MEDICAL SERVICE VOL. 42 No. 8 SEPTEMBER-1985
Item
- Title
- MEDICAL SERVICE VOL. 42 No. 8 SEPTEMBER-1985
- extracted text
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medical
service
official house journal
of the catholic
hospital association of India
. "the love of christ
urges us" 2 cor 5 :14
vol 42 .
editorial board
September 1985
no 8
contents
dr c m francis
dr ravi narayan
* prem chandran john
dr
dr daleep mukarji
mr augustin veliyath
1
editorial
2
fr george lobo sj
prof george joseph
2
lifestyle and health—alcohol advocacy
3
3
oral rehydration therapy
denise ayres
7
primary health care: the challenge for nursing
education
amelia mangay maglacas
11
bishops set goals for justice and development
fr yvon ambroise
13
6
jana saukhya—a brief report
19
7
trained dais in rural himachal pradesh
renu sobti
22
legal education—14—workers' rights (part—II)
p d mathew
24
chai news and notes
33
dr paul neelamkavil
fr edwin m j
dr prem pais
dr k r antony
editor
■
I
4
5
fr john vattamattorn svd
cover design
p m isaac bangalore
8
9
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
"Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of ind ia
EDITORIAL
LIVING FOR OTHERS
One of our Indian novelists described of three levels of living. He finds
at the lowest level the dog-like life fighting for food as the 'end all and be all'. He
would identify a large chunk of our population under this category drawn from all
classes, castes.and. religions of people, whether rich or poor, educated or illiterate,in the towns or villages but all animated by basic selfishness. The second cate
gory is those who have attained a certain sense of humanity by religion or culture
and they are like common crows the robber birds, but as soon as they find food,
call out to their kin to share the meal with others. This category of people consi
ders this sharing as a virtue at least for the purpose of attaining 'punya' and 'Moksha'.
Then lastly a small tiny minority, who are like the proverbial 'Mother', willing to
'Live for others'. Then the novelist identifies in Jesus Christ Himself this spirit
to live for others.
How about us ? Our attitude ? Our spirit of service ?
commitment to live for others?
Our dedication and
“Break the bar, break it
Let the captive mind frfee
Let life with its boistrous laughter
Fill the dry river bed............... “
Thus dreampt our great saint Poet Rabindranath Tagore, of life. Life with full of
laughter and liberated mind, with overcoming of all kinds of dryness so that life can
flow smoothly like a river filled with water, for the teaming millions of our country.
Yet what is the reality we see today?
Living for others as far as we are concerned should be living for the poor.
Our services should primarily be geared to them, services in the field of health, edu
cation or otherwise. And the overriding reason for this is because God is with them.
It is in the struggle of the poor that God speaks and reveals Himself. We need to
opt for the poof not because they are better than the rich; not because they are holy
and the rich are not; much less because they are the majority. We need simply
to follow God's lead.
If our option is to live for others, this can meaningfully be realised only
by living for the poor. Then of course our involvement, our services and all should
be more and more where the poor are.
LIFESTYLE AND HEALTH
—Alcohol Advocacy
Is there increased pressure for healthoriented social 'policy changes that relate to
the availability of alcohol! Are people involved
in an alcohol debate ?
—Marcus Grant
There is a growing awareness today that
alcohol causes health problems. Ten years
ago, an article here would have devoted most
of its space to chronicling the range and se
verity of alcohol-related problems. It would
have been neaessary to demonstrate the link
between drinking and disease.
Today, that link is well understood, at least
by most of these who are concerned with
public health. What remains the challenge for
the next ten years, is to ensure that the same
awareness is spread through governments, the
general population and the scientific commu
nity. That is the aim of alcohol advocacy.
Within the WHO programme on alcoholrelated problems, advocacy is one of the four
priority areas for action. The others are: na
tional alcohol policies, international coordi
nation, and the development of techniques for
identification, prevention and management in
primary health care settings. All are impor
tant, but without effective alcohol advocacy,
it would be difficult for the other three to make
any headway at all.
So what does alcohol advocacy really
mean? Dr. A.R. Al-Awadi, the Minister of
Public Health and Planning of Kuwait, who
chaired the Technical Discussions on alcohol
at the Thirty fifth World Health Assembly in
1982, said that it had to do with "the creation
of social awareness" and "the stimulation of
the political will of the people".
In developed countries, many of the major
causes of death and disease are the direct re
sult of people's lifestyles. This is increasingly
becoming true for developing countries as
well. Bad diets, lack of exercise, unhealthy
habits like smoking and drug-taking, the effects
of pollution, stress-these and many other fac
tors contribute to an ever more unhealthy
environment in which to live and raise families.
The purpose of alcohol advocacy, like health
advocacy as a whole, is to help create a situa
tion in which pe pie actively choose health.
The first step in promoting such a concept
is to ensure that the relevant people have
access to the right information. Of course,
this involves gathering data and bringing them
together in reports, books and articles, but
that is only one part of the process. Advocacy
also involves making sure that people are read
ing ail these fine words and that; having
read them, they are prepared to do something
to make matters better.
A review was undertaken by WHO of all
the various documents on alcohol production,
consumption and related health problems that
had been issued or drafted by the Organiza
tion during the past few years. The clear con
clusion was that the information available
had been insufficiently exploited for advocacy
purposes. What, for instance, are the implica
tions for public health of trends in alcohol
production and trade?
Whilst alcohol consumption is beginning
to fall in some Western developed countries,
it is continuing to rise steadily on a global
basis, with particularly sharp increases in a
number of developing countries in Africa, Asia
Mr. Marcus Grant, is a Senior Scientist with WHO's Division of Mental Health.
September 1985
3
and Latin America. Even though some of
these countries were beginning from a com
paratively low base figure, the present trends
would, if they continued, lead to very high
consumption rates before the end of the 1980s.
In order to focus the attention of governments
on this important issue, WHO has not only
prepared a basic report on the current situa
tion, but has ensured that the topic is given
prominence in a variety of other journals with
wider circulation. (The present article is itself
part of that effort I)
The point to note is that if a government
wants to take steps to deal with the health
consequences of rising alcohol consumption,
it will not just involve the ministry of health.
Finance, justice, labour, traffic and many
other ministries will also have to be involved.
Thus, alcohol advocacy takes place within
governments, to promote better national
health policies.
A more obvious kind of alcohol advocacy
achieves its ends through the mass media.
Sometimes this takes the form of health pro
motion campaigns, designed to influence
people's drinking habits. It is now rare to try
to frighten people into changing. Much more
effective is an approach which actually seeks
to involve people in making active choices
about their own health and about the environ
ment in which they live. In this sense, through
community involvement, advocacy is already
a two-way process. The expressed needs of
the people are fed directly back into the ad
vocacy effort, reinforcing and amplifying its
messages.
But there are other ways in which the media
carry alcohol advocacy. Just think how much
drinking is portrayed in the cinema and on
television. Or consider how news reporting
and editorial comment in newspapers can
communicate messages about drinking. What
is required is a real working partnership bet
ween health practitioners and media practi
4
tioners. The objective is not to limit the media,
not to “use" the media, but to work with the
media to produce a more health oriented pre
sentation of alcohol issues. Good partnership
is good advocacy.
Nor are media practitioners the only group
with whom such a partnership can be formed.
Advocacy work through the promotion of
productive links with a wide range of discip
lines. The encouragement of research on al
cohol is itself a kind of advocacy within the
scientific community. Often, a particular to
pic, such as alcohol-related problems in adolescene, may have attracted a great deal of
public interest but comparatively little scienti
fic study. WHO is well placed to stimulate
research efforts, particularly in an area such
as biological risk factors for alcohol depen
dence, which require long-term international
collaborative efforts.
One problem of the advocacy approach
is how to establish indicators of success. The
traditional epidemiological approach to mor
tality and morbidity data is hard to apply in
this area. Whilst it still represents the bottom
line for all preventive health measures, it may
be that in assessing the effectiveness of ad
vocacy other kinds of intermediate successes
are more relevant.
If increased social awareness is the objec
tive, then are more people becoming involved
in community activities? Are there more items
about the health aspects of alcohol in the
popular press and on radio and television?
If the political will of the people is to be sti
mulated, is there increased pressure for healthoriented social policy changes that relate to
the availability of alcohol? Are people, in
other words, involved in an alcohol debate?
For it is through an increasing involvement of
people in issues relevant to their own health
that the effectiveness of advocacy can best
be measured.
Medical Service
For WHO, the challenge Fs to achieve the
right balance between persuasiveness and
scientific credibility. If you wait until every
last fact is known, you will never be able to
say anything. Meanwhile, hundreds of thou
sands of people will needlessly die of all the
diseases and accidents to which alcohol so
actively contributes.
On the other hand, there is a responsibi
lity to ensure that the messages which are
communicated reflect the best available evi
dence. The principles of scientific enquiry
should not be abandoned in favour of a few
catchy mottoes.
An honest citizen, returning home after a
hard day's work, and switching on his radio
or television set, may maintain that he has a
"right” to be entertained. The same citizen,
reaching for his beer or wine bottle, may
equally forcibly assert his right to drink what
pleases him and in what quantity he likes.
But as well as a right to choose the lifestyle
that suits him best, he may also feel that he
has a right to be protected against avoidable
risks.
The question is whether all these rights are
compatible with health. Alcohol-related prob
lems are health problems and many of them
proceed from choices made by individuals
and societies about the kind of lifestyles They
want to adopt. But choices are not fixed for
all time. The promotion of healthy lifestyles in
a changing world must remain an important
focus of much WHO effort. Alcohol advocacy
is just one part of health advocacy, which is
what health for all by the year 2000 is all
about.
Courtesy — WORLD HEALTH
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5
ORAL REHYDRATION THERAPY
—Denise Ayres
Miss Denise Ayres is the Executive Direc
tor of Diarrhoea Dialogue, Appropriate Health
Resources and Technologies Action Group
(AHRTAG), London.
Few health technologies have as great a
potential as oral rehydration therapy (ORT)
to make an impact on childhood mortality in
developing countries. Simple, inexpensive
and effective, ORT can be used not only
throughout the health system but at home as
well.
Recognising this, international agencies,
nongovernmental organizations and minis
tries of health in many countries are actively
promoting this therapy. With the assistance
of the WHO programme for the Control of
Diarrhoeal Diseases (ODD), some 70 count
ries are now implementing plans for national
diarrhoeal disease control programmes, with
in which ORT is the main component. UNI
CEF is playing a leading role in the production
of oral rehydration salts (ORS) and in the
crucial area of information activities related to
ORT.
The use of ORT in treating and preventing
diarrhoea is based on the knowledge that glu
cose stimulates the absorption of salt and
water in the small intestine.
The first step
tn turning this knowledge into a more widely
available health technology was the develop
ment by WHO and UNICEF of a formula for
oral rehydration salts. Mixed with drinking
water and given in the necessary quantity,
ORS solution replaces all the salts and fluids
lost during diarrhoea.
An important recent development was the
introduction by WHO of a more stable for
September 1985
mula containing tri-sodium citrate in place
of sodium bicarbonate. Research is still go
ing on to develop mixtures that will replace
the glucose in ORS with cereals such as rice
powder, which are readily available in some
areas and provide valuable nutrients, or that
will also contain amino acids and dipeptides.
Both types of mixture can increase sodium
and water absorption by the intestine and
thus reduce the volume and duration of diar
rhoea.
The development of the ORS formula, dis
tribution of packets and encouragement of
local production of ORS — although a vital
undertaking — represent only one part of the
strategy to achieve widespread use of this
therapy. Actually delivering it remains a
crucial issue: what can be achieved at home,
what role should the village health worker
play and what is the place of ORT in
hospitals ?
Strong local beliefs about the best way to
treat diarrhoea (if any treatment is given at all)
are sometimes incompatible with the ORT
approach. The notion that drinking during an
attack of diarrhoea is bad is a common one —
and not only in developing countries. Before
they can accept ORT. mothers need to under
stand what diarrhoea is; how it leads to mal
nutrition and often death; why fluid and food
given by mouth save lives; and how conti
nued breastfeeding and
extra feeding for
even a few days can speed a baby's recovery.
It is believed that early ORT at home as soon
as diarrhoea starts may result in fewer chil
dren becoming dehydrated and needing treat
ment with oral rehydration salts at health
facilities.
7
Available foods
Home therapy is based on the use of either
fluids and foods already available in the home,
such as rice water and carrot soup, or of drinks
made up from sugar, salt and drinking water
to prevent dehydration from developing.
Obviously, almost all home remedies lack the
sodium bicarbonate or citrate and potassium
chloride contained in the complete ORS for
mula and are, therefore, not as effective in
treating dehydration. .
In the Gambia, health workers have been
taught to administer the therapy, using ORS,
and mothers have been taught to mix a safe
sugar-salt solution at home. The message has
been successfully reinforced by a media cam
paign. After one year, 67 per cent of mothers
could correctly mix a home solution and 47
per cent had used it at least once to treat their
children. Not surprisingly, this early preven
tive treatment at home has meant that the
number of mothers taking children with diar
rhoea to health centres has dropped from 85
per cent to 50 per cent.
A simple recipe for home-made oral re
hydration solution is to mix one level 5 ml
teaspoon of salt with eight level 5 ml teaspoonfuls of sugar in a litre of drinking water.
In a few places, double-ended plastic measur
ing spoons are being used which measure out
sugar at one end and salt at the other. The
advantage of the spoons is that they measure
out enough sugar and salt for a relatively small
amount of water (200 ml) so that the solution
is more likely to be used quickly and not left
standing. The major problem with the spoons
is that they are not always easily available and,
when they are supplied, they frequently come
without adequate advice on their use.
One general constraint in the use of sugar
and salt solutions, no matter what measuring
method is used, may be their lack of availabi
lity of the high cost of sugar and salt in many
8
places. In such circumstances, mothers should
use drinks and foods that are already available
in the home.
Promoting ORT
There has been resistance to the use of the
therapy in hospitals in some developing count
ries. Senior health staff have often been train
ed to use intravenous infusion for all cases of
dehydration, and they remain unconvinced
about ORT as available alternative despite
scientific evidence proving its efficacy in all
but the most serious cases. On-the-spot de
monstrations of the use of ORT with dehydrat
ed patients have proved to be the most effec
tive way of convincing doctors. In many hos
pitals where oral rehydration centres have been
introduced, entire wards previously set aside
for diarrhoea patients can now be used for
other purposes. Large hospitals in Bangladesh,
Egypt Haiti, Jamaica, Nepal and the Philip
pines have all experienced a substantial drop
in the use of expensive intravenous fluids
following the introduction of ORT
progr
ammes. There has also been a substantial re
duction of case fatality in some of these hos
pitals.
Promoting the key health education mes
sages that relate to ORT is important. Differ
ing traditional views on diarrhoea, the wide
range of people to be reached, and the avail
ability of different sizes of packets of oral
rehydration salts all call for very adaptable
approaches to health information programmes.
The innovative information techniques used
range from television and radio spots to print
ed materials, puppet shows and theatre. At
the international level, aid agencies and other
organizations involved in mass communica
tions techniques are collaborating on the
development of coordinated public infor
mation campaigns to promote ORT.
One major vehicle for information is
Diarrhoea Dialogue, a quarterly newsletter
started five years ago to bring regular news to
Medical Service
Since only simple technology is needed for
its use, ORT has brought effective mortality
reduction within reach of even the most re
mote dispensary. Its impact at hospital level
has also been dramatic; it has enabled ex
pensive in-patient rehydration wards to be
closed in many places.
the formal
health structure.
Community
health workers (CHWs) can effectively deliver
ORT services, bringing about dramatic re
duction in diarrhoeas disease mortality rates.
In one community in India, a drop of 75 per
cent has been achieved. Treatment of child
ren in the home also allows CHW's to discuss
with the parents other important topics such
as domestic hygiene and better nutrition for
sick children. In many settings, ORT has pro
vided a stimulus for the accelerated develop
ment of primary health care programmes, and
has become a vital element in the overall
strategy to improve child health in develop
ing countries.
