High use of addictive, doubtful drugs at Carbide hospital, says studyCentral Chronicle, March 5th, 2000 (Sunday)
BHOPAL: Following a damning expose by a renowned US-based Indian doctor on its treatment methods, the Union Carbide-funded Bhopal Hospital Trust (BHT) has confiscated the health books issued to the Gas Tragedy patients at its dispensaries.
The study has punched some gaping holes in the treatment protocol, expressing concern over the prescription of an opium derivative (brand name Corex) over a prolonged period, extending to ten months in some cases, which is long enough to get the patients addicted to the expectorant. Also called prescription audit, the detailed analysis of the drugs prescribed to patients at the Trust-run dispensaries has revealed a complete absence of information-based treatment protocol.
A total of 474 prescriptions from 152 gas survivor households were examined in detail by Dr. Rajiv Bhatia, Medical Director, Occupational and Environmental Health, San Francisco, who was on the 15-member International Medical Commission on Bhopal. The panel had doctors from 11 countries. His report revealed some disturbing trends in the treatment process adopted at the Trust dispensaries, like near-total neglect of the most elementary medical examinations for debilitating respiratory diseases like asthma and tuberculosis (TB) which afflict a very high percentage of survivors.
Of the 474 survivors who were surveyed, hardly five per cent reported pulse examination, only 0.6 % had their abdomen palpated and barely 4.4 % were examined with a stethoscope. The prescription audit highlighted that symptomatic treatment was being dispensed at these centres. A dangerous fallout of this line of treatment is prescription of psychologically and physiologically addictive opium derivative as an expectorant for a long time at a stretch. A standard book on pharmacology by Goodman and Gillman describes the expectorant as of `doubtful efficacy that only suppresses the symptoms.
The Government guidelines stipulate a sputum test for TB in case of constant cough for three weeks. A female patient was given the expectorant at the Trust dispensary in Kainchi Chhola locality for ten months before a TB test was prescribed to her. The study also reports uncommonly high prescription of high potency systemic corticosteroids. The director general of BHT hospitals, Dr. DS Vaish, argues that the health books were not confiscated but `withdrawn for safekeeping. "The patients had been losing them," he says. He says that books were deposited at the hospital. The patients were issued identity cards with registration numbers instead so that their books could be fetched any time to chronicle their treatment.
The safekeeping poses another problem. The apex hospital of the Trust on Karod bypass road, is not yet functional. The three Trust dispensaries in gas survivors localities often refer patients to Government hospitals like Hamidia. Their health books, containing detailed medical of ailments and treatment, are not in their possession. If one of them were to receive treatment for an acute medical condition at another establishment, his life could be endangered in the absence of medical records that lie at the Trust dispensary he visits.
Only 3 of 10 dispensaries in place
Often mocked at as a public relations exercise by Union Carbide, the progress of Trust hospitals imposing edifice is as painfully slow as that of some of the Government concrete monoliths for survivors treatment. It was scaled down from the original 500-bed hospital as directed by the Supreme Court (in 1991) to a 260-bed facility, with a plan for ten community-based health centres in survivors localities. Only three of the ten dispensaries have come up so far. There too, patients are not admitted but referred to Government hospitals treating Gas Tragedy victims in case of acute medical conditions. Some of the victims reported to the surveyors of Dr. Bhatias study that they were not given free medicines as promised. They also reported that the dispensaries only catered to victims from their immediate vicinity, refusing to treat survivors from other localities.