NATIONAL DIGITAL HEALTH MISSION WILL PUT INDIA’S HEALTH DATA ON THE LINE - The Daily Guardian
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NATIONAL DIGITAL HEALTH MISSION WILL PUT INDIA’S HEALTH DATA ON THE LINE

For a programme dealing with massive quantities of private healthcare data, the National Digital Health Mission needs to be vetted thoroughly to prevent security and privacy breaches. To achieve this, authorities will have to employ robust technologies and train the workforce to use them.

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For a hitherto under-documented country such as India, the National Digital Health Mission has been widely hailed as a game-changer of sorts, envisioned to completely redraw the health delivery services map of the country. Going a step further than giving a unique health identity to 130 crore people, the Mission envisages the digitisation of the entire health ecosystem, including professionals, healthcare facilities, insurance firms, pharmacies, labs and diagnostic centres. But like any mission of national importance with cyber technology at its core, it is bound to spark questions on the security and privacy of the health data of patients. Given the private nature of healthcare records, the supremacy of data privacy/security must remain non-negotiable.

In a recent case of a breach of health data, in February this year, a German security firm discovered the leakage of over a million medical records and 121 million medical images including X-rays and scans of Indian patients. Apparently, this breach was a configuration issue and a result of poor protocol practices. In another instance, Religare Health Insurance found the private data of over 5 million of its users and employees leaked on the dark web. Therefore, the security of health data remains a primary concern when it comes to the implementation of the National Digital Health Mission.

STAGGERING SCALE OF THE MISSION

For a mission covering more than 130 crore people serviced by nearly 12 lakh practitioners, 69,000 public and private sector hospitals, including 25778 government hospitals, 3000 drug companies and 18-19 lakh retail pharmacies, inclusive of 5000 organised retail pharmacies, this is a staggering quantum of data to negotiate. As such, a security breach would not be totally out of the ordinary.

VULNERABILITIES IN HEALTH DATA SYSTEM

Moreover, given the interconnected nature and scale of the programme, which involves such a large spectrum of players underpinned by an assortment of technologies, it is intrinsically riddled with data vulnerabilities. Indeedm in the draft on Health Data Management Policy, rules have been laid down for health information providers and users to access data through designated consent managers only after obtaining an informed consent of the data principal with “true ownership and control” remaining with the data principals. Yet, none of these are an iron-clad safeguard against an unscrupulous hacker from outside. That the consent manager is to be an electronic system again makes it even more vulnerable. Then the provision for sharing anonymised data for research and policy formulation is a tricky one because, when combined with other data sets, anonymised data can be re-identified, putting a big question mark on the privacy of data. Similarly, the provision for personal health identifiers to distinguish one data principal from another is also fraught with risks.

FOUNDATIONAL INFRASTRUCTURE

Since the whole Mission is steered by the government, it is critical that the government invests sufficiently in laying down the foundational physical infrastructure which must be of top quality. Given the federated nature of this health exchange system, device and platform differences must be eliminated as much as possible while evolving a common digital standard applicable across the continuum of care for inpatient, outpatient and remote patient monitoring. The interoperability and portability of the patient data from one health facility/hospital to another must be ensured.

SOFTWARE FOR INDIAN CONTEXT

The software standards must be adapted for the Indian context with built-in flexibility, keeping in mind the socio-cultural and economic milieu of the country. Only that software must be deployed where support through regular security patches and updates is provided. In terms of EMRs and EHRs, a balance between patient privacy and practitioner’s ease of use must also be accounted for. Some critical software would include anti-malware software, data loss prevention software, two-factor authentication software, patch management software disc encryption software and logging and monitoring software.

LATEST ENCRYPTION TECHNOLOGIES

There is also a need for employing the latest encryption technologies. Remember, while it’s relatively simple to encrypt data at rest in the cloud, data in use — that is, data being used by an application, and not sitting in storage — is much harder to encrypt.

