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RF_COM_H_64_SUDHA
Lay, Community' and Worker ‘Epidemiology’ - An Integrating
Strand in Participatory Research
Andrew Watterson
Introduction
Effective public health should be based on the World Health Organisation (WHO) principles
of‘upstream’ health interventions to prevent the development of avoidable diseases, rather
than focus on ‘downstream’ medical interventions to treat preventable diseases. The
achievement of such an approach should therefore rest on decision-making underpinned by
the precautionary principle.
The precautionary principle depends as much on informed social, economic and political
decision-making as it does on science and medicine. Indeed for the famous medical
practitioner, Rudolph Virchow, medicine was ‘applied politics’. Central to the approach is a
need to assess the purpose and impact of any developments that might impinge on health in
terms of environmental factors - be they personal, social or physical. In this context the first
step in protecting public health should be the prevention of approval of dangerous substances
or processes - be they in food, water, air, for domestic, leisure or workplace use. This should
be achieved through rigorous toxicology or other scientific and technological testing.
In this context ‘lay/worker/community’ activity for the good of the public health has a part to
play in the process of vetting substances, processes, materials, buildings, factories and other
types of plant and installations. We have witnessed globally the over-confidence of scientists,
regulators and politicians in the past when dealing with potential public health problems: their
inability to deal with uncertainty, their failure to take data gaps seriously when carrying out
risk assessments, their failure to go beyond very narrow risk assessments and skewed cost
benefit analyses which constantly favour capital over community and workers. Some
communities live with the consequences of the failure of such approaches daily - whether in
India and Pakistan, or Nigeria, China, the USA, the UK, Italy, Belarus, or Ukraine.
Lay/worker/community action on public health issues can highlight these failures and bring
important precautionary approaches to bear effectively on decision-making.
A case study - risk mapping on a grand scale
The Women’s Environment Network (WEN) breast cancer survey with local community
groups illustrates how communities themselves can explore possible health issues and look at
ways to promote health supported by NGOs (WEN 1999). Appendix A contains some of the
maps that the women developed. The UK has been top of the world league for several years
on deaths from breast cancer in women. Local community groups have found in the east of
England that they have some of the highest breast cancer mortality rates in the country,
especially for women in younger age groups. The official response was to ignore these facts.
The women themselves did not and organised a variety of means to investigate the problem
and raise awareness of the disease - and the fact that perhaps at best only 40 % of all cases of
the disease have established causes. They asked what role environmental factors could play in
the disease and why so little data were available about environmental exposures and
environmental risks related to breast cancer (Watterson 1995). The WEN breast cancer project
has provided a community based means for such factors to be explored that may complement
or possibly question some of the conventional tools used by epidemiologists.
These participator}' studies now draw on Geographical Information Systems (GIS) approaches
but their roots lie in the risk mapping activities of workers in a Fiat plant in Italy many years
ago. The maps so prepared of course rely on worker/community knowledge of processes and
procedures rather than managerial and ‘expert’ assessments that may sometimes reflect the
theory rather than the real practice of processes and chemical usage. Appendix B shows risk
maps prepared by Canadian factory workers.
WEN and other NGOs represent the prudent decision-makers, the precautionary principle
advocates in the public health field, although this is only part of what can be a polarised
picture on tackling environmental risks as Diagram 1 below reveals.
Diagram 1: Community environmental epidemiology and toxicology: models of
environmental policy and practice
Technological optimists
1.
-
"EXPERTIST"
(small pox
(asthma
(asbestos
(endocrine disrupters
( aluminium sulphate water pollution
( lead in petrol
( CFCs in fridges
2.
-
White coat syndrome.
Laws irrelevant.
No freedom of information.
"Paternalist".
Science and law-led and operationalised by politicians
"unholy alliance"?
No need to enforce laws as experts solve problems
paradoxically often a non-enforced model.
LEGAL
PARTICIPATIVE MODEL - non expertist
(uses community
(environmental
(toxicology.
-
Non jargomstic.
Community as partners in (epidemiology and
standard setting/vetting.
Minimum legal standards.
Right to information.
"Matemalist".
[Source: Costanza 1992; Watterson 1994a]
Prudent decision-makers
These different philosophies underpin the different approaches to risk and to epidemiology.
Prudent decision-makers who use lay epidemiology approaches are searching for public
health data showing there are no major risks associated with hazards: the burden of proof lies
with the manufacturer/govemment to show processes are ‘safe’. The approach is informed but
not dictated by science and scientific methods and recognises the limits of science. This is
‘the prove it’s safe’ position.
Technological optimists rely on the ‘scientific method’ and on the null hypothesis. They look
for evidence that a process or product is hazardous and with clear and calculated risks and
assume no hazard and no risk often when data are lacking or limited. This is ‘the prove it’s
dangerous’ position The next section deals with how lay epidemiology has developed and
how it engages with the technological optimists.
2
Origins of lay epidemiology’
To determine the nature of‘lay epidemiology’ it is first necessary to explore conventional
epidemiology a little. Epidemiology has been defined as:'The study of the distribution and determinants of health and disease related conditions
in populations. It is concerned with both epidemic (excess of normal expectancy) and
endemic ( always present) conditions ...The basic premise of epidemiology is that
disease is not randomly distributed across populations'.
(M Shenker in LaDou 1997)
Comprehensive epidemiology studies, if done on a large enough scale, over a long period of
time and with designs that exclude bias may prove very effective ways of assessing disease
causation in populations. This is, however, a very' expensive process. It is also fundamentally
limited because, although such studies may inform decisions - through exploring correlation
between exposures and diseases, though not identifying individual disease causes - on other
potential public health risks, they simply do not prevent diseases and disasters in the study
being undertaken. Effectively they close stable doors after horses have bolted or shut the cage
after the tiger has escaped. Toxicology and engineering are meant to be ‘secure stables and
cages’ - we know that they are not.
Like most professional groups, epidemiologists do not like to discuss their failures in public.
Some epidemiologists criticise commentators for using positive studies to dam materials and
processes and point out that such studies are often not capable of proving something is not
risky. However, such epidemiologists may be silent on the limitations of epidemiological
studies that show no risks from a hazard exist. This is called ‘negative epidemiology’.
Negative epidemiology
1 “The prevailing view" is usually subjective in science1 according to Hcmbcrg. Hence the
following basic problems sometimes occur in epidemiology to produce ‘negative’ results, but
such results are effectively inconclusive and do not prove processes and materials are safe.
Table 1: Limits of‘negative’ epidemiology
No studies carried out
Studies too small to have statistically significant results
Studies poorly designed and not sensitive
Problems with validity of control groups
Follow up periods insufficient for effects to materialise or materialise fully or follow up
incomplete
6. Accuracy of exposure data needed
7. Wrong exposure categories are studied
8. Exposure is too low and/or too short
9. Measures of morbidity are crude
10. There are random errors
11. Wrong or irrelevant morbidity indicators are used
(Source: based on Sven Hemberg 1992)
1.
2.
3.
4.
5.
The science of epidemiology, viewed as so critical to the development of‘academic’, rigorous
and high status public health medicine, has replaced clinical case studies as the most effective
and credible science for sorting out disease clusters. The view of clinical cases is generally
3
that they are statistically limited sources of information. However, non-epidemiological data,
linked to clinical cases or observations, have sometimes resulted in very effective actions. For
instance the links between exposures to soot and cancer came from Percival Potts’ clinical
observations and case reports in the late 18th century. The links between exposure to vinyl
chloride monomer and the rare liver cancer, angiosarcoma, came through primary care
physicians near a US chemical plant connecting clinical cases. The ‘Back to Sleep’ campaign
in the UK which cut ‘sudden infant death’ rates came from observational studies, not
conclusive physiological studies that could explain mechanisms of mortality (DOH 1998:61).
In the 1920s and 1930s, Sir Thomas Legge who was an early user of‘sentinel’ events to
trigger investigations of health hazards, ( Legge 1934:25-29) used observational data from
workers to identify hitherto relatively unknown risk. For instance, he visited a docks site
where the dockers themselves had linked work with a hard wood to ill-health cases in their
members.
Trade union identification of workplace hazards
Workers have always used observations, knowledge of‘sentinel’ events - sometimes single
warnings or one worker presenting with an unusual or hitherto unnoticed disease - and varied
data to make risk assessments of their workplaces and recognise occupational diseases.
sometimes well ahead of medical and scientific investigators in those workplaces. The table
below illustrates this clearly.
Table 2: Successful trade union recognition of occupational diseases
INVESTIGATOR
Alfred Greenwood, Glass Bottle
Makers Secretary 1891 using
social insurance records
Local woodworkers trade
union secretary observing
workforce 1900s
South Wales Dockers L'nion
secretary observed pitch dust
exposure of briquette w orkers
Sheffield Occupational Health
Project 1990
HAZARD
cataracts in glass workers
ACTION
1900s: compensation but no
action on the process.
Narcotic effects of African
boxwood through slowing heartbeat
Substitution with safer woods
as best available local exhaust
ventilation still created dust inhaled
by w’orkers
1927 finally recognised as an
industrial disease for briquette
workers
The project team found more
cases in one small Sheffield
factory than w'ere i ecorded for the
nation in official records
The centre revealed gross under
reporting of the disease
skin cancer known for
centuries in tar workers
chrome ulceration
Local unemployed centre in
mucous membrane disease in
Sunderland 1994
engineering worker
[Sources: Legge 1934. Watterson 1999]
Rapid appraisal
One approach that now encapsulates much of lay epidemiology is ‘rapid appraisal’.
‘Rapid appraisal is primarily a methodology which provides timely, relevant information to
decision-makers on pressing issues they face in project and programme setting (Kumar 1994
cited by Ong 1996:3). Hence it can be a diagnostic tool or an agent for change or both. It
does, however, not necessarily draw on communities in the appraisal as lay epidemiology
always would. Communities, whether geographic or workplace-based, should be public health
decision-makers as well as the politicians and scientists. The methods that rapid appraisals
deploy are very familiar to those engaged in lay epidemiology and might include a number of
elements.
4
Table 3: Elements of rapid appraisal
Mixtures: mapping matrices, focus groups, time lines and trend analysis and faster than
‘conventional methods’
1. Field work emphasis
2. Reliance on learning directly from local people
3. Semi-structured,.multi-disciplinary, flexible, innovative approaches
4. Focuses on ’insights, hypotheses, best bets rather than final truths or fixed
recommendations’
[Source: Ong 1996:2]
The key steps in the process would include those outlined below.
Step 1 defines purpose, identify target groups and agencies.
Step 2 identifies leader/team to conduct rapid appraisal.
Step 3 organises workshops.
Step 4 entails fieldwork, observation, secondary data collection, interviews.
Step 5 includes data collection and analysis.
Step 6 prioritises needs.
Step 7 feeds back to community and discusses possible actions.
Step S develop a programme of change.
Step 9 evaluates the work and, if necessary, redefine priorities.
Step 10 explores a second rapid appraisal or a view of future based on the first appraisal
(Ong 1996:9)
Participatory research
This draws on lay epidemiology and rapid appraisal techniques to involve communities
actively in the appraisals rather than simply being the passive subject of the appraisal. This
entails opening up the research process to ensure communities and workers can influence any
changes proposed as a result of the research undertaken.
