MEDICAL SERVICE VOL. 42 No. 5 MAY-JUNE-1985
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- Title
- MEDICAL SERVICE VOL. 42 No. 5 MAY-JUNE-1985
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the building of networks for consumer protection • drugs in small rural
hospital—a preliminary investigation • drugs used for killing and planning •
legal education 12—crime and criminal procedure • chai news and notes •
only a true cultural choice can effectively oppose euthanasia
vol 42
no 5
may-june 1985
official house journal
of the catholic
hospital association of India
medical
service
"the love of Christ
urges us" 2 cor 5 :14
vol 42
no 5
editorial board
may-june 1985
contents
dr c m francis
dr ravi narayan
dr prem chandran John
dr daleep mukarji
mr augustin veliyath
1
fr george lobo sj
prof george joseph
2 the building of networks for consumer protection
dr paul neelamkavil
fr edwin m j
editor
editorial
eva lachkovics
3
durgs in small rural hospital—a preliminary
investigation
g d ravindran
2
4
11
4 drugs used for killing and planning
drj iype
15
fr john vattamattom svd
5
legal education—12: crime and criminal procedure
p d mathew
6 chai news and notes
cover design
p m isaac bangalore
published by the catholic
hdspital association of India
cbci centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
17
31
7 only a true cultural choice can effectively oppose
euthanasia
41
,,Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"
EDITORIAL
A True Partnership
"Collaboration with non-governmental organisations in implementing the
global strategy of Health For All by 2000 AD", was the topic for the technical
discussion during the thirty-eighth World Health Assembly held at Geneva on
10th-11th May 1985. In this issue we have given the outcome of this
historic meeting i.e. the final resolution passed at the W.H.A., as the first item
of the CHAI NEWS NOTES column, for your ready references. No doubt this
is a very important and valuable document which contains enough and more
guidelines to organise ourselves i.e. governments at various levels and any
number of voluntary organisations spread all over the country. This resolution
has special significance for us in our country, because India has not only
accepted this but also was one of the six countries who originally proposed
the resolution. By this certainly we have assumed an added responsibility
of implementing the various suggestions in the resolution. This has to be
seen in its full seriousness by all concerned, if we are really sincere and
serious about implementing the global strategy of Health For All by
2000 AD.
Those of us who had the opportunity to take part in the discussion cannot
forget the enthusiasm of the participants representing more than five hundred
non-governmental organisations from all over the world at the national.
regional and international level. There was a general concensus that the
non-governmental organisations are in a better position to implement the
strategy because of their missionary commitment and closeness to the
masses. Welcoming the participants in the technical discussions, the WHO
Director General, Dr. H. Mahler, said that "non-governmental organisations
had shown themselves to be strong advocates for people's concerns and
agents for change". "It is not the question of governments using non
governmental organisations and their resources", he continued, "rather it is
governments facilitating the work of non-governmental organisations who
have a wealth of experience to put primary health care into effective
action".
The free and frank discussions in the groups and in the plenary session
on the second day were indications of dawning of a brighter furture as far as
the relationships between governments and non governmental organisations
were concerned. What is required is a true partnership in the real sense of
the word between governments and non governmental organisations in the
spirit of mutual trust and respect. In a country like India, no government,
however fast and efficient it may be, can meet the challenges and problems
that facing us, without the help of voluntary organisations.
Both the
governments and voluntary organisations will have to work hand in hand
keeping primarily the interest of the masses in mind, but at the same time
keeping each one's identity. What is to be avoided by all means is any
"holier than thou" attitude from the part of both the governments and non
governmental organisations.
Let us all hope and pray and act so that what has been laid down by
the World Health Assembly Technical Discussion may pave way to A TRUE
PARTNERSHIP between the governments and voluntary organisations at
various levels to build a more just society in our country and elsewhere.
CHANGE OF TELEPHONE NUMBERS
With effect from 1st July 1985, the new telephone numbers at the
CBCI Centre will be :
344 470
344 453
344 695
344 615
As our office is at the CBCI Centre we can be contacted
numbers also, besides our direct number : 310 694
by
these
— EXECUTIVE DIRECTOR
The building of networks for consumer protection*
— Eva Lachkovics
When you look at a fisherman's net you
will see a lot of small knots linked together
either directly or indirectly. In this way little
material can cover a considerable area and
hold rather heavy weights. Because of the
knotted texture the net is very flexible, it can
take any shape and wrap all sorts of objects.
It is light and not cumbersome. And once it
floats in the water you can hardly see it and
grap it only with difficulty. These qualities
are indeed very useful for the fisherman.
These same qualities can also be very useful
for the consumers' when they have to deal
with "big fish".
The 'knots' of a network
Consumers and citizens all over.the world
have already woven a big net, they have tied
those little knots and linked small centres to
each other either directly or indirectly. They
have covered the whole globe and formed this
flexible structure that is so hard to attack be
cause of its net-qualities. We call it network
because actually it consists of overlapping
nets and more complicated linkages than a
fisherman's net. The bridges can reach very
far and very near, and can cross each other
and come back to the origin after a few diver
sions. This makes the network even stronger
and more effective.
I am talking about the contacts between
consumers' and citizens' groups, information
centres, universities, government institutions,
development agencies, a lot more other caret-
gories of organizations and of course indi
viduals criss-cross all over the world. The
majority of the groups involved are officially
called non-governmental organizations, NGOs.
The Perak Consumers' Organization is such
an NGO. But if you call them people's orga
nizations it is probably much more to the point
because they represent the people, as consu
mers in the case of consumer organisations.
Significance of a network
What significance does a network have for
these NGOs, for the people's groups, for the
consumers ?
If we talk about consumer protection, we
have one crucial tool we can use against mal
practices of the manufacturers—information.
Finding, spreading and making use of infor
mation becomes the essence of consumer
protection. That is where the network comes
in because it opens an immeasurable poten
tial of channels for information flow. If
one link of the network needs a piece of in
formation, that another one has or can easily
get hold of these channels are activitated.
Facts, figures, experiences, opinions are ex
changed through them with only little effort
and little loss of time.
International contacts are of special im
portance when we are dealing with transna
tional companies. They are present in many
different parts of the world and by the help
of the network we are too, keeping a close
This paper was presented by Ms Eva Lachkovics, project Officer, International
Organization of Consumers' Unions (IOCU), Coordinator, Health Action International
(HAI), at the 'Consumer Rights Seminar* organised by the Perak Consumers' Asso
ciation (PCA) at the Tun Razak Library, Ipoh, Malaysia, on April 1,1984.
4
Medical Service
watch on them. If, to give you an example,
a decision is taken in the US that effects
Malaysia—it could be concerning the export
of a banned pesticide—our US contacts might
send an urgent telex to the IOCU office in
Penang. On receiving it we might pick up
the phone and call lOCU's various member
consumer organisations in Malaysia to notify
them—the Perak Consumers' Association
(PCA) would be one of them.
The
consumer groups, fortified with "hot” news,
might contact the authorities immediately,
who might not yet be aware of the imminent
danger, which gives the consumers a very
strong position. With united strength, rein
forced by publicity, the Malaysian consumer
groups might be able to prevent the import of
a dangerous pesticide thanks to a well func
tioning international network.
Another approach an international network
makes possible, is to compare a particular
situation, for instance the availability of ha
zardous products, in Third World and indus
trialised countries and publicise the results.
Such a study can be used to put pressure on
authorities and industry to remedy a double
standard situation revealed in the study. From
the various information centres, universities
and government sources we can get expert
information which is essential to back up any
case or demand. Facts and figures speak with
a very loud voice and usually do not fail to
impress even bureaucrats.
The exchange of experience is also essen
tial. We can learn from other groups new
techniques and strategies to tackle our pro
blems. Other groups' activities can act as
sources of new ideas, stimulation and encoura
gement. Furthermore, knowing about other
groups' programmes, we can link and coordi
nate our actions, contribute to the efforts of
others and receive their contribution to ours
in return. Concerted action increases each
group's strength and confidence and has a
most powerful impact on the target.
May-June 1985
Imagine a Malaysian consumer protection
network: Little voices all over the country
demand at the same time with all sorts of diffe
rent means, for instance the ban of a dangerous
and unnecessary drug group, anabolic ste
roids. (Anabolic steroids were in the Mala
ysian papers recently as you will remember).
If coordinated the little voices Will become
quite a thunderous chorus. The media will
report about the various activities designed to
achieve the ban. People will become con
scious and wary of anabolic steroids. They
will start asking, why these dangerous drugs
are on the Malaysian market, what security
measures are taken for the consumers, who
has controlled the safety for use in Malaysia
of these drugs, and so on. The authorities
will have to react. So will the medical pro
fession and the manufacturers, if the consumer
protest is strong enough. A single voice
once in a while can easily be drowned. A well
coordinated chorus cannot be neglected.
Even at regional e.g. South-East Asian,
and global levels a network makes coordina
tion possible. lOCU's Consumer Interpol
network for instance, coordinates action at a
global level. Whenever one of its members
gets hold of information on a dangerous or
defective product the information is sent to
the Consumer Interpol centre at the IOCU
office in Penang. From there a Consumer
Altert giving details on the product, the problem
and recommended consumer action is sent
out to all the international contacts without
delay. And the issue will be raised in many
different parts of the world within a very short
time of the detection of the particular hazard
for the world's consumers. This is a very
effective mechanism for consumer protection.
Building of a network
How does such a network come about?
In fact, everyone can develop one. Everyone
5
has friends, colleagues, knows people work
ing in the same field with similar attitudes,
concerns and aims. So you start talking to
them, find out more about what aims you have
in common. You put these people in touch
with each other simply by mentioning them to
each other. Finally you come together to
discuss the problems all of you are concerned
with and decide to do something about them,
what to do, how to do it together and how to
coordinate it. You and your new group will
be drawn to publications dealipg with the
subject of your concern. You will collect
information on it and quite naturally addresses
of people or institutions who have published
this information. You will start writing to
them learning more about them. They will
put you in touch with yet other groups and in
dividuals and your network is growing and
growing. Sooner or later you will arrange
for a bigger conference. It will be the mani
festation of the network and will again mark
the start of concerted action on a bigger scale.
But the growth does not stop there. A network
develops its own dynamics of growth. Once
it becomes known people will approach it to
becomes participants. A consumer protection
network will not stop growing until the reason
for its existence, the consumer problem, is
rooted out.
History of the Health Action Internatio
nal network
As an example I will now outline the history
of the network I am involved in the one I
know best. It is called Health Action Inter
national or just HAI. One of the nuclei of
its development was the International Organi
zation of Consumers' Unions, (IOCU). IOCU
had become more and more aware of the
problems arising from indiscriminate market
ing of drugs hitting Third World countries es
pecially seriously. As a consequence IOCU
conducted studies on the marketing of prob
lematic drugs and produced a consumer ac
tion resource kit on 44 Problem Drugs.
6
During that period many people and groups
in many different countries became aware of
the same problems. Single voices were
heard everywhere through media and publica
tions. Naturally IOCU wanted to get in touch
with these single voices knowing already how
important and effective it is to join forces.
IOCU represented already a very well develop
ed network of more than 120 member consu
mer organisations in some 50 countries and
had no difficulties in reaching out to the va
rious "voices" or being reached by them.
Letters went back and forth around the world,
opinions and experiences were exchanged.
IOCU started collaborating with several groups
outside its membership on the issue of phar
maceuticals. As the contacts and the en
thusiasm to start action grew, it was decided to
bring them all together and combine the efforts
for improvements, and the International NGO
Seminar on Pharmaceuticals took place, in
Geneva, 27-29 May 1981. It was co-sponsored by IOCU and the W. German Federal
Congress of Development-Political
Action
Groups, BUKO, another network, namely that
of grassroots groups in the Federal Republic
of Germany concerned with development
issues in the Third World.
