2. The Sambhavna Trust & the Bhopal
People's Health and Documentation Clinic

About us
The Sambhavna Trust was formed in 1995 to support the victim's ongoing struggle for survival and justice. Through the Bhopal Peoples Health and Documentation Clinic situated close to the severely affected communities, the Trust offers medical care, monitoring and research facilities to the survivors free of cost. Six trustees of Sambhavna are individuals who have been involved with medical, scientific, legal and political aspects of the disaster for the last several years. Funds required for running the clinic are raised through contributions from school children, workers, lecturers, artists and other individuals from different parts of the world. Advertisements through newspapers are the principal means for raising awareness about the disaster and funds for the clinic.

Medicine in Bhopal
The clinic with sixteen staff members offers medical care through modern medicine, ayurveda, yoga and massage therapy. In the last two years over seven thousand chronically ill survivors have received care at the clinic. Due to the absence of medical information about Union Carbide’s gases, withheld by the corporation, doctors in Bhopal stick to symptomatic treatment with indiscriminate prescription of analgesics, antibiotics, steroids, psychotropic and other drugs that carry potential risks. Evidence that iatrogenic injuries so caused have compounded the exposure induced injuries of the victims, are plentiful.

A market research study carried out by the clinic shows that multinational pharmaceutical companies that hold control over majority of the drug market in gas affected Bhopal have benefitted the most from the disaster. Included in the top dozen multinational corporations that control nearly 40% of the market is Rhone Poulenc, the company that purchased the Agricultural Products Division of Union Carbide, of which the Bhopal plant was a part, after the disaster. Indeed there are a number of companies producing toxic chemicals that also produce pharmaceuticals giving an ironical twist to the meaning of market creation.

The work place and environmental risks involved in the manufacture of modern pharmaceuticals and the power of pharmaceutical corporations over government officials/ health professionals indicates the need for development of non-violent healing practices.

This is of particular significance in case of modern industrial diseases such as multiple chemical sensitivity and others related to neurological, immunological or reproductive functions in which modern medicine has very little of substance to offer.

Sambhavna means 'possibility'
At the clinic we use the first-do-no-harm principle in the use of modern medicines. Where required a person is asked to undergo simultaneous yoga or massage therapy or take ayurvedic medicines along with modern drugs. We do not buy medicines from multinational companies but from LOCOST, Baroda a non-profit organization that produces generic drugs at much lower costs.

The emphasis on ayurveda and yoga at the clinic stem from general concerns regarding modern medicine as well as the particular situation in Bhopal where a large population has been on almost constant medication for the last fourteen years without sustained relief in symptoms. Diagnostic and therapeutic procedures mentioned in classical ayurvedic texts are followed with additional use of pathological tests and objective methods of assessment. We avoid purchasing ayurvedic medicines from large companies that have many of the unethical practices common with those producing modern drugs. Twenty-five ayurvedic medicines are manufactured at the clinic with herbs collected or purchased locally.

We have devised a system of registration and medical record keeping suitable for monitoring health condition and efficacy of treatment for chronically ill persons. Persons are issued health books and medical data of individuals are computerized using epiinfo software.

Community health
Community health work that includes health education, follow up of persons taking care at the clinic, identification of persons in need of medical attention and generation of data relating to health and health care in the community, forms an important part of the work of the clinic. We are working towards setting up community based medical units run by adequately trained persons from within the community.

Community health workers are also involved in the use and development of the method of Verbal Autopsy for monitoring exposure related deaths in the long aftermath of the disaster. The method used mostly to ascertain efficacy of public health interventions is based on the assumption that most deaths are associated with specific symptoms or symptom complexes that can be recognized, remembered and reported by lay persons. In this, information about the symptoms suffered by the deceased in different periods following the disaster are taken from the care giver of the deceased along with medical records of the deceased wherever available. These are then sent to a panel of three physicians who independently give their opinion on the probable cause of death and on its reliability to exposure. The final opinion on the probable cause of death is given by the clinic to the family of the deceased, depending upon the degree of agreement among the three independent opinions. In the absence of official monitoring and certification, this opinion is the only document available to families of the deceased to substantiate their claims for compensation. We believe that this can be an effective method for recording and establishing cases of corporate homicide at the workplace or in communities.

Research efforts
Research carried out the 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. As part of our exercise in monitoring the prevailing health care situation, we have recently collected 400 prescriptions along with relevant information from persons registered at the community unit no. 1 set up by the Bhopal Hospital Trust. Preliminary analysis of the data shows that nearly 40 % of the persons taking treatment have been given a cough suppressant with the brand name Corex with an average of 2.1 times per person. This brand containing Codeine phosphate is of doubtful therapeutic value potentially causing physical and psychological dependence. In the situation of high prevalence of pulmonary tuberculosis, emphysema, and corpulmonale in the severely affected community where the BHT Clinic is situated, the rampant use of this drug is fraught with grave risks.