The week india TruePDF 31 march 2019

She was cooperating really well.” After coming out of Jayalalithaa’s room, Beale told the Apollo team that he had asked her to consider going abroad for treatment.. The “mild mitral regu

TATA MEANS BUSINESS: N CHANDRASEKARAN’S CORE FOCUS

JOURNALISM WITH A HUMAN TOUCH www.theweek.in TheWeekMag TheWeekLive $ 50

THE WEEK accesses confi dential documents

to piece together the untold story of the fi nal weeks of her life

HOW DID JAYA DIE?

E X C L U S I V E

H.D KUMARASWAMY REGIONAL PARTIES THRIVE ON FAMILIES THAT RUN THEM

ALLIANCE PAINS WHY SOME PARTIES CAN’T TANGO WITH MODI OR RAHUL

MARCH 31, 2019 • THE WEEK 3

LETTER FROM THE EDITOR

JAYALALITHAA, the politician, and THE WEEK

were born around the same time She joined the

AIADMK in June 1982 by formally paying a rupee,

and delivered her first political speech in

Cudda-lore The opposition had a derisive name for her

debut performance: “The Cuddalore cabaret” In

December that year, the first issue of THE WEEK

rolled off the press Cover price: 01.50

When she died in December 2016, an online

quarterly magazine named Antiserious had put

out some interesting excerpts The portal said that

these were from a cover story that had appeared in

the now defunct Sunday magazine The headline:

“MGR nominates an heir” The writer? Anita Pratap,

currently THE WEEK’s consulting editor THE

WEEK’s first cover on the former Tamil Nadu chief

minister was in 1984, I think—“Jayalalitha: Lady

behind the throne” by Bhagwan R Singh

The only time I met Jayalalithaa was when the

Press Trust of India’s director board met her

in Chennai She was at her charming best and wowed all the directors I was pleasantly sur-prised, I must admit

The cover story this week is special because I have followed Jayalalithaa’s career keenly, and the circumstances of her death had made me wonder about her last days Now we have an answer, and I

am most glad to share it with you, dear reader The cover story is based on information gleaned from confidential documents It takes you to Jayalali-thaa’s bedside, and through the ups, downs and tough decisions of her final days

Being a family man, I cannot even begin to comprehend the loneliness that surrounded Jay-alalithaa I think everyone feels all the more lonely when they are ill So, how would Jayalalithaa have felt? Did the actor in her enable her to mask it so skilfully?

In the current issue, there is a story on

film-maker Ritesh Batra (Lunchbox, Photograph) He

makes an interesting observation about ing loneliness/longing in cinema: “Being lonely means nothing The best actor in the world would not be able to play lonely You cannot ask the actors to sit and be lonely But, longing [can be worked]—something they don’t have, or wanting something, or be somebody else, that is pretty universal.” Universal? Perhaps, yes But some longings are heavier than others, I feel And, for some, it becomes a habit

portray-A Jaya anecdote that has stayed with me is of her as a schoolgirl She and her brother used to be alone at home while their actor mother, Vedav-alli, worked Jaya was an exceptional student

One day, she was praised in class for an essay she wrote For three days, she sat up late into the night, wanting to read the essay out to Vedavalli

On the fourth day, the mother came back late at night to find the child asleep in the living room, with a notebook clutched to her chest The essay was titled—My mother, and what she means to

me The irony!

As Tamil Nadu goes to battle in the upcoming Lok Sabha polls, two captains will be missed Jay-alalithaa and M Karunanidhi While M.K Stalin has stepped into his father’s shoes, a battle royale

is being waged to claim Jayalalithaa’s political legacy

Some people continue to make news long after they are gone

FINAL WAVE

Jayalalithaa flagging off

the Metro Rail service

between Airport and Little

Mount in Chennai through

video conference This was

her last official event

FOR THE WEEK MARCH 25 - MARCH 31

GOA

Despite being a swayamsevak,

Manohar Parikkar never

allowed the RSS ideology to

weigh him down in politics

Tata Sons chairman

N Chandrasekaran is looking

to simplify the group structure

to bring companies closer

BUSINESS

The details of former Tamil Nadu chief minister

J Jayalalithaa’s last days have been shrouded in mystery

THE WEEK uncovers the untold story of a long-drawn and

complex battle to save her life, and how it ultimately failed

54

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of the Malayala Manorama Co.Ltd., Kottayam-686 001 Editor Philip Mathew

• Focus/Infocus features are marketing/PR initiatives

Mani Shankar Aiyar

COVER DIGITAL PAINTING: BINESH SREEDHARANDEATH NOTES

58 The Week Connect: The biggest takeaways from

THE WEEK CONNECT’s symposium on sustainable and safe use of chemicals and petrochemicals

l Interview: BJP’s

publicity campaign has reached a saturation

LASTING LEGACY

AIADMK leaders O Panneerselvam and Chief Minister Edappadi

K Palaniswami pay tribute to J Jayalalithaa on her birth anniversary

point, says Karnataka Chief Minister H.D Kumaraswamy

l Interview: Dalits are

offended like never before, says Jignesh Mevani, politician

During the 2014 Lok Sabha

polls, the prime

minis-ter promised more than

what he could achieve He

promised the moon to the

voters, and brought hopes

to his own constituency

in Varanasi The ments and shortfalls on the ground, across India, and

achieve-in Varanasi, are for all to see There are both hits and misses in Varanasi, though

it was given extra focus

How nice it would have been if the prime minister had taken India as a whole

as his constituency and developed it on the same footing as he did in Varana-

si How nice it would have been if every MP in the country toed Modi’s line

Varanasi will not change for better, so very soon

M.Y Shariff,

On email

I congratulate THE WEEK for beautifully covering every aspect of develop-mental activities being carried out in Varanasi, on civil as well as social fronts, under Modi, the dashing prime minister of India

You have nicely

present-ed the diverse views of persons who are affected

by such developmental activities

As an individual who was born and brought up in Varanasi, I am amazed

to see the fast and quick development activities, particularly in the old city

The perception of some people that it is not good

to demolish some of the oldest neighbourhoods

in Varanasi is because they cannot visualise such development in a city where all civil amenities are overloaded Finally, as it is said, when you progress,

you shed something

Vinay Kumar Srivastava,

Bengaluru

Modi’s candidature for the forthcoming general elections from Varanasi is

a mere formality He will win hands down this time, too The outsider tag did not hinder him in 2014 and it is not going to play

a major role in 2019, as he has endeared himself to the electorate admirably

A number of projects have also been launched in Varanasi and this will help Modi when he seeks a sec-ond term from Varanasi

C.V Aravind,

On email

Even though a subtle attempt was made in the cover story to pick and choose the fault lines in Modi’s projects in Vara-nasi, the report was quite exhaustive Modi has per-formed exceedingly well But, the moot question is whether Modi, the prime minister, showed over-in-dulgence to a particular constituency where he has selfish interests?

Raveendranath A.,

On email

Your cover story was well written But a hidden sar-castic tinge has spoiled its

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LIFE ON THE EDGE: REPORT FROM INDO-PAK BORDER

Prime Minister Modi’s strategy in Kashi could be the blueprint for the BJP’s Lok Sabha campaign

INDIA’S PRIME CONSTITUENCY

VARANASI

GAMING

IS PUBG HARMING OUR CHILDREN?

MARCH 17, 2019 FREE

44-PAGE SUPPLEMENT

THE VIRUS WARRIORS

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E X C L U S I V E

JAYAPUR, THE VILLAGE ADOPTED BY MODI

PLUS

Varanasi for Modi

The naturally fluent and lucid sketching of Varanasi by

Mathew T George was simply incredible (‘Primed for

polls’, March 17) Someone who goes through the story

gets a flavour of Varanasi In Varanasi, they say, all

occa-sions are celebrated, and all national losses are mourned

The Kashi Vishwanath corridor project is getting a mixed

reaction Some perceive it as foundation stone being laid

to modernise the city, keeping intact its ancient values

While others believe it will pave the way for big players to

venture into Varanasi and start their innings at the cost of

traditional shopkeepers

Majority in Varanasi want Modi to remain the MP, as no

other leader can match his stature It is a matter of pride

for every Banarasi to see their MP leading the country as

prime minister

Jaideep Mittra Varanasi, Uttar Pradesh

TheWeekMag @TheWeekLive TheWeekMag 85 89 99 48 69

taste It needs to be taken

into account that the

reporter has come across

only those who are

dis-gruntled and affected due

to development activities

in Varanasi

We should not forget that

when one’s misfortune

Villagers along the LoC

are always on edge when

Pakistan begins

shell-ing the border This is

nothing new But, we

need to think of ways

to tackle the problem

(‘Shelled, shocked’, March

17) The government

should continue to build

bunkers for the residents

and ensure that there are

no casualties Even the

slightest provocation from

the Pakistani side should

be taken seriously and all

precautionary measures

need to be taken Ideally,

there should not be any

settlement in the border

areas But, I am not sure

whether such a thing is

practical

Anjana Unni,

On email

Well expressed

Anuja Chauhan’s column

made a good read She

has expressed her views

well (‘Schizo-nation’,

March 17) The strain

one feels surrounded by

these hypnotised bhakts

is so true I am sure our

respected freedom ers must be rolling in their graves

fight-Dhany Anna Kurian,

On email

I do not agree with Chauhan

Can she show me any Indian (from the majority or the minority communities) who

is feeling the kind of fear that she has mentioned in her column? The only fear is in the minds of the terrorists and the Pakistani army