Perhaps the most important achievement is
the dissemination of this technology outside
—Courtesy - WORLD HEALTH
all those involved in the prevention and cont
rol of diarrhoea. It is distributed free to deve
loping countries, and is available in Arabic,
English, French, Portuguese and Spanish.
For more information about the newsletter
and the work of AHRTAG, write to :AHRTAG,
85 Marylebone High Street, London W1M
3DE, UK.
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September 1985
9
PRIMARY HEALTH CARE
The Challenge for Nursing Education
—Amelia Mangay Maglacas
Dr. Amelia Mangay Maglacas is a senior
scientist in nursing and heads the nursing unit
at WHO Headquarters in Geneva.
Only 15 years to go before the year 2000!
For the past seven years-ever since the WHO/
UNICEF Conference on Primary Health Care
at Alma-Ata-almost everyone concerned with
health has been repeating the slogan, "Health
for all by the year 2000", imagining the mo
ment when it would become a reality, pictur
ing how the world will be when it actually
happens. But, above all, working for it by
emphasising health development through
primary health care. As Dr. Halfdan Mahler,
Director General of WHO, explained, it is
people who matter, people who can make or
break their own development. And a member
of WHO's Executive Board stated last January
that health workers too "can make or break
a health system in terms of what they do or do
not do". This is especially true for nures be
cause, in the majority of countries, they are
the most important group of health worker in
terms of numbers, closeness to people, and
"caring" for people.
WHO has always been aware of this. Back
in 1974, the Organization convened an ex
pert committee on community health nursing
to identify ways in which nurses could signi
ficantly work towards meeting the health
needs of all the people. The recommenda
tions issued by this committee indicated that,
if nursing services are destined to respond to
the real needs of communities, then, nurse
education should reflect those needs.
Unfortunately, the time was not ripe for a
ready acceptance of the changes proposed.
September 1985
Which is why even today, in too many ins
tances, the education of nurses-like that of
other health workers — is still hospital-based
and they are given very little or no experience
in community health. This is the challenge that
faces nurses everywhere today. Throughout
their working lives they should be bearing
firmly in mind the concept of primary health
care. This is why it is essential that the com
ponents of primary health care be introduced
at all levels of their education, to prepare them
to become cooperative partners of the com
munity — which is often more knowledge
able about its own health needs and priorities
than are health workers themselves.
When WHO
convened another expert
committee in October 1983 on education and
training for nurse teachers, with special re
regard to primary health care, it recognised
that more could be done, not only to help nur
ses to accept the new concepts of health and
health care delivery, but also to become
agents of change. If nurses are to realise their
potential as agents of change, they must un
derstand the concept of primary health care
and know how to practise it. There has to be
a fundamental reorientation of thinking and
action through responsible nursing leader
ship in education if nursing is to contribute to
the achievement of the goal of health for all
through primary health care. The changes
required are more than cosmetic-traditional
patterns and structures will need to be chal
lenged. As the accent moves from patientoriented to community-oriented health care,
total care undertaken by a health team will
be the norm. Furthermore, the fulfilment of
primary health care tasks will make greater de
11
mands on cooperation between nurses and
other health-related professionals from diffe
rent sectors.
Two encouraging examples
Some countries have been reorienting their
nurses and nursing education towards the
goal of health for all through primary health
care, and with considerable
effect. Eversince Senegal signed the Charter for Health
Development in the African Region in 1978,
and adopted primary health care as the cor
nerstone of its national health development
policy, it has been progressively training its
nursing and midwifery personnel in the es
sential components of primary health care,
both in the rural and semi-urban communities
and in academic institutions.
Various schools and institutions throughout
the country preparing nurses and teachers of
nurses have adopted the principles of primary
health care as the basis of their curricula and
of learning experiences in rural and semiurban communities. Nurse educators have
been undertaking intensive course, including
field training, in the components of primary
health care to enable them to quickly adaptheir teaching to emphasise local health probt
lems and needs.
Other health personnel such as community
health officers, health post chiefs, and tradi
tional birth attendants are also being given
training, and supervision and support are
accentuated. Continuing education for every
one in the form of seminars and workshops
of two or three weeks is being offered. This
process is proceeding slowly but surely. Al
though it is still premature to give an assess
ment of its results, the outlook is certainly hope
ful.
Thailand is tackling this problem in its
own way. Nurses organized a workshop to
identify what will be required of them if health
care needs are to be met by the year 2000.
This gave birth to a series of seminars and work
12
shops to reorient nursing leaders from both
the education and service sectors, and a com
mittee was appointed to draft an educational
programme that is community-oriented and
that focuses on primary health care. Nurses'
associatoins promoted the idea of a need for
change and mobilised nurses to lend support
to this idea. Today, nursing schools are beginn
ing to implement their community-oriented
programmes and students are being trained in
the communities.
The Challenge
Nurses voicing their commitments, poten
tials, and good intentionswill no longer suffice.
Are nurses prepared to challenge the present
system of education in order to effectively work
towards the goal of health for all, or are they
merely going to pursue the status quo ? The
greatest number of health workers are nurses;
but what are they doing about primary health
care? They, above all other health workers,
have been prepared to be closer to people —
but are they close to all people ?
What can nurses do to really have an impact
on achieving health for all ? A lot of new things
will have to be done:
—
—
—
—
—
—
—
—
new ways of thinking
new attitudes about health
new ways of doing things
new ways of working
new relationships formed
new priorities
new functions
new ways of teaching and learning.
Once the nursing community begings to
apply the new thinking and becomes actively
engrossed in the new way of doing things,
partnership with communities will be visibly
strengthened and the goal of health for all can
be more realistically pursued. Education for
nurses based on the concept of primary health
care is an essential means of achieving this
goal.
Courtesy - WORLD HEALTH
Medical Service
Bishops Set Goals for Justice and Development
(Report of the Indian Phase Bishops Institute for Action VII (Bisa VII) Programme)
—Fr. Yvon Ambroise
National Co-ordinator of BISA VII
1.
What is BISA?
As a follow-up of the meeting of Asian
Bishops in 1970 the Federation of Asian Bis
hops' (FABS) was started in 1972.
FABS established an Office for Human
Development (OHD) as its Secretariat for
Development and Social Action. Through
OHD training programmes are organised for
Bishops of Asia and these training programmes
are called Bishops' Institute for Social Action
(BISA).
From 1974 onwards six such programmes
have taken place. The first in 1974, the second
and the third in 1975. These three programmes
dealt with the social dimensions of the Gospel.
BISA, IV, V and VI took place in 1978,1979
and 1983 respectively. They speculated on
Collegiality for Human Development. BISA
VII, scheduled to take place at Thailand in
January 1986, for which preparations are go
ing on, intends to discover the spirituality
based on the religio-cultural dimensions of
human development.
2.
What's new of BISA VII ?
All the six BISA's were conducted in any
one of the Asian countries for the Bishops
of Asia who wished to participate in the prog
ramme. Evaluation of these programmes show
ed that the programmes ware useful and gave
the Bishops social awareness and collegiality
but did not pave way for operationalization in
one's own country in an effective way. This
was due to lack of corresponding programme
and the onesided exposure programme be
cause of the selection of one particular Asian
country. So BISA VII was planned in such a
September 1985
way that each country would have their prog
ramme in their own country with the expe
rience of their social relality and send their
delegates to an Asian level meeting to make an
Asian synthesis so that each country deve
lops its own operational strategy as well as
contributes to the Asian one.
Theme and Purpose : The theme selected
for BISA VII is — Asia's
Religio-cultural
Heritage and Human Development. For de
cades development work has been avidly
taken up by church and church personnel.
The very soul of this work is its spirituality.
Hence in BISA VII the entire trust is to deli
berate and discover a suitable Asian spiritua
lity for social work. To achieve this one has to
look to the Gospel values and be imbued in
the spirit of our own culture and heritage
which are so deep and rich and thus evolve a
spirituality of our own, with its own character
and dimension suitable to our country and
people. So the participants of BISA VII will
be given a chance to experience personally
the way of living of the poor, downtrodden
and oppressed. With this living experience,
combined with an analytical synthesis of the
situation, the programme intends to lead the
participants to arrive at a desired synthesis by
synthesizing the lived-in-experience of the
poor with a deep contemplative prayer and
reflection.
3.
Goals
— to deepen the awareness among bis
shops of the "responsibility of faith for
social change" in solidarity with the
struggling poor to promote the elabo-
13
ration of a spirituality of human deve
lopment and social action in the life
and struggles of the poor and in the
life and ministry of the pastoral wor
kers.
— to enhance the commitment and de
dication of bishop's to pastoral action
on behalf of justice and human deve
lopment for the struggling poor.
The Objectives :
4.
—
to provide an experience of "being
with" the struggling poor.
— to define from the perspective of the
poor, the realities of poverty and in
justice in the national and the Asian
situation.
— to appreciate the aspirations and the
"spirit" of the struggling poor as they
employ their religio-cultural heritage
in their efforts, growth and develop
ment.
— to affirm the Kingdom values as seen
and lived through the eyes, hearts,
and lives of the struggling poor.
— to articulate
priorities and develop
strategies for action as an Asian
Church response to the needs of the
poor.
5.
Planning
In order to make the experience meaning
ful; genuine and indigenous one and in order
to effect a good follow-up, BISA VII was
planned in four phases.
The first phase was the initiation of the na
tional coordinators and the Bishop/Bishops
each country sent as their delegates. The ini
tiation session at Hua Hin in Thailand from
January 15th to 19th, 1985 was meant for
this/ Fr. Oshida, a Dominican Priest from
Japan, Fr. Aloyslus Pieris, s.j. from Sri Lanka,
Fr. D.S. Amalorpavadass from India and Fr
14
Bede Griffiths, a Benedictine Priest from India
were called to be the resource persons at
Asian Level. Of these four, only Fr Bede Griffiths
could not come for this session for some un
avoidable reasons that kept him in India. Fr
Yvon Ambroise, Asst. Executive Director of
Caritas India, was appointed by the CBCI
as the national co-ordinator for organising the
BISA VII in India and he attended this meeting.
The Second Phase of the programme is
the actual organization and implementation
of the Exposure-immersion programme ac
companied with deep reflection in one's own
country. Those Bishops who participate in the
programme will also elect four Bishops who
would share their experience at the Asian
Level.
The Third Phase of the Programme is the
meeting of the representatives elected and sent
by each country after experiencing the ex
posure-immersion cum reflection at Thailand
from January 15 to 23, '86. At the Asian Level
there will be a sharing of the different ex
periences of each country and with the help
of resources persons mentioned above there
will be an Asian synthesis that will be made.
The Fourth Phase : is the operationaliza
tion and implementation in one's own country.
The Bishops participate in BISA VII as leaders
of their Church in order to exercise their leader
ship to initiate the spirituality of social work
in their Dioceses.
6.
BISA VII in India
The Indian phase of BISA Vll Programme
of exposure and immersion took place from
20th to 30th August at Bangalore and at
Anjali Ashram in Mysore. Preparations for
this programme has been going on since
March. At the invitation of Fr Yvon Ambroise,
National Coordinator for BISA Vll, the Regio
nal Directors of Social Work of different re
gions met together for the first time at Satyo
dayam in Hyderabad from 19th to 21st March,
Medical Service
to plan out the programme. Fr. Mathew Thoya HI from Kerala Forum, Fr. Victor Maria Soosai
from Tamil Nadu Forum, Fr. L. Noronha from
West Bengal Forum, Fr. A. Salema from the
Karnataka — Goa
Forum,
Bro. Bernard
Singh from Bihar Forum and Fr. Francis
Xavier for Andhra Pradesh were present for
the meeting. Later on together with Mr. Rudy
Lobo from Delhi they had subsequent meetings
to choose the sites of projects and prepare
the people for exposure. Fr. Remigius—Di
rector of Caritas India joined the above team
as one of the facilitators during the ten days
of BISA VII programme.
Exposure — Immersion programme
The actual BISA II programme took place
from the 20th to 30th August. Bishops Rt.
Rev. Benedict Osta — Patna, J.B. Thakur —
Muzzafarpur; Gilbert Rego — Simla-Chandi
garh;
Thomas
Thiruthalil — Berhampur;
Aruldas James — Uthagamandalam; Fedrick
D'Souza — Jhansi; James Toppo — Jalpaiguri; Dominic Kokkat — Gorakhpur; Theophane — Jabalpur; Alex Dias — Port Blair;
Linus Gomes — Baruipur; George Anathil —
Indore; Joseph Pathalil — Udaipur; Msgr. A.
Sharma — Ecclesiastical Superior of Nepal,
and Fr. Dias, Deputy General Secretary of
CBCI took part in the programme. Due to
other commitments, some other Bishops who
wished to join the programme could not
attend it.
The first three days of the programme took
place at Bangalore. After the initiation to the
programme. Bishops visited various places
and projects to have a first hand living ex
perience of the poor, down trodden and op
pressed people by meeting them, having a
dialogue and sharing food with the poor
people.
On the first day, they visited Ramangaram,
a small town about 56 km away from Banga-.
lore and met a group of casual workers who
are employed in the silk industries owned by
September 1985
some 100 business people who employ nearly
10,000 people on daily wages. These exploit
ed and oppressed workers shared their diffi
culties and problems with the Bishops. From
there they proceeded to a tribal village inhabit
ed by Lambanis
whose forefathers were
brought from Rajasthan by Zamindars for
cheap labour. Here too Bishops went in
groups to visit the people in their houses and
listened to them patiently.
In the afternoon, they visited some slums
in Bangalore where some slum development
schemes are organised by Ms. Santhosh and
the fathers of the Holy Cross. After meeting
the slum dwellers in their own houses and
situation they all gathered together at the
Ragpickers' den, a project which has been
initiated and sponsored by the Archdiocese
of Bangalore. Bishops nearly spent an hour
speaking to the ragpickers and trying to gather
from them their aspirations hopes and ambi
tions in life. The meeting was very cordial and
homely. The Bishops were touched by the
project and the commitment and dedication
of the animators who are involved in orga
nizing these ragpickers to whom society is
very hostile.
On the second day they visited Kolar Gold
Fields. In the morning they were taken down
4800ft. below the ground level to see the work
ing conditions in the mine. From there, two
by two they visited some of the families of the
miners to see their poor living conditions and
had their meals with them. In the afternoon
they also met different type of groups consist
ing of workers, women, elders of the parish
and youth and discussed with them their
problems. .In the evening they visited a rural
project 'Sunanda' which is run by the Sisters
of St. Joseph of Tarbes.
On the third day the Bishops went to visit
the stone quarries. After meeting the stone
quarry workers in their working conditions they
listened to them carefully the.difficulties they
15
underwent as bonded labourers. The people
shared with the Bishops their experience of
freedom struggle and what it means to them
to be free from the clutches of contractors and
quarry owners. After meeting and discussing
with the workers both men and women the
people took the Bishops to their houses and
shared their meals with them.
During these three days of exposure-immerssion and specially on the last day at the
quarries, it was inspiring to see the Bishops
sitting on the ground under the shade of a
tree and discussing with them and listening to
them. All through the programme, they spoke
to the people, listened to them and shared
their ideas and took meals with them on equal
footing. This was made possible, since the
people were not aware that the persons with
whom they were dealing with were Bishops
from different parts of India. To facilitate this
approach to the people, the Bishops did not
put on any insignia pertaining to a Bishop.
The second phase of 7 days were spent in
prayer, reflection and synthesis in an atmos
phere of peace and tranquility at Anjali Ash
ram. During the first 5 days of the second phase,
Fr. Amalorpavadass initiated the Bishops to
Indian spirituality incorporating the Ashram
life-experience. It took a day or two to get
accustomed to the Ashram life. The Bishops
appreciated very much the experience of In
dian spirituality. Besides the spiritual dis
courses during the day, each one seems to
have enjoyed the other Ashram curriculum
such as getting up at 4.30 a.m. going through
yoga exercises, Pratha Samdhya (morning
prayer) in the open air, celebration of Eucha
rist, Madhyan (midday) Samdhya under a
tree and Saayan (evening) Samdhya with
arati, bhajan, and dhyana. According to Ashram
style, they volunteered to serve the food which
was taken squatting on the ground. After
supper every night they shared their feelings
and evaluated the progress of the day. Within
five days, they not only learnt a lot about In
16
dian spirituality but also started appreciating
the richness and beauty of Indian culture and
significance of Indian religious and cultural
practices. Above all each one cherished a deep
awareness of God emerging out of a Godexperience realized in them. The last two days
were spent in formulating a synthesis of both
the experience of exposure-immersion and
Indian spirituality. In that process they spell
ed out a spirituality for Social Action in India.