Table 4: The benefits of participatory research
exposing unrecognised levels of disease
studying subjective symptoms in an effective way, for instance ME ,Chronic Fatigue
Syndrome (CFS), MCS, syndromes, ULDs, asthma, occupational stress
• low cost way of identifying a wide range of exposures to possible disease causes and
outcomes through interactive approaches able to deal with rapidly changing situations
• increasing capacity of communities and workers to involve themselves in public health
• recognising and using knowledge and experience of communities in identifying particular
health risks
• new approaches to conceptualising knowledge
• enhancing the potential for action outcomes from research findings and raising awareness
of policy-makers linked to an identification of key local concerns
(Source: adapted from Loewenson 1996)
•
•
Table 5 : Weaknesses of participatory research
•
•
aim to identify community perspectives may mean no precise quantification of a particular
problem occurs
may provide inaccurate perspectives although there is major difference between lay
perspectives and lay epidemiology eg malaria examples and CHLD work.
Lay epidemiology
6
This should be a major strand of participatory research although it is often neglected as it
sometimes appears too difficult to mount and potentially open to challenge by regulators and
scientists. The uses of the technique are many and various and do not simply relate to the
investigation of a health hazard and the scientific proof of correlations and causes of diseases.
They also contain important community, individual, political and social elements (Watterson
1994b, Popay and Williams 1994 and 1996).
Table 6: Benefits of lay epidemiology
•
•
•
•
•
•
•
Inform communities about public health problems and solutions
Involve communities in public health policy and monitoring of solutions
Sustain communities and individuals dealing with a common problem requiring
community solutions
Empower communities and individuals in an organisational and possibly social setting
Change attitudes, approaches, sources of data, possible solutions to public health problems
Educate professionals through lay groups about new or different public health
perspectives and vice versa
Campaign for positive change
Definition of lay epidemiology
'...the process by which lay persons gather statistics and other information and also direct
and marshal the knowledge and resources of experts in order to understand the epidemiology
of diseases.'
(Brown 1989)
Table 7: Principles of lay epidemiology - tools, mechanisms, techniques
These may include methods that:• appear ‘easy’ but are not in terms of data gathering
• sometimes observational - different types of data differently used
• generate similar data to that used by epidemiologists and toxicologists but perhaps more
comprehensive, more up to date, more relevant, more current, better informed .
• are qualitative - records and histories that may be used in conventional epidemiology but
given different weighting here. Problems exist already about recall, about job
categorisation and about location and length of exposure and exposure levels in
conventional epidemiology. Records of incidents, accounts of exposures, details of
suspected adverse effects may all be more richly documented in lay epidemiology than
some other sorts of epidemiological study.
The types of questionnaire that may be used in lay epidemiology studies are illustrated by the
Vinatex study (see Appendix C) where the ex-workers organised, planned and partially
implemented a study of workers exposed to PVC to try to track a range of health effects
possibly linked to workplace exposures to vinyl chloride monomer (VCM), a gas used to
make PVC. The workers themselves, in conjunction with an NGO, produced questionnaires,
conducted interviews and gathered data. The questionnaires were modelled on those used by
government departments and international agencies to protect the study from accusations of
using ‘subjective’ data gathering methods. The results were analysed by a university in
conjunction with the ex-workers group. The study has raised major questions about under
estimates of the ill effects of VCM exposure.
Data collection in lay, community and worker studies may also come in other forms, some of
which would be readily recognised and accepted by conventional epidemiologists. These
7
Forms of conventional and lay epidemiology
Lay epidemiology may come in several and sometimes hybrid forms and is sometimes totally
excluded from conventional epidemiology studies. For instance:1. Epidemiologists design, carry out, analyse and present the study.
2. Epidemiologists design, study and train and use lay staff to carry out survey.
3. Epidemiologists invite lay people to contribute to design of study protocol. Lay staff carry
out questionnaire surveys and interviews.
4. Epidemiologists analyse and present data.
5. Epidemiologists invite lay people to contribute to study design. Lay people carry out
surveys. Epidemiologists, with lay people, analyse and present results.
6. Lav people identify problem and invite epidemiologists to investigate the problem. Back
to(l).
7. Lay people identify problems, involve epidemiologists. Joint protocol is drawn up. Back
to (3) and (4).
8. Lay people identify problem, involve epidemiologists. Joint protocol. Lay people and
epidemiologists jointly investigate problem and analyse results. Joint presentation of
results.
The best approach is contained in number 7 above but this may also the most difficult to
achieve because of resistance, apathy or ignorance from health professionals. Compromises
along the way may need to be negotiated.
Ways forward
The benefits of lay, worker and community-led health studies are enormous. How can they be
introduced more widely and supported more clearly? The following approaches may help the
process. Strengthen the means available for social, economic or geographical communities to
participate and indeed initiate lay/community epidemiology and toxicology projects both on
suspect hazards and on industrial and other processes:
• by ensuring that 'no cost' freedom of information about disease and prevention are
available at community level.
• by ensuring easy access to such information.
• by creating information systems that disseminate information rather than restrict
information because communities do not know what information is available or are only
given information if they ask very specific questions.
• by re-educating health workers in community epidemiology principles and techniques.
• by incorporating the need to involve communities in the monitoring, review and audit of
pollutants into the new training of health and technical staff in public and private sectors.
• by all regional health authorities, trusts, local authorities, commercial bodies adopting the
WHO Charter on Environment and Health with a commitment to implement its principles
and practice (Appendix E). Public Health Medicine Departments in health authorities
around the country should have a key role in this process as should community health
councils.
• by central and local government and other funding agencies ensuring that lay/community
epidemiology is built in as a requirement for any research grants or programmes which
involve working on communities or health hazards affecting particular groups.
9
by the adoption of cleaner production and toxics reduction methods, again based on
community/worker input and audit on environmental hazards and the precautionary
principle.
References
Costanza R and Cornwell L (1992). The 4P Approach to dealing with Scientific Uncertainty.
Environment 34.
Department of Health (1998). ‘Quantification of the Effects of Air Pollution on Health in the
United Kingdom’. Committee on the Medical effects of Air Pollutants. HMSO, London.
LaDou J (ed) (1997). Occupational and Environmental Medicine. 2nd rev. ed. Appleton Lange,
California.
Legge T (1934). Industrial Maladies. Oxford University Press, Oxford.
Ong BN (1996). Rapid Appraisal and Health Policy. Chapman and Hall, London.
Popay J and Williams G (eds) (1994). Researching the People’s Health Routledge, London.
Popay J and Williams G (1996). Public Health Research and Lay Knowledge. Soc Sc Med
42:759-768.
Watterson AE (1994a). International attitudes to organophosphates. Farmers’ Ill-Health
and QP Sheep dips. Proceedings of the conference held on 26 March 1994 at Plymouth
Postgraduate Medical School, Plymouth, UK.
Watterson AE (1994b). Whither lay epidemiology in occupational and environmental
health? Journal of Public Health Medicine 16:270-274.
Watterson AE (1995). Breast Cancer and the Links with Environmental and Occupational
Carcinogens; Public health dilemmas and policies. Centre for Occupational and
Environmental Health, De Montfort University, Leicester.
Watterson AE (1999). “Why we still have ‘old’ epidemics and ‘endemics’ in occupational
health” in Daykin N and Doyal L. Health and Work: critical perspective.
Macmillan. Basingstokel07-126.
Women's Environmental Network (199) Putting Breast Cancer on the Map. 87 Worship
St. London EC2A 2BE, UK
10
CLo r'T vl - G
.
WE BHOPAL
©DSASTTW
AFTERMATH 8
an epidemiological
and socio-medical
survey
A summary of the report
medico
friend
circle
PREFACE
The Bhopal disaster has been an unprecedented;
occupational and environmental accident. Equally unprece
dented have been the imperatives for relief, rehabilitation
and research in the aftermath of the disaster.
The local situation has been extremely complicated and
dynamic. While health service providers and researchers
have had to face many medical challenges; government and
voluntary agencies involved in relief and rehabilitation have
had to face many logistical and organizational challenges.
For the medico friend circle too, in its intervention in
research and continuing education strategies in support
primarily of voluntary agencies, it has been both a challenge
and a thought provoking learning experience. The experie
nce of planning, organising, analysing and communicating
our research findings based on a modest study has brought
us further in touch with the apathy, vested interests and
status quo factors which obstruct action in favour of the
disadvantaged in society.
Having seen the intensity of health problems of the
disaster victims and the inadequacies in the strategies empl
oyed to ameliorate them we cannot but help raise critical
comments on all components of the social medical system
who are there to handle such problems.
Our objective, however, is more than critical analysis.
Through this epidemiological study we have tried to make
our own small contribution to a better understanding of the
health problems that prevail in the aftermath of the disaster.
We have also made suggestions for a more comprehensive
relief and rehabilitation strategy.
A word of caution here-most of our observations are of
the situation as it existed at the end of March 1985. Six
months have passed in the process of analysis, consensus
seeking and understanding our findings.
During these six
months, many further developments—both
positive
and
negative—have taken place in Bhopal at the governmental
and the non governmental initiative.
We hope that this report will atleast help to highlight
to our readers among other matters that—
(i)
what people
say and feel is as important
evidence
as whar we can discover through our over-mystified
medical technological approach;
(ii)
in the absence of a community
gical
perspective,
decision
oriented epidemiolo
making
about
relief
efforts following a disaster can be adhoc and often
irrelevant; and
(iii)
for research to be relevant to the lives of the people, the
findingsand inferences drawn must be communicated
to the health service providers and the patients them
selves through an effective communication strategy.
Finally we hope that through this report, we
shall
stimulate debate, dialogue and a commitment to a deeper
understanding of the problem leading to more relevant and
meaningful interventions.
Bangalore
Ravi Narayan
2 Oct. 1985
Convenor
THE BHOPAL DISASTER:
ITS AFTERMATH
Introduction
The disaster that took place on the dark, wintry night of
2/3 December 1984 in Bhopal is the worst man made envir
onmental accident in recorded history.
The shocking,
official estimates of 1754 human deaths, an equal number
of dead cattle and the physical and mental disablement of
over two lakhs people, by a mixture of toxic gases includ
ing Methyl Isocyanate (MIC), do not adequately express the
tragedy that has occurred.
The relief efforts, initiated immediately, were handi
capped and hampered by the lack of authentic information
on the nature of the gases released, by the unwillingness
of the Union Carbide to release information and by lack of
relevant information among the State and Central authori
ties.
The doctors at the Hamidia Hospital, Bhopal, where
hundreds of the victims rushed, were faced with an acute
emergency which they never anticipated, of whose exact
nature they had no inkling, and for the treatment of which
they had no ready sources of information.
Since the nature of the toxic gases released into the
atmosphere had not been made public either by the Union
Carbide or by the Centre (which sent high level technical
experts to Bhopal), this had to be a conjecture based on
reason and visible evidence.
Soon, two theories emerged to account for the varied
symptomatology and stunning mortality of the victims. The
development and testing of these theories, had they been
done properly, would undoubtedly have added immensely
to scientific knowledge. What is more important is that it
would have relieved the sufferings of thousands of people.
The local realities have, however, revealed the power stru
2
ggles in the medical community and how it ignores in the
process, the victims; the lack of human concern leading to
withholding of probable proper treatment; the indifference
of our medical and scientific community to communicate
with our largely illiterate but not unintelligent masses.
The Two Theories
The protagonists of the first theory, the ‘Pulmonary the
ory' believe that isocyanates of which MIC is one, damages
only those tissues with which they come into direct contact
and cannot be carried by the blood to internal tissuesand
organs. Thus MIC can damage only the lungs, eyes and skin
and this according to them explains the predominant invo
lvement of the eyes and lungs in the Bhopal victims. They
also believe that symptoms, if any, related to other systems
must be due to hypoxia caused as a result of lung damageThis theory is strongly supported by a dominant section in
the Gandhi Medical College and the medical community in
Bhopal. They believe that early deaths were due to carbon
monoxide poisoning - one of the constituents of the rel
eased gases. They refuse to accept any alternative theory.