SURVEILLANCE & REGULAR AUDITING

There is a need for 24×7 security surveillance as well, to ensure that every data byte is highly secure. Then the systems must be audited on a regular basis through an independent auditor. The auditor must be able to audit every configuration change made to multiple server components, including File Servers, and track user permission changes. Stringent access processes through password protection must be in place. Ethical hackers must be part of the cyber security teams to regularly check data protection standards and spot vulnerabilities, if any.

DATA SECURITY MEASURES

At the same time, it is also incumbent on the partner healthcare facilities, practitioners, drug companies, diagnostic centres, pharmacies, and even individuals to prepare themselves with the utmost data security measures. For instance, since EHRs in hospitals need to upload/download large files, images and radiology scans from remote servers, a dedicated broadband pipe must be there within the hospital. Then, picture archiving and communications system (PACS) server for Digital Imaging and Communications in Medicine (DICOM) files must be made secure completely through robust access processes.

PRIVACY VS SECURITY OF HEALTH DATA

Although privacy and security of data are intricately linked with each other, there is a subtle distinction between the two. In a country where social approval and acceptance is a measure of a person’s well-being, and being ill or diseased serves as a ‘social deflator,’ an individual wishing to access health services anonymously constitutes privacy. Against this, security is more about authorities misusing that data for surveillance purposes or businesses/individuals illegally using that data for private or commercial use.

In sum, only a continued spotlight on data security will eventually lead to a foolproof system. Remember, this is a top-down system initiated by authorities. Unless the people and the workforce are adequately trained in digital technologies, the system will remain vulnerable to misuse.

The writer is founder and CEO of Lisianthus Tech. The views expressed are personal.

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People commenting on Internet need to be kinder: Suhaani Shah

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Suhaani Shah is disrupting and redefining the magic space in India with an ability to read minds with remarkable accuracy. The magician recently joined NewsX for an exclusive conversation as part of NewsX Influencer A-List and shared art of mentalism, how she learnt, experience of being a woman magician and much more.

Speaking about the concept of mentalism and who is a mentalist, she said, “In India, mentalist profession is not too popular. To explain in layman’s language, magic is the parent category under which there are different genres such as illusionism, escapology, street magic, parlour magic and mentalism. So, it is sub genres of magic. You can also call me a magician and as a magician, I expertise more as a mentalist. In mentalism, there are no props. It’s just mentalist and people and their minds become prop. Mentalist is a magician who does magic without props, just by trying to read or giving an illusion of reading people’s minds, influencing and getting information out from them.”

Talking about how she learnt mentalism, she shared, “I haven’t learnt it from anywhere but I started performing magic in general when I was 7 years old. In the process of doing stage shows, it was mixed of all magic genres. I used to do proper stage shows by traveling city to city. Few years back, I realised that was too much. If I wanted to get into corporate sector and level up my game, I need to do something because stand-up comedy had taken over the country. I realised it’s important to capitalize on that as well. So, what I did was, from an illusionist I started to adapt into mentalism. I did an entire show of mentalism and the videos went viral. I never took formal training for anything in terms of magic. My transformation was slow, but then, 2017 was the time when I turned into mentalist and decided to continue as I loved it the most.”

Sharing the advantages and disadvantages of being a women digital content creator in a digital space, she said, “There have been lots of disadvantages. Even before starting YouTube live streaming and taking up digital space, I was really worried of being trolled. But when I started, there was lot of love. I think I was overthinking negativity a lot. A lot of times, its projection of what you are doing. It was not that I never got negativity. What I realised, which I still do even after a year and having million subscribers on YouTube, is that I am not allowed to make mistakes as a woman. I have seen my co-streamers from the other gender making mistakes, which is taken in a fun. Although I am learning to be thick skin to negative comments but it still affects at sometimes. I have known my co-female creators getting threats just for being opinionated and putting out their views. I feel it’s just reflection of our culture, the more the women come out, face these things and be vocal about it, the safer space they’ll be creating for themselves. There are more men than women on internet, that needs to change. It will happen in its own time.”