The salient features of the experience of the
BISA VII programme could be summed up in
the following way.
1. The Goal of Social Action is not merely
to organize services to people, but to animate
them to engage themselves in the process of
liberation from injustices, exploitation and
oppression present in the society.
2. There are the humanizing and dehu
manizing factors in the poor and one can sense
the contradictions and tensions they are ex
periencing in their day to day life. Some of the
dehumanizing factors are:
—
Exploitation and dominance by the rich
and the powerful, leading to total de
pendence.
—
Lack of resources and skills leading to
extreme poverty.
— A certain state of hopelesness and helplesness.
—
Crude forms of injustice and social dis
crimination.
—
Politically powerless and voiceless.
Some of the humanizing factors are:
— A strong faith in God but not a fatalis
tic one.
—
A desire and aspiration to struggle and
come out of the situation.
—
Expecting an outside intervention as a
liberating force (Messiah)
Medical Service
Hence their life itself is a big struggle to
survive and live as human beings.
3. The problems and constraints they face
in their day to day life are not merely at the
individual level but at the collective and struc
tural levels. And hence, the efforts individually
undertaken are frustrated or bear no fruit at
all. Therefore it demands change at the col
lective and structural levels.
4. People have a vague hope of a better
future. This hope is kept alive by their faith
and inner strength and their unfailing devotion
to God which sustains them in their struggle.
(iv)
A real authenticity in life.
(v)
Proper training and on-going forma
tion.
8.
It was realized that there is a spiritua
lity operative among the poor people and that
one has to discover it.
9.
The Bishops also formulated a holistic
spirituality of social action.
At the end of BISA VII the Bishops planned
a follow-up in three levels: national, regional
and diocesan.
6.
This calls for a deeper and continuous
God-experience, leading to total integrity
and ability to witness in word and deed.
7.
At the National level
(a)
5.
Our response to such challenges de
mands that we liberate ourselves from the
bondage of our prejudices, over concern for
orthodoxy, fear of taking risks, losing com
forts, losing our security and status, being iden
tified with the exploited and of denouncing
structural evils in the process of liberating
the poor.
(i)
A Report will be submitted to the
Standing Committee for the Gene
ral Body meeting of the CBCI.
(ii)
A request will be made to the Gene
ral Body of CBCI to promote such
programmes at the national and re
gional levels through Caritas India.
At the Regional level
(b)
(i)
The Bishops who participated in the
programme will serve as catalysts in
their respective regions to promote
such programmes, for the Bishops,
Diocessan Directors and lay leaders.
(ii)
Caritas India was requested to faci
litate such programmes.
Animators
The role of the Animators (Social Workers)
is a vital factor in the process of liberation. The
requirements of the Animators as emerged from
this experience are:
(i)
Real commitment to people and de
dication to the cause.
(ii)
Ability to inspire and infuse confi
dence in people and sustain their
motivation.
(iii)
Capacity to analyse their realities and
evaluate with them their growing
process.
September 1985
At the Diocesan level
(c)
(i)
The Bishops will share their expe
rience with their priests, religious,
social workers and other core groups
of lay people in their dioceses to
create a better understanding and
right perspectives of spirituality of
social action.
17
Jana Saukhya—A Brief Report
Co-operatives in Public Health
Co-operatives in Public Health was a new
concept in Wynad. The Government is all for
promoting co-operatives in different sectors:
agriculture, industry, credit, consumer goods
and services, labour etc. Health is every body's
business. Why don't we co-operate to pre
serve, promote and restore our own health
and also to create health awareness in the
general public.
This question was seriously asked by Fr.
C.M. Thomas who. has organized several co
operatives in different areas he had served.
There were industrial co-operatives, con
sumer cooperatives, milk producers co-ope
ratives which now run with greater or lesser
degrees of success. His enthusiasm has in
spired others too.
As the secretary of Health service co-ordi
nation in the Diocese of Mananthavady, this
idea of co-operation among different health
service institutions was discussed and certain
amount of understanding and co-ordination
was realized. During this period he completed
a two year certificate course in 'HEALTH
CARE AND WELLNESS MANAGEMENT'
offered by Voluntary Health Association of
India and had opportunity to visit different well
known community health programmes serving
the base level people. There was also a Rural
Health Programme conducted by WSSS un
der the auspices of the Diocese of Manan
thavady.
A fruitful combination of the idea of co
operatives in the promotion of peoples' health
was discussed among friends, people working
in the field of health. The idea was much ap
preciated. But it was new without precedence.
Many interested people promised co-opera
September 1985
tion. So a proposal was forwarded to the
Assistant Registrar of Co-operatives with the
model byelaws and project report of the pro
posed society. The matter was considered.
After several clarifications, permission was
accorded to collect shares and a share capital
of Rs. 50,000/-. was proposed as the authoris
ed share capital of the society. It is easy to
collect promises, but difficult to collect cash I
However, the promoting committee collected
the initial share amount within the stipulated
time and deposited it in the District Co-opera
tive Bank Kalpetta, as directed by the Joint
Registrar of Co-operative Societies.
Though permission was granted to collect
shares, the idea was still being discussed in
the co-operative circles. In other co-opera
tives the members have economic benefits;
there is economic activity in the society. But
so far there was no co-operative society for
public benefits — people's health and edu
cation. The primary aim of the co-operatives is
the individual benefits and not the general
public. Hence, there was also hesitation re
garding the proposed society, since it does not
have economic activity as its primary goal.
After a chain of correspondence and several
talks from the office of Taluk Co-operative So
cieties to the Minister's office, the permission
was withdrawn and chief promoter was asked
to draw the money and return to the members.
An Alternative — Jana Saukhya
The members were keen on the idea and
not to get back the share amount they paid.
So, after several discussions an organisation
was registered under the societies registration
act — to achieve the same goal, with neces
sary changes —JANA SAUKHYA (wellness
of the people).
19
While the organizational work was going
on, there was action on the other side. The
members discussed several possible prog
rammes and to start with, thought of School
Health programme in Wynad. Teachers and
parents from different schools were very posi
tive to the suggestions of the society. A for
mal meeting was convened on 20th August
1984 for a detailed planning. The meeting
came out with the following recommenda
tions :
Payyampally from 22nd to 24th March
1985. 26 teachers from 10 schools
participated the training session.
—
Study tour was conducted from 3rd
to 8th December '84 to School Health
Programme Kanghazha, Health 0'
Million Trivandrum and Kottar Social
Service Society.
—
District Medical Officer was contact
ed and we found them very co-opera
tive.
—
Field Publicity officer was contacted
and he promised to arrange film shows
in the schools. The themes will be re
lated to health and sanitation.
— Intensify contacts with schools.
—
Identity interested teachers for animat
ing the programme in each school.
— Conduct a session for the motivation
and training of these animators.
— Organize a study tour to MG DM Hos
pital Kanghazha where the school
health programme is successfully being
carried out since 1975, and to the well
known community health programmes
in Kerala.
— Select and train student health guides
so that they be in a position to guide
others when the programme is launch
ed.
— A training session was arranged for
student health guides at Pastoral Centre,
Nalloornadu from 28th May to 1st
June 1985. 41 students from 8 schools
participated in the training camp.
— A resource team is being organized.
The members of Jana Saukhya Manag
ing Board had several meetings and
they took part in the training sessions
and some also joined the study tour.
The Launching of the Programme
—
Contact public health department and
the officer incharge of School health
and plan a combined programme for
the school year 1985-86.
—
Prepare resource materials for the
students and teachers and also build
up a resource team.
According to the recommendations of the
meeting the following steps were taken :
—
Schools were contacted and interest
ed teachers were identified.
— A training session was arranged for the
teachers at St. Catherine's High School,
20
8 schools, out of 10 proposed, sent their
students for the orientation seminar. Teachers
brought the participants and a few stayed
throughout. During the planning exercise the
students planned programmes for their res
pective schools. There was a meeting of the
teacher animators, representatives of parent
teacher association and Jana Saukhya team
to finalise the planning, on 9th June 1985.
In this meeting the following decisions were
made:
— The programme shall be launched with
a formal inaguration in August where
the teachers and students participated
in the orientation seminar (8 schools).
Medical Service
— The school health committee shall dis
cuss and finalize the programmes for
each school.
(Though, the programme has common
features, the details need not be the
same in every school).
— During the Onam holidays there will be
a refresher seminar for teacher anima
tors and student health guides. Only
after that we will consider expanding
the programme to other schools.
The following programmes are suggested
for the schools during the year:
1. Sanitation Campaign : A latrine for
each house (at least a pitl atrine).
Cleanliness in class rooms and school
premises.
2. Herbal Garden : K garden of medicinal
plants for common diseases.
Film shows : With the collaboration
of the field publicity department, film
shows on health, sanitation and re
lated subjects will be conducted in the
schools.
4. Health day Celebration : A day shall
be set apart for public functions be
fore 31st January, 1986. The health
day celebration is an occasion to "take
health" to the community, through va
rious cultural programmes.
3.
Funds
We have been operating so far with the
donations from our friends and members and
also with the money borrowed. A grant of Rs.
51,698/25 has been given by CEB EMO.
As a rule, each school should find its own
resources for their programme. Jana Saukhya
will cover only the training and general ad
ministration. The programmes planned in
volves more human effort than money.
Personnel
Apart from the voluntary services of the
President, board members and resource team,
September 1985
two persons are working full time as Co
ordinator and field assistant of the programme.
So far, we could not get the services of a full
time public health nurse — there is a big de
mand for them. The Co-ordinator and the field
assistant had been working in the planning,
training, organizing the programmes and con
tacting different people and government offices
for the training mentioned above and for future
programmes.
Office
At present, the office of JANA SAUKHYA
and School health programme is functioning
at the President's residence. There is a dis
advantage that it is situated in the interior and
2 kms. away from the bus route, though the
parishioners had gladly allowed. We had been
looking for a place in Kalpetta, Dt. head quar
ters for reasons of accessibility and contact,
but so far could not find a room for a mode
rate rent. The search continues.
Future Plans
The Health co-operative had plans to adopt
community health programmes and to run a
people's pharmacy. But now these have been
shelved for the time being. We will concen
trate and intensify our work in School Health
and will expand the same next year. A few
schools are insisting to join this year itself,
but we may consider them only after Septem
ber. Posters, stickers reading materials etc.
are being prepared for the current programme.
We continue our contacts with interested
people and like-minded organizations which
promote health at the base level and empha
sise systems which benefit low income and
base level people such as Homeopathy, her
bal medicine, naturopathy. But, our most im
portant concentration is on building up a
strong base for JANA SAUKHYA itself, en
rolling and motivating more members.
Secretary, JANA SAUKHYA
21
Trained Dais in Rural Himachal Pradesh
—Renu Sobti
Thanks to the training they have received,
the Dais in Himachal Pradesh use aseptic
methods in delivery cases, advise mothers on
immunisation and family planning and help
the paramedical staff during family planning
camps and field.
In the context of the bleak socio-economic
milieu mothers and children in lower strata
and of certain regions are vulnerable to dis
ease, disability and premature death. Our high
Infant Mortality Rate i.e. 125 per thousand
population (Census 1981), is associated with
infection and malnutrition. In India a majority
of the deliveries are conducted at home mostly
by traditional dais who have learnt this art
through family tradition.
However, most of these traditional birth
attendents (dais) are illiterate and have little
knowledge about the antiseptic and other
precautions to be taken during and after birth.
Keeping this in view, to make the practice
aseptic and safe, a short-term scheme for
dais was launched under the New Health
Policy of the Government of India from Oc
tober, 1977.
The scheme, "One Month Dais Training"
is expected to provide at least one trained dai
in every village. The dais for training are select
ed by the village sarpanch and during training
they learn safe, aseptic methods of delivery,
recognise symptoms of complication, acquire
modern knowledge on nutrition and prenatal
and postnatal care. The training includes a
minimum of two deliveries to be conducted by
the dai under the guidance of Trainer. After
a period of 30 days’ training, the dais will be
22
given a stipend of Rs. 300/- and a maternity
kit each. Every dai will be entitled to a payment
of Rs. 2/- for registering a postnatal care and
Re. 1/- for registering and antenatal case.
Till recently, over 398,792 dais have been
trained. The 'idea is’ to train at least one dai
from every village with the ultimate objective
to train all practising dais in the country.
To ascertain the preference of the rural
community
for trained dais, the perfor
mance of trained dais, a study was conduct
ed in six PHCs, three each in the Districts of
Solan and Kangra in Himachal Pradesh. The
performance of randomly selected total 72
Dais, 36 trained (one month) and 36 untrain
ed dais was studied. From each PHC 6 trained
dais and 6 untrained dais, of which 3 trained
and 3 untrained dais from the vintages within
the distance of 5 km from PHC, rest from bebeyond 5 km or remote areas were selected.
1.
Personal Characteristics
Sixty per cent of dais were in the age group
of 40-50 years, while 15 per cent below 40
years and 25 years, and 25 per cent above 60
years of age. Eighty per cent of them had
annual income of less than Rs. 4000/-. About
15 per cent of the trained dais had less than 2
years of experience as a dai while the rest had
more than 10 years of experience.
2.
Selection of dais for training
According to rules dais for training are selec
ted by village sarpanch, but in the villages of
Solan and Kangra the recommendation of
dais for training was done by sarpanch and
interviewed by PHC's doctors, whereas some
Medical Service
of the names were forwarded by sarpanch to
medical officers who preferred very young
girls and divorced girls to old experienced
dais for the training. In most of the places it
was observed that training was given only to
achieve the targets (i) interest of dais regard
ing training was not considered, such dais
obviously did not perform their duties properly
after training, (ii) Moreover, at some places
dais with six months training got training once
again.
3.
Training of Dais
All the trained dais had undergone a uni
form pattern of one month training. The train
ing programme of dais was carried out at
PHCs as well as in sub-centres. The trainees
had received the stipend, midwifery kit while
training certificates were not issued at many
places after the completion of course.
other components of training. Thus, no diffe
rence was observed in the work of trained and
untrained dais in remote villages.
About 20 per cent of trained dais who were
working properly i.e. using aseptic methods,
advising mothers on immunization, family
planning etc. were very helpful to AN Ms and
LHVs during family planning camps and dur
ing their field visits.
Only 10 per cent of the trained dais were
advising mothers for proper intake of food
during the antenatal and postnatal phases.
None of the dais had any knowledge about
colostrum. About 25 per cent of the trained
dais were found to be very helpful in promot
ing the camps for immunization for children
and 20 per cent had been advising expectant
mothers on immunization and on collecting
iron with folic acid tablets from the Centres.
Family Planning
4.
Performance of Trained Dais
The trained dais were found to have gained
sufficient knowledge about aseptic measures,
anatomy of female reproductive organs, the
importance of immunization, prenatal and
postnatal care and family planning methods.
The performance of trained dais in compaigning for immunization, using aseptic methods,
helping AN Ms and LHUs during family plann
ing camps, was better in the villages around
PHCs and in sub-centre villages where the
ANM visits were regular and frequent. It was
found that about 70 per cent of sub-centres
were without any female worker. The reason:
no ANM would work in difficult and distant
subcentres. On the other hand, in the remote
areas, a majority of mothers preferred ANM
services to going to centres on the advice of
dais just because they wanted door-to-door
services. Trained dais felt no co-operation
from PHC staff and villagers, with the result
such trained dais stopped advising villagers
at all on immunization, family planning and
September 1985
Thirty percent of the trained dais were help
ful in motivating on family planning, accord
ing to them some villagers did not observe
family planning for the following reasons:
(i) They waited for a male child to be born;
(ii) Every child is a gift from God; (iii) Fear
of operation; (iv) Shyness in approaching the
centre; (v) Ignorance of family planning me
thods.
