Health for the Millions, Vol. 12, No. 2, April 1986

Item

Title
Health for the Millions, Vol. 12, No. 2, April 1986
extracted text
More than one million people the world over die
prematurely every' year due to tobacco—the health
hazards of tobacco on the chewer or smoker are too well
known to be enumerated here. Tobacco smoking is the
most addictive drug known to man. When nicotine is
inhaled, it takes 7.5 seconds to reach the brain from the
lungs—six seconds quicker than if injected into a vein
in the arm. Diseases due to tobacco arc a man-made
epidemic: tobacco does not have a single redeeming fac­
tor. In fact, according to WHO. "nothing less than the
removal of this man-made hazard would be compati­
ble with WHO's goal of health for all by the year 2000."
While tobacco smoking has declined in the western
world, there has been an alarming increase in develop­
ing countries. In India, smoking and chewing of tobac­
co are responsible for 75 per cent of chronic bronchitis
and emphysema. India has the highest incidence of oral
and throat cancer—36 per cent. The tar content of In­
dian cigarettes is often as high as 31 mg.
The health hazards of passive smoking are only now
being recognized. Non-smoking wives of smokers are
at greater risk of illness. Pregnant women who smoke
can cause irreparable harm to their unborn children.
Parents who smoke not only endanger their children’s
health, but also initiate them earlier into the smoking
habit. Colleagues of smokers suffer almost as much as
the smokers themselves.
Tobacco companies are now aiming at capturing
younger and younger markets—often promising ex­

citing adulthood with the first puff. They have suc­
cessfully identified themselves with success, wealth.
and the most misleading of all. health—they sponsor
healthy activities like sports. Statutory warnings have
had little effect: they are printed too small, in colours
that could be missed. While the government gives lip
service to the curbing of this health menace, the tobac­
co industry is its second largest revenue earner.
Cultivation of tobacco not only uses up precious land
which could grow food: tobacco is a very vulnerable crop
and needs greater use of toxic pesticides. (It is ironic that
besides taking in the inherent poisons like nicotine and
carbon monoxided. the smokers also get to take in tox­
ic residues of pesticides in large amounts). Curing of
tobacco needs excessive firewood, leading to extensive
deforestation with its attendant ecological effects.
For this issue of Health for the Millions, we asked
Parallel Lines Editorial Agency to design a supplement
on smoking which could be used as the basis of anti­
smoking campaigns.
The new drug policy is now on the anvil. In this con­
nection. Dr. Zafrullah Chowdhury visited India. Kanthy Venkat of our office interviewed him. This interview
appears on page 15.
You would have noticed that we have issued new
subscriber numbers with our last issue of Health for the
Millions. These new numbers appear on the address
Hap. Please quote this new number in all future
correspondence.

CONTENTS

Smoking

1

Towards A New Pharmaceutical Order

13

People Vs Profit

Prevention of Xerophthalmia by the ‘Rule of Six’

18

The RAHA Experience

19

News From the States

21

This issue of Health for the Millions has been edited by Radha Holla-Bhar with assistance from Gloria David. Chandra
Kannapiran. Padarn Khanna and Padmaja. Designed and Produced for the Voluntary Health Association of India. C-J4,
Community Centre. Safdarjung Development Area, New Delhi 110 016 by Parallel Lines Editorial Agency. E-8 Kalkaji, New
Delhi-110 019.

Multinational Companies that control the world’s tobacco industry spend large sums on market
research to find ways of attracting kids to smoke: Singapore Anti T.B. Association.

CATCH THEM YOUNG
In Indict Cigarette smoking has gone
up by 90% in 20 yrs.

TOST L00< AT
PEA/AND... AS AAJ
/W£>L£T£y MI7H
such p^tekit/al-to

Th&m_‘50is. sW.UHl
COUL-kM^

THAT'S

smiT
y,\U-

*/’ “

SMOKING BEGINS IN THE WOMB
Spontaneous abortion
Low birth weight babies
Premature babies
Mental & physical growth retar­
dation

4

Complications during birth
Child has more chest infections
Child smokes earlier

PASSIVE SMOKING
Passive smokers can develop lung
cancer
Passive smokers can get bronchitis
Passive smoking aggravates allergy
& respiratory problems
Passive smokers have increased
levels of carbon monoxide
Side stream smoke has 40 times
; more carcinogens than main­
stream smoke.
Passive smoking reduces efficiency

TW'SMOKW
lunch.

Cost of Smoking to Industry
Lost productivity due to sickness
absences
Impaired productivity due to poor
health
Interruptions due to time given to
smoking
Cost of accidents and fire.

5

i

GOING UP IN SMOKE
Two to three hectares of forest are require! to cure one
ton of tobacco. Valuable land needed for growing food
crops is being used to grow tobacco.
Tobacco cultivation needs more pesticides.

BENEFITS OF SMOKING
Bronchitis
Emphysema
Cancer of the lungs, mouth, throat.
oesophagus, kidney, bladder.
cervix
Ischemic hear disease
Heart disease and degeneration
Arteriosclerosis
Gangrene leading to amputation
Backache and other problems.

8

WHO CONTROLS WHOM

INDIA

Rajasthan govern
banned smokin

PUFFING AWAY LIFE
95 percent of bronchitis cases are
smokers.
Death rate in smokers with bron­
chitis is 20 times more than in
non-smokers
Over 50% of smokers get lung
cancer
90% of lung cancer patients die
Smoking is cause of 30% of all
cancer deaths

TOWARDS A NEW
PHARMACEUTICAL ORDER
The health of a nation and its drug
policy
arc
very
closely
interrelated—in fact each depends
upon the other—each complements
the other. At least in theory. But
sometimes, one gains much more
precedence and power than is good.
and dominates the other. This is the
case in the Third World. Drugs that
are useless, irrational and often
hazardous are being sold not just by
the dozen, but by thousands to an
innocent public in the name of
health care.
The USA. with 16 per cent of the
world market, has 700 units produc­
ing drugs. India, with just one per
cent of the market, has 8000 formulators and over 60.000 formula­
tions!
In 1977, WHO. acting on the
recommendations of experts from
India. China. Africa. US. and other
countries, formulated a list of essen­
tial drugs. This list was to be the
guideline for countries to help them
formulate their own rational drug
policies best adapted to their needs.

Chowdhury. After concerted efforts
over years. Dr. Chowdhury manag­
ed against much national and inter­
national opposition to push through
the Bangladesh Drug Policy—a very
rational policy. (For fuller details of
the Bangladesh Drug Policy, refer to
Vol. Vlll. No. 6 issue of Health for the
Millions of December 1982).
What is a drug policy? And what
exactly is involved in it?
A drug policy basically identifies
the essential drugs of the country.
and sees that these drugs are readi­
ly available to its people, at good
quality and at reasonable prices. But
in actual practice, many drug
policies are dictated not by the real
needs of the country, but by other
interests, mainly mercenary.