When asked about what does it feels like to be a women magician, she responded, “The moment you say magician, nobody ever think of a woman and I don’t know why. It’s like an identity threat to me. To be honest, I didn’t think of this till a few years back when another journalist had asked me this question. I am not massively involved in Indian magic communities, so I didn’t know what’s scene there. I didn’t really think of pros and cons. I have to keep my guards up and keep myself safe. I just focus on my craft and work.”

She concluded by sharing her content creators community’s present needs and said, “What I think is needed is to create safe space on internet. I am speaking as a person on digital space. People commenting on internet needs to be kinder, people creating content needs to be more careful. It’s very important to be wise and thoughtful of what we are putting on internet.

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I play around with illusions: David Nobo

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David Nobo is a modern-day magician, illusionist, artist and content creator. His tricks leave people spell bound. David Nobo recently joined NewsX for an exclusive conversation as part of NewsX India A-List. In this exclusive conversation, he talked about his work as magician, kind of illusions he does, his experiences of virtual performances and much more.

Speaking about his work as magician, he said, “I am what they used to call a magician 15 years ago. But then I thank people for making magic clichéd. As soon as we decided to enter into corporate market, we decided to call ourselves ‘illusionist’, just to make magic great again.”

Talking about kind of illusions he does, he shared, “You could expect a lot of interactions, mind-reading, surprises, things appearing, disappearing, people coming up on stage and strange things happening to them, sometimes losing their memories. I play around with illusions that are both optical as visuals as well as psychological. I try to blend both to create a slightly different kind/brand of magic.”

When asked about what difference it makes to be physically out there on a stage vs. performing magic on a virtual platform,  he responded, “I look up to a magician from Las Vegas, who says that ‘all the world is stage’ like Shakespeare. You don’t really need a stage or platform to do magic. 20 years ago, I first started learning magic. After coming from school, I rushed into my room where I had a shoebox with tricks and apparatus in it. I would practice pretending to be on a stage and listening to imaginary applause. 20 years later, I am back in this room with my little box of trick, pretending to be on stage and listening to imaginary applause virtually.  I have given performing in the bedroom a whole new meaning.”

Telling about viability and feasibility of magic as a career option, he expressed, “It is a feasible career option because that’s what I have been doing for the last 15 years. I wouldn’t lie by saying that I have been sailing through Covid. No, it has been difficult. I had to re-adjust a lot of things. Magic doesn’t draw many people because the secret, which people think is the most important part of effect (which is not), is often uninteresting and it involves a lot of practice too. If you want anything enough, you are going to make it. You’ll take up decision and make that decision the right decision.”

Speaking about if going digital is the way forward as far as illusionist is concerned, he expressed, “Digital is part of way forward. No matter how much Covid or any other pandemic happens, nothing beats the human connection of a live show. But right now, going digital has been a blessing.”

Concluding the conversation by expressing the requirements of his and other Indian illusionists, he shared “We are craving for gigs and audience. Best thing about being able to do magic virtually is it is interactive. A lot of magicians need to up their game, understand their audiences and connect to them. Moving with time or being a little ahead of your time rather than behind is always better.”

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KAILASH KHER OPENS UP ABOUT HIS NEW SONG ‘SHRI JAGANNATH ASHTAKAM’

In conversation with NewsX, singer and music composer Kailash Kher spoke about his latest song dedicated to Jagannath Rath Yatra, his devotion towards Lord Shiva and more.

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Kailash Kher recently joined NewsX for a candid chat as a part of NewsX India A-List, wherein he got recognised for excellence as an Indian Entertainment Icon.

