Barcelona

This Catalonian metropolis is a colorful mix of extravagant architecture, vibrant street life, and museums and galleries full of artwork from prominent Spanish artists. The soccer team FC Barcelona or simply “Barca” has a cult following, especially after Spain won the World Cup.

Barcelona - An Eagle's Eye View from Tibidabo (Credit: Uzair Siddiqui)

La Rambla

The street life of Barcelona can be seen best on La Rambla – the street that leads down from the busy Plaza Catalunya to the seashore. The boulevard, which has a wide central walking area comes to life in the evening when performers and local artists vie for attention. Over the course of an hour we came across artists dressed as a flowerpot, a large fly and the most ingenious as an ingredient on a large plate of paella (a Spanish rice dish). There was also a fabulous juggler whose silken movements were amazing, and a spray can paint artist who created an ethereal world on paper in under 15 minutes.

The Paella Man

The Spray Can Artist

The atmosphere on La Rambla cannot be described – it can only be experienced. The boulevard is crowded with kiosks selling newspapers, flowers, sweets, ice cream and curios. Amidst all this were young men from Punjab selling scarves sourced from Delhi’s Sarojini Nagar market, and fluorescent helicopters that could be launched from rubber bands – much like the scene at India Gate. La Rambla is one big carnival every evening.

With its 435 pedestrian malls, Barcelona is a walking city where you can stroll its wide parks, where locals come to sit with friends, chat or read a book. Barcelona is also home to Spain’s four biggest names in art – Gaudi, Dali, Picasso and Miro – all eccentric yet brilliant in their own right. While Gaudi’s stamp on this city is omnipresent in the form of his bold architecture of La Sangrada Familia, Park Guell, and various housing projects, Barcelona also houses fantastic galleries featuring the works of Salvador Dali and Pablo Picasso, in whose museum you will see not only his famous cubist pieces, but also some of his early works.

Barcelona hosted the 1992 Olympics and the Parc de Montjuic revives that memory. Besides the Olympic stadium, this area also hosts a museum that features the history and trophies of FC Barcelona – a feat for soccer fans. Tickets come at a premium for Barca games, but a casual tourist can always join victory celebrations at the fountain at La Rambla.

Barcelona is also a good place for shopping – either real or the window type. Almost every city district has fashionable as well as small traditional shops, but these are most prominent along La Rambla and in the Gothic district. For artwork, there is the centre of the Spanish village, Poble Espanyol, on the Montjuic Hill. You can soak in the atmosphere of a busy street that has been around for a thousand years on the European shopping street Sants and Creu Cobarta. There are over 350 shops as also restaurants and bars.

Inside the Gothic Cathedral (Credit: Uzair Siddiqui)

Expiratory Church, Tibidabo (Credit: Uzair Siddiqui)

After a day full of walking and soaking in the sights and sounds of Barcelona, many a tourist can be spotted lazing over a carafe of sangria, a wine punch typical of Portugal, but quite popular in Spain as well. 

Columbus Day Protest (Credit: Uzair Siddiqui)

Gaudi Gazing in Barcelona

Barcelona is promoted as a modern European metropolis. Its temperate climate, a killer location on Spain’s Mediterranean coast, but above all, its modern architectural style has made Barcelona an attractive city to visit. In this capital city of the Catalonia province, the Catalan Art Neoveau arose in the presence of an architectural scene of eclectic tastes. Above all else, it is the work of Antonio Gaudi (1852-1926) that stands out in this city.

Antoni Plàcid Guillem Gaudí i Cornet (Antonio Gaudi in its English translation) was a Spanish architect who is famous for his highly unusual and individual style that extended far beyond the scope of Modernisme. We spent the entire day exploring two of Gaudi’s brilliant pieces of work, both designated as UNESCO World Heritage Sites  – Park Guell and The Temple of Sangrada Familia.

Sign at entrance of Park Guell, Barcelona

The businessman Eusebi Guell conceived Park Guell as a garden city, which would bring together the ideal conditions of habitation in the middle of an insalubrious industrial city. He chose Gaudi, who had earlier worked on Guell’s palatial home on La Rambla Street (another Barcelona landmark). Gaudi worked on this park from 1900 to 1914, but the project was later abandoned as a commercial failure. The Barcelona City Council acquired it in 1918 and converted it into a public park in 1923. Park Guell is now one of the best public spaces in Barcelona.

Park Guell, Barcelona

Park Guell was designed as a private urban development in the northern part of Barcelona known as Muntanya Pelada (Bald Mountain). In this rocky terrain full of slopes, Gaudi designed all the necessary services such as viaducts to distribute water, squares and streets, a large entrance stairway to a hall for a covered market. Over the roof of this hall is a large public square bordered by an ergonomically designed winding bench decorated with artwork done using broken tiles.

