MEDICAL SERVICE VOL. 41 No. 2 FEBRUARY-1984
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- Title
- MEDICAL SERVICE VOL. 41 No. 2 FEBRUARY-1984
- extracted text
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in motor vehicle accidents
vol 41
no 2
february 1984
official house journal
of the catholic
medical
service
hospital association of India
"the love of Christ
urges us" 2 cor 5 :14
vol 41
no 2
editorial board
february 1984
contents
dr c m francis
dr ravi narayan
dr prem chandran John
dr daleep mukarji
mr augustin veliyath
fr george lobo sj
prof george joseph
dr paul neelamkavil
fr edwin m j
1
editorial
1
2
marriage in god's plan
joe d'souza
3
need people die any more of cholera
w b greenough III
9
traveller's diarrhoea
r h herniman
13
nature cure for rheumatism
asha khanna
17
on your right to compensation in motor vehicle
accidents
p d mathew
21
chai news and notes
31
3
4
editor
5
fr john vattamattom svd
6
cover design
p m isaac bangalore
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
"Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"
EDITORIAL
Children's health : tomorrow's wealth
"Today's children are tomorrow's citizens". This is an old adage yet
ever new and valid. It is estimated that 40,000 children die every day in
the developing world. The question to be asked is : should these children
die everyday like this especially in a world of such scientific and technolo
gical advancement as of today ? The answer is an emphatic NO; but how
far it is from the reality. The World Health Organisation has taken the
theme, "Children's Health: Tomorrow's Wealth" for this year's World
Health Day. This should give us the occasion to think of the State of the
children in our own country. And for us it starts with children in our family
and neighbourhood.
According to a report released by UNICEF on the state of the World's
Children, four low-cost but effective measures, backed by community
awareness and action, can dramatically reduce the present high rates of
child mortality and sickness in developing countries. The four simple tech
nologies are oral rehydration therapy to prevent diarrhoea deaths; promotion
of breast feeding and better infant nutrition; immunisation against preventible childhood diseases; and systematic use of simple growth monitoring
methods for timely detection and treatment of children at risk.
The UNICEF report appeals to employers, teachers, religious leaders,
politicians, trade unions, civil servants, the media, community development
workers and the citizens at large to promote and use these simple ways to
transform the child's future from a tragic to a hopeful one. If people have
the will and make the effort, they can bring about a virtual 'revolution' in
child health and survival for their nations. Only then can the present grim
picture change for the better, the reports points out.
If we believe that children are the wealth of the nation we need to
initiate a massive programme of educating the masses and particularly the
mothers, of making them aware of the seriousness of the matter and how
simple it is to remedy the situation to a great extent if only they take a bit
more care, and above all of providing with the correct knowledge, proper
attitude and necessary skill. CHAI and its members are called upon to
play their role in this regard to ensure a better future for millions of children
in our country.
WORLD HEALTH DAY
Saturday, 7th April, 1984
THEME : CHILDREN'S HEALTH :
TOMORROW'S WEALTH
All are requested to celebrate the day giving due
importance to children's health and their rights.
—Executive Director
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Marriage in god's plan
—Joe D'Souza
If there is a world's plan for our sexua
lity, there is also a world's plan for our
marriage; and there is God's plan, and the
two are diametrically opposed.
In the world's plan, we are role oriented,
duty conscious, self-seeking and separate,
even though living together. In God's plan,
we are spouse oriented, conscious of his/her
beauty, seeking his/her good, and living as
one couple in unity even though we are two
individuals.
As we experienced the beneficial effects
of God's plan in our lives, we have felt
an urge to try and discover more of this
plan of love, and how we can allow
it to pervade our lives through and
through. And so we sought his plan for us
as a couple, as it is written for us in the
Bible, and we selected the following five
features of his plan, hoping that understand
ing his word, we may be guided to live in it
through his power.
a.
To be in God's image
On the first page of the Bible we are told
that we are created to reflect the beauty and
goodness of God : "So God created man in
his own image, in the image of God he crea
ted him, male and female he created them...
And God saw everything that he had made,
and behold, it was very good" (Gen
1 : 27,31).
And so we understood that at the very
basis of our goodness as man and woman,
of our great attraction for one another is the
fact that we are images of God, two different
and complementary ways of being like
him.
February 1984
How then could we continue to live in
mutual attraction and love except by want
ing to be ever more like him, the way we
originally came from his hands. The more
masculine and feminine we are as spouses,
in our form and in our character, the more
we are able to rejoice in each other's beauty
and goodness.
It became our goal for each of us as
spouses to lift the other to the very heights,
to glamourize the other, so that our hearts,
minds and spirits interact in order to create
the harmony on which a family is built.
b.
To Leave and to Cleave
A little further on in the Bible, we are
told that God said : "It is not good that the
man should be alone; I will make him a
helper fit for him" (Gen 2: 18). And the
Lord God created her and brought her to the
man, who cried out in his exaltation : "This
at last is bone of my bone and flesh of my
flesh; she shall be called Woman, because
she was taken out of man". And the sacred
author adds : "Therefore a man leaves his
father and his mother and cleaves to his
wife, and they become one flesh" (Gen
2 : 23-24).
What could be more sacred or precious
than father and mother ? Yet we find that
God said: "No, leave them and cleave to your
wife". What does this mean, except that
for a man, his wife is always first and for a
woman, her husband ? Doesn't my wife alsohave the right to say : "Behold I have left
all things and followed him ?" And before
job, profession, hobby, friends, parents and
even children. That is what God was saying
3
right at the beginning, and the implications
of his care are vast. For, all our worldly dis
tractions and ambitions are to be trampled
underfoot in order that we may be joined to
one another as spouses, never to leave each
other.
Only when we have learnt what it means
to be first for each other, are we prepared to
become one flesh. Being one flesh, in God's
meaning, is not as easy as it seems, and
definitely, it is not merely physical union.
c. To be no Longer Two but One
Many centuries pass in the Bible, before
we are able to understand what being one
flesh really involves, and we can only get it
from the lips of the Word made flesh. He
said of the married couple, to those who
would make a mockery of marriage : "They
are no longer two but one. What therefore
God has joined together, let no man put
asunder" (Mat 19 : 6).
What Jesus is elaborating for us is the
mystery of divine mathematics. He is telling
us that being a couple is a completely new
reality, not an addition of one to make two,
but, as only God can put it "No longer two,
but one"—one heart, one intention, one
feeling, one intution, one aim, never to be
separate from each other. This is the greatest
mystery on earth, the mystery of marriage.
Does not this stir the deepest recesses of
our hearts ? It is something inscribed at the
very core of our being : to lose myself in the
love of my spouse; and yet it needed a divi
ne key to unlock this mystery. Poets and
Novelists and dramatists have written the
greatest of literature on Mystery of love, for
our edification and knowledge; but none
with this divine simplicity : "No longer two
but one’'.
And so we dare to ask him the grace to
leave with our spouse in the depth our being,
4
removing the barreness which prevents the
emptying of ourselves, to feed upon the
stream of each others precious lite, the
source of rich is Jesus himself.
d.
To be One as God Himself is One
To know the source of the mystery of our
oneness we have to come right up to the
death of Jesus. The evening before he died,
he prayed thus for his loved ones : "That
they may all be one; even as thou, father, art
in me, and I in thee, that they also may be in
us, so that the world may believe that thou
hast sent me" (John 17 : 21).