This theory cannot fully explain the varied symptoms of
the victims: nor the fact of multi-systemic involvement with
out lung involvement seen in many patients. While another
isocyanate, toulene diisocyanate (TDI) has been shown
to cause brain damage, the protagonists of the present
theory are silent as to why MIC cannot do so, too. Public
Health specialists in the U. S. say that this exposure can
lead to permanent lung involvement and blindness. This is
in contrast to the Union Carbide which maintains that MIC
can have no lasting damaging effects.
The main protagonist of the second theory, the ‘Enlarg
ed Cyanogen Pool theory', is the Indian Council of Medical
Research (ICMR). In fairness to this body, it must be stat
ed at the very outset that it does not reject the first theory
3
but believes that both have important roles to play in
explaining the varied symptomatology.
This theory stemmed from the observation that the
tissues and blood of the dead victims were bright red in
colour. This occurs both in cyanide and carbon monoxide
poisoning. Haematological (blood) studies by ICMR ruled
out the possibilities of carbon - monoxide poisoning.
Cyanide on the other hand might have been inhaled
directly as hydrogen cyanide or might have been released
in the body after the breakdown of the MIC molecule.
Normally, there is a small cyanogen pool in the body
formed by the generation of small amounts of cyanide 01
cyanogenic substance during normal metabolic processes.
These cyanide or cyanogenic radicals are converted into
relatively harmless thiocyanates by a liver enzyme called
rhodanase and excreted in the urine. Certain foods like
cabbage etc., and smoking are known to increase the
cyanogen pool as evidenced by an increased excretion of
thiocyanates in the urine. Cyanide/cyanogen interferes
with oxygen utilization in the body.
The protagonists of the enlarged cyanogen pool theory
have established that MIC in the body gets attached to the
haemoglobin by a process of carbamylation. They believe
that by a mechanism as yet unknown the cyanogen pool
within the body is increased. In these circumstances, its con
version to thiocyanate by rhodanase, can be accelerated by
administration of sodium thiosulphate (NTS). This is the
rationale in using NTS as an antidote for cyanide poisoning.
The resultant thiocyanates are excreted in urine, and this
can be used to test the proposed theory itself.
The ICMR conducted a double blind clinical trial using
sodium thiosulphate and glucose as a placebo on gas affect
ed patients in January. Majority of patients who received
NTS showed significant improvement and 10 out of the 19
4
patients showed an eight fold increase in urinary thiocyanate
levels. Those who received glucose did not show significant
changes. Unfortunately, and due to reasons best known to
itself, the ICMR has not made the details of the findings of
this crucial trial, public. The opponents of the theory too
have conducted a trial-not double blind, which they say
does not confirm the hypothesis. They too have withheld
their findings from public scrutiny.
The Study by mfc
The mfc had decided at its annual meet held at the end
of January 1985, to respond to a series of appeals from
various non-governmental organizations(NGOs)and citizen's
forums to undertake an epidemiological investigation, so as
to support the victims and the NGOs in their struggle for
proper relief and a more meaningful rehabilitation process.
Some members of mfc visited Bhopal in mid-February to
assess the situation and the actual epidemiological survey
was conducted between 18-25 March 1985 by 11 members
of mfc and 3 friends from the Baroda Medical College.
It must be admitted that the mfc had neither the human
power nor the material resources to launch a full scale in
vestigation. Our initial, fact finding survey revealed :
(i)
official secrecy regarding
disaster;
(ii)
absence of open scientific debates;
(iii)
lack of encouragement to NGOs.
The mfc therefore decided to;
(i)
make an epidemiological assessment of the current
health status and health problems of the people;
(ii)
to examine the findings in the light of the two contro
versial theories;
(iii)
to evolve a critique of the medical reasearch and relief
programme;
all
information
on
the
5
(iv)
to make recommendations for a more meaningful relief
and rehabilitation policy.
The ICMR summaries of research undertaken and press
releases available to us were inadequate and sketchy. We
decided that we would go primarily by the broad range of
symptomatology with which the patients in the community
were presenting. We supplemented this by a thorough physi
cal examination and undertook haemoglobin estimationsand
lung function tests. A criticism against this approach of reli
ance mainly on symptoms could be that it lacks objectivity.
However, we believe that a thorough study of symptoms is
a perfectly valid method of study as has been accepted in a
whole range of medical conditions like chronic bronchitis,
ischaemic heart disease, arthritis etc.
The study population
The study was a community based, case/control study.
Two slums were selected for the study: (i) J P Nagar
situated in the close vicinity of the Union Carbide factory
and the worst affected by the gas leak, (ii) Anna Nagar 10 km
away with the least exposure, which served as the control.
There was no area which was similar to JP Nagar in socio
economic and environmental characteristics and yet escaped
exposure and, therefore, Anna Nagar with the least exposure
was the best control that could be chosen.
Rapport was established with the people by explaining
to them our objectives and making it very explicit that we
were not there to offer any financial compensation, medical
treatment etc. The slum dwellers were given a hand out in
Hindi explaining the role of mfc and a commitment was made
that the salient findings of our study and our recommenda
tions would be made available to them.
Sample Selection
The families for study were selected by random
sampling, an accepted statistical method used in community
6
based studies. Only subjects above 10 years of age were
selected. Those less than ten years were excluded in view
of their probable inability to report symptoms correctly. All
details were entered in a pre-designed proforma. In addition,
lung function tests were done by standard procedures
using a portable spirometer by a doctor fully familiar with
measuring these under field conditions.
Observations
The two slum populations were similar in age and sex
composition, in the number of smokers and of people with
'ong
standing
respiratory
problems
like asthma,
tuberculosis etc. The JP Nagar residents who were the more
affected, were slightly better off economically but this is of
no significance in so far as morbidity rates in JP Nagar are
concerned. (For details of actual figures, see our Report.)
An unexpected finding was that people as far away as
Anna Nagar (our control population) were minimally exposed
and we observed a larger number of serious symptoms in
this group than one would expect. This fact narrows down
the differences in rates of symptoms observed between the
two populations. The health impact of the toxic gases on
the exposed population is therefo e much greater than what
our study reveals.
The subjects described a broad range of symptoms aris
ing from most of the different systems in the body. Each
symptom was described in such graphic detail that it was
obviously based on the patient's own experience and could
not be malingering or wild imaginations as some are apt to
allege. Since these symptoms could arise due to different
causes and since the residents of Anna Nagar, the controls,
were also exposed to the gas, albeit to a small extent, the
latter also reported those symptoms. However, JP Nagar
residents had a much higher (statistically highly significant)
incidence of these symptoms compared to Anna Nagar.
7
The commonest symptom was breathlessness on accu
stomed exertion. The following symptoms were highly
significantly different (higher) in J P Nagaras compared to
Anna Nagar: cough with expectoration, chest pain, blurred
vision, photophobia, headache, fatigue, loss of memory
for recent events, weakness in exremities, muscle ache, ab
dominal pain, nausea, and anxiety/depression (see table).
The following six symptoms were also significantly different:
dry cough, breathlessness at rest, watering of eyes, skin
problems, bleeding tendency, and impotence. On grouping
the symptoms according to the systems, most of them are
related to the pulmonary system (respiratory), the gastro
intestinal system (digestive), the eye and the central nervous
system. It is important to note that this survey was cond
ucted more than three months after the disaster, and the
victims still continued to suffer so many multisystemic sym
ptoms. Moreover every individual in the J P Nagar sample
reported atleast one serious symptom but many in the Anna
Nagar sample did not report any such. Probably the most
crucial finding of significance was that 35% of the patients
had gastro-intestinaI. centra! nervous system and eye symp
toms in the absence of any lung findings. This cannot be
explained by the theory that the multisystemic symptoms are
due to hypoxia (decrease of oxygen in blood stream) secon
dary to lung damage. It points to the possibility of a cir
culating toxin in the blood, affecting all the systems.
Our findings also refute the speculation that much of
the present morbidity is due to a high prevalence of chronic
diseases like tuberculosis, asthma, bronchitis etc., and high
rates of smoking among the affected basti population.
Women in the reproductive age group reported menstrual
irregularities such as shortened menstrual cycles, altered
pattern of discharge, pain during menstruation and excessive
white discharge. These symptoms were compared not only
between the two populations, but also with respect to the
Salient Findings of the Study
Comparison of symptoms/investigations in J P Nagar and Anna Nagar
(expressed in percentage) (No. of cases are shown in brackets)
SI No
Symptom
J P Nagar
1.
2.
3.
Breathless on usual exertion
Chest painztightness
Weakness in extremities
87.16
50. 0
65.54
4.
5.
Fatigue
Anorexia
81.08
66.21
6.
7.
8.
9.
10.
11.
Nausea
58.10
53.37
68.91
77.02
42. 0
45.27
54.72
66.89
72.97
43.92
8.10
14.68
12. 7
12.
13.
Abdominal pain
Flatulence
Blurred vision/photophobia
Abnormal distant vision
Loss of memory for recent events
Tingling & Numbness
Headache
14. * Muscleache
15. Anxiety/depression
16.
17.
18.
Impotence
Haemoglobin (male) (mean gm%)
Haemoglobin (female) (mean gm%)
Standard deviations of means
Anna Nagar
P Value
(129)
(74)
35.50
26.08
(49) ' << 0.001
<36) <<0.001
(97)
(120)
(98)
36.95
39.85
28.26
(51)
(55)
(86)
16.66
(79)
(102)
(67)
25.39
25.36
38.40
21.88
11.59
(81)
(99)
(108)
20.28
42.02
36.23
(28)
(58)
<<0.001
<<0.001
(50)
<< 0.001
(65)
10.14
(14)
(12)
(1.79)*
0.72
12.70
(1.46J*
10.79
(114)
(65/141)
(39)
(23)
(35)
(35)
(53)
(21/96)
(16)
<<0.001
<< 0.001
<<0.001
<<0.001
<< 0.001
<<0.001
<<0.001
< 0.001
<<0.001
<<0.001
(01)
< 0. 05
(1.35)*
< 0. 01
(1.34)*
< 0.001
9
pattern in the same group before the gas disaster and the
difference was found to be stastistically significant.
Nearly half of the nursing mothers in J P Nagar reported
a decrease or complete failure of lactation.
8% of the men reported impotence.
The number of pregnant women in the sample is too
small to come to any conclusion about the effect of the
exposure on the outcome of pregnancy. We are conducting
a detailed study of pregnancy outcome in September 1985.
Many residents had symptoms of anxiety, and some had
frank depression. Many had loss of memory for recent
events.
Mean pulse rates and respiratory rates were not signifi
cantly different in both sexes in JP Nagar and Anna Nagar.
Mean haemoglobin concentrations in both males and femal
es were significantly higher in JP Nagar than in Anna
Nagar, suggesting that compensatory mechanisms in the
body had begun to respond to the hypoxia.
The mean values of lung function tests were statistically
significantly lower in JP Nagar as compared to Anna Nagar
particularly in the age group 15-44 and 45-60 in both sexes.
The pattern was primarily restrictive.
An important finding of grave significance is that 65°/„
of the working persons in JP Nagar experienced a drop
in income ranging from 20°/o to100°/o as opposed to only 9°/o
in Anna Nagar. This reflects the way in which the physical/
mental disability of the people caused by the disaster has
affected their
working
and
earning
capacities.