DRUGS—A COMMODITY
Drug is a commodity. This should
always be borne in mind. As a com­
modity. it has two values—the use
value and the exchange value. As a
commodity, business people are

"LEAGUE OF NATIONS"
Foreign countries, especially
developed ones, try and often suc­
ceed in thwarting the efforts of
developing countries to formulate
their own national drug policies. Sri
Lanka, which had formulated a ra­
tional drug policy, had to bow before
international perssure. and retract
it. One of the stands of Dr. Salvador
Allende of Chile was the need for a
rational drug policy. This policy
would be detrimental to the in­
terests of the business houses in sur­
rounding developed nations, par­
ticularly of the US. as Dr. Henry
Kissinger put it. Dr. Allende could
only live for three years after becom-ing the president of Chile.
Foreign business houses—the key
words. How do they work? Often by
selling their brand names to the
local companies. The income in the
US from royalties alone is much
greater than its entire income from
exports. Their claims to quality.
research and development are also

R&D INVESTMENT FOR 1981-82

NAME OF COMPANY

(in rupees)
2.20 crores
1.20 crores
1.06 crores

SALES TURNOVER FOR THE
SAME PERIOD (In rupoas)

Hoechst
Pfizer
Glaxo

52 crores
45 crores
93 crores

The investment in R&D is only 2 per cent approximately
Figures from Balmohan Singh's speech at the International Symposium on Current concepts in drug design held at the
Central Drug Institute. Lucknow. 1984.

Earlier, in 1975. India had
pioneered studies in this connection
by setting up the Hathi Committee.
Dr. Zafrullah Chowdhury says: “In
Bangladesh, we took it almost as a
Bible. It is the first book which gave
us the insight into the drug
companies.”
Both these reports stirred the
minds of conscientious doctors and
others all over the Third World. One
of the doctors so affected was Dr.

linked with it. So far any company
person, the use value is of no
value—it is the exchange value that
is most important. How much
money can I make from it?
Four factors come into play when
formulating any pharmaceutical
order:
★ foreign countries
★ foreign drug companies
★ medical personnel
★ consumers

not justified. In India. 23 multina­
tional companies like Bayer. CibaGeigy, Burrough-Wellcome, Glaxo.
Phizer, Hoechst. SKF. Roche have
produced 135 substandard drugs.
Their extremely large profit margins
have led to spurious drugs which are
often fatal.
The multinationals are also
outlets for hazardous drugs which
have been banned or severely
restricted
in
their
mother
13

countries—drugs like clioquinol,
highdose estrogen-progesterone
combinations, analgin, amidopyrine.
And their means of doing this is
the medical profession:

MEDICAL COMPLICITY
What doctors prescribe, creates
the demand, and in the case of irra­
tional and hazardous drugs, supply
often meets it. So much so that one
wonders whether the supply itself
has created the demand. And one is
right.
It is the hard sell of the companies.
combined with the doctor’s lack of
knowledge of recent medical ad­
vances. lack of lime for diagnosis.
that creates these unnecessary
deamnds.
“In the Third World, it is through
the doctors that multinational and
national companies are flourishing.
Third World countries are a
goldmine—though only 10 to 15 per
cent of the people have the oppor­
tunity to have health care—modern
health care.’’ Literacy levels are low.
While in other commodities, the
consumer can taken an informed
decision, “In the case of drugs, they
are totally dependant on a middle
man. This middle man is the doctor.
Whatever the doctor is prescribing.
they are taking in good faith.” Ac­
cording to Dr. Zafrullah Chowdhury,
10 pr cent of land transactions in­
volving marginal land owners in
Bangladesh is for buying health
care.

ALL THAT GLITTERS IS GOLD
These people need essential
drugs. But where are the drugs? Of
the 63000 formulations available in
the market, most are irrational—
tonics, appetite stimulants (in a
country where the availability of

RETAIL TRADE MARKET from 1st June 1983 to 31st Moy 1984
In crores

Systemic antimicrobials
Vitamins
Tonics
Cough/cold preparations
Anti inflammatory drugs
Antiparasitic drugs
Analgesics
Blood tonics
Anti T.B. drugs
Enzymes
Steroids (Topical)
Hormones
Antidiarrhoeals
Nutrients
Other irrational combinations
Total sales:
Vitamins, Mineral supplements and
Tonics
Anti T.B. drugs

Rs. 115,38.32.000
Rs. 24.50.35.000

Source: ORG May 1984

food is a major problem) and an­
tacids. These demands are created
by whom? By that well dressed
“Greek bearing gifts”—that ubi­
quitous
being—the
medical
representative.
With his cart full of goodies—
samples, gifts, discounts, 5 Star con­
ferences,—he visits the doctors and
confronts him with “evidence” of
the efficaciousness of his drugs. It
does not matter that these drugs will
malform unborn babies, cause
blindness in the consumers, may
kill them, and are often banned in
most other countries. It does not
matter that these tonics are much
more costly than the food the patient
needs. It does not matter that the pa­
tient can only buy the first two or
three medicines prescribed. It does
not matter that often he can buy
these only if he sells his land. It does
not matter that more often than not

Contribution of Imports to Apparent Consumption of Bulk Drugs
for 81-82

14

208
85
60
48
42
39
37
37
24
21
21
21
19
36
192

Drug

Indigenous production

Import

Vitamin A
Chloroquin
DDS

52.6 mmu (was 59.8 for 1980-81)
59T
26.6T

1242.50 mmu
166.2
18.5T

the "evidence of efficacy” is an ut­
ter and abominable lie (package in­
serts are often missing; if they are
not. they often lie about the symp­
toms for use. the contraindications
and dosages) often with fatal results.
What matters is just how much of
these drugs is the good doctor going
to prescribe.
And last, but not the least, is the
consumer. Drug companies do not
hesitate to approach the consumer
directly through discretely worded
advertisements so that he can per­
suade his doctor to prescribe un­
necessary or harmful drugs.
Thus it is the drug industry
through its marketing practices
directed at the governments, the
doctors and the consumers, who dic­
tates drug demands which form the
basis of a country’s drug policy. The
industrialisation of health in India is
almost complete. It is the Ministry
of Chemicals and Industry who
deals with drugs! Yet public
awareness can work—the rickshaw
puller, the vegetable vendor added
his voice to the general demand in
Bangladesh and got a rational drug
policy. Bangladesh has shown it can
be done. Let us ask for a rational
drug policy clearly and loudly, and
see that we too get it.

