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Times of India: 4/1/2000

Bhopal's Tragedy

Gas Victims' Wounds Have Never Healed

By SAMEERA KHAN

Fifteen years after the people of Bhopal were woken up in their sleep by a cloud of lethal gas, author Milan Kundera's words find echo in the streets: 'The struggle of man against power is the struggle of memory against forgetting.'

For the 200,000 odd survivors of India's worst chemical industry disaster, forgetting is hardly an option.

The memory of December 2-3, 1984, when over 40 tonnes of methyl isocynate (MIC) gas leaked out from the Union Carbide factory is still quite alive.

"The tragedy has not left us even for a day," says Akhtari Khatoon, 40, who along with her seven-member family fled JP Nagar, one of the main gas-affected areas, that cold December night. "Every time I cough, my chest hurts and joints ache, or my eves find it difficult to focus clearly. I know the gas lives. It lives inside me."

Silent Sufferers

Since the tragedy, more than 16,000 people have died due to gas related causes. The deaths continue and at least one-fourth of the surviving population, spread over 36 gas-affected wards of Bhopal, continues to suffer acutely from chemical-induced illnesses.

Time has not healed wounds, in fact, it has aggravated them. The Indian Council of Medical Research (ICMR), which carried out 25 research studies among survivors from 1985 to 1994, found that people with exposure- related symptoms actually increased over the years.

ICMR studies established that the toxins from the gas have crossed into the bloodstream of those exposed and caused damage to the lungs, brain, kidneys, muscles as well as gastrointestinal, reproductive, immunological and other systems. Even today, breathlessness, diminished vision, loss of appetite, menstrual irregularities, persistent cough, joint pains, fatigue, anxiety and depression are the most routine symptoms. The prevalence of pulmonary tuberculosis among the gas-affected is more than three times that of the national average. Bronchial asthma, chronic obstructive pulmonary disease, and earlyage cataracts are increasingly common.

Unfortunately, even as many thousands continue to suffer acutely from a host of exposure-related illnesses and their complications - an average of 4,000 such people visit hospital OPD’s daily in Bhopal – with the premature termination of research, there is an abysmal lack of data on newer ailments now showing up. Doctors involved with survivor care report an increase in neurological and musculo-skeletal disorders. Children born of mothers exposed to the toxic gases are also showing signs of delayed motor and language development. Women are suffering early menopause and many will tell you of their daughters, who were exposed in infancy, having delayed, chaotic, and painful menstrual cycles on attaining puberty.

There is an urgent need to resume long-term studies among the affected population. Since ICMR studies were winded up in 1994, no worthwhile health monitoring is taking place. Even the 1994 International Medical Commission on Bhopal, comprising 14 medical specialists from 11 different countries, had stressed the need for continued monitoring of reproductive effects, cancers, and other adverse outcomes which may have a long latency period. Though the Madhya Pradesh government insists that the Centre for Rehabilitation Studies has now undertaken the job, their preliminary studies ignore gynaecological, neurological and children's health problems.

The urgency to monitor is even more since post-gas leak chromosomal and cytogenetic studies among survivors have presented evidence of chromosomal aberrations of gaps and breaks in the chromosomal material as well as increased sister-chromatid exchange indicating the likelihood of congenital abnormalities among future generations of the exposed persons.

Good Business

At the same time, there's a necessity to review the treatment offered and therapy prescribed. "Much of the treatment to date is symptomatic. Irrational drug usage compounds the injuries caused by the chemicals," says Satinath Sarangi, coordinator of the Bhopal-based Sambhavna Trust, which offers free medical care to gas survivors. "No protocols for treatment of exposure-induced illnesses have been developed and the medical treatment of chronic problems of the survivors remains essentially the same as it was on the morning of the disaster."

Quacks and private practitioners do good business. Indiscriminately prescribing analgesics, antibiotics, steroids and psychotropic drugs. The expense of this medical roundabout is largely borne by survivors who by now have gathered piles of drug prescriptions. For their lifetime of ill health, each victim has got about Rs 25,000 as compensation for personal injuries. In most cases, that money has run out.

The government's primary response to the tragedy has been to build more hospitals, so much so that Bhopal now has more per capita hospital beds than is recommended by the World Health Organisation.

Official responsibility for medical care in Bhopal is shared between the central government, which provides 75 per cent of the finance, and the state government which is supposed to implement the healthcare programmes. Since the disaster, more than Rs 150 crore have been spent from the public exchequer on the provision of medical care to the survivors. The major emphasis of the MP government has been hospital building. Since the gas tragedy, it has set up five hospitals and seven dispensaries. Another super- speciality hospital, Kamla Nehru Hospital, constructed at a cost of Rs 20 crore and lying abandoned for about four years, will be inaugurated later this month. Still another controversial 500-bed hospital is being built by the Bhopal Hospital Trust and funded by money generated by Union Carbide Corporation from its sale of shares in Union Carbide India Limited.

A Patient's View

Unfortunately, according to health researchers, hospitals and nursing homes are being added to Bhopal when the real need is for community-based medical care for chronically ill survivors. They also indicate the need for simple devices like smokeless stoves for survivors with respiratory ailments.

Such needs are dismissed by the Government, and even alternative therapies showing positive results are ignored. For example, research carried out at the Sambhavna clinic has yielded encouraging data regarding the benefits of yoga asanas and pranayama in the treatment of chronic exposure related respiratory disorders. Spirometry and other objective tests of individuals prior to and after yoga practice, for different durations, show sustained and significant improvement of pulmonary functions with yoga care. More amazing is the way burkhaclad women have taken to yoga despite the initial hesitation of it being culturally alien to them. As Rukhaiya Bano, 45, a patient at the clinic says, "It provides me great relief and that's what matters in the end."

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