The causative factor
The presence of such varied symptoms suggests the
involvement of more organs and body systems than the
lungs alone. These cannot be explained by the pulmonary
10
theory alone even though pulmonary lesions can cause
peripheral hypoxia and hence muscular fatigue and so on.
On the other hand, the enlarged cyanogen pool theory can
better explain the varied and apparently unconnected
symptomatology. It must be emphasised that both theories
are probably playing a role in the causation of symptoms.
However, the ICMR has not tested the cyanogen pool hypo
thesis rigourously. It has studied only the seriously ill,
hospitalized patients and concentrated mainly on the lung
symptoms. They do not say whether the non-pulmonary
symptoms (symptoms not related to lungs) were also reliev
ed by sodium thiosulfate and curiously has not made its
findings public. One therefore, may also question whether
the cyanogen pool theory is fully valid.
It must be stressed here that the mfc is not rejecting
the cyanogen pool theory. It is only to point out that the
country's main medical research pody has failed to be
rigorously scientific in testing its own hypothesis.
Sodium thiosulphate therapy
We have already explained how sodium thiosulphate
(NTS) will help remove cyanide radicals from the body.
If the enlarged cyanogen pool theory has been established,
even as one of two causative factors the victims should rec
eive NTS treatment. Some of the local doctors and beaurocrats availed themselves of this, after the cyanide theory
was proposed, yet the affected people in the bastis were
not given the drug.
The ICMR at a meeting held on on 4 Feb 85, issued
guidelines for NTS treatment. The medical group of Bhopal
which was opposing the treatment, was also present at the
meetings, according to the minutes. Yet they opposed the
treatment later with the argument that they are not convinc
ed of its efficacy. The question is not of a doctor's convict
ion. A doctor's choice of treatment cannot be arbitrary. The
11
question is whether there is scientific evidence in favour
of NTS therapy and whether there is equally strong, if
not stronger, evidence against the use of NTS in this
situation.
NTS with its specific action is a better therapeutic agent
than the non-specific remedies that are being used for the
lung symptoms. A dominant section of the doctors of Bhopal
are thus guilty of delaying treatment and by not revealing
the findings of its clinical trial, the ICMR too has to accept
part of the blame for the continuing suffering of the victims.
After a few weeks of controversy the NTS therapy has
now been accepted but mass detoxification is still being
strongly opposed.
The trial with NTS is not the only study launched by
the ICMR. It has sponsored many other studies on the
Bhopal victims, but they lack an integrated approach. Thus
lungs, eyes etc., are being examined independent of each
other, by different investigators and the ICMR is unwitti
ngly lending support to the first theory, namely, that MIC
gas damages only tissues with which it comes into dirrect
contact.
What exactly happened to the gas victims?
So many months after the disastrous gas leak, one still
does not know what exactly has happened to those who in
haled the gases and are still surv:ving. This is not because
all attempts to unravel the mystery have failed but because
an integrated approach has not been taken 10 do so. Months
after the disaster, thousands of the survivors are still suffe
ring from debilitating symptoms which prevent them from
going back to work.
The medical community and the officialdom have been
adhoc in their efforts to render adequate succour to these
hapless victims. A powerful medical lobby in Bhopal have
opposed sodium thiosulfate, a treatment, with good potential
12
to the patients. They have no convincing argument for
their stand. The IMA, (Indian Medical Association) the
organisation which has authority over the medical profess
ion, has remained totally mute. The doctors as well as the
ICMR have concentrated entirely on those who were hosp
italised and have not evolved a holistic, community approach
to understanding the problem. The ICMR sponsored local
studies with exception of the NTS trials have lacked the
rigour and the epidemiological orientation that are neccessary in arriving at a meaningful understanding of the
problem.
A point of utmost significance is that the victims of
the Bhopal gas disaster mostly belong to the lowest strata of
society and are not in a position to fight for their rights, be
it medical aid or monetary compensation. It is, therefore,
not very surprising that the government and its organi
sations have shown marginal interest in the after effects.
It also reveals a lack of interest among our scientific
community
in investigating an environmental disaster
of an unprecedented nature. On the other hand, one
can observe the striking contrast with which al| attempts
were made to retrieve the Black Box of Kanishka, whose
mid-air explosion resulted in the death of only 326 persons
but needless to remind of the upper socio-economic class.
Recommendations
Research
1.
The research and follow up studies should shift focus
from hospital/dispensary based studies of seriously ill
patients
to
family/community based ambulatory
patients.
2.
Well designed clinical trials should be further initiated
using sodium thiosulphate
as a
therapeutic
and
epidemiological tool to further establish the signifi
cant could role it could play in mass therapy.
13
Care, Surveillance and Rehabilitation
3.
Psychosocial assessment and consequent counselling
and rehabilitation are urgently required.
4.
Mass treatment with sodium thiosulphate based on
ICMR guidelines should be initiated maintaining good
medical records.
5
A surveillance programme should be undertaken to
assess risks to pregnant mothers, unborn babies and
new born babies. There should also be close monitor
ing of the gynaecological problems of women.
6.
It is necessary to have a long term surveillance of
lung function in view of the postulated damage to
lungs and resultant lung fibrosis. Similarly, eyes
should be examined regularly.
A comprehensive listing of all gas disaster victims is a
long overdue task necessary for mass treatment, co
mpensation and rehabilitation. This must be done
immediately.
7
Communication
8.
There is urgent need to evolve a continuing education
strategy for all health personnel including doctors
working in both government and non-governmental
centres. These could be through newsletters, hand
outs and informal group meetings.
The areas identified are:
(i) sodium thiosulphate therapy;
(ii) identification and management of psycho-social
stress;
(iii) risks to mothers and unborn foetus and need
for surveillance;
(iv) family planning advice till completion of detoxi
fication;
(v) role of respiratory physiotherapy;
(vi) management of lactation failure;
(vii) caution against overdrugging;
14
need for open minded surveillance cf high risk
groups;
(ix) importance of medical records.
(viii)
9.
There is also urgent need for dynamic creative nonformal health education of the affected community
through group meetings, posters and pamphlets with
information and messages built around their life style,
culture
and existing
socio-economic situation.
The areas identified are :
sodium thiosulphate therapy;
ongoing research programmes
and informed
consent;
(iii) risk to unborn and new born babies;
(iv) family planning advice;
(v) respiratory physiotherapy;
(vi) management of lactation failure including low
cost weaning foods;
(vii) importance of records and regular check ups;
(i)
(ii)
10.
Occupational rehabilitation and compensation: In
the ultimate analysis care of illness, health education,
psychosocial counselling would be inadequate mea
sures if they were not backed by adequate monetary
compensation and urgent occupational rehabilitation of
the disaster
victims. This would
have to be
imaginatively done-keeping their previous occupations
and the residual disabilities in mind.
Coordination
11.
The government machinery alone cannot handle such
a massive task. The government must adopt a policy
of enlisting the help of all non-governmental agencies
and groups wishing to work in Bhopal. This enlistment
must be active and supportive.
and finally
12.
It is imperative that the victims as well as the entire
country must be provided with all the details of how
the accident occurred, of the nature of the chemicals
released and of the reasons why the detoxification by
sodium thiosulphate has been so badly mismanaged.
medico friend circle
The medico friend circle (mfc) is a circle of friends with
medical /non-medical backgrounds who share the common
conviction that the present system of health services and
medical education is lopsided
in the interest of the
privileged few and must be changed to serve the interests of
the large majority, the poor, mfc fosters a 'thought current':
upholding human values, people and community orientation
of health care and medical education, demystification of
medical science and a commitment to the guidance of
medical interventions by peoples' needs and not commercial
interests.
mfc offers a forum for dialogue/debate, sharing of experience
and experiments with the aim of realising the goals
outlined above, and for taking up issues of common
concern for action.
For further
contact--
details
Ashvin Patel
ARCH
21 Nirman Society
A Ikapuri
Vadodara 390005
regarding mfc BHOPAL STUDY
OR
Anil Patel
ARCH
Mangro! (At & P.O.)
Via Ra jp ip la
Dist Bharuch
Gujarat 393 150
(A detailed report of the study including background,
objectives, materials and methods, observations and results,
discussion, recommendations, important appendices includ
ing proformas and references and reading list is also availalable on request from the mfc organizational office
326 V Main I Block Koramangala Bangalore 560034
Price Rs. 8. 00)
So mw-
V
mm&P
mines,minerals
PEOPLE
—I
_
I
Our Land, Our Minerals,
S Our Rights
♦ Mining in India
The problem o’f mining is manifold.
The destruction of the preexisting habitat
for the mining industry undermines the
possibility of any other Tise of the other
resources of the area.
The Mining
Iwustry is wide spread and severe
adverse impacts are visible from small
scale rat hole mining and stone quarrying
to large open cast and deep underground
mines.
The social and political implications of
mining assumes far reaching implications
when this principle mineral wealth lies in
the most forested regions and those
homelands traditionally inhabited by.
Dalit and Indigenous Peoples.
In the wake of the current globalization
and liberalization programs, dictated to
us by the International Monetary Fund
and the World Bank, in the form of
Stnjctural Adjustment Programs, large
n^P tracts of land are proposed to be
acquired for mining with MNC's.
Mineral extraction today is dictated by
the market forces and cartels controlling
the price according to the profitability...
rather than for the benefit of society or a
community.
Thus a good number of minerals go to
the war industry, or to enhance the
powers of the powerful through strategic
control. Besides this natural resources of
the poorer countries are being over used
with rampant environmental destruction,
while the same resources of the rich
countries are being safely preserved for
their future generations.
•
•
•
•
•
Challenges ahead....
•
♦ mines,minerals&
PEOPLE:
•
•
An Emerging Alliance
mm&P(mines, minerals& PEOPLE) is a
growing
alliance
of
individuals,
institutions and communities who are
concerned and affected by mining.The
isolated struggles of different groups
have led us to form into broad a national
alliance for combating the destructive
nature of mining.
mm&P members at present are
• more than 100 grass-roots groups,
• About 20 diverse support
organizations,
• Across 16 States.
/
With the purpose of...
•
•
Supporting local struggles.
Legal and media advocacy,
_
Information, documentation, research
and fact finding,
Developing campaign strategies,
Skill share, Jatras, Exchanges,
National and International
networking,
Technical and Scientific Expertise.
•
•
•
•
To bring a uniform and balanced
mineral policy
Protection of rights of indigenous
communities,
Fight for people’s control over
mineral resources,
Stress for minimum mining,
Explore better sustainable
alternatives to mining,
Resist environment destruction,
Monitor global and Indian mining
industries.
Of Choices......
•
I
•
Mining should be the last resort for
the use of land. Before resorting to
mining, comparable usability of
resources from existing sources, i.e.
recycling and storage dumps should
be made,
There is much greater wealth for
human kind above these minerals.
•
.
One species of medicinal plant which
turns out a medicine can be worth ten
times the total produce of minerals,
Community knowledge of various
aspects of human life-from medicinal
plants to conununity organisation is
worth ten times the value of a plant
species.
...and Alternatives
We should gear towards a national
*1 policy of what has to be mined and
what should not be mined, from the
interest of the people rather than the
Markets and the Industry.
• We therefore feel the progressive
nations should go beyond economics
of the market place and understand
global stewardship,
• they should contributejo minimising
mining,
x
• and seek ways where we can replace non
renewable with more renewables.
•
>
Z1 •
•
i
Of Values and Decisions......
•
•
The minerals will be for ever- if we do
not mine them,
The wealth above will never be ours-if
we mine them..
mmSP Contacts:
Q NationaTSecretariat
Ravi Rebba Pragada,
National Convenor
1249/A. Road No 62,Jubilee hills ,
Hyderabad -500033, Andhra Pradesh,
INDIA.