Since the kit is not regularly replenished,
the dais could only use scissors for all the deli
veries; at some places even scissors were not
available. In Himachal, both trained and un
trained dais were using scissors'. About 25
per cent trained dais used to cut the umblical
cord with sterilised scissors. At few places
sickle was used which was given to the dai
by the mother herself. Hence kit was not car
ried at the time of delivery. Honoraria was not
paid to any dai', a majority of the dais were
not even informed about the payment of Rs. 2/for registering the postnatal case and Re. 1/(Contd. P. 40)
23
LEGAL EDUCATION —14
Workers’ Rights
(Part II)
— P-D. Mathew
The Employment of Children Act. 1938
What is the purpose of the Act ?
This law was enacted to regulate the emp
loyment of children in certain industrial oc
cupations.
1.
Bidi - making
2.
Carpet weaving
3.
Cement manufacture including bagging
of cement
Occupations connected with:
4.
Cloth - printing, dyeing and weaving
— the transport of passengers, goods or
mails by railways; or
5.
Manufacture of matches, explosives and
fire-works
6.
Mica-cutting and splitting
7.
Shellac manufacture
8.
Soap manufacture
9.
Tanning
10.
Wool cleaning
What are the occupations in which child
ren below 15 are prohibited to work?
— cinder picking, clearing of an ash pit,
building operations on railway pre
mises; or
— the work in catering establishment at
a railway station; or
—
work relating to construction of a rail
way station, or with any other work
which is done in close proximity or
between the railway lines; or
— the port authority within the limits of
any port.
Note
* If children between 15 and 17 are emp
loyed in the above occupations, their
period of work must be adjusted in such
a way that they get at least 12 consecu
tive hours of rest between work periods.
24
Which are the processes in which child
ren below 15 cannot be employed or
permitted to work?
Dispute regarding the age of a child
If a dispute arises between the Inspector
and the employer regarding the age of a child
employed in a workshop, the matter must be
referred by the Inspector for decision to the
prescribed medical authority (Section 3C).
The duty of the Employer to maintain
register
If children below 17 are employed in occu
pations mentioned in Section 3, then the emp
loyer must maintain a register for inspection
by an Inspector.
Medical Service
This register must contain:
THE EQUAL REMUNERATION ACT, 1976
the name and date of birth of every What is the object of the Act
child under 17 years of age employed
or permitted to work;
This labour law was enacted to provide
payment of equal remuneration to men and
(b) the periods of work of any such child
women workers for the same work or work of
and the intervals of rest to which he is
similar nature and to prevent discrimination
entitled;
on the basis of sex, against women in matter
of employment.
(c) the nature of the work done by child:
(a)
(d)
other particulars prescribed by the
rules.
What are offences under the Act ?
(i)
Employing a child in occupations
prohibited under Section 3.
(ii) Not sending a notice to the Inspector
before carrying on work in certain pro
cesses mentioned in the Schedule.
(iii)
Failure to maintain a register or making
false entry in it.
This Act was enacted to give effect to
Article 39 of the Constitution which envisages
to give equal pay for equal work for both men
and women.
* "Remuneration" means the basic wage
or salary and any additional payment in
cash or in kind.
* "Same work or work of similar nature"
means responsibility required from a man
and woman are the same.
(v) Failure to display a notice containing
an abstract of sub-sections (1) and
(2) of Section 3 and 4.
Duty of the employer to pay equal re
muneration to men and women workers
for same work or work of similar nature
What is the punishment prescribed for the
above offences?
An employer must not discriminate on the
basis of sex, whle paying the workers for work
of a similar nature that is done (Section 4).
Simple imprisonment up to one month or
fine up to Rs. 500 or with both.
No discrimination may be made in recruit
ment on the basis of sex
Note
* Prosecution under this Act can be insti
tuted only by or with the previous sanc
tion of an Inspector.
Section 5 of the Act prohibits the employer
to discriminate against women, while recruting labourers for the same work or work of a
similar nature.
* Certificate of age granted by a qualified
medical practitioner will be conclusive
evidence regarding the age of a child.
Note
* A Court inferior to a Presidency Magis
trate or a Magistrate of the first class
cannot try any offence under the Act.
September 1985
* This Act does not affect those laws which
prohibit or restrict the employment of
women in certain occupations or estab
lishments of a hazardous natures.
25
days to a specified authority. The de
cisions of that authority will be final.
* Provisions of this Section do not affect
reservations for Scheduled Castes or
Scheduled Tribes, ex-servicemen, re
tired employees etc. in the matter of re
cruitment.
UNDER
AUTHORITIES
(1)
THE
ACT
Advisory Committees
* The Central or the State Governments
may constitute the Committees to advise
them.
* The Committee consist of ten nominated
persons by the Government of which
one-half should be women.
* Complaints and claims must be made in
triplicate in Form "A" and Form 'B' res
pectively.
(3)
Inspectors
The Government may appoint competent
persons as Inspectors to investigate whether
the employers comply with the provisions of
the Act and the Rules.
What are the offences and their penalties
under the Act ?
(a)
Failure of an employer to produce or
to maintain a register, muster roll or
other documents related to the emp
loyment of workers.
(b)
Refusal to give evidence or any infor
mation to the authorities mentioned in
the Act.
* The Government may make orders re
garding the employment of women
workers after considering the advice given
by the Advisory Committee.
(2) Officers
claims
to
hear
complaints
and
* The Government may appoint officers,
not below the rank of a labour Officer,
to hear and decide complaints with re
gard to the contravention of any pro
visions of this Act and claims regarding
the non-payment of wages at equal
rates.
Penalty for the above offences is a fine
up to Rs. 1000.
(c)
Discriminations in recruitment for the
same work or work of similar nature
on the ground of sex.
(d)
Not paying remuneration at equal rates
to men and women workers for the
same work or work of a similar nature.
(e)
Failure to carry out any direction made
by the Government under Section 6(5).
Penalty for the above offences is a fine
up to Rs. 5000.
Note
* The officer is given power of a Civil
Court for the purpose of taking evidence
and for enforcing attendance of witnesses
and compelling the production of docu
ments.
* After hearing both parties and making an
adequate enquiry regarding the claims
and complaints to give adequate direc
tions to the person concerned.
* Any employer or workmen aggrieved by
the order may make an appeal within 30
26
Note
* "Company" means any body corporate,
and includes a firm or other association
of individuals.
* Provisions of this Act regarding offences
by companies, cognizance and trial of
Medical Service
offences by courts (i.e. Section 11 and
12) will be same as in the case of the
Contract Labour (Regulations and Abo
lition) Act, 1970.
* Any special treatment accorded to wo
men in connection with the birth of a
child is not against the spirit or provisions
of the Act.
* Forms mentioned in the Acts are avail
able at a trade union office or with labour
welfare officers and Inspectors.
THE INTER - STATE MIGRANT WORK
MEN (REGULATION OF EMPLOYMENT
AND
CONDITIONS
OF
SERVICE)
ACT, 1979
The purpose of the Act
The system of the employment of inter
state migrant labour is an exploitative system
prevalent in Orissa (known as Dadan Labour)
and in some other States. In Orissa, Dadan
Labour is recruited from various parts of the
State through contractors or agents called
Sardars/Khatadars
for work outside the
State in large construction projects. InterState migrant workmen are generally illite
rate, unorganised and they are forced to work
under extremely adverse conditions. They
are exploited in several ways by the contrac
tors and their agents.
In view of their hardships and to secure
effective protection against their exploitation
the Central Government felt the need of legis
lative arrangements both in the State from
where they are recruited and also in the State
where they are engaged. Hence this legisla
tion was enacted in 1979 to regulate the
employment of inter-State migrant workmen
and to provide for their conditions of service.
Application of the Act
It applies:
September 1985
— to every establishment and every con
tractor, who employs or who employed
5 or more inter-State migrant work
men on any day of the preceding twelve
months.
Explanation
♦ "Inter-State migrant workman" means
any person who is recruited by or through
a contractor in one State under an agree
ment for employment in an establish
ment in another State,' whether with or
without the knowledge of the principal
employer.
* "Contractor" includes a sub-contractor,
Khatadar, Sardar, agent or any other
person, by whatever name called, who
recruits or employs workmen.
* "Workman" means any person employed
in or in connection with the work of an
establishment to do any skilled, semi
skilled, or unskilled, manual, supervisory,
technical, clerical work for Payment. It
does not include a person employed in a
• managerial or administrative capacity.
Registration of Establishment employ
ing inter-State migrant workmen
Legal provisions, regarding the registration
of establishments, stated in the Contract Labour
(Regulation and Abolition) Act, 1970 are
equally applicable to the registration of es
tablishments under this Act.
Without obtaining a certificate of registra
tion, no principal employer is allowed to emp
loy inter-State migrant workmen in his es
tablishment (Section 6).
A contractor cannot legally recruit workmen
in one State for the purpose of employing
him in any establishment situated in another
state without obtaining a valid licence from a
licensing officer.
27
What are the duties and obligations of a
contractor ?
The main duties of a contractor are:
(1) to furnish information within 15 days
regarding the recruitment of inter-State
migrant workmen to the specified au
thorities ;
(2)
similar to that of other workmen doing
similar work in the same establishment.
* In no case, would he be paid a wage less
than the wage fixed under the Minimum
Wages Act, 1948.
* His wage must be paid always in cash.
to issue to every inter-State migrant Displacement allowance
workman a pass book affixed with a
At the time of recruitment, the contractor
passport size photograph of the work
must pay to the workman displacement allo
man indicating in it the following:
wance equal to 50% of the monthly wages
payable to him or Rs. 75, whichever is higher.
— the name and place of the establish
This allowance is not refundable by the worker
ment where he is employed;
and it must be in addition to the wages or
— the period of employment;
other amount payable to him (Section 14).
— the rate and modes of payment of
wages;
Journey allowance
— the displacement allowance pay
able;
— the return fare payable to the work
man on the expiry of the period of
his employment;
— deductions made;
— other particulars as may be pres
cribed by the rules,
The Contractor is obliged to pay the work
men expenses of the journey to and from the
place of his residence to the place of work in
the other State. Besides, the workmen is en
titled to payment of wages during the period
of his journey as if he was on duty (Section
15).
Other facilities
to furnish information in a prescribed
Every contractor who employs inter-State
manner to the specified authorities re
migrant workers in an establishment has a
garding workmen who cease to be duty:
employed as inter-State migrant la
— to ensure regular payment of wages ;
bour. He must also send a decleration
— to give equal pay for equal work irres
to the specified authorities that all
pective of sex;
wages and other dues are payable to the
workmen and the fare for the return
— to ensure suitable conditions of work;
journey to their State have been paid,
— to provide protective clothing to the
(4) to maintain the pass book of the work
workmen;
man up-to-date.
— to report to the specified authorities
(3)
and close relatives of the workman
(Section 16).
Wages welfare and other facilities to be
provided to Inter-State migrant workmen
Wage rates and other conditions of service
* The wages and holidays, hours of work
and other conditions of service will be
28
Note
If the contractor fails to provide the above
facilities within the prescribed period, the
Medical Service
principal employer will be liable to provide the
same. The expenses incurred by the principal
employer for providing the facilities may be
recovered from the contractor (Section 18).
What is the responsibility of the principal
employer and the contractor with regard
to the payment of wages?
* Every contractor is responsible for pay
ment of wages to the workman. Wage
must be payed before the expiry of the
fixed period.
* Every principal employer must nominate
a representative to be present at the time
of payment of wages by the contractor.
It is the duty of the representative to cer
tify the amount paid as wages.
* It is the duty of the contractor to ensure
the payment of wages in the presence of
the authorised representative.
* In case the contractor fails to make pay
ment of wages within the prescribed
period, then the principal employer will
be liable to make payment of the wages
to the workmen. He is entitled to recover
the same amount from the contractor
(Section 17).
Is the workman liable to pay the debt
after the completion of his employment
under the contractor ?
* It is the duty of the principal employer
and the contractor to ensure that the loan
given to the workman does not remain
outstanding after the completion of the
period of his employment. The obliga
tion of a workman to repay any debt
obtained by him during the employment
is deemed to be extinguished at the comp
letion of the period of his work and ho
suit or proceeding will be entertained in
any court for the recovery of such debt.
September 1985
Offences and Penalties
1.
Obstructing the Inspector
Obstructing an Inspector from making any
inspection, examination, inquiry or investiga
tion in relation to the employment of inter
state migrant labour is an offence punishable
with imprisonment up to 2 years or with fine
up to Rs. 2000 or with both (Section 24(1).
2. Wilfully refusing to
ments
produce docu
Those who wilfully refuse to produce on
demand of an inspector or any other autho
rised person, any register or documents or
prevent any person from appearing before them
will be punished with imprisonment for a
term up to 2 years or with fine up to Rs. 2000
or with both (Section 24(2).
3. Contravention of the provisions of the
Act and the Rules
Those who act against any of the provisions
of the provisions of the Act or the rules may
be punished with imprisonment for a term
up to one year or with fine up to Rs. 1000 or
with both. If the offence is continued an addi
tional amount up to Rs. 100 per day will be
fined during the period of contravention (Sec
tion 25).
4.
Other offences
Offences which are not included in the
above categories and for which no other
penalty is elsewhere provided, will be punish
able with imprisonment for a term up to 2
years or with fine which may extend to
Rs 2000 or with both.
Note
Provisions of this Act regarding:
—
Offences by companies (Section 27),
29
— cognizance of offences by court (Sec
tion 28),
—
limitation of prosecution (Section 29),
—
power to exempt in special cases (Sec
tion 31),
—
protection of action taken under the
Act (Section 32),
are similar to those provisions explained
under the Contract Labour (Regulation
and Abolition) Act, 1970. See pages
16-17.
Does non-observance of the provisions
of these Acts violates the Fundamental
Rights of a workman?
In the Asiad workers' case (AIR 1982, SC
1473), the supreme Court held that non-obser
vance of the provisions of labour laws really
violated the Fundamental rights of the work
men. According to the judgement, employment
of children below 14 years in construction work
violates Article 24 of the Constitution, as cons
truction work is a hazardous employment.
Non-observance of the provisions of the
Equal Renumeration Act, 1976 which de
mands payment of equal wages to men and
women for work of similar nature, according
to the judgement, is in effect and substance a
breach of the principle of equality before the
law enshrined in Article 14 of the Constitu
tion. Similarly, not complying with the de
mands of the Contract labour (Regulation and
Aboliation) Act, 1970 and the inter-State
Migrant workmen (Regulation of Employment
and Conditions of Service) Act, 1979, which
requires a contractor to provide basic ameni
ties to the workmen, was violation of Article
21 of the Constitution.
Th,e Court also held that non-payment of
statutory minimum wages to workmen under
the Minimum Wages Act, 1948, violated the
Fundamental Right contained in Article 23
of the Constitution. This Article is clearly de
30
signed to protect the individual not only
against the State but also against other citi
zens who indulge in "traffic" in human be
ings and "beggar" and other forms of forced
labour. The Court held that these labour laws
are clearly intended to ensure basic human
dignity to the workmen and if they are depriv
ed of any of the rights and benefits to which
they are entitled under the provisions of this
welfare legislation that would be a violation
of the Article 21 of the Constitution.
Can service rendered for a wage less than
the statutory minimum wage be consi
dered as "forced labour"?
Article 23 of the Constitution prohibits any
form of forced labour. In the judgement on
Asiad worker's case the Court held that the
word "forced" must be construed to in
clude not only physical or legal force but also
force arising from the compulsion of socio
economic circumstances which leave no choice
or alternatives to a person in want and comp
els him to provide labour or service even
though the remuneration received for it is less
than the minimum wage. Hence, where a per
son provides labour or service to another for
remuneration which is less than the minimum
wage, it clearly falls within the concept of
"forced labour" under Article 23 of the Cons
titution.
What are the Constitutional means avail
able to a workman for the enforcement
of his Fundamental Rights?
If any of the rights of a workman given
under these labour laws are violated by a con
tractor or principal employer, the workman is
entitled to approach the High Court under
Article 226 or the Supreme Court under
Article 32 for the enforcement of his Funda
mental Rights and request the Court to make
appropriate orders for the enforcement of the
same.