I feel if someone is asking for proof on the Balakot airstrike, then he or she must not only

be treated like anti-national but also be deported from the country

Madam, our intelligence agencies work day and night

to make sure that you sleep peacefully inside your home

We are intelligent enough to understand who we should choose as our next prime minister We do not need your advice

S.N.H Pandit,

On email

Realise the problems

Online and video games were always there; but the kind of pleasure young people get from such games

is not a pleasing sight (‘Hand held snare’, March 17)

The availability of mobile devices, along with cheap 4G data, has helped such online games reach all young people

Everyone talks about mobile addiction causing lots of problems But there is noth-ing being done to stop it and channelise such energy and enthusiasm elsewhere

Tapesh Nagpal,

On email

Chief Associate Editor & Director Riyad Mathew

Editor-in-Charge V.S Jayaschandran

Senior News Editor Stanley Thomas

News Editor Lukose Mathew Deputy News Editors Mathew T George, Maijo Abraham

Resident Editor, Delhi K.S Sachidananda Murthy Chief of Bureau, Delhi R Prasannan

Contributing Editors Barkha Dutt, Anita Pratap,

Anuja Chauhan

Chief of Bureau, Mumbai Dnyanesh V Jathar

Deputy Chiefs of Bureau, Delhi Vijaya Pushkarna, Neeru Bhatia

Chief Subeditors Ajish P Joy, Susamma Kurian,

Navin J Antony

Senior Subeditors Anirudha Karindalam,

Anirudh Madhavan

Subeditors Diya Mathew, Karthik Ravindranath,

Reuben Joe Joseph, Nirmal Jovial

Photo Editor: Sanjoy Ghosh Deputy Photo Editors

Bhanu Prakash Chandra, Salil Bera

Delhi: Aayush Goel

Chief Picture Coordinator

Bimal Nath C.

Research: Jomy M Joseph

Art Editor: Jayakrishnan M.T Assistant Art Editor: Binesh Sreedharan Senior Infographic

Designer: Sreemanikandan S Illustrator: B Bhaskaran Layout Artist: B Manojkumar Designers: Deni Lal, Job P.K Graphic designer: Syam Krishnan Artists: Rajesh A.S., Sumesh C.N.,

Sujesh K., Ajeesh Kumar M., Jairaj T.G.

Research Head: K Manoharan Research Assistant: Rani G.S.

THEWEEK.IN

Vaisakh E Hari

Vinod V.K., Jose K George, Anita Babu, Elvis Kurian John, Justin Paul George

Vice President, Marketing,

Chief Marketing Officer (North) &

SENIOR SPECIAL CORRESPONDENTS

Delhi: Rekha Dixit, Mandira Nayar, Namrata Biji Ahuja, Soni Mishra,

K Sunil Thomas Srinagar: Tariq Ahmad Bhat

SPECIAL CORRESPONDENTS

Delhi: Pratul Sharma, Namita Kohli, Pradip R Sagar Mumbai: Rachna Tyagi Bengaluru: Prathima Nandakumar Thiruvananthapuram: Cithara Paul Mumbai: Nachiket Kelkar Chennai Lakshmi Subramanian Kolkata: Rabi Banerjee

CHIEF REPORTER

UAE: Raju Mathew, Dubai

MARCH 31, 2019 • THE WEEK 11

‘JUNK’FOOD FOR THOUGHT

An art collective in

Gurugram has come up with a unique show to educate people about the hazards of mindless consumption of plastic items The show’s

biggest installation is

The Toxic Chamber, a

‘cave’ made of plastic

trash where visitors

can ponder over their

carbon footprint.

APERITIF

THE BIG PICTURE

PHOTO BY AAYUSH GOEL

POINT BLANK

I have always maintained that you can spin the ball into the batsman or out of the batsman

You cannot do anything more than that I am just adding more ammunition to my skill and try and add more strength

to my game and that’s all it has been

R Ashwin,

cricketer, on his variations

What is new that Priyanka Gandhi will

be doing? Wasn’t she the daughter of Sonia Gandhi earlier also, or will she cease to be one in the future? So first Nehru, then Rajiv, then Sanjay, then Rahul, and then Priyanka There might

be just some more Gandhis

Mahesh Sharma,

Union minister Modi’s election speeches are centred

on the Indian Air Force’s action in Balakot and are intended to whip up

a frenzy among the voters He hopes that Balakot will carry him to victory I believe the people of India are wiser

P Chidambaram,

Congress leader

At the cusp of history, Indians have a choice to make Are they electing a six-month government or a five-year gov-ernment? Are they choosing between a tried, tested and a performing leader or

a chaotic crowd of non-leaders?

Arun Jaitley,

Union minister During my school days, people used

to suggest that I lose weight When

I joined Hindi film industry, people made scathing remarks about my fig-ure Everybody suggested me to go for fitness regimen But I never bothered

I have always been comfortable with

my body

Vidya Balan,

actor

MILESTONES

l THE PERFECT CHIP

Indian golfer Diksha Dagar, 18, became the second Indian woman

to win the Ladies European Tour event She won the South African Women’s Open on March 16 Aditi Ashok, who won the Hero Women’s Indian Open in 2016, was the first to achieve the feat

l TRUE HERO

Pakistan announced a national award for Naeem Rashid, a Pakistani national who was killed while trying

to stop the white-supremacist who killed 50 people in New Zealand’s Christchurch A teacher, Naeem had migrated from Pakistan to New Zealand a decade ago

WORD PLAY

Predictalitics will change the future of

health care Coined by Daniel

Kraft—in-ventor of a device that facilitates the

minimally invasive harvesting of bone

marrow—predictalitics is the process

by which the digital data of a person is

used to predict what diseases he is at

risk of This would enable people to make

better health choices Future consumers

of healthcare will be more empowered,

for sure.

l FIGHTING REVENGE PORN

Facebook has unveiled a new AI-powered tool that will detect re-venge porn The tool will proactively detect and block near-nude images that are non-consensually shared across Facebook and Instagram

MARCH 31, 2019 • THE WEEK 13

POWER POINT

SACHIDANANDA MURTHY

sachi@theweek.in

ILLUSTRATION BHASKARAN

Political defections are normally

acrimoni-ous and messy affairs But Danish Ali,

long-time loyalist of former prime minister H D

Deve Gowda, has defected to the Bahujan Samaj

Party with the blessings of the Janata Dal (Secular)

patriarch and his son H.D Kumaraswamy, the

Karnataka chief minister Ali, who hails from Uttar

Pradesh, left the JD(S) at a time when he was

en-joying maximum clout in the party as its general

secretary The reason was the lure of Parliament

Thrice Ali had failed to get nominated to the Rajya

Sabha from Karnataka

He had a dream run last year, being involved

in the JD(S)-BSP tie-up ahead of

the Karnataka assembly elections

and the formation of the coalition

government with the support of

the Congress after a hung verdict

Ali also coordinated the grand

gathering of opposition leaders at

Kumaraswamy’s swearing in, and

became a member of the coalition

coordination committee The only

other member from the JD(S) was

Kumaraswamy Yet as spokesmen from other

parties, with whom Ali sparred regularly on prime

time, got Rajya Sabha seats, he started looking for

the right opportunity

During the BSP-JD(S) negotiations, Ali had

impressed Mayawati, who was scouting for

Mus-lim faces Once he convinced the BSP supremo,

Ali won over Deve Gowda, too, with the

unusu-al move of seeking permission to defect Deve

Gowda, who is unlikely to field a Muslim from the

party’s eight-seat quota for the Lok Sabha

elec-tions was also sending a message to the Muslim

voters in Karnataka It was an arrangement which

suited the shrewd former prime minister, who

used Ali as the point person for non-BJP

opposi-tion parties

Another politician who relied on an outsider for

Delhi politics has been Rashtriya Janata Dal chief

Lalu Prasad He had depended on Haryana

busi-nessman Prem Gupta, who went on to become a

Rajya Sabha MP and a junior minister in the mohan Singh government Otherwise, regional parties with specific influence in their own states use someone from the state to be the point person

