BHOPAL GAS TRAGEDY

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Title
BHOPAL GAS TRAGEDY
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MEDICO FRIENDS CI 1CLE QUESTIONNMRE^PROFORMA

17

25 MARCH,

1985 .. BHOPAL

SECTION I ° INFORMATION REGA.WIHG HOUSEHOLD

1 o

House Number

2. Area/Basti
3o Head of household
4. Religion

s

5. Type of cooking fuel used?

(tick whatever is used)

i) Firewood

(v) Kerosene

ii) Cowdung cake

(vi) LPG Gas

iii) Saw-dust

(vii)- Other
(specify)

• <» -

o

iv) Coal

6 o

o

Composition of family:

(start with household head - Do not
include members who are dead or
missing since Gas leak)

Sex

Age

N ame

NOo

t

i

1.
2 o

3
4•
5-----

i

-^■4-. :
7 o

|

8c

g*
10o

'

.. 2

A

EC'JION I -e- con tn o o o
7 e

2

o

s

_nfornation regarcing family members dead or missing since gas leak (include all deaths after 3o12»1984)
I

Age | Sex

Name

No.

I

i

I
i

1

' Date

IiOccupat-, Smok- Chronic History! Stay
of
Iing
i ion
> ing
lung
istatus disease serious|in
prior
I illness jthis
to
iprior ibasti
3/12/84 i to
I since
I 3/12/84 I when
i
I
—
I

iCause

l:of
death

1 or
* I
;missing.
I
I

4
i

i

3 o

4 .;

I

J
5.'

t—

i

i

i

I

* Specify whether dead or missing s

M = missing
D = dead

Name of Investigator s
Date

o
o

I
'
I
|
!

I

Was he/
she
present
here
during
gas leak

C’j

s

s

3

SECTION II : FOR INDIVIDUAL MEMBERS OF HOUSEHOLD

1o

House NO.

<*

2o Area/Basti
3. Head of household
4o Name of individual

5 . Staying in this basti
since when (month d year)
6o

a)

.

Occupatio n/j ob/
vocation

a

b) Since when
(years, months)

n

c) Has gas leak affected
your job7 (specify)

d) What is your present
occupation

2

7 . Income data-

Per day

‘ Regular/
i irregular

i
i

Per month

Before gas leak

i

After gas leak

8

Where were you during the
gas leak
s

9. Did you use any safety measures? How did you protect yourself,
(water towel, direction of running with respect to UCIL,
doors closed/open, etc.)

10 o

Smoking status^’
Current

Past

Nonsmoker

11. Hospitalization for gas effect?
When?

For how long?

Other (specify)

■

s
SECTION II

4

contn..•

2

I

12. Chronic illnesses

Yes/No

Chronic
illness
other than
respiratory

Parti­
culars

Chronic resplrytory illnesses
ILung
__I Other
Asthma iIB
i Bronch
cancer?
(speciI
I -itis
._
•' ly)
h

I

Duration

_____

Treated/
untreated

t

i

1

_L

.1

13. Number of episodes of the following in one past 3 months.

Duration

No. of attacks

Disease

1. Common cold
2. Cough

3. Pneumonia ■
4o

Fever

Name of Investigators ••
Date

•*

s

‘c

SECTION III

5

s

EXAMI N ATI ON D ET Al L3

1. House No.
2 o Area/Basti

3. Head of household

4O Name of individual
5 . Examination details?

Yes
If yese
(specif yh d ar a t i on

No

Symptoms
1o Dry cough______________
2o Cough with expectoration

3o Blood in sputum (haemoptysis)

4. Breathlessness at rest
5 o Breathlessness on exertion

f

6. Breathlessness on exposure
I
to specific allergen

7. Fever
8. Chest pain or tightness

9. Skin problems (itching,
burning, infection)
10. Jaundice and its symptpms
11. Blood in stool or vomit
12. Bleeding tendency

J

13. Blurred vision and photophobia »

14. Headache
15 o Weakness in extremeties
16. Muscle spasms

17. Fatigue
18o Loss of memory (amnesia)
19. Anxiety, depression

6o

General examination 2
cms

i)

Heights

ii)

'Weights

ill)

Pulse rates

iv)

Respiratory rate:

o .

kgs

I

6

2

7o Eye examinations

i) Cornea

ii) Acuity of vision
iii) Pupilary reflexes

iv)

Anterior chamber

v) Lens

So

Anaemia

9» Jaundice

(Sclera)

10. Cyanosis

11. Skin examination
12 o

Oedema

13. Respiratory system;.

i) Shift of mediastinum
ii) Air entry

iii) Foreign sound.
14. CVS

15 o

CNS
i) Paralysis

ii) Was ting

iii) Planter
iv) Knee
16. Alimentary system
i) Liver

ii) Spleen

iii) Ascites
17. Diagnosis

18o Remarks

Name of Investigators oo

Date

2

8

2

s

SECTION V ? ADDITTQNAL PROFORMA FOR WOMEN
2

1. House No*.
2- Area/Basti

3 o Head of household
4 o

Name of individual
2

5. Marital status

6o Menstrual history;
Present (after
gas leak)

past (since when)

Details

1. Occurrance (oer month)

2 o Duration

---------- [

3. Flow

4. Peculiarities
i

5.. Leucorrhoea

t

6. Itching
7 o

7 o

Burning sensation
with urination

i

1

i

Yes/No
a) Whether pregnant during gas leak?
b) If yes, exposure during which month of pregnancy?

c) Outcome of pregnancys
I Remark (when.- how, any peculiar
‘
ities?)—

Detail

T--- -

1. Spontaneous abortion
2 o MTP
Still birth

4„ Premature delivery
5 o

Live-birth

6. Still pregnant
(whether foetal
movements normal)

Name of Investigators

Date

s

7

i

SECTION IV s LUNG FUNCTION TEST

1o House No o

s

2o Area/Basti

2

3. Head of household.
4o Name of individual

5. i) Height :

cms

ii) Weight s

kgs

iii) Surface area:

6

Lung function.;
Recording

FEV1

FVC

1

2
3

Name of Investigators
Date

2

s

5

s

SECTION III ; EXAMINATION DETAILS
7,

1. House No.

2. Area/Basti

3. Head of household
4 . Name of individual
5 . Examination detailss

Yes
If yes,
(specify) duration

No

Symptoms
________
1 Dry cough
2O Cough with expectoration
3. Blood in sputum (haemoptysis)

I

4. Breathlessness at rest
5. Breathlessness on exertion
6. Breathlessness on exposure
to specific allergen

tI

7 • Fever
8. Chest pain or tightness
9. Skin problems (itching,
burning, infection)
10. Jaundice and its symptoms

i
I

i

11. Blood in stool or vomit

I

12. Bleeding tendency
13. Blurred vision and photophobia ;

T

14. Headache
15. Weakness in extremeties

16. Muscle spasms
17. Fatigue
18. Loss of memory (amnesia)

19. Anxiety, depression

6

General examination:

i) Height;

o cms

ii) Weight;

o . kgs

iii) Pulse rate: .
iv) Respiratory rate: <>

i

_.l
i

6
7 o

2

Eye examinations
i) Cornea

ii) Acuity of vision

iii) Pupilary reflexes
iv)

Anterior ch amber

v) Lens

8. Anaemia

9o

Jaundice

(Sclera)

10. Cyanosis
11. Skin examination
12 . Oedema
13. Respiratory systems
i) Shift of mediastinum

ii) Air entry

iii) Foreign sound
14. CVS

15. CNS
i) Paralysis
ii) Wasting
iii) Planter

iv) Knee

16. Alimentary system
i) Liver

ii) Spleen

iii) Ascites
17. Diagnosis

18. Remarks

Name of Investigators
Date

c

7

s

SECTION IV s LUNG FUNCTION TEST

1 . House No.
2

Area/Basti

s

3. Head of household

4 - Name of individual

5. i) Height s

cms

ii) Weight 2

kgs

iii) Surface area:

6e Lung functions
Recording

FEV1

FVC

1
2
3

Name of Investigator2
Date

2

8

s

s

SECTION V s ADDITIONAL PROFORMA FOR WMEN
1 o

House No«>

s

2 o Area/Basti

3 o Head of household.
4 o

.

Name of individual

■o

5<. Marital status

6o Menstrual history«

1

Present (after
gas leak)

past (since when)

Details

Occurrence (per month)
—

t

2o Duration
3 o Flow

4o Peculiarities
5o Leucorrhoea

6o Itching
7. Burning sensation
with urination

7o

a)

i

1
Yes/No

Whether pregnant during gaS leak?

b) If yes. exposure during which month of pregnancy?

c) Outcome of pregnancy?

Remark (when, how, any peculiar­
ities?)
___

Detail
1„ Spontaneous abortion
2 o MTP
3 o Still birth
4 <. Premature delivery
5 o

Live•birth

6. Still pregnant
(whether foetal
movements normal)

Name of Investigators

<.

Date

O

S

Section VI, Patient’s perception about available hggl.-tb
facilities.

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MEDICO FRIENDS CIICLE QUESTIONS AIRE _P ROE ORMA
25 MARCH, 1985 . BHOPAL
17
SECTION I ; INFORMATIOK REGARDING HOUSEHOLD

1 o

o o

House Number

2 <. Area/Basti
3

Head of household
2

4«. Religion
Type of cooking fuel used

(tick whatever is used)
/

i) Firewood

(v) Kerosene

ii) Cowdung cake

(vi) LPG Gas

iii) Saw-dust

(vii). Other
(specify)

.-«

iv) Coal

6o Composition of family?

(start with household head - Do not
include members who are dead or
missing since Gas leak)

La^

Name

No o

-i—

1.
2,

4---

3.
4. -!—
---56.

.
!

7 o

I

t

I

8e
9 o

10.

Be-f'
o q'Yi.
I*.

NA - ’hSoV c^n.

Sex

Afl

r
!

SECTION I
7 e

'

contn o oo

2

i

S

IYifornation regarding family members dead or missing since gas leal: (include all deaths after 3»12o1984)

Cifl)
No» I

Age | Sex

Name

I

i
i

II

■ Date

i Cause

lof

• death
‘ or
* i
• missingj

!Occupat- ,Smok- Chronic History)Stay
i ion
of
|ing
lung
' in9
I status disease serious|in
i
prior
illness[this
to
I
prior
basti
j
j
3/12/84 ! tO
since
I 3/12/84 when

1__

I

—

I

1,
7

jb

f

i

I
i

4 .;

I
-

1•
T

‘’si-

+

f

i

I

T

7

3/

1

I

i

I

* Specify whether dead or missing s

M
D

missing
dead

Name of Investigator s
Date

+•

I

Was he/
she
present
here
during
gas leak

»

u/
o

SECTIOII : FOR IHDIVIDUAL MEMBERS OF HOUSEHOLD

lo

House No.>

2o Area/Basti

3. Head of household
4o

Name of iridividua 1

Staying in this basti
since when (month d- year) » 6

a) Occ up a t i on/job/
vocation
/
A,e_
b) Since when
(years , mor. ths)

O

©

Q

Q

c) Has gas leak affected
your job? (specify)

d) What is your present
occupation
7

Income data-

Regular/
i irregular

Per day

II

Per month

1I
I

Before gas leak.

After gas leak

8

9o

v>here were you during the
gas leak
s

o

o

Did you use any safety measures? How did you protect yourself?
(water towel, direction of running with respect to UCIL,
doors closed/open, etc.)

-

10 6 S mo k i ng st a t u s

Pas t

Curient

Nonsmoker

I
11. Hospitalization for gas effect7

When?
For how long?

Ot

r/ (specify)

5

contno..

SECTION II s

12o Chronic illnesses7
Parti­
culars

4

Yes/No

Chronic
illness
other than
respiratory

Chronic respiratory il nesses
Other
Bronch Lung
As thma TB
cancer (speci­
-itis
fy)
i

f

Duration

i

Tr©a>^a/f
ui^trp-dted

Ii

13. Number of episodes of the following in the past ^months?

No. of attacks

Disease

1. Common cold

2. Cough
3 . Pxieumoni-e.
4o Fever

Name of Investigators ..
Date

s

Duration

2

5

2

SECTION III 2 EXAMINATION DETAILS

s

1«, House No.

2. Area/Basti
3o Head of household

2

4. Name of individual
5 » Examination detailss
I

Symptoms

1 o Dry cough

No

I Yes
tIf yes,
!(speci /)i duration

_______

2o Cough with expectoration

4

3<> Blood in sputum (haemoptysis)

t

4 - Breathlessness at rest

.

——--------------

5 o

Breathlessness on^exertion

6. B^eerth-Les^n-cas on exposure <

to--sp-eeif'i’C aiH-ergen

7. Fever
8. Chest pain or tightness
’9~Skin problems

(itching,

i

'
burning, infection)
10. Jaundice and its symptoms

11. Blood in stool or vomitI
12. Bleeding tendency
£
13. Blurred vision and photophobia

14. Headache
15. Weakness in extremeties
16. Muscle ■sp-asma17. Fatigue
18. Loss of memory (amnesia)
19o Anxiety? dcipL css ion

7'/

6o

General examinationz
i)

< cms

Heig‘

o o

ii) Wei ht2
iii)

Pulse rates

iv)

Respiratory rater

5-e
K

73 >

f

J)

I

t

kgs

o

.

i

i

6

7. Eye examinations

U

i) Cornea
ii) Acuity of vision
iii) Pupilary reflexes

X

iv) Ant^ri
v) Lens

:mia

8.

9<, Jaundice

(Sclera)

Cyanosis

mA

^1). Skin examination
Oedema

13o Respiratory systems
Shift of mediastinum

ii)/ Air entry
iii) Foreign sound.

14. CVS

15o CNS

i) Paralysis

<5^

ii) Wasting

iii) Planter
iv) Knee

k
A
\

16o Alimentary system
i) Liver

ii) Spleen
•»

iii) Ascites

17. Diagnosis

18. Remarks

Name of Investigators
s
Date

8

s

s

SECTION V ? ADDITIONAL PROFORMA FOR WOMEN
1 . House No»

2

2. Area/Basti
3 o

Head of household

4o

Name of individual

o

Marital status
6o

u o

Menstrual historys
Present (after
gas leak)

past (since when)

Details

C7cH

1. Occurra
si2.

3

Flow

4o

Peculiarities

5 . Leucorrhoea

4-

6 o

Itching

-H

7

Burning sensation
with urination

4-

Ins

i

-^L_

7 o a) Whether pregnant during gas leak?

Yes/No

b) If yes. exposure during which month of pregnancy

c) Outcome of pregnancy?
I

Detail

Remark (when., how, any peculiar­
ities?)

1 u Spontaneous abortion

2

MTP

3 «. Still birth
4o Premature delivery'/’^

ST-.five- birth p

6o Still pregnant
(whether foetal
movements normal)
—X> L '<->Y

OM F

H -Name of Investigators

Date

.

2

ft

iCrten VI# Patient's per-oeption about available taeaKh
facilities.

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8

s

SECTION V s ADDITIONAL PROFORMA FOR WOMEN

1 o

House No0

2 o Area/Basti
3
4o

o

Head of household
i
Name of individual

'o

5. Marital status
6. Menstrual history^
Present (after
gas leak)

past (since when)

Details

1

Occurrance (per month)

2

Duration

I

t

3. Flow
4o Peculiarities

5.. Leucorrhoea
6 <. Itching
T

7o Burning sensation
with urination

I

7 c a) Whether pregnant during gas leak?

Yes/No

b) If yes,' exposure during which month of pregnancy"

c) Outcome of pregnancy?

I
!

Detail

Remark (when, how, any peculiari ties?)

1„ Spontaneous abortion

2 o MTP
3. Still birth

4- Premature delivery
5» Live birth

6. Still pregnant
(whether foetal
movements normal)

Name of Investigators

Date

s

.

v<
Tr’r

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H

I-

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i,

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J

BHOPAL CITY

CHHOLA

AERODROME

mE\
XENTR1

s

RAILWAY STN.

BAIRA>x^
QARH
PROJECT

'UPPER
— LAKE

ANAND
NAGAR

CHANDBARH

3W

^-5^

ARSA

GOViND
PUR^

-Vi<jqw
I

P\PLAN\

ARgRA HILLS J

y‘'XX\/y'

SHAMLA
HlLLVi^

J

rr v

,.4/
KALIA

/

«?0TH

//

HABIB]

barkhera

gamjJ

M.AC.T.
area

RiYER^

TO BOMBAY

7/^
!

UNION
CARBID

A°

Khat
PUR^

CHHOLf

K£ncmi
SHAHJAd*
tfSAD /

rly.

/kajica^p

GAS AFFECTED ZONES
OF
BHOPAL CITY

COLONY

SINDH!
COLONY
STRAW
PRODUCT

fBuy.
SINl>

Z/3US
STAnd

AISHBAGM
^STADIUM

S.Z.HOSP.

/CEN.
LIBRF

BARkhi

INDEX

- UPPER LAKE
7JAMAN -

SEVERIUX AFFECTED-----

Slower

^^LAK§/
PROF /
COLhHVS

/lal^Are.t>
GROWHP;v

^RkA

moderately AFFECTED----

X SLIGHTLY affected

rv.n

___ CHAND IR
fbUNQAUO

CENTRAL
SCHOOL

-TO I TARS I

STUDY OF MEDICAL ^LIEF TC GAS-VICTIMS.

Aim

The aim of this ^uiry was to 1) study the health-facilities available
to a basti severely affected by the gas-le<6c;
ii) study people1 s experience, perception of these
facilities in order to suggest improvements
(if any) in the existing facilities.

MKTHOPt

One person from each of the families from the random­
sample from JP Hagar was interviewed with the help
of a questionnaire. Responses to these questionnaire
were categorised. The questions & a tally of the
answers is presented in Sub-Sec. IX.

The Govt* polyclinic and €he MD*I*G* hospital* both
located near the JP tfagar and specially meant for the gasaffected people were visited* Three doctors (out of 14®
working there were interviewed with specific 5-6 points in
mind (see below) without upsetting the doctor with a written
questionnaire*
Some independent observations were made* The findings

are given in Sub-Section I#
Three non-governmental clinics in the adjoining area
were visited to know their approach towards these patients.
The findings of this equity are given at the end.
SuboSectlcn I«

Governnient-run-clinic and
O.P.D. in
D«X»O« Hospital*

A ” polyclinic w and a hospital specially opened to
treat the gas—affected people is within one Km^distance from
JP Nagar. The ••Polyclinic* is opep all throughout 24 Hrs* but
does not consist of specialists from different branches as is
suggested by the word “polyclinic”, but is only an ordinary
dispensary. The hospital (•DIG Hospital1) which is near the
polyclinic is however staffed by specialists fro®' different
branches like paediatrics. SNT. Surgeryj..A*e.
Facilities at D.X.G. Hospital wer^ as fellow:
(Contd.***

V

-I 2 i-

Staffing pattern! There are 14 doctors and lesser number of
paramedics; all are regular doctors (not interns) Including
post-graduate specialists from differenHaranches*
Tjminq! O.P,D* runs from 9 a.m* to 1*00 p.m* in the morning
and 1 hour in the evening* One doctor told that about 600-800
patients attend the O*P*D* every day* It was observed that
there were very long queues which must be producing a lot of
strain on doctors and especially on patients*

Availability of drugst The doctors said that on the wholes
there was no problem of supply^-bcth in range and quantity«

Standard guidelipas> for diagnosing and treating gas-victimsThere were no standard guidelines and the doctors interviewed
had no definite^ knowledge about the role of Inj. Sodium
Thiosulfate neither had they seriously thought about alb&e&tg MTP

to pregnant women*
Policy of referrals» There are no definite criteria for referring
patients to a bigger hospital, Those which could not be managed
here were sent to higher level*
Facilities for inx^eatiqationfi Facilities for routine biochemical
and microscopic investigations are available* Blood Gas Analysis
was being done in certain pat tents and urinary Thiosulfate
levels were measured with the help of spc tro-p ho tome ter in thosepatients selected for a course of Inj. Sodium Thiosulfate*

Doctor1 g perception! Doctors said that the patients are 111 but
are exaggerating, and are implicating the gas in all types of
complain ts*

-» 3i-

Section

XI t

Patients* perception about

available health facilities.
One person from each of the gas-affected families
surveyed in J.P.Nagar (the worst-affected area) was to be
interviewed. But the questionnaire was cyclostyled on the 2nd
day and hence only 40 could be interviewed. Out of these,
these. two
were
on-respondents because in one, the whole family had gone
to hospital; and in the second, inmates had presumably gone out
for work.

What follows is the English translation of the original
questions in Hindi and the tally of the answers to these
quest!ons< answers being suitably categorised.
QyNot 11
AnS.ee•

Where do you go for medical treatment?
a) Government’s dispensary i 2Q respondents;
b) Private doctort 33 respondents;
c) Self-medicationt 1 respondente

Five persons had not gone to any private doctor, whereas ten
persons had net gone to a Government-dispensary, but some cf
them had been directly admitted to a Government Hospital; after
which they dedided to gc to Pxlvate-practitlonere because of bad
experience in the Government hospital.

Ans...