PEOPLE
VS
PROFIT
On the 26th of February,
Kanthy Venkat interviewed Dr.
Zafrullah Chowdhury.
KV: Can you tell us something
about your drug policy?
ZC: Bangladesh drug policy was
formulated and promulgated
in June 1982. It became a
highly acclaimed policy. The
main reason behind this is that
it is based on scientific facts
which are known to the doc­
tors and other people for a long
time. But unfortunately due to
the high pressures of the
multinationals it became dif­
ficult for any government to
implement it. Bangladesh
government implemented it.
Il is purely a rational drug
thereapy based on the WHO
recommendations on essential
drugs. There were sixteen
criteria for establishing this
policy-12 are purely scientific.
and four were economic.
KV: Which were the main criteria
of your drug policy?
ZC: Every7 medical textbook would
say that active ingredients
should not be mixed with
various spices. Various tonics
and vitamins should not be
mixed up. Combinations arc
not favoured by medical tex­
tbooks. Especially in the case
of anitaboitics. combinations
cause more toxicity, create
more problems, and increase
risks.
Every drug has its side ef­
fects. Except pure water—even
oxygen can give you side ef­
fects. That’s why drug are po­
tent things.
Uneccssary tonics, gripe
waters, cough mixtures are to
be eliminated.
Addictive drugs are to be
avoided where practicable.

KV: What were the economic
considerations?
ZC: Economic considerations arcvery important for a poor
country' like Bangladesh, were
50 per cent arc landless and
more than 60 to 70 per cent do
not gc' the full 2000 calories.
Foreign companies are need­
ed to provide better technology
and finance capital. Now. after
1982. a foreign company can­
not work unless they establish
a factory, bring finance, pro­
duce raw materials. They can­
not manufacture simple
medicines like vitamins and
antacids.
In many' Third World coun­
tries. the multinationals come
with a name—with just a sign
board. They do not bring any
money, or machines or
anything else. This is called
loan agreement. It is prevalent
in many Third World coun­
tries including India. The
multinationals get their drugs
produced by small unknown
companies. This hampers
quality.
Based on all these criteria.
we checked on 4000 drugs
then available in the market.
We found that more than 1700
drugs were useless. In some
cases, they were positively
harmful. And so we stopped
these drugs.
KV: What
was your
main
thrust?—removing
the
multinationals or removal of
hazardous and irrational drugs
irrespective of who produced
them?
ZC: In case of hazardous and irra­
tional drugs were made no dif­
ference between a national and
foreign company. Government
will not allow production of
any bad. harmful or hazardous

drug. They must produce
essential drugs. Rational drug
therapy' is the mainstay. We
will not make concessions for
any body, whether multina­
tionals or national companies.
We want quality drugs at
cheaper prices. We want real­
ly good essential drugs. We
want the multinationals to pro­
duce more antibiotics, more
life-saving drugs, which need
more and better technology.
We do not want them to pro­
duce simple drugs but
something very special for
ulcers or cancer. We do not
want them to go away from
Bangladesh. We want them to
behave ethically.

KV: What about double standards?
ZC: In the western world, where I
stayed for many years, the
drug companies behave dif­
ferently than in the third
world. T hey have strict regula­
tions. lor example. in
America, there is the I DA. You*
cannot claim anything: it must
be scientifically proved. The
quality should be good. Before
a drug is marketed, they will
ensure that it doesn’t cause
any harm or risk. But in Third
World countries, like India.
lake the case ol Analgin.
Chlorostrcp
or
Streptopenicillin. These drugs arc
positively
harmful.
No
developed country would
allow you to mix up penicillin
and streptomycin together.
They must be separately used.
Il has been slopped in most
developed countries almost 30
years ago. But it is still double
standards— one for the
developed countries and one
for the T hird World.
We also notice that our drug
prices are much higher as
15

compared with the rest. If we
compare the per capita income
of the developed countries.
their drug prices are much
lower than the Third World
prices.
KV: Did the Hath! Committee
Report influence you?
ZC: India made a pioneering effort
in establishing the Hath! Com­
mittee in 1974. Their report
was published in 1975. We
were excited. They explained
how the multinationals behave
in a big country like India.
How unethically they are pro­
ducing and marketing drugs.
How they are overcharging.
This was an inside view. This
was a very important report.
We were already concerned.
With this report, we thought
that we must do something.
Alongwith the WHO report on
essential drugs, this created an
awareness among doctors.
consumers and others.
KV: Do you thing consumer
forums are important for
creating awareness?
ZC: I think they are very impor­
tant. Afterall the body belongs
to the consumer. It does not
belong,to the government or
the doctor. The consumers
have to be aware, they have
the right to know what affects
their body. It is the respon­
sibility of the doctors to inform
the consumers. Free flow of in­
formation is important. But
the multinationals are spen­
ding so much money in coun­
tries for propaganda to keep
them in darkness. The con­
sumer forum has taken the
issue up in India and other
Third World countries.
KV: Your policy has been at work
for over three years now. What
are its effects on your national
economy and also the
prescribing practices of the
doctors.?
ZC: Once we could survive the
pressure of the various
developed countries and the
multinationals, our country
started to get the benefit of the
drug policy. First of all, when
bad drugs were removed from
16

the market, the drug com­
panies started producing life­
saving drugs. Now there is a
tremendous increase in essen­
tial drugs production. When
the multinationals produced
only tonics and vitamins, or
when each had a monopoly
over an antibiotic, they could
dictate the price. After the
drug policy, more companies
started producing antibiotics.
So there was competition and
prices came down.
For eg., a British multina­
tional called ICI produced a
drug called Septran. Before the
drug policy, it cost 30
Bangladeshi Taka. The same
drug came down to 30 ps after
the drug policy. The price has
come to one-third of the
original price. They increased
the discount to the retailer to
30 to 40 per cent. The price
could come down further.
KV: What
about
national
companies?
ZC: Infact, our drug policy affected
national companies more than
the multinationals. Only the
multinationals made louder
noise.
The government sat with
the local companies and
said—Look you produce essen­
tial drugs. We will back you.
Just because you are national
companies we cannot allow
you to produce bad drugs.
Within two years, the na­
tional companies realised that
they could also produce better
drugs, they could also sell their
products, they could have
good business! Their business
has increased tremendously.
Also vitamins and antacids
have been reserved for na­
tional
companies
exclusively—but vitamins as a
single ingredient product. We
also eliminated the bottles;
most of the time the bottles
cost more than the vitamins
inside.
At the same time, there is
also an effect on the prescrip­
tion practices of the doctor. If
there are bad drugs in the
shelf, people will write it. We

should not forget that there is
no continuing education for
the doctors in the Third World.
In the western world they
always take their doctors for
furthering their education, to
give them modern uptodate
knowledge and information.
There is no such provision in
the Third World countries.
Most of the information to the
doctor comes from the drug
company representative.
Now. after the drug policy.
doctors are writing more
essential drugs. Previously.
they would write six to seven
drugs in one prescription. Now
they write less than four drugs.
KV: What about quality control?
Afterall the multinationals did
claim better quality.
ZC: We should all remember that
drug is a commodity and the
people who manufacture are
businessmen. They will do
anything to maximise their
profits. In a Third World coun­
try both national and interna­
tional companies produce
substandard drugs. Spurious
drugs are also produced. Ofcourse. substandard drugs are
produced by callous people.
They want to make more pro­
fit. Spurious drugs are
available because one can
make more profit. But
substandard drugs help the
companies, while spurious
drugs help outsiders—ie. the
smugglers.
Fundamentally, if we want
to have quality drugs, we have
to cut down the profit margin
of the company. One of the
most important ways is pric­
ing. Drug companies should
not make more profit than
other companies. In other
cases of commodities, con­
sumers can check it. Like if
you go to a shop to buy a sari.
you can compare the quality
and prices. In case of drugs, a
consumer does not have the
facility. They depend on the
doctor. And the doctor
depends upon whatever the
drug company tells him. The
doctor’s education does not