We are already in the image of God and
Man and Woman; but we are much more
perfectly His image when we are one as a
couple, as God himself is one. Now no man
has ever seen God, but if God is love, he who
has seen God. He who has seen two beings
no longer two but one, has seen who God is.
No one can doubt any longer that God is
real, when he has seen the reality of couple,
loving unity: when he has seen them, in joy
and sorrow; in good times and evil times, in
sickness and health, to love and to HONOUR
each other, all the days of their lives.
This is a living miracle, and it happens
only because the Holy Spirit of God, whom
Jesus promised, has come to make his home
with us; in fact, he is the oneness between
us. As become aware that the spirit of love
of the Father and the Son in the same Spirit
of Love in our couple too, who has come to
dwell in us for ever. This is our Sacrament.
And this Sacrament the living presence of
God spirit we continue to give to each other
with a cup of tea, a tablet of aspirin or a
monthly pay cheque, as we did when
for life we surrendered to each other in
love.
e.
To Love unto the Giving of Life
And finally we get from the Bible the
secret of how this is possible, in practice; a
Medical Service
touchstone of our ability to loose ourselves
in giving, in order to become one. St. Paul
tells us : "Husbands, love your wives, as
Christ loved the Church, and gave himself up
for her." He did this, he continues, "That
he might sanctify her......... (and) present her
to himself in splendour without spot or
wrinkle or any such thing" (Eph 5 : 25-27).
These words of St. Paul, though addres
sed to husbands, apply equally to wives and
to every follower of Christ. Ordinarily, when
we think of our wives or our husbands, what
do we see above all ? The things that
annoy us, that grieve us, that even make our
lives unbearable. But St. Paul advises us to
feel the feelings of our spouse in these con
ditions; to experience the circumstances that
have oppressed him or her, to die to oneself
in order to feel the other's feelings of sorrow
and confusion; to be willing to under go this
death within him/her, as often as need be,
that he/she may live again in all radiance for
us pure and faultless. This is what Jesus
did for his bride, the Church, experiencing
her sin as death on the Cross, so that we
may live his new risen life.
A husband who loves his wife, St. Paul says,
loves his own flesh, and feeds and nourishes
it, just as Christ does the Church. If Christ's
body had to be broken on the cross to be
Eucharist for us, can we refuse to be broken
to be eucharist for our spouse, who is flesh
of our flesh and bone of our bone ? We
often pinch ourselves to seek the answer;
this is because the answer like the willingness
or obstinacy of our own flesh. But to those
of us who are willing to be so given, there
opens a lifetime of joy. This is the secret of
God's plan for our marriage. To be willing
to be so given is to accept within us the
abundant grace which flows from the death
and resurrection of Jesus, in our Sacrament
of Marriage, our Matrimony.
February 1984
Marriage—Contract or Covenant ?
Looking around the world to observe why
so many marriages either break up entirely or
put up eternally with a life-time of separate
loneliness, we see that it is because one or
both the partners were unworthy or unable
to honour the terms of the marriage contr
act
A contract is binding only in so far as its
conditions are upheld. And so, viewing
marriage as a contract, the world feels justi
fied to make and to break this contract at
will. But God has desired our marriage to
be covenant, as permanent and irrevocable
as his covenant with Israel, and the death of
his Son has made it unto a Sacrament.
Can God ever withdraw his faithful love
from his people, orJesus the bridegroom, from,
his Church ? St. John says : "Having loved
his own who were in the world, he loved
them to the end" (13:1). And our Lord
himself confirmed : "Greater love has no
man than this, that he lay down his life for
his friends" (John 15 : 13).
And so our Sacrament of Matrimony is
irrevocable, not because of our human love,
but because in God's plan our marriage is a
sign and a sacrament of his love for us. Our
joining in the sacrament of Matrimony is a
joining made by God, not by man, and no
man (and no wordly power) can put as
apart.
Can this call to be a sacrament be lived
by mere human strength ? "Wives, be sub
ject to your husbands, as to the Lord......
Husbands, love your wives, as Christ loved
the Church and gave himself up for her"
(Eph 5 : 22,25). And for what reasons ? So
that our spouse may become daily more
spotless and without blemish, more and more
everyday, our bridegroom or bride. That is
the aim, of our matrimonial love. Whether
it is a cup of tea or a slice of toast we give.
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whatever we do in the love make him or her
ever more faultless and pure, without
wrinkle, or stain or any such thing.
In God's plan our wedding day is not the
greatest day in our lives; it is only the begin
ning of our sacrament. And we prepare for
this sacrament not by an engagement—
another legal tie to be made or broken—but
by betrothel. From this day I pledge myself
to build my relationship with you, ever seek
ing from God and within my heart, whether
it is you I can look upon forever with the
compassionate eye of Christ, and love with
his redeeming love.
If we have tried and longed for this
enough, and if we have sought Jesus and
invited him, we know that he, our Sacrament
will be there at wedding. And he will turn
our water into wine. He will make of our
lives a miracle. For every sacrament of
matrimony, like every eucharist, is nothing
short of a miracle. Namely, when Jesus is
there in our marriage the wine of our love
does not get diluted, but rather becomes
richer with the years. And the last wine
is always the best wine. What a contrast to
what the world offers !
Perhaps the reason why Jesus gave him
into his mothers request at the wedding of
Cana, eventhough his hour had not come
because he was aware that his marriage
and every Christian marriage would picture
and proclaim to the World, in an unforget
table way, the meaning of his marriage to the
February 1984
Church on the Cross. That was the hour,
the hour he longed and prepared for, all his
life. He realised how his turning water into
wine for the sake of a couple, would be the
forerunner of the changing of wine into his
blood for the church, his bride. And when
he did this at the last supper and on the
Cross, he promised that he would never
again taste of the wine, and until he would
celebrate his marriage feast in heaven, united
forever to his people, whom he had owned
such a price.
So now we see what our Sacrament of
Matrimony really means, and why it was for
Paul the great mystery that matrimonial coup
les to reproduce the love of Christ for his
Church;
This is my Body, he had said, broken for
you, this is my Blood poured out for you.
It is the same thing; we husbands and wives
say to each other daily. And the strength
to say it, and to live it, so that our spouse
be daily redeemed and renewed and beauti
fied, comes from the Cross of Jesus, and
from living his Sacrament of Marriage and
the Eucharist, both patterned on the Cross,
the supreme symbol of love.
And so we often hear Jesus say to us in
the intimacy of our sexual relationship, and
our total loving as a matrimonial couple,
even as he says to us daily at mass—"Do
this in memory of Me".
7
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Need people Die any more of cholera ?
Cause, Concerns, and Control
—W.B. Greenough 111
"While an effective cholera vaccine
appears to be on the horizon for the
future, right now no one need die of
cholera", says william B. Greenough III
Director of the International Centre
for Diarrhoeal
Diseases
Research,
Bangladesh (ICDDR, B), the world's
only international institution devoted
solely to studying diarrhoeal diseases.
has been controlled, or even eliminated.
The reason : in big cities, where good health
facilities exist, cholera death rates are ex
tremely low. And most big city dwellers
simply are unaware of cholera realities in the
countryside, where most people live, and
where medical help is unavialable, especially
given the very short time span between
disease onset and death.
Among the less publicized facts on
public health in the developing world
is the uncounted number of people in
the countryside, several developing
countries, who die of the disease each
year. The prime victims are young
children.
How fatal is cholera ? And when and
where does it strike ?