Can you walk down to the Gov. enmen tf s hes; ital/dispensary?
This question was apparently superfluous since the
Govt’s dispensary was less than 1 Km. a way-we 11 within
the walking distance. But still the answers to this
question are varied. Answers were a) Yes; 29 respondents;
b) No : 2
•
c) No Answer; 7 ••
(These patients either go only to
the private practitioners or dii ctly to a bigger
Govt. Hospital).
How long do you have to wait in the d ispensary^ in the
queue
for your turn—to
come?
--------- -----------------J
The question was subdivided into wZhow much time for
examination and
how much time for getting medicines."
But people could not tell total amount -.of time taken
in the dispensary and not the br^ak-up. The answers
were as follows;

4

Ans:...

Nil respondents.
a) Up to 1 hour
6
b) 1- 2 hours
8
c) 2— 4 hours
d) more than 4 Hrs :
13
M
®) So answer
t
11*

*(either da not go to the Govt, dis>ensary or no proper
■answer elicited).

T’***-, *. -

How many □ays1 ofjnodiGlnes aro given at a tine?
X't^^ondesitsr
tt) only
u»y *
j 2V
«
b) 1-3 &:
H
f* nan 'i ciay»i 6
4) Fro;.ar response not elicited s 4 respmdrrts.
Thii; iuJ.li iu«lu<iau th® practice at th® private
el Leics else..
(^) »3> you grt sti
- iron th« Govt’s
11;..

Ans

^ns.»»•

-i ?.rv7

s) i, .’>u .’ «j •.-e^j.'ondents Jb) No* 5 rtfsp-undents.
(T>) If net; <3 7 i heve Lu buy an/ r.jallc?8j®s from the
market?
1) a fen .-C'.’Aiclnes i 5 r. v^oaiUnts
?) A|! :h’ -- V. J~-esj SfeHe of the ze:.pondents,
♦* (Proper re-.’ ■n?:-' net elicited la five persons).
'.ryfcre tne aiedicine^ useful?
a> No relief
s 10 respondentsj
b) a little, spa^tc itic reiie'*.; .U respoudcnc&x
c) «ubsh’snti&} rclleSt 1 res ondent,
{
st
on*a :y,t obtained In
■ .-rsons)
How ws? the bclK; -■ lour of the Govern sst—doctor? —
no r< gardn si)
Efr.gv~,ry
-3) hartiiy ary enquiry : 15 respondents^
b) sympathetic enquiry : 17 re«fcadent
■;.U;V4
iGX
11}
Li. } IX-j crim?! mfe Lon done
t 6 renpon<.s<sntsj
b) Cvcsosy exam „nut ton
•15
“
u
ill
c) rropc;r <ix»iini.nation
1W

■'■.■>^2

a) «o advice given
8 30 r<?3
b) Assurance givan
I 1
s) Advice ibout fcod* «« etc» I

.

«
M

-i 5

( In 6 persons, this question about Government-doctor’s
behaviour was not applicable since they do not go to the
government-cum-clinic. Sub-categories s a. b, c. in the
answers to this question were not present in the questionnaire,
but wre drawn after scanning thro’ tne res; onses.)
Q.No.8> Kmk Were you referred to the hospital anytime during
this~illness?
Ans..,
Yes i 19 respondents!
No
i 17
*
(No proper response obtained flora two persons)
If yas, how was the experience at hospital?
• 9 respondents!
a) Sarno
b) Worse
! 5
•
N
3
c) Better
d) Very goods Nii
(categories t at b. c« d made after scanning thro*
the responses).

Q.Ne.9! Did you go to a private-doctor?
Ans..
Yes t 33 respondents!
No
: 5
•
(If yes, did
toll you aa>Uilrg different about
your illness?
NO
j 32 respondents?
"
(the specific medicine is not
Yes I 1
available how; but in being
manufactured
Probably a
reference to TD? producing
sodi^jm Thiosulfate) •
Q.Ho.lOt How much did you spend for private treatment?
Ans. . .
a) Nil t (Nil. Does not iBclude those 5 who did not go
to any private doctor)•
b) Upto Rs. 100/t 10 respondents.
c) Between B». 100 and te. 500/. i 10 respondentsf
a) Beyond ?s. 500/-« 13 respondents.
(Categor es a. b, c. d prepared after scanning thro’
the reoponse. The original question had asked for a
break-up of doctor’s fees end money spent on drugs.
But very few could give such a break-up.)

(contwl

•e<r

Has any doctor told you so far anything about the
----------- - nature of your disease or has givwe any advice?
Mb > Tt rosj^ndentsr
Aew.»
Yeai 1, (*,Tt,s a recurring Illness.")
cl.Me,lit

Some not^bK individual pj^frrlUagi
On* family («»• 371)
spmt relatively a very high
amount (h» J^SOO/.) en medics 1 treatment. One patient wag
advised by the doctor to abatata frum sour, oil/# pungent food!
Two fam 11 toe had a dioastrove es^iriemo in th® Govt.
hoapitf l*©r.e wceber of the family
*02)
aenfc to the n rtury«
though ha vos only uw»n?cioue> a child frbca another family
(&>,443>
allegedly sect to the uwaptury tnrle® (I) Whan^he
we® only unconscious. One more person (Chotniatr house No, 190)
reported that he w* dhtsned into mort’ury twice when unconracioue#
Tn the first instance he managed to walk out btM: fall uneonselaua
at the d or-etap. At the second time* his son renewed hta» This
family was, however, missed by our sukvfv
iMjCiag systematic
equity thro* * questionnaire.

Insect
XXZt Pyivai:aZ^l»Mtarv KadteBl Gaftk.ra».
Three such centres wro available near the Msti, Ona of them
wus a free clinic specially set qp after the gas-disaater, appa.
rontly wxtti the help ox » Muslim tfwrifcabie grotp* This Therapist
W^s using raalnly homeopathic medicines but also used Ayurvedic &
allopathic medicines " depending q?on the case•', He made tall
dates of cure for ga»«elated diseases as well as others. But
during our intensive* free talks with the toati-people for three
days, nobody mentioned o£ any substantial relief or "cure"
with the help of the medicines from this clinic. Most dwellers
had been t® on®
Stetfhal. a general practitioner about 1 Ha
from the busti. He is not M.3.B.S. doctor but his clinic
was ©vorerowdad. He seemed courteous and soft-spoken to his
patients hut hardly examined anybody in detail. Injections,
antibiotics and prednisolone were liberally used. He spoke to
urn for a f«; minutes. ”o bad used antibiotics, antacids, beendhodtlatnrs, stem Us liberally without much result. He did
not know about the details of the controversy about the role of
Inj. sodimn Thiosulfate but thought that the advice given by a
forensic expert is to be taken with a pinch of salt and that his
patients had not ben-’fitted from Inj, N.T,3. In the end, he said

7

*

<5

that he himself was exposed tn the gas, suffers from it even
now and has recently started taking an Ayurvedic preparation
with gratifying results, rinally we met a woman whose clinic
bore the place t " Tjady Doctor.” She had no well-known degree.
She had closed down her clinic after the disaster for two months,
and could not tell much, She used antacids, cough-mixtures,
antibiotics without much result• Most patients did not come
back the next day since * they are too poor to pay fees every
day. ” When asked specifically about woman’s problems, she
vaguely said that there was increased incidence of Gynaec:
ecological ex^in^txon and
problems*. But fe’he does not de
referred these women to her sister who, she said, was a
Gynaecolog1st.

Nona of the^e therapists had received any guidelines from

the Government-

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Alaric

n (1)

n(2}

University of Pittsburg School of Public
Health in London Tine 10/12/84.

M,H, Nagu

Director of Health Services. «.P. in Pres
press Journal 12/12 84,
From A people view of death their right to
know and Live* Kklavya Bhopal.

Ron.Dagnit

•Data on mXC*s Toxicity are scant Learn Much
to be Learned* in C £N, Feb. 11,19 85,

Ano

Methyl Xsocyante its effect on Bye.

RvXj Dagnit

Lee. Ctt.

Papys. J.

•Occupational Respiratory Allergs* in clinics
in Immunology and Allergy Vol. 4, Ho 1 Feb1984.

NIOSH

D isoeganates U.S. Dept, of Health Rducaticn 6
welfare

a (3) Hen Dagul

LOC. clt.

n (4) wllliaai A. Rye.

Ksnun Responses to Isocyanate exposure. J.
of occupational MedidnVol 15 Ho 3 March
1983,

n (5) Ano,

rtethye Isoeyarate M Toxicol©gy It Profile

Ano.

Mathge ir©cyan st*.

Ron. Dagani

boc, clt.

(n.6) Ron Dagni
Paineta M,L>«
Axefond. A.T.
MckerrowC,

Loc cit,
•Newrological conplicationa aftero a aingle
server exposure to
British Journal of Internal Mfcd, 1976. 33,
72-78

(h.7) Ano

Methyl. Isocyanate-Toxicology Profile,

(n.8) Ron.Daganl.

Loc cit.
Doan. School of Rnvt rcanmental Science. JNU
maker on anuloguar point, * that neither of
ths two oases (MIC fc phosgene are known to
cause any tong term effects of tlw ecosptem.
9oth MIC and phogene being highly corrosive
and active gases are degenerted very * quickly
in the atmosphere*. From. *a people*® view of
death,,,,* Bkiavya Bhopal.

Prof. Davs.

(n.9)

Ano

Methyl Isocyanate.

Toxicolocy Profile

(n.10) w.M.Andersar.

Chairman of the Board, Union Carbide
Corporation, U.S. to Peoples Research
Institute of ^nergy 4 Kmvironment
3.f. Baptist Kalkan, 7-26-24 Shinjuku.
Tokyo. Japan.

(a.11) Ran Dagani.

Loc.dt.

(n.12) william. Rye

Loe dt.

(n.13) ^tuart Diamond

K Rew straits Tiaes. Feb 15 1965.

(n.14) ICMP
Update 10th March
1085

Health Effects of Exposure to Toxic Gas
at Bhopal. An Update on XCMR sponsored
Researches. 10th March. 1085.
Part-X- Jage 13.14.

(n.15) ICMR
Up date 10th March
1985. Same as above. Part X K P. 13.

(n.16) Praful Bldawai

Times of India 25-27 March 1985.

(n.17) Arand.Scuhuys.

in * areathing - physiology. Environment,
end bung Diseuse’ Grune L Gtratton
N.Y.Londsn 1974.

(n.18) ICMR Up date
10th March 1985

(n.19)

ICMR Up date
10th March 1985

Log cit. Part I Page 15.
Log cit Page 26-27

(n.20) A people's view
of death...
Eklvya Bhopal.

Loc. ait Page 26-27.

(n.21) Ron.Dagani

Loc cit.

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f
»

STUDY OF MEDICAL RELIEF TO GAS-VICTIMS.

A/AAIM:

The aim of this enquiry was to i) study the health-facilities available
to a basti severely affected by the
ga^.-leak;
ii) study people*s experience, perception
of these facilities in order to suggest
improvements(if any)in the existing
facilities.

METHOD: One person from each of the families from the
random-sample from JP Nagar was interviewed with
the help of a questionnaire. Responses to these
questionnaire were categorised. The questions &
a tally of the answers is presented in Sub-Sec.II.
The Govt.polyclinic and the "D.I.G.hospital" both
located near the JP nagar and specially meant for the gasaffected people were visited. Three doctors (out &f 14)
working there were interviewed with specific 5-6 points
in mind (see below) without upsetting the doctor with a
written questionnaire.
Some independent observations were made, The findings

are given in Sub-Section I.
Three non-governmental clinics in the adjoining area
were visited to know their approach towards these patients.
The findings of this enquiry are given at the end.

Sub-Section I : Governraent-s^uto-clinic and
O.P.D.in
D. I.G.Hospital*

A " polyclinic
and a hospital specially opened to
treat the gas—affected people is within one Km. distance from
JP Nagar. The "Polyclinic" is open all through-out 24 Hrs.but
does not consist of specialists from different branches as is
suggested by the word "polyclinic", but is only ain ordinary
dispensary. The hospital ( ’DIG Hospital* ) which is near
the polyclinic is however staffed by specialists from diffe­
rent branches like paediatrics, ENT, Surgery.r. ^t^X e^eeptr
^rthepaedics.

Facilities at D.I.G. hospital/were as follows:

Contd.•.

p>

Staffing pattern: There are ^L4 doctors and lesser number of
^doctors (not interns) including
paramedics; all are 're­
post-graduate specialists from differenKbranches.
Timing : O.PeD. runs from 9 a.m. to 1.00 p.m. in the morning
and 1 hour in the evening, One doctor told that about 600-800
patients attend the O.P.D. every day. It was observed that
there were very long queues which must be producing a lot of
strain on doctors and especially on patients.
Availability of drugs : The doctors said that on the whole#
there was no problem of supply-both in range and quantity.
standard guidelines: for diagnosing and treating gas-victimsThere were no standard guidelines and the doctors interviewed
had no definite t knowledge about the role of Inj.Spdium Thiosulfate
neither had j^hey seriously thought about advSsxng MTP to preg—
nant women?)
, .n v
Policy of referrals: There were no definite -iateria for refe­
rring patients to a bigger hospital. Those which could not be
managed here were sent to higher level.

Facilities for investigations: Facilities for routinebiochemical
and microscopic investigations are ayailable^Z Blood Gas Analysis
was being done in certain patients and urinary Thiosulfate levels
were measured with the help of spec^o—photometer in those —
patients selected for a course of Inj.Sodium Thiosulfate.
Doctors perception: Doctors said that the patients are ill but
are exaggerating# and are implicating the gas in all types of

complaints•

of’D
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0

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; PatientsT1 pe^eptTorT^aSou^
avai 1 ab le he a 1 th f

AAfakfifl ~

One person from each of the gass-affected families
surveyed in J.P.Hagar ithe worst-affected area) was to be

\ V'vV c -w* C'wO

surveyed;

But the questionnaire was cyclostyled on the 2nd
day and hence only 40 could be surveyed. Out of these, two
were non-respondents because in one, the whole family had gone
to hospital; and in the second, inmates had presumably gone out»»
for work.

What follows is the English translation of the original
questions in Hindi and the tally of the answers to these ques­
tions, answers being suitably categorised.
Q.^o. 1: Where do you go for medical treatment ?

Ans...

a) Government’s dispensary : 28 respondents;
b) Private doctor : 33 respondents;

/6£

c) Self-medication;

1 respondent.
Five persons had not gone to any private doctor, whereas ten

persons had not gone to a Government-dispensary/ but some of
them had been directly admitted to a Government Hospital; after
which they decided to go to Private-practitioners because of bad_
experience- in the Government hospital.
Q. No. 2: Can you walk down to the Government’s hospital/dispensary ?
This question was apparently superfluous since the Govt’s
dispensary was less than 1 Km.away-well within the walking distance.

But still the answers to this question are varied. Answers were ans•..

a) Yes : 28 respondents;
b) No

:

2

-”-

c) No answer : 7
(These patients either go only to
the private practitioners or directly to a bigger
Govt.hospital).
Q.No.3: How long do you have to wait in the dispensary in the
queue for your turn to come ?
The question was subdivided into
how much time £or
examination and ii” how much time for getting medicines."
But people could only tell total amount of time taken
in the dispensary and not the break-up. The answers
were as follows :
II

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Ans• • •

Nil respondents.
a) Upto 1 hour
ti
6
b) 1- 2 hours
8
c) 2- 4 hours
13
d) more than 4 Hrs
II
11*
e) No answer
*( either do not go to the Govt.dispensary or no
proper answer elicited)•

Q.No.4: How many days’ of medicines are given at a time :
ans« .. a) only 1 day : 3 respondents;
b) 1-3 days
: 25
”
c) More than 3 days: 6 a
d) Proper response not elicited • 4 respondents.
This tally includes the practice at the private

clinics also.
Q.Nd.5:(A) Do you get all the medicines free from the GovHs
dispensary ?
a) Yes : 28 respondents (b) No : 5 respondents.
ans •.
(B) If no. do you have to buy any medicines from the
market ?
ans.. . 1) A few medicines : 5 respondents
2) All the medicines: None of the respondents.
**( Proper response not elicited in five persons)•
Q.No.6: Were the medicines useful ?
: 10 respondents;
a) No relief
ans. •
b) a little, symptomatic reliefs 21 respondents;

c) substantial relief: 1 respondent.
(Proper response not obtained in 6 persons)
jj.No.7: How was the behaviour of the Government-doctor ? -

Enquiry
a) hardly any enquiry : 15 respondents;
b) sympathetic enquiry s 17
as regards : I)

II) EXAMINATION

6 respondents;
15
11
c) Proper examination
-o
III) ADVICE
: : 30 respondents
a) No advice given
b) Assurance given
: 1
ii
c) Advice about food.♦.etc: 1

a) No examination done
b) Cursory examination

<o K

( In 6 persons, this question about Government-doctor’s
behaviour was not applicable since they do not go to the

government-cum-clinic. Sub-categories : a, b, c, in the
answers to this question were not present in the questionnaire,
but were drawn after scanning thro’ the responses.)
Q.No.8: Were you referred to the hospital anytime during

this illness ?
ans.

Yes : 19 respondents;
No
: 17
”
(No proper response obtained from two persons)
If yes, how was the experience at hospital ?
a) Same : 9 respondents;
n
b) Worse : 5
H
c) Betters 3
d) Very good:Nil
(categories * a, b.
b, c, d made after scanning thro’
the responses).

Q.No«9: Did you go to a private-doctor ?
ans•••
Yes : 33 respondents;
No : 5
”
(If yes, did the tell you anything different about
your illness ?
No : 32 respondents;
Yes : 1
” (the specific medicine is not
availablehpw; but is being manu­
facture d‘/-P rob ably a reference
to IDPL producing sodium Thio­
sulfate)
Q.No. IQsHow much didd you spend for private treatment ?
ans# •
a) Nil : (Nil. Does not include those 5 who did not go
to any private doctor).
b) Upto Rs. 100/. : 10 respondents.
Between Rs. 100 and Rs.500/. : 10 respondents;
d) Beyond Rs.500/- : 13 respondents.
(Categories a, b, c, d prepared after scanning thro’
the response, The original question had asked for a
break-up of doctor’s fees and money spent on drugs.
But very few could give such a break-up.)

(contd*. •

Q.No.11; Has any doctor told you so far anything about the nature
of your disease or has given any advice ?

ans..

No

: 37 respondents;

Yes : 1.("It’s a recurring illness.")

Some notable individual peculiarities :
One family (No. 373) had spent relatively a very high
amount (Rs. 3,500/.) on medical treatment. One patient was advised
by the doctor to abstain from sour,oily,pungent food 1
Two families had a disastrous experience in the Govt,

hospital-ogie member of the family (No.402) was sent to the mortury,
though he was only unconscious; a child from another family
(No.445) was allegedly sent to the mortury-hVvcice (!) when
was

only unconscious.

One more person (Chotelal, houseNo.190) reported

that he was dumped into mertury twice when unconscious.

In the

first instance he managed to walk out but fell unconscious at the
door-step. At the second time, his son rescued him. \This'family
was , n oweve r. m i s s e d by- orw? " making systematic enquiry
thro1 a__questiQpnaire
Sub-Section III: Private/Voluntary Medical Centres.
Three such centres were available near the basti.

One of them

was a free clinic specially set up after the gas-disaster, appa­
rently with the help of a Muslim charitable group. This rj?herapist
was using mainly homeopathic medicines but also used Ayurvedic &
allopathic medicines “ depending upon the case.” ^e made tall
claims of cure for gas-related diseases as well as others. But
during our intensive, free talks with the basti-people for three

days, nobody mentioned of any substantial relief or " cure 11

with the help of the medicines from this clinic. Most dwellers
had been to one Dr.Singhai, a general practitioner about 1 Km
from the basti. He is not a» M.B.B.S. doctor but his clinic
was overcrowded. He seemed courteous and soft-spoken to his
patients but hardily examined anybody in detail. Injections,
antibiotics and Prednisalone were liberally used. He spoke to
us for a few minutes. He had used antibiotics, antacids, bronchodilatars, steroids liberally without much result. He did not
know about the details of the controversy about the role of Inj.
Sodium Thiosulfate but thought that the advice given by a forensic

expert is to be taken with a pinch of salt and that his patients had
not benefitted from Inj.N.T.s. In the end, he said that he himself

kb

/-

(.•a.

/

■

was exposed to the gas, suffers from it even now and has recently
started taking an ayurvedic preparation with gratifying results.
Finally we met a woman whose clinic bore the plate : 11 Lady Doctor. ”
She had no well-known degree. She had closed down her clinic after
the disaster for two months, and could not tell much. She used
antacids, cough-mixtures, antibiotics without much result. Most
patients did not come back the next day since 11 they are too poor
to pay fees every day.” When asked specifically about woman’s
problems, she vaguely said that there was increased incidence of
Gynaec:problems. But she does not do gynaecological examination
and referred these women to her sister who, she said, was a Gynaecologist.
None of these therapists had received any guidelines from the
Government-doctors•

-mFc-

ENVIRONMENT
EFFECT OF AIR POLLUTION LIKE THIS DEPEND ON

-LOCATION OF SOURCE

- TOPOGRAPHY
-METEOROLOGICAL CONDITIONS
WITH EFFECT DISPERSION
FACTORS HAVING IMPACT ON SUFFERINGS OF BHOPAL

^DIRECTION AND SPEED OF WIND TO S.E,I2KMS/HR

-TEMP. He
-TYPE OF HOUSES
-CULTURAL PRACTICES OF SLEEPING AND BEHAVIOUR
DURING DISASTER.

//A - <S7
TABLE-I: DISTRIBUTION OF LOCALITIES ON BASIS OF SEVERITY
OF FATALITY RATE DUE TO GAS EPISODE.
5.N. SEVERITY

1.

