nursing homes. To the extent there has been private investment in the health care system since the start of liberalisation in 1991 heralded by the likes of Apollo, Fortis and Max, the load is off from government sector.

Unfortunately, even while medical experts and welfare economists are recommending that investment in health (and also education) has a positive bearing on sustainable GDP growth, New Delhi in its wisdom made an allocation of less that 1.5 per cent (₹67,484 crore) in the 2020-21 Union budget for the health sector. Here it needs recalling that Prime Minister Narendra Modi himself talked about the sector ideally claiming at least 2.5 per cent of national budget.

Because of the failing of the government manifest in insufficient investment in health care over the years, people at large are paying a heavy price during the current pandemic. India’s Covid-19 tally has already crossed 8 million with around 45,000 people contracting the virus daily. Mercifully, the recovery rate here is 98 per cent and death rate at 2 per cent is lower than in most other countries. Indians are not known to be disciplined even in the face of a looming danger. The world has been witness to an identical behaviour of a large number of citizens in many developed countries, all leading to exacerbation of the global health crisis.

The Indian festive season has begun with Durga Pooja to be followed by Diwali and ending with the Christmas and New Year. With thousands milling around in festive celebrations throwing caution like mask wearing and social distancing to the wind, a second wave of coronavirus is logically feared.

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Doctors, paramedics and nurses are already a highly stretched community working without a break. Many of them contracted the virus in the process with quite a few dying. Now when hospitals and nursing homes have made it known that in case of a second wave during the not faraway winter infecting a larger number than now, they will not be able to provide beds to all the sick people. Why only beds, the Indian health sector on whose services demand is made by 1.38 billion people and also growing numbers from neighbouring countries, particularly Bangladesh suffers from considerable shortages of doctors and nurses by World Health Organisation (WHO) benchmark.

We have in India 6.4 allopathic doctors, nurses and midwives per 10,000 compared with WHO recommended 22.8 persons per 10,000. No doubt, the health care system here was stressed out before coronavirus hit the country. The situation has only become worse both for medical staff and people needing care since the third week of March when the country went for a comprehensive lockdown to fight the pandemic.

This certainly is not the time when the country can afford to lose any more of its nurses to foreign countries however desperate they may be to shore up their medical support system. But only recently, according to United Nurses Association, Maharashtra chapter, close to 500 nurses made it to the UK, traditionally an alluring destination for Indian Florence Nightingales. They are drawn to the UK and several other countries for much better pay, social security and quality training facilities leading to assured career development. Unfortunately, the profession that should automatically command respect has long been neglected in India with nursing commanding a low status in medical hierarchy.

In attempts to address shortages of qualified human resources in its famed National Health Service (NHS), the UK government introduced a fast-tracked visa for medical professionals in November 2019. To top it off, the eligibility criteria for job entitlement has been revised to the advantage of Indian doctors and nurses.

Why only the UK, other developed countries where English is the medium of communication such as the US, Australia and New Zealand are always welcoming the services of doctors and nurses from India. In consequence, India continues to lose one section of medical professionals at a rate faster than ever before when, according to one reliable estimate, we will need over 30,000 nurses in the next few months.

Moreover, as the medical services are expanded principally by private sector investment and the government too remains engaged in beefing up facilities in rural centres, India will need extra 2 million nurses in the next five years. Acceleration in migration speed in recent periods makes one wonder about the feasibility of achieving the targets. Shortages of nurses are becoming acute this year as around 250,000 who graduate around this time every year could not join the job market with the pandemic standing in the way of final examinations being held.

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In any case, according to a recent government submission in the Rajya Sabha, the country has 3.07 million registered nursing personnel (nurses, midwives, women health visitors and auxiliary nurse midwives). This works out to 1.7 nurses per 1,000 people, 43 per cent less than the WHO norm of 3 per 1,000. At the same time, like in so many other sectors, a large number of women with some kind of basic training and skills but without official registration offer their services in their localities. There is an exponential growth in the number of nursing colleges from 30 in 2000 to over 1,800 now, thanks to leading private hospital chains and also practising non-resident Indian doctors making significant investments.

Students of nursing and midwifery have the option to do either a diploma course or a four-year degree course that allow them registration with Indian Nursing Council. Since the courses are conducted in English and young nurses seeking migration are proficient in conversing in that language, they settle down easily in English speaking countries. The Gulf countries too are an important migration destination for Indian nurses. Their only competition is from nurses from the Philippines.

Nursing courses in private institutions are expensive and the students are required to borrow money from banks to fund their studies. So the pressure is on them to clear their borrowings once they have earned their diplomas and degrees. Let’s see what at the entry level nurses get here and in the preferred foreign destinations. The government on the basis of recommendation of seventh pay commission has fixed the starting salary of nurses in its hospitals in the range of ₹50,000 and ₹70,000. In contrast, the better of the private hospitals will offer a starting pay of up to ₹20,000 plus training and some other facilities. But at a number of privately owned establishments, the pay could be as measly as ₹7,000 a month – that is, less than $100.

Salary and perquisites available to nurses in the UK and the US are many times better than in India. Rewards for nurses in Saudi Arabia and Kuwait are even more. As long as the host countries will leave the door open for Indian nurses, the migration will happen. The only way to put a check on migration will be to give nurses better compensation and recognition for their work.