A6
TH E BULLETIN• SATURDAY, OCTOBER 20, 2012
Ki in s erai rass-rootse ortsin In ia Medicarecomes
under scrutiny in meningitis outbreak
By jim Yardley New Yorh Times News Service
NOWPORA JAGIR, India — On the day he was killed, Mohammad Shafiq Teli was working on a n e w s ewage drain, precisely the sort of un glamorous, if essential, project that village governance is sup posed to provide. Except that, for more than three decades, there had been no local gov ernments here in the villages of Kashmir, India's tinderbox. Last year, despite a threat of violence, rural Kashmiris turned out in huge numbers to elect village councils, known as gram panchayats, in what became a victory for grass roots democracy in a blood soaked land. New officeholders like Teli set to work on long-ne glected development projects. But on Sept. 23, as he was walking to his mosque for eve ning prayers, Teli was shot and killed. His death followed by days the slaying of a panchayat leader in a nearby village. Post ers mysteriouslyappeared in different villages, warning pan chayat members to resign. Pan icked, hundreds have since an nouncedtheir resignations, and many of the new village coun cils have ceased to operate. The intent of the k i llings seemed clear: Here in a district of Kashmir with a long history of bloodshed, someone wanted to derail the panchayats. But who? And why? "There are forces that don't want to see the panchayats succeed," said Mohammad Al taf Malik, a village leader. "The panchayat elections created tremendous hope among the people. Now that hope is slowly diminishing." Kashmir is t h e s tubborn, unsolved riddle of South Asia, a mostly Muslim region of blue skies and snow-capped Himalayan peaks that once witnessed a bloody insurgency and is still claimed by both India and Pakistan, even as some Kashmiris aspire to out right independence. Hundreds of thousands of members of the Indian military and other security forces remain posted in Kashmir; the region went through angry summertime
By Ricardo Alonso-Zaldivar
cies specialize in c ustom izing doses for i n dividual WASHINGTON — Medi patients who have allergies care is coming under scru to ingredients in an FDA-ap tiny in the meningitis out proved drug, or who might break that h a s r e k indled need a smaller dosage than what's available commer doubts about the safety of the nation's drug supply. cially. But some pharmacies The gianthealth insurance have pushed into full-scale program for seniors long ago manufacturing. flagged compounded drugs Medicare has long been produced for the mass mar aware of the risks. "By compounding drugs ket without oversight from the Food and Drug Admin on a large scale, a company istration as safety risks. In may be operating as a drug 2007, Medicare revoked cov m anufacturer w i t hi n t h e erage of compounded inhal meaning of ( f ederal Iaw), er drugs for lung disease. w ithout c o m plying w i t h But Medicare doesn't seem requirements of that law," to have consistently used Medicare's coverage man its own legal power to deny ual, areference for contrac payment, and critics say that tors that handle payments, has enabled the compound says in a section dealing with ingbusiness to flourish. compounded drugs. Now program officials are That situation, adds the scrambling to find out how manual, f a il s M e d icare's many Medicarebeneficiaries basic standard, that treat are among the more than 270 ments must be "reasonable people sickened in 16 states and necessary" in order to be in a still-growing outbreak covered."This means, in the that has claimed 21 lives. case of drugs, the FDA must The illnesses have been approve them for m arket linked to an injectable steroid ing," says the manual. used to treat back pain, made It goes on to say that bill by the New England Com ing contractors should wait pounding Center, a Massa for instructions from Medi chusetts specialty pharmacy. care before cutting off pay The medication was contam ment in specific cases where inated with a fungus. the FDA h a s d etermined A senior lawmaker and that a company is producing consumer advocates are rais compounded drugs in viola ing questions about Medi tion of the law. care's role, including an ap " Medicare i n dicates i n parent lack of coordination its own policy documents between Medicare and the that it can cut off payments FDA, the two most powerful for compounded drugs pro agencies within the federal duced under m a nufactur Health and Human Services ing-like c o nditions," s a id Department. Sen. Charles Grassley, R In response,a department Iowa, who over the years has spokesman says Congress pushed for stronger govern needs to provide the FDA ment oversight of the phar with stronger powers. maceutical industry. "Medicare should explain The meningitis outbreak has called attention to the whether it u ses this step, role of compounding phar and if not, why not. Every macies in supplying medi avenue for explaining how cations routinely used by this health crisis occurred hospitals and doctors to treat and preventing others like patients. Regulated primar it needs exploration," he ily by states, the pharma added. The Associated Press
Kuni Takahashi /New York Times News Seosce
Mohammad Abduiia Lone, of Nowpora Jigir, Kashmir, India,resigned from his position as a sar panch — a type of elected leader — after two fellow officeholders were murdered. clashes between stone-throw ing youths and soldiers as re cently as 2010. Last year, with tranquility restored, the state government conducted the panchayat elec tions. Militant groups called for a boycott, but the turnout was overwhelming, estimated at 80 percent.Soon elected leaders like Teli began directing village projects. And then last month, he was murdered. Initially, state leaders blamed militant groups for the two kill ings. But in an interview last week, the state's chief minister, Omar Abdullah, offered a new twist: Investigators had identi fied a militant as a suspect in Teli's killing but were inves tigating whether the motive might have been rooted in local rivalries, rather than abroader based terrorism movement. Panchayats have long ex isted elsewhere in India, but the absence of the system in Kashmir has meant that po litical power and patronage remained with state legislators and block-level administrators. The panchayats shook that political structure, especially when their elected leaders known assarpanches—began complaining that the estab
lished order was not devolving power and money, as required
nary villagers, some illiterate — were tackling a host of ne by law. glected projects, especially the "Let's understand that you piping of more drinking water have not had afunctioningpan into the village. "It is the poor in the village chayat system herefor more than three decades," Abdullah who benefit from th e p an said. "So an entire generation chayats," said Mohammad Ab of political and administrative dulla Lone, 40, who had been leadership has grown up with sarpanch before he posted his out having to work with this resignation in a local newspa group of electiverepresenta per. "We have initiated lots of tives. Clearly, they would much development work. But now rather not have to deal with everything has stopped. We don't know who killed them." them." As investigators continue to The first killing was on Sept. look into the murders, differ 10 in nearby Palhallan, a vil ent theories and accusations lage where militants are still abound. Kashmiri separatist thought to be active. The victim leaders have condemned the was the sarpanch, Ghulam Mo killings but say that the pos hammad Yatoo,59. Thatincited sibility of official involvement fears among other sarpanches, should not be discounted. who resigned en masse. Less "Everybody will say the mil than two weeks later, Teli was itants have killed them," said killed. That prompted other Mirwaiz Umer Farooq, a mod panchayat members in the re erate separatist leader. "But I gion to resign for fear of being think there is much more than the next target. "Please tell people we have meets the eye. We can't rule out that there are many agencies nothing to do with the pan working at cross-purposes." chayat," said Dilshada Begum, Here i n N o w pora J agir, 37, the wife of Lone, the sar which sits at the edge of the panch who resigned. "Please H imalayas, the work of t h e tell them. I have eight children, panchayat ended abruptly af and he is the only wage earner. ter Teli's murder. Before then, If something happens to him, elected officials — al l o r di what will I do?"
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