HEAVELY
AFFECTED

AREAS

J.P.COLONY,CHH«LAKAINCHI,CHHO-LAROAD,KABADKHANA,RLY.COLONY
KAZI CAMP
33G25

TOTAL
AVERAGE
DEATHS FATALITY
RATE 7.

907

2-34

30642.

170

055

KAB’TPURA.PUTLIGHAR.SHAHJAHANA8AD, CONGRESS NAG AR,BHR A
BAG AREA , BUSSTAND
2.3082.

74

0-32.

, 1G2.
3,68.511
3,68
.511

34
1405

0-012.

2. MODERATE CHAHDBAR.STN.BARAM.TILA
AFFECTED JAMALPURA,KACHCHI MASJID,
BARKHERl.

3. SLIGHT
AFFECTED

TOTAL
POPUL­
ATION

REST OF OLD BHOPAL
4. REST
TOTAL POPULATIOH OF OLD BHOPAL

0.004

THERE WAS REGISTRATION OF 785 DEATHS IN HINDU CREMAT)0N
GROUNDS, 60S IN MUSLIM GRAVEYARDS AND 14 IN CHRISTIAN GRAVE
yards within adays of episode i.c-upto g-ix-84.where about
OF 152. HINDUS AND 68 MUSLIMS WERE NOT KNOWN. IN ALL
1405 DEATHS WERE NOTED INCREMATION £r BURIAL GROUNDS.

PROJECT
«• «•
•— •¥• *» "•
To evolve a strategy of medical relief
and rehabilitation which best meets
the people's medico-social needs and
expectations.

An approach document is the study/
intervention by the team from the
medico friend circle to be conducted
in Bhopal 17-25th March 1985.

Objectives-methodology-ilan of action
outcome.

(Finalised in Bombay on 10th March, '85.)

These are not our objectives.
1.

To organise a parallel study by a
non-governrrental voluntary agency.
In addition to the numerous studies
being undertaken by ICHR in collabortion
with local departments of the Gandhi
Medical College and other research
institutes in the country.

2.

To organise studies to identify long
term sequelae of MIC exposure including
cercinogenecity or mutagenicity or to
obtain basic understanding of the
biological alterations associated with
exposure to MIC.

MFC does not have the resources, the organi­
sation, the expertise or for that matter
the mandate for such studies.

We believe that the primary role of relief.
Service, research is that of local and
national institutions and delivery services
specifically established for this purpose.
(..2

Our role is to catalyse, evolve, stimulate, suggest
and enable a greater people orientation in the
efforts.
OBJECTIVES
A - To evolve a strategy of medical relief and
rehabilitation which most effectively meets
the medico-social needs of the gas disaster
victims and their expectations
/
by
i) Assessing the current health status and
medico-social problems of the people and
quantify/Qualify them within the available
technical resources of the team.
ii)

By priontising these problems in terms "1
of magnitude and implications for relief
and rehabilitation.

ill)

By identifying health problems and issues
which urgently require health education
input and to clarify the content and
context of this education.

iv)

By studying the existing plan of medical
relief and rehabilitation services
available to the people.

v)

By studying the peoples perceptions of
these services.

B - To evolve a strategy to operationalise the
strategy outcome of A by working towards
its adoption by the local government health
service organisations
by

i)

Assessing the perceptions of government
doctors in dispensaries and polyclinics
to the medical problems and relief efforts
and eliciting suggestions from them for
its improvement.

ii)

Studying the local dynamics of decision
making, organisation^ coordination and
communication for xiief and rehabilitation.

• •3

METHODOLOGY

The MFC team will be arriving in the selected Bastis
of Bhopal three months after the tragedy. Numerous
teams of investigators and relief workers both
governmental and non—governmental have visited the
people, made enquiries, offered or promised relief,
raised expectations about compensation and assistance
and have carried out various tests. These teams
have not often been complementary and quite often
worked at cross purposes.
For the MFC team to ensure that it is able to get
reliable/authentic/relevant information from the
subjects Of the enquiry it has to apply an approach
that will counter this pre-conditioning of the
basti dwellers and establish a meaningful rapport.
This rapport must be free of suspicion, dependency
or false expectations.
We have therefore decided to employ the following
strategy.
1.

Preparation of the community

&) A series of informal group discussions will
be held in the bastis during which members
of the visiting team will explain the
objectives of the study, the methodology
and the possible outcomes.

The approach in these group meetings will
be frank, open and participatory. It will
clarify the nature of the enquiry, the
absence of concurrent terminal medical
relief, the free availability of data
to individuals and the community, the
method and need for a sample. It will
encourage participation by the community
in operationalising the proposed plans.
b) To supplement this effort a small pamphlet
in Hindi which clarifies and emphasises
the salient features of the study - the
objectives, approach and components —
will be prepared and distributed.

c) To respond to requests for consultation,
examinations, dialogue, reassurance and
counselling by families not included
in sample a small team will be kept
available specifically to undertake this
task.
(..4..

• •4..

2.

d)

A referral link will be established with the
government dispensary and polyclinics and the
NGO clinics so that the inevitable expectation
of medical relief may be suitably channelised.
The doctors and health workers in these
clinics will be contacted earlier and informed
about the study and procedure of referrals.

e)

In the last two days of the stay informal group
discussions will be held in the bastis to
share the main findings, explain some of the
implications, demystify the situation and
respond to the peoples queries about their
problems.

Sample
a) Three bastis with reported differential
exposure to gas have been selected.
b)

Approximately 250-300 families will be
covered in these three bastis by a systematic
sampling.

c)

All members of the selected families will be
included as subjects of the study.

d)

The number plates issued by ICMR for enumerating
the households will be used to identify/select
households.

3* Survey

The survey will be recorded on proformas which have
both a family component and an individual sheet.
a)
b)

Identification data
History of complaints after disaster esp.
presenting<

c)
d)

Clinical examination
Tests for visual acuity, lung function etc.

e)

Interview regarding perceptions of relief
available and expectations.
Other relevant investigations (resources for
which are mobilised by 14th March)

d)

(Seprate proforma for survey has been prepared and
is being converted into a standarised key of questions
in Hindi for the investigators)•

(••5.

i

..5..
4.

7u?ditionaX components
g)

Interview with senior government officials
and decision makers to identify content/
rationale/compon-nts of medical relief
and reltabilitation services (actual plan).

h)

Interview with doctors in government
dispensaries, polyclinics as well as GP*s
in affected areas to assess perceptions
of problems, awareness of guidelines,
available services and suggestions for
impro moment.

1)

Perusal of all available data/records/
inforraation/survey reports available and
accessible locally with voluntary groups
and governmental organisations.

PLAN OF ACTa-. N
Till 16th March

Identifyin team
Mobilising resources/equipment
Reviewing available literature
reports on the problem.
Clarifying issues for study.
Finalising objectives (10th
March, Bombay)
Finalising family/individual
proforma
Finalising key/standardisedinstruction for use of proforma.
Finalising format for group
discussions.
Finalising organisational details.
Finalising local arrangements.
Finalising of bastis and f milieu
ip sample.

From 17th March
till 25 W March

Group discuss:ons in Bastis.
Orientation of investigation team.
Preliminary round of survey and
finalisation of daily plan.
Surjtfvey of families.
Interviews with local doctors and
decision makers.
Terminal meetings with bast! dwellerson findings.

Preliminary tabulation.

_
(

..6.»

Outcomes
1.

Evolution of a medical relief and rehabilitation
strategy geared to the medico-social neeos of the
disaster victims and their expectations.

2.

Identification of a priority list of medico-social
problems for which rational management guidelines need
to be evolved and disseminated.

3.

Identification of Health problems and
for which health education materials/media/methods
need to be evolved for patient education, preparation,
Cano =o»‘e preliminary content guideline.

for these)•
Follow up Action

1.

Forward report/plans/suggestions to

MP Govt, health Services
Bhopal Medical College Faculty
Doctors of Bhopal including local IF*A
ICMR and associated institutions#
2.

Evolve
Evolve health
hecilth education materials and methodologies
along
with
voluntary and government agencies
along wi th other
c
for the problems identified in survey.

3.

Evolve guidelines for medical professionals in
who are providing relief services to disaster victims,
(requesting IMA to organise meetings to discuss
these nd disseminate them !)

Note:-

This approach document has evolved out of a review
of available news and research reports on Bhopal,
report of a fact-finding team from Mfc presented
at the Bhopal convention, interviews with doctors,
experts, relief and action groups who are concerned
about Bhopal and/or have visited it ifcx in recent
weeks and finally out of a one-day consultation
of some members of the proposed mfc team at Bombay
on 10th March, 1985.

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Any other matters*
with kind regards*
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Raul

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Koramangala
Bangalore 560034
20 APRIL 1985

Need for a communication strategy on health issues
following the Bhopal gas tragedy
S U M M A R Y

THERE IS a need to evolve a continuing education s-trategy fox^.«.....^.
medical personnel and a health education strategy for people-

exposed to the toxic -gas as part■of an overall -community
•health approach to the disaster aftermath. A multi-pronged
approach using^different methodologies of communication for

different groups of people needs to be developed. One of the
aims would be to translate existing knowledge into supportive
interventions in the lives of the people. It would also, in

some ways, meet the people’s need and right to information
about their own health. Hence, it will have to be a dynamic
interaction responding to new developments in the people1s
health status as well as to research findings as they become
known.'
4

PLAN

1. Objectives

2. Background
3. Methodology
4. Existing methods of communications-

5. Perception of the health situation by medical personnel
6. Inferences

7. Building up content/methodology of communication for
different target groups
8. The community health approach within which this
communication strategy would be most effective
Conclusions

References

k

1.

.Objectives

1.1 To evolve:

(a) a continuing education strategy for medical personnel
(b) a health education strategy for the affected people
as part of an overall community health approach to
the disaster aftermath.
2. .Background
2.1 Four months have passed since the occurrence of the
Union Carbide gas leak in Bhopal which took toll of
thousands of lives.

2.2 Evidence has been building up from dispensary and

hospital OPDs and epidemiological surveys that survivors
of the exposure to the toxic gas are now suffering from
delayed sequelae affecting diverse organ systems within
the body.

2.3 Tremendous effort has been made in providing medical
and other relief through government agencies, the medical

community, voluntary agencies and the citizens groups.
2.4 The ICMR in collaboration with local medical college staff

and experts from different parts of the country are engaged
in 20 or more research projects ”to study sequelae of the
lesions produced by exposure to the toxin on a long term
basis including the effects on the lungs, growing foetus,
teratogenecity, gene mutations and carcinogenecity,

neurological and mental health effects.'’
2.5 There have already been positive outcomes of this research
effort which can benefit/modify therapy of the affected
people, viz..
(a) therapeutic efficacy of sodium thiosulfate

administration in a significant proportion of

victims. This has resulted from clinical
toxicological studies and a double blind study
using thio-sulfate backed up by blood gas analysis

and thiocyanate excretion in the urine.

(b) preliminary observations on mental health status
and recommendations by the ICMR team of psychiatrists.
2.6 Voluntary effort too has contributed to medical care:

(a) making public the rationale of using thiosulfate
and organizing people 'to demand that its use be
implemented on a mass scale (Morcha, Saheli, mfc);

2

2

(b) highlighting and making public the risk to the

foetus^and advocating preventive contraception
till detoxification is over (mfc);

(c) highlighting gynaecological problems of women
which have been so far ignored (mfc);

(d) highlighting the need for and implementing
respiratory physiotherapy (Union Research Group) °t
(e) ^highlighting functional disability "(mfc) and

■

y&h exh Al'ejpl

implementing occupational rehabilitation (AGAPE/
Union Carbide employees Association)

(f) training community health volunteers (SEWA & BRWS)
2.7 Impact of both the above efforts (2.5 & 2.6) z however,

have been able to reach only a small segment of the
affected population.
2.8 A major lacunae in all the above efforts is the absence

of adequate communication of methods/results between
medical personnel/ between government and voluntary
sector/ between all the above and the affected people.

At the field level/ this results in ignorance/ confusion/

controversy and anarchy reducing the efficacy of the
medical intervention.
i

2.9 Of course this is only one of the factors responsible, for
the prevailing medical anarchy. Some of the others ares(a) lack of coordination of medical relief effort;
(b) research projects though passing through a coordination

committee.function like vertical programmes;

(c) lack of objectivity/openness in discussing issuess
eg., thiosulfate;
(d) the strong opposition to the above could make one
believe that there are more powerful issues at stake
than just the therapeutic efficacy of thiosulfate’ —
? vested interests;
(e) personality clashes;
(f) ambition — utilizing the research opportunity for
career advancement;

(g) a- purely drug centred approach, which is reflective
of one’s medical education;
3

3

(h) working in isolation - not seeing the need for
a multi-disciplinary approach at tackling this

health disaster. Purely medical/technical interven­
tion can never touch the solution to this problem.

Besides medical personnel, sociologists, anthropo­
logists, physiotherapis.ts, nutritionists,

rehabixitation experts, communication experts,
journalists need to work along with citizens groups,

religious groups, social workers and representatives
of the people themselves;

(i) Absence of a community health approach at field/
service level;
(j) medical hierarchy;

(k) over secrecy.
2.10 In this.paper we shall confine ourselves to the
communication strategy.

3.

Methodology

3.1 During the second half cf March 1985, a sixteen member
team of the medico friend circle carried out ah
epidemiological survey of tne gas affected people.
3.2 A
sample ofAfamilies of tie most affected JP Nagar
control^ from Arranagar v.ere studied.
and a control
3.3 The study included the followergs
(a) a morbidity survey with detailed history taking
and physical examination;

(b) hemoglobin estimation and lung function tests;
(c) a study of the people's perceptions of existing
health facilities.
3.4 We also interviewed?

(a) affected people in the bastis; :
(b) doctors/para-medics manning, government dispensaries
polyclinicst community health centres and hospitals;
(c) staff and post-grAduatl students,oc Gandhi Medical
College;
{ '

I

■

•. / ■

(d) private practitioners wording in .ttye basti area
and elsewhere in Bhopal;
(e) voluntary agencies providing relief/rehabilitation;
■’U
j

.. . .4

.

4

(f) citizens groups working with and fo'r the affected
people; and

(g) decision makers in the government and voluntary
sectors.
4.

Existing methods of cornmunication

4.1 Within the medical community these included

4.1.1

Symposia on clinical aspects of disaster
aftermath held at Gandhi Medical College
open to staff/students/lMA/doctors club members
etc., held at bi-monthly or monthly intervals.

Some observations

(a) attendance by private practitioners was
low especially by those working in the

affected areas;
(b) they were mainly exercises in one way
communication between Gandhi Medical College

staff and the audience, (reflecting medical

hierarchy)
(c) lack of open dialogue/sharing of experiences/

objectivity
(d) at one of the symposia attended (on lung
function) attended by our t earn^an anti-thiosulfate

lobby dominated the proceeding with an obviously

biased approach.

4.1.2

Newspaper (media) reporting seemed to be the only

other source of technical/medical information.
Some observations

(a) the infrequent ICMR/voluntary agency press
releases arc not reported in full and often
not accurately;

(b) media coverage tended to favour the strong
local medical lobby and hence gave biased
information;

(c) they covered the sensational aspects, blowing
it out of proporti-on.

...5

5
4.2 Between different

voluntary/citizens groups

4.2.1 Informal flow of communication through group discussions/
meetings and even collaborating in action takes place.

4.2.2 Hero also because of ideological and personality reasons
some groups were alienated from each other and worked
in isolation.

4.3 Between voluntary groups and government services

4.3.1 There is a big communication gap here and lack of
coordination.
4.3.2 This has resulted in mutual suspicion, questioning of
each others motives/ working at cross purposes, even

negating the work done by the other.
4.3.3 It sometimes has also resulted in duplication of

scarce resources: eg., clinics run by a voluntary group
and the government were almost opposite each other.
4.3.4 Breakthrough in therapeutic lines of treatment do
not reach the peoples eg., most doctors manning
peripheral clinics (both government and voluntary)
were totally ignorant about thiosulfete, its rationale,

availability, efficacy etc., while it was being studied
and given in a community based hospital just a stone’s
throw away.

4.4 Between the people and the medical services

4.4.1 Medical services both government and voluntary are
strongly clinic based—being distribution centres for
a variety of drugs which are available in plenty.

4.4.2 Even basic health education was not being attempted
leave alone education responding to this particular
health disaster situation.

4.4.3 Only citizens groups were taking health issues to the

bastis, discussing them with the people and if

necessary, organizing the people to get adequate
medical attention.
4.4.4 These attempts were looked at with suspicion and
fear by the medical establishment, rather than
seeing them as positive steps to let. the fruits
of their own endeavours reach the people
..<6

6

5.

Perception of the health situation of gas affected

people by medical personnel
5.1 In the absence of effective communication of study
findings/recommendations to the treating medical personnel

there is ignorance about the clinical presentation/

pathology resulting from toxic gas exposure. Hence
there are misinterpretations of symptoms resulting in
incorrect diagnosis and therapy.
f

ulcth Ceru. tA

5.2 Fatigability resulting from tissue anoxia, produced by an
increased "cyanogen pool" in the body is being labelled
as "laziness" and "wanting to make the best use of the

aid pouring in".
5.3 Respiratory symptoms duetto lung damage (fibrosis) are
being diagnosed as TB (without proper investigations)
as these slums are supposed to be endemic for TB.

5.4 Genuine psychic entities like depression, anxiety etc.,

are being seen as "compensation malingering1' when there,
is adequate evidence., that in such disaster situations

the experience is stressful enough, to produce major
psychological changes.

5.5 These judgemental/unscientific attitudes towards the
affected people/by some sections of medical personnel

are seen both in the government and voluntary sectors.
6.

Inferences - general

6.1 From the above observations it was felt that a multi­

pronged approach should be evolved for effective

communication of medical/health issues relating to
the gas affected victims for different categories of

people.
6.2 The content of the communication could be decided by a
body representing as many groups as possible.
6.3 This would have.to be a dynamic process responding
to new developments in the people’s health status
and to research findings as they become known.

6.4 All known existing methodologies of communication/
health education should be used? eg., group discussions,
audiovisuals, slide shows, posters, demonstrations,
posters, pamphlets, mass media etc.

... 7

7
6.5 Different groups of people (target groups 1) should

be kept in mind:
(a) the affected people

(b) Service providers:
—government health sector medical personnel;

—staff/students of Gandhi Medical College;

—voluntary agency workers/citizen groups

(c) Decision makers in government - Centre and State
(d) Media
7.

Methodology of a communication strategy

7.1 Methodology
7.1.1. Regular newsletters giving main research findings,
current understanding of the clinical presentation/
pathology, therapeutic guidelines and their rationale
should be posted out to individual medical practitioners

on a mass mailing system.

7.1.2 Meetings/discussions at convenient times of doctors/
medical personnel actually working in affected bastis

should be organized at regular intervals to share/get

an up-date on the situation.
7.1.3 If possible clinical conferences for this group emphasising
the more common presentations rather than the rare

should be organized.

7.1.4 Specific care should be taken to involve personnel
working in the voluntary/private sector.

7.1.5 It is necessary to build on and make use of resources

of the different groups working there, eg:
(a) Technical information/guidelinesr ICMR/Medical
College, staff

(b) Organizing/implementing programs
Public Health service

MP Government

(c) Organization of people
Communicating with the people

Citizens Group

!

which have a
community ba s e
und credibility.

Zahreeli Gas Kand -Hangarsh Morcha/N<\garik Punarvas
Aur, Rahat Samiti
(d) Respiratory Physiotherapy/
Nutrition Supplementation

Union
Gi.'oup

Research

Q

(e) Trained Community Health
Workers

SEWA-Bhopal through

Bengal Rural Welfare
Society

(f) Demystifying health issues, s
producing communication aids: Eklavya

(g) Occupational rehabilitation

Church group

These are given only for example; many more groups may
be involved.
7.1.6 The most crucial element is a dynamic, creative
people-oriented approach. Too much formalisation
should be avoided as this often keeps vital knowledge

away from people and may be counterproductive.
7.1.7 The above caution is particularly true at the stage
of communication with the people.
(a) Open group meetings in different parts of
the bastis need to be held;

(b) Health messages need to be adequately
demystified;
(c) Audio-visuals Would help;
(d) All groups with community base should be
enlisted so that there is some consensus on

health messages given to people and confusion is
avoided.

(e) Health messages have, to be built on the life
style of the people and their particular

L

socio-economic situation for it to have any
meaning. Hence, close interaction and learning
from the people is essential. This is particularly
relevant in the present situation since the
disaster aftermath has led to
socio-economic
crisis in the life of the victims apart from
the health effects.

7e2 Building up gentent of communication for medical personnel
7.2.1 Only broad areas of conterifc are outlined here. Details
have to

worked out locaXly with the help of

specialists of concerned departments and medical
personnel from the -field. Some of the areas are:
9

9

( ZZo-?
7.2.2 TheTapecfEic efficacy Zf sodium thiosulfate giving

_

7

(a) ICMR guidelines;
(b) Scientific rationale for this line of treatment

792»3 Diagnostic flow charts and therapeutic guidelines J
regularly to tackle various specific problems, egJ

jaundice; pregnant women with fatigability/lung
complications etc.

~Cuo o^q

Z7p/^

i

hl -JL

4^

7.2.4 ^Findings and recommendations of ICMR study team of

psychiatrists, to help make diagnosis, avoid
^^z^is-diagnosis and play a more counselling role.

