Medical Research carried out by the Sambhavna Clinic


The disaster in Bhopal created a situation in which a huge population has been and will continue to be on constant medication. The paucity of information on the health impact of the leaked chemicals and the absence of appropriate treatment protocols has led doctors in Bhopal to indiscriminately prescribe drugs without any scientific basis. The large scale use of drugs with significant potential toxicities has undoubtedly compunded exposure-induced injuries in many cases.

One of the aims of the Sambhavna Trust is to contribute to the welfare of the survivors of the Bhopal gas disaster through research and information dissemination. The Trust carries out medical research that addresses the current and projected medical needs of the survivors and functions as a repository of medical and other information on the disaster which is accessible to the survivors and the general public. The Trust also relates the medical relief and research activities of the government and other agencies with reference to the survivors of the Bhopal gas disaster.

The Sambhavna Clinic publishes research and reports on its own activities in the its annual reports and other publications. These can be obtained directly from the clinic (please email/write to us) or from the:

Pesticide Action Network UK / Bhopal Account Pesticide Action Network North America / Bhopal Account
Eurolink Centre 49 Powell Street, 5th Floor
49 Effra Road San Francisco
London SW2 1BZ CA 94102
UK USA
Tel : +44-(020)-7274-8895 Tel: +1-415-981-1771
Email : admin@pan-uk.org Email: panna@panna.org
www.pan-uk.org www.panna.org
You can also make a donation to the clinic through these addresses.

The Bhopal Hospital Trust - A brief background

In October 1991, the Supreme Court of India, in its final judgement on the case against Union Carbide revoked the criminal immunity that had been granted to the corporation and directed that it finance the construction of a 500-bed hospital for the medical care of the survivors.

The Bhopal Hospital Trust (BHT) was set up in 1992 by Union Carbide in response to a warning from the Bhopal District Court. This warning stated that if the company repeatedly ignored summons to appear in court then the shares the multinational held in its Indian subsidiary would be attached. Union Carbide put just one thousand pounds into the Trust Fund and for the rest of the Trust's assets pledged its shares in the Indian subsidiary.

This scheme was foreseen and categorically forbidden by the Bhopal District Court who maintained that the money for the fund should come from the company's own coffers and that the shares of the Indian subsidiary would remain attached until the accused appeared in court. However, in December 1993, Sir Ian Percival (the sole trustee and former Solicitor General to Margaret Thatcher) used the Supreme Court order to defeat the District Court sanctions and argued that the criminal charges against Union Carbide and its officials be dropped so that its share price would not fall. Eventually, in February 1994, Sir Ian was granted permission to sell the attached shares so that the BHT could build its hospital in Bhopal. (Sir Ian died in April 1998 and left behind financial accounts of the BHT showing that he spent US $2.5 million on travel, refurbishing his London office and other expenses).

With the corporation's history of callous disregard for the medical situation in Bhopal, there are good rasons to suspect that the welfare of the survivors is not exactly a priority for its medical initiatives. The BHT's plans have been severely criticised   by national and international groups including the International Medical Commission on Bhopal.

Survivor's organisations in Bhopal have sent letters of protest pointing out that Bhopal already has far too many hospitals - possibly more beds per thousand of the population than anywhere else in the world. Also that in the absence of any information-based treatment protocol being offered, the Trust's hospital will be just one more building, pleasant to look at but ineffective. They have charged that the sole purpose of the BHT is to build a humane image for the corporation while helping it to abscond criminal justice on the massacre.

As well as the BHT hospital, the Trust has opened five community clinics to date (of a total of 10 planned). The Sambhavna Trust as part of its ongoing research collected a sample of prescriptions given to survivors at these clinics. The results follow.


A Brief note on prescriptions collected from Bhopal Hospital Trust (BHT) 17th - 19th July 2000

By: Dr Atanu Sarkar
MBBS, Master in Community Health (JNU-New Delhi), Doctoral Fellow (JNU-New Delhi)

Program Officer, The Catholic Health Association of India (CHAI)

  • Coordinator of the project on Medical Care and Medical Research of Bhopal gas victims sponsored by CHAI.

The Hospital and the five clinics run by Bhopal Hospital Trust were built in order to provide long awaited quality medical care to the gas victims. The wide publicity around the BHT hospital and clinic created hope and expectation among the gas victims who had been denied basic medi-care since the disaster in 1984.

The prescriptions were collected by Sambhavna clinic field workers during their visit in 1998-99 and made photocopied for documentation.

The present study is based on the photocopy of the prescriptions collected from patients undergoing treatment at BHT, by Sambhavna Trust, Bhopal. Dr.Rajiv Bhatia of the International Medical Commission on Bhopal (IMCB) analysed the same prescriptions and presented the following facts.