Talking about his newly-released song dedicated to Jagannath Rath Yatra, he said, “We, at Kailasa Entertainment Pvt. Ltd, create such a rendition on every Indian festival. In the 15 years of my career, God has made me realise that we should share valuable things from our rich heritage. This is my responsibility. Our heritage remains, even if we don’t. Sambit Patra is my friend and we keep interacting frequently. I told him that we would also make him sing one day. The occasion of Jagannath Rath Yatra was coming. On 4 July, we were talking and that’s when I pitched this idea to him and he graciously accepted it. He came on 7 July, my birthday and we recorded this song the entire day. In just four days, we were ready with this miracle called ‘Shri Jagannath Ashtakam’. Today, this song is out there for the entire world to listen and people are praising it a lot.”

Kher added, “We have urged the devotees of Lord Jagannath to offer their prayers from wherever they are as this time our country is going through a tough phase. We should rather pray for the earth and this challenging phase to pass.”

Expressing his devotion for Lord Shiva and Kanwar Yatra, he said, “Kanwar Shravan Kumar is a symbol of devotion as Shravan Kumar took his parents to the Chaar Dhaam Yatra and offered the holy Ganga Jal in a Lord Shiv temple. In lieu of this tradition, many people now take items of devotion, along with Ganga Jal, which they offer in temples. This happens on a massive scale as India is a huge country but, if Kanwar Yatra is not happening this year, then it is good news (given the Covid-19 situation). We strongly believe in Lord Shiv and have strong devotion towards him. We live by his name. I have a hit song in my Kailasa album, that has become a sort of an anthem for Kanwar and Shravan Kumars. They complete their entire trip while listening to that song.”

Talking about the audience’s response to his show ‘Indian Pro Music League’, Kher said, “This was a very unique show, that’s why people loved and praised it a lot. The reactions that came in were very good, saying that ‘Wow, it’s a beautiful concept’. A show like this, featuring emerging artists with established artists as not just contestants but sitting on the judge’s seat for a day, was amazing and different.”

Sharing his thoughts on how manages to remain positive level even amid such trying times, Kher said, “I strongly believe in the power of God. The law of nature is not within our hands. If you completely surrender and devote yourself then, whatever happens, will happen for good. Everything happens for good, so why not stay cautious a little and not try to take things, that are not in our control. If you can do something, then do truthful work and good work. Help someone genuinely as your instinct is your God.”

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Breastfeeding: Dealing with advice of ‘well-wishing’ aunts and uncles

Dr Emine A Rehman

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Aunty 1: The baby looks so thin, baby needs cow’s milk, my dear. 

Me: Cow’s milk is for cow’s baby, my baby needs my milk.

Aunty 2: Oh God! such small breasts you have, how will your milk be enough? 

Me:  My body has the capacity to create however much milk is needed for my baby and you know it is the best food for the baby.

Aunty 3:  Don’t feed your baby for so long, you are pampering him, he will never leave you. 

Me: How can you pamper your baby by nourishing him?

Aunty 4: Look at you with the baby all the time. In our times we used to do all the household work and brought up so many kids as well. 

Me: Bringing up a baby with love, care, and breast milk is our choice as parents and we need all your help and support to successfully do it

Let’s ponder, how many of us have been the aunty or me in the above conversations in our lives? Almost all, right? Being a first-time mother at the age of 33 was not easy for me, to have a baby late was not a choice as well. Being a paediatrician was a privilege and my personal life took a backseat in the pursuit of higher studies. I thought I knew the solutions to all the challenges of breastfeeding but the reality was far from different. As the saying goes, “It takes a village to bring up a baby”, in modern times “it takes an entire family to breastfeed a baby”. Urbanisation, nuclear families, and career goals have made the art of breastfeeding less familiar to many millennial to-be mothers. 

We want the best for our baby and know that breastfeeding is the best path. However, many of us land up being a bundle of nerves when our babies arrive, not sure where to start and how to go about it. Agreed that breastfeeding is natural both for the mother and the baby but we forget to warn the to-be mothers that it is a helluva painful, stressful, and exhilarating ride. 

