A photograph of Nido Taniam who was killed in a racist attack is displayed at the Arunachal Bhawan in New Delhi. Credit: Bijoyeta Das/IPS.

By Bijoyeta Das
NEW DELHI, Mar 25 2014 (IPS)

L. Khino, 27, vividly remembers Christmas Eve at the Indian capital’s famed Connaught Place shopping hub four years ago: the blinking lights, the buzzing crowd, the winter chill – and the salty taste of her tears.

Khino had just arrived in New Delhi from her home in India’s northeastern state of Manipur. “I was so excited. But suddenly a group of men surrounded me. ‘How much do you charge for a night?’ they asked. I yelled, ‘Get away,’ but they pinched my cheek and touched my back,” she tells IPS."We want a comprehensive anti-racism law because most Indians, including the government, deny that racism exists.”

Others giggled, some laughed aloud. A few snapped photos with their cell phones. “Chinki, chinki,” they kept teasing as she fled into a metro station. ‘Chinki’ is an offensive reference to the East Asian features of many people from India’s northeast.

Khino is one of thousands of youngsters who migrate each year from the eight northeastern states to Delhi, Mumbai, Bangalore, Pune and other cities in their quest for “higher education and better opportunities.” She works at a business process outsourcing centre in the capital’s satellite city Gurgaon.

“Enough is enough. They call us ‘chinki’ everyday, assault and harass us. What is this? Just discrimination or racism?” she asks.

According to activists and student groups, people from the northeast have harrowing experiences across India. They are regularly subjected to verbal taunts, slurs, jokes, physical and sexual assaults as well as cheating by landlords and employers.

For years, complaints have been piling up and the fury has been simmering. Matters came to a head this January when Nido Taniam, the 19-year-old son of a legislator from the northeastern state of Arunachal Pradesh, was killed.

A student in Punjab state, Taniam was visiting Delhi. He had stopped at a store to ask for directions when shopkeepers made fun of his dyed blonde hair. This led to a brawl, and he was seriously assaulted. The next day he succumbed to his injuries.

Taniam’s death led to widespread protests across India. Many from the northeastern community are now campaigning for an anti-racism law to deal with apparent hate crimes. The North East India Forum against Racism (NEIFAR) was formed in February.

Phurpa Tsering, spokesperson for NEIFAR, tells IPS that their short-term demand for fast-tracking all pending cases of hate crime has been accepted.

“In the long run we want a comprehensive anti-racism law because most Indians, including the government, deny that racism exists,” says Tsering, who is from Arunachal Pradesh and is a student at Jawaharlal Nehru University in New Delhi.

A spate of recent attacks on people from India’s northeast has stirred disconcerting questions.

Protesters point out that the identity of mainland India often excludes the northeast, a region often described as far-flung, remote and conflict-ridden. They say northeasterners are frequently stereotyped as morally loose women in skimpy skirts who are sexually available, or good-for-nothing men who are drug addicts or insurgents.

About 86 percent of people from northeast living in Delhi have faced discrimination, according to research by the North East Helpline and Support Centre based in New Delhi. Alana Golmei, the founder, says they receive 20-30 calls a month, and most complain about non-payment of salaries and assaults.

“We have become immune to people calling us chinki, momo, Bahadur, Nepali, chow-chow, king-kong [terms alluding to their physical appearance],” she says. When she calls to negotiate with employers and landlords, she is told she is an outsider. “A strict anti-racism law will give us more negotiating power.”

But can a piece of legislation battle racism?

In 2012, the Ministry of Home Affairs issued a directive to punish anyone who calls a northeasterner ‘chinki’ with up to five years in prison under the Scheduled Castes (SC) and Scheduled Tribes (ST) (Prevention of Atrocities) Act. The SCs and STs comprise some of India’s most socially marginalised people.

Golmei calls this an “emotional, stray reaction” with little effect – there have been no convictions so far. Many in the northeast are not categorised as SC or ST.

Sanjoy Hazarika, director of the Centre for North East Studies and Policy Research at the Jamia Millia Islamia University in New Delhi, wants an amendment and expansion of this Act. “New laws are difficult to make and difficult to push through,” he tells IPS.

Support for anti-racism law depends on a crucial question: if a man from northern or eastern India is beaten up in western India, it is called regionalism; so is it racism when someone from the northeast is attacked?

Hazarika, who is from Assam in the northeast, tells IPS, “We want it to include everybody in the country and all cases of discrimination on the basis of appearance, language, gender, food and attire. Only face is not enough.”

But opinion is divided.

Senti Longchar, assistant professor of psychology at Lady Shri Ram College in New Delhi, points out that people from states like Bihar or Assam look the same as anyone from northern India. “Discrimination against them is regionalism but name-calling and attacks on those with a Mongoloid face is racism.”

India signed the United Nations Declaration on the Elimination of All Forms of Racial Discrimination in 1967. But Longchar cites a Washington Post infographic that uses World Values Survey data to show India and Jordan are the most racially intolerant countries.

Racist hate crimes are only one end of the spectrum of discrimination that people from the northeast encounter, says Kadambari Gladding, spokesperson for Amnesty International, India. She says they are also denied goods and services. “Non-discrimination is not a concession, but a right,” she adds.

Instead of a pan-India law, NEIFAR is advocating legislation specific to the northeast that will deter racist attacks on those with East Asian features, and include positive aspects such as preferential treatment, awareness campaigns, sensitisation of police and inclusion of the northeast’s history in textbooks.