Man-in Delhi Mayawati has depended on her former advocate general Satish Chandra Mishra, a Rajya Sabha MP Dravida Munnetra Kazhagam patriarch

M Karunanidhi always deputed a family member who was fluent in English The role passed from his nephew Murasoli Maran, who was minister in the governments of V.P Singh, Deve Gowda, I.K Gujral and A.B Vajpayee, to Maran’s son Dayanidhi, who was minister under Manmohan Singh Now, under

his son M.K Stalin, the role is fulfilled by Karunanidhi’s young-

er daughter Kanimozhi While Shiv Sena founder Bal Thackerey preferred former Maharashtra chief minister Manohar Joshi to be his point person, his successor Uddhav prefers journalist-turned-politician Sanjay Raut, rather than the Union ministers of the Sena

However, regional leaders who have served as senior cabinet ministers in Delhi like Sharad Pawar, Mamata Banerjee and Naveen Patnaik, have dealt directly with parties

in the national capital Both Mulayam Singh Yadav and his son Akhilesh have dealt with other politicians themselves because of their innings in Parliament, but, otherwise, the Delhi resident for the Yadav clan is Mulayam’s brother Ram Gopal

Though he was never an MP or Union minister,

K Chandrababu Naidu keeps his connections in Delhi from the time he was the convener of the United Front governments of Deve Gowda and Gujral, and later when his Telugu Desam Party lent crucial support to Vajpayee in 1999

Danish Ali has missed a stint in Parliament, so far He hopes it will work out with the BSP On the other hand, Deve Gowda is hopeful of sending two grandsons to Delhi and hopes they would build networks for the party Maybe, with a little help from Ali

A loyal defector

Baru is an economist and a writer He was adviser to former prime minister Manmohan Singh.

ILLUSTRATION BHASKARAN

Where there is oil and natural gas there

is the potential for conflict From West Asia to the South China Sea, from Lat-

in America to Central Asia and in places across

Africa, the control of the sources of energy—the

fuel of economic growth—has been a key factor

in defining conflict through most of the past

century During the cold war, many such

con-flicts were garbed in ideology With the fear of

communism overpowering capitalism declining,

with China chasing capitalism in the name of

socialism, the naked use of power to grab oil and

gas became all too visible No other commodity

has moved the militaries of the United States and

its allies around the world more than oil and gas

No other commodity has been

re-sponsible for regime change in the

developing world more than oil

Venezuela is the latest

geopo-litical hot spot where oil has once

again become a weapon Seeking

regime change in Venezuela, the

US, its biggest customer for oil, has

imposed sanctions on the former’s

oil exports It wants other

coun-tries to follow suit in the name of

democracy India is Venezuela’s

second biggest customer and needs that oil

Though, under the circumstances, Venezuela

needs the Indian market more So Venezuela

has, understandably, offered India a barter deal

that will enable India to pay rupees for oil

Vene-zuela will then have to buy Indian goods to make

use of the cash The incentive for India, apart

from continued access to Venezuelan oil, would

be an increase in demand for Indian goods

Venezuela has long enjoyed a trade surplus with

India, with Indian manufacturers having

difficul-ty in accessing the Venezuelan market

This is not the first time that the US has exerted

pressure on India to give up buying oil from

one of their adversaries US sanctions on Iran

have forced India to find new ways of keeping

that flow coming even as the quantity

import-ed has been curtailimport-ed But, Venezuela is not Iran Not only is Iran an important geopolitical neighbour, given the access it offers to Afghan-istan, Central Asia and beyond, some of India’s refineries can only process Iranian crude India used both arguments effectively in dealing with the pressure exerted by the US to join in on the Iran sanctions when Manmohan Singh was negotiating the civil nuclear energy deal with former US President George Bush Even the unpredictable Donald Trump has offered India some flexibility in dealing with Iran after he re-imposed sanctions

Will President Trump be as accommodative when it comes to Venezuela? These are dog

days for Venezuela Not only has the regime of President Nicolas Maduro become less popular but the oil market, too, has become less stressful for buyers The rise in the use of gas and renewables in both de-veloped and developing coun-tries, along with the growth slowdown both in the West and China, have given consumers like India some breathing and bargaining space

If there was one thing going for Venezuela in India it was the fact that one of its major buyers was the highly influential Reliance Industries But, Reliance is not only sharply reducing its purchase of crude oil from Venezuela, it has also decided to stop exporting refined prod-ucts to that country Reliance has important business interests in the US, generally and specifically in energy, and so it has decided to fall in line with the US rather than face sanc-tions The government of India, however, will have to show diplomatic spine and take a more long-term strategic view It is not easy and how successful New Delhi is in balancing friendship between the US and Venezuela will test India’s diplomatic skills

Venezuela’s slippery oil

CRYING FOUL

Former prime minister H.D Deve Gowda broke down saying he was pained by allegations of dynasty politics against him This was at a rally held to announce his grandson Prajwal’s electoral debut from Hassan The Janata Dal (Secular) patriarch’s tears, however, became ammunition for the BJP It said he shed no tears after the Pulwama attack, but was crying at the rally only to garner sympathy votes for Prajwal At one point, Deve Gowda, his son Revanna and Prajwal were crying together

on stage The BJP tweeted: “Before elections Deve Gowda & his family cries After elections people who vote this family cries.”

SUDDEN SWITCH

Aadala Prabhakar Reddy, a sitting MLA of the Telugu Desam Party was named in the party’s first list

of candidates for the assembly elections, which will be held concurrently with the Lok Sabha polls in Andhra Pradesh But,

he went missing soon after and remained incommunicado The party cadre, who were searching frantically for their leader, finally found him the next day—in the YSR Congress Party’s office He got

a Lok Sabha ticket from the YSRCP

ILLUSTRATIONS JAIRAJ T.G.

MARCH 31, 2019 • THE WEEK 17

CADRE CARE 101

Before candidates come the

ticket-seekers Thousands of

aspirants had trooped into

the BJP headquarters ahead

of the leadership’s huddle to

finalise candidates for the

Lok Sabha polls As they did

not know who to give their

neatly prepared portfolios to,

party president Amit Shah

stepped in and received all

applications himself While

turncoats joining the BJP

are more likely to get tickets,

Shah’s gesture meant that

the cadre went back happy at

having got an audience with

the top gun

CLOSED CEREMONY

The Rashtrapathi Bhavan

did not invite the media to

cover the defence investiture

ceremony, where the president

confers the gallantry and

distinguished service medals

Instead, the photo gallery of

the ceremony, which took

place on March 14, was

uploaded on presidentofindia

nic.in and the list of awardees

was released Talk about the

pleasure of the president!

on the campaign trail His fans say

it shows his confidence ahead of the coming Lok Sabha elections

The detractors, however, think it is the carefree attitude of someone who has nothing more to lose We will have to wait till the results are announced to find out

MARCH 31, 2019 • THE WEEK 19

EMPRESS OF

only her sundry ailments, but also her unhealthy habits and impulsive ways THE WEEK accesses confidential documents

to piece together the untold story

of the final weeks of her life

BY LAKSHMI SUBRAMANIAN

hu-mour is often the first casualty of an illness

But J Jayalalithaa never lost hers, even as her maladies left her gasping for air On September 27,

2016, barely a week after she was rushed to Apollo Hospitals in Chen-

nai, she cracked a joke about her wheezy

breathing “She quipped that it sounded like

someone sitting in the front row of a movie

theatre, whistling at the screen,” recalled Dr

K.S Shivakumar, her longtime doctor

Jayalalithaa’s final weeks had all the drama

of a potboiler, befitting the

actor-turned-pol-itician that she was The illnesses that

plagued the Tamil Nadu chief minister were

sundry She had been suffering from vertigo

for 15 years, had been obese and diabetic for

more than 20 years, and had chronic heart,

respiratory and digestive disorders, thyroid-

and nerve-related problems, and a skin

condition for which she took steroids

Jayalalithaa was hardly conscious for most

of the 74 days she was in Apollo Hospitals, Chennai But when she was, she insisted on running the show Dr Richard Beale, the Lon-don-based intensive care expert who flew in

to help treat her, got a taste of it when he met her in October 2016 Beale visited her after meeting the team of Apollo doctors who were treating her Shivakumar had told him that Amma, as Jayalalithaa was popularly known, was not sticking to her treatment regimen

According to Shivakumar, who was in the

CANDLE IN THE WIND

Jayalalithaa had long been suffering from vertigo, skin allergy, and heart, respiratory and digestive disorders

EXCLUSIVE

21

room, Beale told Jayalalithaa: “You

might be the boss of this whole state,

but I am the boss of this hospital You

should listen to what I say.”

Jayala-lithaa, who was unable to speak

because of her respiratory illness,

replied through gestures “You are

not the boss,” she gestured “I am the

boss.”