Medical Service
Who are entitled to approach the Court
for the enforcement of the Fundamental
Rights of workers and members of other
weaker sections ?
Because of the prevailing socio-economic
conditions in the country, where there is con
siderable poverty, illiteracy and ignorance,
the Supreme Court has expanded the scope of
"locous standi" in litigation. Accordingly if a
legal right of an individual or class of person
is violated and if by reason of poverty or dis
ability they cannot approach the court for
judicial redress, any public spirited individual
or organisation acting bonafide (in good faith)
may move the Court even by addressing a
letter to the Court which will consider it as
a writ petition and take action on it. Matters
regarding the violation of the Fundamental
Rights of a class of poor citizens can be
brought to the attention of the Supreme Court
under Article 32 or to the High Court under
Article 226 by way of Public Interested Litiga
tion.
What is a Public Interest Litigation?
It is a new mode of litigation. It is brought
before the Court to promote the interest of the
poor and illiterate persons who are in a so
cially and economically disadvantaged posi
tion. It is essentially a co-operative or colla
borative effort on the part of the petitioner,
the State or public authority and the Court
to secure the observance of the Constitution
and legal rights and privileges conferred upon
the vulnerable sections of community and to
administer social justice to them.
Note
Issues like keeping of under-trials for years
in jails without trial, blinding of prisoners in
Bhagalpur, exploitation of workers employed
in Asiad projects, eviction of slum dwellers in
Madras, eviction of pavement dwellers in
Bombay, children in jails, mismanagement of
September 1985
the State Home for Women in Agra, banning
of harmful drugs, release and rehabilitation
of bonded labourers etc., were brought to the
Supreme Court under Article 32 as Public
Interest Litigation by varies voluntary orga
nisations and public spirited persons. At the
request of the Court this kind of litigation is
exempted from Court fees and petitioner is
given free legal aid by the Court to conduct the
litigation.
Has the Government any obligation to
enforce the labour laws and to safeguard
the rights of the weaker sections?
The Supreme Court judgement in the Asiad
workers case placed great responsibility on
the Government and its agencies for the en
forcement of various labour welfare provisions
of labour laws as in many cases they are the
principal employers. According to the judge
ment, the Government and its administrative
agencies as principal employers cannot escape
their obligations to the workmen to ensure
observance of these labour laws by the con
tractors and if these labour laws are not comp
lied with by the contractors, the workmen
would clearly have a cause of action against
the Government and its administrative agen
cies (Ref. to Sections 16,17, 18 and 19 of
the Contract Labour (Regulation and
*
Aboli
tion) Act, 1970, Sections 14, 15, 17 and 18
of the Inter-State Migrant (Regulation of
Employment and Conditions of Service) Act,
1979).
The judgement emphasised that whenever
any Fundamental Right which is enforceable
against a private individual is being violated,
it is the Constitutional obligation of the Go
vernment to take the necessary steps against
such violation and to ensure the observance of
the Fundamental Right by the private individual
who is transgressing the same. The responsi
bility of the Government becomes greater
especially when the person injured belongs
31
to the weaker sections of the community and
unable to wage a legal battle against the
strong and powerful who are exploiting them.
A Landmark Judgement for Social Justice
In connection with the organisation of
Asian Games (Asiad 1982) about on lakh
labourers from various States were employed
by the Union of India, Delhi Administration
and Delhi Development Authority for the cons
truction of various Asiad Projects. Most of
these labourers were working under contrac
tors. These illiterate and unorganised labou
rers were exploited by the contractors in
several ways.
They were not paid the statutory minimum
wages and working facilities were not provi
ded to them in accordance with the labour
laws treated above. To enforce their legal
rights and to ensure the observance of the
provisions of various labour laws, people's
Union for Democratic Rights (PUDR) has
brought the matter of their exploitation to the
attention of the Supreme Court by way of
Public Interest Litigation. At first this orga
nisation wrote a letter to Justice Bhagwati
regarding the exploitation of construction
labourers employed in Asiad Projects. This
Court has accepted the letter as a writ petition
and appointed 3 social scientists (Dr. Alfred
de Souza, Dr. Walter Fernandes of the Indian
Social Institute and Prof. Das Gupta of Peoples
Institute for Development and Training, Delhi)
as Ombudsmen (Commission) for the purpose
of investigating and inquiring into the condi
tions under which the workmen engaged in
various Asiad Projects were working. Weekly
reports based on the interviews of the work
men and contractors were submitted to the
court. The Writ Petition was argued by PUDR
(Petitioner) and Union of India, Delhi Admi
nistration and Delhi Development Authority
(Respondents). The judgement on this case
delivered by Justice P.N. Bhagawati and
Justice Baharul Islam on 18th Sep. 1982 is
considered a milestone in judicial history by
making justice available at the highest Court
level, to the weak, poor and the illiterate and
in expanding the ambit of the Fundamental
Rights and in providing unconventional means
to the weaker sections to enforce them.
For further information on Legal matters
contact:
Director, Legal Aid
Indian Social Institute
Lodi Road, New Delhi 110003.
Tel : 622379,
Gram : INSOCIN.
"WOMAN"
A Sound Slide Programme for
CONSCIENTIZATION
This AV Programme highlights the Problems of Indian Woman and the
Dignity of Womanhood
The commentary is made available in English, Hindi, Marathi, Kannada,
Telugu, Tamil and Malayalam on Tape.
The cost of the set is Rs. 476/If you are interested to have a set, write to us today
Director
Ishwani Communications
Pune 411 014
CHAI
NEWS
NOTES
Population Expert Attacks FP Policy Norins
Express News Service : Bangalore, May
24, 1985.
Prof. Ashish Bose, President of the Indian
Association for the Study of Publication, told
Express News Service in an exclusive inter
view here that India's policies on Family Plan
ning were slavish to western norms disregard
ing Indian values.
Earlier in his address to the Tenth annual
conference of the Association at Bangalore
also he had found fault with the present po
licy on Family Planning and raised questions
whether it was possible to divorce family plan
ning programmes from the broad social milieu
of the Indian masses with their values attached
to marriage, family and children.
He had told the conference that the western
norms had eroded the solidarity of the family
and weakened the institution of marriage.
He said that the one child model being
advocated in the West and China was "head
ing for a disaster and bound to fail". According
to him this sort of extreme population control
gave birth to a new set of social problems. "No
one can deny that low fertility will increase the
population of the age — a society loses all
dynamism if it has a zero population growth
because in a few years the nation will be fill
ed with old people with very few young ones
to offset the imbalance."
"Yet, in India we have been blindly follow
ing the western models and our family plann
ing programmes have been heavily influenced
by foreign funding agencies and foreign ex
perts of doubtful calibre", he observed.
September 1985
"To make matters worse it is our bureaucrats
and politicians who are coordinating with
these agencies and setting family targets for
our masses. All the target setting is done by
them in New Delhi — it is like distributing
cement and steel quota to industries!"
Prof. Bose who is extremely critical of the
bureaucratic stranglehold of what is actually a
"people's movement" feels that this one-way
communication must stop if family planning is
to become innovative in India.
"Women who play the central role in any
family planning movement have been totally
ignored. The women must take over from the
bureaucrats".
Prof. Bose advocated immediate decentra
lisation of all family planning programmes. "It
is ironical that while health is a state subject,
family planning is a Central subject. Every
district should be allowed to prepare its own
plan according to the needs of the area".
Coming down heavily on the area projects
launched by foreign agencies in 66 districts,
Prof. Bose said that these projects were solely
manned by beauraucrats, who more often than
not, have vested interest and were extremely
data oriented. "Sitting in Washington they
demand the baseline reports of the latest de
mography of India and for feat that the funds
may be discontinued. Our Indian officials,
spend 40 per cent of their time filling useless
proformas.
He wanted separation of the government
health programmes and the family planning
programmes to be ended.
33
The government's entire family planning
strategy has been dominated by sterilisation
programmes to control population growth, he
deplored.
"If you ask me why sterilisation — I'll say
because it is the easiest way out. But unfor
tunately the net result is, it has arrested quan
tity not quality. Most women who have been
sterilised are over 40 — even most of the men
are well past 60 and widowers — in short,
people who have passed the fertility stage".
The expert was also very critical of the in
centive policy for sterilisation. He pointed out
that there was a move in the present Govern
ment to give gold medals to FP workers who
motivated the highest number of sterilisation.
"I am warning the Government that if it takes
such a wrong step it willl be thrown out as
unceremoniously as Mrs. Gandhi's Govern
ment in 1977", he said.
He concluded : "Basically what I am try
ing to tell the Government in so many words
is keep out of family planning — because it is
the job of social reformers, — doctors and pri
marily of women's organisation".
—Courtesy - Indian Express
The three day seminar on health and deve
lopment was held at Jyothir Vikasa Kalennahalli from 2nd to 4th June 1985 was attend
ed by the fathers, brothers and sisters working
in Mandya region. The seminar was conduct
ed by CHAI, New Delhi under the auspices
of St. Thomas Mission Society Social Ser
vice Department. Fr. Thomas Therakam, Dr.
Antony, Dr. Vijay, Sr. Jayaseeli and Sr. Mariamma led the seminar.
The seminar began with the team members
and the participants introducing themselves
and their work. The participants then express
ed their expectations from the seminar. 'How
to begin working in a village, what should be
the style of involvement to be pursued, and
34
the question of tension within us' are some
of the areas where the participants asked for
clarifications and wanted discussions. With
regard to the procedure of the sessions it was
decided that equal importance be given to the
theoretical and practical side of various ques
tions. Concepts such as goal of our work,
basis of village work, role in braking the exist
ing social structures, relief work etc. are de
cided to be dealt with during the seminar. On
the other hand, health education, nutrition,
mother and child health care, facing the felt
needs of the village, the working of CHAI
are subjects on which practical knowledge was
sought.
Then a case study was taken up (Fr Ashok)
and the participants spliting into groups ana
lysed the case and found out the reasons for
the failure of Fr. Ashok in his undertakings
and thought about a right position to be pur
sued in any social welfare scheme.
The second day began with Sr. Innocent
introducing the medicinal value of herbs found
everywhere. Taking outside the classroom,
she demonstrated various herbs, identified
them and explained their medicinal value.
Though short, it aroused interest in participants
to know further on this matter.
Dr. Antony, then demonstrated a diarrhoea
patient, explained the symptoms of dehydra
tion and how a victim of diarrhoea could be
treated.
Health should be seen not as health care
only but it has to be viewed and studied in a
much wider perspective. Health is the total
well being of the individuals and families and
communities as a whole and not merely the
absence of sickness. So its social dimension
with all its implications are to be taken into
consideration.
WHO's call for health for all by 2000 A.D.
envisages a greater involvement of agencies
whether Government or non-governmental in
Medical Service
health education programme, especially among
knowing the people and their feelings are very
the rural population. One of the parameters
essential. This is possible by constant and re
to gauge the standard of health of a people in
gular contacts with the people as well as study
the rate of infant mortality. So health care of and observation. He also emphasized the need
expectant mothers and Infants are of para
for keeping various records to facilitate our
mount importance. They are the most vulne
work. He also said that any problem of a vil
rable group in the society and therefore needs lage has to be viewed in a wider perspective
extra care and attention. Giving various statis
and not in isolation.
tical datas about infant mortality Dr. Antony
The third day was mainly spent for planning
made it very clear that illiteracy is the root
the future programmes for the region. The
cause for an unhealthy community. So MCH
participants, basing on the guidelines given
programme should not merely be a CRS food
by
the directors drew up tentative programmes
distribution programme but rather it should
for
the future.
primarly and basically be an education prog
ramme, he said. So, the approach, planning,
The faith reflections basing the slide shows
methodology etc should have these aims in
and prayers during the Holy Mass helped the
view. Well prepared classes on health, suited
participants to imbibe more spirit and dyna
to the people, time, context etc. should be
mism in their missionary activities. The inter
come the main part of the MCH programme.
ventions and sharing of practical experiences
by Dr. Vijay, Sr. Jayaseeli and Sr. Mariamma
Only healthy mothers can be get healthy
also enriched the participants very much.
children. So, better food, immunisation etc.
are of great importance for the health of both
the mother and the child. Since diarrhoea is
one of the main causes for child death. Dr.
Antony in the next session elaborately explain
ed various remedies to tackle dehydration.
Sd/Director of Social Workers
St. Thomas Mission Society,
Mandya, Karnataka.
How to start a village programme? Dis
cussing this question Fr. Thomas said that
EMPLOYMENT
1.
WANTED an MBBS doctor for immediate appointment.
doctors may contact directly :
Interested
Sr. Mary Paschal DM
Sister Incharge
Carmel Matha Health Centre
Eleanganny P O, Vanapuram Via
N.A. Dist., T.N. 606 753
2.
An experienced surgeon presently working in a government hospital
would like to work in a Mission Hospital as a Surgeon in General or
Orthopaedic section or both.
Institutions interested to have his
services may contact directly :
Dr. B Das Gupta
A-1, Circular Road, Burnpur
West Bengal 713 325c0Mlvy
326. W
cell
H SlScfc? A R Y
*-^
KorarrUAg^l
560034
Bangs io^lodi.
.
',n
Mahidol University Honour for
WHO Regional Director
Fellow of the Royal College of Physicians,
Edinburg, U.K.
The Mahidol University in Bangkok, Thai
land, has awarded an honorary degree of Doc
tor of Public Health (honoris causa) to Dr
U Ko Ko, WHO Regional Director for SouthEast Asia. At an impressive
ceremony in
Bangkok on 11 July, the degree was conferr
ed by His Majesty the King of Thailand in
recognition of Dr Ko Ko's distinguished re
cord of service in the field of public health.
Dr U Ko Ko served the health services of his
country in various capacities including Di
rector of Disease Control, in the Ministry of
Health. He was also Professor of Preventive
and Social Medicine at the Institute of Medi
cine II in Rangoon.
In a citation read at the convocation cere
mony, Dr. Natth Bhamrapravti, Rector, Mahidol
University, referred to the services rendered
by Dr Ko Ko in his country, Burma, and also
his contributions to public health internatio
nally after joining the World Health Organiza
tion in 1969. Professor Natth specifically men
tioned the contributions of Dr Ko Ko towards
health development in Thailand, especially
with relation to health manpower develop
ment in Mahidol University and in the process
of the establishment of the ASEAN Training
Centre for Primary Health Care Development
(ATC/PHC) in Bangkok, as a leading centre
of expertise in PHC.
Dr. U Ko Ko, who has been WHO Regional
Director for South-East Asia since March 1981,
was earlier conferred an Award of Honour by
the Mahidol University for his outstanding
contributions towards the progress of the
University with special reference to the ATC/
PHC at Bangkok.
Dr U Ko Ko, having obtained his medical
degree from the Unversity of Rangoon, unidertook post-graduate training in Public Health
at the University of Edinburg and at the London
School of Hygiene and Tropical Medicine.
The Regional Director, who is the author of
a number of scientific and research publica
tions is also a Member of the Royal Society
of Health, London, an Honorary Fellow of the
Indian Academy of Medical Sciences and a
36
As a national officer. Dr U Ko Ko was a
member of the WHO Expert Advisory Panel
of Cholera. He represented his country at the
WHO Regional Committee for South-East
Asia and at the World Health Assembly. He
was elected Vice-President of the 22nd World
Health Assembly in 1968. He was also a mem
ber of the WHO Executive Board. Dr. U Ko Ko
joined WHO in 1969 and, after serving in posi
tions of increasing responsibilities, was ap
pointed Regional Director for South-East Asia
in 1981.
Courtesy - WHO
WCC's Castro Asks
operation on Health
for Co
GENEVA (EPS) — In remarks during the
38th World Health Assembly, World Council
of Chruches General Secretary Emilio Castro
questioned terms under which church and
other non-governmental organizations (NGOs)
co-operate with governments in internatio
nal health questions.
Speaking as part of a panel of NGO and
government representatives (10 May), Castro
observed that "governments are prepared to
accept co-operation from NGOs, but on their
own terms. Obviously, governments are res
ponsible for national welfare. But, is it right
to ask NGOs to collaborate without involving
them in decision making ?"