At this conference the HAI network was
consolidated and given its name. Its purpose
was defined: "to resist the ill-treatment of
consumers by multinational drug companies".
The roots of the drug problems were diagnos
ed : "the multinational drug industry is deeply
implicated in the trade in hazardous, useless,
inappropriate and often unconscionably ex
pensive drugs". It was a very diverse group
representing some 50 organisations from 26
countries, which nevertheless agreed on such
crucial principles.
Diversity is another strength of networks.
It allows manifold and unusual approaches
and prevents attacks for being one-sided or
narrow-minded. Every group of the network
retains its original profile and self-reliance.
Medical Service
Nobody has to divert from their mandates.
Furthermore nobody becomes dependent on
anybody else's action or inaction which is
another asset of networking. Whoever wants
to and can contribute does so, whoever does
not, does not impair the network's dynamics
either. Such was the accordance at the Geneva
NGO conference. Nothing more formal than a
simple press statement confirmed the groups*
pledges. The network kept the flexibility
of a fisherman's net and all its other assets.
One of the immediate action plans of HAI
was the setting up of an international clear
ing house for information on the relevant issues.
The HAI clearing house was and still is based
at the IOCU Regional Office in Penang,
Malaysia. It is of- utmost importance for a
network, especially for a huge international
one like HAI, to have a centre for pooling in
formation. Otherwise the information flow,
which makes the network what it is, cannot be
upheld. This will become obvious when I
will explain the functions carried out at the
clearing house.
The regular vehicle for the information
flow, apart from mountains of correspondence
was introduced about half a year later. It
was the bimonthly network newsletter, HAI
News, carrying current outstanding news on
members' activities, drugs, drug regulation
and policies, drug industry and health in gene
ral.
Almost exactly one year after the Geneva
conference a special coordinator for the clear
ing house arrived in Penang, because the work
that was to be done was not just a little side
job. It slowly but steadily became quite
substantial. Well, the coordinator that arriv
ed was I.
At the pulse of networking
Now what do I do as a "professional networker?" What is networking all about?
May-June 1985
When I came to Penang I first of all had to
make myself acquainted with the already exist
ing network—participants, their activities and
their interests. Some of them I had already
met personally in Europe. Personal acquain
tance or even friendship invigorates a contact
considerably. That is why conferences and
seminars are so important. You can relate to
people much better if you know them perso
nally. And you have to relate a lot in a net
work. I slowly grew into the network and
started relating to people.
Everyday a lot of information and letters
land on my desk either from contacts or
through the many magazines our library is re
ceiving regularly. I have to scan the infor
mation as to its usefulness in relation to our
work. If I get a piece of news on a particular
issue which I know a certain group is working
on, I send it to them right away. If a parti
cular item is of great interest to the whole of
the network I write a short summary and carry
it, together with the source, in our newsletter,
HAI News. If somebody is interested to know
more about this item they can contact the
source directly. A network newsletter is a
convenient means not only to spread informa
tion but also to link up groups. I also tie
new knots myself. If I cannot answer an in
formation request myself, I usually refer to
another group, information centre or anybody
who might be able to help according to what
I know from my previous correspondence.
Answering information requests is not just
a mechanical job. As 1 already pointed out,
it is important to relate to people. By sending
a few accompanying lines with the informa
tional material you can encourage the groups
and give them the kind of moral support that
helps against frustration. The mere thinking
of a person acts already as encouragement.
I recently had an enthusiastic letter from a
Filipino lady working on medicinal plants
thanking me for all the information I had
sent to her—information, that I had received
7
and considered useful to her. This informa
tion was indeed useful to her and encourag
ed her to write an article, which again I asked
her to share with the whole network.
When I get letters from people who are
interested in HAI or want to participate I
have to categorise them a bit, in order to use
my time efficaciously. Is it a short formal
letter that refers to information more or less
"for the file" only? Can you read commit
ment to our cause between the lines? Does
enthusiasm literally jump out of the paper?
Is it a business letter? And so on. Usually
you can tell a lot from one letter. You get a
notion on whether the person wants to do
serious work on the subject or is just a busy
body, whether he or she has experience or
needs guidance and many other little things.
If the contact seems promising I will spend
some time thinking how I,could help best and
writing a stimulating letter. If the letter looks
vague and undecisive asking just for any in
formation without saying why and what for,
I would not waste much of my time on it and
send just general material on HAI. If the
persons are serious they will come back for
more.
Some time ago I received a letter from a
Pakistani medical student who seemed full
of energy and real concern for drug abuse,
mismarketing and double standards in Pakis
tan. I was impressed and replied at length.
Soon more detailed questions came. I ans
wered, sent him lots of materials and put him
in touch with other HAI members who could
be of further assistance. And immediately
he started
single-handed a newspaper
campaign demanding the ban of the dangerous
anti-diarrhoea drug, clioquinol, which was
banned in Malaysia in 1982, by the way. He
was successful., Clioquinol was banned in
Pakistan on July 28, 1983. But Syed, my
contact, was not content. He wanted the
immediate stop of sale and the ban of some
other dangerous drugs. By now he has be
8
come a very active and faithful HAI participant.
I published his success in HAI News and keep
supporting his actions with information and
advice as much as I can. He in return contri
butes a lot to the information pool of the HAI
clearing house.
Another one of my functions is trying to
connect isolated activities in one country with
similar ones in others. For example recently
I got a letter from a contact in Australia who
wanted help for a study on painkillers. So I
sent him, apart from informational materials,
some addresses of groups who, as I knew,
had already done or were doing research on
painkillers. I hope some collaboration will
result from this.
A survey on anabolic steroids which I
have already briefly mentioned was coordi
nated from the HAI clearing house last year.
It served on the one hand to collect infor
mation, on the other to activate and stimulate
several Third World groups and strengthen
the HAI network in the developing world.
Seventeen field workers in twelve different
countries were asked to carry out a survey on
marketing and promotion of these potent
drugs, which are totally inessential and can
cause horrible side-effects, such as sex changes
in little girls, stunted growth in children and
liver damage. The information, put down in a
comprehensive report, was later used to make
a case against irresponsible marketing prac
tices of certain drug manufacturers. This
information was of course channelled through
out the HAI network, stimulating the whole
network and strengthening the links between
the field workers and HAI.
Results of individual actions of other groups
are also channelled. through the network,
either using HAI News as a vehicle or by send
ing out the reports, publications or announce
ments directly to the contacts.
Medical Service
Continuous growth of a network
All these activities contribute to the con
tinuous growth and development of the HAI
network. The HAI clearing house is the main
catalyst of this growth, but not the only one.
Last year, for instance, IOCU and other HAI
participants sponsored two persons' travel
through Latin American countries in order to
make new contacts for the network. Later
they were linked to the HAI clearing house in
Penang, where we now have a staff member,
who speaks Spanish and Portuguese and can
help me with these contacts. By now HAILatin America is already starting to sprout and
blossom. The same is now underway for
Africa. A doctor, sponsored by IOCU, just
returned from his "African Safari" on behalf
of the HAI network.
As for this region, last November, an ASEAN
workshop on Pharmaceuticals and Health Po
licies took place in Penang, hosted and coordi
nated by IOCU together with the Quakers
International Affairs Program's (QIAP) re
gional office based in Bangkok. It was meant
to strengthen the HAI network in this part
of the world and form the nucleus for some
concerted action in the area. It was highly
successful and brought about the establish
ment of a sub-HAI-network, the ASEAN
Health Action Network. HAI's successes are
rather substantial although not always no
ticeable at first sight. I'll give you just a brief
outline : HAI or rather HAI's many partici
pants have managed to raise worldwide aware
ness of the drug problems caused by mismar
keting and of possible remedies such as essen
tial drugs lists, rational pricing schemes and
preventive health care measures. Doctors
and government officials appreciate and con
sider HAI's efforts and publications. HAI
has contributed to restrictions and bans of
many hazardous drugs in many countries and
companies have changed labels, writhdrawn
certain advertisements or even some of their
products because of the heavy concerted ‘con
May-June 1985
sumer criticism. HAI has published a Draff
International Code on Pharmaceuticals as a
discussion document which has attracted wide
attention of consumer and health groups as
well as medical associations, governments,
industry and international bodies like the World
Health Organization (WHO) and the United
Nations Conference on Trade and Develop
ment (UNCTAD). The draft, a manifest of
consumers' demands with respect to drugs, is
being internationally discussed. This means
the consumers and their needs are seriously
taken into consideration thanks to the HAI
network.
Uniting Forces
I explained ail this at length to give you a
concrete example of the development of an
already existing, huge, well functioning con
sumer protection network. It is well known
and respected at the relevant international
body, the World Health Organization (WHO),
and equally well known and feared by the
pharmaceutical industry. It shows the va
rious aspects of networking and gives an ac
count of the impact consumers can have if
they unite forces. Apart from HAL, IOCU
is involved in two other comparable global
networks, the International Baby Food Action
Network (IBFAN) an the Pesticides Action
Network (PAN).
You have come here to unite forces too.
You are consumers who are concerned with
consumer protection. No matter which area
you are particularly worried about, be it drugs,
pesticides, food, infant formula, etc, if you
want, you can become part of a powerful net
work and get all its support and backing up
here and now. You can work with the Perak
Consumers' Association (PCA), which is a
member of the Federation of Malaysian Con
sumers' Association (FOMCA) and thereby
a member of IOCU too. What you need is
concern with a consumer problem and the
firm determination to do something about it.
9
The next important thing is information. Col
lect some information about the problem of
your concern and link up with friends with
the same interest. PCA can give you advice
on how to proceed further with your informa
tion. And already you are part of a network,
which will give you more confidence. You
won't feel alone and helpless anymore, which
will even enhance your commitment and
enthusiasm. Action will involve you more and
more once you have started.
When you have collected any information
on your particular issue always ask yourself
some crucial questions:
*
How can I use it most effectively?
* Who could help me spread this infor
mation ?
*
Who could have information matching
mine and leading further?
*
Who could need my information to build
on it?
*
Who is working in the same area whom
I could collaborate with in the future?
These are networking questions, ques
tions which I ask myself everyday. They are
the lubricant for the smooth running of a net
work. In fact they are the lubricant for any
action that is to be taken in the consumer inte
rest, because isolated action is an isolated
voice which might not be heard. Therefore,
the aim must be not to leave it isolated. The
first answer to these questions might be PCA,
but later on you might indulge in networking
on a larger scale in the consumer interest.
The references below will help you to get
acquainted with the mentioned networks and
will give you ideas for action.
10
References
— Report of the International NGO Semi
nar on Pharmaceuticals, Geneva, 27-29
May 1981. ’
— Forty-Four Problem Drugs—A con
sumer Action and Resource Kit on
Pharmaceuticals, IOCU Regional Office
for Asia and the Pacific, Penang, Mala
ysia, May 1981.
— Anabolic steroids — Availability and
Marketing, report of an international
survey coordinated by the IOCU Re
gional Office for Asia and the Pacific,
Penang, August '83.
— Prescription for Change — Health Ac
tion International's Guide to Rational
Health Projects, by Virginia Beardshaw,
IOCU, The Hague, Netherlands, 1893.
— Report on the IOCU/QIAP Regional
Workshop on Pharmaceuticals and
Health
Policies,
Penang, Malaysia,
22-25 November 1983 & April 1984.
— HAI News, newsletter of the informal
network of NGOs and individuals com
mitted to strive for "Health for all",
published bimonthly by the IOCU Re
gional Office for Asia and the Pacific,
Penang, Malaysia.
— Consumer Interpol
Handbook: Po
licing the global trade in dangerous pro
ducts, IOCU, Penang, Malaysia, 1983.
— Breast is Best : From Policy to Practice,
An IB FAN Action Guide, International
Baby Food Action Network (IBFAN),
Geneva, London, Minneapolis, 1982.