Tel/Fax : + 91 40 3542975, 6505974
E mail mmpindia@hd2.dot.net.in
mm_p@satyam.net.in x
Website: mmp.n3.net
Q Singhbum Secretatariat
Xavier Dias
North, North-East Convenor,
No.27,Annexe,lO^Rd ('
CurcuitHouseArea(east),
JamshedpurTel:0657220266,
Ema i 1: mmpnorth@dte. vsnl. net.in
...and therefore, in togetherness we
appeal....
Emphasise Minimum Mining
i
Com H '•
•
Community Health I Environment Health Survey Skillshare ((.’HESS)
13- 17th August 2001, Bangalore
OPERATION CHART FOR PLANNING AND ORGANISING A
HEALTH SURVEY
PART 1: Planning the survey
1. Recognise and define community needs and problems.
2. Decide what information is required to deal with these needs and problems.
3. Enquire whether this information is already available; study and use any available
information.
4. Decide whether a survey can succeed in gelling the information required.
5. The First Planning Decisions
i)
List the main questions the survey is to answer.
ii)
Outline the methods (sampling plan ) by which the information can be
obtained.
iii)
Decide on the time required for the field work
6. Decide on (he sampling plan
i)
Flow arc the people to be selected for inclusion in the survey ?
ii)
1 low many arc to be included ?
iii)
What arrangements arc needed to get (he interviewers to the
respondents ?
7. Estimate the survey costs
i)
What will the survey cost in terms of staff, time, transport and others ?
ii)
Is the survey as outlined in (5) and (6) too big or too complicated or
too costly ?
iii)
Does the survey plan need changing ?
8. Make the final decisions on the survey including:
i)
the essential information to be collected
ii)
the scale of the survey
9. Design and write out:
i)
Questions and questionnaire
ii)
Sampling plan
10. Prepare the Interviewer instructions
PART 2: Organising the survey
1 1. Prepare the community for the survey
i)
Let people in authority know what is planned and get their agreement
and co-operation. Explain the purpose of the study to them.
ii)
Prepare the community or institution for the coming survey.
12. Test the survey methods
i)
Test the questions and questionnaire.
ii)
If possible do a small pilot study.
13. Train the interviewers
14. Start the field work
i)
Arrange to meet the interviewers regularly and often for discussion.
ii)
Cheek completed questionnaires with the interviewers.
15. Abstract the Information
Arrange for abstracting information from the questionnaires. Is local help
available for this work ?
16. Write and distribute the survey report.
Source: Planning And Organising A Health Survey (Book 1) by IP. Lutz
International Epidemiological Association
The Community Health / Environment Health Survey Skillshare (CHESS)
A.
BACKGROUND.
Environmental regulations in India, even if properly implemented, will
result in the steady poisoning of the environment. It goes without saying
that a polluted environment will manifest itself in the form of health
disorders amongst human and other living populations exposed to the polluted
environment.
Based on numerous cases around the country, common sense evaluation clearly
confirms that industrial pollution has damaged community health. However,
the specific nature of the damage or its extent remains unknown. As a
result, community health has hardly influenced pollution policy. The
indications that this is the case is evident:
1. Pollution legislation aims at controlling pollution rather than
preventing it.
2.
Pollution legislation merely prescribes norms that legalise pollution.
3. What is legal is not healthy. Pollution norms are prescribed based on an
assumption of assimilative capacity of nature rather than on facts that
point to die cumulative nature of the most deadly kinds of pollutants.
4. Polluters remain unpunished for their pollution and effects on community
health.
Importance of Community Health Surveys
Citizens and community groups need to be able to identify
environmentally-caused health disorders, and the sources of environmental
disturbance(s) that cause such disorders. This is important for several
reasons:
1. Ensuring that the "Polluter Pays": The Polluter Pays principle is
important not merely as a deterrent for further or future pollution, but
also in the context of recovering the ecological debt owed to the
communities of living beings and their future generations. Ecological debt
goes beyond the fiscal and requires a deep-rooted sense of apology by the
polluter for the damage caused by its actions.
2. Mobilising the Community: Often health disorders within a community are
seen at a family level, with people blaming the compromised health of their
family members on fate or accident. Many of the subtler effects - learning
disorders, immune system depression, reproductive or gynecological anomalies
- are noticeable as trends only when seen at a community level. Mapping the
health of a community brings home the fact that the fate of the community as
a whole is linked to its environment.
3. Preventing Future Harm: Armed with the knowledge that certain kinds of
industries and pollution can cause community wide health effects,
communities can play a more active and informed role in deciding the course
of their communities' development. Combined with an operational
understanding of the Precautionary' Principle, such knowledge can help in
preventing the setting up of polluting industries.
4. Countering Government/Industry: Community health surveys need not be
conclusive in establishing cause-effect relationship between environmental
disturbance and health disorders. They need to sufficiently appeal to the
common sense of the community members and the public to be able to challenge
the baseless assertions by Govemment/industry that a community's ailments
have nothing to do with tire pollution they are subject to. Health surveys
can help reverse the burden of proof, with communities demanding industries
and governments to establish beyond doubt that their polluting
activities/industries are not related to the community's health problems, or
will not cause health disorders.
5. Health Care Needs: Health surveys also allows for better understanding of
the health care needs of communities living in environmentally disturbed
areas Such an understanding is crucial to designing the health care
interventions necessary for the community members.
B
AIM:
Equipping Communities to Deal with Health Surveys:
C.
OBJECTIVES.
# To create a multidisciplinary resource base of predical practitioners, .
community activists and toxicologists capable of conducting community health
surveys in communities subject to industrial pollution;
# To promote interaction between community activists and community health
experts to facilitate a discussion aimed at understanding the limitations.
and strengths of community health surveys;
s To understand the role of community health surveys in campaigns against
industrial pollution,
cov'i.a.-,.,. ,
D.
THE SKILLSHARE (ORIGINAL PLAN)
The skillshare would discuss the following elements:
1.
Toxicology
2.
Pollution & Community' Health
3.
Design and Implementation of Health Surveys - Resource Implications
(costs, personnel, time etc)
4.
Understanding the strengths and limitations of community health surveys
5.
Using Community Health Surveys for campaigning.
6.
Resources and resource sharing opportunities.
7.
Case Studies
Participants
Community activists, medical practitioners from affected communities,
occupational health doctors/activists, community health doctors/activists,
toxicologists, lawyers.
OF PRE SKILL SHARE SURVEY
RESULTS
E.
1
■■
■
'
. >• A
t—tj
\
,
-
I
..........
,
,
"
> > r c x.£V
List of participating groups/organization/campaign
ci t ■<.[
Cl-Thanal Conservation Action and Information network
C2-Occupational Health and Safety Center, Mumbai
C3-Paryavaran Suraksha Samiti, Narmada
J'- "A''
,
(
P-S-if .
C4-Citizens for Alternatives to Nuclear Energy(CANE)
C5-Mines.Minerals and People(MMP)
1.
fl'hat would you like us to cover in the Skill Share(general)?
Cl- a)Bastc human physiology and interactions of the various systems within for our general understanding,
b) The sequence that generally follows in the human body from the various routes of exposure to the health
effects- acute and chronic and after(and also we need to understand their various forms like genotoxic,
teratogenic, carcinogenic, etc.)
c) MultipljLfac.tors.or sources are sometimes blamed for the same health problems seen, For eg. In one
<—■ informal health survey on endosulfan sprayed area in / f- y Kasargod we found a very high percentage of
women having gynecology related problems- but many also revealed that they had Copper-T implants and they
were relating their problems to that.
d) Synergistic effects of various chemicals/ chemicals and lifestyles made causative linking difficultsimultaneously making it easier for the polluters to blame some other thing for the effects (like chewing pan,
cigarette smoking, vehicular pollution, malnutrition lack of iodine etc as possible reasons also)
C2-a) Factory act and its occupational and environmental ramifications.
b) Workmen’s compensation Act, ESI Act.
c) Disaster Management planning and antidotal treatment in case of chemical factory disaster, preparedness,
training of local doctors and networking.
C3-a)Known impacts of air and water pollution.
b) Impacts of constant exposure .
C4-a)Methodology used for Kaiga Health Survey conducted by CANE.
C5-a)Mining and health
bjlndustrial Pollution and impacts on community
Occupational Health
c)
2.
IVhat would like us to cover in the Skill share (Specific to your campaign)
Cl a) A community having health disorders may be due to a single external factor like endosulfan in Kasargod oi
due to multiple external factors Jlife a mixture of pesticides like in Idukki or due taa a waste dump and burning.
How will it be possible to develop a tool or set of tools to link disorders to the factors, especially when we
interact with the community directly with focus on women and, children.
B)People in the surroundings of industrial area having a lit of all kinds of chemical industries like fertilizers,
pesticides, chlorine and chlorine compound manufacturing units, paper industries, rare earth factory etc- their
individual and synergistic actions is madding.this too complex conditions.
c) Plantation workers exposed to agro-chemicals over many years and their families affected by the
same- directly and indirectly.
d) Workers and community living around and exposed to chemical in pesticide manufacturing units like the
Hindustan Insecticides Limited factory at Eloor which manufactures DDT, endosulfan, diclofol, and used
manufacture BHC till 1997.
C2-a) Noise induced hearing loss.
b) Occupational lung diseases
c) Hospital waste
to fish
C3-a)Suspected cancer in an area downstream of effluent carrying mostly suspected due
consumption
b) Impact of heavy metals, organic chemicals on health.
C4-a)How to calculate food and nutrition data in calories (food and nutrition data are collected in grams)
b)Any specific indexes that we need to calculate general health of the people.
C5-a)Health effects of mining(specific mining cases listed belowO
b)Effects on workers
Effects on women workers(reproductive health)and community members
c)
3.
What toxic chemicals/products/processes are you dealing with in your campaign?
Cl-a) Pesticide- especially organochlorines like endosulfan and organophosphates like phorate. The health issues
due to direct intake by communities exposed to aerial spraying and otherwise, workers involved in spraying, and
also indirect intake from contaminated water or food from the area sprayed.
2.
b) Pollution due to effluent and emission from pesticides factory producing DDT. endosulfan,
diclofol, and BHC (till 1997) The HIL factory lets out the effluents into a stream which contaminates large areas
of wetlands before draining into the river Pereira. A Green peace study found 111 chemicals, 56^fof which coulc
belJSs reliably identified, of which 39 were organochlorines including DDT and metabolites, endosulfan and
breakdown products, HCH etc There are other highly polluting factories in the same area manufacturing
phosphate fertilizers (FACT) rubber processing chemicals (Merchem) The study also found high levels of
cadmium, chromium, zinc, copper and mercury in the same effluent stream. The stream is not being directly
■ used for drinking water/ other purposes now, but at least 300 families live on its banks directly inhaling the
pesticide smelling fumes emanating from the stream and consuming coconuts, ducks, eggs, which smell of the
chemicals.
C2-a)Noise
b)Cotton dust and chemical exposures causing lung diseases.
c)HIV, Hepatitis B&C
"
C3-a) A cocktail of dyes, pharmaceuticals, illntermediate chemicals etc.
^Decentralized cottage level waste recycling of containers, drums, bags containing
chemicals.
C4-a)Radioactive Pollution
C5-a)Coal, bauxite, uranium, mica, limestone, granite
b)Downstream industries (coalwasheries, smelters, refineries, crushers,etc,)
4. What experiences/ case studies / videos/slides/ campaign material would like^to share with others during *
Skill share.