Public square on top of the columnar hall, Park Guell

Gaudi's tile work, Park Guell

The outstanding feature of Park Guell is its integration of architecture with nature. The Porter’s Pavilion and Keeper’s House Pavilion dominate the entrance, the former with its four-armed cross and both with attractive mushroom-shaped chimneys.

Porter's Pavilion (right) and Keeper's House Pavilion, Park Guell

Gaudi’s most famous project and his labor of love is the Temple of Sagrada Familia. Being a devout Catholic, Gaudi devoted his later years to this project, which he designed to have 18 towers – one each for Jesus, Mary, the 12 apostles and 4 evangelists. Construction began in 1882, slowed down by 1912 due to personal tragedies in Gaudi’s life, the economic hard times in Barcelona and the death in 1918 of his patron, Eusebi Guell. In June 1926 Gaudi was himself hit by a tram and died three days later in a pauper’s hospital in Barcelona. He lies buried in La Sangrada Familia. The work on this project continues up to this day, some according to Gaudi’s original plans, much of which were destroyed in the Spanish Civil War. Work is likely to be completed around 2030, making this perhaps the only World Heritage Site that is still being built.

La Sagrada Familia, Barcelona

La Sangrada Familia is a church of the basilican plan and with a Latin cross, has five naves in the central part and three in the transept. The limit on space has led to its optimum use and explains the cloister around the temple. The style of Sagrada Familia is Gothic, based on controlled geometric structures. It has a paraboloidal base structure, columns in the central nave and a tree-shaped columnar form that supports vaulting of a hyperbolic base and internal modulation of windows that filter and distribute light. Once complete, the church is estimated to accommodate 13,000 worshippers.

Interiors, La Sagrada Familia - The tree shaped columns

Apostle Towers

There are various symbolisms in the structures and the sculptures. Four towers on each of the three facades are dedicated to the twelve apostles, the first bishops of the church. For this reason, Episcopal symbols crown the pinnacles.

The anagram of the Holy Trinity crowns the cypress, the Tau – the first letter of the name of God in Greek, the cross in the form of the cross-piece of the Son (Jesus Christ) and the dove of the Holy Ghost.

Holy Trinity, Tau and the Doves

Gaudi himself completed the eastern façade known as the Nativity Façade. It is ornamented in a baroque fashion with motifs of plants and animals, and of course a nativity scene. Opposite to it is the Passion Façade, on which work started in 1954 and was completed in 1987. The abstract figures, including those depicting the crucifixation, created a storm, as the style was very different from that of Gaudi. The work now focuses on the nave and the southern façade known as the Glory Façade, which will depict life and death.

Nativity Facade

Passion Facade

Entry to the under-construction church is 12 euros; a combined ticket for the church and the Park Guell museum can be purchased for 14 euros. An elevator ride up one of the towers followed by a short climb up the narrow stairs is another 2.5 euros. Beware – the elevator does not bring you down. It’s a long walk down narrow stairs. Those brave enough to go up and then walk down get fantastic views of Barcelona as well as close-up views of the church. It is a photographer’s delight.

Barcelona from Sagrada Familia Tower

The Churches of Granada

Granada was the last bastion to fall to Christian armies in 1492 after almost seven centuries of Muslim rule in Al-Andalus. It is therefore not surprising to find grand churches in Granada. It was an expression of newly acquired power. Christopher Columbus also discovered the American continent in 1492 and in time that brought much wealth to the Spanish monarchy. New wealth and new power led to an unprecedented building spree, which is seen nowhere better than in Granada and Sevilla.

The Cathedral de la Anunciacion (also called the Metropolitan Cathedral), dated 1522-1704, is one of the most impressive examples of Spanish Renaissance. Emperor Charles V decided to turn it into a royal mausoleum. In the building five naves are juxtaposed to a rotunda with a double ambulatory, and presents a multiple symbolism. The circular cimborrio (central tower) is also the royal vault, alluding to the Holy Sepulchre in Jerusalem. The central alter indicates a very precise ideology – the sacred sacrament of the Eucharist irradiating over a city that was still Muslim. After the death of its primary architect Diego de Siloe, the main façade was completed by Alonso Cano. It was conceived as a triumphal arch whose tripartite design disguises the interior structure of the five naves and intensifies the play of light and shadow.

Cathedral de la Anunciacion

The Capilla Real (Royal Chapel) was commissioned by the Catholic monarchs Ferdinand and Isabella in 1504 for their burial site; work started in 1506 and finished in 1521. The Chapel is an example of the late Castilian Gothic style: Latin cross plan, with an apse and a choir, ribbed vaults and decorative emphasis in the upper part of the wall. On the inside, the most outstanding features are the Renaissance grate located in the transept, the sepulchers of the monarchs and those of Felipe the Handsome and Queen Juana, and the alterpiece of the Holy Cross. On the outside, the Chapel has only one façade, with a front dated to 1526 and rebuilt in 1733 to unite it to the Cathedral complex. At the bottom of the nave, another front leads into the Iglesia del Sagario.

