|16th Anniversary health care report: the ongoing medical disaster 2.12.2000|
|1984-2000>>>>>>||A comparison of the three main health care givers to the gas affected in Bhopal:|
|1. Department of Bhopal Gas Tragedy Relief and Rehabilitation|
|2. The Sambhavna Trust / Bhopal Peoples' Health and Documentation Clinic|
|3. The Bhopal Hospital Trust / The Bhopal Memorial Hospital Trust
|1. Department of Bhopal Gas Tragedy Relief and Rehabilitation||2. Sambhavna Trust / Bhopal Peoples' Health and Documentation Clinic||3. Bhopal Hospital Trust / Bhopal Memorial Hospital Trust|
|Established||1985||1995 / 1996||1992 / 1998|
|Resources||Grants from Union government||Individual donations and voluntary work contribution from India and other countries||Sale of Union Carbide's shares that were confiscated in the criminal case|
|Activities||Medical relief and research through the Centre for Rehabilitation Studies||Medical care, monitoring, research, community organization, health education||Medical treatment|
|Administration||Bureaucrats headed by Principal Secretary||Board of Trustees includes three individuals who have been involved in medical care of survivors from the time of the disaster||Board of Trustees, none of whom have had any involvement in medical care of survivors. At least two trustee posts remain vacant remains without representation of social workers|
|Total Expenditure||Approx 250 crores||Approx Rs. 49.36/- lakhs||Well over 100 crores|
|Staff||140 doctors and about four times as many para-medical and other staff||20 including 4 doctors||About 100 doctors and about four times as many para-medical and other staff|
|Population served||About 500,000||Over 10,000||Not available|
|Facilities||7 hospitals, 2 poly clinics, 5 civil dispensaries||1 clinic||1 hospital, 5 clinics|
|No. of Beneficiaries per day||About 4750 (gas victims and non-gas affected)||About 100||About 1000|
|No. of persons registered for care||Not available||9742||About 9000|
|Problem||Solution||1. Department of Bhopal Gas Tragedy Relief and Rehabilitation||2. Sambhavna Trust / Bhopal Peoples' Health and Documentation Clinic||3. Bhopal Hospital Trust / Bhopal Memorial Hospital Trust|
|Lack of information on the health status of the victims||- Epidemiological and clinical research
- Monitoring of health conditions of the gas victims undergoing treatment
|- Information gathered by the Centre for
Rehabilitation Studies (CRS), that was established with a corpus of Rs. 5 crores, is
ridiculous and laughable
- Absence of monitoring of health status of survivors undergoing treatment
|- Community based survery of health status and
health care in five severely affected communities with a population of over 10,000.
- Information on the health status of persons undergoing treatment are recorded and computerised on a regular basis.
|- Absence of epidemiological or clinical
research. No published information
- Absence of system to monitor the health status of the gas victims undergoing treatment
|lack of information on continuing exposure related mortality||Community based methods for monitoring ongoing
exposure related mortalit
Development of criteria to establish the nexus or its absence between exposure and subsequent death
|- Based on the 1998 report of the CRS, a total
2165 deaths in 1997 are attributable to gas exposure. There is no information on
mortalities in subsequent years.
- Scrutiny committee consisting of the Head of the Departments of Gandhi Medical College and District officials for monitoring exposure related deaths was dissolved in December 1992.
|- Successful implementation of the technique
of Verbal Autopsy since 1995 for monitoring exposure related mortality in the gas affected
- 86% of the deaths in gas affected communities found to be related to the gas disaster.
|Absence of system to monitor exposure related mortality|
|lack of information on treatment protocol of the gas induced illnesses||Developing appropriate treatment protocols for exposure related symptom complexes||Treatment protocol published by Indian Council of Medical Research (ICMR) is 11 years old. Scant attention has been paid in this publication to problems other than respiratory. More than 90% of the Government doctors are unaware of any such publication let alone be familiar with its contents.||Constant efforts being made towards developing
treatment protocols for specific symptom complexes
|No efforts in this direction|
|Indiscriminate use of harmful and unnecessary drugs in the treatment of gas victims||Ban on stocking and prescribing harmful and unnecessary drugs||- According to a joint study conducted by
Socially Active Medicos (Indore) and the Bhopal Group for Information and Action, Bhopal,
27% of the drugs used in government hospitals are either harmful or unnecessary and 13% of
the drugs are banned in other countries.
- A study conducted by International Medical Commission on Bhopal, highlighted indiscriminate use of steroids, antibiotics, psychotropic and symptomatic drugs in government hospitals.
|- 2.7% of drugs used in the clinic are
harmful/unnecessary. The mistake has since been corrected.