To top it all, mothers also have to deal with the benevolent, free-advice churning aunties and uncles amid this roller-coaster. Many a times, the well-wisher could be our own father, mother or even husband. Equipped with knowledge and confidence, I could defend and retort to many of them. However, the dream is to equip every Indian mother with enough knowledge to be the ‘me’ in the above situations.

Adequate breastfeeding is a single practice that can prevent lakhs of children from dying worldwide. World Health Organisation and UNICEF recommends that breastfeeding is initiated within the first hour of birth, the baby is given nothing but mother’s milk till 6 months and breastfeeding to be continued till 2 years of age and beyond. The global rates for breastfeeding are 43%, 41%, and 45% at the first hour, 6 months, and 2 years, respectively. So, it is not as universal as it has to be. A survey by POSHAN revealed that the exclusive breastfeeding rate is 54.9% in India. Mothers face many challenges like the feeling of inadequate milk, household chores, expectations from the workplace, and pressure to supplement with formula etc. She needs the support of her near and dear ones as well as the community to overcome these hurdles. Currently, mothers can get guidance from ASHA/ Anganwadi workers and gain knowledge through materials circulated by the Government of India via radio and TV. She can also access various peer groups in social media as well as consult trained lactation counsellors. World Breastfeeding Week is celebrated every year in the first week of August and this year the theme is “Protect breastfeeding — a shared responsibility”.

Breastfeeding can no longer be left as “ladies’ matter”. Confident and knowledgeable mothers are the foundation of future generations. Hence, let’s come together to support our mothers and become the true “well-wishing” aunties and uncles for our younger ones.

The writer is an Assistant professor, paediatrics department, AIIMS, Hyderabad.

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COMING OUT OF THE SHADOWS: HOW TO PROTECT MENTAL HEALTH OF TEENAGERS

We should expand social-emotional learning programmes to help build resilience in the growing minds.Capacity building for mental health management is an immediate must to meet a looming calamity.

Suravi Sharma Kumar

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Emerging from waves of Covid-19 pandemic, more than ever, we must prioritise the mental health of the growing minds — the children and adolescents. It is our collective responsibility to keep the well-being of young ones at the forefront in the preparation for future Covid-19 waves and recovery plans. Generation Z is quietly perceiving the layers of changes in our lives since the virus encroached on our spaces in early 2020. Now, while the much-awaited return to school is exciting for many, there would be children feeling anxious or even frightened (UNICEF, Aug 2020) to go back to regular school.

This is a time of the year when adolescents would have been spending days at school and college in the company of hundreds of others, preparing for school rituals, sports events, carving out their future plans, but, throughout the last year and a half, they are instead trudging through a difficult new normal. The virus brought in many stressors to the psychological environment, the impact of which is yet to be played out in statistical data charts and graphs to analyse the repercussions on society and the upcoming generation. The pandemic control measures have contributed to new mental health issues or a worsening of existing ones in all but the impact ripples are far and wide or even beyond what we can think now in the teens and adolescent age group.

Some children or youth may be grieving the loss of a parent or a loved one, others may be living in fear of the disease or fear of losing a bread earner in the family or a job. Millions in our country have been dropped out of school despite their and parents’ best efforts to educate them due to their inability to get a device or internet connectivity.

Adolescents across all socio-economic groups have been struggling to adjust to a life without the structure that a traditional school day provides. Social isolation, lack of peer support and the need for personal/ real-world connection seems to be growing. The lost sense of school life’s demands and timely examinations to keep the learning minds occupied have been creating tension in the psychological environment of every child. Out of all, children of essential workers and homeless children are at increased risk for having to live within the confines of homes on their own without adult supervision and the other without the basic amenities of life now made worse under the pandemic.

Across socio-economic conditions, there are children trapped in dysfunctional families with physical, verbal and even sexual abuse, and there’re those living with stressed adults who have been resorting to substance abuse within the confines of homes. To add to the list, flaring up of cyber dependency has been alarmingly on the rise as screen time for children are now the highest in our recent history.