Answering questions. Dr. Greenough
speaks with candour on prevailing
conditions, social perceptions and
scientific options.
We hear more of diarrhoea than of
cholerea. Does that mean cholera has
been contained?
Reports that cholera has been wiped out
simply are inaccurate for any country.
Today cholera continues to take an enormous
annual toll in poor, developing countries
worldwide. However, no accurate estimate
of deaths is possible—because the disease
is so devasting and surveillance so inade
quate that governments rarely can define
or wish to acknowledge the extent of the
problem.
Unfortunately, in many countries a
widespread belief exists in the most educat
ed and sophisticated circles that cholera
February 1984
About 30—50 per cent of untreated
cholera victims will die. And, in cholera
endemic areas of developing countries,
cholera remains dormant for six to eight
months, before suddenly resurfacing with a
vengeance—almost each and every year.
Though much has been learned about
cholera in the last 20 years or so—especially
about what happens inside the human body
and how to counteract the debilitating, often
deadly effects—many important aspects of
the disease and the organisms that cause it
remain a mystery. Two of the most crucial
unknowns, are where and how do the
cholera bacteria remain dormant during the
off season, and what are the specific environ
mental conditions that trigger the bacteria's
sudden reemergence, usually in epidemic
proportions.
Despite' all the studies that have been
done at our centre and around the world,
despite the advanced state of science, we
do not know for example, why annual
chollera epidemics in a given country occur
about the same time each year—even
through evironmental conditions can vary
9
from year to year. We have been unable to
pinpoint what crucial factors favour a large
epidemic.
How badly does cholera affect children ?
How does the disease spread ?
The victims are primarily young children.
For once some one has been "challenged",
and has survived contact, with a large
enough dose to produce the disease, the
body builds up immunity. In most cases,
cholera does not strike the same person
twice or, if it does, the second infection is
less likely to be life-threatening.
As for how the disease is transmitted, it
was discovered as early as 1848 that cholera
mainly gains access to human hosts via
contaminated water used for drinking,
cooking and utensil washing, and via the
"faecal-oral" route, when food is prepared
by hands that have not been washed after
prior contact with faeces.
What, in your view, is the prospect of
checking the spread of the disease ?
To interrupt the transmission cycle,
governments around the world, with the help
of international agencies such as WHO
UNICEF and ICDDR,B are engaged in
massive educational compaigns aimed at
instilling and improving hygienic habits.
Also being tried are expensive installations
of improved water and sewage facilities.
However, the scope of the problem is
enormous and such remedies will require
expensive, painstaking efforts, over many
years, to yield large scale results.
Does prevention
promise ?
by
vaccination
hold
Scientifically speaking the battle against
cholera has taken an existing positive
turn in the past four years. For, being
investigated are about a dozen poten
tially effective vaccines, one of them
10
tested at ICDDR,B. Although
cholera
vaccines have existed since about 1890,
none was ever rigorously tested, until the
1960s. At that time, the vaccines then
required by international health regulations
were shown by the ICDDR,B to be effective
in controlling the spread of cholera, and of
a little sustained , use in preventing illness.
While such vaccines no longer are
widely required, large numbers of travellers
still are inoculated. This is mainly because
many doctors simply are unaware of the
latest developments; and many who are,
probably believe the vaccine might do some
good and would not do any harm. This is
an unfortunate attitude, because the vaccine
being used not only is ineffective but also
has some very unpleasant side effects.
How is the search for alternatives
progressing ?
Given the 'negative' discoveries, scienti
fic attention now is focused on oral vaccines,
both 'live' and 'killed', consisting of specific
parts of the cholera bacteria that cannot
produce the disease or any side-effect, but
can elicit an effective intestinal antibody
response. Such a vaccine is similar to the
one for polio now used routinely the world
over.
For the past three years, a specific 'killed'
cholera vaccine has been tested on human
volunteers in the United States. It was
found to totally prevent cholera in about
67 per cent of the volunteers challenged
with a dose far larger than one normally
needed to produce the disease. Moreover,
even among those who did get ill, the disease
was relatively mild, and no one developed
life-threatening symptoms.
Finally, in related experiments with
volunteers in other countries, no 'challenge'
of cholera bacteria was given. However,
the vaccine was found to provide intestinal
immunity equivalent to that of naturally
acquired cholera.
Medical Service
Such a vaccine, if effective, would be
administered easily by a non-medical ‘person.
Moreover, the potential oral cholera vaccine
is a 'sturdy' one, meaning that it may be
possible to maintain it without keeping it
cold. This latter attribute is crucial, for
one of the most important problems con
fronting developing country vaccination
programmes is the need to maintain a "cold
chain" to prevent deterioration, as vaccine is
transported throughout the countryside.
In 1984, at the request of the World
Health Organization and with the agreement
of the Bangladesh Government,
the
ICDDR,B will begin in Bangladesh a large
scale field trial of this vaccine. At least
80,000 people will receive it before the
cholera season. When chole ra arrives, it
will be apparent whether or not the vaccine
worked. If it did, ICDDR,B researchers
will be watching those people for 6, 8, 10
or even 20 years. For no one can predict
the length of such immunity.
Does this mean that we are on the
verge of a breakthrough ?
Here, some caution would be in order.
Even if the proposed cholera vaccine is
very effective, it cannot be a panacea for
cholera for a long time to come. At least
for the next few years we cannot expect to
prevent cholera on a large scale. But we can
prevent cholera deaths 100 per cent of them—
by taking advantage of the most important
cholera development in the past two
decades—the discovery of the correct for
mulation for intravenous rehydration therapy.
February 1984
and the perfection of an oral rehydration
therapy or ORT.
By using these two rehydration methods,
intravenous for very severely dehydrated
patients and ORT for the moderately and
mildly dehydrated, no one need ever die of
cholera. That is the most important thing
we have accomplished in the past 20 years,
and it is no small achievement.
And so, while an effective cholera vaccine
appears to be on the horizon for the future,
right now we must concentrate our energies
on reaching people the world over with the
therapy we have at hand—a therapy that
has been proven to be 100 per cent effective
against one of the most deadly diseases
mankind has ever known.
Is there cholera in India
Around 1950, the number of cases
reported to the public health system and
officially notified ran into six digits, with
a five digit tally of deaths.
By 1980, these shrank respectively into
four and three figures. There after,
cholera does not figure in official
statistics.
It is possible that incidence and fatality do
occur, especially among children, but due
to the similarity of symptoms as well as
of treatment, to those of diarrhoera,
cholera gets clubbed with the latter. And
an estimated 1.5 million children in India
die of diarrhoea.
Courtesy—Future, unicef
11
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Travellers' Diarrhoea
The commonest cause of travellers' diarrhoea
is contaminated food or water
—by R.H. Herniman
There is nothing new about diarrhoea. It
is a condition that has afflicted travellers
from time immemorial. But what is new
today is the tremendous increase in the num
bers of people travelling and the distances
they travel. There are few places in the
world that cannot be reached in 24 hours. If
we count tourists alone, there are more than
500 million people travelling each year,
and anyone who travels is liable to get diar
rhoea.
The experience is all too well known : the
journey, the excitement of arrival in new and
foreign places, the exotic foods and drink,
and then the uneasiness, the abdominal
cramp and the sudden emergency rush tow
ards the toilet (if one is lucky enough to be
near one). Then the business of being ill in
a strange place, the misery of being confined
to a hotel room while work is unattended or
a holiday ruined.