  1. Proportion of visits where health workers and BHT recorded the specified symptoms and symptom categories.
  2. Co-relations between the symptoms recorded on the health workers interview and symptoms written on the physicians prescriptions (first recorded visit).
  3. Frequency of prescriptions for the most common classes of drugs for all recorded visits.
  4. Odd ratios for prescriptions of drugs in category for selected symptoms.

The present study has looked in to:
1) nature of reported clinical examinations
2) appropriateness of drug prescribed
3) nature of dosage of appropriate drugs prescribed.

The prescriptions were collected by the Sambhavna Trust, Bhopal. The Trust collected the prescriptions of 400 individuals. A total of 101 prescriptions of patients were selected for study and the total 380 visits have been checked. Analyses are broadly divided into three tables. Although the sample size was small compared with gas affected population; it gives clear idea about general trend and a guide for further courses of action.

Table-1 illustrates the signs and symptoms mentioned in the prescriptions. There are several prescriptions that do not have any mention of symptoms (patient's descriptions of his/her suffering/s), or with just one or two words (like 'pain' without any mention of its location or intensity and 'cough' without any mention of whether it was dry or productive) or little descriptions of signs (doctor’s observation/s like – pulse rate or blood pressure only) and very few proper descriptions on signs and symptoms. Proper descriptions are very important for follow-up and also for other physicians who may see the patients. Treatment of patients is based on these kinds of improper examinations. In Table-1, 380 visits are divided into three columns:
1) either no description of symptoms or just a few words
2) mixed i.e. descriptions of symptoms in few words along with description of signs in few words
3) proper description of sign and symptoms.

 

Table1:

No description of symptoms or just few words Mixed i.e. descriptions of symptoms in few words along with description of signs in few words Proper description of sign and symptoms at least to diagnose the disease
252

(66.3%)

63

(16.6%)

65

(17.1%)

Total 380 visits

Table 2 illustrates the extent of irrational therapy. There are several prescriptions where drugs have been prescribed without any justification (according to any standard pharmacology text) and may harm the human body, like Corex cough suppressants containing opium derivative, alprazolam as anxiolytic, benzodiazepine as anxiolytic, or combination of Corex and alprazolam, or single drug anti TB therapy, overdose of anti- helminthic and so on. Combination of Corex and anxiolytic may have a serious effect on the brain resulting in disorientation and drowsiness etc. Overdosing on anti-helminthic may cause abdominal discomfort. A single TB dose results in resistant bacteria. There are several prescriptions where drugs have been prescribed which has no or little therapeutic value. For example, multi vitamin capsules/tabs for few days (without mentioning symptoms/signs of specific vitamin deficiency), iron capsules for few days, unnecessary antimicrobial (just for symptoms of common cold, pain in the abdomen and so on) below the minimum recommended dose according to age and body weight of the patients and may result resistance of bacteria against antibiotics, combination of antacid and H2-receptor blocker (ranitidine or famotidine) for just abdominal pain (abdominal pain might be due to any cause. A combination will not give any extra benefit - it is just unnecessary expenditure) and so on. There are some prescriptions where both harmful and useless drugs are prescribed. It is worth noting that the aforementioned categories of prescriptions do not necessarily contain only harmful, useless or both kinds of drugs. These may or may not be associated with the appropriate selection of drug/s. There are very few prescriptions where neither harmful nor useless drugs have been prescribed.

Table 2:

Harmful (may or may not be associated with proper selection of drug/s) Useless (may or may not be associated with proper selection of drug/s) Both harmful & useless (may or may not be associated with proper selection of drug/s) Neither harmful nor useless (proper selection of drug/s)
100

(26.3%)

184

(48.5%)

29

(7.6%)

67

(17.6%)

Total 380 visits

Table 3 illustrates the prescribed dose of properly selected drugs. There are a number of prescriptions where the right drugs are prescribed but in the wrong dose, i.e. frequency of intake per day, duration of course and strength of each intake.

Table3:

Improper dose Proper dose
92

(45.3%)

111

(54.7%)

Total 203 visits

Note:

  • There are 2 cases where anti TB drugs are prescribed without investigation and where doses did not follow any WHO or Govt. guidelines. There are 2 TB cases where proper investigations and treatment protocols have been followed.
  • There are 22 visits where alprazolam and 1 visit where benzodiazepine were prescribed with out any justification.
  • There are several prescriptions where concerned doctors wrote "No sensitivity to any drugs", perhaps to save themselves from any probable legal suit from patient/s. Doctors are not willing to pay more attention to examining patients, writing signs and symptoms in the prescription sheet - they do show concern in avoiding possible legal action on account of drug reaction.

Conclusion: The brief analyses of prescriptions collected from BHT have revealed that the concerned doctors are not careful about clinical examination and recording. In most cases harmful and useless drugs had been prescribed. Moreover, nearly half of the rightly chosen drugs were not given following the proper dosage schedule. This study throws light on the effects of the knowledge and attitude of doctors and the hospital authority. It is necessary to trace back to the doctor’s level (attitude and practice) and authority level to corroborate these findings.