Check the machines and
personnel for quality control.
Whether the machines are in
good working conditions or
not. Then what are the
chemicals used for quality con­
trol. What is their value?
Usually bigger companies
spend Just about V2 to 1 per
cent on quality control.
Good quality contorl will not
increase prices either. It is a
question of habit, a question of
intention, how concerned you
are about the people. If you are
concerned about people, you
will produce good drugs.
KV: Who should be involved in for­
mulating a drug policy?
ZC: In the Alma Ata declaration of
WHO, guaranteeing Health for
All by the Year 2000, they had
eight criteria. Of these eight,
five were exclusively related to
drugs. So health policy and
drug policy are very closely

related. In fact for the Third
World, drug policy is no less
important than health policy.
To my mind it should really
take precendence.
In Third World countries,
people spend more than 40 per
cent of their income on drugs.
In the first world, only 10 to 15
per cent is spent. Drug policy
cannot be left with the in­
dustrialist. It must be the
health ministry and health
professionals who should
decide. Also, the consumer
should be involved. The con­
sumer must be involved from
the very first day. The health
of the industry is not that im­
portant. It is the health of the
people which
is most
importnant.
equip him to check the quali­
ty of drugs. Almost 99 per cent
of the doctors have never
visited a drug company. It is

not in their curriculum to
check the quality. So the
responsibility lies with the
drug companies and the
government.
If the government brings
about strict laws and if the doc­
tors are taught in medical col­
leges or through refresher
course I think the quality of
the durg can be easily
improved.
In Bangladesh we have
checked who controls the
market. Usually in the Third
World countries, it is a small
number who control the
market. If you can control this
small number of companies,
you can easily guarantee
80-85 per cent will be good
quality drugs. So we are
checking the bigger com­
panies first. Big companies
must produce good quality
drugs.

RESEARCH FOR LOCOST
LOCOST is a non profit trust that seeks to promote the rational use of medicines. We also supply quality
drugs to those working with rural/urban poor.
LOCOST offers support for research in the following areas:
★ Review of academic literature of specific drug categories like analgesics, antispasmodics, haematinics,
etc. and/or of controversial drugs like analgin, etc.

★ Identification of information gaps in drugs usage, ADR reporting and designing and implementing study
to fill up gaps.
★ Review of contents, sales, prices, market share, etc. of top selling allopathic and traditional medicines,
fixed dose combinations, and over-the-counter products.

★ Review of promotional literature of top selling formulations and companies.
★ Production/distribution bottlenecks of some essential drugs like Vit. A, Rifampicin. INH. etc.

★ Pricc/Salcs trends of essential drugs
★ Social cost benefit analysis.

★ Prescription pattern studies and prescription guidance.
★ Perceptions and responses related 10 communication processes and aids in drug selling and in drug therapy.
LOCOST’s priorities are towards rural poor and urban poor. Our budget is modest. Well designed short term
(one month to six months) research proposals, with concrete output on which action can be taken are welcomed.
Write to:
LOCOST. GPO Box No. 134. Vadodara 390 001 (Gujarat)

17

PREVENTION
OF XEROPHTHALMIA
BY THE 'RULE OF SIX'
Dr. (Mrs.) Radha Y. Aras

In India we have more than one
million persons who became blind
in early childhood simply because
their Vitamin A requirements could
not be met. Every year 15.000
children become blind for the same
reason before their sixth birthday.
It is easy to remember about
prevention of Vitamin A deficiency
by the “rule of six” The number
“six” recurs numerous times in the
diagnosis and prevention of
xerophthalmia.
The eye is involved in six stages
depending upon the severity of the
deficiency:
★ Night Blindness
★ Conjunctival Xerosis
★ Bitot’s Spots
★ Corneal Xerosis
★ Corneal Ulceration
★ Keratomalacia
The target group for prevention of
xerophthalmia is from six months of
age to six years of age.
Mothers should be encouraged to

breastfeed their babies for at least
six months, and if possible longer.
The baby needs additional sup­
plementary food at six months.
Specific nutrition education
directed to the mother must em­
phasise that al least one of the
following six foods should be includ­
ed in the daily diet of this child:
★ Carrots
★ Tomatoes
★ Pumpkin
★ Dark green leafy vegetable like
spinach
★ Drumstick or its leaves
★ Papaya
This education is particularly
necessary for the prevention of
Vitamin A deficiency in pre-school
children belonging to poor families.
These children often slip through
the system of recognition, registra­
tion and delivery of health care.
National Vitamin A prohylaxis
programme for prevention of nutri­
tion blindness —administration of

66,000 mcg of retinyl palmitate in
oil'by mouth in the target group.
The frequency of application—
once in six months.
A health worker can be trained in
these six aspects- of prevention of
Vitamin A deficiency in the com­
munity. Primary prevention or iden­
tification of cases in the earlier
stages and prompt treatment and
follow-up is easy to remember by the
“rule of six”.
References:

(1) Shukla, P.K.: Nutritional Problems
of India, P. 119-129, Prentice-Hall of
India Pvt. Ltd., 1982.
(2) World Health Organisation: Vitamin
“A ’’Deficiency and Xerophthalmia;
Report of a Joint WHO/USA1D
meeting, WHO Tech. Rep. Ser. No.
590, 1976.

Dr. Aras Is Reader, Department of Preventive
and Social Medicine at Topiwala National
Medical College. Bombay 400 008.

VHAI ANNOUNCES
A Correspondence Course leading to certificate in Community Health Planning. Organization and
Management
Target group:
* Persons in the Voluntary Sector who have been appointed
as area managers, or advisors for health education:
•People who wish to learn how to train others of their own
locality, in community health education, services and
management.
Objectives:
*To develop and improve the skills of directors, area
managers and consultants of community health
programmes:
•To improve efficiency and widen the scope of persons
engaged in planning, organizing and managing of com­
munity health programmes.
Methodology:
*The course will consist of seminars, regional study
meetings and individual learning material.
Duration of course:
*Two years to complete all the assignments including
...
seminars and personal visits to the student’s project.
For details, prospectus and application forms, contact:
The Senior Co-ordinator Community Health Education. Training and
Personnel Development.-VI1 Al. C-14. Community Centre.SDA.
New Delhi-1 1U 016.

18

THE

RAHA EXPERIENCE

Situated in the wooded, elevated
tablelands of Madhya Pradesh, the
Raigarh Ambikapur Health Associa­
tion caters to the health and
development of tribals. Most of the
tribals in the area belong to the tribe
Oraon. They are a nomadic tribe, on­
ly recently turning to agriculture.
Their economy is not really focused
on "increased production", but
rather on fulfilling the needs of im­
mediate consumption. Nearly every
village has a "baid". who uses herbs
for treating the ill.