Travellers* diarrhoea can cover a wide
range of conditions from food poisoning to
cholera. In general we can describe it as an
illness of sudden onset with water diarrhoea
more than three to four times a day, often
with abdominal cramps, nausea, vomiting
and even fever. The illness can sometimes
last up to a week and will then subside, even
if no treatment is given. This is perhaps the
most common form, but there are variations,
from the very mild attack with one or two
loose stools to an extensive diarrhoea with
vomiting and collapse.
February 1984
Travellers' diarrhoea isn't caused by a
change in climate or by exposure to drau
ghts, or by air conditioning. It results from
an infection, usually picked up from conta
minated food or water—and of course local
residents are usually exposed to it. The
commonest cause of the infection is one of
several types of the bacteria Escherichia coli,
but other bacteria may also be to blame, such
as Shigella (it can cause dysentery) or
Solmonelia, or those causing food poisoning
(e.g. Staphylococcus auraus). Viruses may
also be the culprit as well as bigger intestinal
parasites such as Entamoeba hystolytica
(causing amoebic dysentery) and a parasite
with two tails called Giardia lamblia.
So the causes of travellers' diarrhoea are
many. From the patient's point of view, the
cause is not so important as the treatment,
which we will mention later; but from the
health authorities' point of view it is impor
tant to know the causes of the diarrhoea
since they can also be responsible for ende
mic illness in the population and even for
large epidemics.
Strange Food
Many travellers blame strange food and a
change of diet for their diarrhoea, and there
is good reason for this. After all, as we have
mentioned, food and water may carry
the infecting agent, especially wheie hygiene
is poor. But in addition travellers in strange
places may relax their own code of clean
13
liness and take risks they would not take at
home. In a holiday environment people
tend to drink too much alcohol and eat large
heavy meals that they are not used to. All
this may dilute the acid in the special risk.
Anyone taking, stomach which acts as a
natural defence against infection and, with
the defences down, the infection can gain
entry to the intestine and start its painful
work.
Certain travellers are at antacids or
drugs for ulcers in susceptible, since these
drugs also neutralise the protective acidity
of the stomach. Diarrhoea is potentially
more serious in young children and older
people, who can quickly become severely ill
due to loss of body fluid and salts. The
same would apply to persons with a metabo
lic disorder such as diabetes, or to heart
cases receiving treatment, especially those
taking diuretic drugs or digitalis.
The risk of getting travellers' diarrhoea
depends on where one travels. Areas, where
standards of food hygiene are not high, and
where there is already a high incidence of
diarrhoeal disease in the population, are
more likely to be associated with travellers'
diarrhoea; but a traveller from one high inci
dence area to another is not so likely to be
affected as he may have built up immunity
to the offending agents. The traveller most
at risk is one who travels from a low inci
dence area to a high risk area.
Having been attacked by diarrhoea, what
should the traveller do about it ? There are
many suggested treatments for this age-old
malady. The first and most important thing
to remember is that the danger in diarrhoea
is dehydration, that is to say loss of body
fluid and salts caused by the diarrhoea.
From the patient's point of view, the vital
thing is to replace the fluid and salts lost.
This is particularly important in children and
14
older people. The fluid and salts can perfec
tly well be replaced by mouth, even if the
patient is vomiting; however where vomiting
is severe or loss of fluid excessive, it may be
necessary to use intravenous fluids under
proper medical supervision. WHO recom
mends a special mixture known as oral
rehydration salts (ORS), packets of which
are widely distributed in developing countries
with the assistance of UNICEF. The mixture
recommended by WHO contains, in each
sachet : 3.5. grams sodium chloride; 2.5
grams sodium bicarbonate; 1.5 grams potas
sium chloride; and 20 grams glucose, all to be
dissolved in one litre of potable water. ORS
preparations with these or similar ingredients
are available in almost all countries. If they
are not available the traveller should at least
drink pleanty of fluid in the form of thin
soup, weak herbal tea, or some bland drink
such as barley water with a little salt and
sugar added. Highly sweetened and acidic
drinks should not betaken. In the case of
infants and children, some feeding should be
maintained, particularly breastfeeding of
babies.
In most cases, maintaining a high fluid
intake, preferably with an oral rehydration
mixture, is all that is needed until the diarr
hoea stops. There is no evidence that drugs
play much part in curing travellers' diarrhoea
except under certain specific conditions.
This is a rather controversial area, since a
vast number of commercially available "anti
diarrhoea agents" are on the market. It is
doubtful whether any of these really cure
the diarrhoea, although they may tempora
rily reduce its severity and relieve symp
toms.
Let me be more specific. Antibiotics
are of value only for cholera or for frank
dysentery due to shigellosis (or amoebiasis).
There is also a specific drug for giardiasis.
A number of anti-diarrhoea drugs are availa
Medical Service
ble for the relief of abdominal cramps, and
these may be helpful in some adults who for
convenience desire temporary relief of symp
toms, but they should only be taken for a
day or two and should never be given to
children, older persons, or anyone with dyse
ntery. There is some evidence that drugs,
such as bismuth subsalicylate, which help
prevent the secretion of the diarrhoea fluid
from the intestine may be useful, but more
experimental work is needed to find this out
before their use can be recommended. There
is little evidence that any other preparations
of combinations are useful.
So the mainstay of treatment should be
oral fluids. If relief is not rapid, then medical
help should be sought and the appropriate
additional therapy should be given under
medical supervision.
Although rapid and effective treatment
is of great concern to the individual traveller,
it is equally important for the health authori
ties to try to prevent travellers' diarrhoea
from occurring. In the present era of jet
travel, tourism is particularly affected. Tropi
cal countries trying to develop their tourist
industry are very conscious of the need to
prevent diarrhoeal outbreaks. For athletes
in competition, for pilgrims, and for business
men, prevention is vital.
The Joest way of preventing travellers'
diarrhoea is to avoid exposure to the infec
tive agent. To do that, food and water must
be clean and standards of personal and
environmental hygiene must be adequate.
Public health authorities in countries with a
high incidence of diarrhoea should ensure
that a good standard of food and water
February 1984
hygiene is maintained in establishments
serving travellers. To support this, it is
necessary to have adequate laboratory faci
lities, so as to be able both to perform the
necessary checks on food and water, and to
identify the causative agent when any out
breaks of diarrhoea occur.
What can the individual do to prevent
diarrhoea while travelling ? First and fore
most, it is prudent to reduce the risks as
much as possible : eat clean food, drink
clean water. This means in fact drinking
only water that is boiled or bottled (be sure
it is carbonated), hot drinks made with boi
led water, or other carbonated beverages,
and eating only food that has either been
well cooked immediately before serving, or
is protected from infection (that is to say,
food from tins). Beware of salads and
avoid them if at all possible.
There is some evidence that taking pro
phylactic antibiotics may be of some value.
However, if they are used at all, they should
be used only by adults travelling for a short
period (less than three weeks) to high-risk
areas where it is impossible to obtain safe
water and food. This would especially apply
to persons with conditions associated with
decreased gastric acidity or other serious
conditions.
Moderation in all things is a good motto,
and this applies to travelling : eat and drink
sensibly, do not take risks, and—if the worst
happens—then be prepared and have some
oral rehydration mixture handy.
—courtesy HERALD OF HEALTH
15
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Medical Service
Nature cure for Rheumatism
by Asha Khanna
Rheumatism, Arthritis and Sciatica are
crippling diseases. Their symptoms are
similar to each other and that is why they
are treated on the same lines.