The WCC leader said that while "NGOs
can't carry out health work counter to govern
ment programs,.... they can ask to be heard
Medical Service
in the prior planning process". He said that
while many government health ministries were
eager to include NGO financial, technical, and
personnel resources in their national health
programmes, they expected NG Os to fit into
their plans without prior consultation on such
"major national choices".
On the other hand, he. added, "NGOs
may........ fear losing their identity when they
integrate into government programs".
Castro cited the 1982 WHO adoption of a
code on the worldwide marketing of breast
milk substitutes as a notable example of suc
cessful NGO/WHO
collaboration. He said
that as "independent forces", NGOs "can act
as mediators". As such, he said, they "should
be at the disposal of the international commu
nity."
The WCC Christian Medical Commission
has an official relationship with the World
Health Organization,
including semiannual
meetings of a CMC/WHO standing com
mittee.
Courtesy - CMC, Geneva
Seminar-Cum-Retreat
CHA organised three short courses with a
duration of one week each, for Sister Nurses,
Paramedicals and Hospital Administrators dur
ing the months of April-May (from 15th of
April to 9th May 1985) at Amarjyothi, Capu
chin Ashram, Kattappana, Idukki Dist, Kerala.
The speciality of these courses compared to
others, were that they all were Seminar-cumRetreats for the promotion of spiritual and
personal growth through clinical experience
and they were all subsidised with financial
assistance received from MISSIO, AACHEN.
As for the first course there were thirty two
participants while for the second and the third
September 1985
their numbers dropped to seventeen and four
teen respectively due to the practical difficulty
of releasing these personnel from many insti
tutions.
The evaluation sheets of the participants of
these three courses give clear indications with
regard to the following points:
The courses were highly appreciated by all
concerned. The various subjects and the ex
position of the same by the eminent professors
enlightened them on various issues, cleared
many doubts and misconceptions and creat
ed in them a sense of increased self awareness.
Many of them mentioned that the topics were
directly related to the apostolate of.thehealing
ministry and hospital administration and these
lectures have helped them to question as to
how they relate themselves to the sickly
bretheren in times of their suffering and death.
They were reminders of committed Christian
life and as such helped them in analysing the
priorities in the religious life. There were re
newed enthusiasm and life among the parti
cipants. Throughout the course a very spon
taneous, happy and prayerful atmosphere
prevailed which many of them have recorded
as "rare and wonderful experience" of the
seminar. All the participants were deeply tou
ched by the hospitality they received at Amar
jyothi Ashram. They were also greatly impress
ed by the Franciscan simplicity, the great con
cern for one another and above all by the in
dividual attention they received in the Ashram.
The natural beauty of the selected spot, the
pleasant climate, the comfortable accommo
dation, delicious food, trip to Thekkady—all
added to the beauty and charm of these cour
ses. All of them expressed their heartfelt grati
tude towards the convenor and Organiser:
Rev. Fr. John Vattamattom SVD and Direc
tor : Rev. Fr. (Dr) Felix Podimattom OFM
Cap for providing such beautiful courses and
expressed their desire to avail more of such
opportunities in the future.
37
Hospital Sunday Celebrations
1. St. Joseph's Cluny Hospital, Pondi
cherry
In the evening there was Eucharistic cele
bration and
homily on the theme by the
Bishop of Nellore for which there were large
gatherings. After the mass there were sweets
distribution and the needy were served with
meals. The celebration came to a dose by
8 p.m.
Around 5.30 p.m. on 17th March 1985 the
open space in front of the hospital was filled
to overflowing with patients, their relatives,
doctors and staff of the neighbouring hospi3. St. Joseph's Health Centre, Aniladv.
tals-about 200 in all for the hospital Sunday
S.A. Dt.
celebration based on the theme "Towards a
People Oriented Drug Policy". Followed by
It celebrated the hospital day with more
mass and a light refreshment, cultural prog
than 500 people irrespective of their age and
ramme saw on foot. Words of welcome and
education, on 29th March 1985. There was a
short talks on the theme followed. There was
Eucharistic celebration and homily on the theme
a short play presented exceptionally well by
"Towards a People Oriented Drug Policy"
the staff. It clearly brought home the message
by the Parish Priest, Fr. Louise. He emphasised
of mass exploitation by drug companies, the the need for bringing drugs within the reach
mistaken belief that more medicines means
of the poor and urged all the health care per
faster cure; shortage of eseential life saving
sonnel to have Christ like commitment in
drugs and the flooding of the markets with serving the poor. Followed by it there was a
tonics and vitamins; over prescription of gla
short entertainment programme and sweets
mourous and costly medicines by doctors;
distribution.
the drug companies influence to get the medi
cines pushed up through the doctors; the 4. Leonard Hospital, Batlagundu, Madurai
undue packing costs and the indiscriminate
A week before the celebration of hospital
rise in the prices of the medicines. The spec
Sunday, there was a get-together of all the
tators highly appreciated it and with the Na
tional Anthem, the evening function came to staff to decide as to how it should be conduct
ed. At this time there was a discussion on the
an end.
theme to point out the use and misuse of drugs
and the importance of practicing "naturopathy"
2. St. Joseph's Hospital, Nellore
as a "way of life". The group decided to have
With an exhibition open for all on the theme
a prayer service and some role plays for the
"Towards a People Oriented Drug Policy",
occasion. Accordingly, on 24th March 1985
it celebrated the hospital day on 30th March
a prayer service was conducted in the evening,
1985. Using charts and exhibits the common for which there was a great gathering. Then,
and communicable diseases, their treatment,
through a series of role plays — the need for
the drugs used, its dose, its effects, side effects
approaching hospitals at an early stage in the
etc. were explained to the people. The tutors
case of certain sicknesses; the need for im
munisation, the importance of personal and
spokp also on banned drugs, drug hazards,
preventive measures, preservation of health
alround cleanliness; necessity of adequate in
take of water; need for nutritious food; method
by nutritious food, hygienic living conditions
of treating the dehydrated; need for the for
and the responsibility of the health practitio
mation of good habits etc. were displayed. The
ners in prescribing medicines. The people
whole function was an eye-opener to many.
appreciated it very much.
38
Medical Service
5.
Holy
Cross
W. Bengal
Hospital,
Rajibpur,
The hospital tried to get all the personnel
of the catholic dispensaries of the diocese
for its celebration of hospital Sunday on 17th
March 1985. There were doctors, nurses,
priests, nuns and lay people. At the Eucharis
tic celebration Fr. Mario brought out beauti
fully tne works of the great physician — Jesus;
and his unlimted love for man. After this,
there was a seminar in which Dr. Edward
Jude, Medical Officer, Holy Cross Hospital,
spoke on the theme of the use and misuse
of drugs and the dangers involved in it. Fr.
Chellaswamy, Director, Adult Education,
spoke on the healing ministy in the Church.
Sr. Monica H.C. shared with the group her
experience and views, on Community Health.
Following, there was a discussion in which
all the nurses.and hospital staff of various dis
pensaries participated. The points of dis
cussion were:
1. To hold regular meetings of all dispen
saries of the diocese to share knowledge,
experience and solve difficulties.
which the parish priest spoke on the signi
ficance of the hospital day celebration. Fol
lowed by mass the. dispensary was blessed
and the patients were prayed over. There
were sweets distribution and a small enter
tainment programme. Finally, the meaning
of the theme "Towards a People Oriented
Drug Policy" was explained to the people and
they appreciated it.
7. St.
Ajmer
Francis
Hospital, Beawar Road,
The management, staff, students patients
and their relatives observed 17th of March
1985 as hospital Sunday on the theme "People
Oriented Drug Therapy". There were both
talks and role plays depicting the dangers in
volved in the drug misuse and in treating the
patients by non-qualified
pharmacists'
It
was appreciated by all.
8. Our Lady of
Basha, Raipur
Providence
Hospital,
It celebrated the hospital day on 17th
March 1985 with all the indoor patients. After
2. Purchasing of medicines in bulk or giving the aim and meaning of the celebra
from voluntary health associations to tion a 'Bhajan Service' was conducted. Fol
lowed by it a few of the healing scenes of
ensure cheap and quality medicines.
Jesus Christ were enacted by the Boar
3. To hold regular immunization prog
ders. People took part in it with much devo
rammes for the villages around the dis
tion.
pensaries and to contact the District
Headquarters for supplies.
9.
Ursuline
Dispensary, Khunti, Ranchi
After having informed the people about
the celebrations, 24th March 1985 was ob
served as the hospital day. Followed by mass
a talk was delivered on the theme by one of
the sister nurses, and then sweets were distri
Prem Seva Sadan, Cheruvumdaram, buted to the children.
Followed by a sumptous meal and small
entertainment programme and with the firm
decision of celebrating the hospital Sunday
every year the function came to an end.
6.
Khammam
The 24th March 1985, was a memorable
day in the history of this village as it never be
fore had a hospital Sunday celebration. There
was a grand Eucharistic celebration during
September 1985
10. Our Lady of Health Dispensary, Padrekudi, Ponbethi, Pudukkottai
The 17th of March 1985 was observed as
the hospital day around the theme "Respect
39
Life". There was a Eucharistic celebration
and then a fancy game to put the people at
ease with one another. Followed by it, there
were exhibitions, debates and film shows. All
these helped the people to realize the impor
tance of respect for life, the need for collec
tive action, importance of cleanliness etc.
Everything was planned and executed by the
people themselves.
(Contd. from P. 23)
for antenatal case. At a few other places many
formalities had to be done to get the money.
Many dais complained that the distance bet
ween the villages and centres was more. As
they were not getting any incentive, a majo
rity of trained dais did not show more interest
in registering the cases. Records of birth and
deaths were mainly maintained by chowkidars or AN Ms of those areas.
A majority of the dais were interested in
getting stipend of Rs. 300/-, maternity kit and
a certificate too; furthermore, some of them
wanted to be recognised in the area after the
training. A few other dais admitted that they
were richer by the training received than the
knowledge and skills they had.
Awareness and Popularity
A majority of the medical officers, health.
staff and sarpanchs were found to be aware
of the dais Training Programme but due inte
rest was not shown by most of the doctors.
As reported by doctors hardly one or two
meetings had been arranged by the higher
authorities regarding this scheme in three
40
years. They were mainly interested in bigger
programmes like malaria, family planning etc.
Villagers, however, were aware of the trained
dais; at many places only trained dais, where
they were working properly, were called for
deliveries rather than the untrained. People
felt that trained dais could do better work,
guide them properly for immunizatim, family
planning programmes etc. Now about 50 per
cent of untrained dais wanted to get trained in
the popular training programme.
On the other, hand, in the remote areas it
was found people had preference for expe
rienced dais trained or untrained.' It was also
observed that people had preference for old
and experienced untrained dais rather than
young trained dais..
It is hoped that trained dais are expected to
play a vital role in providing better mother and
child health care services, thereby reducing
the Infant Mortality Rate. Experienced dais
should be selected for the training as villagers
have preference for experienced dais rather
than young trained dais.
Courtesy—WELFARE
Medical Service
Catholic Hospitals in India —
Guidelines for the use of drugs and pharmaceuticals
Preamble: The Catholic Hospital Associ
ation of India and its member institutions
subscribe to the motto "The love of Christ
Compels Us". It is an urge to come to the
help of all people, wherever they are and
whatever their situation, treating them as
whole persons, following the example of
Jesus Christ. What the people need above
all is an understanding care as brothers and
sisters in Christ. We have to give love and
consolation, removing despair and ingorance.
The large majority of patients who need
or seek care or cure from the member-insti
tutions of CHAI suffer from infections, dise
ases due to undernutrition, lack of safe water
supply and sanitation, polluted environment,
wrong life styles, and lack of even elemen
tary health care facilities. The requirement
is adequate nutrition, safe drinking water,
better sanitation, protection of the enviro
nment, basic medical care and health educa
tion, adopting health-promoting life styles
and preventing disease. Our institutions
should provide primary health care and health
education, to all those who seek care; more
importantly, our institutions must get out to
where the people are and provide essential
health care, as Jesus went about healing and
teaching. In this effort to reach the unrea
ched, we should co-operate whole-heartedly
with those health workers and volunteers
in the field, helping them and, in turn,
taking their help (more to help than to be
helped). An intimate knowledge of the dy
namics of the society in which we live and
act is necessary to help our people attain and
maintain health.
There will be others who need further
treatment and management of specific disea
ses, requiring more specialised care. Many
of our institutions have the necessary faci
lities and can provide the needed diagnostic,
therapeutic; rehabilitative and preventive ser
vices. Depending on the available resources
our hospitals should provide such services,
after ensuring that primary health care needs
of the communities in which they function are
met.
Many of the problems which bring about
illness have social and economic bearings;
poverty, unemployment, illiteracy and other
similar factors contribute to sickness, and
death and a vicious cycle is created. Solu
tions to these major problems are difficult, take
time and require great efforts. They are mos
tly beyond the scope of the hospitals; yet,
health care services have an immediate and
effective role to play. This has many facets,
one of which (an important one) is the proper
and judicious use of drugs and pharmaceuti
cals, including those for cure, alleviation and
prevention.
The whole issue relating to the use of
drugs and pharmaceuticals should be rece
ived from the perspective of a health policy,
which gives the goals, priorities and the dire
ctions of our health care services. Advances
in Science and Technology have put into our
hands the means of preventing disease and
alleviating suffering. We must get the wisdom
and humility to use them properly for the bene
fit of humanity.
1. Policy: There is today, a welcome move
ment, both national and international,
towards a more rational drug policy. The
members of CHAI can be effective partners
■*
**
H
uTH CELSi
3^1. V Main. i Slock
®angalore-6^0034
in this wider movement. Every health
care institution or facility (hospital/dispensary/health centre) should frame its own
policy for the proper use of drugs and phar
maceuticals in the context of the pur
pose for which the facility was established.
The policy must be people oriented—for
the benefit of the individual, the family
and the community. It should prevent the
exploitation of the health care facility (and
through them, the people) by the drug
manufacturing firms, pushing their pro
ducts by all kinds of gimmicks, gifts and
temptations and the "hard sell" by thecompany representatives. The durg policy
should be evolved by the informed parti
cipation of all concerned in procuring,
prescribing and dispensing drugs. Such
informed decision will ensure commit
ment to the policy and long-term effecti
veness.
(777) Stores the drugs under appropriate
conditions so as to maintain
quality;
a. pre-packaging,
b. compounding, and
c.
dispensing,
adopting scientific, legal and ethical
principles;
(v) uses proper inventory control;
(v7) initiates and implements policies
for supply within the hospital;
(v77) wherever indicated and feasible,
undertakes the manufacture of pharma
ceutical formulations, such as intra
venous fluids, oral rehydration salts,
mixtures and ointments, following all
the rules and regulations and quality
controls;
(v777) arranges for the routine checking
and analysis of drugs; and
(/) identifies the drugs required for the
hospital or health centre considering
b.
potency, and
b.
(/V) arranges for
2. Pharmacy: Whether large or small, each
health care facility dispensing drugs should
have qualified pharmacist(s), who mana
ges the pharmacy efficiently, providing
service. The pharmacist
a.
a.
(/x) maintains the various registers, as
required by law and necessary for
information, follow-up and action.
efficacy
quality
Library: The pharmacy will have a small lib
rary of books, monographs, and leaf
d. economy, and
lets, dealing with professional, tec
e. availability; and places proposals
hnical, legal and other matters. The
before the drug and therapeutic
pharmacy will also subscribe for rele
committee for selection;
vant journals.
c.
safety
(77) Procures the selected drugs
2
a.
at minimum price,
b.
in the right form and quantity, and
c.
at the right time;
3.
Drugs and therapeutics Committee: It is
essential to have a drugs and therapeutics
committee. In its simplest form, in the
small hospital or health centre it would
consist of
(/) the administrator,
(c)
(77) the doctor,
new information about older products
already in use, which may help to
modify their use.