Cl-a) We would like to share the aerial spraying of endosulfan issue in Kasargod and one of the study related to
health a-'survey done in a village in Kasargod and findings collated out of a death register survey from three
villages.
b) We would like to share the Right to Know campaign and the issue at the Industrial belt at Eloor, with slides
on the pollution there..
C2-a) Compensation to workers for occupational lung diseases and noise induced hearing loss as per ESI Act
b) Compensation to workers with radiation injury, accidents as per workmen’s compensation act..
c)Books on disability assessment, occupational diseases( in schedule III of WC Act)
d) Books on occupational HIV and hepatitis B&C . Antidotal treatment in case of chemical disaster,
experience of struggle by Parivartan in chemical belt in Konkan.
C4-a)Presentation using slides on Base line^ health survey conducted around kaiga.
b) Nuclear Power Plants and Public Health.
C5-a)Videos: Jadugora uranium;Baplimalli bauxite (Orissa) ; Silicosis
b) Case studies: Mapoon story of Australia(indigenous people and Aluminium
companies)Story of Orissa-chromite areas, Environmental Aspects of bauxite and aluminium production in Brazil
and Indonesia: Rossing Uranium- revealing health and environmental risks, Mica in AP
5.Any other ideas /suggestion not covered by above.
Cl-a) Can we think in terms of producing some fact sheets on health impacts due to the chemicals discussed in
this Skill share. This couldjbe one of the outcome of the skill share.
.. b)Could it be possible of develop an easy to understand note on the terms like genotoxic, teratogenic,
carcinogenic and such other terms which are commonly used to depict the toxicity of these chemicals.
C2-a)Guidehnes for impairment and disability assessment for compensation purposes.
b) Doctors” training and networking.
C5-a)How to do health surveys .an occupational health.
b) How to monitor industrial pollution
c) Critique of our existing health survey questionnaire.
women having gynecology related problems- but many also revealed that they had Coppcr-T implants and they
were relating their problems to that.
d) Synergistic effects of various chemicals/ chemicals and lifestyles made causative linking di fficultsimultaneously making it easier for the polluters to blame some other thing for the effects (like chewing pan,
cigarette smoking, vehicular pollution, malnutrition lack of iodine etc as possible reasons also)
C2-a) Factory act and its occupational and environmental ramifications.
b) Workmen’s compensation Act, ESI Act.
c) Disaster Management planning and antidotal treatment in case of chemical factory disaster, preparedness,
training of local doctors and networking.
C3-a)Known impacts of air and water pollution.
b) Impacts of constant exposure .
C4-a)Methodology used for Kaiga Health Survey conducted by CANE.
C5-a)Mining and health
b)Industrial Pollution and impacts on community
c)Occupational Health
2. What would like us to cover in the Skill share (Specific to your campaign)
Cl a) A community having health disorders may be due to a single external factor like endosulfan in Kasargod or
due to multiple external factors Hide a mixture of pesticides like in Idukki or due taa a waste dump and burning,
How will it be possible to develop a tool or set of tools to link disorders to the factors, especially when we
interact with the community directly with focus on women and children.
^People in the surroundings of industrial area having a lit of all kinds of chemical industries like fertilizers.
pesticides, chlorine and chlorine compound manufacturing units, paper industries, rare earth factory etc- their
individual and synergistic actions is mailing this too complex conditions.
'' »c) Plantation workers exposed to agro-chemicals over many years and their families affected by the
same- directly and indirectly.
d) Workers and community living around and exposed to chemical in pesticide manufacturing units like the
Hindustan Insecticides Limited factory at Eloor which manufactures DDT, endosulfan, diclofol, and used
manufacture BHC till 1997.
C2-a) Noise induced hearing loss.
b) Occupational lung diseases
- c) Hospital waste
C3-a)Suspected cancer in an area downstream of effluent carrying mostly suspected due
consumption
b) Impact of heavy metals, organic chemicals on health.
to fish
C4-a)How to calculate food and nutrition data in calories (food and nutrition data are collected in grams)
b)Any specific indexes that we need to calculate general health of the people.
C5-a)Health effects of mining(specific mining cases listed belowO
b)Effects on workers
c)Effects on women workers(reproductive health)and community members
3.
What toxic chemicals/products/processes are you dealing with in your campaign?
Cl-a) Pesticide- especially organochlorines like endosulfan and organophosphates like phorate. The health issues
due to direct intake by communities exposed to aerial spraying and otherwise, workers involved in spraying, and
also indirect intake from contaminated water or food from the area sprayed.
2.
b) Pollution due to effluent and emission from pesticides factory producing DDT, endosulfan.
diclofol. and BHC (till 1997) The HIL factory lets out the effluents into a stream which contaminates large areas
of wetlands before draining into the river Pereira. A Green peace study found 111 chemicals, 56n of which coulc
be3s reliably identified, of which 39 were organochlorines including DDT and metabolites, endosulfan and
breakdown products, HCH etc There are other highly polluting factories in the same area manufacturing
phosphate fertilizers (FACT) rubber processing chemicals (Merchem) The study also found high levels of
cadmium, chromium, zinc, copper and mercury in the same effluent stream. The stream is not being directly
used for drinking water/ other purposes now, but at least 300 families live on its banks directly inhaling the
pesticide smelling fumes emanating from the stream and consuming coconuts, ducks, eggs, which smell of the
chemicals.
C2-a)Noise
b)Cotton dust and chemical exposures causing lung diseases.
c)HIV. Hepatitis B&C
C3-a) A cocktail of dyes, pharmaceuticals, illntermediate chemicals etc.
b)Decentralized cottage level waste recycling of containers, drums, bags containing
chemicals.
C4-a)Radioactive Pollution
C5-a)Coal. bauxite, uranium, mica, limestone, granite
b)Downstream industries (coalwasheries, smelters, refineries, crushers,etc,)
4. What experiences/case studies / videos/slides/ campaign material would likes to share with others during
Skill share.
Cl-a) We would like to share the aerial spraying of endosulfan issue in Kasargod and one of the study related to
health a survey done in a village in Kasargod and findings collated out of a death register survey from three
villages.
b) We would like to share the Right to Know campaign and the issue at the Industrial belt at Eloor, with slides
on the pollution there..
C2-a) Compensation to workers for occupational lung diseases and noise induced hearing loss as per ESI Act
b) Compensation to workers with radiation injury, accidents as per workmen’s compensation act..
c)Books on disability assessment, occupational diseases( in schedule III of WC Act)
d) Books on occupational HIV and hepatitis B&C . Antidotal treatment in case of chemical disaster.
experience of struggle by Parivartan in chemical belt in Konkan.
C4-a)Presentation using slides on Base lines health survey conducted around kaiga.
b) Nuclear Power Plants and Public Health.
C5-a)Videos: Jadugora uranium;Baplimalli bauxite (Orissa) ; Silicosis
b) Case studies: Mapoon story of Australia(indigenous people and Aluminium
companies)Story of Orissa-chromite areas, Environmental Aspects of bauxite and aluminium production in Brazil
and Indonesia: Rossing Uranium- revealing health and environmental risks, Mica in AP
5.Any other ideas / suggestion not covered by above.
Cl-a) Can we think in terms of producing some fact sheets on health impacts due to the chemicals discussed in
this Skill share. This could be one of the outcome of the skill share.
b)Could it be possible of develop an easy to understand note on the terms like genotoxic, teratogenic,
carcinogenic and such other terms which are commonly used to depict the toxicity of these chemicals.
C2-a)Guidelines for impairment and disability assessment for compensation purposes.
b) Doctors” training and networking.
C5-a)How to do health surveys on occupational health.
b) How to monitor industrial pollution
c) Critique of our existing health survey questionnaire.
SUBMISSION ON THE HEALTH STATUS ANU HEALTH CASE OF VICTIMS OF THE
BHOPAL GAS DISASTER OF 1984
TO THE INTERNATIONAL MEDICAL COMMISSION ON BHOPAL (JANUARY 1994)
by
Dr.Thelma Narayan, MBPSM.Sc,(Epidemiology).
COMMUNITY HEALTH CELL, BANGALORE,
MEDICO FRIEND CIRCLE, INDIA.
CONTENTS
Summary
1.
Introduction
2.
Health Status - a review
3.
Medical/Health Care
4.
Evolving alternatives
5.
Conclusion
6.
References
.'"All scientific work is incomplete - whether it be
observational or experimental. All scientific work
is liable to be upset or modified by advancing
knowledge.
That does not confer upon us a freedom
to ignore the knowledge we already have,
or to
postpone the action that it appears to demand at a
given time."
A.B.Hill
SUMMARY
Studies done and published during the past nine years show concrete
evidence of continued, multi-systeaic clinical ranifestat.ions.
which
in several thousand victims are severe and in others moderate and
mild. Immunological effects and genctoxicity are also evident.
There
is serious disruption in quality of life.
This has occurred among a population living below the poverty line, who
were totally unaware of the hazard potential of their neighbourhood
plant.
Medical care has been largely hospital/clinic based, symptomatic,cura
tive care. There is some evidence cf irrationality and overdrugging.
The preventive aspects of health care are inadequate and .there is no
attempt at person centred, wholistic health or even of the basics of
primary health care or community health.
Further victimization of the victims is evident from protracted lega_
cases, unjust settlements, grossly delayed processing of compensation
claims and disbursements,
and disregard for the
invaluable human
dignity of the affected people.
Comprehensive,
just and humane health services are urgently needed.
These will necessarily have to build on present realities
in the
government and voluntary sector.
A shift in emphasis towards greater
community organisation and building of community capability
is
suggested so that the victims are in greater control of their own
Other components of community health also need to be built
health.
up/strengthened.
INTBODUCTTON
Studies since the Bhopal disaster,have increased our understanding
of the health effects on people exposed to toxic gases in December
1984.
These clinical, epidemiological and laboratory studies done
by varied organizations provide evidence of the bodily harm caused
to approximately half a million Indian/world citizens. They in no
way measure the suffering caused to those affected and their
families.
These nine years have also been witness to the response by Union
Carbide (the concerned company), the state and national government
and the international community.
These could be seen in terms of:
* availability/lack of timely authentic information;
* research efforts and utilization of their findings;
* evolution of appropriate therapeutic measures;
’ organisation of medical care and rehabilitation; and '
* utilization of medical information to work out compensation,etc.
Glaring lacunae exist in all the above, which would be considered
beyond the levels of acceptability for other groups of citizens
more favourably placed, even within the country.
This response is
added insult to the injury that was caused to innocent victims.
During present times the concept of social justice and equity in
health and health care has been accepted worldwide and has led to
the articulation of the Alma Ata Declaration to which most nation
states are signatories.
It is therefore important for members oi
the medical profession, and all those involved /interested in
health issues, to work towards making these concepts and the goal
of "health for all" a reality in specific situations such as Bhopal
It may also be worth remembering that Bhopal is no accident,but is
representative of a large number of instances of industrial and
environmental hazards to which populations, particularly in the
Third World, are susceptible.
HEALTH STATUS
The definition of Health by the WHO as " a state of complete
physical, mental and social well-being and not merely the absence
of disease or infirmity", can be taken as the gold standard tor
health efforts.
In the Bhopal situation all the different aspects
of health need to be considered in comparison to this standard.
POPULATION EXPOSKD/AFFKCTED
Of the total population of 850,000 in Bhopal in 1984,the officially
estimated exposed population was 5,21,262 (ICM2).
The ICMB estimates of the distribution of affected people
follows: Severely exposed area
:
32,477 people
Moderately exposed area
: 71,917 people
Mildly exposed area
:
4,16,868 people
is
as
: 2 :
It la important to have a reasonably accurate number of those
exposed,
as they comprise the ’population at risk'
who could
potentially manifest adverse health outcomes as a result of the
exposure.