In Rheumatism one suffers from pain in
the joints, tendons, nerves or muscles of the
limbs. When this affliction comes, the pain
is felt when the joints are moved or when
pressure is exerted on the joint.
There are several varieties of rheuma
tism :
1. Chronic Rheumatism—It includes
rheumatoid arthritis and osteo-arthritis, ach
ing chest muscles, stiff neck, inflammation of
tendons and ligaments, and sciatica.
The various morbid changes in chronic
rheumatism are dependent not on an infec
tion, but on the ability of the individual to
resist the disease.
The sources of infection include the teeth
(i.e. decayed teeth) the tonsils or a sore
throat, the cavities behind the nose, the
intestines, the urethra and the pelvic organs
of women.
The pain is generally influenced by chan
ges in the weather, cold and damp aggrava
ting it considerably.
2, Rheumatoid Arthrities—Causes the
sufferer to have a burning feeling and terrible
pain in the affected joints. There is swelling,
redness, stiffness and heat in the joints too.
The age of onset is from twenty to forty
years. It is most common in the female sex.
The joints most commonly affected in order
of frequency are those of the hands and feet,
wrist, ankles, knee, jaw and the neck.
February 1984
3. Muscular Rheumatism—The onset
generally sudden with severe aching pain in
the affected muscles, interrupted by spasms
intense pain when movements involving
these muscles are carried out.
4. Osteo-arthritis—The age of onset is
later usually from forty to sixty. Here joint
pain is generally bad in wet weather and is
worse at night. Some degree of malnutrition
and anaemia is also present in this case.
5. Sciatica—It is often the result of
rheumatic trouble in the tissues of the large
nerve in the thigh.
Causes
Rheumatism can attack young children
under the age of twelve also, and this can
later result in heart disease. Symptoms are
the following : A child affected by the
disease, unlike the normal child, is abnormally
sensitive to weather changes. This child is
also more prone to skin rashes like nettle
rash or eczema.
The reasons of these crippling diseases
(which will be referred to as one) are many,
including infections, metabolic problems,
degenerative problems, allergies, faulty diet,
injuries, malnutrition, anaemia and after
effects of other illnesses. Since this imposes
a lot of stress on the body, a maintenance of
a completely adequate diet is especially
necessary for anyone who suffers with this
problem, but it is impossible to give a gene
ralized diet since food allergies can also
cause arthritis.
17
Treatment
Furthermore, in order to prevent this
disease, be sure to brush your teeth after
each meal. Brush up and down so that you
clean between the teeth. Go for a regular
dental check up.
Take good care of the joints by exercising
them regularly. The importance of regular
exercise cannot be overlooked due to the
fact that exercise nourishes the joint. You
may ask how ? The answer is : Each joint
has a pad of cartilage as a cushion between
the two bones. A fluid baths this cushion
and keeps it lubricated and in good condition.
As the joint is moved the fluid is spread over
the entire joint space. Much of the time,
most of our joints are kept in one position.
So the fluid does not come in contact with
part of the joint surface and this part natu
rally suffers.
Actually the patient himself can greatly
control or arrest his disease by avoiding such
foods as carbohydrates and dairy products,
and items which have significant fat content
which cause calcium deposits in the joints.
Citrus fruits are to be avoided.
Furthermore, the arthritis victim normally
does not wish to exercise his body because
the body hurts when he does so, and his
body hurts more and more when he refuses
to exercised.
The self-manipulation of various limbs
with a great will power will improve the
patient's condition and in this way, even a
cure can be procured. The 'yogic' movements
performed in slow motion, without strain,
requiring the patient to attain a position in
which only the slightest discomfort is felt are
ideal. The various stretches and holds are
able to reach deep into the joints and appa
rently loosen the deposits. The methodical
repetition of the movements practised very
slowly and cautiously seems within the
18
course of time, to produce excellent results.
But a person who has a severe case of arth
ritis should first seek the approval of her
physician, before going in for yoga. Simple
form of exercises like moving each joint
slowly till it does not hurt—can be carried
out every night before going to bed.
The following poses will be found useful
to the person who practises yoga, to ease
out the pain and stiffness in the affected
muscles and joints. Santulan asana, trikona
asana, veera asana, gomukhasana, briksashana, setubandasana, sidhasana, natrajasana
and shavasana for complete relaxation.
During the first week the patient should
practise two to four asanas. During the
second week and after he should gradually
add other asanas. He should never try to do
all during the first week only.
Apart from the above mentioned treat
ments, various herbs, vegetable and fruit
juices have been found to give relief in these
conditions. Potatoes have proved to be
very useful for arthritis sufferers. The water
in which potatoes are boiled can be consum
ed or the potato juice can be extracted and
taken raw. One potato or two would be
ideal.
Celery is also beneficial. Extract the juice
of one celery pod, with its leaves and take
it daily or on every alternate day till the
problem is over.
Early morning before bed tea, seven to
eight cloves of garlic should be swallowed
raw with water. A few garlic cloves should
be crushed and fried in oil. This oil when
applied locally on the affected area brings on
great relief. The area is covered with a light
piece of cloth.
The following fruit and vegetable juices
will be found to be useful if consumed in
moderate amounts :—Apple, cherry, lemon,
Medical Service
grapefruit cucumber, beetroot, celery, carrot,
watercress, tomato and spinach.
(Hindi: Ghikanwar) by roasting it in butter
as this provides comfort to the sufferer.
The most beneficial amount of juice to
use will vary with each individual case. It is
wise to start with | cup and go upto 1| cups
a day and never more than 2 cups. Fruit
juices may be used in larger quantities than
vegetable juices.
Stiff muslin bags with dried Elder flowers
can be added to the hot bath of the patient.
In ancient days Marjoram was also used as
a cure for rheumatism. Sprays of the herb
were packed inside cloth bags and they were
placed in boiling water and the bag was then
placed while as hot as comfortable on the
affected part or limb.
The various parts of Baniyan (Bargad)
tree can be used to provide cure for these
diseases. The milky fluid produced by this
tree can be applied locally on the painful
area to reduce the pain and swelling. Its
leaves should be dried and powdered and
teaspoon should be taken twice a day. This
opens the stiff joints of the sufferer.
The oil of the leaves of thorn apple
(Dhatura) should be applied on the affected
area to relieve the pain. The hot poultice of
the leaves of the seed nite herb (mokey)
relieves the swelling and pain. The patients
can eat the leaves of the herb Babedols Aloes
Besides all this the patient should take a
lot of rest also, and this is the best treatment.
Rest of mind is as important as rest of the
body. It is well to avoid emotional distur
bances, for these may increase the discom
fort. Above all, the patient should not feel
depressed, but develop a hopeful attitude.
Even if the healing process may be prolon
ged, remember, you can always help yourself
by maintaining a courageous and helpful
attitude towards your life and disease. These
are the two best and inexpensive medicines.
—courtesy HERALD OF HEALTH
(Contd. from page 31)
Msgr. Varghese Puthenpurakal
moderator for the discussion.
was
the
The concluding session was presided over
by Coadjutor Bishop Rt. Rev. Peter
M. Chenaparampil.
Over 200 people
including
students attended the seminar.
college
The concluding item of the programme
was a social evening—a get together —of
doctors and hospital staff in which the
February 1984
doctors of the Alleppey Medical College
Hospital and District Government Hospital, in
all 50 people, attended. Rt. Rev. Peter
Chenaparampil, the Coadjutor Bishop, inau
gurated a CHAI Blood Donors Association on
this occasion.