— The Pesticide Handbook — Profiles
for Action, IOCU, Penang, Malaysia,
January 1984.
Medical Service
Drugs in small rural hospital
—A preliminary investigation
G.D. Ravindran
This study was conceived after we came to
know that the theme for CHAI convention
was on drugs, and drug policy. We wanted
to study the drug situation in the small hospi
tals. We prepared a questionaire consisting
of 31 questions covering the following topics:
No. of
hospitals
No. of
drugs
5000
3
110-175
5000-10000
2
60-198
10000-15000
2
235
No. of patients
attending OPD
1.
General description of the hdspital
15000-20000
2
105-277
2.
Drug availability
20000
1
154
3.
4.
Drug selection
Dispensing/Prescribing
5.
Drug information and continuing edu
cation
6.
Adverse reactions.
7.
8.
Drug Budget
Treatment of Malaria, TB, Diahorrhea
2.
Injections constituted 14-33% of the
total drug.
9.
Additional information regarding the
changes made by doctors working in
these hospitals.
3.
10-20% of the drugs consisted of tonics
most of the hospitals had one brand of
Iron tonic, one brand of B Complex and
one brand of calcium.
4.
Though malnutrition was one of the
major disease, none of the hospitals
stocked food substitutes which augur
well for our institutions.
5.
Many of them stated that they came
across steroids being used for all condi
tions in the general practice—prescrip
tions that they received. Only 3 types
of steriods were being used in the hos
pitals they were (1) Bethamethasone,
(2) Dexamethasone, (3) Prednisolone.
This also shows that less of steroids are
being used.
6.
One area of concern is the different types
of antibiotics that are being stocked in
practice
St. John's has a rural placement scheme
for its doctors. All the hospitals under this
scheme have 25-50 beds. So we selected
the hospitals and sent the questionaire to the
students who are working in these hospitals.
A preliminary report based on the first ten
responses was presented at the CHAI con
vention in November 1984.
This raises an important question why
should hospitals which are being used by
fewer number of people have large number
of drugs in their pharmacy.
Statistically speaking this number may be
insignificant for an analysis, but the issues
raised by the analysis are significant and call
for some introspection.
High lights of the Study
1. Smaller the OPD load larger the no. of
drugs that were stocked in the pharmacy.
May-June 1985
11
our pharmacy.
It ranged from 2-14
types. Is it necessary to use so many
antibiotics? One saving grace was that
Gentamycin and Cephalosporidine were
not yet stocked by the hospitals.
7.
8.
12.
50% of hospitals had more than one
brand of Ampicillin, Septran or Ery
thromycin. Is this because of the in
ducements and aggressive tactics of
medical representatives ?
Lomotil was stocked in 5 pharmacy.
According to the doctors they did not
use it in their practice.
Criteria for selection of drugs.
cost factor
5
Local company
4
Profit for the hospitals
3
Efficacy
2
Expiry date
2
Patients acceptability
2
Reputable company
1
Whims and fancies of Administrator
1
Many comments were made—one person
More than two brands of phenylbutazone wrote that the company helps the hospital
and Oxyphenbutazone were stocked in in finding doctors for its hospitals. Hence the
50% of the pharmacies.
company drug was being prescribed in the
hospital irrespective of cost and efficacy.
10. Different brands of antipyretics and
50% of them were cost conscious. Ex
analgesics were stocked in all the phar
cept 2 none of them mentioned the efficacy
macies.
of the drug.
11. Selection of drugs.
13. Though all the hospitals had laboratory
a. Medical Officer
3
technicians only 3 had trained pharma
cist. According to the new rule every
b. Medical Officer 4- Administrator 3
hospital should have a pharmacist. We
have a great dearth of pharmacists. The
c. Administrator trained
2
study brings out the importance which
d. Administrator untrained
2
the hospitals give to the pharmacist.
9.
The conclusions that can be drawn are in
40— of the hospitals Medical Officer is not
consulted. This gives rise to a lot of friction
between the medical officer and. the manage
ment.
14.
PRICING
No standard criteria was followed. The
pricing was very arbitrary. It ranged
from charging cost price or retail price
marked on the drug or the whole sale
drug price 4-tax 4-many levels of profit
which ranged from 5% — 50% the cost
price of the drug. Is this ethical?
15.
Except one doctor no one knew the
amount spent on drugs or the status of
the pharmacy financially. Most of them
were saying that the administrator were
not forthcoming with further details.
a. It would be easier for the hospitals to
stock low cost drug because the ad
ministrator decides.
b. In the 3 hospitals where the doctor and
the hospital administrator decide about
the drugs a beginning of the pharmacy
council can be seen.
12
Medical Service
In a small hospital we expect more hospitals
used Rifanpicin and
Ethamdrugs to be prepared by the hospital. butol. 3 hospitals referred the patient to
Carminative mixture was prepared in all sanitoriums. One made the bold confession
the hospitals. 50% of hospitals men
that in their hospitals poor patient got only
tioned that they also prapared Gly INH & thiactazone and streptomycin was
cerin Magsulf paste. In most hospitals withheld due to nonpaying ability, (a shock
other than these nothing else was being ing example of our preferential option).
prepared.
Malaria
17. There was no consistent rule about ex
Not a single person wrote about the use
pired drugs. They are used between 6
of
primaquine
for radical treatment of Malaria.
month — 1 year after expiry in some
Many
were
aware
of the use of primaquine.
hospitals.
But primaquine is not available in the market.
18. 3 hospitals mentioned that they had a
Diarrhoea
formulary.
16.
Only two hospitals made a constructive
3 other hospitals had an essential drug
effort
to use ORS fluid therapy in practice.
list.
26. To the question what changes that they
20. 4 hospitals had a standard regimens.
have brought about in their pharmacies
21. Only one hospital had all the above
(1) 90% of the doctors state that they
components (18-20).
have been using generic names for
19.
22.
23.
24.
antibiotics in their hospital practice.
To gain knowledge about use of drug,
doctors used MIMS and textbooks.
7 of the doctors were aware of banned
drugs. One person did not know about
it.
Very low incidence of adverse drug
reach were mentioned. These involved
pencillin and B-Complex. No other reac-,
tions were mentioned. This reflects
the awareness that our doctors have
about adverse reactions.
(2) All of them state that they have
reduced the number of tonics &
injections.
The important suggestions xwhich were
featured in the answers were
1.
The hospitals should have a clearly
written drug policy which should be
known to everybody working in the
hospital.
2. CHAI should arrange regional workshops
We choose 3 diseases to study the drug
to continue medical education for the
regimes followed in our hospitals. The
senior nurses/pharmacists working in
criteria being the variety of treatments
rural dispensaries.
that are available and also the impor
Overall impression
tance.
Though the situation looks outdated, mis
Tuberculosis
informed and, irrelevant there are many signs
We found that all hospitals follow standard of hope of a new awakening, a new sensiti
regimes of streptomycin/INH/Thiactazone. Two vity and a search for greater relevance.
25.
May-June 1985
13
Drugs used for killing and planning
—Dr. J. lype
Drugs are manufactured by pharmaceuti
cal companies for PRESERVING OR PRO
LONGING LIFE or for relieving suffering of
humans and animals. Until recently the
MOTTO was this all over the world. Now
there are drugs manufactured for KILLING;
many drugs are also used by the medical pro
fession by its LETHAL (killing) dose, legally
to kill human beings at different stages of exis
tence.
'*1 will not give a person a homicidal drug
to kill. I will not give to a woman a pessary
to procure abortion. I have become a physi
cian to PRESERVE life and not to destroy
life”. Now this whole Hippocratic oath is
reversed, and EXTERMINATION is consi
dered as a great service to the nation. Doc
tors directly kill in euthanasia or mercy killing;
they exterminate normal babies, in the name
of medical termination of pregnancy, even
though there may not be medical causes. The
noble medical profession, has become ignoble
I. Drugs manufactured for killing un
born babies
Prostaglandins are a group of naturally
occurring hormones, one form of which, pro
duces strong contractions of the uterus. This
form PROSTIN was approved by the Food
and Drug Administration, originally, for one
purpose only and that was termination of mid
trimester pregnancy. Since then two other
forms of the drug have been approved; they
also are primarily used for killing in the middle
three months or later.
One complication of the drug, mentioned in
the Upjohn Companies' literature, is that the
baby occasionally is BORN ALIVE (a mistake ?)
The remedy for this complication not men
May-June 1985
tioned in the literature, has commonly been to
let the baby die from lack of attention. The
Upjohn company has become known inter
nationally as the 'death peddler' because of
this drug, since it is the first major drug house
to make a drug, whose only major purpose is
to kill living human beings. Nation wide pro
test has come in America and a wallet size
card has been distributed to the millions
throughout the world. It asks if you want to
support the only company that is producing a
drug, whose only major purpose is to kill.
II. Abortifacients:
Are available in the market both in modern
medicine and in indigenous medicines for kill
ing the unborn babies. Ergot preparations
and oxytocics used in delivery cases are also
used as abortifacients.
III. Drugs used for killing in euthanasia
or mercy killing
Any drug can be used this way to kill by
its LETHAL (killing) dose. Euthanasia bill
was in the parliament of 'Ahimsa' India twice
and the same bill with some modifications is
now with the government of Gujarat. What
ever be the terminology used or whatever be
the mode of killing by drugs, killing is killing
only.
IV.
Drugs used in human experimentation
There was international furore over the
Indian monkeys being used for experiments in
laboratories and space ships. Hence India
prohibitted export of monkeys. Babies pro
cured by wilful abortion are used for expe
riments as guinea pigs even today in grand
15
the hormone eostrogen. Hence this one and
other combinations are used now as the pills
for contraception.
Later it was found that
eostrogen is producing immense problems in
the cow's body and the law has come pre
venting the drugs being administered to the
cows. Surprisingly women are asked to
continue to consume them in plenty all over
the world even though they are producing
adverse effects and complications.
scale, and surprisingly there is no voice raised
against it!
Hitler used human live adults for experi
mentation and world construed it as horrible
and condemned it. It may be a new drug to
be experimented on the baby or an old drug
for a new effect found out by accident. It
may be a virus or bacteria injected to the baby
to produce a disease and, in the end, by the
same poison or organism baby is killed.
V. Drugs used for Family Planning
When eostrogen was given to the cows it
yielded more milk and accidently it was found
that the cow was also not becoming preg
nant. Doctors tried it on women and found
that women also did not become pregnant with
Medical literature is flooded with real re
ports and statistics regarding the complica
tion of the pills. Many have started question
ing the safety of the pills. It is carcinogenic
for the uterus, breast etc. It is diabetogenic,
thrombus forming and if it occurs in the heart.
it results in heart failure.
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32
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16
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Medical Service
LEGAL EDUCATION—12
Crime and Criminal Procedure
(Due to space limitation we could not continue the column on legal education
during the past few months. With this issue we are continuing this column.
—Editor)
—P.D. Mathew
A crime is an offence against the community
or society at large. It is the responsibility of
the State to prevent crime and to punish cri
minals. A criminal can be punished only in
conformity with the requirement of law. The
Indian Penal Code, Central and State laws
define various types of crimes or offences
and prescribe definite
punishments. The
Code of.Criminal Procedure 1973 (New Code)
lays down specific provisions with regard to
the judicial procedure to be followed in the
investigation of offences and the trial of the
accused. A great majority of the Indian citi
zens are ignorant of the provisions of crimi
nal laws. Ignorance of law, legal rights and
duties often result in individuals violating these
laws or not exercising their legitimate rights.
Sometimes the authorities concerned with the
prevention of crime and the punishment of
criminals seem to exceed their legal powers or
use illegal means in dealing with the accu
sed persons. The ignorance of law among the
weaker sections is sometimes exploited by
the custodians of law and other powerful ele
ments in society for their vested interests. It
is the duty of every citizen to know his legal
rights and obligations, so that he can behave
in a responsible manner and render assistance
to the authorities where necessary and if call
ed upon to do so. It would, also help him in
preventing his exploitation by fellow citizens,
police, bureaucrats and members of the legal
profession and the judiciary.