(

Risk to the unborn fetus./ Need for(preventiv^ 5 •
‘ Cu-T VS

contraception till detoxification is over. Copper T
and oral contraceptives to be avoided because of
status of women’s health.

J

46 Need for good under five care

va7.

.7 Nutrition supplementation

cT

V"

^5 on cm '

(a) Because of ill health and poor wage earniiRg^^s
capacity^ there is a role for supplementation

particularly for under fives and pregnant and
lactating women;

25g
)o

- ---------------

zrzc> / /-

(b7 Low cost food mixes made out of locally available
cereals, pulses and jaggery can be used;

LZ)

^c)JPreparation of these mixes could become an income
generating project for women.
2.8 On lung problems
(a) Refreshers on' diagnostic skills in this area as
f

\

this covers a large proportion of cases;
(b) Therapeutic guidelines;
—(c) Respiratory physiotherapy (breathing exercises)

T^VL^c-^

7b^\

.1/

and yoga;
k^T^Advice to people with lung damage to avoid smoking

Yvnc.^lce

be

and if possible dust and fumes.

rig.

7.2.9 For eyes
Ha) appropriate advice —X

j

»3 klOjOO-l

\(b) occupational rehabilitation because though
there may bo no structural damages, patients
complain of blurring of vision, watering and
I
redness of eye.

Q)IV\

Mcx^t^r |-kUl
Or Hc<b

..•10
I
V(_y!> ics^»

10
7.2.10 For jaundice

Vo

<a) awareness regarding higher incidence;
,(b) diagnostic aids and therapeutic guidelines;
(c) use of disposable or adequately sterilised

syringes and needles
7.2.11 Rehabilitation

CM’2-'

(a) Diagnosing and referring the handicapped
for appropriate rehabilitation

Drug utilization
Caution against overdrugging particularly steroids
and anti-biotics, their side effects and rationale
for use.

Building up content of communication ^ox affected people
7.3.1 Here again broad areas have been outlined. Local
initiative is needed to work out details,

demystify jargon and use appropriate media/methodologies.
7.3.2(Details about thiosulfate - selection criteria, possible

effects, side effects, dose, method of administration,
precautions.
Possible risk to the newborn
! 7.3.4: For couples who were sterilised and have lost

__—

V

all their children, possibilities of recanalisation—
when, where, hoh
For mothers with suppression of lactation, details

about supplementary feeding. What to give, how to
give, when to give etc.
.3.6

reathing exercises for those who have difficulty
in breathing.

7 .,3.7 For those with white patches on the eyes to contact
the eye department, Hamidia Hospital as surgery
may be beneficial.
1
r
:

In case of jaundice:

need to report to the dispensary^

hospital to find out what type of jaundice it is.
Details abcut the different types of jaundice, and
what precautions are to be taken.

7

.-^Caution about over-drugging especially during pregnancy.

7^. S^ltMSTeed to kt$ep health record safely.

11

^<5-1^-

11

8.

Community Health Approach

8.1 A basic community health approach would be necessary within
which this communication strategy would be most effective.
This could include the followings

8.2 Organizing local basti health committees and encouraging
local leader, nip. Caution should be taken to see that all
caste/class/religious groups are represented/encouraged
to participate actively as very often these committees
can be dominated by the powerful and vocal who may try
to maintain status quo.
8.3 Training community health volunteers

8.4 Strengthening mother and child health services. The entire
exposed MCH population can be considered 1 at risk1
and provided the best possible services, vizs
(a) good ante/intra and post-natal care;

(b) under five services with road to health cards,
immunization, curative care and health education for

mothers particularly regarding nutrition;
(c) nutrition supplementation would help them fight the

pathology and regain as much normalcy as possible;

(d) balwadis and day care centres.
The ICDS Scheme itself could be implemented intensively in
this area.

8.5 Health education
8.6 Rehabilitation services to be stressed as the disaster
has resulted in some irreparable physical and even mental
damage.

(a) Assessment of work and wage earning capacity
to be carried out and suitable/acceptable gccupational
rehabilitation provided for those affected;
(b) Respiratory physiotherapy;

(c) Keen watch to be kept for possible congenital
abnormalities which will need rehabilitation;
8.7 Enli^Lng the support of existing groups within society
who play a counselling role dg., religious; teachers
to support a mental health strategy, Doctors too, to be
sensitized on this issue,
8.8 A referral system from hcaltf worker, dispensary, polyclinic

to hospital to be functioning •ft/.fth the larger institutions/
seniors playing an actively supportive role to the smaller/
more junior.

12

ri

12

8.9 Active coordination of all health effort for greater
effectivity;
8.10 Follow up morbidity surveys making data/information

available to medical community/public.

CONCLUSIONS

1. One of the basic rights of people, that for information
regarding their own health status and factors affecting it
need to be urgently met.

2. This right to know is usually a casualty in the present

scientific

social and health system - this has only

been highlighted by the dramatic nature of the Bhopal

gas disaster.

3. For scientific, research and medical interventions to
have any meaningful impact in the lives of the affected

people, they have to be sensitive to the needs of the
people in this particular circumstance.

4. There is an urgent need to translate existing knowledge
research findings into supportive interventions in the

lives of people.
5. A communication strategy would be one of the inputs in this

process.
6. This would have to build on the various resources in
the people, the voluntary and citizens groups, working

there and the army of government health personnel

working in and for the affected people.

7. We believe that this is possible in the present situation
of Bhopal if a bold, imaginative and open attitude is
fostered by the decision makers.
8. We also believe that this will not be easy in the

present situation of Bhopal since the same apathy,
vested interests, status quo factors which obstruct
action in favour of the disadvantaged in our society
operate in Bhopal.

9. We have one hope that people are gradually becoming more
aware of their own rights; they will demand these
rights and also an acccuntobility from people in
responsible positions.

13

*

13

10. The strategy*'we have outlined is one of the many

strategies necessary to support this process.

REFERENCES

1. ICMR, The Bhopal disaster—current status (The first

nine days) and programme of research
2. ICMR, Projectizaticn of ICMR supported research
3. ICMR, Health effects of exposure to toxic gas at Bhopal,
An up date on ICMR sponsored researches, 10 March 1985
4* ICMR/ Medical research problems in Bhopal (V Ramalingaswami)

5. .ICMR, Pathology and clinical toxicology of the Bhopal

disaster (S Sriramachari)

6. ICMR, Medical Research on Bhopal Gas Tragedy, Press
Release, 31 MJan 1985.

7. ICMR, ibid. 12 Feb 1985

8. ICMR, ibid. 27 Feb 1985
9. ICMR, Thiosulfate therapy in MIC exposed, Minutes of
meeting at ICMR, 14 Feb 1985

10. ICMR/ Guidelines for treatment of Bhopal gas victims,
Press release, 4 Apr 1985

11. mfc Medical Relief and Research in Bhopal—the realities

and recommendations
12. mfc Approache document of a project to evolve a strategy
of medical relief and rehabilitation which best meets

the people’s medico social needs and expecations
13. Rani Bang, Effects of the Bhopal disaster on the women’s
health—an epidemic of gynaecological diseases. Reports

I & II

14. Praful Bidwai, Bhopal’s unending tragedy. Times of India,
25-27 March 1985

15. mfc bulletin No.112, April 1985, Medical Research in
Bhopal--Are we forgetting the people?
16. Disaster at Buffalo Creek (Special Section)., Am. J.
Psychiatry, 133s3, March 1976.

/

f
I

1

’■ V

■

«

J

>

■h-. .•

■ .X

.■ j-;

i’

I

E/k - 5%
I

Lung Function Tests in subjects

exposed to

M I C
as compared tc controls

■

V

iu (Z-^/vsout

A

Showing the pattern of compromise in Lung function in the affected

area as compared to the control area.
Obstructive pattern

No change

Total

29

9

98

136

Nagar
( Control
area )

4

3

130

137

Total

33

12

228

273

ir\r M J

•

Restrictive pattern

A rea

**** J ayaprakash
Nagar
( effected
are a )

Mina & V.K.

**

*

X2

value

•a=

26.42

at d.f. = 2 and p

.001

Highly significant.

P/C^\

■ Z74

52.

Results of the Lung function tests as carried out in JayaPrakash Nagar

( Affected area - Exposed to M I 0 )
age

g rou n

lO -14

15^ 44

Sex

No.

BSA ( M2 ) FEVI(Lit)

M

4

1 .23
0.14

0.74

1 .72
( .77

3

1.22
0.12

1.76 1’0?
C .84

2.0 7
C .88

M

45

1.49

2.04
C .47

2.39 2^^
C .47

0.11

1.64
0.44

1.97
0.38

1.50
0.14

1.88
0.53

2.20
0.43

1.37

1.51

0.09

0.48

1.86
0.58

1.35

0.94
0.39

1 .83
0.35

F

M

F

61 +

M

56

12

11

2

1.37

0.04
F

3

1.32
0.0 6

Total

1.59

F

0.09

45 -60

yvc(Lit)

1.39
C .31

I

o

1.96
0.31

FEVj/FVC ( % }

7^

«

afirxS 85.5

^'3

7f^r9

?

6 i ' J'f

136

BSA : - Body surface area in Square meters.
FEVi : - Forced expiratory voiiu ie in first second in Litres.

FVC : - Forced vital capacity in litres.
FEV^/fVC :- Ratio expressed a s %
Figures in Red indicate Standard deviation while figures in black­

indicate mean readings for the particular group.

I

Results of Lung function tests as cavrind out in Anna Nagar & V,E. Nagar

( Control areas - Not exposed to MIT )

ge group

Sex

No.

BSA ( M2 ]. FEV1 (Lit)

10 -14

M

4

1.22
0.19

1.93
0.48

2.20
C .51

87.8

F

6

1.15

2.10
0.40

84.2

0.13

1.77
0.33

15

44

45 -60

61

LIT) FEV-j/FVC (

M

55

1.51
0.12

2.66
0.51

2.99
( .55

88.9

F

52

1.35

2.54

88.6

0.12

2.25
0.42

0.43

M

6

1.53
0.09

2.26
0.19

2.54
0.24

88.9

F

7

1.41
0.22

2.13
0.18

2.48
0.21

85.9

M

4

1.38
0.15

1.91
0.15

2.17

88

0.16

1.28
0.05

i . 9(

2 . 13

0.0 7

0.15

F

Total

FVC

3

8^.2

137

BSA : - Body surface area in Square metres.
FEVjl : - Forced expiratory voluie in first second in litres.
FVC : - Forced vital capacity in llitres .
FEVj/FVC

Ratio in

Figures in red indicate standard deviation while figures in black
indicate mean readings for the Particular group.

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Table showing the pattern of couprouse in lung function in the
surveyed areas :

Rest. r a 11 e r n

Obst. pattern

10-14 Yrs.

Anna Nagar & V.K. Nagar

Jayaprakash Nagar

Age group

Obst.Hat tern Rest.Pattern

4

M

F

15-44 f fs

45-60 Yrs

M

& 3

F

2

M

I

1

11

1

1

11

i

2

4'

5

4

F

61 +

ft 8

M

1

F

2

1

1

9

29

4

1

Total

C

‘I* J

In all 38 out of the 136 people survev+^d in Jayaprakash Nagar (affected

area ) showed some compromise in Lung function as compared to 7 out of

the 137 surveyed in Che control areas of Anna & V. K. Nagars.

£

Table showing the significance levels of Pulm^onary Function tests

(Tests of significance performed between affected & control areas
after matching for age, sex and socioeconomic status )

*ge group

BSA

10

14

M
F

t
t

15

44

M

z = 0.95

F

Z= 0.V1

M

t = 0.54

45 -60

C . C8
o.8

**

FEV1

FVC

t=l.79
t =(’ • 56

t=l.04
t=0.57

**
z= 6.5O**7'1
z= 5.88
z values s Jgnificant at 5<rleve] .
**
**
z= 7.34
z = 7.22

t

2.14*

t

2.13**

*(at d.f.=16 p<Z05 )**(at cl. i.=16 p^.05)

61

F

t =0.46

M

1=u.38

1=3.88*
t 3.26**
(at d.f.16 p.001<p<.01);
* * (at
'
u.i.16 p<T).u5)
t= 1.61^
t 4.4u*
*(atd.f. 4 .014p<A05

1=0.88

F

1=2.80*
*(at d.f.= 4 p<.05)

7-bJT6-|Q..P/2-&T A'TidN

1=0.89

a p R.e£uuxS -

As sem from the table there is a significant decrease i n 1 li e

FEV-.&
1 FVC ir boll) the males and the females in the affected areas as
compared to the controls in the age group of 15 - 44 years as well as

45

60 years.

In the age group over 61 years there is a significant

decrease in the FEV

1 only in both sexes indicating an obstructive pattern
^3^2. 'KV

which could be possibly due to chronic bronchitis which is

in

this age group. No effect is seen in the younger age group of less than
cc

14 years.

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ABOUT OLD PEOPLE

Like other minorities, old people also always
get neglected.
*

Like children they were more vulnerable

to the gas, and many of them died,

The ones who have

survived are today not very healthy.

But people have

little time or energy to pay attention to than and

giventnem care theyneed.

Because people do not like

to feel that they are neglecting old people, they often
just forget about them!

And they can a.ford to do this

because old people are no longer earning members of the
family.

However, old people must be given special attention,

care and love.

It is true they are often no longer

contributing to the family income or support, but they
have done so all their lives and have contributed to

the growth and maintenance of society.

They brought

us up with their hard work and sacrifice.

They provided

the labour and services of the last generation.

They are

the retainers of the culture from which we learned our
values and often our skills.

If we care to make them

remember, they can tell us of our history.

All of this

is so easy for us to forget. and so we feel that we owe

them nothing, those old people sitting doddering in the
corner, alone, waiting for death.

Let us not let than

to

go so soon from us.

Let us try/care for them.

Old people have special problems.

don’t work so well.
joints get stiff.

Their bodies

They have aches and pains.

Their

They tend to get chest-infections.

and more so because of the gas affect.
can turn into pneumonia easily.

Chest infections

They get easily consti­

pated and their intestines can get blocked up.

If they

get diarrhoea, their old dried up bodies can loose

all its remaining water in no time.

Their old bones

are brittle, and can break easily if they slip and fall.
Because most of them are toothless, they are not able to

eat or chew enough wholesome food*

Nor are they able to

cook for themselves if they need to, and they feel they

can’t demand specially prepared food, so they suffer

Old people’s minds sometimes

from chronic malnutrition.

become weak, particularly when they are ill, and they

get confused and frightened.

So it is, in fact, just

a matter of time before one or more of these factors
gets the better of an old person, and she or he fades
away after a fatal bo^t of some ordinary1 illness.

We

say, "oh, he died of old ageia m
As health workers, we would like to help people
"live*1 in their old age.

living death.

It should not be a kind of

Some simple advice may help you to care

for the old people in your family or neighbourhood, to

make them healthier and happier.
1, Look old people in the eyes and greet them
with recognition and interest.
2. Ask them about their aches and pains and other

health problems, and encourage them to get a
check-up and advice or medicines for relief
frcm a doctor or health worker who cares.
3. See that they get enough warmth in winter, by
being well-covered sitting next to a fire at
night and spending time in the sun each day.

4. Make sure that old people who have lost their
teeth get enough food which is nutritious, soft
and easy to digest. like that which is prepared
also for very young children.

J

They should get

z

green vegetables which are cut up, which
will give them strength and help than to clean
their intestines and relieve constipation.

They should drink plenty of water and other

fluids, especially when they have diarrhoea.

5. Chest infections should be treated with a full
course of antibiotics which should be got

free of cost from a Government Health Centre.

Above all, always try to make old people feel that

they are needed members of the family and the community.
If you do this, they are likely continue to contribute

for the upbringing of the children and for the common
good.

GOVERNMENT PENSION

OLD PEOPLE

The government already has a pension schone for

old people who do not have any close relatives to

support them.

In the heavily gas affected area.

this scheme should be extended to all old persons.

In addition, nutritional supplementation should be
made available.

A part of way Health Centre’s activity

should be devoted to care of old people.

Tnis will

greatly reduce the burden on individual families and
ensure a minimum standard of nutrition and medical
care for old people which will otherwise be impossible

to implement.

We must press the government for these

facilities in the Health Centres.

sf
-T- <2-S > V<

r
/ '/

9

CA. e-<^- 5 e ‘

.. .

62

) Some medicines should never be taken on an^ empty
stornjb like Aspirin, as they may cause ulcers in the stomach.
)) Never depend only on medicines.

Remember that your body

has ays of healing itself if it gets a change.

Proper food

and^rinkin^ water. rest cleanliness. fresh air. some exercise

andlove - all of these things axe required to regain the best
of aalth.

Every person has a right to live in conditions

whee this is possible.

We must fight to gain them.

YOR HEALTH IN THE FUTURE

What will happen to your health in the future?

The question is difficult to answer.

Doctors and

scientists are carrying out research, but they are not

communicating the res Its to the gas-affected people.

All

of us must join together to force the authorities to provide
this and thus establish our right to information.

Secondly, much depends on the quality of medical care
given by the health authorities.

So far the Government

has made announcements but not followed them up with enough
seriousness of action.

If medical care is not organised

in a systematic way. the long-term effects will be worse.
Do not get disheartened by the damage your health has

suffered until now.

The human body has great capacity to

compensate for loss in functioning of organs.

Even if half

of our lungs, kidneys or liver are damaged, the remaining
half can take care of our body.

(cents •. .63)
f

63

Insist that the Government carry out the measures we
have suggested to prevent further damage.

You must continue

to struggle for your right to information and your right for
proper health care.

a s

5 es

You must not fall prey
pray to some of

fatalion cynicin- or dependency on others which is a danger
after such a ghastly disaster.

All of us must keep on

struggling for a better life.

We must also join all the

exploited and oppressed people to organise and fight so
that one day man-made disaster will not be possible.
The attitude of the medical establishment and of the

rich people of Bhopal that the poor are "greedy* for

compensation is shameless.

These rich people seem to feel

that nothing has happened^ because they live on the other

side of Bhopal.

People throu^iout the whole world beyond

India have been shocked and yet the residents of Arera

-S v o

> \y^

Colony feel that the gas-affected people don’t even deserve
meagre amount that the Government has spent.

If you hear

this attitude spoken by anyone, just don’t pay it any mind.
You deserve heavy compensation and you all must organise and

fight foz^Lt.

There has never in the history of the world

been a worst industrial accident, and it is not only your

right but your historical task to win the battle and
s'Re

stronger than the struggle of all victims of oppression

by Capitalist industries all over the world!7

' J

Fight for your right to Health ;I

Fight to your right to life 1
Fight to your right to Information;I

(conts....64)

28

OTHER ORGANS - THE KIDNEY,

EH
LIVER AND BRAIN

Although the most obvious effects of the gas were on

the eyes, the lungs, the gastro-intestinal tract and the
blood, there is evidence that the liver, kidney, brain and

reproductive organs were also affected.

But because of the
‘----- - -------------------- --

secrecy maintained, very little scientific information is

available•

As mentioned before, postmortem examinations

showed cherry red colour and oedema of various organs and
tissues.

A number of gas victims died of kidney failure at a
nursing home in old Bhopal within two to three months of
the gas leak.

Kidney failure is known to occur as the

result of inhaling Moncmethyl Amine, which is a decomposition
product of MIC when MIC combines with water vapour in the air.

Destructive changes in the liver have been reported
from postmortems.

These are still unconfirmed.

Possible

cases of jaundice due to toxic liver failure may have been
confused with the usual seasonal wave of infectious hepatitis
due mainly to polluted drinking water during the hot months.

In March we began urging the people to report all cases of
jaundice to a Government hospital or dispensary,

Another

serious c&u^e for jaundice could have been viral hepatitis

which would have been spread by unsterilised intravenous
needles and syringes used in the desperate attempt to save

lives during the first few days of the gas leak disaster.
Viral hepatitis takes about lOQ^Sys to develop into jaundice,

and is usually fatal.

Surprising and fortunately, not many

cases of viral hepatitis seem to have occurred,

People usually

do not go to doctors when they have jaundice, because the

usual type of jaundice has no special cure in allopathic

(Contd...29)

♦

29

medicine/ and people know It*

However/ you should report

any case of Jaundice which you come to know of to your health

worker or to a doctor so that all cases of jaundice are
properly recorded and the cause detected/ whether it is the

1

seasonal jaundice of infectious Hepatitis/ Viral Htepatltis

due to unsterilined intravenous injections/ or Toxic hfepatitis
due to the effect of the gas or other poison*

Alcohol is

bad for the liver and dangerous for people who have had

jaundice.
The effects of the gas on the brain are also not proven*
Many persons were unconscious for varying lengths of time.

Hundreds of persons reported poor memory and inability to
concentrate/ known effects of M.I.C.

of the brain were also not normal.

The postmortem specimens

Human embryos affected

by the gas while in the mother’s womb may or may not develop

some degree of mental retardation because of the starvation

for oxygen due to the gas poison.

We will discuss more about

the effects of the disaster on the minds of people in the

later section on mental health.
e

30

THE REPRODUCTIVE SYSTEM
■

A very high proportion of women suffered after the gas

leE.k from

system.

variety of problems related to their reproductive
A$ usual, women’s problems have been neglected by

the tfiedica| establishment•

x-

Till today there is not a single

report by the ICMR or any other established body on the
menstrual ijrrecu^rities, the excessive white vaginal discharge

and the suppression of lactation reported by hundreds, even

thousands of women in the heavily gas-affected localities.