Capilla Real, Granada

The Iglesia de Sacrario, dated 1705-1722, is in the Baroque style and occupies the site where the Major Mosque of Granada used to stand. The building follows on a smaller scale the Basilica of Saint Peter – Greek cross inside a square. A hemispherical dome covers the central part and domical vaults cover the four sides of the transept. The front is divided into two parts, with sculptures by Augustine Vera Moreno in the second part – Saint Peter in the middle, flanked by Saint John Nepomuceno and Saint Ivo.

Iglesia de Sacario, Granada

In the immediate vicinity of the Cathedral are two educational institutions – Antigue Universidad Literaria and La Madrazza. The University building is dated 1527-1544 and is in the Renaissance style. Emperor Charles founded it in 1526 to indoctrinate the Muslims who remained under Christian power after the conquest of Al-Andalus. After the expulsion of the Jesuits in 1767, the teaching was transferred to the old Colegio de San Pablo de la Compania de Jeus and the building became a heritage site. La Madrazza (The Madrasa) was established in 1349 by Sultan Yusuf I as a school and university. It is stated to have a splendid prayer hall and mihrab, but sadly it was closed for repairs.

Puerta del Pardon is a cathedral in the Renaissance style dating to 1537, with the second part done in 1810. Its name comes from a convicted criminal who sought refuge in the cathedral and was later pardoned. Roman triupmphal arches provided inspiration for its design, signifying the victory of Christian forces. Above the spandrels of the lower arch are the allegorical figures of Faith and Justice, which suggest that the land was given to Christian monarchs because they acted with faith and justice.

Puerta del Pardon, Granada

Puerta del Pardon, Granada

The Hospital Real (Royal Hospital) is as grand as any early to mid-16^th century church in Granada. It is built on a Greek cross plan with each quadrant consisting of a fountain courtyard and rooms in the surrounding verandah. The transept is crowned by a central tower. The construction of this hospital is dated 1511-1599; the frontispiece dated 1632 is one of the finest in Granada. Hospital Real was built on the orders of King Fernando V, as part of a public service programme undertaken by the Crown following the conquest of Granada. This building is now part of the University of Granada and houses a large library. Strangely, this was the only building in Granada in which we had to pass through metal detectors and our bags were also screened through X-ray.

Frontispiece, Hospital Real

Fountain Courtyard, Hospital Real

Spain Diary - Getting there and some history

The Commonwealth Games in Delhi, its associated chaos, vacations in schools and colleges for two weeks and a speaking assignment in Spain, led us to plan a trip to this country. My fascination with Spain is largely due to its Moorish past, its rich history, a mixed culture and architectural styles. Naturally, we will begin with Andalucia, the southern part of Spain.

Here is the itinerary that we plan to follow.

Our itinerary in Spain
1. Arrive in Madrid; proceed to Granada (Oct 2)
2. Granada to Cordoba and back (Oct 4)
3. Granada to Seville (Oct 6)
4. Seville to Barcelona (Oct 7)
5. Barcelona to Madrid (Oct 13)

I will try to write this diary as we go along. But I will also keep updating it with pictures and facts as and when I get more time from the travels.

Oct 2, 2010
Our journey began with Qatar Airways QR233 leaving Delhi at 4:50 am. The 4 hr flight was uneventful, the plane was nice and movie selections were good. We reached Doha at about 6:45 local time and connected quickly to QR071 to Madrid. A group of Pakistanis traveling together were quite excited and always wanted to use toilets when food trolleys were in the alley. The coolest one was a Sikh from Quetta, who kept reading an Urdu novel through the flight to Spain. Cannot get any more cross-cultural than that. I again met this group two days later in Granada. They worked for a Spanish fertilizer company in Pakistan and were on a company-organized pleasure trip.

Bajaras Airport in Madrid is quite large but did not have as much traffic, at least when we arrived. It is Spain's busiest and the world's 11th busiest airport. The new Terminal 4, which opened in 2006, was designed by Antonio Lamela and Richard Rogers. According to a Madrid travel site, "the award-winning design attempts to use its sweeping visual effects to psychologically create a stress-free feeling among passengers prior to their journey". I wonder why they overlooked the stressed-out arriving passengers. There were three sets of stairways to cross to get from the aircraft to the arrival hall, which was not very convenient. But the immigration was efficient and luggage arrived quickly. The lady at the information counter was helpful, telling us exactly how to get to the bus station (Estacion del Sur) for the next leg of our trip to Granada.