This is to promote legal literacy among the
ctizens. It deals only with the concept of
May-June 1984
crime, the structure of criminal courts, F.I.R.
provisions of the Code of Criminal Procedure
with regard to investigations by the police and
complaint.
What is crime ?
A crime is an act of commission or omis
sion contrary to law. It is presumed to be an
act against the community or society at large.
The State has power to punish a person com
mitting a crime if he is found guilty. In other
words, crime is an act which is declared punish
able by the State. In India various acts of
crime are defined in the Indiad Penal Code
(Sections 109 to 511) and other Central and
State laws.
Presumption of innocence
In Criminal law it is generally presumed that
an accused person is innocent until the con
trary is proved through a judicial process.
The Code of Criminal Procedure
The Code of Criminal Procedure 1973
(New Code) lays down the judicial procedure
to be followed in bringing of a person accused
of a crime to justice. It also provides for a
machinery for the punishment of offenders
and a procedure to prevent crimes.
What are the objects of the Now Code ?
The objects of the New Code are:
17
to ensure the accused a fair trial in ac Compoundable and non-compoundable
cordance with the principles of natural offences
justice;
The Code lays down a complete list of
2. to ensure the accused a fair trial as of compoundable offences in Section 320. Com
right without needless and harmful de poundable offences; less serious in nature,
are those offences which can be compromised
lay; and
with or without the permission of the court
3. to simplify trial procedure so that the by persons mentioned in the specified sections.
poorer sections of society get justice A compromise petition, after it is filed cannot
easily and expeditiously.
be withdrawn. A case can be compounded,
before judgement is pronounced, even in re
What are the kinds of offences defined vision.
by the Code ?
The accused is acquitted if the case is le
There are mainly 3 kinds of offences:
gally compounded. On the filing of a comp
romise petition signed by both the parties in
1. bailable and. non-bailable
respect of an offence, for which no leave of
the court is required, the Magistrate is in duty
2. cognizable and non-cognizable
bound to order an acquittal.
3. compoundable and non-compoundable
1.
Criminal Courts
Bailable and non-bailable offences
There is a column in the Schedule to the
Code which lays down a list of offences which
are bailable and those which are not bailable.
Bailable offences are less serious than nonbailable ones. In bailable offences the accus
ed has a right to get bail. But in non-bailable
offences granting of bail is left to the dis
cretion of the Court.
Structure of Criminal Courts
Supreme Court
High Court
Sessions Court
— National level
— State level
— District level
(Divisional level)
Judicial Magistrate
of the first class — Sub-divisional level
(Taluka—Tehsil level)
Judicial Magistrate of the second class
Cognizable and non-cognizable offences
Cognizable offences are offences for which
a police officer can arrest a person without a
warrant. They are more serious than noncognizable offences. In non-cognizable off
ences the police cannot arrest the offender
without a warrant from the Court. Cogniz
able offences are listed in the Schedule of the
Code of Criminal Procedure. Certain offences
punishable under other Central and State
Acts are sometimes made “cognizable” for
effective implementation of the provisions of
these Acts.
18
Note
* The State governments can declare a city
or town which has more than one million
population as a metropolitan area. Bom
bay, Calcutta, Madras and Ahmedabad
are already declared metropolitan areas.
In metropolitan areas the Judicial Magi
strates are known as Metropolitan Ma
gistrates whose jurisdiction is limited to
the metropolitan area.
* In every district there is a Court of Ses
sion. It is presided over by a Judge
Medical Service
appointed by the High Court. If neces
sary the High Court may appoint addi
tional Sessions Judges and Assistant
Sessions Judges.
* In any district the High Court may also
appoint a Judicial Magistrate of the
Fitst Class as the Chief Judicial Magis
trate.
* If requested by the Central or the State
Government the High Court may appoint,
for a specified period, an experienced
person in legal affairs as special Judicial
Magistrate to deal with a particular case
or a class of cases.
* The Sessions Court has an overall cont
rol over its subordinate courts, viz.
Courts of the Chief Judicial Magistrates,
Magistrates of the first class and Magis
trates of the second class.
* The State Government appoints Execu
tive Magistrates one of whom is District
Magistrate and others Executive Magis
trates subordinate to the District Magis
trate to perform executive or adminis
trative functions and specified judicial
functions etc.
* The State Government may, if required,
confer the power of the Executive Ma
gistrate on a Commissioner of Police.
* A person convicted for capital punish
ment (death) may file a mercy petition
to the President of India if his appeal is
rejected by the Supreme Court.
Powers of Criminal Courts
The Indian Penal Code defines crimes and
prescribes specific punishment. The types
of cases each court can deal with are specified
in the Schedule to the Code. As for example,
a murder case cannot be tried by a Court of
Judicial Magistrate of first class or second class,
it must be tried in a Sessions Court. Thus
Judicial power given to each Court in dealing
with cases and passing sentences is limited.
The following table may help you to under
stand the power of each Court in relation to
passing of sentences on convicts.
1.
Any sentence authorised by law : Section
28(1)
2. Sessions Judge or Additional Sessions
Judge
Any sentence—but a sentence of death shall
be subject to confirmation by the High Court:
Section 28(2)
3.
May-June 1985
Assistant Sessions Judge
Any sentence except —
(a) a sentence of death, or
(b) imprisonment for life, or
(c) imprisonment for more than 10 years:
Section 28(3)
* Every Judicial Magistrate as well as
Executive Magistrate is given a specified
area in which he can exercise his terri
torial jurisdiction.
* The Supreme Court situated in Delhi is
the highest Court of the nation and it is
the final authority to deal with appeals in
criminal cases. It has also original
jurisdiction (jurisdiction to deal with a
case without referring the same to a court
subordinate to it) to deal with criminal
matters under Articles 32 of the Consti
tution.
High Court
4.
Chief Judicial Magistrate
Any sentence except —
(a) a sentence of death; or
(b) imprisonment for life; or
(c) imprisonment for a term exceeding
seven years: (Section 29(1).
19
5.
Magistrate of First Class
Any sentence of imprisonment not ex
ceeding three years or of fine not exceeding
Rs. 5000 or both: Section 29(2).
6.
Magistrate of Second Class
Any sentence of imprisonment not exceed
ing one year or of fine not exceeding Rs. 1,000
or both: Section 29(3).
Notes
* A Magistrate cannot award a sentence
in excess of his jurisdiction.
* If an accused is convicted for several
offences in the same trial, the Court is
empowered to pass several sentences for
such offences prescribed by law. But
generally the Court directs that seve
ral punishments to be inflicted on the
convict for several offences must run
concurrently i.e., during the same period.
* Children below 16, who have committed
an offence not punishable with death
or imprisonment for life, may be tried by
a Court specifically empowered under the
Children's Act 1960 or under any law
providing for the treatment, training and
rehabilitation of youthful
offenders.
If the Children's Act is not in force in any
State, then a Chief Judicial Magistrate
can conduct such a trial.
* Where a fine with imprisonment is im
posed on an accused and if the fine is
not paid he can be given a further term
of imprisonment in addition to one al
ready awarded. Rules regarding the
same are explained in Section 71 and 72
of the Indian Penal Code and Section 31
of Code of Criminal Procedure 1973.
POLICE
OFFICERS
Powers of Police Officers
1 There is a. hierarchy of Police Officers be
ginning from a constable to a Superintendent
of Police in a district.
May-June 1985
Usually the office-in-charge of a police
station is called the Station House Officer
(S.H.O.). He and his Superior Officers can
exercise power within the local area to which
they are appointed. The commission of a
criminal offence is to be reported to the police
station within whose jurisdiction the offence
has taken place. This is called the First In
formation Report- (F.I.R.).
What is the duty of the Citizens to assist
Magistrates and Police ?
Every person is bound to assist a Magis
trate or police officers when they reasonably
demand his help in preventing (i) the escape
of a person being arrested; (ii) breach of peace;
(iii) and any damage to railway, canal, tele
graph or other public property (Section 37
Cr. P.C.).
What is the duty of the Public to give
information to the Magistrate or Police
Officer ?
Every person, who is aware of the commis
sion of any of the following offences is bound
to give information forthwith to the nearest
Magistrate or police officer (Section 39 Cr.
P.C.).
Conspiracy to overthrow the Govern
ment
2. Offences against the public order and
public peace
3. Taking of bribes by a public servant
4. Adulteration of food and drugs
5. Murder
6. Theft accompanied by preparedness to
cause injury
7. Robbery and Dacoity
8. Criminal breach of trust by a public
servant
9. House trespass
10. Counterfeiting of currency notes etc.
1.
21
Note
♦ Failure to give information of the above
offence without any reasonable excuse
is considered an offence under section
202 of the I.P.C.
* The burden of proving the failure to do
so is on the person aware of the com
mission of such offences.
Information to the Police and Their
Power To Investigate (Sections: 154-173
of Cr. P.C.)
When an offence is commited, any person
(whether he himself is agrieved or not) who
know about it can give information to the
police officer of the nearest .police station to
investigate the case. The offence committed
may be cognizable or non-cognizable. In
cognizable cases the police can investigate
upon information received without a Magis
trate's order. In non-cognizable cases the
police canpot investigate without a Court's
order. In such cases the police will refer the
matter to the Magistrate to obtain an order to
conduct investigation.
What is FIR?
F.I.R. (First Information Report) is the first
information given to a police officer regarding
the commission or occurrence of an offence.
Note
It is not necessary to mention all the de
tails of the offence. The F.I.R. must be lodged
as early as possible. Undue or unreasonable
delay in lodging the F.I.R. inevitably gives rise
to suspicion, which puts the court on guard to
look for possible motives and the explanations
for the delay.
Note
* Any person aware of the commission of
an offence can give information to the
police officer.
* It must be given to the officer in-charge
of the nearest police station.
* It can be given orally or in writing.
* If given orally, it must be written down by
the police officer.
. * It shall be signed by the informant.
* The substance of the information must
be entered in the "Station House Regis
ter," (Section 154(1) Cr. P.C.).
* A copy of the information as recorded
(F.I.R.) must be given to the informant
free of cost (Section 154(2) Cr. P.C.).
What is the remedy if F.I.R. is not record
ed by the police officer ?
On refusal to record the F.I.R. by a police
officer the aggrieved person may send the
substance of the information in writing by
post to, or approach in person, the Superior
The F.I.R. must contain the following points. Officer of the Police Station Officer, i.e. SubDivisional Officer or the Superintendent of
1. The name and address of the accused
Police
(D.S.P.). If in the opinion of the latter
2. The date, place and time of the occur
a
cognizable
offence has been committed, he
rence of the offence
may either investigate the case himself or di
3. Particulars regarding the offence viz., rect a subordinate officer to investigate it.
identifying details of property where it
is a "property crime," or motive if it
Has F.I.R. any evidentiary value ?
is a crime against person, etc.
The F.I.R. is an important document as it is
4. Identity of the witnesses, if any.
the starting point in an investigation. Hence,
What must be the essential contest of
F.I.R. ?
22
Medical Service
the obligation to speak truly and to avoid ex
aggeration or falsehood. By itself, it is not
substantive evidence in a trial to prove the guilt
of a person. Yet the first information is a do
cument of considerable importance in crimi
nal trial. It can be used to corroborate (sup
port) or to contradict the testimony of the
Informant witness, by the accused. In case
where the informant dies before the trial and
the F.I.R. is recorded on his statement, it may
be considered a "dying declaration" and it may
be used to establish the cause of his death.
To sustain a conviction, "first information"
must be corroborated by other evidence.
through his subordinate officer, investi
gates the facts and circumstances of the
case.
2.
