IMCB submission to the empowered
|1. Pattern of diseases amongst victims of Bhopal gas disaster
The existing complaints of the individuals are due to longterm affects of diseases due to gas exposure, and relate to the chronic stage of the persistent respiratory disease and possibly neurological and ophthalmic too. Although this leads to incapacity in many ways, there is rarely a need for hospitalisation. As far as we know, the respiratory disease almost certainly irreversible and not amenable directly to simple medication. The community clinic can provide the general chest care that people with chronic respiratory disease would benefit from - early treatment of infections with antibiotics (and perhaps short course of steroids) and prevention of others with say regular flu and pneumococcal vaccinations. A further role for these clinics would be the discouragement of expensive and potentially harmful treatments (especially longterm steroids and theophyllins) and investigation of the appropriate role of simple treatments such as inhaled bronchodilators, inhaled steroids and even respiratory rehabilitation.
3. Current provision of hospital beds in Bhopal
Total number of beds has substantially increased since 19994:
I. Pulmonary medicine centre - 30 beds
There is enough physical infra-structure without sufficient staff to cover or run them at full capacity. The total number of beds (well over 2100 now) in Bhopal per capita, if corrected for demographic composition of the population, is probably higher than Europe now. This is certainly much higher than the World Bank recommendations. Further expansion of the number of beds either in hospital or in primary/secondary care units, as in Bhopal Hospital Trust plans, is inappropriate and not required.
4. Development of community and primary care
Patients with common ailments should be seen at the community level and those needing more specialised care could then be treated at the less crowded hospitals. To create confidence amongst consumers and reduce dissatisfaction, hospital based doctors should provide outreach services on the community on rotational basis.
5. IMCB Model
The plan therefore recommends a bottom-up approach: development of the community care FIRST, before any further hospital care is developed.
6. Management of the proposed plan
We believe that a permanent representation of the above mentioned medical professionals and consumer groups on the empowered committee and future Boards and Trusts is essential for effective implementation of plans to meet the changing needs of the consumers.
The IMCB, with its multi-disciplinary nature proposes the establishment of a National Medical Commission on Bhopal, to oversee the successful implementation of the proposed plan. The Commission would comprise of government representatives, respected and independent medical professionals, with no vested interests and representatives of the consumers. The IMCB itself would also be represented, through a member, and be ready to advise where necessary
Dr. Sushma Acquilla