Arrival Hall, Terminal 4, Bajaras Airport, Madrid

The taxi from airport to Estacion del Sur was expensive; a 15-min ride cost us 30 euros. The landscape and vegetation reminded me of the dry hilly terrain of Denver (USA) where we lived for a few years and have visited often. Estacion del Sur is like most bus stations in Europe. Lots of ticket windows, sitting areas, lots of vending machines and places to eat. We catch the 5:30 pm ALSA bus to Granada, the trip costing 16.20 euros per head.

The trip from Madrid to Granada took 5 hours, which included a 30 min stop midway. The café (possibly owned by the bus company) offered cold and soggy sandwiches, stale donuts, coffee and soft drinks. The terrain from Madrid started with dry rolling hills but later changed into rich agricultural land with olive plantations. Alternative energy was prominent in modern windmills and farms of solar panels.

Windmills and Olives, Madrid-Granada Highway

Midway stop, Madrid-Granada Highway

We arrive in Granada around 10:30 pm and take a taxi to our hotel - Pension San Joaquin, which we booked through the internet. It is along a cobblestone alley, just off the Gran via de Colon, close to the old part of town. Our triple room is basic, but is clean and functional. Best of all, internet is free and there is WiFi in our room. Pension San Joaquin is designed like an Andalucian home, around a decorated central courtyard. The housekeeping service is good and the reception staff is helpful, even though they can speak very little English. There is no breakfast, but there are plenty of restaurants, and cafes near the hotel. Further,  the hotel's coin-operated coffee machine serves decent coffees for only 0.5 euros. Those have made parts of this blog possible.

Our hotel - Pension San Joaquin, Granada

More on Granada as we start exploring it. We have a date with Alhmabra tomorrow.

Oct 3, 2010

We spent the day exploring Granada, a majority of it being spent in Alhambra, the fortress palace built by the Moors, which takes architectural finesse to new heights. The Nasirid Palace within this complex is a beauty. I have seen Topkapi, the palace of Ottomans in Istanbul, which would be contemporary to this building, and the Red Fort in Delhi, which was about two centuries later. Neither of these buildings come close in the finesse and detailing seen in the Nasirid Palace. The Taj Mahal in Agra, again about 200 years later, would be a close competitor.

Nasirid Palace, Alhambra, Granada

Granada cannot be appreciated without a bit of history. You find it around every corner in this city. If the Muslims built Alhambra, the Christians who followed went on to build with a vengeance, dotting the city with many fine churches in the Gothic, Renaissance and Baroque style. The Granada of today is a young and vibrant city with about a quarter of its population being students; its university and medical school are highly rated.

Granada is the gem of present day Andalusia province in Southern Spain. Al-Andalus was the Arabic name given to a nation governed by Muslims at various times between 711-1492. The Moors, as the Arabs who ruled Al-Andalus were called in general, were not part of one continuous dynasty. The Umayyads who ruled present-day Syria and Iraq till the middle of the 8^th century, conquered the Iberian peninsula when Tariq ibn Ziyad led Muslim forces on the orders of the Caliph Al-Walid I to Gibraltar in 711. The word “Gibraltar” itself is derived from Jabl-al-Tariq (The Mountain of Tariq), designating that famous geological formation in the Strait of Gibraltar at the entrance to the Mediterranean between Spain on the European continent and Morocco on the African continent. In a seven-year campaign, which was followed by some reverses, almost the entire Iberian peninsula was brought under Muslim control. Al-Andalus became part of the expanding Ummayad empire. The Caliph in Baghdad ruled Al-Andalus through a governor.

In 750, when the Abbasids defeated the Umayyads, the exiled Umayyad prince Abd-ar-Rahman took control of Al-Andalus by 756 and established himself as the Emir of Cordoba. For the next 150 years, his descendants ruled as emirs of Cordoba, with vacillating control over Al-Andalus, sometimes not extending beyond Cordoba. Abd-al-Rahman III who took control in 912 restored Umayyad power and expanded his dominion over the entire Al-Andalus and parts of Northern Africa. In 929 he elevated the emirate to a Caliphate, competing in prestige and power with the Abbasid caliph in Baghdad and the Shi’ite caliph in Tunis. This was the golden period of Al-Andalus.