The Police Officer must send his report,
i. a copy of the F.I.R. to the Magistrate
e.
empowered to take cognizance of the
offence.
3.
If necessary, the Police Officer may arrest
the offender.
4.
If it appears to the officer in charge of a
police station that there is no sufficient
ground for investigation or the offence
reported is not of a serious nature, then
he may not investigate the case. In
this case the Police Officer must com
municate the reason for non-investigation to the informant (Section 157(1)
& (2) ).
5.
The Magistrate on receiving the police
report may either ask for further detailed
investigation or proceed with the case
and dispose of it in the manner provided
in the Code of Criminal Procedure. This
scheme keeps the judiciary informed and
enables it to exercise a supervisory role.
What is the procedure to be followed by
the police in non-cognizable cases ?
If information of an offence is given to a
Police Station Officer which is a non-cogni
zable offence committed within the limits of
the police station, the police officer must re
cord the information in the Station House Non
Cognizable Register and then refer the infor
mant to the Magistrate (Section 155).
Note
* In the case of non-cognizable offences
the Police officer has no power to arrest
a person or to investigate the matter
without the order of a Magistrate.
What is the power of a Police Officer to
investigate cognizable offence ?
An officer in-charge of a police station can
investigate without the order of a Magistrate
any cognizable offence comitted within the
local limits of that police station (Section
156(1)).
What is the power of a Police Officer to
require attendance of witness?
A Police Officer who is investigating a coginizable offence has the power to send an
order in writing to any person, who is acquain
ted with the facts and circumstances of the
case, to appear before him. Such a person
has a duty to attend before the Police Officer
and answer all the questions relating to the
case put up to him.
Note
What is the procedure to be followed for
investigation ?
1.
From the information received, if the
Police, Officer suspects the commission
of an offence, he, either in person or
May-June 1985
* To obtain information from women and
children below 15 years, the Police Offi
cer must go to the place where they re
side. In other words, for purpose of an
investigation they must not be compelled
23
to meet the Police Officer in any place
other than the place where they reside
(Section 160(1) Cr. P.C.).
* It is obligatory for the Police Officer to
pay reasonable expenses of every person
attending the investigation at any place
other than his residence (Section 160(2)
Cr. P.C.).
Examination of witnesses by police
The Police Officer empowered to investi
gate the case may examine orally any person
acquainted with the facts and circumstances
of the case. A person examined in the course
of a police investigation is obliged to answer
truly all questions put up to him except ques
tions which tend to expose him to a criminal
charge or penalty (Section 161 Cr. P.C.).
is the witness who makes the statements
to a Police Officer bound to sign the do
cument or report written by the Police
Officer ?
Section 163 Cr. P.C. prohibits any Police
Officer from making any inducement, threat,
or promise for the purpose of obtaining a
statement.
Neither can he prevent by warning or other
wise any person from making a statement
which he may be disposed to make on his
own free will, i.e. a person is free to make a
confessional statement if he so desires.
The Police Officer has. no authority to
assault, or to confine a witness or an accused
in order to obtain a statement or to extort a
confession from him.
CONFESSION
* The statement of a witness can be used
during trial by the accused and, also,
by the prosecution (with the permission
of the trial court) to contradict the wit
ness (Section 162 Cr. P.C.)
During an investigation, an accused person
may like to make a voluntary confession of the
truth of the facts of the offence. A confes
sion obtained by threat or violence is not a
valid confession and it will not be admitted as
evidence at the trial. An accused person is
not bound to make a confession. The con
fession made by an accused to a Police Officer
has no evidentary value i.e. it cannot be used
during trial against the accused. The Crimi
nal Procedure Code, Section 164, has made
special provisions regarding the manner of
recording a valid confession by a Magistrate.
* Statement includes both oral and written
statements.
What is a confession ?
A person making statements to a Police
Officer during the course of an investigation
is not bound to sign the document.
Note
* The first information report (F.I.R.) re
corded against the accused is not a
"statement" in the le'gal sense as it is not
made in the course of an investigation.
* The accused person is entitled to get
the copies of the recorded statements
of the witnesses for the purpose of crossexamination.
24
Has the Police Officer any authority to
torture a witness or an accused so as to
induce him to make a particular state
ment ?
A confession is a voluntary disclosure
made by an accused person that he has com
mitted an offence.
Who is authorised to record the confes
sion ?
Only an authorised Magistrate can record
the confession of an accused person.
A
Medical Service
confession cannot be recorded by a Police
Officer. The confession may be recorded
either during the investigation or before the
commencement of the trial.
7.
How is the recording of a confession to
be made ?
1.
The Magistrate before recording any
confession from the accused must
explain to him that he is not bound to
make it and that it may be used as
evidence against him (Section 164(3)
Cr. P.C.).
He must not record the confession
unless he has reason to believe that it
is made voluntarily.
2.
Every question and answer must be
put down in full (Section 281 (2) Cr.
P.C.).
3.
The record shall be shown or read
over to the accused or interpreted to
him (Section 281(A)).
4.
The accused must be at liberty to ex
plain or add to his answers (Section
281(4) Cr. P.C.).
5.
The record must be signed by the ac
cused and the Magistrate (Section
281(5) Cr. P.C.).
6.
The Magistrate must make the follow
ing memo at the foot of the record and
sign it: "I have explained to Mr. X
that he is not bound to make a confes
sion and that if he does so, it shall be
used as evidence against him and I
believe that his confession was vo
luntarily made. It was taken in my
presence and was read over to the per
son making it and admitted by him to
be correct and it contains a full and
true account of the statement made by
him," (Section 164(3)).
(Signed) AB
Magistrate
May-June 1985
The Magistrate after recording the con
fession in the above manner must for
ward it to the Magistrate by whom the
case is to be tried. The recording
Magistrate may not be the Magistrate
having jurisdiction to try the case,
(S. 164(3) ).
Note
* After the recording of the confession
the accused person may retract his con
fession.
* The Bombay High Court held that a
retracted confession if proved to be
voluntarily made can be admitted along
with other evidence.
* Even if a Magistrate makes certain techni
cal errors like not writing the memo etc.,
in recording the confesion it can still
be accepted as evidence if the error does
not cause damage to the defence of the
accused.
* It can be revoked only when there is
some written record which is defective.
Has the Police Officer power to search
in the course of investigation ?
During the course of investigation if the
Police Officer has1 sufficient reason to believe
that any material related to the offence is
hidden in any place within the limits of his
police station, he himself may make a search
of that place to obtain the material or appoint
a subordinate officer to search for the thing in
a specific area. (For legal provisions regard
ing search warrant please refer to legal edu
cation series No. 2).
What is the procedure when investiga
tion cannot be completed in 24 hours?
(Section 167 Cr. P.C.)
* If the accused is in police custody and
if it appears that the investigation cannot
25
be completed within 24 hours and the
2. Further evidence may be obtained by a
accusation is well-founded, then the
remand.
Police Officer must forward the accused
along with a copy of the entries in his What is the procedure to be followed
diary to the nearest Magistrate.
when evidence is deficient ?
* The Magistrate may authorise the de
If the evidence is not sufficient, the Police
tention of the accused in police custody Officer may release the accused from custody
for a period of not more than 15 days at on his executing a bond to appear a Magis
at a time.
trate if required (Section 169 Cr. P.C.).
* After every 15 days, the Police Officer
must produce the accused in person be What is the procedure to be followed
fore the Magistarate to obtain permission where the evidence is sufficient ?
for further detention in judicial custody.
If there is sufficient evidence, the Police
The total period of detention may be 60
days depending on the nature of the Officer:
offence(s) being investigated. On co
1. forwards the accused under custody to
mpletion of this period, the accused has
a Magistrate competent to try him or
to be released on bail if he is prepared
if the offence is bailable and the ac
to furnish bail.
cused is willing to give security, takes
security from him for his appearances
* When the Magistrate refuses to grant
before the Magistrate;
permission to the police to detain the
accused in police custody he either be
2. sends to the Magistrate any weapon or
detained in jail-custody or released on
other article necessary to be produced
bail.
before him;
* The Magistrate authorising detention in
3. requires the complainant and the wit
the custody of the police under section
nesses to execute a bond to appear
167 Cr. P.O. must record his reasons for
before the magistrate to give evidence;
doing so.
* If an investigation is not completed within
4. delivers a copy of the bond to one of the
six months from the date on which the
executants and sends the original with
accused is arrested, the Magistrate can
his report to the Magistrate (Section
issue an order to stop further investiga
170).
tion into the offence, unless the Police
Officer gives special reasons for the What is the nature of the police report
continuation of the investigation beyond made at the end of investigation?
six months. If the investigating officer
This report is known as “charge sheet."
feels aggrieved by this Order, he can
It contains:
apply to the Sessions Judge for having
it vacated.
1. the name of the parties,
What are the grounds for remand in
2. nature of information,
Police custody ?
3. names of witnesses and
1. There is sufficient evidence to believe
4. whether the accused is forwarded in
that the accused has committed the
custody or released on his bond with
or without sureties.
offence.
May-June 1985
27
Note
* Complainants and witnesses on their way
to any court are not required to accom
pany the Police Officer.
* They cannot be subjected to unneces
sary restraint or inconvenience.
* They are not required to give any secu
rity for their appearance other than their
own bond.
* If any witness or complaint refuses to
attend or execute a bond, the officer-incharge of the police station may for
ward him to the Magistrate who may
detain him in custody until he executes
the bond (Section 170 Cr. P.C.).
** These provisions are intended to indi
cate while there is a civic duty on per
sons acquainted with the facts of the
case to assist the State (Prosecution)
during the trial no unnecessary restraints
are placed bn witnesses by the police.
What is a "Police Diary" ?
Every police officer making an investiga
tion must daily enter his proceedings in a diary
(Case Diary). It must record:
Before the commencement of his trial, the
accused is entitled to get from the Police
Officer a copy of the first information report,
police statements of prosecution witness dur
ing the initial investigation and all other do
cuments or relevant extracts on which the
prosecution proposes to rely in the trial.
Note
* A criminal case (police case) always
begins with the giving of a "charge
sheet." It gives all the particulars of a
case and, if a witness is examined and
his name is not on the charge sheet, one
may draw the attention of the Court to
it if the accused feels that the police are
"improving" upon the case. The pro
secution, however, are not prevented
from applying to the trial court for sum
moning additional witnesses not cited
in the charge-sheet. It is for the court
to summon them if the cause of justice
so requires.
1.
the time at which the information
reached him;
What is to be done by the Police Officer
at the completion of the investigation ?
2.
the time at which he began and closed
his investigation;
* Every investigation is expected to be
completed without unnecessary delay.
3.
the place or places visited by him; &
4.
a statement of the circumstances as
certained through his investigation
(Section 171(1)).
* As soon as the investigation is completed
the Police Officer must forward the re
port to a competent Magistrate in a
prescribed form.
Note
* The object of keeping "case diaries" is
to enable the Court to be informed of
investigation by the police to aid it dur
ing trial.
* It can be used by the Court and the
Police Officer and the accused under
certain circumstances (Section 172(3)).
28
What are the documents an accused per
son is entitled to get before the com
mencement of his trial ?
* Along with the report the police must
forward to the Magistrate all documents
and relevant extracts and the statements
of prosecution witnesses on which the
prosecution proposes to rely.
* Even after forwarding the above docu
ments the Police Officer may continue
the investigation if he obtains fur
ther evidence on the offence committed
Medical Service
and forward the report to the Magis
trate (Section 173).
What is the procedure to be followed in
case of suicide, murder, accident, etc?
* When a Police Officer receives infor
mation regarding the unnatural death
of a person (death due to suicide, murder,
accident etc.) he shall immediately give
intimation to the nearest District or Subdivisional Magistrate to hold an inquest
i.e., a judicial inquiry to ascertain the
cause of a person's death (Section 174176 Cr. P.C.).