This number would be the denominator for calculating
exposure related morbidity and mortality rates,
besides being
crucial
for organizing medical care and arriving at compensation
amounts.
The Government does not have a complete list of victims and it is
estimated
that 1,00,000 victims who are residents of. the 3n
officially declared gas affected municipal wards have not been
registered.
It is strange that a country that successfully
conducts census operations and regular enumerations for elections,
besides other exercises like the Sample Registration Scheme and
several other large studies by national research institutions and
operations research groups, suddenly finds it near impossible to
list a relatively small population in a confined and concentrated
geographic area.
Factors such as migration are not specific only
to post disaster situations and other issues such as verification
and misreporting are certainly not as difficult as made out to be.
This basic and simple need for reasonably accurate data needs
reiteration, as individual and collective rights to compensation,
medical care and rehabilitation depend on it.
.2 MORTALITY
In November 1989 and October 1990 the recorded number of deaths
due to the disaster were 3,598 and 3,828 respectively
(Dept.or
Relief and Rehab., Bhopal Gas Tragedy, Govt, of Madhya Pradesh,
Bhopal).
Abortions and still births are not included here
However,
10,000 claims on account of death were still pending
before the claims commissioner in 1992.
Local sources say that
over 70 per cent of claims taken up so far have been arbitrarily
rejected.
Local sources also mention 3-4 gas related deaths
per week in Bhopal in 1993,based on newspaper reports,
i.e., 156208 excess deaths per year.
The mortality rate among those exposed is decreasing over time
(6).
This could probably be explained by the fact that those more
severely affected have died in the immediate and intermediate
period and the more healthy survivors live longer.
The mortality
rates are however still slightly higher among the severely exposed
as compared to the controls (6).
. .3
: 3 :
Crude Death Rate (per 1,000 population)
Year
1986
1987
1991
Source :
Severely Exposed
14.10
11.79
8.55
(6,11)
Abortion Rate
1985.1987
1991
Source: (11).
Control
6.04
7.23
7.46
5.6%
2.1%
5.9%
24.2%
9.6%
6.8%
•
The stillbirth.
perinatal and infant mortality rates
downward trend, but are slightly higher in the severely
area as compared to the control (6).
2.3
MORBIDITY : A brief xxYi^H
2.3.1
Important overall features Ires a review
show a
exposed
literature
a)
LQng
tanu- progressive symptomatology and clinical findings
during the nine years since the disaster. Animal studies and
type of lesions developing, suggest a life time continuation of
ill health.
The acute, subacute and chronic phases, are part of
a continuum,
representing the natural history of the after
effects of exposure.
blMulti-systemic clinical picture involving the respiratory.ocular,
gastrointestinal, reproductive, psychological,
neurobehavioural
and neuromuscular systems.
There is some evidence of depressed
cell mediated immunity and of genotoxicity.
Well designed toxicology studies also demonstrate
multi-systemic involvement.
long
term,
c)MIC. and its degradation products are highly toxic, reactive and
exposure to it is associated with considerable long tens effects
(20, 13,10,18).
d)The majority of. tha exposed population live haloa ths. poverty.
line defined by the Government of India.
The environmental and
occupational conditions of poor housing, unsafe water supply,
inadequate sanitation,inadequate nutrition,poor work environment
and unemployment is a cause for greater exposure to other
infections, to which the victim.<t are more prone, due to factors
cited in (b).
This further aggravates their ill health.
. .4
2.3.2
The Ryes
In the acute phase a large proportion of the exposed population
had superficial Keratitis, conjunctivitis and swelling of the
eye lid.
Several had superficial corneal ulcerations in the
interpalpabral region which responded to treatment.
There were
persistent symptoms of watering of the eye, burning and itching.
Later studies (6), (12) found chronic conjunctivitis, deficiency
of tear secretion, high prevalence of corneal opacities and
early age onset of cataracts.
Another 3 year cohort analysis of community clusters
(13)
suggests a threefold excess of eyelid inflammation, ‘twofold
increase of new cataracts and loss of usual acuity among the
more severely exposed clusters.
There was also an excess of
recent eye infections and hyper responsive phenomenon.Toxicology
(animal)
experiments also showed evidence of dose related
progressive chronic inflammation (13).
2.3.3
The. Bes-piratorv System
The experience of people (S), several studies
(1),(6),(10 ) ,(14 )
and reviews (3),(9) (18) indicate a heavy load of morbidity due
to respiratory problems throughout the post disaster period.
It
continues to be a major cause of death among the exposed
population (10).
An 18 month follow up of a self selected group of patients
chronic
exposed to the toxic gas revealed a pattern of
respir/tory disability showing flow volume reductions along with
restrictive lung damage with alveolitis (6).
A follow up study of a random sample of 288 case (6) showed that
a large number of cases were symptomatic at. the end of 5 years.
There is an emergence of hyper reactive airway injury with
asthma like features among 24%,
Chronic Obstructive Airways
Disease among 11.4%,
bronchiolitis obliterans in 13%
and
restrictive lung disease in 1.4% of the sample.
12.8% had
recurrent chest infections requiring the use of antibiotics.
It
was concluded that exposure related lung injury had damaged both
large and small airways,
resulting in different types of
obstructive airways disease.
Misra et al (6) studied pulmonary functions of 250 patients with
respiratory symptoms during December 1984,
with severe and
moderate exposure and followed them up every year.
After the
fourth year prevalence of clinical symptoms were as follows:
exertional dyspnoea (98.4%), recurrent respiratory infections
: 5 :
(73.0%) and chest, pain (42.0%).
97.5% had evidence of sma 1 1
airway obstruction, which was suggested as a marker for the
diagnosis of toxic gas induced lung disease.
It was later
reported (11), (covering a period till March 1991), that there
was no change in the pulmonary parameters of patients examined,
but sequelae of chronic bronchitis and corpulmonale
were
increasing.
.*
i
/
, |
i
j
i
r
i
2.3.4 The. SeproductiYe SzaJLea
An early cross sectional community based study (1985) indicated
alterations in menstrual flow,
length of menstrual cycle,
dysmenorrhea and leucorrhoea among women, impotence in men in
exposed areas.
these were significantly different from control
groups (1).
.
An epidemiological study in September 1985
(2)
also showed
altered menstrual patterns and reported a significant four fold
increase in the incidence of spontaneous abortions.
Still
births too were significantly high.
i
!
'
■
2.3.4
An epidemiological study by Varma (reviewed in 10) showed high
pregnancy loss - 43.0% of 865 pregnancies at the time of the gas
leak, within 1 Km of the plant, did not result in live births.
Ment.al Health
I
Exploratory studies in February 1985 showed that 50% of people
in the community and 20% of those seeking medical care were
suffering from psychiatric problems (5).
In a community based
epidemiological study in March 1985, 44% of people in a severely
exposed area,
had anxiety or depression and loss of memory,
which was significantly higher than the control group. (1)
i
i
<
Behavioural studies conducted two and a half months post
disaster revealed that memory, mainly visual perceptual, and
attention/response speed, along with attention/vigilance were
-severely affected in the exposed population (17).
i
j
'
(
i
j
. I
- !
i
1
A later study (5) using standard questionnaires (SRQ) and
psychiatric interviews (PSE),
found that 22.6% of patients
attending general clinics suffered from psychiatric disorders,
namely anxiety neurosis (25%), depressive neurosis (37%),adjust
ment reaction with prolonged depression (20%) and adjustment
reaction with predominant disturbance of emotions (16X).
In a
community based survey using random sampling (done-by the same
study group) the prevalence rate of psychiatric disorders was
94/1,000.
94% of the patients had a diagnosis' of neurosis
(neurotic depression (51%), anxiety state (41%), hysteria (2%)
and had a temporal correlation with the disaster.
. .6
i
•I
.
o
2.3.6
Tmmnne System
Studies of immune function (16) showed a depression of cell
mediated immunity.
Among the exposed the T-cell population was
found to be less than half (28%) than that found in a normal
Indian population (65%). Animal studies corroborate this (10).
2.3.7
Genetic effects
A review indicates that animal and invitro studies demonstrate
genotoxic effects of MIC (10). Cytogenetic studies on small
samples of exposed people snow statistically higher frequency of
chromosomal aberrations (16, 10).
2.3.8
Comments
The studies have been done in a post disaster situation and
often under several constraints, including a lack of access to
available information, due to the medico-legal implications.
Though there are methodological limitations to some of the
studies (3), (10), (18), (19), when seen together, and with the
additional back-up now available of animal and laboratory
studies, there is adequate evidence of serious long term damage
to the health of the victims who survived.
It is only but
humane to translate these facts and findings into expressions of
adequate medical care, Just compensation and rehabilitation with
a sense of urgency.
3.
MKDIGAL/HEALTH GAEK
3.1
Maintenance of. medical records'- In the immediate aftermath of the
disaster there was a massive response by the Government health
services and by voluntary organisations to respond to the medical
crisis.
However,
lack of maintenance of accurate records has
caused a major problem for the victims.. This factor needs
emphasis even now.
3.2
The
lack of authentic information regarding the
possible
causative agents, along with misinformation,
created confusion
regarding appropriate therapeutic measures to be adopted.
The
utilization of sodium thiosulfate (NaTS) as an antidote was
embroiled in controversy (1). There have in fact,
surprisingly,
been no other attempts towards findings appropriate therapeutic
agents.
3.3
Medical services: A 30 bed hospital was started by the Government
very close to the severely affected area.
More recently the
number of beds have been increased. Several cl 1 ni rs providing
out-patient services by doctors and allied health workers were
started at different locations within the exposed areas.
These
provide primarily symptomatic, curative care.
. .7
V
Within three months of the disaster the medical officers of these
clinics / hospital were trained, by a team from the National
Institute
for
Mental Health and
Neurosciences
(NIMHANS)
Bangalore, to recognise and treat mental health problems that had
emerged in the post disaster situation.
A manual and several
videotapes of case studies were prepared for the purpose.
Voluntary
organisations in Bhopal started health
services
catering to specific geographic areas.
Some of these groups
trained local community health workers and had more community
based services including health education, awareness raising etc.
However their number and outreach is small.
3.4
Peoples organisations developed and activist groups also ' started
work.
They raised wider issues concerning the disaster and also
concerning the health consequences.
Epidemiological studies
undertaken by some of them, under conditions of severe resource
constraints,
lack of access to information and
suspicion,
recognised early the widespread prevalence of multi-systemic
clinical symptoms and signs, which could not be explained by lung
damage alone (1). Similarly the important area of womens health,
which was totally neglected thus far, was studied and highlighted
(2).
Efforts at evolving a communication strategy were made (22)
along with wider advocacy and building of solidarity groups
elsewhere.
Efforts of victim organisations have been crucial in
getting interim relief and challenging court orders
3.5
Zha. Indian Council of. Medical Besearch initiated several studies.
Following double blind clinical trials of Sodium Thiosulfate, the
ICMR gave recommendations for its use to medical practitioners
through the State Health Services.
These guidelines were given
scant recognition, without reason.
The ICMR also subsequently set-up the Bhopal Gas Disaster
Research Centre, based in Bhopal. Twenty two long term research
studies were initiated with the involvement of various departments
of the Gandhi Medical College in Bhopal and with collaboration /
support of several other specialized research centres in the
country.
Medical officers and staff in the community clinics
participate in the data collection for these studies .and have
received training for the purpose. A supplement to an issue of
the Indian Journal of Medical Research published findings of the
ICMR studies in 1987. Some papers have also been published in
other journals. However other than these, all reports are classi
fied as confidential and are not available to other researchers
or to the medical practitioners, and much less to NGO's and the
affected people.