Having sent the message,

Jayalali-thaa took Beale’s advice “We talked

about many things—what she likes

to watch on TV, rehab, etc.,” he said

in a media conference held weeks

after she died “She couldn’t speak

clearly, but she could mouth, and I

could understand very well She was

cooperating really well.”

After coming out of Jayalalithaa’s

room, Beale told the Apollo team that

he had asked her to consider going

abroad for treatment “[Before going

in] Beale had not discussed this

op-tion with us,” said Dr Babu Kuruvilla

Abraham, critical care consultant

at Apollo “We came to know about

their talk only after Beale came out of

her room.”

According to Abraham, Beale told

him: “Very strong-willed lady I could

not persuade her to shift abroad.”

Perhaps, Jayalalithaa was influenced by what had happened

to M.G Ramachandran, former chief minister and her political mentor, who was admitted to Apollo Hospitals in October 1984 after a kidney failure “MGR was taken to New York for treatment,” recalled Dr

R Girinath, cardiothoracic surgeon who was part of the teams that treated MGR in 1984 and Jayalalithaa

in 2016 “When he was taken from [Apollo] hospital, he had not lost consciousness.” MGR returned without fully recovering from his illness, and had to spent the last two years of his life shuttling between Chennai and New York for treatment

He died in 1987

Jayalalithaa died on December

5, 2016, after she suffered a cardiac arrest She was 68 As the details regarding her treatment were kept under wraps, rumours began to spread that she was not given proper medical care, and that many of the interventions had ended up worsen-ing her condition

In a bid to dispel the rumours, a team of doctors, including Beale and Abraham, held a media conference

in Chennai on February 6, 2017

Beale said everything that could be done to save her “was done excep-tionally well” at Apollo

On September 25, 2017, the Tamil Nadu government constituted a commission headed by A Aru-mughaswamy, retired judge of the Madras High Court, to inquire into Jayalalithaa’s death The commission was initially given three months to submit its report, but was later grant-

ed extensions four times The final deadline is on June 24

Even as the Arumughaswamy commission is wrapping up its pro-ceedings, the rumours surrounding Jayalalithaa’s death refuse to go away

The absence of a detailed account

of her treatment has only kept them

afloat, even though there is no evidence supporting allegations that she was mistreated

THE WEEK accessed confidential documents—including statements made by Jayalalithaa’s doctors before the commission, testimonies of consultant specialists who monitored her progress, and a treatment summary by Apollo Hospitals—to piece together a comprehensive account of her final weeks This is the untold story of the long, complex battle to save Jayalalithaa’s life, and how and why it ultimately failed

Dr Richard

Beale (in pic)

told Jayalalithaa that

she should listen to

his advice Unable to

speak, she replied

through gestures: “You

are not the boss I am

the boss.”

DIET SHOCK

To fight fatigue, Jayalalithaa often consumed an energy drink, which caused her blood sugar to spike

MARCH 31, 2019 • THE WEEK 23

Shivakumar, 50, had been lithaa’s primary medical consultant since 1998 His wife is the niece of V.K Sasikala, Jayalalithaa’s close con-fidante “I would advise Amma on which doctor to consult, talk to the doctor, and organise the treatment,”

by drinking water boiled with lotus petals Normally, she would have breakfast at 7:15am, lunch before 11:30am, dinner between 6pm and 7pm At 11:30pm, before going to bed, she would repeat the blood test and note it in her diary.”

To ascertain the nature of her diet, the commission took note of her diary entry for August 19, 2015 That day, she woke up at 6am, checked her weight (102kg) and fasting blood sugar level (150 milligrams per decilitre, against the recommended

80 to 130mg/dL) For breakfast, she

SWEET TOOTH,

BITTER HEART

Jayalalithaa loved ice cream

And grapes, bananas, cakes and

sweets To fight fatigue, she often

consumed an energy drink called

Revive, which caused her blood

sugar to spike “She used to have ice

cream even in the night,” Shivakumar

told the commission She had sweets

even when the Apollo team was

struggling to stabilise her “Amma did

not have control over her food intake,

though she knew she had to exercise

control.”

had two idlis, two slices of bread

and 150ml cups of tea and coffee

Two cups of rice for brunch Poriyal

(sautéed vegetables) and curd rice

for lunch, topped with two cups of

green tea and four biscuits A

vege-table puff, a piece of cake and 200ml

green tea at teatime, and three slices

of wheat bread and 200ml milk for

dinner She recorded a blood-sugar

level of 175mg/dL at midnight, and

140mg/dL the next morning

According to Shivakumar,

Jay-alalithaa’s health had been steady

since 2001 “Her sugar levels alone

varied,” he said “She was treated for

thyroid problems (hypothyroidism),

and though there were certain other

anomalies, her health was fine.”

That changed in 2014, after a

spe-cial court in Karnataka convicted her

of amassing assets disproportionate

to her known income “There was a

change in her thyroid level and her

health,” he said “Her walk became

slower, as she felt increasingly

giddy because of vertigo.” She began

consulting a neurologist, an ENT

specialist and an ophthalmologist,

and was treated for a “nerve-related

problem”

She continued to have sweets and

fruits “Malai vazhaipazham [hill

banana, which she liked] increases

blood-sugar and potassium

lev-els Generally, if the latter goes up,

there is a risk of death But her level

remained within safe range,” said

Shivakumar

On June 23, 2015, a month after

the Karnataka High Court set aside

her conviction in the

disproportion-ate assets case, Jayalalithaa took an

echocardiogram It showed that she

had grade-1 diastolic dysfunction

(the first of four rungs in the

dysfunc-tion ladder), and that the mitral valve

in her heart was not functioning

properly Worse, there was

‘vegeta-tion’ in the mitral valve—an infected

mass caused by bacterial growth, so

named because of its similarity to

Jayalalithaa took care to wear clothes that hid her condition; hence, those distinctive long-sleeved blouses and saris swaddling her torso She was allergic to ink, so her habit of reading newspapers and going through files took a toll on her health When the allergy flared up, she would take photos of the affected area and send it to Shivakumar, who would then forward it to skin special-ists “She was given medication for rashes on her thighs and back She had a cyst on her calf, which was also treated,” said Shivakumar

Concerned about Jayalalithaa’s wellbeing, Sasikala asked the special-ists to advise the chief minister about taking time out “They asked her not

to spend too much time indoors, and recommended that she visit places like Siruthavoor or Kodanad, where she could relax and be close to na-

FIGHTING TO STAY FIT

Jayalalithaa inaugurating

a gym at the secretariat

in Chennai in 2014

natural vegetation A surgery, ever, was not performed, apparently because of her high blood sugar

how-She also underwent a scan to trace the cause of her vertigo By May 2016, when Jayalalithaa was reelected as chief minister, several of her ailments had turned severe The most visible among them was atopic dermatitis,

a chronic skin condition that would occasionally flare up, making her skin red and itchy “[Because of her ill health] the swearing-in ceremony was short,” recalled Shivakumar “By the first week of September, her skin condition worsened On the advice

of the specialists who treated Amma, she was given a steroid tablet called Wysolone—8mg in the morning and 8mg in the evening The dosage was later reduced step by step She would have taken this tablet for about 15 days.”

MARCH 31, 2019 • THE WEEK 25

ture,” said Shivakumar

On September 21, 2016, a day

before she was hospitalised,

Jayalali-thaa flagged off a new corridor of the

Chennai Metro Rail She gave signs

of being under the weather with her

speech, gait and the way she waved

the flag “Sasikala later told me that

Amma was very tired, so she cut short

her government functions to come

home and rest,” said Shivakumar

The next morning, she cancelled

her itinerary and called for

Shivaku-mar “I went there around 11am,” he

said “Amma said she had run a slight

temperature in the morning, but did

not have fever Because I felt that she

was fine then, I left for Apollo

Hospi-tals to perform a surgery.”

He returned to check on her again

at 4pm “Amma told me that a girl

working there (in Poes Garden) had a

fungal infection, and asked me about

how it affects the body She said she had sent the girl to hospital She told

me that if she herself gets such an infection, she would not be able to bear it.”

Shivakumar left again after the checkup At 7pm, as he was on his way home after work, Sasikala phoned him again saying Jayalalithaa was unwell “I went back at 8:45pm,”

he said “Amma had cough, and was

on her bed She had slight fever, and was feeling a little breathless I called

a person at Apollo and asked him to bring a nebuliser The cough wors-ened She told me that she wanted to

go to the bathroom Sasikala stood outside the door as she went.”