* Then he must go to the. place of the in
cident and in the presence of two or
more respectable neighbours make an
inquiry and draw up a report on the in
juries on the body and of the apparent
cause of death. This report must be
signed by the Police Officer and two
witnesses.
* If there is any doubt about the cause of
death, he must, if possible, send the body
for examination to the nearest Civil
Surgeon or other qualified medical man
appointed by the State Government.
* He may, if necessary, summon two or
more persons for the purpose of investi
gation and any other person acquainted
with the facts of the case and every
summoned person is expected to answer •
truely relevant questions put up to him.
What is the procedure of investigation in
case of death in police custody ?
When a person dies while he is in police
custody, the nearest Magistrate competent to
hold the inquest must hold an inquiry into
the cause of death, either instead of, or in addi
tion to, the investigation conducted by the
Police Officer. During the investigation he
must record the evidence taken by him, ac
May-June 1985
cording to the procedure prescribed and the
circumstances attending the death. If re
quired, he himself may examine the body and
cause the dead body to be disinterred to as
certain the cause of death (Section 176 Cr.
P.C.).
Note
When an inquest is made by a Magistrate,
he must, whenever practicable, inform the
close relations of the deceased and allow them
to be present at the inquiry (Section 175(4)
Cr. P.C.).
COMPLAINT
What is a complaint ?
It means an allegation made orally or in
writing to a Magistrate with a view to initia
tion of action, that a certain person (known or
unknown) has committed an offence.
Note
* This is the second way by which legal
action against an accused person can be
taken.
* This is a remedy for initiating action in a
non-cognizable offence or when the
police officer does not take action on the
basis of the F.I.R. in a cognizable
offence.
* The object of the complaint must be to
move the Magistrate to take action against
an accused person.
* Neither the FIR nor the police report on
the conclusion of an investigation is
considered a complaint.
♦ The legal action taken by the Magistrate
agajnst the accused must be according
to the Code of Criminal Procedure 1973.
29
Who can complain to a Magistrate ?
In a criminal case, the prosecutor is al
ways the State because a crime is an offence
against society. Hence, a complaint need
not necessarily be made by the person in
jured or aggrieved. In some cases the vic
tim is not even able to speak. A complaint
can, therefore, be made by any person aware
of the offence. But, in some cases this right
to complain is restricted by legislation; for
example, in an offence of adultery the hus
band alone has the right to complain. Under
section 195 of the Cr. P.C. or in cases of
contempt of the lawful authority of public
servants only the concerned authority is al
lowed to complain. If they do not, no one
else can complain.
For further information in Legal matters
contact :
Director, Legal Aid
Indian Social Institute
Lodi Road, New Delhi 110 003.
Tel : 622379; 623135
Gram : INSOCIN
All India Conference of Medical Guilds
To be Conducted in. Pune
Date : 21, 22 September, 1985
Reg- Fee : Rs. 35/- per member (only Rs. 20/- for students)
For further details and registration forms, please contact:
Dr. T. B. D'Netto
St. Luke's Medical Guilds of Pune
No. 2 St. Patrick's Town
Sholapur Road
Pune -411 013
30
Medical Service
CHAI
NOTES
NEWS
Resolution of the world health assembly
The Thirty-eighth World Health Assembly,
. Recalling resolution WHA 34.36, and re
affirming its commitment to the implementa
tion of the Global Strategy for Health for All
by the Year 2000 through the solemnly agreed,
combined efforts of governments, people and
WHO;
Mindful that the attainment of the goal of
health for all by the year 2000 is an integral
part of international social and economic
development as well as a direct contribution to
world peace;
Emphasizing the crucial need for a real
partnership between governments, nongovern
mental organizations and WHO in order to
achieve the goal of health for all by the year
2000;
Recognizing the
commitment of non
governmental organizations and the comple
mentarity of the resources which they can
mobilize for the achievement of strategies for
health for all;
Taking into account the conclusions and
recommendations of the Technical Discussions
held during the Thirty-eighth World Health
Assembly on "Collaboration with nongovern
mental organizations in implementing the
Global Strategy for Health for All";
1. APPEALS to the global family of non
governmental organizations to support the
strategies for health for all, and calls for their
involvement and the increased use of national
and international resources towards this end;
May-June 1985
2. CALLS on the national nongovern
mental organizations:
(1)
to commit themselves in practice to the
implementation of the strategies for
health for all by the year 2000;
(2)
to establish close collaboration with
governments, in a spirit of partnership,
for the implementation of national
health for all policies and programmes;
(3)
to encourage and support in all ways
self-care and self-help groups at the
community level for the effective imp
lementation of primary health care;
(4)
to establish appropriate national co
ordinating mechanisms, such as natinal councils of nongovernmental or
ganizations, to provide a focal point
for nongovernmental activities in
health and health-related fields;
3. URGES international nongovernmen
tal organizations:
(1)
to take appropriate measures to fur
ther the collaboration between na
tional
nongovernmental
organiza
tions and Member States in the imple
mentation of health for all strategies;
(2)
to collaborate with WHO and other
international organizations in pro
viding support and cooperation in
health for all activities;
(3)
to coordinate their activities to en
sure mutual support and cooperation
in health matters;
31
4.
CALLS on Member States:
(2)
to encourage and support the estab
lishment of self-help and self-care
nongovernmental groups at the com
munity level, giving particular empha
sis to women's groups, in order to
implement primary health care ap
proaches effectively;
6. REQUESTS the Executive Board to
review the existing framework of WHO's
(1) to promote, foster and support the collaboration with organizations from the
partnership
approach by involving nongovernmental sector, together with the
nongovernmental organizations in existing rules and procedures, with a view to
policy formulation, planning, imple strengthening it and making in more effective;
mentation, and evaluation of the na
tional health for all strategies;
7. REQUESTS the D irector-Genera I:
(3)
(4)
to stimulate the active involvement of
youth and student organizations, since
these represent the generation that will
be responsible for the world's health
in the year 2000;
to encourage and support the estab
lishment of nongovernmental co
ordinating or other appropriate me
chanisms at the national level to faci
litate mutual dialogue and close con
sultation on health matters;
(1)
to pursue his efforts to promote the
involvement of international non
governmental organizations in the
Global Strategy for Health for All;
(2)
to promote and support partnership
activities of Member States, WHO
and nongovernmental organizations
for the implementation of strategies
for health for all;
(3)
to review periodically the progress
made"in promoting and fostering col
laboration between governments and
nongovernmental organizations.
Sixteenth plenary meeting, 20 May 1985
A38/VR/16
The passing away of a
crusader
z A health campaigner
(5) to utilize the expertise and experience
and
a
friend
of the third world
of nongovernmental
organizations
through consultation, and for th is
purpose prepare inventories of their
resources, skills and collaborative
health activities with governments;
On 23rd May 1985 in Stockholm passed
away one of the most courageous men. His
name was De. Olle Hansson, professor of
Paediatric Neurology in the University of
Gotenberg, Sweden. He died of cancer.
to facilitate the mobilization of ade
quate resources for the work of na
Since 1965 he had single handedly fought
tional nongovernmental organizations against the unethical practices of pharmaceuti
for health work;
cal companies. He was the first person to
report in 1965 that clioquinols (mexaform,
5. REQUESTS the regional committees
enterovioform, etc. were absorbed from the
to consider ways and means of strengthening
gut) and were associated with blindness (optic
the involvement of national and regional non-.
atrophy).
governmental organizations in the implemen
tation of regional and national strategies for
He fought against Ciba Geigy's “denial of
health for all;
facts", e.g. absorption of the drug, association
(6)
32
Medical Service
of mexaform like drugs with SMON, (Suba
cute Myelo Optic Neuropathy) which in simple
words means paralysis, loss of baldder control;
burning pain in the limbs and blindness.
Dr. Olle Hansson stood as a witness on
behalf of the SMON victims in the Tokyo
Court, where the SMON case was fought for
8 years. His contribution as an expert who
was willing to take the side of the people
against one of the most powerful multinatio
nals is exemplary. He had the courage to
stand against the medical establishment which
continued to perpetuate the lie that SMON
was caused by 'virus' and as a genetic dis
order of the Japanese. It was his effort along
with that of other socially conscious laywers,
doctors and journalists that led to the benning
of mexaform in Japan way back in 1971.
His efforts in Sweden led to the diagnosis
of 43 cases of SMON in Sweden itself.
In 1976, Dr. Olle Hansson proposed a
boycott of all Ciba Geigy products for con
tinuing sales of their products mexaform and
enterovioform in the third world countries.
Doctors from Sweden, Denmark and Norway
joined in the protest. They wrote in the medi
cal journals, newspapers, etc. By 1981, Ciba
Geigy had lost 25 percent of their market in
Sweden. And by mid 1982, one third of their
market was lost. Dr. Olle Hansson insisted
that the drug industry knew only economic
arguments and protest by prescribers and con
sumers in boycotting their products was a
major tool in our hands.
Dr. Hansson's efforts helpd SMON victims
in Japan obtain compensation—a percentage
of which was set aside by the victims them
selves to fight against drug induced suffering
elsewhere. Similarly 38 individuals afflicted
with serious side effects in Sweden, sued
Ciba Geigy and they were paid 1.8 million
Swedish Kroners in an out of court settlement.
May-June 1985
Last year it was Dr. Olle Hansson who in
formed the Drug Action groups worldwide
about Tandril and the association of deaths
due to agranulocytosis. Consumer Alerts
were immediately sent off. Ciba Giegy rea
lizing that facts from their own internal do
cuments were now known by the public, were
forced to decide to withdraw the product by
the 3rd quarter of 1985.
Dr. Olle Hansson was at this time not merely
fighting Ciba Geigy but fighting cancer,
which had already begun to spread.
The fight that Dr. Olle Hansson was involv
ed in was against malpractices and deliberate
misinformation. He believed that informed
public could resist their being manipulated
and exploited in the name of medical science
by profit oriented commercial interest in con
nivance with vested interest within the medi
cal establishment and bureaucracy.
Dr. Olle Hansson was one of the pillars
of Health Action International, which isanin
formal co-operating network of health groups,
consumer groups and public interest groups
worldwide.
Health Action International (HAI) networkers
have been fighting for safe, rational and eco
nomic use of pharmaceuticals in their own
countries and also worldwide.
Dr. Olle Hansson was a source of infor
mation and inspiration to individuals, groups
and organizations involved in drug action.
His work and life depicts what a single person
with a purpose, awareness, courage and con
cern for the people could do. He fought a
lonely battle against pharmaceutical malprac
tices since 1965. It was only in the eighties
that his contribution was beginning to be
appreciated by the people in the third world
for whom he had been fighting. His ex
perience in fighting unequal battles against
33
malpractices of the powerful drug lobby has
been of special significance to our country.
He fought for effective drug control at the
national and international levels.
India is on the threshold of formulating its
national drug policy. For the first time,the
common man is going to demand that his/her
interest be safeguarded and given a higher
priority than the so called growth of the drug
industry.
India's Hathi Committee report inspired
the Bangaladesh Drug Policy. Will it inspire
our own New Drug Policy? When Bangladesh
decided to adopt WHO recommendations on
essential drugs, there was an uproar; the policy
has stayed despite the pressure and so have
the multinationals. 130 new drugs which
are essential have since been registered by
them while 170 hazardous drugs have been
withdrawn. The total number of drugs with
drawn under Drug Ordinance of June 1982
were 1707.
The growth that Dr. Olle Hansson fought
against was increased production and exports
of irrational and hazardous drugs; greater
profits for drug companies; more commission
for chemists, drugists and more revenue for the
state, at the cost of the consumer.
The fight has been for the right of every
individual to essential and life saving medi
cines which are available not merely in posh
nursing homes or city hospitals, but in the
remote areas where the other Indians live.