NEIFAR is researching anti-racism laws in other countries, particularly Bolivia, to push for a model that suits India, says Id Gil, a Manipur native who studies in Delhi and works for the forum.

He tells IPS, “Every racial remark has the potential to kill somebody, as we have seen in Nido’s case.”

A MDR-TB patient at a Médecins Sans Frontières clinic in Manipur in north-eastern India. Credit: Bijoyeta Das/IPS.

By Bijoyeta Das
NEW DELHI, Mar 5 2014 (IPS)

For years Joba Hemron, 50, prayed that her cough would go away. She was diagnosed with Tuberculosis (TB) in 2011. She was put on a Directly Observed Treatment Short-course (DOTS), provided free at a public health clinic in Bongaigaon district in Assam.

But soon she began missing too many doses. “My sons work in the fields, I was too weak to go on my own to get the pills,” she says. She went to a private clinic, hoping to collect all the medicines at once. That was expensive, which meant she could again not complete the course."Each time the patient moves from one doctor to another, physicians tinker around with the drug combination, further worsening the drug resistance."

Three years and five doctors later, she kept losing weight. “I took medicines whenever convenient but I was only getting worse.” Her family sold a goat and with the money traveled to the state’s capital, Guwahati.

She was diagnosed with multi-drug resistant TB (MDR-TB). “I don’t know what this means, no one explains anything. Will I get well?” she asks. Her frail body shakes as cough rakes her lungs.

For many like Hemron, lack of proper diagnosis and interrupted dosages are increasing their resistance to available drugs. Drug resistance is human-made – an iatrogenic disease resulting from mismanagement of TB, experts say.

Drug resistant TB can occur as a primary infection or develop during a patient’s treatment. India accounted for the greatest increase in MDR-TB in 2012 with an estimated 64,000 new cases.

India provides free TB treatment through the Revised National Tuberculosis Control Programme (RNTCP), which reaches 1.5 million patients. TB remains the deadliest infectious disease in the country with two deaths every three minutes. India has more than a quarter of TB cases globally.

Ramanan Laxminarayan, vice-president of the Public Health Foundation of India says the national TB programme is “stuck in the 1990s.” It is yet to rope in all available tools and involve the private sector.

“Every case of MDR-TB can be 20 times more expensive to treat than a sensitive strain and cause much greater inconvenience, pain and suffering for the patient,” he adds.

Despite regular adherence to medicines, some patients are becoming resistant to frontline drugs. In Mumbai, doctors at Hinduja Hospital said they had identified patients who are “totally drug resistant,”and did not respond to any available drugs. The Indian government rejected the claim.

According to the World Health Organisation (WHO), about 450,000 people contracted DR-TB in 2012. About half of them are in India, China and Russia. An estimated four-fifths of DR-TB cases are still undetected. There were 170,000 MDR-TB deaths globally in 2012.

Madhukar Pai, associate director at McGill International TB Centre, a research organisation situated at the McGill University Health Centre in Montreal, Canada, explains that neither public nor private healthcare providers offer quality TB care. He says there are many instances of wrong drug regimens, low quality drugs, scarce monitoring of treatment adherence, patient movement between providers, adding single new drugs to already failing regimens, and inadequate use of drug-susceptibility testing. All this results in MDR and extensively drug resistant (XDR) TB.

MDR-TB treatment is expensive, the treatment often lasts up to two years, with increased risks. Access to the two new MDR-TB drugs— bedaquiline and delamanid, remains limited. They are available in India only through compassionate use mechanisms.

Most patients in India go the private sector but some abandon treatment because of high costs. By the time patients end up in public hospitals they infect many, and also develop severe forms of drug resistance, Pai says.

“In the private sector, irrational TB prescriptions are so common – doctors make up their own drug combinations. This is disastrous. And each time the patient moves from one doctor to another, physicians tinker around with the drug combination, further worsening the drug resistance,” he says.

About 10 percent of drugs in India are estimated by some doctors to be fake, which can muddle up treatment. Testing for drug-resistance is limited in the public sector. “Empiric treatment is used,” Pai says, not treatment that is tailored to a patient’s drug susceptibility profile. This results in selection of drug resistant strains.

The solution isn’t “merely technological”, says Mike Frick of the Treatment Action Group, a research and policy think thank based in the U.S.

New diagnostic machines like GeneXpert may uncover more cases of drug resistance but “it cannot solve the health system’s failure to link patients to the highest level of care that is their right,” says Frick. India fails to provide psycho-social and economic support for patients.

Globally, funding for research into TB has fallen. Governments have slashed budgets; Pfizer and AstraZeneca have abandoned anti-invectives research – increasing the wait for better drugs, diagnostics and vaccines. “It decreases our chances of replacing toxic drugs in the current MDR-TB regimen with newer, safer drugs that are easier for patients to tolerate,” Frick tells IPS.

In 2013, there were numerous reports of drug stock-outs in India, which the government denied. Many patients had to stop treatment; others were turned away from clinics. When treatment is incomplete, it creates an opportunity for drug-resistance to develop.

“The cruel irony is that even as Indian generic manufacturers continued to produce many of the TB drugs that people in other countries depend on, the Indian government couldn’t guarantee TB drug availability to its own people,” Frick adds.

TB is an opportunistic disease and HIV positive patients are more susceptible. Daniel, who asked only his first name be used, is a HIV positive patient. Six months ago he was diagnosed with MDR-TB. “The medicines are so hard, drain me of all strength,” he says.

He is forced to go to public hospital because of the exorbitant costs of medicines. “But there are long waits and everyone comes to know about you. It only adds to the existing stigma.”