A civil war between 1009 and 1013 led to a collapse of the Cordoba Caliphate. Al-Andalus broke up into small independent states called taifas, which came under threat from Christian kingdoms to their north. The taifa rulers sought help from the Almoravids, the Islamic rulers of Maghreb to their south. In 1086 the Almovarid ruler of Morocco, Yusuf bin Tashfin, defeated the Christian armies and by 1094 he annexed all the muslim taifas. The Almovarids were followed by another Berber Muslim dynasty, the Almohads in the 12^th century, who were defeated by the Castilian Alfonso VIII in 1212 at the battle of Las Navas de Tolosa. The final Muslim threat to Christians on the Iberian peninsula came from the Marinids in Morocco who took control of Granada and surrounding areas during the 14^th century. The Marinids were defeated at the Battle of Salado in 1340 and Gibralta, till then under the control of Granada fell in 1350. Thereafter, rebellions and wars among Chritian states ensured the survival of Granada for almost 150 years. King Ferdinand of Aragon and Queen Isabella of Castille were married in 1469 and this union marked the final assault on Granada. The Pope declared their war a crusade. In January 1492 after a long siege, Mohammad XII, the Moorish sultan, surrendered the magnificent fortress palace Alhambra, bringing to an end the Muslim rule in Al-Andalus.

Jaundice in Japan

I am just back from Yokohama, Japan, where I went to attend the United States-Japan Cooperative Medical Sciences Program (USJCMSP) Workshop on “Enteric Viral Hepatitis A and E in Asia”. As the name suggests, most of the participants were from USA and Japan, but there were a few from elsewhere as well.

Yokohama is Japan's second largest city about one hour south-west of Tokyo by fast train. The Narita Express (N’EX) takes 90 minutes to get there from the airport. It is clean, efficient and a very comfortable reserved train. The fare is JPY 3,500 one-way or JPY 5,500 return (~ Rs. 3000 or $65). A new feature for tourists is the NEX-Suica combination ticket for the same price. The Suica is a top-up card that enables cash-free local travel and shopping.

The Tokyo metro is one of the world’s best. The stations are busy but functional in every way; some of the larger ones are underground cities. The only problem is that ticket machines at many smaller stations are almost always in Japanese, leaving the traveler a bit lost. But help in the form of an official or eager youngsters ready to practice their English, is never far away.

There was no time to explore Yokohama, partly because of the busy conference schedule and partly due to the weather, which remained rainy and windy due to a passing typhoon. The planned walk in a Japanese garden followed by dinner in a traditional Japanese house was limited to the latter. From the bus and hotel windows, Yokohama appeared to be a modern city with skyscrapers and skywalks. This was my forth visit to Japan, the first being in 1993. One visible change I noticed was an increase in the number of cafes. Coffee drinking is becoming popular in Japan as well. A Cappuccino is never far away.

The Yokohama Sakuragicho Washington Hotel (where I stayed) was large and functional to meet the needs of a business traveler. For JPY 11,500 (~ Rs. 6400 or $140) one gets a room that fills up very quickly with just the bed and a counter that accommodates a TV screen, a hot plate and has room for a laptop. Internet was fast and free. The toilet was small enough for me to touch both walls while standing in the middle. But, it had everything that one needs – a shower-cum-bath, a basin, a toilet, soap, shampoo, conditioner, clean towels. And water from the tap is drinkable.

The Japanese toilet has also undergone a transformation. All toilets now have bidets. This is a device, which at the push of a button extends from under the flap to wash you after the job is done. And it is hands-free!! Here is the link to a video that is a funny, real-life experience of using a Japanese toilet.

At the conference a researcher even showed data that correlated a drop in hepatitis A virus transmission in Japan to the introduction of bidets. Technology to the aid of public health.

The conference was quite good. There were about 50 people, many of them the world’s experts on hepatitis viruses. The talks were excellent and the discussions meaningful. The focus was to discuss new developments in the biology, epidemiology, pathogenesis and control of enteric hepatitis A and E. Hepatitis A and E viruses (HAV and HEV) are enteric, i.e. infect through the gut but finally affect the liver causing jaundice, a lot of morbidity and about 1% mortality in affected patients. Both viruses are transmitted primarily through contaminated water and food, and sanitation is central to their control. As expected, countries that are poor and have large populations deprived of development are also endemic for these viruses. It is estimated that the cumulative burden of HAV and HEV is 5 billion and 2 billion, respectively (world population ~6.8 billion). This is enough reason to study these viruses and the diseases they cause.

What were the highlights of this conference? Many interesting new studies were reported that described the changing epidemiology of HAV and HEV, and recent outbreaks in Asia. While most Asian countries do not see hepatitis A as a clinical disease because it is so endemic that by 10 years of age pretty much everyone is exposed, has asymptomatic infection and is then protected for life. But with widely disparate standards of hygiene in many countries, the generation growing up on bottled water in our countries is increasingly at risk. A vaccine is available, but is expensive and is impractical for use in the vaccination programme of a country like India.

Hepatitis E epidemiology is however very interesting. At any time in India no more than about 30-40% people show exposure (based on antibodies to HEV). This leads to a lot of disease in young adults. HEV also causes high mortality in pregnant women, but the reasons are not fully understood. Proposals made at this conference suggested that pregnancy is a state of immunosuppression (to preserve the fetus) and viral infection compounds the problem. But why don’t all viral infections lead to high mortality like HEV. The use of proteomic and metabolomic technologies are beginning to unravel the host status during these infections, and allowing us to understand these details.