Promoting Health
RAHA started in 1969 to coor­
dinate the activities of all the health
services in the area, previously run
by different institutions. The
Association, under the guidance of
the charismatic Fr. Van Besouw.
took off in 1975. A meeting of RAHA
in September. 1974 defined com­
munity health as the goal, with
prevention of ill health as the focus
of activity. A need was felt to decen­
tralise the existing educational pro­
grammes. and train Village Health
Promotors (VHPs). A mobile team
with volunteers from five different
institutions met with the village
leaders and the religious leaders to
convince them that the village
would be more healthy if it had local
people looking after its health. Once
the concept was explained, the
villagers were invited to select from
among themselves one man and
woman who could help the com­
munity. The only criteria for selec­
tion was the respect these persons
commanded from the community
and their effectiveness. The mobile
team conducted intensive health
camps al the health centres for these
chosen health promoters. Topics
chosen for training included basic
hygiene, sanitation, nutrition.
mother craft and natural family
planning. Emphasis was given to the
recognition of common diseases and
the need for early referral and first
aid. After some months, at a second

camp, the promotors were given a
first aid and medicine kit free.
Today, there are 1400 village
health promoters. About 3000 have
been trained so far. The VHPs meet
once a month for follow’-up. These
meetings are of crucial importance.
Besides reporting and getting fur­
ther inputs from the health centre
staff, the VHPs exchange their ex­
perience and are further encourag­
ed to do things together. Govern­
ment Community Health Guides
also come for these follow-up
meetings. They get on-the-job
education from the RAHA staff, and
they share the medicines they get
with the RAHA trained VHPs. The
government PHCs also recognise the
competence of the VHPs and accept
cases on their recommendation.
VHPs are not paid anything, but
the community is encouraged to
give them an annual remuneration
In accordance with the tribal
custom.
With the increase in the number
of VHPs (there is one for every 1000
population, and sometimes two).
everyone felt the need for a link per­
son between the staff, the health
centre and the VHPs. For every
health centre, at least two VHPS
were chosen for this purpose. These
supervisors help the VHPs after
receiving additional training. They
visit the villages, as well as give
weekly talks at MCH clinics. They
are paid Rs 50/- per month, and are
given bicycles io help them travel
easily from village to village.
In August 1985, an evaluation
was done of the VHP supervisors.
The community felt that they had
contributed tremendously toward:
★ Removing superstitions
★ Reducing the incidence of
cholera
★ Almost complete eradication
of malaria
★ Bringing the incidence of
water-borne diseases under
control
★ Improvements in mother and

child health
★ Increased awareness of health.

People's Need
In a truly people-initiated move­
ment. RAHA started its Dai training
activities. The VHPs and the people
felt the need for trained dais. Mater­
nal and child mortality due to
tetanus was alarmingly high. The
VHPs approached the local dais,
most of whom welcomed the train­
ing. Today. RAHA has trained over
500 dais, some of whom are also the
VHPs for their communities. Dais
look after the MCH activities of the
community. They are trained in bet­
ter methods of delivery, while they
encourage the traditional good
habits like giving colostrum to the
newborn, delivering the child in a
squatting position etc. The in­
cidence of tetanus, both in mothers
and in children, has been substan­
tially reduced especially due to the
more hygienic delivery practices.

Women's Development
While the women are expected to
work equally hard alongwith their
men in the fields, they are given no
voice at home or in the community.
The Grihini Training Programme.
which started as early as 1958. is an
attempt to make lhem aware of their
dignity as human beings. Grihini
training is a residential course
where women are taught home
economics and management, in­
terpersonal and interfamily relation­
ships. health care, nutrition, mother
craft alongwith traditionally taught
skills like tailoring and crafts. There
are 24 Grihini Training Centres in
MP and more than 800 girls are
trained every year.

Tribal Balwadis
There are 213 balwadis under
RAHA. These cater to the physical.
mental and emotional development
oi children under sLx years of age. At

19

the start of the programme, the
1CDS scheme of the Government
was studied in detail, and its
syllabus for training anganwadi
workers copied for the balwadi
workers' training. Today there are
two training sessions every year.
Almost 50 workers are trained at
each session.

Jagruk Kisan
RAHA has also a programme for
the education of the marginal tribal
farmer, who owns his own field. As
most of the land is inherited, there
are many legal problems arising
from the illiteracy of the farmer. He
has no way of proving the land to be
his, except for landmarks. RAHA
helps him solve these problems and
gives him legal education.

Insuring Health
One of the major problems RAHA
faced early in its functioning was the
high cost of health care. In 1980,
they started a novel Medical In­
surance Scheme. The initial thrust
towards insuring for hospitalisation
received very little community sup­
port as no one wanted to be
hospitalised. A proposal for “local
treatment” got a better response.
Membership fee is extremely low: two
kgs of rice or its equivalent per per
20

son per year. RAHA doubles the con­
tribution. This local treatment fund,
or “Samaritan Fund" finances all
preventive, protective and curative
expenses at the health centre and so
encourages early treatment. A small
percentage of the fund goes towards
the central fund, which pays
towards the hospitalisation of the
member. The patient has to pay the
first Rs. 100/-. Anything over this
amount upto a maximum of Rs.
1,000/- is paid for from the central
fund. This covers the hospital bills
and medicines. The patient has to
pay towards his own food. The
scheme holds good even if the pa­
tient is hospitalised in hospitals
other than the three which come
under RAHA.
The success of the scheme is due
to the emphasis placed on the
prevention of illness in the first
place, and early recognition and
treatment in the second place. To­
day, there are over 45,000 members
participating in this scheme.

Health in Schools
In 1980. a school health pro­
gramme was initiated with a
workshop conducted by VHAI. After
an initial slow period, 40
unemployed youths were selected
and trained as school health guides.

They attended to the health guides.
the schools, gave health education
and promoted health consciousness
among the staff and students. For
this, they were paid a nominal
remuneration. The programme
however, ran into trouble. The
guides were outsiders, and were not
accepted fully. They worked, not out
of a sense of commitment, but for
the money. And when they got bet­
ter offers elsewhere, they left. But
the seed they had sown bore fruit.
School masters and teachers w^ere
now too involved to let the pro­
gramme die down. They gradually
took over the activities of the guides.
Now each school involved in the
programme has a health master.
Each class has a health monitor.
The monitor is responsible to the
master for the health activities of his
classmates. Each class including
class I has some health input. While
the smaller children are told of the
importance of keeping nails short
and clean, it is the duty of the older
children to ensure that this is done.
Within six months of this pro­
gramme's inception, there has been
feedback from parents. Children
know what causes diarrhoea,
toothache, malaria, and they tell
their parents how to prevent these
diseases. Often they refuse to take
food covered with flies, or unboiled
drinking water.
Children make songs, plays and
dances with health as the theme. On
the days that the schools close, a
school health camp is held. This is
also the time for the 10-day camp for
the health masters. Their work is
reviewed, and more inputs given.
They learn from each other’s ex­
perience. At the second camp the
health masters are given a first aid
box also. The school health coor­
dinator visits the schools regularly
for encouraging the staff and
students, and to help them im
mediately with any urgent problems
they might be facing.
While RAHA has been successful
in building up an extensive health
programme, the project staff are by
no means resting on their laurels.
They are still thinking of new areas
of development which will help their
communities and methods of mak­
ing old programmes more effective.