After coming out, Jayalalithaa walked to her bed, sat on it, coughed hard and collapsed Sasikala held her and shouted for help, as Shiva-kumar called P Vijayakumar Reddy, husband of Apollo Hospitals vice chairperson Preetha Reddy

Two girls were also in the room—

part of a group of 10 that Sasikala had chosen to be at Jayalalithaa’s side in rotation As the house did not have

special medical facilities, all of them waited for the ambulance

THE FIGHT BEGINS

was coming at 10pm,” said

Dr Raymond Dominic Savio, critical care consultant at Apollo Hospitals “Around 10:25pm, she was brought in to the ground-floor emergency room.”

Savio told the commission that Jayalalithaa was administered first aid for 30 minutes She regained consciousness when she came out of the emergency room, but could not speak because of the oxygen mask She had fever and was dehydrated

As her condition remained critical, she was taken to the multidiscipli-nary critical care unit (MDCCU) on the second floor

A team of doctors was soon mobilised, and they administered two injections to clear her infected, fluid-filled lungs A pacemaker was kept on standby, as her heartbeat was fluctuating She had urinary tract infection caused by E coli, a bacteria found in human faeces The doctors found that she used to wear adult diapers; they were not sure for how long They drained urine from her bladder using a Foley catheter and started medications to fight the infection

The initial diagnosis revealed

a wide range of issues—obesity, hypertension, poorly controlled diabetes, hypothyroidism, irritable bowel syndrome and chronic diar-rhoea, and asthmatic bronchitis It was also noted that she had a history

of intermittent fever, “for 5-7 days”, with increased frequency of bowel movement She had vaginal candid-iasis, a type of yeast infection, and her grade-1 diastolic dysfunction had deteriorated to grade-2

A panel of 18 specialists soon took over the treatment The panel comprised experts in everything,

There was

a change

in her thyroid level and her health [in 2014] Her walk became slower,

as she felt increasingly giddy because of vertigo.

Dr K.S Shivakumar,

Jayalalithaa’s longtime doctor

from intensive care to pulmonology,

cardiology, nephrology,

endocrinol-ogy, haematolendocrinol-ogy, neurology and

internal medicine The Apollo

doc-tors also began consulting external

specialists in India and abroad

On September 23, Jayalalithaa’s

heartbeat became normal “She

became conscious,” said Savio “We

removed the ventilator and provided

oxygen through mask Amma spoke

to some of our team members in the

morning, and also to Dr Shivakumar

and Sasikala.”

For the doctors, though, bad news

kept coming An initial set of blood

cultures showed growth of

entero-coccus bacteria, which called for

further medication “This infection

could have resulted from Amma

using diapers continuously because

of her irritable bowel syndrome,” Dr

Ramesh Venkataraman, critical care

consultant, told the commission

Jayalalithaa suffered from what

doctors called septic shock—an

im-mune response to harmful bacteria

that could cause organ failure and

a dangerous dip in blood pressure

“Amma was taking five tablets for

blood pressure,” Dr Y.V.C Reddy,

cardiologist, told the commission

“Because she had septic shock when

she was admitted, all her medicines

were stopped, and then given one by

one The dosage of each tablet was

increased based on her BP We were

giving her up to three tablets.”

Jayalalithaa was also diagnosed

with acute respiratory distress

syn-drome (ARDS) and endocarditis, an

infection of the heart’s inner lining,

usually involving a heart valve

The doctors noted that there were

“suspicious vegetations on the

an-terior mitral leaflet with mild mitral

regurgitation”

The mitral valve is one of the four

valves in the heart It regulates blood

flow from the left atrium to the left

ventricle When oxygen-rich blood

fills the atrium, the mitral valve

opens to allow blood to flow to the ventricle And, within seconds it shuts off to prevent blood from flow-ing back into the atrium

The “mild mitral regurgitation”, which Jayalalithaa’s doctors took note of, meant that the mitral valve was not shutting off properly It meant that the left ventricle was

‘regurgitating’ blood back to the left atrium

A reasonably healthy person could have undergone surgery But not Jayalalithaa She was obese (5ft tall, 106kg), her blood sugar had shot

up to 400mg/dL, and her blood was infected There was also a leak in the valve and a 2mm perforation, with the vegetation measuring around 1cm—not huge, but a concern never-theless Giving medication to shrink the vegetation was not an option, for

it could have stunted its growth and led to further complications

On October 5, a team of three doctors from the All India Institute

of Medical Sciences, New Delhi, flew

to Chennai Dr Nitish Naik, the diologist in the team, looked over the

car-reports and decided that surgery was too risky He cited two main reasons: Jayalalithaa was still being treated for endocarditis, and the trouble with her mitral valve was mild and had not increased in severity since her previous ECG, done in June

The Apollo doctors agreed with him But for good measure, they also contacted Dr Stuart Russell, cardi-ologist at Johns Hopkins Hospital

in the US He, too, endorsed Naik’s view in a videoconference The chief secretary, who had taken charge of day-to-day administration at the chief minister’s office, was then informed of the decision

Another surgery, however, was needed to help her breathe The hospital had formed a respiratory committee to treat her breathless-ness On October 7, an ENT sur-geon performed a tracheotomy on Jayalalithaa An incision was made

on her neck to open the windpipe, creating a direct airway that allowed her to breathe using a tracheal tube, without using her nose or mouth

“She was stable after the procedure, and at 11am, she started responding

to verbal commands,” noted Naik The AIIMS team left the same day

In their report, they noted that alalithaa continued to be critically ill and that it would take her “quite some time” to recover

Jay-But how long? According to ham, the critical care consultant who joined the Jayalalithaa team on October 1, it would have taken her one and a half years to recover fully

Abra-“Once, in October, when Amma was in MDCCU, she called me and

Though there was vegetation and perforation [in the mitral valve], angiography would have increased the complications, as Amma was on ventilation.

Dr R Girinath, cardiothoracic

surgeon

MARCH 31, 2019 • THE WEEK 27

asked me about her problems—how

long it would take to cure her, and

when would she be able to go home

I told her the truth Amma’s blood

was infected, leading to an infection

in the heart, which resulted in the

accumulation of fluid in the liver She

had ARDS, too It would take one and

a half years, and daily

physiother-apy, [for recovery] I requested her

cooperation.”

Abraham, however, held back

one detail: As her heart and lungs

could not function without external

support systems, the doctors had

reckoned that the chances of her

making it were just 40 per cent

REBOUNDS AND REVERSALS

On November 22, 2016,

Jayalal-ithaa was fully conscious and feeling cheerful She had rea-son to celebrate: The AIADMK had swept the bypolls in three assembly seats, which were held three days earlier “The victory is a gift given by the voters and I feel immensely elat-ed,” read her statement to the media

Despite being on a strict diet, Jayalalithaa celebrated the victory

by having her favourite sweets and fruits “Amma was given sweets on two occasions—on Diwali (October 30) and after the election victory,”

said Dr Bhuvaneswari Shankar,

dieti-cian at Apollo Hospitals “She asked

for malai vazhaipazham, seedless

grapes and mango The portions were very small So, even if the fruits had plenty of sugar and potassium, there was no harm, because she had them in very small quantities.”

Throughout her stay at the pital, Jayalalithaa was on a low-fat, 1,600-calorie diet She was often given sugar-free milkshakes, as she was unable to consume solid food on most days When she could, she had curd rice, cornflakes and coffee

hos-“For the first two days [after she was admitted], Amma had hospital food,” said Bhuvaneswari “After that, Amma requested food prepared

OCCUPATIONAL HAZARD

Jayalalithaa was allergic

to ink, so her habit of reading newspapers and going through files took a toll

on her

ZEST FOR LIFE

Jayalalithaa had her cook come to Apollo Hospitals and prepare food for her under the supervision

of doctors; (right) a screen grab from a video, shot after she was shifted to a private room

in November 2016

by her own cook Her cook came

to the hospital and prepared the

food under our supervision, using

ingredients we supplied Did it differ

drastically from the food we serve in

our hospital? I would say no.”

Several doctors, however, told the

commission that Jayalalithaa did not

stick to her diet She used to have

khichdi, sambar rice, tender coconut

water, apple, grapes, French fries and

ice cream Bhuvaneswari said she

took care that the total calorie intake

from such food never exceeded 1,200

calories Her blood sugar levels were

monitored and strictly controlled

“With regard to food intake, she

had what she liked,” said Abraham

“If we refused to serve her favourite

dishes, she would see to it that she

got it.”

Dr R Narasimhan, consultant

pul-monologist at Apollo Hospitals, who

was also part of the respiratory

com-mittee, said Jayalalithaa kept herself

“When she became stable, I met her and she asked me whether I had re-ceived the book I said no She called her assistant and asked him to get the book Shivakumar had also asked for the book, so she asked him to give

it to the both of us.”