(7/7) the nurse, and
(/V) the pharmacist (secretary)
If there is a medical superintendent, he/she
will also be a member. Depending on the
size of the hospital, more members can be
added, without making it unwieldy. The
optimum number may be kept at 7; such a
committee will have
(7) the hospital administrator
(77) the medical superintendent
(777), (/V) doctors, by rotation
(v) nursing superintendent
(v7) an outside expert (clinical pharmacologist/pharmacist/stores manager)
The drugs and therapeutics committee shou
ld meet often in the initial stages and later on
less fequently (say, once in 3 months), There
will be requests for additions (in the light of
newer, more efficient drugs becoming available,
experience, changes in personnel and services)
and suggestions for deletions. The committee
should aim at keeping as small a number of
drugs and formulations as possible, without
sacrificing
efficiency; this will ensure
a reduction in stock and money tied-up as
also greater efficiency in management. The
drugs and therapeutics committee could
publish occasional newsletters or bulletins
for health personnel and public giving infor
mation regarding
(i)
developments in drugs and pharmaceuti
cals,
(ii)
medical and nursing implications in the
use of certain drugs and in specific situa
tions, and
(v77) Pharmacist (secretary)
In the larger hospitals, there can be two
committees :(1) therapeutics (2) Purchase.
The drugs and therapeutics committee will
have the following responsibilities:
(7) formulate the drug policy of the hospital
(77) prepare the drug list with details for the
hospital (formulary)
(iii) side-effects/hazards/contra-indications
about new and older drugs.
4.
Choice of drugs: The
depends on
choice of drugs
(i)
prevalent diseases and national pro
grammes,
(iv) monitor and review drug reactions,
using appropriate forms for report
(ii)
treatment facilities,
(iii)
available personnel, and
(v) disseminate information regarding
(iv)
financial resources.
(/77) review and update the list periodically
(a)
administrative and professional policies,
(b)
availability of new products and formu
lations, together with adequate data
regarding indications, adverse reac
tions, interactions and contra- indica
tions, and
The drugs selected should be efficient (effe
ctive with good cost-benefit ratio) and safe.
It is necessary to ensure quality. It ia a
fallacy to think that the more reputed firms
produce better quality drugs. Many of these
larger firms give contracts to small scale firms
3
names can lead to lower prices. To start
with, the list of essential drugs prepared
by WHO may be used as a basis (Technical
report series, 685). Many other lists are
available, e.g., Christian Medical Council
list; formulary of postgraduate Institute of
Medical Education and Research, Chandi
garh; Bangladesh, Sri Lanka and Tanzania
drug lists and so on. A list adapted from
the WHO list is given in Appendix, to be
modified to suit the requirements of a parti
cular health care facility. The drugs are
grouped into broad pharmacological and
therapeutic categories. All those who
prescribe medicines in the health care
facility should stick to the list; ordering
medicines outside the list should be done
only in exceptional cases. There should
be all relevant information (concise, acc
urate and comprehensive) available;
(loan licences) and the products will not have
any better quality. Quality control can be
achieved by
(i)
W.H.O. certification scheme regarding
the quality of pharmaceutical products on
the market
(ii)
Good manufacturing technology
(iii) product information, based on the basic
studies and clinical trials carried out by and
on behalf of the manufacturer, analysed
critically and
(iv) samples sent to an independent analy
tical laboratory.
It is also necessary to ensure stability and
bio-availability. The drug must have keeping
quality under the environmental (tempera
ture, humidity, etc) conditions. Bio-availabi
lity will be determined by, among others, the
fraction of the dose of the drug that enters the
systemic circulation. There can be differe
nces in the rate of dissolution or of solution
of the formulation and also in the rates or
completeness of absorption of the drug from
the gastro-intestinal tract. Added to this will
be factors like differences in peripheral utili
zation.
(i)
(ii)
International generic name
Pharmacological effect and mechanism
of action
(iii)
Clinical indications
(iv) Dose; duration of treatment; range for
children; dosing interval; special situa
tions such as renal, hepatic and cardiac
insuficiencies,
5. Drug list: The list should include all those
drugs required to satisfy the health care
(v) Contra-indications.
needs of the large majority of patients for
whom care (out patient or in-patient) is (iv) Precautions, especially in situations like
pregnancy, lactation, etc.
provided by the hospital. It should also
include drugs in common use required in
(vii) Adverse effects and drug interactions.
emergency. The drugs in the list should be
(viii) Effects of overdosage; therapy-general
available at all times in adequate amounts
and specific.
in the appropriate dosage forms. All drugs
listed will be in generic names. The cus
tom of usage of brand names has posed 5.1. Depending on the policy, traditional
medicines may be included in the list,
very high barriers to market penetration by
if the doctors are conversant with their
equally effective but cheaper drugs. The
use. Of importance are medicines in
expensive promotional activity of the manu
Ayurveda, Siddha, Unani and homeo
factures boosts up the cost of medicines.
pathy. Large scale production of AyuThe gretear utilization of generic drug
4
rvedic drugs is now undertaken by many
pharmacies in the country. Ayurvedic
medicines are prepared in the form of
distillates (arka), fermented prepara
tions (asava and arishta), linctus (avaleha),- incinerated
matter (bhasma),
powder (churna), ghee (ghrita), tablets
(vatigutika),decoction (kwatha) and others.
The siddha medicines use mercury, sul
phur, iron, copper, gold, arsenic and
other minerals as well as vegetable poi
sons; care must be exercised in their
use, particularly by those not trained in
their use. The Unani medicines consist
mainly
of herbal but also
in
clude animal, mineral and marine drugs,
used either singly or in the form of decoc
tions, infusions, tablets, powders, confe
ctions, syrups and aquas. In the case
of these drugs and pharmaceuticals belon
ging to the different systems of medicine
also, it is important to have all the rele
vant information as listed in 5(i) to (viii).
Simple home and herbal remedies could
be useful as also the non-drug therapies.
6.
7.
Procurement: Drugs may be obtained from
differnent sources; it is necessary to have
a procurement policy. Considerable savi
ngs can be effected by strategic purchase
policies. If there is a central purchasing
agency on a national, regional or diocesan
level, the drugs can be obtained at reduced
prices by bulk purchases and repacking in
smaller quantities for member institutions,
using effective but less costly containers.
The technical and legal implications must
be looked into. Another method is to
order in bulk for the requirements for a
whole year but to be supplied in small
quantities at stated intervals.
Meeting with representatives: The drug
committee should lay down a policy as
to when and how the representatives can
meet with the medical and pharmacy
personnel. This should be aimed at a
three-fpld objective:
(1) to get valid and reliable information about
new drugs and formulations,
(2) to avoid wastage of time, and
to reduce thp high pressure salesmans
hips with free samples and gifts for the. indi
viduals to influence their decisions. .
(3)
It would be better if the representatives meet
the hospital personnel in groups, so that
scientific and valid information can be given,
questions asked and clarifications obtained.
This would ensure that ineffective products
are not given to patients who could have
been treated better with more effective or
safer drugs or with no drugs at all.
8.
Storage: The drugs must be stored pro
perly. Those which require refrigeration
must be stored carefully in refrigerators
and the temperature of the refrigerator
checked every day. Schedule drugs must
be kept as required by law and proper
registers maintained. In hot climates,
the drugs can be kept cool by simple
methods.
Bin cards must be prepared; the cards
should give full details of date of order, price,
vendor's name, expected date of delivery,
quantity ordered, quantity received and ex
piry date. Drugs with expiry date must be
monitored carefully.
9.
Management: The purchase and distri
bution of the drug must be managed effici
ently with respect to the quantity stocked
(minimum and maximum), order quan
tity, lead time and ensuring continuity of
supply; there is need to prevent overstoc
king, maintaining the stock at the optimum
level, reviewing past records of requisi
tions and utilization and changes in services
5
and availability of drugs. "First-in, first
out" policy may be followed; this would
ensure that the drugs, even with short
shelf-life, move sufficiently quickly. Tra
ining should be given in proper materials
management.
(iii)
Has the patient been informed of the poss
ible adverse reactions ? This is particularly
important in the ambulant patients.
11.1 Poly-pharmacy (prescribing many drugs
for one disease) must be avoided.
With more rational, selective and discri
minating prescribing, combination drugs
10. Costing: There may be conflicting inter
are
on their way out. In Japan, very few
ests in costing the drugs-humanitarian and
of the new products are fixed-dose com
the need to have a 'margin' to meet the
binations, whereas in our country, there
expenses. The usual method is to mark
are
more and more of the fixed-dose
up the price above the purchase (whole
combinations. Polypharmacy indicates
sale or hospital) price by a certain percen
tage, keeping the final price (as given to the
patient) within the usual retailer's price. (i) lack of knowledge of the action of the
drugs,
This method may be given up and repla
ced by adding a fee-for-service to the cost;
(ii) inability to critically diagnose the condi
this would prevent the tendency to go for
tion and evaluate therapy
constlier medicines as they would give a
higher gross margin. The tendency, if it (iii) lack of confidence on the part of the pres
criber,
exists, of making a profit from drugs to
meet "other expenses" must be curbed,
(iv) exploitation by the drug industry, and
a possible alternative would be to charge
(v) gullibility of the public (especially with
for consultations.
respect to tonics, vitamins and other
nutritional formulations).
11. Prescribing: The following points must
be considered while prescribing;
The combinations are often irrational;
(i) Does the condition require a drug at all ? they lack flexibility; some of the components
Or, does the patient need advice? Sir may be unnecessary; and the drugs may even
William Osler, father of modern medical be incompitable.
practice said: "One of the first duties of
the physician is to educate the masses 12. What can CHAI do? There are a number
not to take medicine".
of measures which CHAI can do to help
in the optimal use of drugs and pharmace
uticals in the member institution.
(ii) Is the safest and simplest medicine be
ing prescribed for adequate duration and
no more? The doctor must balance safety 12.1. Procure the drugs at the minimum cost
by centralised purchasing in bulk pack
and efficacy against the hazards. It is
ing and distributing.
necessary to prevent iatrogenic diseases;
the simplest effective drugs with minimal
toxicity must be prescribed. Praticular 12.2. Manufacture a few of the items which
are commonly needed by the member
attention must be paid for the effects
hospitals, ensuring good manufacturing
on the unborn child, while prescribing for
procedure and quality control.
the pregnant woman.
6
Arrange for the checking of drugs 12.5. Keep member institutions informed of
(quality control) at the request of member
all related developments and publi
hospitals.
cations by organisations with similar
interests.
12.4. Publish a medical letter on rational drug
therapy, separately as a monthly letter 12.6. Identify resource persons or groups
who can be invited by member hospitals
or in the "Medical Service". This can
in their re-orientation programmes.
give all necessary information about
drugs, the bioequivalence, the dosage 12.7. Organise regional seminars and work
schedules, the indications, adverse reac
shops.
tions and contra-indications. The cost
benefit information should give the adve 12.8. Generate a list of acceptable and inter
changeable drugs for the small, medium
rse consequences of therapy (including
and large sized hospitals.
therapy-ralated morbidity and mortality)
12.9.
Arrange for periodical training progra
apart from the approximate cost per dose
mmes for the pharmacists and others
and the total treatment. It can have
in procurement and management of
thought provoking information sheets on
drugs and pharmaceuticals.
various aspects of drug policy.
12.3.
Appendix
1. Anaesthetics
1.1. General anaesthetics and oxygen
* ether, anaesthetic
halothane
nitrous oxide
inhalation
inhalation
inhalation
* oxygen
thiopental
inhalation (medicinal gas)
powder for injection, 0.5 g, 1.0g. (sodium
salt) in ampoule
* lidocaine
1.2 Local anaesthetics
injection, 1%2% (hydrochloride) in vial
injection, 1 % 2% + epinephrine 1:100,000
in vial
topical forms, 2-4% (hydrochloride)
2. Analgesics, Antipyretics, Nonsteroidal Antiinflammatory Drugs
2.1 Non-opioids
* aspirin
ibuprofen
indometacin
* paracetamol
tablet, 100-500 mg
tablet, 200 mg
tablet, 25 mg
tablet 100-500 mg
7
2.2 Opioid analgesics and antagonists
* morphine
injection, 10mg (sulfate or hydrochloride)
in 1 -ml ampoule
naloxone
injection, 0.4 mg (hydrochloride) in 1 ml
ampoule
* pethidine
injection, 50mg (hydrochloride) in 1 ml
ampoule
3. Antiallergics
* chlorphenamine
tablet, 4mg (maleate)
injection, 10 mg in 1 ml ampoule
* epinephrine
injection, 1 mg (as hydrochloride) in 1 ml
ampoule
cromoglicic acid
oral inhalation (cartridge) 20 mg (sodium
salt) per dose
4- Antidotes and other Substances used in Poisonings
4.1. General
* charcoal, activated
powder
* ipecacuanha
syrup, containing 0.14% ipecacuanha
alkaloids calculated as emetine
4.2 Specific
* atropine
injection, 1 mg (sulfate) in 1 ml ampoule
deferoxamine
injection, 500 mg (mesilate) in vial