Abortions,I stillbirths, perinatal deaths, and deformities in
babies born since the gas leak, however, has been the subject
of sensational news, much of it unreliable.

The house-to-

house survey study by ICMR has attempted to detect the incidence
of these abnormalities and to compare it with the expected

rates.

Unfortunately, because such community statistics were

never collected before in Bhopal, it is not possible to
CJ

compare the figures with previous years.

Since women’s problems

associated with reproduction are usually dealt with silently

at heme and kept hidden, they rarely get recorded.

Indeed,

it sometimes seems that only because of the threat to the

man’s offspring is there an interest jn the women.

Nobody

cares about ordinary non-pregnant women, or women who cannot

have children!

GYNAECOLOGICAL PROBLEMS

In early January women volunteers of the Zahreeli Gas
Kand Sangharsh Morcha carried out a house-to-house survey of

several of the areas worst affected by the gas.

They found

an extra-ordinarily large number of women complaining of
excessive white discharge which the women said had begun or

increased only since the g&s leak.

Another typical complaint

was that their menstrual periods were heavy. and were coming

(Contd...31)

31

more frequently after as little 10-15 days*

A team of four

doctors of the Medico Friend Circle presented a brief medical
report and recommendations st the National Convention convened
by the Zahreeli Gas Kand Sangharsh Morcha at Bhopal on the
17th February, 1985, in which they mentioned these problems

in women, and the need for the Government to pay attention.

In early March, three months after the gas leak, two
woman doctors of the Medico Friend Circle responded to the
call of the ^ahreeli Gas Kand Sangharsh Morcha activists and

carried out a field clinic investigetion in two badly gasaffected bastis. Jaya Prakash Nagar and Kazi Camp.

them was an experience^gynaecologist .

One of

They compared the

findings of 114 women living here with 104 women of Sudama

Nagar (the **control group”). ary

equally poor colony situated

away from the Union Carbide Fcictory*

The doctors were assisted

by Morcha volunteers, and two nurses of the dispensary
by the Self-Employed Women’s Association (SEWA)*

Towards

the end of March two more independent community-based studies
confirmed that the problems were peculiar to gas-affected
women and hence likely to be due to the gas ieeik from Union

Carbide.
What did
the doctors find?
— .
X -L
*'
a

1)

S

\ L *

I

,

J

About SC per cent of the women had abnormal white
discharge from the vagina which was typically profuse.

thick, whitish yellow, lacking foul smell or local

irritation, end hence unlike the abnormal white
discharge seen in infections due to micro-organisms.

In the control group, only 27 per cent of the women
had abnormal white discharge.

2)

Swelling and tenderness of the structures on both
(Contd...32)

32

sides of the uterus in 79 per cent of gas-affected
women with back-ward bedding and restricted mobility
of the uterus in about 65 per cent. indicating a

disease known as pelvic inflanmaticn*

Only 27 per

cent of women in the control group had pelvic
infl amn i a t i on •
Ulceration around and inside the opening of the

me?;n=?g’

uterus (cervical erosion and endocer-

vicitis) in 75 per cent of women (most of whom also
had no.l and 2)/ compared with 44 per cent in the
control group.
4)

Excessive menstrual bleeding in 30 per cent of the
women, compared to only 1.2 per cent in the control

group.
•Pelvic inflammatory disease (P.I.D.) of nearly 8C per cent

incidence is extra-ordinarily high.

The usual incidence in

patients attending gynaecological hospital clinics is from
3 to 10 per cent.

The excessive menstrual bleeding

and

retroverted fixed uterus most probably resulted from P.I.D.,

and appears to have been associated with the gas exposure,.

Many doctors disbelieved this conclusion.

They argued

that poor women living in these slums are not clean and have
a high rate of tuberculosis and other infections which would

be the cause of this swelling.

However, tuberculosis usually

makes up only a small proportion (5 per cent) of P.1.0. cases,

and is not painful or tender.

Usually women with tuberculous

P.I.D. are not able to have children and their menstrual flow

is scanty.

The other usual cause of P.I.D. is pus-forming

bacteria.

Even this cause is unlikely in the gas—affected

(Contd...33)

■

-

(l

-J.

j'

33

women because so many of them had received antibiotic
tablets and capsules from the Government and voluntary

groups after the gas leak.

addition/ the doctors noted
In addition,

that the women were remarkably clean, despite their poverty.

When we found out these facts/ we became particularly
concerned because P.I.D. can lead to infertility or abnormalities:

if pregnancies occur later.

Excessive bleeding can also lead

to severe anemia (thinning of the blood) in malnourished
slum women, putting additional strain on the lungs to get

enough oxygen from the air for the body to keep alive and

functioning.
The Government/ however, paid no attention.

A small

attempt to run a woman’s guidance centre and check-up clinic
was made in April and May by a volunteer woman doctor and
others working with the Trade Unions Relief Fund (of Bombay)/

but this could not be continued for leek of another doctor
and need to attend to many types of other work also.

The

Jana Swasthya Kendra has wanted to open a spe ci a 1 wm an1 s

clinic ever since it started.

But no woman doctor has been

available for this work on a continuous basis, and therefore

there has been an unfortunate delay until now.
In the month of September/ more than 9 months after
the gas leak occurred. a team of about 40 women volunteers
from women's organisations outside of Bhopal, co-ordi nated
by the Medico Friend Circle, carried out a survey of women
in three of the most gas-affected areas - Kenchi Ghhola,

J.P. Nagar and Kazi Camp (ICMR demarcated areas).

The survey

went into depth to try to understand the effect of the gas

on the women’s reproductive system, including menstruation.
(Oontd.•.34)

34
It was a 30% random sample survey, or, in other words, the

ICMR-numbered households to be surveyed were choser) at random

as in a lottery, 30 out of every 100.

In this way, women of

about 150C households were interviewed carefully for about
half and hour each.
During the survey, which toolc two days in each of the

three bastis to complete, a gynaecological clinic was set up

and run by two doctors end other volunteers with the help of

the local people.

One of the doctors had led the first M.F.C.

field clinic investigation six months previously (mentioned
above).

She noticed that, in general, the incidence of P.I.D.

and associated problems of excessive white discharge and.
disturbed menstruation was now mucn reduced compared to the

findings in March, approaching that which is expected under

the ordinary poor conditions of a slum.

The clinic was open

to all women including those whose numbers were not in the
survey sample.

DO YOU STILL HAVE PROBLEMS ?
If you are a woman who still has excessive white discharge,

menstrual disturbances. pain in the lower abdomen or back,

kx± burning on passing urine, itching and ulcerations or any

other special problem of similar kind. or if you have not

been able to have children after trying, do consult a woman
health worker and ask her to help you or see a doctor who

should examine you properly.
JC'C-

This is important even if your
<

C>-<-

problem Is not due to thelges, and after all that has happened

to you because of the gasz^you deserve complete free medical
treatment for all your complaints throughout your life.
If you have Pelvic Inflammatory Diseaset F.I.D.), a

(Contde..35)

35
doctor must prescribe a course of antibiotics for you and

examine you again after one week to see that the^swelling

has gone away*
if there is no infection, but you still get pain during

your periods, a simple, cheap tablet called "asip^in“ will

probably, relieve your p^in.

(It is the same tablet used for

headache.)
If you have been having heavy bleeding during your

periods, you should take simple iron tablets known as “ferrous

sulfate*•

If you are pregnant, or you are breast-feeding

your baby, add catcium in the form of a “calcium lactate”

tablet along with a tablet of ferrous sulfate twice a day
before meals. No further tonic or injection is necessary.
ail
as^these are just a waste of money which you can use on

better food.

You may continue a tablet of each “%«y f«r

three months.

You must demand that your husband be sensitive to your

health problems in the same way that you are sensitive to him.
You must tell him not to insist on sexual intercourse if you

get pain because of it.
such problems.

Consult a woman health worker about

We would like to point out that sexual

intercourse is not the only or the best form of sexual relations.
Some gas-affected women reported to the wcman doctor

5,

volunteers in February that their husbands werejhaving failure

or weakness of penile erection since the gas leak :- id therefore
unable to complete sexual intercourse

•<

Tills was an

incidental finding, since we had inquired only whether they

were practicing contraception.

Many men have also confided

this problem to doctors and health workers of the Jan§ Swasthya
Kendra since June.

It is probable that in the early days

(Contd...36)

36
after the gas leak, this was due to the toxic effect of the

In any case.

gas, but it is not^likely to be so any more.

if you have a problem, do consult a doctor or health worker.
0Occasional
t
failure of erection occurs in all normal men, and

Sexual

only Causes a problem if they start to worry about it.

function is very sensitive to one’s mood and frame of mind.

It does not mean that you are "not a man", and the word "namardi” should never be used by anyone to describe this problem.

WHITE DISCHARGE A*D FERTILITY -{THE MUCUS METHOD
Sisters, please remember that a certain amount of white

discharge during part of the menstrual cycle is absolutely
normal. . Tn fact, if you notice carefully, normal white
61. f/1 O uc

discharge changes its^texture and colour in a regular
sequence during the space between one menstrual period and

the next•

It also means that you are fertile and that you can

have children.

f>

4^

Non-fertile white discharge ia sticky, tacky

or creamy and yellowish or white in colour.

(

If you examine

this between your £h± finger and thumb (after gashing your

hands well first), you will find that it breaks when you move
your finger and thumb apart, as we’ve shown in the picture.
Normal healthy wcmen are fertile in the middle of their
menstrual cycle, and this is signaled by several days of clear
slippery stretchy transparent mucus discharge which gives a
wet. slippery feeling between the legs on these days.

This

type of discharge usually continues for 2-6 days or so, and

then suddenly changes within a day or two to sticky tacky or

creamy white or yellowish discharge as before.
After this happens, if you have not had sexual relations

during the fertile mucus stage and therefore could not have

become pregnant. your menstrual period will come to in about 12
to 16 days.

(It may come sooner, in 10 days, if you are still

breast-feeding your last baby.) /
(Cbntc:... 37 )

37
The changes in the vaginal discharge correspond to the

monthly production of an o«uni. or ec^. inside t±xn woman’s body.

The ovum is released (ovulation) from the one of the two
ovaries, and travels through one or the other uterine tube

into the uterus.

If sexual intercourse occurs, a large number

of sperms in the man’s semen are released inside the woman’s

vagina around the mouth of the uterus.

The/ try to swim up

into the uterus, and through the uterine tubes if necessary.

to find the single ovum and unite with it.

Actually, only

one sperm is needed to combine with the one ovum, but since
it’s a blind search, many more sperms than necessary are

produced in the man’s semen.

The slippery, stretchy mucus

coming from the mouth of the uterus helps the sperms swim and
climb up into the uterus. and keep the sperms alive for some
time if the ovum is not yet available.
The ovum lives for only about 12 to 24 hours (one day)
(J\Y\

and the sperm for about 48 - 72 hours (two to three days),
h.

The ovum is released on the last day of the fertile mucus

phase.

Therefore, if you are using this knowledge as a method

to avoid pregnancy, you must not have sexual intercourse
dcujo of-piIe
yuntil xhree days have passed after the last day of fertile

mucus.

you ever find the fertile type mucus starting,

starting again, which is unlikely^Tbut can occur if the ovum

Palled tc get released earlier for some reason, simply count
off three days for safety after the fertile mucus stops again.

If you wish to learn tc use this fertility awareness as

a family planning method, it is better that you learn it
properly

from a special teacher of natural family planning

(or a health worker specially trained).

Doctors and health

workers of the Jana Swasthya Kendra (Bhopal) will be able to

guide you to find such a person.

It will take you up to

(Contd..<38)

38
three months of careful observcition, and regular weekly

consultation with your teacher in the beginning before you can be

absolutely confident.

Until then, your husband should use

Nirodh, even when your vaginal discharge appears to be infertile.
to avoid any mistake.

You may also use this method in the reverse when you
want to have children.

It may be that you have not been

able to have intercourse vzith your husband on the fertile days*

But since there are many reasons why wbmen and men aren’t
able to have children, you and your husband should have a

thorough check-up if there has been any long-standing diffi­

culty.

The mucus method is specially good for women who have
long or irregular menstrual cycles in whom ovulation is delayed

or some times early.

It is also very good for young (inothaYS

who ore breast-feeding a small baby and have not yet got the

first menstrual period since the baby’s birth, as the first

ovulation occurs about 2 weeks before the first menstrual
— Older women approaching menopause sometimes get
pregnant because they think they are no longer fertile.

is true their fertility is less than before.

It

But a woman

who already has learned to recognise her fertile mucus will
not fell into this trap when the infrequent ovulation does occur.

The mucus method has many other advantages :
it does not cost money.
it does not disturb your normal pattern of menstruation

or stop your ovulation, like hormone pills or injections
it does net cause bleeding or infection with risk of
co 2-^

later infertility.
;?

the loop or copper-T,
(Contdd..39)

39

it is not permanent. like the male and female
sterilization operation.

it does not depend on a doctor, and
it can be used in reverse to achieve pregnancy.

But there are some difficulties, too.

It requires anS

It

intelligent scientific outlook on the part of women*

requires co-operation and respect of the women by the men*

In short, it requires a personal decision on the part of

couples to recognise and regulate their fertility*

Ml three

of these conditions are difficult to meet in today’s society*

A strong women’s liberation movement can help to bring about
the required change, however^J
PREGNANCY AND CHI ID BEARING

Effects of the toxic gas on pregnancy and particularly
on the unborn child have been the subject of greatest concern

and public controversy*

Despite the Government •« repeated

denials of an increase in the rate of abortions and stillbirths.
independant surveys, statements of lady doctors, midwives.
gas victims and graveyard records told otherwise from the

beginning*

Recently, even the Government has publically

admitted that both the abortion rate and stillbirth rate
were in fact significantly raised^

The rates were highest in

the first few days and weeks/ but continued to remain higher

than usual well into February and March*
At the time when the first MFC team investigated for

its report in mid-February, abortions of •missed* type, were

reported by both private and Government doctors though non­
official channels*

This indicated that damage and death of

the embryo within the womb probably occurredtime of

(Contd* * * 40)

40
*3

the exposure to the toxic gas, but that some more time

elapsed before the abortion occurred.
Psychological and physical stress factors also undoubtedly
played a role in the higher abortion and stillbirth rate#

for there was unprecedented upheaval, fear and grief among

the people.

This is as much a responsibility of Union Carbide

as is the actual toxic effect of the gas.
Many women who gave birth to children after the gas leak

reported more difficulty and pain than during previous
deliveries.

This may have been due to the problem of carbatj

mylation of muscle proteins, like myogJ^bin, interfering again
with oxygen availability and utilization.
( jr- o e.

f

A *-

LACTATION

<

1 '

Most jwomen who were breast-feeding their children at the
time of the gas leak reported a decrease in their milk output.

The milk output of buffaloes and cows was also reported by
official Government sources to have reduced drastically.

down to 10%•

Since milk out-^ls very difficult to measure in

women, and furthermore, since no attempt was made to confirm

this by the authorities, it is difficult to prove.

But we

were able to see many emaciated infants who were brought to

us because of diarrhea.

The cause was detected to be

unsterilised bottle feeding of cow’s or buffalo’s milk since
the baby could not be satisfied by the mother’s milk alone!

NEW BORN CHILDREN
Many mothers reported to us that their children were
born with peeling skin on the

palms and soles and had

blisters on the other parts of the body.

Some of these cases

(Contd...41)

41
we saw*

They also reported that there was an abnormal

greenish discolouration of the body which lasted about a

We could not confirm this by seeing it ourselves*

month or so*

In general, new born children are reported to be smaller
than their older borthers and sisters were.

Some of these

low-birth-weight babies have been born prematualy.

The death

rate of newborns, ordinarily^ high among poor people, was

further raised.
... -

.

Recording of birth weight and rate of growth

C\K

of children isrimportant part of child health care, and
particularly so for ehildren of gas victims, but so far there

is little evidence that the Government is making provision for
thi s.
'DEFORMITIES IN CHIWREN

Deformities in newborns, although less than were feared.

are probably about 3 to 4 per cent. or about twice that
V

of the .normal rate.

Expert opinion was required to assess the

extent and probable way by which the toxic gas could have

created these deformities#

However, quite often postmortem

was not performed and medical experts were not friwayb
v ail ahi e •

■» al scientists
4
*i. 4.who
.'v* may» v.
—
... — «_ t. —
j
Medical
have
gathered

selected cases to do research were not in touch with the
do
people, nor did they care to share their observations with
the people, but^prepare^ to address the elite scientific
conmunity and perhaps become famous by printing a paper in

a scientific journal.

We, however, noticed that the most frequent cases of

severe abnormality were of "anencephaly* (lack of formation
of the brain, so that there is no skull) and wspina bifida”
(a gap in the back-bone through which the nerves of the spinal
column bulge out).

We came to know of. a few cases in which

spina bifida was combined with closed anal canal and club-feet.

If your child has a deformity and has survived. surgery
(Contd.•.42)

42

may be possible to correct it.

You should claim special

liie-long suppoz-t for the child from Uhion Carbide.
mental retardation -•>

4^

I'A

c*

»

»

As we mentioned before, mental retardation is a possible

outcome because of the interference in oxygen supply to the
brain of the baby when it was in the mother’s body.

There

are simple ways to assess your child’s mental growth and

abilities in early childhood.

If you worry that your child’s

mental growth is retarded, consult your health worker who
will teach you seme simple tests.

Qiildren who get mental

retardation because of the gas leak deserve to get special

support from Union C. rbide and the Government throughout their
lives. and their parents will have tc demand this.

FUTTOE COHO:PTIONS AND UNBORN CHIIDRBN
All the children who were in their mothers’ wombs at

the time of the gas leak were born by the end of September.

Henceforward^the children being born are those conceived

after the gas leak to parents, both mother and father, whose

organs of generation, the ovaries and testes, were exposed
to tile toxic gas which they inhaled into their bodies.

Some

doctors are concerned that the primitive ovaries^ and testes
of giz^ ^Etner boy children mayy^iave ^Tsol, been a ffected.

The

ovaries of a girl child are particularly vulnerable, because

they already contain all the primitive ova

that she will

later produce during her child-bearing age.

A man, on ’the

(Contd...43)

y

43
other hand, keeps on producing new sperms throughout his

adult life.

Today, we cannot tell you jmeM whether or not there will
be any effect in your unborn children. or in your children^
children.

After the atomic bomb was dropped by America over

the two Japanese cities of Hiroshima and Nagasaki 40 years
ago. serious deformities have occurred in the children of
the survivors due to radiation damage.

Chemical damage is

different from radiation damage, and it is possible. therefore.

that there will be no effect.

However, it is important that

all of you are aware of the possibility. and that the Government

keeps on monitoring for about two generations in order to
detect the slightest new development.
Earlier, doctors of the Medico Friend Circle had advised

couples to practise contraception until such time as the
remaining poison from the gas was removed from the body to

avoid risk^.

although it appears that there are still people

who have higher than normal levels and urinary excretion of
thiocyanate, indicating the persistence of free cyanide being

released in the blood-stream.

This is xiow not a factor to

worry much about in most people, particularly in those wlic
no longer have symptoms.

Those persons witn general symptoms.

which we discussed in the earlier sections, should t ake 1 to

3 injections of sodium thiosulfate.

After that, or until

further notice. we don’t think there is any more need to

worry about avoiding pregnancy if you want to have a child.
If you do wish to practise>contraception for any other

reason, the best method is the proper use offNirodh by men.

Consult your health worker about this.

For vzomen, it is

better for health reasons that hormone pills and injections are
avoided, and so you also should see that your husband uses

Nirodh properly, and that it doesn/t teap during use.

(Contd...44)
i

You may

44

also learn the mucus method of natural family planning (or

fertility awareness)/ which we discussed already in detail/ so 1c

that you will recognise the exact days in the month on which

conception can and can not take place.

If you realty want

a permanent method of birth control/ the male or female
sterilization operation can be done.
Some persons lest their small children in the gas leak

and want their sterilization operations reversed.
many persons have had this

Already

reversal operation*4 done.

There

is about a 25-50 per cent chance of success.

Inform your

health worker if you are interested in this.

You should receive

specially good care during and immediately after the operation.
It will be done free of cost.
If you find that you are pregnant/ we would like you to

follow certain routine care advisable fo r al1? pregnant women•

The Government has set up special centres for this/ and should

be required to set up more and better facilities for women
the present ones are poorly run and inadequate.

You should

attend regularly from the third month to see that the baby

and the womb are growing normally/ and that any abnormality can
be detected end treated early.

Your delivery should preferably

be conducted, in a hospital or in specially opened maternity

centres run by the Government so that any problems during the
delivery can be immediately attended to by a qualified doctor

or nurse.

The neighbourhood dai should be trained and brought

into collaboration with these maternity centres/ as they know

the overall physical and social needs of the women and can

reassure and continue to assist in the delivery of the baby

when ail is normal.

In a hospital or maternity centre/

(Contd.•.45)

45
your baby will be immediately tested to see that it is
quite OK, its weight will be taken and any abnormalities
will be recorded officially*

advice will be given.

