The Sambhavna Trust was set up as a registered charitable trust in June 1995 with the sole
objective of improving the health condition of the survivors of the Bhopal disaster.
Through the Bhopal Peoples' Health and Documentation Clinic situated close to the affected
communities, the Trust provides medical care, health education, and research and
monitoring facilities to the survivors free of charge. The clinic opened on September 1,
1996 and has registered nearlt 10,000 people to date, mostly from the severely affected
- To provide appropriate medical care through modern medicine as well as Ayurveda, Yoga
and other alternative therapies.
- To generate information on the health consequences of gas exposure and to educate
survivors on preventive and curative measures.
- To carry out medical research that addresses current and projected medical needs.
- To function as a repository of medical and other information on the Bhopal gas disaster
and make such information accessible to all.
- To relate the medical and other activities of the government and other agencies with
reference to survivors.
- To support and conduct seminars, conferences, research, training programmes and other
educational and academic events towards the welfare of survivors.
The seven member Board of Trustees that administers Sambhavna consists of doctors,
scientists, writers and social workers who have been involved with various aspects of the
disaster since its occurrence. Several members of the board have received national and
international recognition for their scientific and social contributions. Except the
Managing Trustee who is paid a monthly honorarium of Rs. 4500/-, all trustees work on a
voluntary basis and meet three to four times in a year. Decisions are made through a
consensus among the members of the Board.
We have a five member International Advisory Group made up of professionals from Italy,
the UK and the USA who have provided longterm support to the cause of the Bhopal
survivors. The volunteer-based Bhopal Medical Appeal-UK generates awareness and support
for the clinic through publicity campaigns. A 14 member panel of medical advisors from
Canada, South Africa, Sweden, the UK and the USA provides valuable technical support as
Among the 20 staff members at Sambhavna: nine are survivors of the disaster; 17 are
employed fulltime; eight are women; nine are under 30 and four are over 40. Four are
qualified in medicine, two of whom are specialists. Five people are post graduates, four
are graduates and seven are educated to school level. We are paid favourably in comparison
to other local non-government institutions and a ratio of 1:4 is adhered to in determining
minimum and maximum salaries. Most if not all, decisions regarding the day-to-day and
longterm work of the clinic are taken by consensus at the weekly meeting of the fulltime
staff members. The job of coordinator is chosen (by drawing lots) every two months from
among the staff members.
The Sambhavna Trust collects its funds mainly through small donations from a large number
of individuals. Appeals for funds are publicised through newspapers in India and abroad.
The Pesticides Action Network - UK (formerly The Pesticides Action Network) collects
donations on the Sambhavna Trust's behalf and tranfers them to the account of Sambhavna
Trust after obtaining the required permission from the Ministry of Home Affairs. The
Trust has so fas received Rs. 3.6 lakhs approx. through individual donations in India and
a total of 40.66 lakhs approx. have been transferred from PAN-UK. In the last four years
well over 6000 individuals have sent donations towards the running of the Bhopal Peoples'
Health and Documentation Clinic.
The clinic runs on a very tight budget requiring judicious attention to all expenditures.
The Trust has incurred a total expenditure of Rs. 49.30 lakhs approx, an annual average of
Rs. 12.36 lakhs or Rs. 1.03 lakhs in an average month. The bulk of expenditure has been on
payment of salaries, purchase of medicines, equipment and the clinic building. Audited
accounts of income and expenditures of the Trust are publicly available and displayed
We believe that medical care should be based on the principle of "First do no
harm" and that therapy should not compound the injuries sustained as a result of
exposure. Development of integrated systems of therapy based on the specific symptom
complexes presented by survivors (as opposed to attention to individual symptoms) is
ongoing. We have also developed our own system of registration to confirm and record
history of exposure as well as monitoring the health status of individual patients which
we believe to be essential. We are active in five main areas:
- Community health work
- Research and monitoring
- Seminars and training
At Sambhavna we offer both Allopathic and Ayurvedic systems of medicine. We also give
Yoga instruction. We have a fully equipped pathology laboratory and we prepare and
distribute many of our own medicines.
- Allopathic care
Allopathic care at the clinic distinguishes itself in its attention to development of
treatment protocols for specific symptom complexes, weeding out unnecessary and harmful
drugs and including Ayurveda and Yoga in the overall treatment regime. We have general
medicine, gynaecological care and mental health care units.
- Ayurvedic care
Ayurvedic health care at our clinic includes the use of medicines described in the
standard Ayurvedic texts rather than factory-manufactured drugs; predominant use of herbal
drugs over mineral preparations and use of modern investigative facilities and tools for
objective assessment. We have two units of Ayurvedic care: general medicine and
We use Yoga at Sambhavna to treat several chronic diseases suffered by the gas exposed
including those of the respiratory, musculo-skeletal, neurological and endocrine systems.
More than half the people doing Yoga for exposure-induced respiratory disorders at the
clinic have been able to discontinue medication they have been dependent on for over 10
- Pathology laboratory
Routine, microscopic and bio-chemical tests for blood, urine, sputum, and vaginal and
cervical smears are carried out in house. In addition, samples are collected and sent to
the medical college or private laboratories for more specific tests.
- Preparation and distribution of medicines
We make 64 Ayurvedic medicines using locally collected or purchased herbs. Single herb and
herbal mixture powders, decoctions, oils, tablets and poultices are all prepared on the
premises. In dispensing medicines the utmost care is taken to ensure that people are well
informed about their prescriptions.
Community health work
Our approach to community health consists of empowering the community and its individuals
to take control of their own health. Our four community health workers are the only ones
of their kind in all Bhopal.