The demand for essential drugs is associated
with the demand for an immediate withdrawal
of medically known hazardous and irrational
drugs, from the markets. Total ommission of
this aspect from the National drug policy draft
prepared by the Steering Committee of the
National Drug and Pharmaceutical Council is
very disturbing.
Dr. Olle Hansson stood for 'right to infor
mation by the consumers and prescribers'.
He insisted that the people should know
about the medicines they consume. Tandril
(sold under any other name) could 'shut down'
the bone marrow. His dose of estrogen pro
gesterone drugs which are still being used for
pregnancy testing can lead to abnormal babies
being born (thanks to the stay order obtained
by Organon, Nicholas and Unichen from
Calcutta and Bombay High Courts against the
Drug Controller of India's ban order on the
product in 1983) their sales continue—flaunt
ing drug control flaunting rules of ethical
marketing practices.
34
While all over the world various intellectuals,
scientists, doctors, consumer groups, human
rights groups involved in the health and drugs
issues share the sorrow of Dr. Olle Hansson's
passing away, his death challenges all of us
to continue this unequal fight between
Davids and Goliaths, between concerned in
dividuals and cooperate powers and their
supporting bureaucracies and political patrons.
Dr. Olle Hansson was not merely an expert
in his field. He was a true teacher, whose
quiet tenacious struggles taught us how to
fight for others and for truth and justice; how
to persevere, be consistent and single minded.
In Sweden and world over he is a hero
and considered a legend. For us he was a
friend, we needed and valued.
Dr. Olle Hansson visited India in April 1983
as a guest of VHAI. During this visit he ad
dressed a public meeting at the All India Ins
titute of Medical Sciences on the role of antidiarrhoeals (with focus on clioquinols—mexaform and enterovioform). Meetings were
arranged with some of the leading neurologists,
the Drug Controller of India, health activitists
and legal experts.
It was due to his untiring efforts that Ciba
Geigy was forced to issue a statement regard
Medical Service
ing the withdrawal of mexaform and enterovioform from the international market by
March 31st, 1985. (It is ironical that while
the leading producer of hydroxyquinoline has
been forced under international pressure from
medical professionals and consumer groups,
to a decision to withdraw its leading product.
our Drug Control authorities and our doctors
continue to want it). His efforts forced Ciba
Geigy to decide about withdrawal of Tandril
from the world market.
nal drugs will be allowed to be dumped on
our people. How many Indians will or will
not have access to essential and life saving
drugs? Whether their distribution, availability
and prices, will or will not be taken care of.
it will be decided here, how unbiased drug
information will be made available to our
health personnel and our people to help in
rational decision making.
2.
Consumer Education and Research
Centre, Ahmedabad
VHAI along with others will continue to
fight for peoples health. Ensuring that our
people get 'people oriented national drug
policy' would be our greatest tribute to Dr.
Olle Hansson. He has not merely shared with
us valuable information but has provided a
sense of solidarity. He recognized the need
for medical professionals to take public stand
on issues related to peoples health when jus
tice is being denied. Swimming against the
current has always required great moral
courage.
3.
Centre for Education and Documen
tation, Bombay
Dr. Olle Hansoon stood as an epitome of
moral courage and deeply valued it in others.
4.
Drug Action Forum, West Bengal
5.
Drug Action Forum, Andhra Pradesh
6.
Drug Action Forum, Karnataka
7.
Medico Friends Circle, Pune
8.
Federation of Medical Representa
tion Association, Patna
It is not merely the passing away of one of
the most experienced drug activists but the
passing away of a great teacher: a teacher of
moral courage, of selfless struggle; it is the
passing away of a rare friend of the common
and under privileged people.
9.
Foundation for Research in Commu
nity Health, Bombay
10.
West Bengal Voluntary. Health Asso
ciation, Calcutta
VHAI shares its grief with thousands of
others across the world. VHAI is fighting
along with other drug action groups who are
part of the All India Drug Action Network,
namely:
1. Arogya Dakshata Mandal, Pune
11.
LOCOST, Baroda
12.
Catholic Hospital Association of India
(CHAI)
Dr. Mira Shiva
Coordinator, Low Cost Drugs & Rational
Therapeutics and Convenor, All India Drug
Action Network.
May 29, 1985
for a Rational Drug Policy.
Report of the Seminar for
Village Health Promoters con
ducted at Junwani from 25th
to 27th Feb. 1985
In the Monsoon session of Parliament will
be decided how many hazardous and irratio
A 3 days local seminar from 25th to 27th
of February was organised for Village Health
May-June 1985
35
Promoters by the medical association of the
diocese under the guidance of Sr. Jyothi and
the consignee Fr. Gerald Almeida and his
co-workers to prepare better health workers in
rural areas. 45 selected women attended the
seminar.
Fr. Gerald inaugurated the session. The
saying "prevention is better than cure" was
emphasised. He invited the women to know
their role as good mothers and explained to
them the necessity of personal cleanliness and
keeping their homes and surroundings clean.
Thus he made known to them the very pur
pose of calling each one of them for this
seminar. The idea was further explained and
deepened by a role play and followed which
there was a group discussion at length. All
the groups stressed the heed for personal
attention to keep things clean.
The selected women were then enlightened
on their role as health workers in the village.
They would work as intermediaries between
the nurse and the villagers both for health
and moral support. They are instructed to
submit their monthly reports to the sister of
the dispensary and work in collaboration with
her. At the time of breakout of epidemices
they are to keep the authorities informed.
Along with personal hygiene the leaders were
instructed to give special attention in the
matter of use of water. The theme was made
quite vivid by group discussion and slide shows.
As the wells and lakes constitute the main
sources of water supply the emphasis was
laid on the necessity of keeping these wells
and lakes clean so as to prevent any con
tamination. The use of potasium perman
ganate, bleaching powder, filteration boiling
of the drinking water etc. were advocated as
safe approach to be accepted in this respect.
Apart from physical health mental hygiene
also go a long way in building up human
persons. Various mental sicknesses and their
consequences were explained in the group.
36
Fear, doubts, guilty conscience, worry etc.
effect the wholesome growth of the persons.
Finally the necessity of following a balanc
ed diet with the right amount of carbo-hy
drates, fats, protein and vitamins was dealt
with, making clear to the participants the de
ficiency diseases that can arise in the absence
of such a diet. A lesson on cooking without
loosing vitamins, was taken by one of the local
women who had done a health worker's train
ing earlier.
The seminar ended with a variety of enter
tainments presented by the participants on the
topics of the seminar and the participants went
back with the conviction that they are the
agents of health. Surely the group is a pro
mise to effect such and many other prog
rammes in future that will endorse the human
society to grow to its fullness.
—Sr. Elsy Mary SMMI
St. Joseph's Leprosy Hospital,
Tuticorin: Brief Annnal Report
for the year 1984
The hospital has given high priority to the
antileprosy campaign. In this respect it has
conducted a series of surveys which include
general survey, epidermiological survey, school
survey and healthy contact survey.
The facts arrived at are the following:
The total no. of known cases of leprosy
patients
2881
Total no. of registered cases for
treatment
1892
Total no. of patients released from
control
879
Total no. of patients released from
control in 1984
200
Medical Service
Regarding the impatients service, a total
of 451 patients have received admission in
the hospital. In the physiotherapy room 320
patients have received physical exercises. The
hospital has supplied 405 patients with micro
cellular rubber sandals and two patients with
spring shoes and other artificial aids.
The hospital caters to the occupation
therapy and rehabilitation of the cured ones.
Inpatients who are on stabilization of antilep
rosy treatment and are able to work and those
patients who are cured and rehabilitated ear
lier, work in mat making, weaving, in the
poultry and dairy farm, candle making, sewing,
cycle repair and as helpers in the farms. The
number of these patients are decreasing as
the hospital tries to rehabilitate them at home
rather than in the hospital premises. A total
number of 30 patients have been helped with
loan under GLRA scheme.
The hospital is interested in the promotion
of health education. It imparts continuous
education to individuals and groups of pa
tients, their families and the public using va
rious methods.
A leprosy week was observed holding pub
lic meetings and staging dramas, depicting
the early signs of leprosy, giving the message
to the masses that it can be cured and that it
is not a hindrance to social life.
Seminars and meetings for the staff are
being conducted from time to time to re-equip
them with the latest know how in the treat
ment and rehabilitation of the patients.
1. Brief Report on Community
H ealth Activities of Diocese of
Rajkot
Diocese of Rajkot is an infant mission
diocese formed in the year 1977. This dio
cese is concentrating its activities more on
rural apostolate. As a part of this goal, co
May-June 1985
mmunity health activities are given due impor
tance.
Medical Apostolate of the Diocese:
Community Health Promotion activities are
being carried out through 12 mission stations
of the Diocese. They are in Bedi, Rajkot,
Chachana, Nanikhakkar. Porbandar. Junagadh, Morvi, Ribida, Merubagh, Hapa, Gogha
and Mithapur.
Nature of'activities of the health centres.in
Bedi, Chachana, Nanikhakkar, Morvi, Ribida,
Merubagh and Gogha is almost the same.
These health centres are situated in rural areas
of the Diocese. There is one qualified re
ligious Sister in each health Centre. She
provides medical aid to the local people in the
health centre upto noon. In the afternoon,
she visits surrounding villages, with the help
of other Sisters, with medical kit and provides
medical aid to the local people on the spot.
They discuss about various aspects of health
and preventive aspects of diseases with the lo
cal people especially with the house-wives.
In four stations viz. Ribida, Merubagh, Gogha,
and Chachana the village working girls, who
are appointed by the Diocese to assist the re
ligious in the village work help the qualified
Sister to visit the surrounding villages. * They
often use charts, posters etc. during the vil
lage visit for the health education of the people.
Occassionally the religious organise medi
cal camps for the poor people of the surround
ing villages generally with the co-operation of
govt, doctors. During the camp, quite a lot
of village people undergo thorough medical
check-up. Then, the serious cases will be
referred to or admitted in the hospital. For
minor cases the doctors prescribe medicine
and the nurse sisters do the follow up treat
ment.
For example, we organised an eye camp in
Ribida on 17th of May for benefit of village
37
people of Ribida and surrounding seven vil
lages. More than 150 patients ben efitted
out of the camp. We organised this camp in
collaboration with the opthalmology section
of General Hospital, Rajkot. They provided
free medicine to about 100 eye patients during
the camp, and more than 30 patients were
given spects from the hospital after the camp.
Sixteen cases were referred for operation fixed
to be conducted on 7th of June, in the General
Hospital.
In Gogha, Chachana and Morvi, the re
ligious 'have got mobile health units to orga
nise the health promotion activities. With
the.help of mobile health units we are extend
ing medical aid to a large number of patients.
Health centres in Hapa, Merubagh and Porbandar are newly started ones and will be
initiating activities in line with the old ones as
described above.
We started immunization programme in all
stations except in Junagadh and Satadar.
CHAI helped us to purchase medium size
fridges to these stations to preserve vaccines.
In Junagadh, the Sisters have been work
ing in a Government Leprosy Hospital for the
last 30 years. The dedicated service of the
missionary sisters is widely appreciated by the
local people. In Satadar, a village which
is situated in Gir Forest area about 60 km away
from Junagadh, there are 60 leprosy patients
staying in a housing colony of 30 houses.
The sisters go to Satadar once in a week to
dress up the wounds of the patients and to
give the medicines. We have provided a
milk goat each to all the families. We are
thinking of other rehabilitation measures as
well for these patients.
In Mithapur religious are working in the
Tata Hospital of Tata Chemical Ltd. and in the
T.B. Sanitorium. A few sisters are visiting
nearby villages and provide medical aid to the
local people.
38
2. Community Health Orienta
tion Programme in Rajkot
Diocese
The Diocese of Rajkot (Gujarat), on the
initiative of Sr. Isabella Mary, the Diocesan
Health Coordinator, organised an orientation
programme in Community Health on 2nd
and 3rd of May for the sisters working in rural
health centres. Fr. Thomas Joseph of Catho
lic Hospital Association of India conducted
the sessions.