Any necessary treatment or

Keep all records carefully, as

they may be valuable#

HEALTH CARE OF CHIIDREN
Many children were badly affected by the gas, for they
were in a very tender period of life. Some of them will
carry the damage in their bodies for the rest of their lives.
They
and in some cases this may get worse as they grow up.

may be helped to overcome this, or at least to live with it.
Along with health care, the

by proper health care and guidance.

progress of these children or any deterioration in their

health must be properly monitored so that needed facilities
can be easily claimed in compensation from tftiion Carbide.

The Government has a special moral responsibility to see that
the children’s health is well looked after in the gas-affected
area.

MEDICAL CARE WHEN YOUR CHI ID IS SICK
doctors and health workers must be made

available by the Government to look after the children
properly whenever they fall ill.

Health workers must help

the doctors to identify all the children who are weakened
and therefore at special risk.

You should not take your child

to many different doctors or centres, but settle on the same
centre so that you and the doctors and health workers get

to know each other.

If the doctor and health worker get to

know you and your child well, you will be able to get the
best health care for your child.

aJso,

the child will be

less likely to get the wrong medicines by mistake. or too

much medicine.

This is very important.

Bad accidents

46
have occurred because of the child being given the wrong
medicine or getting too much medicine from different placesREGULAR CHECK-UP AND WEIGHING

Your young children should be seen by a health worker

or a doctor once a month regularly9 even if they are not sick.
The most important part of this check-up is measuring the
For all children from birth until

weight of your child.

they complete five years of life/ this should become a
routine as these are the tenderest most vulnerable years

Your child•s weight will be recorded

of your child*s life.

by your health worker on a "Child-Health Card*/ and you
yourself will be able to see from the card whether the child

weighs enough for his or her age/ and whether she or he is
gaining weight every month as a child should.

On this same

card/ your health worker will record other things/ too/ like
whether the 4Siild has had any illness or disability/ and
upon which dates the child has received vaccination against
diseases.

A copy of your child’s Health Card will remain

with you in your house.

A health worker can go from house-

to-house carrying a simple weighing machine to weigh each

small child every month/ and you have a right to demand this
service from the Government.
If it is found by weighing that your child is not growing
properly/ your health worker will advise you to attend the

nearest Child Health Clinic set up by the Government.
neglect this advice.

Do not

It is always better to detect the cause

of growth failure at an early stage.

It could be due to not

getting enough food/ or diarrhea off and on# or worms/ or

ear-discharge/ skin infections/ or tuberculosis.

It could

also be due to damage to your child’s lungs from the gaS/ or
to some other long-term effect of the gas which has weakened

(Contd.. .47)

4 7

your child’s resistance to diseases.
VACCINES AGAINST DANGEROUS DISEASES
r
Scintists

say that MIC/ like other isocyanates/ is likely

to reduce the gas victim’s ability to resist diseases by
weakening the body’s self-defense system.

This is in addition

to the other ways in which the people have been weakened by

the gas.

Your child’s ability to fight particular diseases may
be strengthened by giving vaccines.
injection or by mouth.

Vaccines are given by

Dangerous diseases which attack young

children, like Tuberculosis, Whooping Cough, Diptheria,
Tetanus, Polio/ and Measles, all have vaccines.

The vaccine

for Whooping Cough/ Diptheria and Tetanus is combined together
and is called ” Trippie Vaccine”•

You must see that your

children are vaccinated at the right time by a health worker.
The proper time-table for your children's vaccination is

given here for you to understand.
VACCINATION TIME—T2B LE FOR CHILDREN

When to give
the Vaccine?

Which Vaccine?

Against what Disease will
it protect the Child?

Soon after birth/
only once.

•’B .C.G.”

Tuberculosis (causing
fever and wasting or
death) •

In three doses/ at
4th/ 5th and 6th
month after birth,
“booster dose at
2 years”•

”Trippie”
Vaccine
(injection)

(on skin)

Whooping Cough
Diptheria (high fever/
white patch on
tonsils)
Tetanus (stiffness and
convulsions).

Five doses, oneea month/ Oral
starting in 4th month
”Polio”
(with Trippie)
Vaccine

Polio (several strains
of the polio virus,
causing paralysis and
wasting of limb)

One dose/ as early
as possible after
9 months.

Measles (which makes a
child weak and prone
to get diarrhea and
pneumonia)•

3

“Measles”
Vaccine
(Injection)

(Contd.•.48)

48

By any chance. if you miss a doso, do not abandon the
course of vaccine.

Consult your health worker or doctor

for advice.

Except for Measles Vaccine, all the other vaccines are
available from the Government Child Health Clinics.

The

Measles Vaccine should also be made available free of charge
for all children in the gas-affected localities.

You may

wonder why?

Measles is a disease caused by a virus.

Viruses are so

small that they cannot be seen by anyone even with an ordinary

microscope (but they can be seen by scientists through the

very expensive "electron microscope")•

Other diseases caused

’ , Chicken Pox, Jaundice, and
by viruses are the Common Cold,
1

Polio.

can kill viruses.

Doctors dun -Jt have ^<any=

So there is no way to cure these diseases by giving any
medicine.

We have to depend on the body's own natural defense

system which can destroy the virus within a few days or weeks

and cast it out of the body.

Therefore, ordinarily if a

child is well cared for, kept clean, given enough easily
digestible food and drinking water, and gets enough rest.

he or she will recover without any medicines except some

simple vitamins ancp medicine (when needed) bring down high fever.
But in a child who is weak, or whose family is poor.
Measles can play havoc.

It reduces the body's appetite for

food, and breaks down its ability to resist other common
diseases.

Therefore, children cannot successfully fight the

infecting organisms which cau$e cough, pneumonia, diarrhea.

ear discharge and skin infections.

So after getting Measles,

a poor child frequently remains sick with multiple infections.

gradually becoming weaker and weaker.

The child now cannot
(Contd. • .49 )

49
eat enough food because of the infections which weaken him,

and he cannot fighl^the infections because he cannot eat enough

food - thus, the child gets caught into a vicious cycle of

malnutrition and infection, from which is very hard or may
be impossible for even a very good doctor to save him.

This

vicious cycle can ultimately lead to death. as we have drawn
in the diagram for you.

In this way, /Measles is indirectly the No.l Killer-Disease

of children in India and other poor countries.

Especially

in Bhopal, therefore, the vaccine to protect children from

getting Measles must be given once to all children of middle
class and working class families upto the age of five.

It is

cheap and safe, and should be made available inmediately by
the Government as a top priority

THE IMPORTANCE OF CLEANLINESS
Certain problem diseases, like diarrheas, worms and skin
Infections, can be reduced greatly by practising some simple

rules of cleanliness as a way of life,

teach your Children the following rules
1)

Please practice and
3

Wash your hands with soap and water after passing

stools and before eating or handling any food for
others•

2)

(Ash may be used instead of soap if necessary^

Trim you fingernails once a week. (The dirt in the
nails can cause diarrhea and worms).

3)

Use latrines.

If you defecate in the streets or open

fields, flies and animals can pick up and spread

disease germs.
4)

Protect food from flies.

Flies spread diarrhea.

(Contd < • • 5() )

50
Fight flies in all possible ways, and cover sleeping

children with thin cloth or netting.
and soap to prevent

5) Bathe daily with

skin diseases.

Children will learn these clean habits only if parents
themselves practice them.

Parents also can benefit greatly.

since they will not have to waste so much time and money on
taking care of sick children.

In order for the daily practice c£ clean habits to be
possible, the Government will have tc increase the supply <jf
water, provide mere drains and build enough sanitary latrines.

You musty ensure that your demand for decent sanitary conditions
in y**ur coimuunlfcy are met by the Government.

WHAT ABOUT STRENGTH?

At T) Tore ICS?

There is not a single tonic or injection in the world
that can give real strength to the body.

Strength can only

be built up by adequate and wholesome food, enough exercise

and restz freedom from illness, and a clean environment.

In

addition, continuous lox/e and attention from parents and
other people are necessary for a child to feel strong.

These so-called "Tonics" which you want to be given to
your children have a very limited role to play.

They contain

a mixture of substances called "vitamins" (like Vitamin A, B, C

and D), and *J/salts" (like Iron and Calcium).

They are necessary

in small quantities for your body to work properly.

These

m i z? i^-rcJL

vitamins andysalts are present in the different foods we eat.

If we do not get proper djood, v-e lal.U. rynr I u j ^frtl
and'.salts,

vitamins

-to problems like redness and soreness of the

mouth, white spots on the face, night-blindness and even loss

(Contd...51)

51

of appetite.
tn

When these problems arise, tablets of vitamins

(~c^.

But at the sane time/ the diet must

and^salts may be given.

be improved/ as food deficiency is the root-cause of the

problem •

If enough food is taken/ and other causes of ill

health are removed/ a child’s weight and strength vill increase.
If it does not/ consult your health worker or a doctor to

find out What is wrong.
rnnoenx(

If vitamins and/salts like iron and calcium are needed/
they should be taken in the form of tablets to avoid the

unnecessary and inflated expense ef M tonics’*.

If small children

cannot swallow tablets/ liquid solutions can be prepared and

dispensed free of charge at the Government Child Health Clinics,

but you will have to raise a demand for this.

Otherwise you

can grind up the tablet and mix it with sugar wa^er.

This will

save you^money which you can spend on providing extra food
for your little children to make them strong.

FOOD TO GROW STRONG
Good food does not necessarily mean very costly food.

A vegetarian diet can give all that is necessary for a child
to became strong.

But you must remember that a mixture of

foods is necessary.

Only lice ex only rotis with chillies

will not do.

Tnere has to be a mixture of one cereal (rice.

wheat/ jowar/ ragi, makka, etc. ) with any one pulse ( dal.

Ghana/ etc./ about one third as much as the cereal) ana any one
vegetable or fruit that is available in the season, like
Jr" <^.On yfc*-'

guava/ banana?^r papayaj.

the vegetable or dal.

Children require a littlet oil in

Milk contains protein and calcium and

is good for growing children.
seezls

Soj&are jroundnuxts.

Sio routed

n?Ocrmf/ -h^o-rt eJn .)

pulse^are very nutritious and contain extra vitamins.

Green

leafy vegetables contain protein/ vitamins/ calcium and iron.
(t pa-pa.L\c<-f

.J) err r^cL CCo-rroh^f

( <^c .) cud

‘ryit^kc

(Zr.cP

(Contd...52)

52

Rotis can be made more wholesome for children by mixing

beoan or soya bean flour in 1/3 to 1/4 proportion with wheat

or jowar flour, and by adding a little oil or ghee if possible.
Gur is good for children in small quantities as it contains

iron in addition to sugar.

For families who are not -sgrtetr vegetarians, eggs are
good to have occasionally.

Very small fish which are sometimes

cheap are also autritious, as they contain a lot of protein.

minerals and some fat.

Cheaper animal meats can occasionally

supplement the diet in ncn-vegetarians, but it should be

inspected and well cooked to avoid disease.

Bones are sorna­

times available separately at low co^t and. can be made into
■1

*

wholesome soups for children to soak their chapatis in, or

te mix with rice and vegetable*
FEEDING OF SMALL CHILDREN

Very small children require special care in feeding.

Mother’® milk is the best for the first siK months of life.
For this. the mother needs to eat plenty of wholesome food J

As we mentioned before, lots cf gas—affectedt women reported

a reduction in their breast milk so that their infants remained
hungry and weak.

If even now, you find that you cannot produce

enough milk to satisfy ycurjtaby, consult a woman health worker.
Slie wilx suggest various ways for you to try and increase

your milk output.

In case these efforts are not enough, you

may have to supplement your milk by goat's, cow’1 s,
s. or buffalo's

Certain precautions are to be followed when giving
top milk and a woman health worker can guide you if you ask

her.
y

^.v
r-

y I

You should not feed your child by bottle, but instead

use a katcri and spoon whiclk you can clean properly,

Buffalo,

cow and goat milk which is thick should be diluted to half
strength in the beginning and supplemented xjith some sugar to

make it similar to woman's milk which is sweeter.
Mother's milk is ordinarily enough for a baby to remain
(C^nM

c -»*

53
healthy until the age of six months only*

After this, you

might have noticed that children who are still only breast-fed

begin to become weaker and get sick more often.

This is also

the age rhat a little child begins to crawl around putting
everything on the ground into her mouth, so the child is

more prone to getting infections and injuries.
also needs more food for its body to grow.

The child

It also needs

food-energy to spend on moving around. just as we do.

a child has a double requirement of food.

So

Scientists have

found out that a healthy child of two years age needs to

eat one half the amount of food needed by the child1s mother
in order to grow properly!

So now do you wonder why children

who are only breast-fed up to one year become weak?

You should start feeding your little crild at the age
of six months, or even at four months if for some reason

your breast milk is not sufficient.
and gruels of cereals (laps!).

Start with water of dal
Soft

Add just a little oil.

khichdi (dal and rice. or dal and dalia) is very good.

Tomato

juice and mashed vegetable like potatos, lauki, pumpkin.

carrots and even green vegetables like spinach may be started
soon.

Soft-boiled egg, particularly the yellow portion, Can

be given.

Mix a little salt but no c illies in the food

you give to your baby, as chillies will irritste his stomach.
Ask your health worker about other things to feed your
children.

yooc-/'"'

77/77

.S'

54

7

MENTAL HEALTH

The nigljmare of the gas-leak has deeply affected the
minds of all the people.

The children were probably the

worst effected, because they could not understand vzhat had

happened to cause such a terrifying event which ripped them
away from their parents and their brothers and sisters.

It

must seem like some all powerful black magic which took over
their lives on that awful night and the few days following.

A number of children lost all of their family members.
Even today/ parents who bring their children to the Jana

Swasthya Kendra complain that they do not eat well.

At night

they sleep fitfully/ or wake up suddenly frightened.

Seme

children wet their bed at night.

School children have more

than the normal problem in remembering and are not able to

study because of difficulty in concentrating.

Many children

who used to go for work to help add to the family income are
still not able to gc back to work.
Do not scold or beat your children for any of these

p rob lem s of the i r s.

They will not be able to overcome them

because of your beating/ and it will probably make things
worse•

So there is no benefit.

You must win your child’s

trust and build up his confidence in yoU/ so that fche or she
‘ ' you
.
- - about
will tell
all
his
-

. -

*

ears.

In this way/ you can

_

gradually coa<£ the trappea nightmare to come out of your

child’s mind.

She will then be able to see that she gets

frightened because of what happened tn the past/ but that

this is naw no longer happening or likely to happen,

To build

h i /vi

up your child s confidence in he^e-self spend time^ with him.
Remind him of his abilities and past achierements.

If you

can make time and save a liLtle moneyz take your small children
to see things and places where they would like to gc,

Help

them and encourage them with their studies if they are in School.

(Contd...55)

55
When they

Some girl fi&ildren have had a worse time than boys.

lost their brothers, it was not only grief that struck the parents.
but an extra social and economic shock.

So many parents have

made their daughters feel guilty for surviving in place of the
We have

sons, and even say they should have died instead.

heard the repeated nightmares of little girls who in tneir

dreams keep attempting to search for and bring back their
brothers.

to you.

You must reassure your daughters that they are dear
Because of the gas leak, certain training and oppor­

tunities should be opened up for gas-affected girls to make

them as gainfully employable as boys, so your daughters do not
have to be

burden.

It may be difficult for you to follow this advice and be

so understanding.

Youi: probably have to work hard to fulfill

your ovn daily minimum requirements.

not be in a good frame of mind.

Also, you yourself may

However, this asi>ect of your

child’s health cannot be attended to by anybody else.

If you

need help, find a health worker or a doctor whom you can trust

for sympathy and good advice.
You. may have found that the impact of the Gas Disaster
was so deep on your mind. that you are still not able to meet
the demands of everyday Life.

Or you may have someone at home.

or a friend. in whom the tragedy has caused a psychological

illness which has required a doctor’s treatment.

Ahis Illness

may have made life a miserable torture, and prevented many of you
from attending your normal work for days or months.

Or some

pre i/L£tx_£

persons may have had ^psychological ^^roblems

which hajge

become much worse after the devastating upheaval of the disaster.

All such persons need proper and sympathetic care.
The two most important psychological problems created by

(Contd...56)

56
gas leak which still linger on are called “depression”

Drowsiness, 1etha rgy, we akne s s t

and ”anxiety” by doctors.

sadness. poor appetite, loss of sexual urge — these complaints
are due to “depression”, Tightness in the chest, palpitation.

shortness of breath, excessive sweating, disturbed sleep and
nightmares, foragetfu 1 ness, tenseness in the body leading tc
body-ache - these are all symptoms of “anxiety”.

Anxiety and

depression are usually present together in mixed proportions.
more or less of each, and tend to fluctuate during the day.
Severe guilt and negative feelings about one’s self arc others

are typical of depression.
even panic.

Anxiety produces intense fear and

Both of these feelings seem unrealistic tc those

who are not anxious or depressed and so we tend tc discou.nt
the feelings of such people^.

The truth is that these

people’s feelings are much more powerful than our own, and can
ov via lence,

even drive the person to desperation and suicide'.

We must not

discount such feelings, but help the person to off-load their

burden of emotions by sitting and talking with them and listening
with respect.

Quite often^his wilPfdver a peri^-oftimeT) make

all the difference in the person’s *.i±e to regain his or her

confidence, ordinary sense of reality and self-esteem

It is

equally important however, for gaining self-esteem. for the

person to know that she or he is being useful to others, and
preferably earning something

Those of you who suffer from

any of the symotems we mentioned should remember that. although

for the present the symptoms are troublescme, they are not

dangerous tc your life.

For example, do not get disturbed

by paipfi.tatioxis (thumping of the heart) - there .* s nothing
wrong with your heart.

Tell all ycur complaints to your doctor

or any other trust-worthy person.

Doctors, firiends, relatives

all should listen to your complaints and may perhaps be able to

suggest ways to overcame your problem.
(Contd...57)

57
Certain medicines are available andean be prescribed by

a doctor to help you overcome the ac£ute anxiety or shorten
deep depressions.

Sometimes these medicine relieve people of

a lot of suffering and enable them to get back tc normal life

much faster.

You should not feel defeated if you have to take

drugs for a few days or weeks to help you over come a. mental
crisis*

'Che doctor’s help is urgently required and very helpful

if you feel it is woruthless to live or feel like committing

suicide or attacking others.

Your doctor will, have to supervise

the dosage of medicines carefully, KK’wd.xiaEtetE and beware of

taking too much of these psychological medicines.

Ultimately

you will have to develop your own strength and. legs to stand on*
Psychological illness requires the maximum support from friends
and relatives tc help the person rather than depending on the

doctor and on medicines alone.

Your health worker can also help.

Relatives/ friends, and health workers will have to
patiently spend time with a disturbed or ill person, gently fc
trying to catch her interest. involve him or her in activities

and skills in whicn there was a previous interest.
remind her of past achievements.

Patiently

Encourage and specially

Disturbed persons with

appreciate his new initiatives.

similar problems can meet together with a speciolly trained
health worker and discuss how and why things are so difficult
to do. and so frightening, and what are their compelaints, and k

how they can help or suggest to each other
oitfabit',

re Sts t'

cope with the)demands of normal lif^.

oppress, top,

-ways to

Some disturbed persons

themselves are often able to understand each otner and make
r

breakthroughs with ill persons better than normal people because
they know the terrible private feelings first-hand^

But they

will need to have around a mature and experienced mental health
worker (who may have once been ill herself or himself) for

(Cond....58)

5S
organising stable mental health group programmes on a. continuous

basis, and to help people in mental crisis.
Disturbed and mentally ill persons deserve our respect.
Don’t ever forget they are human beings.

Somehow^ from some-

where, they will also need love to recover^

,

ROOT OUT SICKNESS IN SOCIETY

People usually have mental problems because they cannot
adjust to the (injustices and cruelty around them.

Or they

cannot get over a terrible and frightening exr^rience. like

rape, in which, they were overpowered and their life ba] ance
destroyed•

Or they have been continuously forced to do things

or live in a certain way which crushed their needs and desires

beyond human tolerance.

Or the burdens of their family respon­

sibilities and mis-fortunes are too much for them to cope with.
and they cannot earn enough money because they can’t get work.

People call them insane. or say that they are sick, and

may take them to doctors for ” treatment81 •

Or people say that

such a person has been possessed by a ghost. and may try to

exorcise it by magic.
/n

But in all this< wc too easily forget about the wrongsjjln

society which have driven these people to breakdown point.
Don’t we ourselves know the oppression in the society?
we also struggle and suffer everday drom

corruption, cruelty and violence?

injustices and

If things got just a little

worse. we also perhaps would go insane, wouidtf’t we?

many of us been afraid of this?

Don’t

Ano haven’t

But is there really something

xikh wrong with us that makes us break down?

Or is it seme tit i ng

(Contd.^59)

59

wrong ir the world v.hich w have to live in?

Something vrong

with the way we are forced to live^ where you can survive only
Some -

if you submit or become dishonest, violent and corrupt!

thing wrong with a world where innocent people v/ere killed
like mosquitos by Union Carbide^ insocti^e factory which was

only concerned about making money?
If you think about all this, do you still think that the
poor broken-down people are the root of the sickness?

Or is

it that the sickness is in society, and. that the really sick
ones are those who are insane after money and power even to the

point that they will kill innocent people?

If you think this way, then you think like we health

workers do*

And if you are concerned about mental health

like us, then all of us together should get ready to join the
,.j On fy.

struggle to root cut the sickness from society and build

a decent life for all.

Join and fight Union C.. rbidci

Fight

all forces which help Union C vbide to put you down.