NEWS FROM
THE STATES
BVHA—Annual General Body Meeting

BVHA’s 18th Annual General
Body Meeting was held at Navjyoti
Niketan. Patna on February 21-22.
1986. This state VHA—a pioneer
among all. now has Anthony Kokoth
as Executive Secretary since March
1985. with a membership of 120
health care institutions. These in­
clude community health centres.
dispensaries, hospitals or other
health related groups. Dr. Amki

Rama Rao. VHAI. delivered the
keynote address on ‘Health and
Society'.
The theme this time was School
Health Programme. Interested educa­
tional or community health person­
nel were also invited — VHAI’s
resource persons were Dr. Am la
Rama Rao and Christina De Sa. Over
75 participants attended and were
guided through group discussions to
understand the school health con­
cept. and to share their involvement

in allied programmes We also
shared with the participants, our ex­
periences in school health training
programmes and salient features of
other programmes in the country.
We hope this seminar will initiate
and facilitate the active participation
of a Core Group of enthusiasts to
move towards action-oriented
school health programmes at this
regional level.
Christina De Sa

OTHER NEWS
NEEDLELESS INJECTIONS
French engineers have developed
an injection gun which operates
without a needle. The pressure on
the gun liquid alone ensures
penetration.
The first quality oi the needleless
gun is its high level of safety against
microbic and viral transmission, as
no foreign body can penetrate. The
gun, which docs not require any ex­
ternal energy support for its opera­
tion. is portable. It could be an ideal
tool for mass vaccination, according
to the French bulletin. “Cadust".

persons suffering from this can use
the same set of muscles for other ac­
tivities. Instead, it is because of ab­
normal nerve circuits set up in the
brain by the conflict that is posed by
the act of writing (where the flexor
muscles oppose the extensor
muscles. and have to be
simultaneously controlled delicate­
ly to form letters). Even learning to
write with the other hand docs not
help the victims lor more than a few
years.

WRITERS BEWARE!

MALNUTRITION MAKES
PESTICIDES MORE TOXIC
In parts of the world where

A study recently conducted in
Southampton's University School ol
Medicine and the Wessex Neuro­
logical Centre reveals) that the
cramp some people suffer from.
when holding a pen. does not have
a psychological origin. It is due to a
brain abnormality caused by the
physical effort of writing.
The study rejects the idea of it be­
ing a purely muscular malady, as

protein-caloric malnutrition (PCM) is
a primary concern, pesticides arc
often used to maximise crop yields
and preserve foods alter harvest. Ac­
cording to Dr. Indira Chakravarty at
the All India Institute of Hygiene and
Public Health, however, pesticide
residues, themselves, may create a
public health problem.
Dr. Chakravarty believes that per­
sons suffering from PCM are more

susceptible to the toxic effects of
pesticide residues. She states the
well-known fact that an individual's
nutritional state renders him more
or less susceptible to the toxic effects
of foreign chemicals: however, her
research with malnourished
animals also shows the specific
metabolic and physical changes that
take place when they arc exposed to
the organophosphorus pesticides.
the most commonly used pesticides
in agriculture today. Preliminary
results extrapolated to humans in­
dicate that pre-existing PCM renders
individuals highly susceptible to the
toxic effects of residual pesticides.
Consequently. Dr. Chakravarty
advises that the nutritional status of
a community be assessed before any
new pesticide is introduced. Fur­
thermore. she states that in coun
tries where malnutrition is rampant.
vigorous control should be kept over
any pesticides used.
(For more information, write to: Dr. Indira
Chakravarty.
Head.
Department
of
Biochemistry and Nutrition. All India Institute
oi Hygiene & Public Health. 1 10C.R. Avenue.
Calcutta-700 073. India).

21

WORLD ANTI—LEPROSY WEEKIN ST. THOMAS
HOSPITAL & LEPROSY CENTRE, CHETPUT, NA
World Anti-Leprosy week was
observed in St. Thomas Hospital &
Leprosy Centre from 26.1.86
to 30.1.86. In this week, a
public function was arranged in
which the patients, the staff
members, school children, members
of youth clubs and madhar
sanghams and the public took part.
A short play was staged by Leprosy
Inspector Trainees, emphasizing the
fact that any person, irrespective of
caste, creed or colour could be af­
fected by leprosy: people need not
have unnecessary fear of leprosy.
Early treatment leads to early cure.
The kathakalachcbam by our staff
members portrayed the story of
Kuchelar and Krishna in an in­
novative manner, in which
Kuchelar. being affected by leprosy.
approaches Krishna and the whole
dialogue emphasizes that leprosy' is
not God's curse and that leprosy.
like any other disease is curable. A
puppet show by the MCH depart­
ment depicted the story of two
sisters who are affected by leprosy.
The one who takes regular treat­
ment is cured and has a happy mar­
ried life while other one who was
negligent and unwilling to take
treatment suffers from deformity
and realises the need for treatment
very late. All these programmes
were very educative, informative
and interesting.
The chief guests of the function
were Mr. Peter Platte, the Acting
Consul General of the Federal
Republic of Germany, and his wife.
The Consul General, on behalf of the
President of the Federal Republic of
Germany, handed over the highest
award “Das Grosse Bundes—
Vcrdienst Kreuz" to Dr. M. Aschhoff.
Medical Superintendent, for the ser­
vices rendered in the field of leprosy.
general medical care and communi­
ty development since 1960. Mr.
Peter Platte, in his speech, mention­
ed that he and his Government are
well aware oi the various activities
of St. Thomas Hospital & Leprosy
Centre and they have the highest
regard for this institution. It was an
auspicious and cheerful day and all
ol us congratulated Dr. M. Aschhoff
22

and her community sisters. Dr. M.
Aschhoff. in her speech, mentioned
that she accepts this award on
behalf of St. Thomas Hospital &
Leprosy Centre and thanked all her
sisters and the staff members for
their selfless services. Mrs. Peter
Platte distributed prizes to 1 10 win­
ners of essay and oratorical competi­
tions and different sports and
games.
Video shows on “Leprosy" and
“Gandhi" were arranged for the stall
members which were informative
and educative. The Anti Leprosy
Week observed in St. Thomas
Hospital & Leprosy Centre played an
important role in creating
awareness among the public.
especially the youth imparling
knowledge about leprosy and in
changing the altitude of people
towards leprosy, mainly the social
stigma attached to it. This pro­
gramme is another milestone to
achieve the national goal of
“Eradication of Leprosy by 2000
A.D.”