Representatives of St. Sebastian's Hospi
tal, Arathinkal, St. Joseph's Hospital,
Shertalli, St. Michael's Hospital, Kattoor and
Assisi Hospital, Punnapra participated in the
programme.
19
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Medical Service
LEGAL EDUCATION—5
On your Right to Compensation in Motor Vehicle Accidents
P.D. Mathew
Taking account of the inevitability of road
accidents in modern society and the need
for just and expeditious compensation to
the victims through institutions outside the
court system, the law under the Motor Vehi
cles Act (Act IV of 1939 along with the
amendments made in 1982) provides the
principles and procedure to be followed for
accident compensation. The following para
graphs explain the rights of citizens involved
in road accidents and the dependants of
those who die in such accidents, against the
driver, owner and insurance companies. It
further explains the procedure to be follo
wed, the specific Tribunal to be approached
and the amount of compansation a claimant
is entitled under various circumstances.
What is compensation ?
Compensation is the amount of money
paid for the damage caused to a person or
property.
Who can claim compensation ?
Compensation can be claimed by :
Note
* The legal representatives are the law
ful heirs of the deceased, who are enti
tled to succeed to his property.
* Those entitled to claim compensation
have the power to appoint an agent
(including a lawyer) and authorise him
to act on their behalf in claiming com
pensation.
* An application for compensation can be
made even by one of several represen
tatives of the deceased on behalf of all
of them. Such non-claimant legal
representatives shall be impleaded as
respondents to the application.
To whom should the application for
compensation be made ?
In every state a specialised Tribunal
(court) is set up under the Motor Vehicles
Act known as the Motor Accident Claims
Tribunal. It is usually located within the
premises of district courts and a judge of the
status of District Judge presides over it. The
application for compensation should be
addressed to the "Claims Tribunal" having
jurisdication over the area in which the acci
dent occurred.
i.
the person who sustained the injury,
or
ii.
the owner of the property, or
Form for making the claim
iii.
by all or any of the legal representa
tives of the deceased (where death
results from the accident), or
iv.
by any agent duly authorised by the
person injured or legal representa
tives of the person deceased.
Each state has a prescribed form for
making claims. The form is available for
a nominal charge from the Stamp Vendor or
Court Official. One may even write a claim
on a plain paper. The format itself changes
from State to State but in every case it
should contain at least the following points.
February 1984
21
♦ Full address, age and occupation of the
applicants.
♦ Name and address (if known) of
a.
driver of the Motor vehicle;
b.
owner of the Motor vehicle;
c.
the insurer of the Motor vehicle;
* Relationship of each applicant with the
deceased (if the accident has caused
death);
* Age of the deceased;
* Monthly income of injured person or
deceased;
♦ Nature of injuries sustained and disa
blement caused;
* Date, time and place of accident;
* Registration number
Vehicle involved;
of the
Motor
* Quantum of compensation claimed and
basis thereof;
* Grounds on which compensation is
claimed;
* If claim for compensation is not made
within 6 months of the accident, the
reasons thereof.
When can the claim be made ?
The application for compensation can be
made any time after the accident but not
later than six months after its occurrence.
Even if the application is made six months
after the accident, the Cliams Tribunal can
still admit the claim provided sufficient rea
sons for the delay are shown in the applica
tion.
Who is liable to pay compensation ?
Amount of compensation fixed by the
Claims Tribunal will be paid by the owner or
22
driver of the Vehicle or the insurance com
pany which has insured the vehicle. Accord
ing to law every motor vehicle has to be
insured at least against third party risks. This
helps speedy recovery of claims. The insur
ance campany is liable to pay to the extent
of the insured amount out of the award
granted by the Tribunal.
Proceedings of the Tribunal
The Claims Tribunal has exclusive jurisdi
ction over motor accident compensation.
The Civil Courts have no authority to stop
the proceedings before the Tribunal by injuction or otherwise. On receipt of an applica
tion for compensation, the Claims Tribunal
shall, after giving the parties an opportunity
of being heard, hold an inquiry into the claim
and may make an award determining the
amount of compensation which appears to
be just and specifying the person or persons
to whom compensation is to be paid. In
making the* award the Claims Tribunal shall ‘
specify the amount to be paid and the party
by whom it is to be paid viz. the insurer,
owner or driver of the vehicle.
Note
* In these proceedings the Claims Tribu
nal has the powers of a Civil Court and
it can follow summary procedures in
order to avoid delay and dispense quick
justice to the 'victim.
♦ The Tribunal is empowered to award
interest on the amount of compensation
sanctioned from the date of claim to
the date of payment.
Remedy for inadequate compensation
If a person is not satisfied by the amount
of compensation granted by the Tribunal, he
may appeal to the High Court within 90
days from the date of the award. If an
Medical Service
appeal is preferred after 90 days, reasons
must be shown to the Tribunal to justify
the delay.
An appeal to the High Court will not be
granted if the amount in dispute in the
appeal is less than Rs. 2000/-.
How does one obtain the money
awarded by the Tribunal
The ordinary procedure is to seek from
the Tribunal itself a certificate for the amount
awarded addressed to the District Collector.
The Collector has powers to recover the
amount in the same manner as arrears of
land revenue and pay the same to the clai
mant.
In some cases where the claimant cannot
recover the amount by ordinary procedures,
he may approach the Tribunal again which
can direct payment of such compensation
from the amount every insurance company
is required to deposit with the Reserve Bank
of India as a security deposit.
nent disablement, if an application is made to
the Tribunal on the principle of no fault.
If the claim is made on the principle of
no fault, the claimant is not required to
prove or to establish before the Tribunal, the
negligence, fault or guilt of the driver or the
vehicle.
In this case the above fixed compensa
tion must be given to the claimant in spite of
the fault or negligence of the victim of the
accident. In other words, the owner of the
vehicle, by which an accident has occurred,
is liable to pay Rs. 15,000/- in case of death
and Rs. 7,500/- in case of permanent disab
lement even if the accident has occurred
without his fault. The above mentioned
minimum statutory compensation cannot be
reduced on the plea that the victim of the
accident was at fault or negligent.
Note
* Permanent disablement means
a.
QUANTUM OF COMPENSATION
What is the amount of compensation
one can claim ?
Amendments made in 1982 in the parent
Act of 1939 have fixed the amount 'of com
pensation in certain cases of motor vehicle
accidents on the principle of "no fault". It
has also made special provisions to pay
compensation to the claimants in hit-and-run
accidents.
permanent damage to either eye or
ear or anypart of the body or
joints; (b) permanent disfiguration
of the head or face (Section 92-C)
* If a claim for compensation is made to
the Tribunal under Section 92-A, then
the application for the claim must
contain a separate statement to that
effect immediately before the signature
of applicant.
I. Liability to pay compensation on the
principle of no fault under Section
92-A
* A claim for compensation made under
Section 92-A on the principle of no
fault is expected to be disposed of
as expeditiously as possible (Section
92-B(1) )
In case of a motor vehicle accident in
which a person dies or suffers permanent
disablement the owner of the vehicle is
bound to pay Rs. 15,000/- in respect of the
death, and Rs. 7,500/- in respect of perma
♦ The above provisions of Chapter Vll-A
of this Act will also apply to cases
arising out of death or permanent dis
ablement of any person under Work
men’s Compensation Act 1923. In
February 1984
23
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.