With increasing stress comes an increased risk for mental health symptoms or reemergence of dormant disease, at a time when there are fewer options for getting the support that can help lower stress levels. These are various factors identified as Adverse Childhood Experiences (ACEs), and we know from research studies that when young people have these early experiences, they face an increased risk of lifelong morbidity or mortality.

When schools begin to reopen, we will need to implement more formal structures for mental health screening in the institutes and community settings. We must take precautionary measures against stigma and superstitions affecting caregiving, and there should be social laws in place to minimise the stigma around mental health conditions.

We all know law affects the operation of stigma in society and is the most efficient tool for blunting the effects of prejudice and stigma by protecting the diseased person against harmful conduct from miscreants/ ignorant lot in the society. The authorities must propagate strong messages in the society to create an inclusive environment for the people needing psychiatric help. India’s mental healthcare system needs strengthening. The authorities should now proactively implement the Mental Healthcare Act 2017. And this is a time when there is a dire need for integrated mental healthcare policy in the country covering all aspects of a sick mind.

We also need to enhance mental health awareness and stigma-busting programs in the local dialect or language through government and private sector initiatives. We should expand social-emotional learning programs to help build resilience in the growing minds. Capacity building for mental health management is an immediate must to meet a looming calamity, and suicide prevention programs should be revamped. There is a serious shortage of mental healthcare workers in India, the numbers of which according to WHO are: psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07) for a population of 100,000.

Tele-psychiatry may be an immediate possible solution with such deficient conditions and it has proven to be a promising tool with children and adolescents, more so in emergencies.

Authorities must support schools and behavioural health care agencies in working together to ensure that when schools reopen, students will have the mental health services they need on campuses and in their communities to provide screenings, interventions, and referrals.

Our young people are the future of our country. We must remember that the period from age 10 to 25 remains a critical time of brain development and maturation. Both the experiences our young people face now and the support they receive from us in coping with and navigating these challenges will have profound impacts on their abilities to be successful adults, parents, and citizens for years to come.

The writer is a medical doctor (pathologist) and holds an MA in Creative Writing from the University of London. The views expressed are personal.

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NCPCR going to check beggars’ kids for substance abuse in Chandigarh

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The National Commission For Protection of Child Rights (NCPCR) is going to check beggars’ kids for substance abuse. On 26 July 2021, NCPCR is going to instruct Chandigarh Administration to utilise all mediums to check beggars’ kids for substance abuse using medical tests in case required. This whole program would be managed under the recently launched Joint Action Plan (JAP), in which the Narcotics Control Bureau, Ministry of Health and Family Welfare, and Ministry of Social Justice and Empowerment, Ministry of Education are actively involved as stakeholders. NCPCR is going to start such initiatives under JAP across India.

NCPCR has identified 272 such vulnerable districts across the nation where State stakeholders would extensively work on Children who are substance abused and would wean away drugs from their lives while adopting various mediums. A recent study by the Ministry of Social Justice and Empowerment identified 4.6 lakh children in the country who are addicted to inhalants, the only category of substance in which the prevalence was higher among children than among adults. The five states with the highest prevalence of inhalant abuse among children were Uttar Pradesh (94,000 children), Madhya Pradesh (50,000 children), Maharashtra (40,000 children), Delhi (38,000 children), and Haryana (35,000 children).

Priyank Kanoongo, Chairperson of NCPCR told The Daily Guardian, “We introduced to have exclusive De-addiction and Rehabilitation Facilities for Children in 272 Vulnerable Districts. The MoSJE shall expedite the process to establish exclusive de-addiction facilities meant for children. However, if there are any constraints or lack of space, a separate portion in the existing facility has to be identified and partitioned for the children. Also, there has to be a provision of separate toilets; and safety and security of children have to be ensured.”

“The action plan mandates that ‘Prahari Clubs’’ be set up in schools in collaboration with Gandhi Smriti Darshan Samiti, in which children will discuss issues related to drug abuse and become monitors of the abuse,” he added.

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