By November 13, her condition had somewhat stabilised She sent out a signed letter saying she had taken a rebirth and was waiting to get back to work Six days later, she was shifted out of the MDCCU to a pri-vate room on the same floor It was

in this room that the two videos that later went viral were recorded

In the videos, Jayalalithaa is seen reclining on a bed, an oxygen mask round her neck She sips from a plas-tic cup with a straw, as she looks out

of a window on her left “For vastu

reasons, the doors behind her were kept closed,” said Abraham “Outside the window, in the corridor, artifi-cial plants had been placed Behind

occupied in other ways as well

“Till September 27, Amma wore an oxygen mask,” he said “[When her breathlessness subsided] she told me that she was reading a book It was

The Private Life of Chairman Mao

She asked me whether I had read the book, and recommended that I read

it I will develop leadership qualities, she said.”

The book was an interesting choice Written by Mao Zedong’s

personal physician, The Private Life

has intimate details of his ality, habits, sexual escapades and political beliefs and actions It is banned in China for its controversial content The book was published in

person-1994, three years after Jayalalithaa first became chief minister and began making a mark in national politics

Jayalalithaa told Narasimhan that she would have the book sent to him But then her condition slipped

MARCH 31, 2019 • THE WEEK 29

her cot, there were three pictures of

deities In front of her, there was a

television.”

It was hardly the rebirth

Jayalalithaa had hoped for “She

was on and off sedation for around

two months,” Narasimhan told the

commission “From September

28 to November 19, if you asked

me whether Amma was stable, I

would have said no But she was

in a position where she could be

managed with critical care.”

In November, Jayalalithaa’s

relatives got Samin Sharma, a

US-based cardiologist, to once again

assess whether she needed heart

surgery He arrived in Chennai

on November 25 and met Dr N

Ramakrishnan, director of critical

care services at Apollo “Dr Sharma

said it was necessary for her to

undergo angiography at some point,

and that he was ready to conduct

the operation the same day,”

Ramakrishnan told the commission,

citing a note prepared by Abraham

“The note further states that when

the Apollo team contacted Dr

Beale, he said the surgery was not

necessary.”

Girinath, the cardiothoracic

sur-geon, said a Mumbai-based tious disease specialist, Dr Soman, had also recommended that the angiography be performed at the earliest The doctors at Apollo and AIIMS considered the opinion, but decided to wait till Jayalalithaa was stable

infec-The reason was that the 30-minute procedure was too risky “There are more complications than the time involved,” said Girinath “Though

there was vegetation and perforation [in the mitral valve], the angio would have increased the complications, as Amma was on ventilation.”

On November 29, the doctors went over the reports again and reached a consensus “Further coronary evalu-ation could be planned effectively at

a later date,” said their report

Through December 1 and 2, Jayalalithaa’s blood sugar fluctuated from 112mg/dL to 440mg/dL By December 3, though, some of her vital stats—like her potassium lev-el—were returning to normal range She was fully conscious, had begun undergoing physiotherapy regularly, and required minimal respiratory support The AIIMS doctors, who had been monitoring her progress, met Jayalalithaa and told her to have more solid food She had lost around 5kg because of the hospital diet They also agreed that the angiography could wait, and conveyed this to Sasikala and government officials The AIIMS team left the same day And then, her ailments struck back with a vengeance

THE DOWNWARD SPIRAL

It took just two days for her

condi-tion to hit rock bottom

On the evening of December 3, she began coughing and her tracheal secretions began to increase As her condition worsened, she was put on ventilator again and her blood and tracheal secretions were sent for culture The results showed renewed infections

However, she began to improve the next morning But, at about 4:20pm, she developed breathlessness and was placed on the ventilator imme-diately While being treated, she had

a massive cardiac arrest Doctors present in the room tried to revive her When CPR (cardiopulmonary re-suscitation) did not revive the heart, the doctors decided to connect her

to ECMO (extracorporeal membrane

She asked

me whether

I had read The Private Life of Chairman Mao, and recommended that I read it I will develop leadership qualities, she said.

Dr R Narasimhan, consultant

pulmonologist

oxygenation, a cardiac and

respirato-ry support technique)

Dr K Madhankumar, specialist

in heart transplant and ECMO, was

summoned “I was at home when I

got the call,” he said “I was told that

Amma was being administered CPR

and that she might need ECMO

When I entered her room around

5pm, Sasikala was pleading with

doctors to save Amma.”

Jayalalithaa’s heart had stopped

half an hour ago As CPR had failed,

the doctors decided to perform

sternotomy, a surgical procedure in

which an incision is made along the

breastbone to provide access to the

heart “It took ten minutes to sterilise

her chest region, split open her

skin and muscles, cut the sternum

(breastbone) and see her heart,” said

Madhankumar

Dr Minal M Vora, consultant in

cardiac anaesthesia, had arrived by

then At least four other specialists

were also in the room “The time we

took to connect Amma to ECMO—

including the time to perform

ster-notomy—was 30 minutes,” said Vora

“We got Amma’s central line [primary

nerves of the heart] and connected it

to the aorta part The ECMO was up and running by 5:30pm.”

Meanwhile, according to the ical summary, she suffered another episode of ventricular fibrillation To stop the heart from flatlining again, she was delivered a shock using an internal defibrillator

med-Her kidneys, too, were failing The doctors started a renal therapy, using the ECMO circuit Around 10:30pm, Jayalalithaa blinked several times, and the doctors noted that the pupils were dilated 5mm and “reacting sluggishly”—which was, again, not a good sign

“As the bleeding from her heart was profuse, we took her to the op-eration theatre,” said Madhankumar

“A duct from her thigh was attached [to her heart] This happened around 11:30pm.”

The doctors took measures to prevent further complications—like cerebral oedema, or the excess accumulation of fluid in brain Other than that, they could only wait and hope that ECMO would do its job

“The work of an ECMO is to keep up

the blood circulation,” said kumar “We try for a minimum of 24 hours to revive the heart function

Madhan-An appropriate decision is taken only after that.”

ECMO had a success rate of just

28 per cent, according to Dr T Paul Ramesh, the principal doctor in Apollo’s ECMO team “Sasikala urged

us to keep trying even if there was only 1 per cent chance of recovery,” said Ramesh

The chief secretary was informed

of the situation A neurological amination revealed intermittent eye movements and slow blinking “The right pupil was 5mm, irregular and not reacting,” noted the doctors “But the left pupil was 5mm, irregular and sluggishly responding to light.” The AIIMS team returned in the evening of December 5 By the time they reached the hospital, Jayala-lithaa had been on ECMO for 24 hours “The neurologist opined that there was no response to any stimuli,” they noted “However, true neurologic status could not be assessed because of hypothermia

ex-It was decided to assess the status again after a few hours, once normal body temperature was attained.” The assessment was done at 10pm

As the doctors clamped the ECMO tube, there was rapid loss in blood pressure It meant that her heart could not function by itself When the pacemaker was switched off, the ECG monitor showed a flat line

At 11:30pm, a select group of reaucrats, ministers and politicians, along with Sasikala, received the last update regarding Jayalalithaa’s condition “Continuing ECMO and other organ-supportive measures was futile, considering that there is

bu-no intrinsic (heart function),” said the treatment summary

The candle had finally lost to the wind

UGLY SPAT

V.K Sasikala and O

Panneerselvam have been battling

to claim Jayalalithaa’s legacy

MARCH 31, 2019 • THE WEEK 31

The inquiry quagmire

The investigation into Jayalalithaa’s death is

bogged down in a perception battle

BY LAKSHMI SUBRAMANIAN

Kalas Mahal, a

250-year-old heritage structure at

Chepauk in Chennai, is at

the centre of a high-profile

legal scuffle Every day, at least half a

dozen VIPs and as many lawyers walk

in and out of the chambers of A

Aru-mughaswamy, a former Madras High

Court judge Arumughaswamy heads

the single-member commission that

has been inquiring into J

Jayalali-thaa’s death since September 2017

The commission has so far

ex-amined 147 witnesses, including

ministers, bureaucrats and doctors

who treated Jayalalithaa But, despite

the long drawn-out proceedings,

it has not been able to lift the air of

mystery surrounding her death, nor

has it been able to reach a conclusion

regarding how she died

That the witnesses are being

examined in secret has not helped

its cause Also, the commission has

not examined O Panneerselvam: the

former chief minister was the first to

allege that Jayalalithaa was not given

proper medical care

There is criticism that many

ques-tions to the witnesses concerned

conspiracy theories Several

deposi-tions that THE WEEK accessed bear

this out During cross-questioning,

the witnesses were frequently asked

whether Jayalalithaa was

“slow-poi-soned”, whether angiography was

not done on purpose, and whether

the doctors had any ulterior motive

behind their decision to not opt for

heart surgery

Politics has played its part in

the proceedings There have been long-winded discussions on the conspiracy theories floated by the cabinet colleagues of Chief Minister Edappadi K Palaniswami Their allegations are aimed at V.K Sasikala, Jayalalithaa’s confidante, who has been fighting AIADMK leaders to claim her political legacy