The recently published clinical trial for a new HEV vaccine was presented at this conference. This trial tested a Chinese recombinant HEV vaccine in almost 100,000 people – half of whom got the vaccine and the other half got a placebo (the hepatitis B vaccine). These people were then followed up for one year to see how many get naturally infected with HEV. There were no infections in the vaccine group and 15 infections in the placebo group, giving a one-year efficacy of 100%. But it is these same numbers that illustrate the economics of using HEV vaccines. If there were 15 infections among 48,000 persons over 1 year, this gives a rate of 0.0003. In other words, over 3000 persons will have to be vaccinated to prevent 1 infection over one year. That is clearly not affordable, unless the vaccine is dirt cheap.

An interesting example of the hygiene hypothesis was also presented. This hypothesis suggests that lack of early childhood exposure to infectious agents, gut parasites and allergens increases susceptibility to allergy and asthma. In a retrospective study of atopy and respiratory allergies, Italian men with these allergic conditions showed significantly less exposure to HAV and the gut parasite Toxoplasma gondii. laeding the authors to conclude - "Respiratory allergy is less frequent in people heavily exposed to orofecal and foodborne microbes." Click here to read the paper.

The cellular receptor for HAV is a protein called TIM-1 (also called HAVcr1). It has been shown to regulate the development of asthma in humans. There are two forms of this gene - the long form and the short form. The long form of TIM-1 protects from allergy/asthma but 1 or 2 copies of this gene result in more severe HAV disease. During human evolution, HAV infection has driven natural selection of the short form of this gene, which protect from HAV but predisposes the carrier to allergy/asthma. This is a great example of environment and gene interaction.

The bottom line is - A little dirt never hurts. How much is enough? That is the question to ponder over in an over-sanitized world.

"Suberbug" bugs India

Coming back to the blog after a long time.

The issue today is the “Superbug”. Indian print and visual media is full of reports about NDM-1, translated as New Delhi metallo-beta-lactamase-1. No, NDM-1 is not the “superbug”. It is the name given to a gene that causes multiple drug (antibiotic) resistance to bacteria that carry this gene.

The Lancet Infectious Diseases, a British journal, published an article titled “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study” on August 11, 2010. This article reports results from a study in which the authors “investigated the prevalence of NDM-1 in mutidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK”. They found widespread prevalence of NDM-1 in India and Pakistan. Some, but not all, of the UK cases were linked to travel and hospitalization in India.

Here is a link to the paper.

If you want to read it, you have to register at the Lancet site. This is surprising since the work was partially funded by the Wellcome Trust, which has a stated Open Access policy.

“The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed”. This is the final interpretation of this scientific study. There is nothing wrong about that.

So what is the brouhaha all about?

It is the last paragraph of the paper, which reads as follows.

“Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and blaNDM-1 will likely spread worldwide. It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money. As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening”.

This is an unusually tough conclusion, not fully supported by results shown in the Lancet Infectious Disease paper. The authors say, and I quote “We could not prove statistically significant strain relatedness between the Indian and UK isolates”.

Naturally, the growing medical tourism industry in India has felt threatened. And the response from the Indian media and its political class has been along expected lines. It is a classic case of paying no attention to the message, but trying to shoot the messenger.

India’s Minister for Health and Family Welfare and his deputy have gone on record to debunk the findings as being overblown and underwritten by multi-national drug companies (see Report).

If we buy that, should we not consider the possibility that the Indian press and politicians are reacting so at the behest of our medical tourism industry?

Objections have also been raised on equating the drug-resistance gene with India’s capital, New Delhi. So how did this name – NDM-1, come about?

This gene was discovered by one of the authors of the Lancet study, Timothy Walsh from Cardiff University, UK. His group obtained this gene from a Swedish national of Indian origin who underwent surgery in New Delhi and acquired a urinary tract infection due to an antibiotic-resistant form of the bacterium Klebsiela pneumoniae. The discovery was described in a paper titled “Characterization of a New Metallo-b-Lactamase Gene, blaNDM-1, and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from India”, published in the December 2009 issue of the journal Antimicrobial Agents and Chemotherapy. This article is open access, so I can post it. Click here for the paper.

The Lancet Infectious Diseases research was a natural follow up to investigate how widely prevalent this gene might be in enteric bacteria in the Indian sub-continent. And, as expected, they found it to be widely prevalent in India and Pakistan.