Medical Service
such a situation the person entitled to
the compensation may claim under
either of the Acts, but not under both.
II. Liability to pay compensation for
death or permanent disablement on the
principle of fault
Mote
♦ Hit-and-run motor accident: It means
a motor vehicle accident in which the
identity of the vehicle cannot be ascer
tained in spite of reasonable efforts.
♦ Grievous Hurt may include :
A person has a right to claim compensa
tion with respect to death or permanent
disablement not only on the principle of no
fault under Section 92-A, but also on the
principle of fault (of the driver) under Sec
tion 110-A of this Act or any other law for
the time being in force. (Section 92-B)
— Emasculation (deprivation of mas
culine power)
If the claim for compensation is made
under Section 92-A and also on the principle
of fault, the claim for compensation under
Section 92-A should be disposed of as ex
peditiously as possible.
— Privation of any member or joint
A person liable to pay compensation
under Section 92-A is also liable to pay
compensation in accordance with the right
on the principle of fault.
If the compensation awarded by the
Tribunal on the principle of fault is more than
the amount of compensation fixed under
Section 92-A (i.e. Rs. 15,000 for death and
Rs. 7,500/- for permanent disablement) than
the person liable to pay the compensation
must also pay the claimant the amount that
exceeds the compensation fixed under Sec
tion 92-A.
III. Compensation in case of hit-andrun motor accidents
The compensation that a claimant is
entitled in hit-and-run accident is Rs. 5,000
with respect to death and Rs. 1000 with
respect to greivous hurt. This compensation
is to be paid from the Solatium fund establi
shed by the Central Government (Section
109-A (5) )
February 1984
— Permanent privation of the sight of
either eye
— Permanent privation of the hearing
of either ear
— Destruction or permanent impairing
of the head or face
— Permanent disfiguration of the head
or face
— Fracture or dislocation of bone or
tooth
— Any hurt which endangers life, or
which causes the sufferer to be,
during the space of twenty days, in
severe bodily pain or unable to
follow his ordinary pursuits (Section
320 of India Penal Code).
* Solatium Fund ; It is a fund establis
hed by the Central Government to pay
compensation in case of death or
grievous hurt caused by hit-and-run
motor accidents.
* If the Solatium Fund does not have
adequate amount of money to meet
any claim for compensation the claim
may be kept pending for payment till
that amount becomes available in the
Fund (Section 109-A (5) (b) ).
* The amount of compensation received
by a person, under Section 109-A,
25
from the Solatium Fund is to be refun
ded if the same claimant receives com
pensation under any other provisions
of this Act or under any other law in
force (Section 109-B, 91).
Note
lating compensation on the principle of fault
the courts may proceed to assess damages
under two heads viz :
1.
Personal loss to claimant
2.
Loss to the estate of the deceased
The provisions of the Act explained in
this leaflet are based on the Central Act.
Government of States and Union Territories
may make amendments in the Act with res
pect to the form of application, inquiry
proceedings, authorities, ane mode of paying
the compensation etc., to suit their specific
requirements and situations. For example,
in hit-and-run accidents the Delhi Adminis
tration has authorised authorised the SDM
(Sub-Divisional Magistrate) under whose
area the accident takes place, as the "claim
inquiry officer'*. The claims for compensa
tion have to be submitted on prescribed
form within one month from the date of the
accident to the SDM. In this case the clai
mants are not required to pay any fee for
making an application.
Under the first head, pecuniary benefits
received by the claimant from the services of
the deceased can be claimed while under the
second head, loss suffered by the whole
estate of the deceased can be claimed. Estate
means the monthly savings of the deceased
from his wage or salary, after the mainten
ance of his dependants.
The Claim Inquiry Officer concerned will
hold inquiries in respect of the claims arising
out of hit-and-run motor accidents and shall
submit his report to the claims settlement
commissioner namely the Deputy Commis
sioner or the District Magistrate. Along
with his recommendations the claims settle
ment commissioner shall sanction the claims
on the basis of the said report and send the
same to the "claims inquiry officer** along
with the amount of compensation by cheque
or treasury challan for payment to the party
concerned.
* Permanent economic loss arising as a
result of the injury;
Assessment of compensation
principle of fault
on the
Since there is no fixed formula or any
legislatively recommended method of calcu
26
Generally every Tribunal adopts its own
method of calculating compensation. Varia
tions in calculations should be justified from
the facts and circumstances of each case.
Basis of calculating compensation for
personal injury on the principle of fault
* Degree of disability caused to the per
son due to the accident;
* Expenses for medical treatment;
♦ Loss of income during treatment;
* Additional expenditure which the injury
is likely to incur on account of his
physical incapacity;
* Mental suffering of the victim.
In the case of adults, age and yearly
income must be taken into consideration to
calculate the amount of compensation. If,
however, the victim is a school going stu
dent, the loss of future potentiality of earn
ing can be assessed having regard to his
academic performance and the consequent
Medical Service
loss of future carrier earnings. If the victim
is a non-earning member of the family,
compensation can be assessed by evalua
ting the loss of services he might be render
ing to the family.
Duty of driver in case of accident and
injury to a person
When any person is injured due to a
motor vehicle accident, the driver or any
person incharge of the vehicle must take
necessary steps to secure medical treatment
for the injured person and, if necessary, take
him to the nearest hospital unless the injured
person desires otherwise. In the absence
of any police officer at the site of the acci
dent he must report to the nearest police
station as soon as possible and in any case
within twenty-fours hours of its occurrence
(Section 89 of the Motor Vehicles Act
1939).
Duty of officials to furnish particulars
of vehicle involved in accident
A registering authority or the officer-incharge of a police station has a duty to
furnish to the claiment of compensation,
information relating to the identification
marks and other particulars of the vehicle and
the name and address of the person who
was using the vehicle at the time of the
accident or was injured by it. To obtain
such information the claimant must pay a
prescribed fee to the officer-in-charge.
Is there any remedy for police inaction
in pursuing the accident case ?
If the local police does not take initia
tive in investigating the matter based on FIR,
one may make a petition to the District
Superintendent of Police to take necessary
action. One may also make a private com plaint to the Judicial Magistrate having
jurisdiction over the area in which the acci
dent occurred.
February 1984
Points to note in accident cases
* At the time of the accident note down
the number of the vehicle and name,
age and address of the driver.
* Don't allow the vehicle to proceed till
police come to the accident site to make
a report.
♦ Make sure that on FIR is lodged at the
nearest police station as early as pos
sible to enable the police to investigate
the accident.
* Get as many witnesses as possible to
make statements to the police.
* If the victim of the accident is alive
after the accident he must be taken to
a government hospital for treetment.
* If the victim is treated by a private
medical practitioner, a certificate to that
effect must be obtained from him. A
Medical Certificate of the doctor who
treated the victim is necessary to as
certain the nature and the degree of
injury and its possible cause.
* If the accident is fatal, the body of the
victim must be sent to a government
hospital for post-mortem. Report of
the post-mortem is required to establish
the fact and the cause of death.
* in the event of every motor vehicle
accident, the police must file a criminal
case against the driver for causing in
jury or death to a person by rash and
negligent driving.
♦ The award of the Tribunal is not depen
dent on the result of the criminal case
against the driver.
* The amount of compensation paid to
the applicant on the principle of fault
will also depend on the contributory
negligence of the victim of the accident.