Do not

get defeated1.

5OPENSATI0N FOR DAMAGE TC MENTAL HEALTH

A word about compensation and the mental effects of the
gas disaster.

In Amer«ica, where Union Carbide has its pc1.rent

Company, cases have been fought tiy gixn-ps of people and won
e
in $ourt which have proven ti-at the psychological effects of
man-made disasters are as damaging as the physical effects.

Large awards of compensation have beenfgranted to disaster victims f

for the mental agony and the- long*’lasting disturbances .in their
lives and in their human relationships which the disaster caused,
'fhe companies responsible for the conditions leading to disaster

(Contd•..60 )

60

have had to pay this compensation to che victims,

A famous

example &s of this is the Buffalo Creek Disaster.
SOME ADVICB ABcuT MEDICIiKS

In each section of this book. we have mentioned something

about the use of medicine for particular problems.

But xhere

are some general principle^ which you should x'omember when the

question of using medicine comes up.
1)

Always, tQkfi^thg cor^ct^ dose

proper!: time.

:at the

An over-dose Ccm also occur from too freauent

doses, or taking too many different medicines from different
places

2)

k- < v y,

1 e'J

• ’

Take ful 1 cour^- cf cs-itain mecicias^, like antibiotics

used in infections*

You may need to continue the medicine for

some time even after the symptom* are relieved*
3) ,Avoid injections^ unless they arejnecessary to save
(

like streptomycin in TB and Bronchodilators in an attack

of asthma) or to prevent disease (like Trippie and Measles
Vaccine) ^rd cannot be given by rnouth.

4)

Avoid expensive medicines in bottle, capsullces and

expensive racking.

Most medicines can be supplied

cheaply and have the same effect but only cost you less.

more
Drug

companies have found many ways bo fc-oi people into paying more
money than necessary.
~

A1;_ u3z_ f;-akc medicinesz and accept medicines only

from persons whom you can trust.

Some medicines have expiry

dates and should be destroyed.

The Government is supposed tc

(Contd... 61)

A

61

keep a control on this.
6)

Avoid medicines known as ,s steroids* .

These medicines

come under Various names, like Wysolone, Betnelen, Betnesol,
Celestone, etc. etc.

Many private practitioners prescribes

steroid tablets along with other medicines because they give
the person a feeling of getting well.

They often seem to

relieve symptoms magically and the appetite may increase.

But

they can be very dangerous, because they can mask the wk* real
disease and make you get worse later on.

other dangers.
/

They also have some

If you suspect that a djctor has given you or

your child a steroid drug. show it to your health worker and
find out.

Steroid are often given to relieve people who have

asthma, but it is better if they use other asthma medicines
and avoid getting dependent on steroids.
7)

Avoid unnecessary medicines during precfnanc^, especia 1 ly

during the first three months*

Always tell a doctor if there

is a chance that you may be pregnant.

Many medicines can cause

damage and deformities in your baby.

As far as possible, only take

the special medicines which wre advised and given to you from

an

Antenatal Care Centre set up by the Government, like Iron

and Calcium tablets or medicines which are given in pregnancy
to treat any complication or complaint of yours.

8)

Brink plenty of water throughout the day wnen youx are

taking certain medicines, like antibiotics.

16) - - .

/'■y

kl-A - 55

/

fSMALL BOOK FOR GAS VICTIMS
(Still untitled)
(Hindi, translated from English)

"Cfo I active s :
1.

tr give gas victims information about the medical

aspects of the gas lealc and what is known about
how the toxic gas has affected their bodies.
2.

to give practical suggestionsrabout how to get
■r

treated medically and how to prevent further

damage to their lungs, eyes and general health.
Target Readership :
i

a person educated up to hinth standard should be
able to read this bock.

It is expected that there

will be a relatively small number of poor gas victims
who will read this, but these persons must be located

and coaxed to become active.
5
Government angan*wc.di workers and healthrworkers

should be able to find this book useful.

the various sections of this book should be suitable
A

* ___

to be read out to individuals or groups of people

for learning purposes, as well as health worker

training, like Where there is nn Doctor.

@*@*@*^)*@*^*.^*^
t

BROTHERS ANO SIS'TCRS,

Many of you suffer from a variety of different complaint^
which you never knew of before the gas leaked.
because we are health workers.

ourselves.

We know this

Some of us are gas victims

We have been working among you for many months.

r''
(Conti...2)

2

end we have listened to and experienced your problems.
We have also been trying to treat these problems, and

to understand exactly why and how they have occurr*^#
As you know well, the most corrcnon physical symptcms

which persist even today are
Breathlessness, at rest or after a little work

Cough, dry or with sputun

Burninc of eyes, watering and seme blurring of vision
Loss of appetite. nausea, bloating of stomach

after food and upper abdominal pain.

Tiredness and pain in the muscles after a little work.
There are also mental symptoms which further compromise

your ability to cope with the every day demands of life, like
Anxiety and palpitations

Disturbed sleep
luack of mental concentration, and

Poor memory.
The reproductive system has also been affected.

If you

are a woman, you may or may not have yet recovered from
Menstrual disturbances

Excessive white discharge and lower abdominal pain

Complications of pregnancy, like abortion, still
birth difficult labour# and low birth weight of

babies.
Reduction of breast milk.

In your weakened condition, you may have found it
difficult to give adequate care to your young children or

to keep the house as is customary.

If you are a man, you

may have found it difficult or Impossible to complete sexual
v-.^

e

j’

(Contd...3)

/ BOX 1 /

r

* .* *

*

■*

-

*

*

•*

*

*

I

*

If you^r were exposed to the cloud of poisonous gas
which cam** out of the Union Carbide factory in December

*

%

§

1984, you would have experiencea a varying ajncunt of

£

*

*

I

suff ring due to the inmediate effects.

This would have

depended upon

*

1) how close you were co the factory. a nd the

*

*

I
I

direction oi the wind.

*

2) whether you were out in the open or protected

$

Inside a pukka house.
*
&

3) whether or not you ran away early. by what means

I
*

you could run and in which direction you went.

*

4) whether or not you could cover your face with

§
*

*

*

1
1

water or a wet cloth while you were exf-csed to

$

the gas, and

I

5) whether or net you were in weakened ccnditic^n

before -che gas leaked because of illness of

Iw

■1

atarvation*

*

I
*

*

*

w

I

Because most of you were poor, you were more prone
to severe! of these factors.

*

For example, you had to

I
I*

sleep in the open or in a shack which the gas cloud
easily enter.

You had no conveyance by which to escape

@
A

easily and quickly.

*

You didif*t have adequate water*

noberte

had inferrned you about the risk of gas leak

*

Also

*

from the factory or what to do in case it occurred.

&

I

A

*

*

Hence, depending on all these factors, you would
have suffered more or less severe effects of the poi­

sonous gas in the beginning.
*

I
I

Y-u may even have lost

members of your family who died.

Many of you were

*

9
*

*

admit ted t <
gfe4 In serious condition,
* most Of yOU h;.v^ r

°ver time
recovered
from the effects of the
*
© iiranedlate illness. but many of you still
suffer.

*

*

*
*

3
intercourse because of poor erection-

BOX 1 /

ARE YOr’ '

m'NG?

WE HEIuPZ

Many of you must be wondering Jhow the poisonours gases

of Uhlon Cerbide have come to pla^t such havoc with your
healthj particularly since most of the medicines given to

you hardly give you any relief.
You may also be wondering go many other things,

will happen to your health in future?

l^hat

will there be any

problem in the development of your children?

whet would

happen to yet unborn or newly-born babies?

In this small book we will try to answer in as simple a way
as possible, some of the questions which may have been haunting

your mind.

We will also give you some advice which may be

useful•
BOXES 2,3 fir 4
THE LTOGS

we start with the lungs, because, like our eyes, they

were affected liranediately by direct exposure to the gas. I The
richt and left lung together form one of the vital organs

without which our body cannot live*

We breathe with our lun^s.

If our breath is stopped^ we die.

Before looking at the ways in which the gas has affected

peoples lungs, let us first understand what normal healthy
lungs like, and hew lungs work.
TOE NORMAL STRICTURE AEO F'.MCTIOM OF THE LWGS
The lung consists of :
1) a network of air tube^, which divide and subdivide
into ssmallar and smaller branches, looking rather like
an
upsiue down tree. The anallest branches end up into

4
2) thousands of tiny £ir sacfc#, which we can Imagine

to leek scciewhot like lots and lots of bunches of grapes*
We have drawn a picture to try and give you idea of this.
When we breathe in air, it reaches the air sacks
through the air tube tree.

The walls of the air sacs

and of the smallest air tubes are extremely thin*

Then

walls are made up of flat cells* somewhat like cur houses

are made of bricks* or a floor is made of tiles.

All the

air sacs are surrounded by another network of very thin*
very small and soft blood vessels called Cc^pillaries*

This

Important network of tiny capillary vessels covering

air sacs Looks like our next picture*
Normally* the air we breathe in c nsists of a mixture
of gases.

One of the gases* oxygen* is essential for life.

When we breathe in* the fresh air brings with it an adequate
amount of oxygen. Through the air tubes* oxygen reaches the
air sees. From the thin-walled sacs* ^t easily passes into

the blood flowing through the soft and thin capillaries*
The red pigment in the blood* known as haemoglobin* picks up

the oxygen something like a magnet attracts iron filings*
ano carries it through the blood stream*

Thus# from the

lungs the oxygen gets carried by haemoglobin in the blood
to all the other parts of the body*

Our body is like an erigine.

It requires fuel* which it

gets in the form of the food which we eat* and oxygen to
utilise the fuel.

Our body engine will soon come to a halt

if either foal or air supply is cut off*

are performed by the body machine.

Various functions

In the process* just like

a steam-engine gives off smoke the body-enoine produces a
!

f-

waste gas called c«?jbon dioxide.

Carbon dioxide gets carried

away from our legs* arms and other parts towards the lungs

again by the blood.

In the lungs* through the same small

capillary blood vessels which collected the oxygen* it passes

I lil Iwl

5
out across the air sac walls.

As we breathe out, the body

casts off the carbon dioxide waste gas which disperses in

the atmosphere.
(You may be interested to know that the carbon dioxide
h -vc. <» \\'x

‘v*’

r

<«• W

is absorbed by plants and trees which use the carbon and
i

cast off the oxygen, hence cleaning the air for us to breathe.
butyls another story...)

The whole process of supply of oxygen to the body.

its use by the body, and the removal of carbon dioxide is

called respiration.
HOW H.-‘VE TO® TOXIC GASES AJ'TECT® YOW s^SFT^ATI K >

When respiration is blocked at any point, one of the

main things a verson feels in breathlessness.
cannot breathe in enough fresh air.

air, that is, hungry for oxygen.

He feels he

He feels hungry for

The gases of Union Carbide

prevented normal respiriticn mainly in three ways« 1) by

re} lacing oxygen in the air and blood with irrespirable
toxic cases, 2) by d&nagint the air secs and capillaries
through which oxygen crosses into the blcod> end 3) by

causing the air tubes to become obstructed.
RtFLAC.t.HtWT QI- OX¥<3BN IN TIE AIR
I

• i ;

when the poisonous gas cloud came out of the factory,
it replaced the air which contains life-giving oxycen.

The

toxic c^aesj breathed in cijbui not be used in the way oxyoen

used to sustain life.

Cyanide gas which was present in

the cloud, in fact, algo prevented the body from using
whatever amount of oxygenf it could get and caused rapid

death to many helpless persons and animals.

‘The harder people

(Contd•..6)

6

breathed, as when they picked up theii children or other
loved ones and ran/ the more they -were likely to inhale

a fatal dose and die.

IRRITATION OF TOE AIR TIBES
Certain components of the gas cloud caused severe
Irritation in the ^alls of the air tubes and air sacs.
Gas victims all recall that they felt as if chillies x^ere
’Tue

being

kn<r\^j

- ---

or nose

- -irr
/rr irkaJ"!cty^

Jrritaticn of the air passages

caused them to water.

Because of this watering# passage of

This also

oxygen and other gases ws-s partially obstructed.

caused part of the breathlessness.

People coughed in a

protective attempt to remove the irritating substances with

the fluid secreted into the air passages.

TOXIC DAMAOi T

THE LUNG TISSUES

Certain chemicals in the gas cloud Initiated reactions

in the cells lining the air tubes and air sacs.

This caused

extensive direct injury to the lungs# preventing! them from
functioning•

This injury also resulted in collection of

water in the lungs# a condition the doctors call "pulmonary
oedema11 (pulmonary » lung# oedema » swelling)•

This water

from the lungs mixed with air came out from the mouth as
white froth, and had to be wiped away from the faces of
dead bodies when photographs were taken for later identification*

The lungs# so to say# were drowned in their own watery

discharge.

In those persons who did net die of it# this

drowning of the lungs caused severe breathlessness and

suffering. JjBven today they continue to suffer from breath­
lessness and cough.> ’

v

r

r

V U;
(Contd...7)
., l
i

f

' • '•

7

COLLECTION OF DEBRIS IN TOE LUNGS AM) COUGH
Couch Is a protective response by our body to ensure

that there Is no obstruction to the free flow of. fresh air
into our lungs

Just as we sneeze when some material enters

cur nose, likewise the muscles used for breathing respond

by cough to clear the lower air passages of any foreign

material or secretion*

In normal times, just as the dead

leaves of a tree fall off. so also the dead cells Lining

the air tubes get shed off into the air passages, as we have

drawn in this picture.

As result of the damage from the

poisonous gases, a large number of desd cell matter collected

as sticky debris blocking the luno air passages, and obstructing
the flow of air.
After sone time, if the sticky debris does not get

removed by coughing, it •organises*’ into solid plugs which
permanently block the air passages.

SECONDARY infection of THS Ltm
Another possibility is that the injured lung can qet

infected with^formation of pus.

J0

Just as wounds on the

outside of the body get infected, so also lungs injured by
the harmful gas tend to get infected and take a longer time
to heal.

Pus can be seen in the sputum which people cough

up, and they may get fever.

Tney also become more breathless

again, ©nd the cough increases.

Gas affected people who are coughing up/sputum withJpus

Jta it should be? treated with full courses of antibiotics free

of charge from the Government dispensaries.

If there is not

much relief after 5 days or a week, they should get their
sputiim tested to make sure that they do not have tuberculosis.

(Qontd.•.8)
r >• '

I '• \

J

8

Tuberculosis attacks weakened lungs and bodies.
$Vsz4

J

The medicine

b •<,

for tuberculosis i*£T algp available free of cost from special
•r

Governmert dispensaries and must be continued for a long

time (upto 2 years) under the careful supervision of

©■

doctor or health worker.

EXEPCISES TO HELP

LW\s

Simple breathing and postural exercises done regularlyr
can help to increase the flow of fresh alx^ in the lungs and

open up blocked airways# helping the expulsion of sputum

during coughing*

Strong deep breathing and breathing into

a water-filled bottle through a tube as shown in the picture

CciB loosen up sputum and expend blocked er collapsed airways.
Inhalation of steam also helps.

Coughing out sputum in

positions -jwhich the head and chest lower than the rest of
the body (postural drainage), further helped by brisk and

firm pats on the side and back of the chest# also increases

drainage when heavy or# copious secretions collect in the
lungs# cs in some people with a lot c;f damage to the large

airways.

A

If there is no infection (no pus)# every day

forcefully breathing into an ordinary rubber balloon can
dislodge thick plugs blocking the smaller air passages•
These exercises for recovery would have been most helpful

in tiie first couple of months after the accident# but
unfortunately# the Government health authorities did not take
action to teach such measures to the people.

But some exercises

may still be helpful# particularly in helping antibiotics to

cle-tx^ up infections of the lung.

Regular deep breath!no of

xresh clev.n air helps {prevent the lungs from beccmlnry infected

again.

(Contd.♦.9)

9

HEALIKG OP LUN’G DzWWSE BY FIBROSIS

Tn those persons who were bediy affected, the most

damage^ areas of the lungs have gotten slowly healed by
replacing of the air sacs and small air tubes with a different
type of tissue which is tough and fibrous.

Exactly the

same thing happens when you hurt yourself, and later a
seer forms replacing the smooth sklr with a mark which feels

different when you touch it.

The scar tends to shrink

pulling the skin together, which you must have noticed
if you’ve ever seen a person whc was once badly burnt on
the body or face.

Likewise fibrosis of the lunes causes the

lungs to harden and shrink, and makes it difficult for the
remaining good parts of the lung which are in between to
function.

^aturilly, persons with severe lung fibrosis

would feel breathless just about all the time. and they would
suffer a great deal.

Not too much can be done to help persons once fibrosis

has set in.

cT

Before it occurs, it can be partially prevented

CA1

rZx by a drug called LBVAMISO» (also used as medicine for removing
roundworms)•

This has been shown by observation of the
protective effect levamisd given to a group of several gas

affected patients treated socn after the accident at the
K.E.M. Hospital, Bombay.

Exercises are not supposed to be

helpful, but certain physical precautions can be taken by
arsons who have lung fibrosis.

They {should

given the

lightest possible work to do. be ensured a linht but nutritious
diet^ and get plenty o£ fresh unpolluted air.

Fibrosis of the lungs is also known to occur in workers
employed in certain occupations where theft lungs are exposed

over a long time to damaging chemical times, fibres, dust;or
smoke iarticles in the air.
$11 know.persons working- in
such occupations, like those who gin or spin cotton or work
XJX'A1

.

in cloth mills, straw products, plastic or chemical industries.

(ccnti

10)

10

asbestos sheet and cement manufacture, stone masons and
slate pencil factory workers, etc.
much longer.

The list can become

Protective measures, like masks and other

control devices, are usually not ensured by the employers.
and so the workers must work under unnecessary risk without
any choice.

In the case of gas victims it is even more

important that they be protected from such harmful elements

t

r- 'I in the air to prevent further damage to their lungs,
,1^
or to
prevent attacks of asthma in those who have become hyper­

sensitised and allergic.

Even cookino smoke and fumes from

wood, coal or kerosene can be harmful.

ALLERGIC HYPERSENSITIVITY At© ASTHMA
MAllergyM means that a person has developed a hyper—
sensitivity to a certain substance or group of substances.

Whenever this substance in present in the environment or
gets into the body, the body or a part of it reacts.

Hyper­

sensitivity of the lungs results in spasm of the tiny muscles

in the walls of the air tubes, as you can see from the picture
we have drawn here.

‘The condition is also known as asthmas

The tubes thus became temporarily thinner, and carry less

air than what the body needs.

So one feels hungry for air,

and this becomes yet another cause of breathlessness.

MIC is known to cause hypersensitivity in human beings.
It is also known to produce cross-sensitivity with other
—ii •nr

mi ■

I

iiiiwii

11 .................................... ,l|t

chemicals such as polymers used In the plastic industry.

So

the asthma which has caused suffering since the gas leak to
many gas-exposed persons is most probably due to hypersensi­

tisation from MIC.

The fact that people keep getting asthmatic

attacks indicates either that traces of MIC are still present

(Contd, •.11)

11
in the environment in some form or another (like dust of
MIC polymers )# or that other coirtnon substances in the

environment are serving to trigger off the allergy.

A person is more prone to get an attack of asthma

if she or he gets col$# or if she is worried about a
problem which doesn’t seem to have a solution, causing

mental end physical tension in the body.

Lung infections

also make asthma worse.
A person who is suffering from asthma can be recognised

by a fine whistling sound which can be heard coming from the
chest, especially if one puts one’s ear on the person’s back
or chest and listens.

This sou&d is produced by air being

forced to pass through the many narrowed air tubes.
^“hen you get an attack of asthma, try to breathe out
slowly through pursed lips as we will explain to you the

section on breathing exercises.

The steady back-pressure
>

thus maintained in the lungs will help to keep the small

airways from snapping shut and trapping stale air in the
air sacs.

□rues called "broncho-diiators" are also necessary

to release the spasm of the small airway muscles.
cases, tablets will do.

In most

In severe cases, injections are

necessary and must be given immediately.

You should be

treated regularly by the same health worker under a doctor’s

supervision.

Your health worker should meet you frequently

even when you are well, so as to help you to better understand

what factors trigger off your attacks.
To prevent attacks of asthma, take all the4 precautions
we advised in the previous actions.

Make sure you keep warm

and avoid circumstances which will cause you to sneeze and

cough•

If you get a cold, or sneezing and a runny nose from

some irritating substance, take simple anti-cold medicines

(anti-histamines and asjlrin) early enough to control it.

Take as much rest as possible and drink hot liquids.

Taking

- 12 z vitamin C will help prevent a cold and increase your

power to fight infections.
FATIGUABILITY OF THE MUSCLES USED IN BREATHING >

A

It was noticed by doctors during the second month

after the gas leak that people who did not have fjhyslcal

signs of lung damage or asthma were still ccmplaining of
breathlessness even after slight or moderate accustomed

exertion.

Unfortunately, many doctors suspected that the

However, so many

gas—affected people were telling lies.

people complained of the same thlng^ that some doctors
began to take them seriously.

Since then, scientific

evidence has been built up indicating that one or more
toxic chemicals in the gas have in some way interfered with

the normal working of muscles all over the body, including

the muscles of breathing • ■ This type of breathlessness appears

to have gotten partially or completely relieved after injections
of sodium thiosulfate.
health care for weakened or damaged lungs

I

We want you to understand the importance of a regular
medical check-up for your lungs and breathing power.