- Vetting of clinic's drug list by specialist in pharmacology.
|Delhi based Dr. Atanu Sarkar analysed the
drugs prescribed in the BMHT run clinics, and found that:
26% of drugs prescribed are harmful
49% are unnecessary and
8% are both harmful and unnecessary
|Harmful health effects of drugs used in the treatment of gas victims||Including the use of drug free therapies and therapies based on medicinal herbs in the medical treatment of the survivors||Absence of drug free therapies such as yoga,
Budgetary allocation for Ayurved and Unani system of treatment is only 1% of the total medical budget
|Successful treatment of gas-induced disorders, through Yoga and massage therapy. Treatment through Ayurvedic medicines and Panchakarma procedures||No arrangement of treatment through drug free therapies and medicinal herbs|
|Alarming rise in number of TB patients in the gas affected communities||Community based program for identification, prevention and treatment of TB||Investigation and treatment of TB is hospital based. No initiatives in health education, follow up and prevention of TB through community involvement||Successful development of a system to monitor, prevent and treat TB through community based health education involving voluntary participation from individuals in the gas affected communities. Decrease in number of non-complying patients through intensive follow up in the communities.||Hospital based diagnosis and treatment of TB is in a worse condition than government hospitals. Absence of community based programmes for identification prevention and treatment of and health education on TB|
|Absence of any scientific research on treatment of exposure-induced illness||Continuous scientific research on gas induced illnesses and their treatment||No scientific research on treatment of exposure-induced illnesses||- Scientific research on
effects of Pranayama and Yogasana on the gas related respiratory disorders.
- Scientific papers presented in national and international conferences
|Absence of scientific information of treatment of exposure-induced illnesses|
|Failure of treatment in providing sustained relief||Continuous monitoring of efficacy of treatment||No information on efficacy of therapeutic intervention||More than 75% of persons have reported more than 25% relief in their illness, on their fifth visit to the clinic||Absence of information on efficacy of treatment|
|Lack of proper attention and information on gas induced gynaecological disorders||Special attention to gathering information on gynaecological health problems, their investigation and treatment.||No research on gynaecological health consequences of the disaster in spite of a special hospital for women care. lack of essential facilities, equipment and specialists to deal with gynaecological problems||Ongoing scientific research on gas induced gynaecological health problems. Facilities for regular Pap's smear examination and other equipment available only at Sambhavna||Lack off information on gas induced gynaecological health problems. Lack of necessary equipment and specialists|
|Lack of proper attention and information on gas induced mental health problems||Special attention to gathering information on mental health problems and their treatment.||In spite of the ICMR reporting a high prevalence of mental illness in the survivors, no current reliable information on mental health problems. Just one psychiatrist in the entire system of health care||Regular visit by mental health specialist to treat problems such as panic disorders, depression, irritability, insomnia and others. Shirodhara technique of Panchakarma has been successfully employed to cure mental illnesses.||Lack of current information on gas induced mental illness and non availability of mental health care professionals|
|Patients dropping out of treatment||Counseling and monitoring of patients who drop out of treatment||Absence of facilities to monitor and counsel drop out patients||House visits made by community health workers to monitor and counsel drop out patients||Absence of facilities to monitor and counsel drop out patients|
|Information on health impacts of exposure, their prevention and treatment not available to gas victims||Community health education among the survivors||Leaving aside the health education of gas victims, the investigation reports of blood, sputum, urine and smear samples collected by ICMR in the course of their study involving more than 80,000 gas victims have not being given to concerned persons||With the help and cooperation of voluntary workers from gas affected communities, our health workers have been successfully conducting health education programs||No initiatives towards health education among survivors|
|Corruption and misuse of resources||Public scrutiny of income and expenditure of the institutions||The Comptroller and Auditor General's reports have charged the M.P. Government with mal-administration of funds in the relief and rehabilitation of gas victims||Yearly accounts of income and expenditure are displayed publicly every year and are publicly available||The matter of unauthorised withdrawal and expenditure of funds by the former trustee of the Bhopal Hospital Trust, Mr Ian Percival still pending in the Supreme Court. Rs. 5 Crores spent by Percival on office refurbishment, travel and other accounts. Evidence of corruption in the purchase of equipment for the hospital.|
|Lack of scientific consultation on gas induced illnesses and their treatment||Ensuring participation of specialist doctors and scientists in the treatment of gas victims||Absence of specialist consultants in the treatment of gas victims||National and international advisory groups give specialist advice. Three of the trustees have been and continue to be involved in the treatment of the gas victims since the disaster||Absence of specialist consultant. None of the trustees have any experience in the medical care of gas victims|
|Lack of medical information on gas induced illnesses and their treatment||Generation of scientific information on health impacts of the gas disaster||No efforts in this direction||Scientific and medical information collected by our documentation centre is publicly available||No efforts in this direction|
|Lack of information on health and health care in the gas affected communities||Dissemination of information on health impacts and preventive and ameliorative measures to the survivors||No system of issuing health books to the gas victims||A health book issued to every person registered for care at the clinic.||Initially the health books were issued to the persons taking treatment but these were taken back when severe irregularities regarding the treatment were brought to light through analysis of information in these health books. Presently no system for providing health books to patients.|
|Lack of equipment for diagnosis of exposure induced illnesses||Ensuring availability and utilisation of medical equipment||Equipment available but not being utilised||Several types of diagnostic equipment are not available||Equipment available but limited utilisation|