Caught in the melee is Apollo pitals, which has long been objecting

Hos-to the way the commission is tioning In February, Apollo Hos-pitals petitioned the Madras High Court demanding the setting up of

func-a medicfunc-al bofunc-ard to exfunc-amine mfunc-atters related to Jayalalithaa’s treatment

The hospital said in its petition that the “deposition documents of over 50 doctors are riddled with errors, due

to the inability of the probe panel to comprehend medical terminology”

But the commission opposed the plea, saying the hospital should not

be allowed to stall its proceedings as the hearings were nearly over

S.M Mohan Kumar, manager (legal) at Apollo Hospitals, had earlier requested the commission to set up a 21-member medical board

“Jayalalithaa suffered from a complex matrix of diseases, and each [disease] overlapped the other,” said Kumar in his application “Hence, Apollo prays that the medical board have doctors representing 21 specialisations that represent Jayalalithaa’s illnesses….” The commission had, in April last year, received permission from the state government to set up a panel of doctors But it could not find doctors who were willing to be part of it The commission’s questions to the witnesses are based on the clinical and practice guidelines published in

2015 by European Society of ology, which has more than 90,000 cardiologists in and outside Europe

Cardi-as members “Surgery must be performed on an emergency basis, irrespective of the status of infection,” says one guideline

Apollo Hospitals, however, has argued that there was good reason to decide against surgery, and that the rationale behind the decision was ex-plained by experts such as Dr Nitish Naik of All India Institute of Medical Sciences, who was part of a team that monitored Jayalalithaa’s treatment

“The team of doctors at Apollo and AIIMS, and the consultants abroad, gave sincere, high-quality medical support,” Naik told the commission

It is clear that a perception war is being played out in and outside the courtroom Arumughaswamy ad-mitted as much in January this year, when some official documents were leaked to the media by a clerk What remains to be seen is whether the war will end on June 24, the deadline for the commission to submit its report

A perception war is being played out in and outside the courtroom

Arumughaswamy (in pic) admitted as much

in January, when some official documents were leaked to the media by

a clerk

TOO MUCH

TO COPE

The many maladies that

plagued J Jayalalithaa

Eighteen consultants were directly

involved in her treatment, including experts

in intensive care, pulmonology, cardiology, nephrology, endocrinology, haematology, neurology and internal medicine The doctors at Apollo Hospitals also consulted specialists in India and abroad

Cardiac problems

Blood transfusions were done as she was bleeding profusely After another episode of ventricular fibrillation—rapid, inadequate heartbeats—shock was delivered using an internal defibrillator to stop the heart from flatlining again

Kidneys were failing Doctors started renal

therapy They used the ECMO circuit to replace the body’s blood-filtering function

A duct from her thigh was attached to her heart to counteract the copious bleeding from the heart

Endocarditis: Infection of the

heart's inner lining Occurs when

germs spread through the

bloodstream and attach to areas

in the heart

Diastolic dysfunction:

Ventricles do not relax as

required when the heart beats

and become stiff This

hampers collection of blood

Mitral malfunction: The mitral valve

regulates blood flow from the left

atrium to the left ventricle In Jayalalithaa's

case, it was not functioning properly

In-valve anomalies: Her mitral valve also

had “vegetation” (bacteria infected mass),

perforation and leak Part of it had calcified

Obesity, hypertension, poorly controlled

diabetes, respiratory illness and chronic diarrhoea

GRAPHICS SREEMANIKANDAN S./SYAM KRISHNAN

Immediate cause of death

MITRAL VALVE

5f

CPR failed; doctors then put her on

extracorporeal membrane oxygenation (life support)

Sternotomy (an incision along the breastbone to provide access to the heart) was performed to connect her

to the ECMO circuit

Comorbidities After 24 hours on life support, doctorsconducted an assessment and found that

the heart was not able to function without life support

MARCH 31, 2019 • THE WEEK 33

Why cardiac surgery

was not done

Jayalalithaa was obese, her

blood sugar had shot

shrink vegetation could

have led to complications

Doctors from the All India Institute

of Medical Sciences, Delhi, looked over the reports and decided that surgery was too risky

400

Another procedure, a tracheotomy,

was performed to help her breathe

An incision was made on her neck to open the windpipe, creating a direct airway that allowed her to breathe using a tracheal tube, without using her nose or mouth

Doctors decided to wait till Jayalalithaa was stable to perform angiography, since the procedure was too risky in her condition

Atopic dermatitis

A chronic skin condition that

makes skin red and itchy Doctors

gave her a steroid tablet called

Wysolone—8mg in the morning

and evening

Urinary tract infection

An infection in any part of the urinary system Painful if limited to bladder but, can be serious if spread to kidneys

Acute respiratory distress syndrome

Fluid builds up in the lungs and prevents it from filling with enough air, causing reduced oxygen in the bloodstream Doctors administered two injections to clear her infected, fluid-filled lungs

Allergy to ink

Even reading newspapers and going

through files took a toll on her health

The presence of harmful bacteria,

causing organ failure and a dip in

blood pressure Doctors stopped

all her BP medicines, and then

started giving them one by one.

The dosage was based on her BP

INK

Irritable bowel syndrome

A chronic intestinal disorder that causes cramping, abdominal pain, bloating and diarrhoea or constipation, or both

Standing on the embankment, Mahadev Gomare, in

La-tur, Maharashtra, is staring into the Gharni River with the

pride of a mother looking at her child As a local farmer

with several generations of his family living off the land, the

trans-formation of what was, until recently, a dry riverbed into a gently

flowing river, is nothing short of a miracle.

But Gomare knows that there was no miracle there.

Back in 1993, Latur, Gomare’s hometown, shot to fame for all

the wrong reasons when a devastating earthquake killed over

10,000 people Misfortune continued to haunt the people of this

ill-fated village Drought like conditions for the last several years,

failed crops, poor precipitation cycles, farmers suicides, limited

incomes, debt impairment and unsustainable farming

practic-es, cattle injuries an endless list of tragedies wreaked havoc for a

decade that followed the earthquake But this spell broke in 2013.

The transformation of Latur from an arid and tragedy prone

land to one of relative prosperity with the promise of a better

tomorrow started with one project The Art of Living River

Re-juvenation Project that covers over 100 villages in Latur today A

small army of volunteers supported by the villagers have made

these villages self-sufficient in meeting their water requirements.

Latur is but one story in what is now becoming a national

move-ment in India’s first genuine and perhaps the most successful

attempt to rejuvenate her dying rivers and their tributaries.

Of the 41 rivers and their tributaries that have been brought

back to life, 28 rivers and their tributaries are in Maharashtra, 5

in Karnataka, 7 in Tamil Nadu and 1 in Kerala Over 5055

villag-es and around 5 million people have benefited from this project

cumulatively.

The army of volunteers who have managed to revive these

riv-ers includes geologists, hydro-geologists, environmentalists,

and agriculturists working alongside the community leaders in

rural parts of the country.

The multi pronged approach doesn’t only revive rivers but

up-lifts communities as well Building artificial recharge structures,

undertaking extensive afforestation focusing on the native

spe-cies and training the local farmers on sustainable agricultural

practices is a part of the river-revival initiatives.

The Art of Living River Rejuvenation Project started in nataka with the simple identification of long-degraded rivers of yore With the help of remote sensing and satellite maps, geog- raphers and geologists plot the once flowing and thriving riv- ers buried deep under layers of silt Factors like slope, drainage network, soil texture, land use, Geo-morphology, lineaments, groundwater prospects and village boundaries are studied and analysed The scope is eventually expanded to include ponds and wells as well In addition to these, GIS based thematic maps, long term rainfall patterns are also analyzed to approximately estimate the availability of surface water for groundwater re- charge This holistic understanding of the project area points to suitable locations for constructing artificial recharge structures Implementation of the tasks involves clearing silt, recreating catchment areas through groundwater recharge structures and replanting trees for a holistic and long-term solution All this can’t be achieved without local help To inculcate a sense

Kar-of ownership, the local population is sensitized and prepared to participate wholeheartedly in the project at hand.

Dr Lingaraju Yale one of India’s foremost experts on natural water resource management who leads the River Rejuvenation Project says the rejuvenation of geo-hydrological processes in

a river basin brings a balance between erratic rainfall events tributed over a short period of time He evolved the concept of

dis-Since 2013, when The Art of Living River Rejuvenation Project began, more than 41 dying rivers in

4 states have been brought back to life The transformation this has brought about in the lives of

farmers and rural folk is a real eye opener

BY KALYAN SUBRAMANI

The art of bringing

rivers back to life

MARCH 31, 2019 • THE WEEK 35

FOCUS

If you’d like to know more about our River Rejuvenation work

or volunteer with the team, please visit bit.ly/artoflivingrivers

or scan this QR code:

River Rejuvenation and application of technology to rejuvenate

rivers “We focused on natural vegetation that conserves

rain-water in the form of base flows along the stream and through

shallow and deeper aquifers When the rainfall would be

defi-cient, this conserved water will be available.”