dimercaprol
injection in oil, 50 mg/ml in 2 ml ampoule
naloxone
injection, 0.4 mg (hydrochloride) in 1 ml
ampoule
protamine sulfate
injection 10 mg/ml in 5 ml ampoule
sodium calcium edetate
injection, 200 mg/ml in 5 ml ampoule
sodium nitrite
injection, 30 mg/ml in 10 ml ampoule
sodium thiosulfate
injection, 250 mg/ml in 50 ml ampoule
5. Antiepileptics
* diazepam
ethosuximide
* phenobarbital
8
injection 5 mg/ml in 2 ml ampoule
tablet, 250 mg
tablet, 50 mg, 100 mg syrup, 15mg/5ml
tablet,
phenytoin
25
mg,
10Omg
(sodium
salt)
injection, 50 mg (sodium salt)/ml in 5 ml
vial
carbamazepine
K
valproic acid
tablet, 200 mg
tablet, 200 mg (sodium salt)
6. Antiinfective Drugs
6.1. Anthelmintic drugs
mebendazole
tablet, 100 mg
piperazine
tablet, 500 mg (citrate or adipate) elixir
or syrup (as citrate) equivalent to 500 mg
hydrate/5 ml
pyrantel
chewable tablet, 250 mg (as embonate)
oral suspension, 50 mg (as embonate)/
ml
tiabendazole
. chewable tablet, 500 mg
6.2 Antiamoebic drugs
‘ chloroquine
tablet, 200 mg (as phosphate or sulfate)
diloxanide
tablet, 500 mg (furoate)
metronidazole
tablet, 200-500 mg
dehydroemetine
injection, 60 mg (hydrochloride) in 1 ml
ampoule
6.3 Antibacterial drugs
6.3.1 Penicillins
ampicillin
capsule or tablet, 250 mg, 500 mg (anhy
drous) powder for oral suspension, 125
mg (anhydrous)/5 ml
powder for injection, 500 mg (as sodium
salt) in vial
benzathine benzylpenicillin
injection, 1.44 g benzylpenicillin (=2.4
million IU)/5 ml in vial
benzylpenicillin
powder for injection, 0
*6
g
(=1 million IU), 3.0 g (=5 million IU) (as
sodium or potassium salt) in vial
9
phenoxymethylpenicillin
tablet, 250 mg (as potassium salt)
powder for oral suspension 250 mg (as
potassium salt)/5 ml
* procaine benzylpenicillin
,
powder for injection, 1g (=1 million III),
3 g (=3 million IU)
6.3.2 Other antibacterial drugs
* chloramphenicol
capsule, 250 mg
powder for injection, 1 g (as
succinate) in vial
cioxacillin
sodium
capsule, 500 mg (as sodium salt)
powder for injection, 500 mg (as sodium
salt) in vial
doxycycline
capsule or tablet, 100 mg (as hydrochlo
ride) injection, 100 mg (as hydrochlo
ride)/5 ml in ampoule
erythromycin
capsule or tablet, 250 mg (as stearate or
ethylsuccinate)
oral suspension, 125 mg (as stearate or
ethylsuccinate)/5 ml
powder for injection, 500 mg (as lactobionate) in vial
gentamicin
injection, 10 mg, 40 mg (as sulfate)/ml in
2 ml vial
• metronidazole
tablet, 200-500 mg
injection, 500 mg in 100 ml
salazosulfapyridine
tablet, 500 mg
♦ sulfadimidine
tablet, 500 mg
oral suspension, 500 mg/5 ml
injection, 1 g (sodium salt) in 3 ml ampoule
♦ sulfamethozazole4-trimethoprim
tablet, 100 mg+20mg, 400 mg+80 mg
* tetracycline
capsule or tablet, 250 mg (hydrochloride)
6.3.3 Antileprosy drugs
clofazimine
♦ dapsone
* rifampicin
ethionamide
10
capsule, 100 mg
tablet, 50 mg, 100 mg
capsule or tablet, 150 mg, 300 mg
tablet, 125 mg, 250 mg
6.3.4 Antituberculosis drugs
* ethambutol
tablet, 100-500 mg (hydrochloride)
* isoniazid
tablet, 100-300 mg
* pyrazinomide
tablet, 500 mg
* rifampicin
capsule or tablet, 150 mg, 300 mg
* streptomycin
powder for injection, 1 g (as sulfate) in
vial
* thioacetazone+isoniazid
tablet, 50 mg4-100mg, 150 mg 4-300 mg
6.4 Antifilarial drugs
* diethylcarbamazine
tablet, 50 mg (citrate)
6.5 Antifungal drugs
amphotericin B
powder for injection, 50 mg in vial
* griseofulvin
tablet or capsule, 125 mg, 250 mg
nystatin
tablet, 500 000 IU
6.6 Antileishmaniasis drugs
* sodium stibogluconate
injection, 33%, equivalent to 10% antimony,
in 30 ml vial
6.7 Antimalarial drugs
* chloroquine
* primaquine
* quinine
* amodiaquine
sulfadoxine + pyrimethamine
tablet, 150 mg (as phospate or sulfate)
syrup, 50 mg (as phosphate or sulfate)/
5 ml
tablet, 7.5 mg, 15 mg (as phosphate)
tablet, 300 mg, (as bisulfate or sulfate)
injection, 300 mg (as dihydrochloride)/ml
in 2 ml ampoule
suspension, 150 mg (as hydrochloride)/
5 mi
tablet 500 mg+25 mg
7. Antimigraine Drugs
* ergotamine
tablet, 2 mg (as tartrate)
8. Antineoplastic and Immunosuppressive Drugs
azathioprine
bleomycin
tablet, 50 mg
powder for injection, 100 mg (as sodium
salt) in vial
powder for injection, 15 mg (as sulfate)
in vial)
11
busulfan
chlorambucil
cyclophosphamide
cytarabine
doxorubicin
fluorouracil
methotrexate
procarbazine
vincristine
tablet, 2 mg
tablet, 2 mg
tablet, 25 mg
powder for injection, 500 mg in vial
powder for injection, 100 mg in vial
powder for injection,
100 mg, 50 mg
(hydrochloride) in vial
injection, 50 mg/ml in 5 ml ampoule
tablet, 2.5 mg (as sodium salt)
injection, 50 mg (as sodium salt) in vial
capsule, 50 mg (as hydrochloride)
powder for injection, 1 mg, 5 mg (sulfate)
in vial
9. Antiparkinsonism Drugs
biperiden
levodopa
levodopa 4- carbidopa
tablet, 2 mg (hydrochloride)
tablet or capsule, 250 mg
tablet, 100 mg 4-10 mg, 250 mg 4-25 mg
10. Blood, Drugs affecting the
10.1 Antianaemia drugs
ferrous salt
folic acid
hydroxocobalamin
iron dextran
tablet, equivalent to 60 mg iron (as sulfate
or fumarate)
oral solution, equivalent to 15 mg
iron (as sulfate) in 0.6 ml
tablet, 1 mg
injection, 1 mg (as sodium salt) in 1 ml
ampoule
injection, 1 mg in 1 ml ampoule
injection, equivalent to 50 mg iron/ml in
2 ml ampoule
10.2 Anticoagulants and antagonists
heparin
phytomenadione
warfarin
injection, 1000 lU/ml, 5000 lU/ml 20 000
lU/ml in 1 ml ampoule
injection, 10 mg/ml in 5 ml ampoule
tablet, 5 mg (sodium salt)
11. Blood Products and Blood Substitutes
11.1 Plasma substitute
dextran 70
12
injectable solution, 6%
12. Cardiovascular Drugs
12.1 Antianginal drugs
* glyceryl trinitrate
* isosorbide dinitrate
' propranolol
verapamil
tablet, (sublingual) 0.5 mg
tablet, (sublingual) 5 mg
tablet, 10 mg, 40 mg (hydrochloride)
injection, 1 mg (hydrochloride) in 1 ml
ampoule
tablet, 40 mg, 80 mg (hydrochloride)
injection, 2.5 mg/ml (hydrochloride) in
2 ml ampoule
12.2 Antiarrhythmic drugs
isoprenaline
lidocaine
procainamide
propranolol
quinidine
tablet, 10 mg; 15 mg (hydrochloride or
sulfate)
injection, 20 mg (hydrochloride)/ml in
5 ml ampoule
tablet, 250 mg, 500 mg (hydrochloride)
injection, 100 mg (hydrochloride)/ml in
10 ml ampoule
tablet, 10 mg, 40 mg (hydrochloride)
injection, 1 mg (hydrochloride) in 1 ml
ampoule
tablet, 200 mg (sulfate)
12.3 Antihypertensive drugs
hydralazine
hydrochlorothiazide
propranolol
sodium nitroprusside
methyldopa
reserpine
tablet, 50 mg (hydrochloride)
tablet, 50 mg
tablet, 40 mg, 80 mg (hydrochloride)
powder for preparing infusion, 50 g in
ampoule
tablet, 250 mg
tablet, 0.1 mg, 0.25 mg
injection, 1 mg in 1 ml ampoule
12.4 Cardiac glycosides
digoxin
digitoxin
tablet, 0.0625 mg, 0,25 mg
oral solution, 0.05 mg/ml
injection, 0.25 mg/ml in 2 ml ampoule
tablet, 0.05 mg, 0.1 mg
oral solution, 1 mg/ml
injection, 0.2. mg in 1 ml ampoule
13
12.5 Drugs used in shock or anaphylaxis
injection, 40 mg
5 ml vial
dopamine
(hydrochloride)/ml in
injection, 1 mg (as hydrochloride) in 1 ml
ampoule
* epinephrine
13. Dermatological Drugs
13.1 Antifungal drugs
♦ benzoic acid4-salicylic acid; ointment or cream, 6% +3%
miconazole
ointment or cream, 2% (nitrate)
ointment or cream, 100,000 lU/g
nystatin
13.2 Antiinfective drugs
ointment, 5 mg neomycin sulfate4-500 IU
bacitracin zinc/g
neomycin-f-bacitracin
13.3 Antiinflammatory and antipruritic drugs
ointment or cream, 0.1 % (as valerate)
lotion
ointment or cream, 1 % (acetate)
* betamethasone
* calamine lotion
* hydrocortisone
13.4 Astringent drugs
solution, 13% for dilution
aluminium acetate
13.5 Keratoplastic and keratolytic agents
solution, topical 5%
* salicylic acid
13.6 Scabicides and pediculicides
lotion, 25%
cream or lotion, 1 %‘
* benzyl benzoate
* lindane
14. Diagnostic Agents
tuberculin, purified protein derivative (PPD)
injection
14.1 Ophthalmic drugs
fluorescein
eye drops, 1 % (sodium salt)
14.2 Rediocontrast media
adipiodone meglumine
barium sulfate
iopanoic acid
meglumine amidotrizoate
sodium amidotrizoate
14
injection, 25% in 20 ml vial
powder
tablet, 500 mg
injection, 60% in 20 ml ampoule
injection, 50% in 20 ml ampoule
15. Disinfectants
chlorhexidine
iodine
solution, 5% (gluconate) for dilution
solution, 2.5%
16. Diuretics
amiloride
furosemide
tablet, 5 mg (hydrochloride)
tablet, 40 mg
injection, 10 mg/ml in 2 ml ampoule
hydrochlorothiazide
mannitol
spironolactone
tablet, 50 mg
injectable solution, 10%, 20%
tablet, 25 mg
17. Gastrointestinal Drugs
17.1 Antacids and other antiulcer drugs
aluminium hydroxide
tablet, 500 mg
oral suspension, 320 mg/5 ml
cimetidine
tablet, 200 mg
injection, 200 mg in 2 ml ampoule
oral suspension, equivalent to 550 mg
magnesium oxide/10 ml
magnesium hydroxide
17.2 Antiemetic drugs
tablet, 10 mg, 25 mg (hydrochloride)
elixir or syrup, 5 mg (hydrochloride)/5ml
injection, 25 mg (hydrochloride)/ml in
2 ml ampoule
tablet, 10 mg (as hydrochloride)
promethazine
metoclopramide
17.3 Antihaemorrhoidal drugs
local anaesthetic,
astringent and anti-inflammatory drug
ointment or suppository
17.4 Antispasmodic drugs
tablet, 1 mg (sulfate)
injection, 1 mg (sulfate) in 1 ml ampoule
atropine
17.5 Cathartic drugs
senna
tablet, 7.5 mg (sennosides)
17.6 Diarrhoea, drugs used in
17.6.1 Antidiarrhoeal (symtomatic) drugs
codeine
tablet, 30 mg (phosphate)
15
17.6.2 Oral rehydration solution
* oral rehydration salts
sodium chloride
sodium bicarbonate
potassium chloride
glucose
g/litre
3.5
2.5
1.5
20.0
18. Hormones
18.1 Adrenal hormones and synthetic substitutes
* dexamethasone
tablet, 0.5 mg, 4 mg
injection, 4 mg (sodium phosphate) in
1 ml ampoule
powder for injection, 100 mg (as sodium
succinate) in vial
tablet, 5 mg
* hydrocortisone
* prednisolone
18.2 Androgens
testosterone
injection, 200 mg (enantate) in 1 ml
ampoule
injection, 25 mg (propionate) in 1 ml
ampoule
18.3 Estrogens
ethinylestradiol
tablet, 0.05 mg
18.4 Insulins and other antidiabetic agents
injection, 40 lU/ml in 10 ml vial, 80 IU/
ml in 10 ml vial
injection, 40 lU/ml in 10 ml vial, 80IU/ml
in 10 ml vial
tablet, 5 mg
* compound insulin zinc suspension
* insulin injection
* glibenclamide
18.5 Thyroid hormones and antithyroid drugs
* levothyroxine
* potassium iodide
tablet 0.05 mg, 0.1
* propylthiouracil
tablet, 50 mg
mg (sodium salt)
tablet, 60 mg
19. Immunologicals
19.1
anti-D immunoglobulin (human)
antirabies hyperimmune (serum)
* antivenom sera
16
Sera and immunoglobulins
injection, 0.25 mg/ml
injection, 1000 IU in 5 ml
ampoule
injection
All plasma fractions
should comply with
the WHO requirements
for the Collection, Pro-
* diphtheria antitoxin
immunoglobulin, human normal
* tetanus antitoxin
injection, 10,000 IU, 20,000 cessing
ant Quality
IU, in vial
Control of Human Blood
injection
and Blood Products
injection, 50,000 IU in vial
19.2 Vaccines
BCG vaccine (dried)
* diptheria- pertussis tetanus vaccine
* diphtheria-tetanus vaccine
* measles vaccine
* poliomyelitis vaccine
(live attenuated)
* tetanus vaccine
rabies vaccine
* typhoid vaccine
injection
injection
injection
injection
oral solution
injection
injection
injection
All vaccines
should
comply with the WHO
Requirements for
Biological Substances
20. Muscle Relaxants (peripherally acting) and Cholinesterase
inhibitors
neostigmine
gallamine
suxamethonium
tablet, 15 mg (bromide)
injection, 0.5 mg (metilsulfate) in 1 ml ampoule
injection, 40 mg (triethiodide)/ml in 2 ml ampoule
injection, 50 mg (chloride)/ml in 2 ml ampoule
21. Ophthalmological Preparations
21.1 Antiinfective
solution (eye drops), 1 %
eye ointment, 10% (sodium salt)
* silver nitrate
* sulfacetamide
solution (eye drops), 10% (sodium salt)
eye ointment, 1 % (hydrochloride)
♦ tetracycline
21.2 Antiinflammatory
eye ointment, 1 % (acetate)
* hydrocortisone
21.3 Local anaesthetics
solutuion (eyedrops), 0.5%(hydrochloride)
tetracaine
21.4 Miotics
solution (eye drops), 2%, 4% (hydrochl
oride or nitrate)
pilocarpine
21.5 Mydriatics
homatropine
solution (eye dorps), 2% (hydrobromide)
21.6 Systemic preparations
acetazolamide
tablet, 250 mg
17
22. Oxytocics
tablet, 0.2 mg (maleate)
injection, 0.2 mg (maleate) in 1 ml ampoule
injection, 10 IU in 1 ml ampoule
ergometrine
oxytocin
23. Peritoneal Dialysis Solution
intraperitoneal dialysis
solution (of appropriate composition)
parenteral solution
24. Psychotherapeutic Drugs
tablet, 25 mg (hydrochloride)
tablet, 10Omg (hydrochloride)
syrup, 25 mg (hydrochloride) 5 ml
injection, 25 mg (hydrochloride/ml in 2
ml ampoule
tablet, 5 mg
injection, 25 mg (decanoate or enantate)
in 1 ml ampoule
tablet, 2 mg
injection, 5 mg in 1 ml ampoule
capsule or tablet, 300 mg
amitrptyline
chlorpromazine
diazepam
fluphenazine
haloperidol
lithium carbonate
25. Respiratory Tract, Drugs Action on the
25.1 Antiasthmatic drugs
tablet, 200 mg
injection, 25 mg/ml in 10 ml ampoule
injection, 1 mg (as hydrochloride) in 1
ml ampoule
tablet, 4 mg (sulfate)
oral inhalation (aerosol), 0.1 mg per dose
syrup, 2 mg (sulfate)/5ml
oral inhalation (aerosol), 0.05 mg (dipro
pionate) per dose
oral inhalation (cartridge), 20 mg (sodium
salt) per dose
tablet, 30 mg (as hydrochloride)
elixir, 15 mg (as hydrochloride)/5 ml
injection, 50 mg (sulfate) in 1 ml ampoule
aminophylline
epinephrine
salbutamol
beclometasone
cromoglicic acid
ephedrine
25.2 Antitussives
codeine
18
tablet, 10 mg (phosphate)
26. Solutions Correcting Water, Electrolyte and Acid-base Dis
turbances
26.1
Oral
* oral rehydration salts x
(for glucose-salt solution)
potassium chloride
(for composition, see 17.6.2: Oral rehy
dration solution)
oral solution
26.2
Parenteral
♦ compound solution of sodium lactate
* glucose
* glucose with sodium chloride
Potassium chloride
* sodium bicarbonate
* sodium chloride
* water for injection
injectable solution
injectable solution, 5% isotonic, 50% hy
pertonic
injectable solution, 4% glucose, 0.18%
sodium chloride
(NA+ “30 mmo1/1, C1“30 mmo1/1)
injectable solution
injectable solution, 1.4% isotonic
(Na+167 mmo1/1, HC03-167 mmo1/1)
injectable solution, 0.9 % isotonic
(Na+ 154 mmo1/1, Cl”154 mmo1/1)
in 2 ml, 5 ml, 10 ml ampoules
27. Vitamins and M in era Is
* ascorbic acid
ergocalciferol
tablet, 50 mg
capsule or tablet, 1.25 mg (50,000 IU)
oral solution, 0.25 mg/ml (10,000 IU)
* nicotinamide
* pyridoxine
* retinol
tablet, 50 mg
tablet, 25 mg (hydrochloride)
capsule or tablet, 7.5 mg
(25,000 IU), 60 mg (200,000 IU); ora(
solution, 15 mg (50,000 IU)
* riboflavin
* thiamine
* calcium gluconate
tablet, 5 mg
tablet, 50 mg (hydrochloride)
injection, 100 mg/ml in 10 ml ampoule
Drugs and pharmaceuticals marked with (*) are suggested for health centres and smaller
hospitals. Where there is no doctor, the list will have to be shortened drastically to ensure safety.
Position: 2170 (10 views)