This

is important for your own health and well-being as well as
to measure the total magnitude of the effect of the toxic
gases on the people.

So far, the Government health authorities

have not taken this seriously enough.

If they had, then each

of you would have a health card and you would be regularly

called for a check-up by a health-worker

or a doctor.

Now

you must demand proper health care, and therefore you must

what it means.
SPIROMETER

There is a simple small machine called a spirometer

which can measure the amount of air space in your lungs and

your breathing powerl

It can give a good idea to doctors

of the functional damage done to your lungs by the toxic
—— ------ ---

f(T

1^.4

(y

r

S
(Contd •..13)

13

gases of Uhion Carbide.

Of course/ since your own lungs
Of

were never tested before the gas leak/ we cannot comi^are
the test result with your own previous lung strength*
However/ by measuring your height and weight/ we can compare

your result today with the average result of healthy person

of the same height and weight as you are/ who was not
exposed to the gas.
The spirometer is about the same size as a transistor

radio.

This means that Sone health worker can easily carry

it/ and can even come to your house once a month to testy
the functioning of your lungs^ if they have been damaged.

This will enable us to know whether you are improving/
getting worse or staying the same.

For patients who have

lung fibrosis/ or who are at greater risk of developing
fibrosis/ this is a must.

*>3

PREVEOTION OF FURTHER LUM3 DAMAGE

A few precautions should be taken/ especially by those

gas victims whose lungs have been damaged/ as detected during
their medical check-up.

1){ Atmospheres containing smoke/ dust/ fibres or chemical

fumes should be avoided•

For this/ certain ^occupations will

have to be ruled out/ or else complete safety measures will

<s„’

have to be provided by the employer to prevent inhalation of
the harmful substance/ such as proper hygienic masks.

The

Government will also have to make and enforce anti-pollution

laws to prevent Industries from polluting the air.

Since

cooking with wood/ coal or kerosene fuel Involves smoke and
fumes/ natural gas fuel should be supplied to gas victims
on a

priority-basis by the Govern*

"Smokeless Ghulhas" are
(Contd»»«14)

14

comparatively Impractical and expensive in the city, and
ordinarily cannot be used for coal which is the coninon^&t
fuel at present in the gas-affected bastis.

Second best

after natural gas are the newer efficient kerosene stoves
called wNutan Stove* which can be provided to families of

gas victims by the Government while ensuring a regular
supply of kerosene.

All expenses incurred by the Government

in providing safe cooking arrangement and fuel should be
claimed from Lfaion Carbide.

2) Gas victims with damaged lungs, tuberculosis or
asthma should give up smoking bidis and cigarettes.

3) Lung infections should be detected and treated early.

Vte spoke of this before in the section on the lungs.

The

main signs are increase in cough and breathlessness with
c s** p

st** |

’

yv

yellow pus in the sputum, and there may be fever.

If the

sputum is greenish, or blood-stained, you should specially

tell this to your health worker.

You will require a full J y
•

*

course of antibiotic medicine with vitamin B complex and

perhaps some other medicine to give you rest from the cough
and breathlessness.

Drinking plenty of hot fluids. Inhalation

of steam and postural drainage exercises will help to remove
collections of sputum in the lungs.

Somehow, you must also

continue to get a nutritious diet.

This will help you to

recover more quickly, along with the other breathing exercises
which we will describe below, will prevent you from getting
lung infections so often.

You must also keep warm enough

during the winter months.

4) (Improve your breathing habits by doino breathing

exercises.

Most of you who feel breathless can do seme

exercises which will help you to feel better.

To learn

(Contd...l5)

15

properly, you should ask your health worker to teach you
at home or in a class at your health centre*

Here we will

explain the principles behind these exercises and the basics
of how to do them*
When we feel breathless, we automatically take many

short breaths at a faster rate*

Instead, it is better to

take deep breaths and to breathe out slowly through the
mouth, with the lips ' like the mouth of a cloth purse with
the strings pulled*

Breathe out as if you are blowing air

slowly into a rubber balloon against some pressure.

Your

cheeks will bulge out a little every time you breathe this

way*
With this type of breathing, the air we breathe in
remains in the lungs for a longer time and the thin airftubes
and air sacs remain inflated♦

Therefore, there is more time

and space for oxygen in the breathed air to mix up with the

blood in the ltags«

This, after all, is the whole purpose

3.
■-r-

of breathing*

Secondly, deeper and slower breathing means that we
inhale a larger amount of air with less effort*

Thus our

breathing effort is more efficient, and naturally we should
feel better*
Doing this as an exercise for a few minutes a day will

not help.

Try and develop deep and slow breathing against pursed

lips into a habit throughout the day.

beginning, do as follows

Tb learn in the

i

BREATHIHG EXBRCISE NO * 1 (to learn deep abdominal breathing )i

He on a mat on the floor, face upwards,

as much air from your chest as possible.

First expel

Then take a long

(Contd*«*16)

16

and deep breath, and hold on to it for some time*

Then breathe cut slowly through pursed lips as explained
above*

Towards the end of this breathing out, push your

abdomen upwards towards the roof • in order to expel more
air frcm your lungs/inwards to expel more air from your

lungs*
Watch the movements of your ghest and your abdomen
separately*

Both sets of muscles are ordinarily used in

breathing*

The abdominal muscles are powerful and can be

strengthened by regular exercise to increase your breathing
efficiency*

Gradually develop •aMcminal breathing* into

a regular habit*
BRSATHIMG EXERCISE NOt

(to expel maximum air from the chest)*

Stand or sit up with the palms of your hands resting
on the sides of the lower part of your chest wall, like you
see in the picture we have drawn here*

Breathe as you did

in exercise No*l, but towards the end of the breathing out,

ccmpress you chest with the palms of your two hands*
Then take off your hands while breathing in*
This exercise should be repeated at least a few times*

every morning and evening so that the lungs get maximum
ventillation with fresh air daily*

There are other similar breathing exercises which you

can learn, but these are best taught to you by actual demon­
stration by specially trained health worker*

The Government

should employ experts in teaching lung rehabilation exercises

(Contd*.*17)

17

and training health workers so that all gas victims with
damaged lungs will be able to learn and benefit.

alternative emplowent a-d pension

As we mentioned before, with help of modern instruments

like a spirometer, doctors can check your lungs every month
and decide whether you should continue in your present
occupation.

If your doctor finds that you cannot do so, he

should also be able to tell you what other type of job would
be more suitable for you.
If you find that you cannot earn a wage at the same

level as you could before the gas leak. the Government doctor
can test the capacity of your lungs and give you a certificate

On the basis of

about the extent of damage to the lungs.

this certificate you have a right to claim that the Government

should pay you a monthly compensatory pension equal to the
reduction in earnings due to the gas-leak.

In fact, such

compensation should form a part of the total compensation
that Union Carbide must provide for each gas victim.

THE EYES

Besides the feeling of burnt chillies in the throat.
everybody had intense burning and watering of the eyes.

One could hardly help rubbing the eyes.

Only a few persons

realised how Important it was not to rub the eyes but instead
to splash them with water and cover the whole face with a

wet cloth.

No one had ever been told to do this.

In the

circumstances of darkness and chaos, such care was in most
cases impossible.

(Contd...l8)

18
So the initial turning and watering gave way to severe
swelling ©nd discharge.

The people whose homes were near

the factory could not open their eyes for days, and they
suffered intense pain.

After some time, the swelling and discharge disappeared.
but people suffered from eye complaintsJfor months after

the accident.

The jeyes burned and watered constantly.

Cooking over a fire vi-s a torture because of the smoke.
Working in the sun was difficult or Impossible because of

the glare.

Si ht was blurred, so that people in jobs

requiring good vision, like a tailor threading his needle.

a motor or bicycle repair mechanic, a woman bidi maker

tying the thread on the end of the bldl, or a truck driver

etc., had to struggle or even give up their work.

Even

today, a lot of people still have some of these problems

which they never had before the gasfleak.
J

The lingering of these problems indicates that the
poisonous gases not only irritated the eyes at the time.

but also may have changed the eyes or affected them more
deeply in seme ways.

Ihi.s has not been well understood.

but some doctors and scientists are trying to find the

answers.
Some persons, although far fever than the doctors

expected, have ended up with white spots or a(white patch
on the clear part of the eye (corneal opacity) which in a

few cases has led to severe impairment of vision.
a few persons have developed cataract,

C uite

r opacity of the

Lens in the eye, which they say they have got only the gas
leak.

Fest doctors have doubted that the severe corneal

(Contd*..19)

i

19

opacities or the cataracts were due to the gas, and feel

compensetio
that people are lying to claim compensctionxwrongly
for
problems which they had before the cas leak.) In some cases.

this is obviously true, but in most ceses it is very hard

for anyone to prove one way or another.

Because most of

the people were poor, they were net in the habit of getting
photographs taken.

Nor were they likely to have had an eye

check-up done Just before the gas leak.

And since the gas

leak, the patients1 records have been so poorly written * if
at all, that even the delayed development of effects of the
gas are herd to establish.

It has been reported by scientists that experiments of
exposing rats to EIC gas have resulted in cataract of the
eyes after a period of time.

Therefore, it is possible that

cataracts, particularly in young people, may occur due to the
gas exposure.

People must insist that their eyes are completely

examined at regular periodic intervals^

It would help if

these records be kept in simple Hindi so that people could
find out what has been written, which is their right.

People with vision problems without cataract or corneal
opacities may get help from wearing spectacles.

Gas victims

have a right to get complete eye examination and spectacles
free of cost.

Corneal opacities and cataracts may be treated

by operation when necessary, also free of cost, and special

additional compensation should be claimed in cases where
the damage can be proved to be the result of the gas exposure.

SYSWHC EF

■s 7F Tir£ TOXIC GAS

Beyond the effects of the gas cloud on the lungs and
the eyes, all other parts of the body also were affected

(Contd.».2C)

20
because the toxic gases were carried across the lungs into

the blood stream.

In the worst days of the disaster.

postmortem examinations were done on hundreds of dead bodies.

and changes in colour and apinearance of various organs and
body tissues could be directly seen.

These postmortem

appearances could be co-rclated with signs and symptoms

observed in the living gas victims.

Researchers in our

country took hints from these findings, and some of xdie

results of toxicological tests and experiments are slowly

becoming available.

Let us take up each of the body systems

which were affected one by one. arid see what is already known.

A
THE BLOCD A® HAEMOGLOBIN

C n- S ,
\ 'T'-

V,
v.

w '

It was noticed immediately at postmortem examinations

that the blood throughout the body was a strange uniform

bright red colour.

Sane doctors call this "cherry red".

Even the faces and skin of victims, dead or still living,
showed a strange reddish flush which has been recorded in

colour photographs*

The veins which usually look bluish

in colour because they contain darkened de-oxy eneted blood

(on its way back to the lungs to pick up more oxygen) wtere

S I

reddish and contained instead blood of the same bright red

colour as that carried in the arteriesp(which distribute
oxygen to the whole body),

In fact, in certain organs, like

the brain. photographs taken after opening the skull at
postmortem show that it was difficult to tell the difference

’i

between veins and arteries criss-crossing over the surface, for

they were the same colour.
(Contd...21)

21

This type cf appearance# known as arteriallsation of
< the blood. results from the venous blood containing an

It is known to occur

abnormally high content of oxygen.

in two well-known types of fatal poisoning - cyanide and

carbon monoxide poisoning.

In cyanide poisoning it occurs

because cyanide prevents body tissues from being able to
take up and use oxygen.

Therefore, the blood cannot get rid of

its oxygen load, and must keep it, thus resulting in theJ
red colour of blood in the veins.

I

C,°'

In carbon monoxide
t

poisoning^ ctrbori monoxide changes the red pigment of the
blood (haemoglobin chances to metha^oglcbin and carboxyhaemoglobin) so that it takes on a permanent pinkish colour

end alsofcannot release oxygen

Both cyanide and carbon

monoxide are new known to be thermal (heat) breakdown
products of methyl isocyanate, according to TJnion Carbide’s
own internally published Information manuals.

Cyanide and

carbon monoxide poisons, because they act somewhat similarly.

deepen the effect of each other.

Cyanide poison is more

quick to kill than carbon monoxide, but both poisons are used

by desperate people to Commit suicide.
But there is apparently another way whieh^might explain

the bright red blood.

From previously published scientific

reports, was known that isocyanates (like MIC) can combine
with lots of different protein components in the body.

is called carbamylation of proteins.

This

Scientific research by

ICMR since the gas leak has looked for such changes in body

proteins collected from the blood and tissues of severely
affected gas victims.

The results of this research show that

haemoglobin is me of the proteins which has been carbamyls ted.
The change in shape of the haemoglobin makes it unable to
pick up the waste product carbon dioxide, which it usually

y) \

v*> <

x ; tv-

(Contd.•.22)

22

exchanges for its load of oxygen.

Since ncv the haemoglobin

cannot accept the carbon dioxide, it must retain its load of

oxy- eni and the blood thus keeps its bright red colour on

its way back to the lungs.
An expensive machine called a ’'blood gas analyser" was
kept at the DIG Bungalow Hospital for gas victims, which
measures quantities of oxygen and carbon dioxide uncombined
with haemoglobin (free)•

This machine showed that the blood

of gas victims contained too little free oxy.en and too much
free carbon dioxide.

< A'

'

’

' Q. '

Another surprising thing was shown by a very cheap
machine, called a “ihaemoglobinometer", which measures the

amount of haemoglobin in blood (or you can say, how thick
or thin the blood is).

Within two months of the gas leak.

the blood of gas victims who got tested shewed more haemoglobin
than normal.

Despite the people being' poor and sick, their

blood was net thinl

As health workers among the people, we

noticed that wonen, particularly pregnant women, who usually
have very thin blood (which we call " anemia”) usually did not
appear anemic.

Iheir tongues, lips and finger nails were

not pale, although their finger nails were sunken like spoons,
telling us that they had been anemic before the gas leak.
This meant that people “s bodies were making mere haemoglobin

probably to compensate for the haemoglobin which had been

made useless by the toxic gas.

In the early days after the disaster the antidote to

cyanide poison, sodium thiosul^atd^ was given to about a
hundred victims and brought about remarkable relief.

The

ICMR noted this and rapidly developed a test to detect levels
of thiocyanate being passed out in the urine of patients.

Thiocyanate is the harmless detexified form of cyanide poison.

The (urine thiocyanate test was carried out with the help of
(Contd•••23)

23

another machine called a "spectrophotometer"*

This machine

was also installed for some time at the D«I»G« Bungalow

In general/ the researching scientists found that

Hospital*

the urine of qas victims had higher thiocyanate levels than
the average in non-gas-aftected persons, and that the
excretion of thiocyanate in the urine increasea several

fold after receiving sodium thiosulfate injections.

ThiBs

work done in January led the ICMR to issue recommendations
that gas victims with the typical symptoms be given sodium
thiosulfate injections and their urine thiocyanate levels

monitored by spectrophotometer#
Steasurements of the free blood gesesr namely 0, and
2
CO^, were also done with the blood gas analyser after sodium

thiosulfate injections#
of free CO

/!#

These measurements showed a lowering

and Increase of free 0t towards normal levels.
2

Patients receiving the sodium thiosulfate injections.

unless they had severe lung damage, by an large reported
relief of their symptoms#

Their breathlessness got reduced

or disappeared, palpitations settled down, nausea disappeared.
appe<ite increased, tirednessfand pain in their muscles

improved, and they were able to take up ordinary physical

work again.

In fact, patients reported relief of many other

symptoms, too - so many that sceptical doctors felt it could

not be true.

Some doctors suggested that Sodium thiosulfate

must be acting only as a "placebo", that is, a drug which

brings relief purely because patients believe it will bring

relief!
But aoctors working at the D.r.G. Bungalow Hospital

recorded meticulously that the fast pulse and breathing rates
of their patients became slower, chest pain and severe abdominal
(Contd,..24)

24
pain got relieved/ tolerance to standard graded exercise
increased/ and surprisingly even lung crepitations and

the whistling sounds of asthma reduced or disappeared after
sodlisn thiosulfate.

They were often able to co-relate the

improvements in physical signs and symptoms increased
excretion of thiocyanate in the urine of the patients

and improvement in the blood gas balance.
However^ another thing was noticed.

Although the

orginal relief due to sodium thiosulfate was often dramatic

and even complete/ the symptcms and signs tended to come
back again, along with a return of raiseo urine thiocyanate

and re-Riistortion of the CO„ balance* The symptoms were
z
usually less severe than they had been in the beginning, and

they got relieved again with one or more injections of

sodium thiosulfate.
The scientiric reasons for all this is yet to be
understood.

One thing seems certain.

somehow involved.

Cyanidefpoison is

Either it came from the original poisonous

gas cloud which all the victims inhaled cn the night of

December 2nd/3rd, or it has somehow been produced continuously
in the bodies of gas victims as a break down product of an

accummulated poison attached to the body tissues and slowly
releasing it/ leading to the symptoms of chronic or recurrent

cyanide poisoning.

Although hydrogen cyanide itself was

present in the original gas clou.!/ and probably responsible

for killing many people/ cyanide is known to get naturally
detoxified in the human body and to pass out rapidly as
thiocyanate in the urine.

So why should gas victims still

feel sick and pass thiocyanate in their urine so many months
after the gas leak?

It is this question which leads us to

relieve that the cyanide is coming from another source,
perhaps the proteins M carbamylatedw by isocyanate.

X.

All of us

(
y^vs/'-

(Contd*••25)

25
anxiously await the final results of the

scientists*

research.

THE STOMACH AND DIGESTIVE SYSTEM
Some gas victims suffered most from difficulties with

their digestive system^ even more than breathing difficulties*
In the beginning vaulting and involuntary detaecation or
Even months after the gas leak.

later diarrhea was common.

they were still feeling uneasy in their stomach. and nauseous

at the slightest provocation•

Some women bidl workers had

to to give up the job because they would get sick from the

smell of tobacco.

They

Most people had a loss of appetite.

could not eat more than one or two rotis, and then their
stcmach would feel uncomfortable, heavy and blown up.

Many

people suffered from abdominal pain*

The Jana Swasthya Kendra doctors noticed a very intersting
thing when they started work in the month of June.

The first

and most common comment of people after they had received a

few injections of Sodium Thiosulfate was that they new felt
hungry, they enjoyed eating their meals and they found that
*

the ration they had been receiving from the Government suddenly
Even in September# Jana Swasthya

appeared to be too little!
VxA

’’y

Kendra doctors found that/ gas victims who complained of upper

abdominal pain and tenderness when the point was pressed got

relieved after sodium thiosulfate injections.
We do not yet fully understand the reasons for these
late findings.

In the early postmortem examinations, the

lining of the stomach was
swollen.

■abnormally bright "cherry" red and

The same appearance was found even in the stomachs

of persons who died a month or more after the accident.

If

you remember what we had seen happening in the earlier section

(Contd...26)

26
on the blood you can begin to Imagine the effect ofi the

other vital tissues supplied by the same blood.
Firstly# most of the oxygen which crossed the lungs
got locked up in the blood attached to haemoglobin.
giving even the venous blood a bright red colour*

The

circulating blood “naturally penetrated and coloured

all the tissues including the stomach lining#
Secondly, the blood became gradually thicker, because

the haemoglobin present from before was no longer
/

useful and new haemoglobin was made to compensate#

Thirdly, curbamylation of proteins by isocyanate must

not have been restricted to haemoglobin alone, but also
probably caused a change in the protein enzymes of the

stomach and intestines which are needed for digesting
the food, like trypsin and chymotrypsin#

Fourthly, the recurrent presence of free cyanide in

the body prevents the body*s cells from using oxygen

as they require*

This would eventually lead to brer-k-

down of the cells* function, and quite understandably
to collection of fluid cr swelling, known as oedema.

Long-standing swelling or oedema of the stomach and intestines
would impair appetite and digestion, give one a feeling of

being full without eating much, and generally make one feil

sickened *

In some way, sodium thiosulfate ma;Jbe able to

reverse the toxic mechanisms causing oedema, and thus, bring

about the relief which m^ny of you have reported after

taking treatment*
Ordinarily, people who have bruning pain in the upper
part of their stetrtach, as we*ve shown in the picture. and

(Contd. #Z7)

27

uncxmif ortable fullness in their stomach after eating.
have a condition celled “hyper-acidity” 9 and they are

treated with medicines called •’antacids*1 •

If the rain

is severe, they are given more medicine to relax the tension
of their stomach and intestines, called "antispasmodics*.
Doctors have given lots of antacid-antispasmodic medicines to

gas victims, end people have got partial and temporary relief
from the pain and discomfort.

But because the cause was

deeper, the condition did net get cured by these medicines.
However, you may find that these medicines will help you

to get some relief if you still have stomach trouble after

taking sodium thiosulfate injections, and if no other cause
can be found.

Do tell your health worker about your problem.

He or she s will listen and give you advice, and record your
problem and proerress on a health card.
Any Substance which is irritant can increase the acidity

in your stomach.

Therefore, it is best to avoid strong

tea, coffee, chillies, and use cf tobacco in any form if
you are prone to get hyper-acidity.
i

* *• •*<•*4*

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This booklet has been published jointly by Rural Litigation and
Entitlement Kendra (RLEK) 21, East Canal Road, Dehradun
and Bharat Dogra C-27, Raksha Kunj, Paschim Vihar, New
Delhi-110063 and printed by Kulshrestha Printers 11 Tyagi
Vihar, Nangloi, Delhi-110041

(16)
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