Studies in the past have revealed that deforestation is the root

cause of dry riverbeds and wells Without tree roots to hold and

store water, sediments are easily washed away by rainwater

leading to erosion Further, the eroded silt is accumulated on

riverbeds and flattens the cavity that stores water The resulting

phenomenon causes water to spreads thinly over a vast area of

land making it evaporate easily and quickly.

As part of a long term solution to help more effective recharge of

water sources, The Art of Living team has planted millions of local

trees including banyan, pipal, tamarind, Indian gooseberry, jamun

and neem along the catchment area Hardy and drought-resistant,

these endemic trees don’t require too much water.

Availability of water also leads to increased usage and

theby taking the situation back to square one Until the rate of

re-charge surpasses extraction, it is imperative that work be done

on a more efficient use of existing resources.

Ramaswami, a retired Army officer who now heads the

Sala-manthanam village in Tamil Nadu says, “Without rains for the

last 15 years, we had a crisis on our hand that was forcing our

farmers to work as labourers (outside the village) to earn a living

Today, thanks to The Art of Living’s initiative, the wells are full

of water and even if there are no rains we have plenty to last for

more than a year.”

The transformation in the villages that have benefited from

this project is quite remarkable Dayanand, a farmer from spur village in Karnataka says, “In the last eight years, there was

Kala-no water Farming was rain dependent So I had only one crop

a year Now, water is available throughout the year and I grow three crops a year My income was $30,000 to $40,000 back then but has now gone up to $ 3,00,000.”

Nagaraj Gangolli, Director for River Rejuvenation projects a have been working with farmers to adopt crop patterns that are not water intensive /help to improve water efficiency This has various moot points leading to financial sustainability of a farm-

er Hence the organization is working on effective methods that help farmers establish and connect to different marketplace even digitally that entices farmers to work as a commune These activities in and around the River Rejuvenation area have helped

to associate farmers for better Watershed

When the rains came in 2015 and 2016, after the structures were constructed, water started flowing into them “After 15 years their river was alive again Seeing the success of the reviv-

al effort, government support was assured,” says karan Kuppan, Tamil Nadu State Director for River Project The project is also empowering women in rural India under MNRE-

Chandrase-GA act scheme

The way ahead

The task ahead is more daunting as the magnitude of the work that needs to be done is huge to produce tangible results at the national scale The Art of Living River’s team way forward is to identify different Geo-hydrological and Agro-Climatic condi- tions across the entire nation, create relevant Proof of Concepts (PoCs), that demonstrate the applicability of Integrated Water Resource Management methods Data-marts created across its current areas of work and its PoCs areas would help derive a toolbox that will act as resource go-to for everyone from policy makers to water professionals, experts in the development sec- tor to government departments The advanced toolbox will offer easy access to practical information and guidance for better water management nationally and locally.

Kalyan Subramani is a Bangalore based author

Aiyar is a former Union minister and social commentator.

ILLUSTRATION BHASKARAN

Tribals constitute only eight per cent or so

of the Indian population, but their ful condition so preoccupied the found-ing fathers of our Constitution that the Fifth

dread-Schedule, consecrated to tribal governance and

welfare, is one of the longest in the Constitution

Tragically, the Fifth Schedule has in actual

implementation remained pretty much a dead

letter Rajiv Gandhi attempted to put some teeth

into it through his famous constitutional

amend-ment on panchayati raj That eventually emerged

as a constitutional directive to Parliament to

pre-pare the conformity legislation for the protection

and promotion of tribal interests, and not leave

this to the nine state assemblies concerned This

constitutionally-mandated

legislation was embodied in

Parliament’s Panchayats

(Ex-tension to Scheduled Areas)

Act, 1996 PESA was further

supplemented by UPA-1’s

Scheduled Tribes and Other

Traditional Forest Dwellers

(Recognition of Forest Rights)

Act, 2006 But, as detailed in a

2013 report on panchayati raj,

prepared by a

government-ap-pointed expert group under my

chairmanship, implementation

has fallen far short of

legisla-tive expectation Alas, as with

most such reports, ours, too, is gathering dust

in a corner of some distant cupboard of some

neglected ministry

The consequence of such gross governance

deficit is that most tribal areas have become

hotbeds of insurgency Although ruthless police

action has reduced the number of “red districts”,

the underlying problem bubbles in a cauldron of

tribal discontent Maoist cadres have infiltrated

their villages and secured the willing (or

unwill-ing) cooperation of the tribal people, adhering to

Chairman Mao’s principle that a guerrilla is like

a fish in water who needs the support of the

peo-ple he lives among to carry on the insurgency.The 2006 D Bandyopadhyay committee report, prepared under the aegis of the former Planning Commission, is perhaps the most instructive in this regard It focuses on the stark choice faced by tribals between being oppressed

by devious, highly corrupt, and exploitative agencies of the state government and the vicious violence inflicted randomly on them by the Naxalites/Maoists It is a Hobson’s choice, but one that usually favours the Naxals, because they

at least live among the tribals, while the officials

of the state governments are loathe to serve in remote tribal areas Further, the unholy nexus between dishonest officials and avaricious forest

contractors aggravates the acute absence of any sem-blance of good governance.This conundrum had been taken into account in drafting PESA, whose provisions, if sincerely implemented, would empower tribal people and their duly-elected leaders to implement their own agenda for development, while being held transparently account-able to their respective tribal grama sabhas This would have the back up of the Forest Dwellers Act that guarantees the right of tribals to not be displaced without their consent and not be exploited for the sake of someone else’s evil profits

That is the only way forward to end the ace of Naxalism It is to be hoped that national and regional parties will detail such an approach

men-in their respective manifestos as they sally forth

to garner the votes of the deeply distressed and much-deceived tribal voters, particularly in the Fifth Schedule states of the central Indian tribal belt, where tribal poll preferences might well de-cide the political prospects of the rival contend-ers for power

The tribal challenge

MARCH 31, 2019 • THE WEEK 37

H.D KUMARASWAMY: IT IS

WRONG TO SAY THAT COALITION

GOVERNMENTS ARE UNSTABLE

JIGNESH MEWANI: ONLY THE POST-PULWAMA SENTIMENT CAN SECURE A WIN FOR MODI

VICTORY MANTRA

The BJP hopes to

increase its tally in the

south by allying with the

AIADMK in Tamil Nadu

ALLY RALLYING

Parties look to firm up their alliances before the Lok Sabha elections

BY SONI MISHRA AND PRATUL SHARMA

Nearly a month ago, the Modi

government debuted a new

tag line—namumkin ab

mumkin hai (the

impossi-ble is now possiimpossi-ble) It was meant to

send out a positive message of the

work the government had done in

the past five years But the BJP felt it

needed a stronger slogan that could

catch the electorate’s attention and

add zing to its campaign

And so, within days of his return

from the US after undergoing

treat-ment for soft-tissue cancer, Finance

Minister Arun Jaitley chaired a

meet-ing of the BJP’s campaign committee

The panel brainstormed and came

up with another tag line—Modi hai

toh mumkin hai (with Modi, it is

possible) It was punchier, and more

importantly, centred on Modi, the

BJP’s face for the elections

The slogan came in handy as Indian Air Force jets pounded a suspected terrorist camp in Balakot, Pakistan, on February 26 Within hours of the attack, hoardings with the catchphrase and Modi’s picture sprung up in several states “This slo-gan proved to be apt,” said a member

of the campaign committee “It was coined to send a strong message to the people as they react differently

to Modi and see him as a powerful leader.”

And who better to hype the slogan than Modi himself?

Addressing election rallies in jasthan, Uttar Pradesh and Gujarat,

Ra-he used it to tell tRa-he people about how Pakistan had been taught a lesson with the air strikes He then

talked about the work done during his tenure These two themes—mus-cular nationalism and welfarism—are set to form the basis of the BJP’s poll campaign

The opposition, on the other hand, would want to stress on Modi’s ten-ure as a period of betrayal and un-kept promises This was clearly spelt out in the resolution adopted by the Congress Working Committee, which held its latest meeting in Gujarat—Modi’s backyard The Congress, in the resolution, criticised Modi for his

“unkept” promises on job creation and on solving the farm crisis

The party attacked Modi for his

“reckless decision” of tion and “hasty implementation of a flawed GST”, which it said disrupted the economy and destroyed millions

demonetisa-.

.