UTTAR PRADESH
The 2nd General Body Meeting of
the UPVHA was held at Literacy
House. Lucknow on March 9. 1986.
Surajit represented VHAI.
After the introductions. Dr. K.P.
Gupta. Director of Family Welfare.
UP. initiated the dialogue by draw­
ing everybdoy's attention to the
vastness of UP state, which forms
about one sixth of the territory of In­
dia. The problems in the state are
many: one of the major factors be­
ing the rapid growth of population.
In spite of a network of state
hospitals and health centres spread
all over, government alone can do
very little to provide essential health
services to reach the goal of Health
for All by 2000 AD. He insisted that
the Alma Ata Declaration should be
translated into action, and not re­
main only on paper as an idealistic
theory. In order to do so the govern­
ment is keen on collaboration with
voluntary organisations in UP to
work out methods of implementing
primary health care needs, especial­

ly family welfare programmes, con­
cerning mother and child health
care, which need urgent attention.
Dr. G.D. Tripathi has been recent­
ly appointed as Deputy Director to
look into the problems specifically
faced by the various voluntary
organisations in UP. Problems and
difficulties encountered by volun­
tary organisations in dealing with
the government or otherwise should
be highlighted by applying to him
directly with all the requisite infor­
mation. The government is willing
to provide finances in terms of grantin-aid and extend necessary
assistance even to the extent of pro­
curing sophisticated equipments to
the voluntary agencies engaged in
the fields of providing eye relief.
leprosy and primary health care.
Voluntary organisations can look
after the primary health centres and
help them to function in a better
way. if they so desire, with prior per­
mission from the government.
However, the government in that
case, would have complete control
over the finances and administra­
tion. With proper assistance and
supervision provided by the govern­
ment. a voluntary organisation can
make PHC centres run efficiently.
One such centre has already been
taken over by a voluntary agency
and is being run in an effective man­
ner. Finally. Dr. Gupta insisted on
voluntary organisations taking the
lead in imparting health education
by reaching out to the maximum
number of people.

The programmes scheduled for the
year 1986 include:—
(i)
Community Health Training
Programmes
(ii) Workshops and Seminars
(iii) General
Awareness
Programmes
The audited statement of expen­
diture for 1985 was presented and
unanimously passed by all present.

DELHI NEWS—Dr. J.S. Tong
The International JOINT CON­
FERENCE
ON
VASCULAR
SURGERY, was held at Taj Palace.
New Delhi from January 19 to
January 21. The first international
conference on vascular surgery that
has been held in India. An important

Paul Harris Award To Professor Manubhai Shah
The Paul Harris Vocational Serviced Award was presented to Prof. Manubhai Shah for his outstan­
ding contribution and commitment to promotion and protection of consumer interest by Dr. D.C.
Kothari, an eminent industrialist and Vice President, International Standards Organisation at a func­
tion at Taj Coromandel Hotel, Madras.
Lauding the services rendered by Prof. Manubhai Shah, the presentation recalled Oliver
Goldsmith’s village preacher saying that Prof. Manubhai Shah used ’ more of his skill to raise the
wretched than to rise; to relieve wretched was his price.”
It was the first Paul Harris Award conferred upon Prof. Manubhai Shah on behalf of three Rotary
Clubs—Madras West. Ambattur and Annanagar.
The Award was set up by them to honour the memory of Paul Harris, who founded Rotary in 1905.

recommendation of the conference
was that the time has come when
this branch of surgery could be turn­
ed over to general surgery. Present­
ly in India it is generally done by
Cardio—Thorocic surgeons. The
Hon’ble Mrs. Mohsina Kidwai.
Minister of Health and Family
Welfare graced the opening
meeting.
The conference was sponsored
jointly by the Indian Hospital
Asociation and South Suburban
Hospital. Hazel Crest, Illinois, U.S.A.
(near Chicago). Seven foriegn pro­
fessors took part as resource per­
sons. 50 people attended.

VHAI NEWS
Dr. Zafrullah Chowdhury, of
Gonoshashthya Kendra and chief
architect of the Bangladesh Drug
Policy visited VHAI from 25th to
28th February. He spent time with
VHAI staff. discussing (he
Bangladesh drug policy, and the
need for a rational drug policy for
the rest of the Third World. In view
of (he impending announcement of
India’s drug policy Dr. Chowdhury
met the selected representatives of
the press on the 26th. VHAI arrang­
ed a public meeting at the Vishwa
Yuvak Kendra on the 27th, where
Dr. Chowdhury spoke. The topic
was “Towards a New Phar­
maceutical Order.’' Mrs. Tara Ali
Baig was the chief guest. Various in­
terested national and international
organisations sent their represen­
tatives. The talk was followed by an
informal discussion.

GUJARAT
The Insilute of Rural Manage­
ment. Anand, hosted a four-day
workshop on Community Health
Projects from February 18 to
February 21. There were 32 par­
ticipants including Purabi Pandey
and Darlecna David from VHAI.
T he objectives of the workshop in­
cluded identification of organisa­
tional. financial and management
problems as well as discussing
solutions.
Most projects start with a
dedicated pcrson/tcam trying to
fulfill a desire to “serve the com­
munity”. Organisational structures
depend often on the type of funding
patterns. 1’his has created a lol ol
variation in organisational struc­
tures and consequently, varying
problems.
Ragarding finance, a project
detailed how it had reduced the cost
of drugs considerably by switching
over to homeopathy and herbal
medicines. Another project, from
I laili. sold health cards to help sup­
port VHWs and the revolving fund.
Purchase of this card for a nominal
fee is the criterion for membership
in the community health pro­
gramme. To be able to purchase the
card, the person has to demonstrate
knowledge ol GRS and the use ol
growth ( harts.
The group identified I’RADllAN
and the Society lor Service to Volun­
tary Agencies as organisations who
could help in preparing project
proposals.
As regards management, and

training of various categories ol
health personnel, again a great
variation was present—for VHWs
from as short as one week to two
years of continued training.
Methodologies for such training also
differed from project to project.
There were also appreciable dif­
ferences over the compensation
issue.
The participants came to the con­
clusion that there is urgent need lor
more community health work in the
country. Exposure to the communi­
ty and working on specific items of
the National Health Policy by com­
mitted people may be a way to in­
itiate more health related activity.
Future plans include training pro­
grammes in Community Health
Management every year by IRMA.
and livid placement of students in
Community Health Projects. IRMA
and VHAI will work out a strategy
to disseminate information on in­
novative programmes to the
participants.