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28
Medical Service
Relevant
information, reports and
documents required to obtain adequate
compensation.
1.
Identity of the vehicle (Its registration
number);
2.
Identity of the driver of the vehicle
who caused the accident;
Address of the owner of the vehicle
and insurance company;
3.
4.
Date, time and place of the accident;
5.
First Information Report (FIR) given
at the police station;
6.
Police report of the site of the acci
dent;
7.
Doctor's certificate regarding the
nature and cause of the injury and
the degree of disability;
8.
Post-mortem
death);
9.
Statements of witnesses of the acci
dent;
10.
Birth certificate (to ascertain the age
of the victim);
11.
Documents regarding the salary and
income of the victim;
12.
Vouchers regarding medicine, food
and travelling expenses etc.
report
(in
case
of
Means to ensure claims against insurance
companies
1.
The vehicle should be driven
licensed persons;
2.
The licence should have been renew
ed at the appropriate time;
February 1984
by
3.
Conditions of insurance policy should
be observed;
4.
Transfer of ownership of insured
vehicle should be notified to the
insurer;
5.
In getting insurance all material facts
must be disclosed and no misrepre
sentation made;
6.
In claim proceedings the insurer
should be joined as a party.
Free Legal Aid to the poor
Poor claiments are entitled to get free
legal aid from the District Legal Aid Com
mittee whose Chairman is the District Judge.
An application for legal assistance must be
made to the said committee in a prescribed
form. This must be accompanied by
an income certificate obtained from a
concerned
officer.
In
some
states
Scheduled Castes and Scheduled Tribes are
exempted from paying court fees. .In case of
other poor people, the court allows the liti
gants to pay a certain percentage of the court
fees at the time of filing the application for
compensation and the remaining portion will
be deducted from the compensation fixed
by the award before it is paid to the claimant.
A ceiling of income entitled a person to free
legal aid is fixed by State Governments.
For Further Information In Legal Matters
Contact.
Director, Legal Aid
Indian Social Institute
Lodi Road, New Delhi 110003
Tel : 622379, 624760
Gram: INSOCIN
29
CHAI
NEWS
NOTES
Report on Community Health Programme—an extension service
M & R F Hospital, Naganhalli, Mysore
Community Health A Source of
Joy to our Commitment
As a further step in the community health,
exactly after 6 months of the dais training,
the 10 trained indegenous dais were called
back for a refresher course of 5 days from
5th to 10th Jan. 1984. It was the second
course of the series and a follow up of the
first one which was held from 5th to 11th
June 1983. Seven trained dais, 4 MCHE
guides and 2 nursing assistants of the hospi
tal participated in the present course.
After the initial welcome speech, and
opening prayers by the public health nurse
Sr. Concepta, a review of the topics dealt in
the previous course was made. The dais re
membered very well the topics because of
the practical experience they gained through
their village work.
This time the course was based on the
following topics :
1.
Physical, Physiological and Emotional
changes that take place during adole
scence, menstruation and in pre
gnancy. Personal cleanliness, need
for antinatal check up, common ail
ments during pregnancy and the use
of simple home made medicines.
2.
Importance of Immunisation and ways
of bringing up baby into a healthy
individual.
3.
30
Measures to combat common ail
ments and superstitious beliefs pre
valent in the villages.
4.
Importance of house visits and the
link role of the dais between the
hospital staff and the patient.
5.
First aid.
The method used for this training was
simple speech, explanation, case study, brain
storming with incidents, reflection discus
sions, role play and reading of charts, pictures
from the news papers and periodicals on
patients, germs, disease communicants, bad
sanitation and ignorance.
Comparatively
this time the dais were very enthusiastic and
cooperative. They themselves organised re
creations and took active part in singing
dancing and dramatising.
At the concluding session a tea party was
arranged and the staff together with the
paticipants experienced the joy of mutual
benefit of such short courses. It was en
couraging to note that the hesitating, hiding
and shy type of women came forward boldly
to give a vote of thanks to the Public Health
nurse and the staff of M & R F Hospital. It is
very interesting to note that from one village
namely Geera no patients come to the hospi
tal for minor ailments because of the dedica
ted service of our trained dais. It is planned
to give another follow up training to the same
dais, after an interval of 4 months.
Legal Education Workshop in
Indore Diocese
A three day work shop on Legal Education
was conducted at the Bishop's House,
Medical Service
Indore, from 11 to 13 January 1984 by the
Indian Social Institute, New Delhi at the
request of the Indore Diocese Social Service
Society. About 20 young socially committed
people including priests and sisters from
various parts of the diocese, participated in
the workshop which was lead and guided by
Fr. P.D. Mathew S.J., Advocate, Supreme
Court and Director, Legal Aid Cell, Indian
Social Institute, New Delhi. Others who
spoke at the workshop include the Hon'ble
Justice Shri P.D. Muley (High Court, Indore)
and Advocate R.P.C. Sanghi.
During the three days, the participants
were helped to analyse not only the Indian
socio-economic legal reality but also shown
how law could be used to bring about desired
social changes in the society.
For the many participants, the workshop
was/an eye opener and they became aware
of their own constitutional, fundamental and
legal rights and also the various wrongs com
mitted against them or against the poor who
[ are voiceless citizens of this great country.
Through the discussion on the case
studies, the participants were familiarised with
the rights of people when they are arrested,
the law on rape workers right, on the right
to compensation in motor vehicle accidents,
public interest litigation and legal aid to the
poor etc.
At the end of the workshop, a decision
to form a legal aid cell, attached to the
Indore Diocese Social Service Society was
taken. The participants felt that there is
great need in the country to make the people
aware of their many legal rights and also to
give adequate information about the various
socio-economic projects, launched by the
various Governmental machinery especially
for the poor, so that they can actually claim
for their rights and facilities for themselves.
Presently many projects intended for the
poor do not reach them due to their ignorance
February 1984
and also due to the apathy of the bureau
cracy. Therefore, the participants decided
to launch a massive programme of legal
education for the poor, through non-formal
education centres, legal aid camps, etc.,
to educate them about their fundamental
rights and to inform them about various
socio-economic schemes, procedures to be
followed to avail the schemes to their best
advantage, and also to help them organise
themselves to protect their interests through
legal and constitutional methods.
Other decisions of the proposed Legal Aid
Cell include, starting a Legal Library, indentification and training of Para Legal personnel,
socio-legal survey and research, free legal
advice to the poor, collection and dissemina
tion of relevant legal information.
Seminars on "Respect Life"
Under the auspices of St. Sebastian's
Hospital, Arathinkal a half day afternoon
programme was held. The programme com
menced with a special Mass and ended with
a public meeting attended by over 100
people, mostly married women. Rt. Rev.
Msgr. Varghese Puthenpurakal presided over
the meeting. Mr. Joseph Mathen (Ex. M.P.)
and Rev. Sr. Celine Francis (ASM!) spoke on
"abortions", "birth control" and "natural
family planning as an approved way to plan
a family". The function was held on 25th
September 1983.
At the diocesan level a half day programme
was held on Sunday 16th October, 1983 at
St. Joseph's College auditorium. The pro
gramme commenced with a Bible Service
with meditations on relevant lessons. This
was followed by a seminar which was inau
gurated by Rt. Rev. Bishop Michael Arrattukulam.
Dr. (Miss) Daisy Kandathil and Mrs. Marykutty Antony gave orientation talks. Rt. Rev.
{Contd. on page 19)
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