Some might consider associating the city (New Delhi) with the bug/gene (NDM-1) to be offensive. But it is not unusual in scientific research to name a pathogenic organism after the place of its possible occurrence or discovery. Names like Chandipura (named after a village in Maharashtra), Kyasanur Forest (in Karnataka), Rift Valley Fever (an area in Kenya) are commonly found names in the virus world.  

While every Western tourist to this city is familiar with “Delhi Belly”, the Lancet report is too much to digest for the Indian establishment. Instead of crying foul, it would do everyone a lot of good if we focused on the huge problem of antibiotic resistance facing the country. Rampant and unchecked over-the-counter sale of antibiotics is causing high levels of drug resistance. And since bacteria (and other pathogens) can travel fast (without visas of course) in this jet age, it does not take very long for pathogens with newly acquired properties (genes) to go around the globe. The 2009 swine-origin influenza (first called Mexican flu, despite protests by Mexico) is an excellent recent example of this.

The priorities of our Health Ministry seem to be all wrong. Instead of shooting down the Lancet Infectious Disease report, they should be addressing the overuse of antibiotics in India.

For a different point of view, see the blog of a respected Indian microbiologist.

A Tale of Two Faisals

In this week gone by the Indian news media was full of two young men with a common name – Shah Faisal and Faisal Shehzad. This is a tale of hope and despair, a tale of hard work and twisted ideology, and a tale of two countries – one looking forward and the other going back to medieval times.

Shah Faisal, 27, is a doctor from the Indian state of Jammu and Kashmir. He has just topped the Indian Civil Services Examination, becoming the first person from his state to do so. In 2009, over 440,000 young men and women took this examination of which 875 candidates – 680 men and 195 women qualified to join the prestigious Indian Civil Services. Shah Faisal came out on top. His is a story of hard work, hope and a system that works despite plenty of odds.

Faisal Shehzad, 30, is the suspect who attempted to bomb Times Square in New York City (picture below). It is alleged that he has links with various terrorist organizations and has gone through training in terrorist camps in the Waziristan area of Pakistan.

Times Square, New York City; April 2009

These two young men have contrasting family backgrounds and circumstances.

Shah Faisal is the son of school teachers – Ghulam Rasool Shah and Mubeena Begum. They taught their three children the value of hard work, which earned Shah Faisal a place in the Jhelum Valley Medical College in Srinagar. But tragedy struck in 2002 when Ghulam Rasool fell to the bullets of unidentified terrorists in Kashmir. The family shifted from their village to Srinagar, where Mubeena Begum taught in a school to support her family.

Faisal Shehzad is the son of a Vice Air Chief Marshal of Pakistan. He grew up in an upscale neighborhood of Peshawar before migrating to the United States in 1998 to study computer science and engineering, worked in the US and recently became a naturalized citizen. Faisal was arrested while trying to leave USA on a one-way ticket to Islamabad after the failed bombing attempt in Times Square.

Many years ago my father gave me the guru-mantra for life. When I was just entering college, he asked me to be the best at whatever I do. He said, “even if you cut grass, be the best at it”. I reflect on that advice and the two Faisals.

Shah Faisal is a trained doctor and in today’s India would have made a lot of money through medical practice. Instead, he studied Public Administration and Urdu Literature for a year to take the Civil Services Examination. When a journalist asked him why, his answer was - "But my people need me as a civil servant. I want to be a role model for Kashmiri youth."

Faisal Shehzad came from a privileged background but only managed to study at B-grade American colleges, possibly with Dad’s money. He was not even a good terrorist, his dud device being a testimony for that. And thank Allah for that. 

Why did the Faisal who was born with a silver spoon (or shall we now say a silver foot) in his mouth take to terrorism? How come the Faisal who was himself a victim of terrorism, is today the toast of his countrymen? The answers perhaps lie in the systems and mindsets in the two South Asian neighbors – India and Pakistan.

Faisal Shehzad grew up in the Pakistan of 1980s when Zia-ul-Haq ruled it using religion as a tool, fully supported by a West that was eager to use the jihadis (freedom fighters then) to get the Russians out of Afghanistan. He was indoctrinated at an early and impressionable age, like thousands of others of his age, who have now earned Pakistan the dubious distinction of being a “migraine for the world”. Even today, on Pakistani blogs the sane voices are getting drowned by those who see this as a conspiracy against their country. Many others are claiming Faisal Shehzad to be an American citizen. Come on people, get your head out of the sand.

Shah Faisal however grew up in a system, which despite many odds, has always impressed upon its youth the value of education and hard work as the way forward. A young man who is willing to do this always comes out a winner. There are plenty of examples that give this hope to millions who live in abject poverty but aspire for a better tomorrow. That is why even while growing up in a Kashmir scarred by unrest and violence, he never gave up hope.