MADHYA PRADESH
The MP VHA held its 14th General
Body Meetingiii Bhopal on February
7 and 8. 1 his year’s theme was the
Eradication ol 1 ubciculosis and
Lepn >sy.
Dr Panini from the I uberculosis
Association ol India <md Ms M.A
Scvtha from the National *1 ubvi

culosis Institute at Bangalore
presented papers.
Dr. Pamra described the
epidemiology ol tuberculosis and
detailed the advances made m treal23

mem. especially in the post­
Independence period. He explained
the importance of various studies in­
cluding the one at Chingleput in
Tamil Nadu. Today T.B. is treated at
home with no need for patients to be
kept isolated.
Ms Seetha detailed the problems
associated with the detection and
treatment of T.B. patients. The pre­
sent
health
care
delivery
mechanism treats the patient as if it
is doing him a favour. The concept
of “case-holding”— ensuring that
the patient takes his treatment
regularly and fully is not emphasis­
ed enough. Though case-holding is
a public health concept, treatment
of T.B. patients should be on an in­
dividual basis. The doctor-patient
relationship should be maintained
and the patient, his idiocyncracics.
his family's views, all taken into con­
sideration. Failure io do this is the
most important cause of the high
percentage of defaulters today.
Again, facilities for treatment need
to be brought closer to the patient.
Voluntary agencies are best suited
for this as they have flexibility and
can lake quick decisions.
In an informal discussion. Ms.
Seetha suggested that the voluntary
agencies work together with the
government in setting up an ex­
perimental project for a period of six
months to one year to see the effec­
tiveness and replicability of such
cooperation.
Dr. Douglas E. Henry. Superin­
tendent of the Leprosy Mission.
Chandkhuri Leprosy Hospital and
Homes. Baitalpur. stressed the need
for public education in combating
leprosy and explained in detail the
modes of treatment and the drug
regimen used.
Sanjay Sharma of VHAI attended
the meeting.

VHAD NEWS
VHAD held its Hird General Body
Meeting at TNAI on the 14th of
March. 1986.
A. They conducted a review of the
activities of the last half of 1985.
Among those discussed were:

★ Assistance in planning com­
munity health programmes
24

given to four organizations:
“Sharan” in Mongolpuri (West).
Medicare Society and Panchshcel Ladies Club (South) and
Rajdhani Public School (East) at
their requests;
★ An elementary School Health
Survey questionnaire to know the
health status of the family and
the family and the family’s
understanding of health needs.
it The secondary questionnaire to
be used for more comprehensive
survey with three teachers tak­
ing on the responsibility for
guiding at least 10 students each
for the comprehensive survey
will be taken up after the
primary survey reports are
completed.
★ 82 schools have been visited by
the two VHAD Coordinators.
Some of these schools have been
visited more than twice to help
them complete the surveys and
draw up the short and long term
School Health plans to collabora­
tion with teachers, students and
parents.
B. The Zonal Coordinators have
visited the Corporation and DDa
dispensaries in the areas and are in
contact with the doctor and health
visitors.
★ Among the activities to be con­
ducted in future arc the develop­
ment of at least three Informa­
tion and Service Centres in the
next three months.
★ A Training Centre which will be
non-institutional in nature and
identify and cater to the training
needs of member organizations
will be developed.
★ Teachers have shown en­
thusiasm
about Summer
Courses on Health. Principals
have agreed to depute two or
more teachers for weekly/fortnighLly courses.
The budget was also discuss­
ed. Dr. Ali Baquer was reelected
President, Ms. Purabi Pandey.
the Hony. Secretary and Mr. Vic­
tor Karunan, the Treasurer who
has taken the place of Mr. S. San­
tiago. Mrs. Suman Kurade.
Mahlla Dakshata Samiti. replac­
ed Mrs. Narendra Nagpal as
Board Member.

BOOK NEWS
NEW ARRIVALS
* IN SEARCH OF DIAGNOSIS
(Analysis of present system of health
cu re j

First anthology of bulletin articles.
Ed. Ashvin J Patel, first published
December 1977. Reprinted May
1985. Price Rs. 12.00 or US $5.00. In­
cludes Health Service Evolution,
Medical Education. National Health
Policy. Alternatives in Health Care.
Population Problem. Drug Industry.
Nutritional Problem in India. Protein
Gap Myth, Tonics and Community
Health Care.

Available with VHAI

★ HEALTH CARE WHICH WAY
TO GO? (2nd Edition)
(Examination of issues and
.alternatives)
Second anthology of bulletin ar­
ticles. Ed. Abhay Bang and Ashivin
J Patel, first published October.
1982. reprinted May, 1985. Price Rs.
15.00 or US $6.00. Includes Drug
Issues. Lathyrism. Water Supply.
Oral Rehydration Therapy. Pro­
blems of Nurses. Community Health
Workers. Dai Training, Government
Rural Health Scheme, Political
Dimensions of Health and mfc
debate on which way to go.
Available with VHAI

* HEALTH AND MEDICINEUNDER THE LENS
Third anthology of bulletin articles.
Ed. Kamala J Rao and Ashvin J
Patel. October. 1985. Price Rs. 19.00
or US $6.00. Includes Critical Ex­
amination of Community Health.
People's Participation, Health for All
by 2000 AD, Health Education.
Drug M.suse. Medical Research.
BCG vaccination, Supplementary
Feeding Programmes, Drug Policy
and Therapeutics, Minimum Wages,
Family Planning and the Kerala
Model.

OPPORTUNITIES
WANTED
For a new 50 bedded Hospital in a small but well connected place, the following staff is needed:
>

Doctors

M.S. (Surgery) M.S. Gynee & Obrt.
M.D. Medicine M.B.B.S., D. Ch.
Staff Nurses

Laboratory X-Ray Technicians

Free quarter, good salary and excellent working conditions assured.
Apply to:
President
Shri Muktiranjan Jain Sarvajanite Hospital
Post LIMDI Via DAHOD Panchsahal Dist.
GUJARAT 389 180.

CALiWAl ©EF
M.I.B.E. GRADUATE SCHOOL FOR NURSES, BOX 170, INDORE, M.P. 452 001, Invites applications for the

Ward Sister Diploma Course. mid-O Stober. 1986 to mid-April, 1987. This diploma is required for
admission to Sister Tutor/Nursing Administration/Public Health Courses. June to December. 1986.
AH courses Hindi/English.

Application/Prospectus Rs. 15/- available from the DIRECTOR.

DIPLOMA IN COMMUNITY HEALTH MANAGEMENT BY VHAI
AND
RUHSA DEPARTMENT OF CHRISTIAN MEDICAL COLLEGE, VELLORE
A Course oi 15 Months
Starts in July 1986. for People Interested in Community Health Work
The Rural Unit tor Health and
Social Affairs (RUHSA).
RUHSA Campus P.O.
North Arcot District
T amil Nadu 632 209
For Details and Application Form.
Write to:

I

BENE

THE

S OF SMOKING

Discoloured Teeth o Cough © Premature Births o Brain Damage

Wrinkles • Reduced Birth Weights of Babies © Premature Deaths
Emphysema o Phlegm o Bronchitis o Still Births o Yellow Nails
Asthma © Shortened Lifespan o Bad Breath o Hardened Arteries

and

of the Lungs, Larynx; Oral Cavity and Esophagus

STUB OUT YOUR HAUO? NOW... '

JOIN THE HEALTHY PEOPLE.
Media
Health for the Millions, Vol. 12, No. 2, April 1986.pdf

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