- Health and health care surveys
We have carried out door-to-door surveys of five communities with a total population of
about 10,000 in order to generate a database on the demography, health and health care
status as well as the social, economic and environmental condition of the residents. While
outlining priorities these surveys have also been a means of making contacts in the
community and building local health committees. Our health workers also identify people in
need of special medical attention and ensure that this is made available either at
Sambhavna or elsewhere.
- TB care and health education
Despite official knowledge regarding the unusually high prevalence of TB in the survivor
population (over three times the national average) there are no official initiatives in
this direction. Our work in TB care consists mainly of education, identifying those with
symptoms of TB, having their tests done and, where required, ensuring medicine
availability. We also follow up to ensure compliance with dosage. Much of this work is
shared by "patient leaders", former TB patients who provide much effective
inspiration in the community.
- Monitoring and house visits
We evaluate the quality of our care and patient satisfaction in order to find out the
efficacy of treatment and to ensure compliance of treatment regimes by visiting a random
sample who have dropped out of care at Sambhavna. Our health workers find out the reasons
for dropping out, whether the person found relief of their symptoms and whether he/she is
receiving treatment elsewhere. People thought to be in need of continued care are
encouraged to revisit the clinic.
Research and monitoring
The government stopped monitoring exposure-related mortality in 1992. We have picked up
this activity by employing a technique called Verbal Autopsy - a scientific method of
proven validity used for establishing the cause of death of individuals in a community.
Other research projects include an assessment of drug distribution in gas affected Bhopal
and the effects of Yoga therapy on chronic respiratory disorders related to the disaster.
Much of the information on the disaster and its aftermath is lost, unavailable or
classified. Of the information that is actually available, a large part remains within a
tight-knit circle of bureaucrats, scientists, medical researchers and academics.
Government efforts to collect and distribute this information are absent and
non-government initiatives towards documentation of the continuing disaster are rare. We
collect, collate, and distribute medical and other information related to the disaster.
Quite possibly this is the only public repository of its kind.
Seminars and training
We have organised several seminars involving local, national and international medical
professionals, scientists, environmentalists and survivors' organizations. We have also
participated in various local and national seminars. Our research paper "Effects of
yoga practices for respiratory disorders related to the Union Carbide gas disaster in
1984" was presented at the XVI World congress of Asthma in October 17-20, 1999.
Our vision for
The medical situation in Bhopal is likely to remain an issue of serious concern for at
least the next 30 to 50 years. An estimated 35,000 children exposed in utero or
conceived by exposed parents in the three years following the disaster are likely to
require special medical attention all their life. Late manifesting cancers also call for
longterm health surveillance and treatment facilities. Chromosomal aberrations, observed
in an unusually large number of those exposed, warrant that health surveillance of the
exposed population is carried out at least for two generations.
Over four years of work have produced encouraging results and given us
some degree of confidence regarding our role and relevance. They have also instilled the
courage to dream and plan for the future of the clinic. For the next five years these
consist mainly of upgrading and expanding facilities (medical care, diagnostic equipment,
the pathology laboratory and medicine manufacture), creating new services and becoming
further involved with the affected communities. The increasing patient-load on the doctors
calls for the appointment of at least two additional physicians/specialists and
corresponding increase in space and para-medical personnel.
The results of our community health work have been most encouraging,
particularly in terms of involving more and more people. There is a strong possibility of
building on this to create a community-based network for monitoring activities. We have
collected information from different parts of the world on the development of health
surveillance techniques that are implemented by lay members of the community. It is
possible to train survivors in Bhopal in such techniques as 'lay epidemiology' and 'verbal
autopsy' and in using simple equipment for water/air quality monitoring so that a
community can be self sufficient in longterm monitoring of its health and that of its
- That the disaster in Bhopal is not an isolated event. Workers and communities are
routinely poisoned all over the world.
- The reduction and eventual elimination of hazardous chemicals from the planet and our
daily lives is the only solution to the growing number of slow and silent Bhopals in our
- Until that happens, the safety of our health and lives depends on watchful monitoring,
strict enforcement of regulations and exemplary punishment to offending agencies. In this
respect, ensuring justice in Bhopal can be seen as a public health initiative with
potential for significant and widespread change.
- The limits of modern medicine in taking care of modern industrial diseases are becoming
increasingly apparent. Evolution of an appropriate system of health care, monitoring and
research for survivors of Bhopal is of consequence to all people worldwide.
- It is possible to combine traditional and western systems of health care to provide
sustained relief to the chronically ill survivors of Bhopal.
- It is possible for an individual to be an active participant in the process of healing
and the community to be involved in all aspects of public health.
- It is possible to evolve systems of health surveillance and environmental monitoring
through active participation of the community of survivors. Our work in documenting
longterm consequences of exposure is part of the survivors' ongoing struggle of memory
- It is possible to depend upon the compassion of ordinary individuals and generate enough
funds to run our clinic without the help of corporate charities, big business, large
grants from foundations or government assistance.
- It is possible to generate opportunities for hope through creative and collective
intervention in a situation of despair.
We welcome everyone to visit Sambhavna and find out more about the ongoing medical
disaster in Bhopal and our efforts towards caring for survivors. We have a steady stream
of volunteers both from home and abroad who have contributed their time and skills to
If you would like to contribute financially you can send a cheque in rupees directly to
the clinic (if you are in India). If you outside of India then please send a cheque or
postal order to the Pesticides Action Network office closest to you:
|Pesticide Action Network UK (PAN-UK) / Bhopal Account
||Pesticide Action Network North America (PANNA) / Bhopal Account
||49 Powell Street, 5th Floor
|49 Effra Road
|London SW2 1BZ UK
||CA 94102 USA
|Tel : +44-(020)-7274-8895
published by the Sambhavna Trust 2.12.2000
(online and in print available in Hindi/English at the clinic)
People's Health and Documentation Clinic
Kanwar Ram Nagar
730914 Email: email@example.com