I met Shah Faisal this past week at a felicitation event for him at the Hamdard Study Circle in New Delhi, where he trained for his Civil Services Mains and interview. His speech, to an audience made up mainly of school and college students, was full of hope. His statement “If I can do it with my circumstances, you can too”, sums it all up. While preparing for the Civil Services, he was looking for role models and was reported to keep pictures of former Civil Servants from Kashmir on his cell phone. Today he is a role model for thousands of Kashmiri youth who are desperately seeking to build their lives from the rubble of militancy in their State.

Dr. Shah Faisal (right) with his two mentors - Prof. Syed Aftab Zaidi, Director, Hamdard Study Circle (centre) and Mr. Saiyid Hamid, ex-IAS and Chancellor, Jamia Hmdard, New Delhi (left).

Well done, Shah Faisal. You do all Indians proud.

Damn you, Faisal Shehzad. You are a blot on your religion, whose interests you claim to profess through your misdeeds.

April Fools' Day 2010

April 1, 2010 is a historic day for India. It has wisdom and vision written all over it.

Today the Right to Education (RTE) becomes a Fundamental Right. The Constitution of India contains a Charter of Rights, which guarantee civil liberties to every citizen. Rights mean those freedoms that are essential for personal good  as well as the good of the community. Thus far, the Indian Constitution guaranteed the following Fundamental Rights to each Indian.

1. The right to equality
2. The right to freedom of speech and expression
3. The right to freedom from exploitation
4. The right to freedom of religion
5. Cultural and educational rights
6. The right to constitutional remedies
And now:
7. The right to education

It now becomes the duty of the State to ensure that every child in the age group of 6 to 14 years goes to a school. This is poised to benefit over 10 million children in India - children like Azharuddin and the anonymous girl from my photo archives. Azharuddin was pictured loitering around the tomb of Bahlol Lodi in the Chirag Dilli area of New Delhi. He did not go to school, but loved playing cricket and getting his picture taken. The girl, a polio victim (notice the stick in her hand; she uses it to walk) was pictured in the Charminar area of Hyderabad.

Azharuddin - Chirag Dilli, New Delhi

Girl child - Charminar, Hyderabad

There will be problems, issues of logistics, not enough schools, not enough teachers, not enough trained teachers, etc. etc. etc. We now have the will and therefore we will solve these problems.

Thank you and well done Prime Minister Dr. Manmohan Singh and Education Minister Mr. Kapil Sibal.

Stand up and be counted

This All Fools' Day the 15th Census of India was also kicked off. This is the largest counting exercise ever done. Over 1.2 billion people will be enumerated and everyone over 15 years of age will be photographed and fingerprinted, issued a unique identification number (UID) and issued a biometric card.  Over 2 million volunteers will span the length and breadth of this land to do this over the next year. For more information on this unique exercise see:

Official site: http://www.censusindia.net/; http://censusindia.gov.in/
News Reports: http://news.bbc.co.uk/2/hi/south_asia/8598159.stm
http://timesofindia.indiatimes.com/india/Counting-a-billion-India-begins-new-census-/articleshow/5749740.cms
UID Authority: http://uidai.gov.in/

Way to go India. This April Fools' Day is truly historic for us.

Deja-vu

I am back on the blog after a long break. Been very busy. But could not stay away from writing today. It has been a strange day and therefore this post will have nothing to do with my major themes of travel/history/architecture and infectious diseases.

Today I reached Hyderabad for a meeting and learnt that I would be staying at the Golconda Resorts. It is a fabulous property next to the Gandipet Lake on the outskirts of Hyderabad. The ambience is nice, the rooms are wonderful, the staff is helpful and the morning walks are peaceful.

But the last time I stayed here, it was 26/11 and Mumbai was attacked. I remember sitting glued to the TV in my room, horrified of what was happening. India was under attack and we seemed like jokers to the world. A few terrorists had killed with gay abandon and held the country to ransom for three days. It was India’s 9/11. It hurt our psyche and changed us forever.

As I checked into Golconda Resorts, I could not but help remember the last visit. I had this strange premonition that this day would be historic. It was indeed.

Sachin Tendulkar has scored 200 runs in a one-day cricket match against South Africa. Today, India has come together to rejoice in one of the greatest sporting feats. No one had broken the 200-runs barrier in a 50-overs match. There are only 300 balls to be played and one expects an opening batsman who stays the entire time to face roughly 150 balls. Sachin did it in 147 balls. And he did it against South Africa, which is currently one of the best bowling sides in the world.

 
My only regret is that I was traveling and could not see Sachin's historic innings live. Well done, Tendy. Thank you for all the good times you have given us. Thank you for uniting us as a Nation to rejoice in your feat. This is not just your moment. It is ours too.

We will not and must not forget 26/11, but we should also remember 24/2. I will always remember Golconda Resorts for these bitter-sweet memories.