Bishop Gregory Karotenbrayil, in his wel
come address, stressed that the healing mi
nistry of the Church should render relevant
and meaningful service to the poor rather than
entering into a profit making business through
institutionalised approach. The Diocese, with
its small dispensaries spread in the rural areas,
has adopted this as a policy.
Through deliberations and reflections that
followed the whole day, the participants came
up with the realization that diseases have their
deep roots in the socio-economic, political
and cultural imbalances. While dispensaries
are busy with curing illnesses, 70% of the
diseases are preventable for which the ser
vices of doctors are not needed but a process
of enabling the people for adequately handling
their health. Community diagnosis of a
simple disease diarrhoea (but a major child
killer!) made clear the point that health and
development are interrelated.
These analysis, added with the good will
of the participants, paved the way for some
creative future planning which includes
advanced training of personnel in Community
Health and formulation of a Master Plan for
promotion of Community Health in the whole
Diocese.
3.
Diocese of Trivandrum
A meeting of the hospital directors and ad
ministrators of Trivandrum Archdiocese was
Medical Service
held on 13th of March. Twenty Two persons
participated in it. His Grace the Archbishop
the Most Rev. Benedict Mar Gregorios pre
sided over the meeting. The Diocesan Di
rector, Fr. George Purathoot welcomed the
Archbishop and the participants. His Grace
in his inaugural address stressed the impor
tance of the healing ministry and expressed
that all our efforts must be motivated by the
love of Christ and that there must be collabo
ration and understanding in all our activities.
He promised all kinds of help for the promotion
of health care activities in his diocese.
The main aim of the meeting was'to make
the CHAI health policy a reality in the CHAI
unit of Trivandrum Archdiocese. The Dio
cesan Director, Fr. George, shared on the
theme of the "People Oriented Drug Policy"
and thus the main theme of the convention
was highlighted to the participants during his
talk.
The plan of action presented by the Kerala
groups in the CHAI convention in Bangalore
was intimated to the members in the meeting.
The urgent need for a CHAI diocesan^unit
was proposed by the director. All the mem
bers unanimously agreed to the proposal and
the Board of Directors of the CHAI Diocesan
Unit was elected.
The members shared their experience
through open dialogue among the participants
and the infrastructure of the diocesan hospi
tals and institutions were made known to all
concerned.
"Health for a million" programme is effec
tively being carried on throughout Trivand
rum Archdiocese. It is an on going prog
ramme in the diocese. Another important
programme in the diocese in the M.C.H.
programme. In both these programmes emp
hasis is given to health education training
programme.
May-June 1985
Before the meeting broke up a plan of ac
tion based on the broad outline of the regional
planning was also drawn for the diocese.
—Fr. George Purathoot
4. Orientation Programme on
Community Health in Jabalpur
Diocese
In an attempt to activate the existing Com
munity Health Programmes in Jabalpur Dio
cese, the Diocesan Social Service Society
organized a one week Orientation programme
from 13th to 17th of May for priests and sis
ters involved in Community based activities.
The Community Health Department of Catho
lic Hospital Association of India, represented
by Fr. Thomas Joseph and Sr. Mariamma
Antony conducted the sessions.
The sessions started with defining a comp
rehensive vision of health — situating ill
health in the context of socio-economic and
political imbalances of the society and arriv
ing at a philosophy of health that it is a state
of total well being and not merely the absence
of disease or infirmity. Social analysis, co
mmunity diagnosis showing the link between
physical illness and social illness, awareness
building education, communication methods,
planning, importance of right attitudes in
development work, etc, were some of the ma
jor topics dealt with. Faith reflection sessions
and the liturgy helped the group to see the
message of Gospel in relation to the social
realities of today. Some concrete plans were
chalked out for the future which includes
mainly developing a team of trained person
nel in the Diocese. A follow up of the pre
sent meeting was also planned for November
1985.
39
Only a true cultural choice can
effectively Oppose euthanasia
(On Thursday, 6 September, at Castel
Gandolfo, Pope John Pau! // spoke to
members of the Catholic University of
the Sacred Heart's 54th Cultural Rene
wal Course concerning the value of life
and the need for the Christian commu
nity to affirm it and to work for a true,
educated choice for life within the family
and society. The following is our transla
tion of the Pope's speech.)
Dearest Brothers and Sisters,
I am particularly happy to greet each and
every one of you, participants in the 54th
Course of Cultural Renewal of the Catholic
University of the Sacred Heart. I address my
greetings especially to the organizers of the
meeting, and above all to the Rector Magnificus, Adriano Bausola, whom I thank for the
respectful words with which he opened this
informal meeting.
The theme which you have chosen for the
summer course this year—"The value of life"—
is as important as ever. You have had oc
casion to analyse its religious, ethical, psycho
logical and social aspects, emphasizing how
life maintains its value in its every stage and
condition and how the possibility for each one
to give meaning to his own personal experi
ence depends, in large part, on the firm
commitment of everyone, even if life is tried
by the limitations of sickness or the weight of
old age, which is the inevitable prelude to the
mysterious "passage" of death.
Among other problems, you have confront
ed one particularly debated today, that of
euthanasia, examining it in the context of
questions deriving from, the intangibility of
human life.
May-June 1985
Repeatedly confirmed and developed
This intangibility is a logical corollary of the
Christian conception of life, of the lordship
of God over life and death, of man's belonging
to Christ, both in life and in death (cf. Rm
14 : 8). This is an explicit teaching which
occurs again and again in the Bible, beginn
ing with the first pages of Genesis and the
"Thou shalt not kill" of the Decalogue (cf.
Ex. 20 : 13 and Deut 5 : 17), up to the First
Letter of John (cf. 3 : 11 -15); this is unani
mously expressed in the Tradition of the
Fathers, beginning with the most ancient
written record, which is that of the Didache,
and it has been confirmed by penitential prac
tice which from the earliest times has sigmatized homicides one of the gravest sins.
This teaching has been repeatedly confirmed
and developed in our time by the Pontifical
Magisterium and by conciliar and episcopal
documents.
In the light of these teachings the believer
must acquire and ever greater consciousness
of the intangibility of every innocent human
life and give proof of inflexible firmness in the
face of the pressures and suggestions of the
dominant cultural environment, decisively
standing against every attempt to legalize
euthanasia, and also to continue the struggle
against abortion.
An irreconcilable conception of life
But the real problem to be confronted, in
regard to the outlining of a growing social
acceptance of euthanasia, seems to be a diffe
rent one. As has already been seen in the
case of abortion, the moral condemnation of
euthanasia remains unheard and incompre
41
hensible to those who are imbued, perhaps
unconsciously, with a conception of life
which is irreconcilable with the Christian
message or rather with the very dignity of
human person, correctly understood.
To find proof of this, we need only consider
some of the negative characteristics more in
vogue in the culture which abstracts from
transcendency:
— the habit of disposing at will of human
life as its source;
— the tendency to appreciate personal life
only to the degree that it can provide
riches and pleasures;
— the valuing of material wellbeing and
pleasure as supreme goods, and con
sequently, the concept of suffering as an
absolute evil to be avoided at all costs
and by every means;
— the concept of death as the absurd end
of a life that could still have given en
joyment, or as the liberation from a life
still continuing although already "de
prived of meaning", because it is destin
ed to continue in pain.
All this in general accompanies the con
viction that man, leaving God out of the ques
tion, is responsible solely to himself and the
freely established laws of society.
It is clear that where these attitudes have
taken hold, in the experience of persons and
social groups, it can paradoxically appear logi
cal and "humane" to "gently" put an end to
one's own or another's life, when it could
hold only suffering and serious impairment.
But this is in reality absurd and inhuman.
The commitment that is demanded of the
Christian community in such a socio-cultural
context is more than a simple condemnation
of euthanasia, or the more attempt to block
the road towards its eventual spread and subse
42
quent legalization. Basically the problem is
above all how to successfully help the men
of our time to become aware of the inhumanity
of certain aspects of the dominant culture,
and to rediscover the most precious values
which have been obscured by it.
The emergence of euthanasia, as a further
resort to death after that of abortion, must
therefore be taken as a dramatic appeal to all
believers and to men of good will to move with
urgency to promote with every means and at
all levels a true cultural choice for our society's
future.
Therefore of particular importance are,
above all, a presence and a decisive action of
Catholics in all those places and organiza
tions, national and international, in which
decisions of extreme importance for the direc
tion of society are made.
Likewise the same must be said concerning
the vast field of the social communications
media, on whose importance in relation to the
formation of public opinion it is superfluous
to insist.
But it is no less important and necessary
to spread the awareness that everyone, simply
with his own life style, contributes to reaffirm
ing the Christian concept of life, or to cons
tructing a different one.
It is urgent, therefore, that all who are reach
ed by the Church by word and action be help
ed :
—- to become aware of the diversity which
has often become established between
faith and life, as a consequence of an
uncritical practical acceptance of hedo
nism, consumerism, and other concepts
underlying a certain life style;
— to discover the genuine Christian con
cepts concerning life, suffering, death,
and the true scale of values of life, conMedical Service
ceived of as a vocation and a mission,
for which everyone is responsible be
fore God;
— to build anew on these concepts one's
own individual, family, and professio
nal existence, not fearing to go against
the current with Christian firmness.
Renewal of authentic Christian feeling
Essentially, the problem of euthanasia
requires and demands with dramatic urgency
a serious and constant commitment to a real
and personal renewal of authentic Christian
feeling. Further decays and negligence could
result in the suppression of an incalculable
number of human lives, and in a further and
grave degrading of all society and human life
in general to ever more inhuman levels.
Finally it can be added that the principal
subject of all this commitment cannot be other
than the family. This finds justification above
all in the same motives that support affirma
tions of general ’ importance concerning the
central role of the family in evangelizing mis
sion of the Church (cf. Familiaris Consortio,
n. 65) and for the future of humanity (cf.
ibid., n. 86). But there are additional specific
motives in relation to the problem of euthanasia
and the commitments required of the Christian
community for its solution. In fact, the sector
most consistently opposed to the risk of be
coming victims of euthanasia is composed of
the elderly, especially the invalids and those
who are no longer self-sufficient. A different
attitude, of acceptance and love, has in the
family a privileged ground to take root and to
spread (cf. Familiaris Consortio, n. 27).
Proper attitudes, contrary to those outlined
above concerning life, suffering, and death,
which prepare the ground for euthanasia, can
May-June 1985
ordinarily assumed and convincingly carried
forward only on the basis of an appropriate
family education.
One can therefore conclude that it is prin
cipally through the family that there can take
place an effective renewal of the Christian
message on the value of life, of every human
life, even if seriously handicapped, weakened
by age, or torn by suffering.
Stimulating and impelling discussion
I am pleased that the Catholic University
of the Sacred Heart has dedicated these days
of study to such a stimulating and at the same
impelling discussion, which has given you a
way to examine the anomalies of present-day
society, which is so contradictory but also so
desirous of authenticity and sensitive to the
problems that trouble mankind. I am sure
that you, combining the sensitivity of intellec
tuals with the will to verify events in the light
of the Gospel, will recognize the duty to be in
this society the light that shines on the lamp
stand and the salt that gives flavour and pre
serves from corruption (cf. Mt 5 : 14). For
that matter, the themes developed during the
Congress clearly tesify to your concern and
your generosity.
I am confident that you will give particular
attention to the points that I have thought use
ful to touch upon, even if rather briefly, and
that you will be able to find the way to con
tinue to take an interest in this question in
order to make your contribution in clarifying
it. I accompany your efforts with my prayer,
while I cordially impart to everyone my affec
tionate Apostolic Blessing.
Courtesy : THE VOICE OF THE CHURCH
43
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