•
-
. .8
: 8 :
3.S
MadicaL malpractiOff Z ever medical 1 nation: Chronic ill health has
turned out to be a bonanza for private practitioners and pharma
cists.
We have received personal communications regarding over
drugging and irrational therapeutics.
An informal study also
revealed the use of several banned drugs.
The possibility of
iatrogenic problems is real and its extent needs to be studied.
3.7
Preventive/community health: The Integrated Child Development
Services were introduced by the government into the area.
Victims organisations however even now mention the lack of
sanitation and adequate safe water supply (8). Other preventive
and promotive health work at the community level with community
involvement is lacking. Health education, child health programmes,
counselling and supportive services have not developed.
3.8
The procedures for assessing the medical status for processing ci
compensation claims is said to be convoluted,
inefficient,
corrupt and tardy.
It is also technically flawed (4).
A
document of the U.S. National Institute of Mental health reports
that failure of secondary level support systems is one of the
most demoralising experiences for victims.
This has been a
regular occurance in Bhopal.
3.9
Interest in. the Bhopal i a sue and hence in the people affected is.
also waning.
The ICMR has closed down all but 2 of its research
studies.
Payment of interim relief has stopped and payment of
compensation through the claims courts have had a very slow
start.
At the current rate they would take several years to
complete the Job.
Rehabilitation work centres for women have
also closed.
3.10
While there are a larger number of research papers in inter
national journals every year, very little gets back to Bhopal.
This raises an important issue concerning social accountability
research. Besides the victims being used as guinea pigs,
it
is the public or tax payers money that keeps most of the research
institutions running, necessitating public accountability.
4.
EVOLVING ALTERNATIVES
4.1
Given the ground realities of :
* Serious,
progressive effects on the health, well-being and
livelihood of victims;
* a medicalised approach to health care, prone to overdrugging
and irrational therapeutic practices;
* waning interest by governmental and non-governmental
organisations;
it seems necessary and urgent to buiId a more comprehensive.
humane and .lust health care. service for victims.
We however
probably need to build on the present realities with all their
limitations.
Health care services for the urban poor in the
country
are ill-developed, with the private sector
being
. .9
9 :
predominant.
The functioning of the government health system in
general is inefficient and unempathic to people.
However it is
clear that in Bhopal the prime responsibility for provision of
health services to victims is with the government.
Steps like
setting up of an infrastructure of facilities and staff have
already taken place.
Working towards improvement in quality and
increased responsiveness to the specific health problems of
victims, with greater use of the principle of community health is
now needed.
Building up peoples organisations within the affected communities
with much greater access to information. along with participation
in decision maki ng wi11 be some of the steps that can help
restore thei r health in the:r own hands.
The role of NGQ's could
be in training health workers and building community leadership
around the area of health.
O
4.2
The
idea of a national medical commission on Bhopal has been
raised several times in the past and deserves thought,
support,
advocacy and the working through of organizational details.
4.3
It would be useful to have a forum and regular means of
communication, by which those interested and involved with Bhopal
can keep in touch.
This could be through holding more regular
national meetings and regular newsletters on Bhopal,
in other
words developing a Bhopal Network.
A Bhopal based core group
could
be the secretariat.
Efforts to maintain
continued
awareness regarding the situation in Bhopal among wider groups
could be a major task and contribution.
4.4
Developing a local communication strategy between various
would most certainly help.
NGO's
Solidarity
groups,
Activists
*
X
X
Affected people/
Victims organisations
groups
X
*
X
Govt, health services
Research organisations
Private practitioners
The medical profession
While interests may seen to differ, even sharply, in the ultimate
one group has to affect- the other in a positive way,
from the
viewpoint of the victims.
. .10
■. 10 :
4.5
While acknowledging the inportant role played, of keeping the
Bhopal issue alive, the experience of the past 9 years has also
exposed the frailties, organizational limitations,
problems of
leadership
and _ incompatibilities within
the
"oro-peotle"
HGQ/actlyiat. sectors aa. well.
In a spirit of introspection many
aspects of critiques of the "establishment" could be applicable
to us as well.
We therefore need to equip ourselves better,
be
more tolerant, and allow space for dialogue and growth.
4.6
Several suggestions have been given in the past about developinc
a. comprehensive health care system for the people (2),(9),
(21)
affected by the Bhopal disaster.
Key components are:
4.6.1
Basic needs of adequate shelter, potable drinking water and —
sanitation to be met.
"
4.6.2
Need for adequate nutrition, income and employment.
Just
settlement of compensation and provision of alternative
employment can provide the purchasing capacity necessary.
Working conditions suited to the health situation of the
victims need to be ensured, e.g., dust free environment,
relatively light work, rest periods, good lighting etc.
4.6.3
Basic medical and health care:
a)Patient retained records /copies in folders that are
water,insect, dust proof are suggested as being important
for further treatment and for legal purposes in case a
reopener clause is allowed.
Practice
b)
of rational therapeutics, workshops on rational
therapeutics for practitioners, provision of therapeutic
guidelines to all practitioners in the area on common
presenting conditions,
with regular updating.
Adverse
(
Drug Reactions need to be monitored.
Programmes
c)
for specific communicable diseases,
e.g.,
TB, trachoma, water berne diseases etc.
Health
d)
education.
Mother
e)
and Child health.
School
f)
health, child to child programmes, play therapy.
g)Mother and child health care.
Womens
h)
health care.
Community
i)
based programmes for disability, especially res
piratory disability.
Mental
j)
health care- counselling, selfhelp groups, community
building,use of appropriate psychiatric services when needed.
. . 11
: 11 :
/
k)
Building
community organization through health committees
or basic units comprising 10 families each.
1)Identifying, training,supporting community health workers
and building links with referral government /NGO health
centres/hospitals.
m)Regular assessment of the health situation and health work.
X
■*
’
i
/ |
,
;
4.7 Research: There is need for continued research efforts-clinical,
epidemiological, toxicological and forensic with dissemination of
findings.
,
i
5.
CQNCLUSTQH
A socio-epidemiological analysis of the consequences of the Bhopal
disaster on the health of the victims, outlined in this submission,
places on Union Carbide, the Government of India, the Government of
Madhya Pradesh State, on society in general and all of us in
particular, an urgent responsibility to respond meaningfully to the
continuing suffering of the victims.
This response has to move from unjust legal remedies,
inadequate
and tardy monetary compensation and ad hoc medical interventions to
a more wholistic and humane community health care support system,
sustained and supported by an empowered 'victim' community.
While
doing so, we need to constantly keep in mind that 'Bhopals' exist
widely and many more Bhopals will take place in the coming years,
especially in the Third World because of the current economicpolitical
trends.
The rights of workers
and
impoverished
communities urban and rural, will therefore to be safeguarded
through continuing solidarity of effort at all levels - local,
regional, national and global.
6.
REFERENCES
1.
Medico Friend Circle, 1935, Tne Bhopal Disaster Af termath
epidemiological and socio-medical survey, MFC Regd Office, Pune.
2.
Medico Friend Circle, 1990, Distorted Lives:
Women's
health and the Bhopal disaster, MFC Regd Office, Pune.
3.
Narayan,T, 1990., Health impact of the Bhopal Disaster: an epidemio
logical perspective, Economic and Political Weekly,. Vol, XXV, No.33
(Dissertation submitted for the Masters in Epidemiology at the
London School of Hygiene and Tropical Medicine).
4.
Sathyaxala,
C.,
Vora, Hand Satish.K., 1990,
Against All Odds:
Health Status of the Bhopal Survivors, CEC, F-20
(GF),
Jangpura
Extn, New Delhi 110 014.
an
reproductive
f- ICMR Centre for Advanced Research on Community Mental Health,
National Institute of Mental Health and Neurosciences, 1987, Bhopal
Disaster:
Manual of mental health care for medical officers,
NIMHANS, Bangalore.
-. Bhopal Gas Disaster Research Centre, Indian Council
Research, Annual Report, 1990.
for
Medical
7.
Permanent Peoples Tribunal (PPT), Asia '92,
1992,
Findings and
Judgements of the Third Session on Industrial and Environmental
Hazards and Human Rights, 19-24 October, Bhopal-Bombay,
PPT-India
secretariat. New Delhi.
3.
Testimonies of the following organisation to the PPT:
Bhopal, 1992, Mimeos.
8.1
8.2
8.3
8.4
8.5
8.6
9.
Session
at
Testimony of Zahreeli Gas Kand Sangharsh Morcha.
Testimony of Children against Carbide.
Testimony of Bhopal Gas Pidit Mahila Udyog Congress.
Testimony of Nirashrit Pension Bhogi Sangharsh Morcha.
Testimony of Gas Pidit Mahila Stationary Karmchari Sangh.
Testimony of Bhopal Gas Pidit Sangharsh Sahyog Samiti.
Narayan, T,1992.,
Aspects of Community Health in relation to
Industrial Hazards,
Submission to the PPT (see No.7),
Community
Health Cell, Bangalore, Mimeo.
lO.Dhara Ramana, 1992, Health effects of the Bhopal gas leak : a review,
Epidemiologia e prevenzione, n. 52, 1992.
'1.Bhopal Gas Disaster Research Centre, Indian Council of Medical
Research, Consolidated report (Summary) Draft, January 1992.
'2.Raizada,J.K., Dwidei, P.C., Chronic ocular lesions in
tragedy, Ind.J Ophthalmol, 1987, 35: 453-455.
Bhopal
gas
13.Andersson N, Ajwani M.K., Mahashabde S, Tiwari M.K. , Kerr Muir M,
Mehra V, Ashvin K, Mckenzie C.D., Delayed eye and other consequences
iron exposure to methyl isosyanate, 93% follow up of exposed and
unexpcsed cohorts in Bhopal, Br.J.Ind Med.,1990; 47:553-558.
14.
Rastogi
S.K., Gupta B.N., Husain T, Kumar A, Chandra S, Ray P.K.,
Effect of exposure to toxic gas on the population of Bhopal: Part II
- Respiratory Impairment, Ind. J Exp.Biol.,26:161-164.
15.Patel, M.M., Kolhatkar, V.P., Potdar, V.P., Shekhavat, K.L., Shah,
H.N.
and Kamat,
S.R., Methyl Isocyanate Survivors of Bhopal
sequential flow volume loop changes observed in eighteen months
follow-up. Lung India, May 1987, Vol.5, No.2, pp 59-65.
16.Saxena A.K., Singh K.P, Nagle S.L., Gupta B.N., Ray P.K., Srivastav
R.K., Tewari S.P., Singh R, Effect of exposure to toxic gas on the
population of Bhopal:
Part IV Immunological and
chromosomal
Studies, Ind.J.Exp Biol., 1988; 26: 173-176.
17.Gupta B.N, Rastogi, S.K., Chandra H, et al, Effect of exposure to
toxic gas on the population of Bhopal: Part I- Epidemiological,
Clinical,
Radiological and Behavioural studies., Ind J Exp Biol;
1988, Vol 26-, pp 149-160.
18.Mehta P.S,
Mehta A.S,
Mehta S.J, Makhijain A.B,
Bhopal
Tragedy's Health Effects:
A review of methyl isocyanate
toxicity, JAMA, Dec 5, 1990, Vol 2264, No.21, pp 2781 - 2787.
Koplan
19.
P.K, Falk H, Green G, Public Health Lessons from the Bhopal
chemical disaster, JAMA, Dec 5, 1990, Vol 264, No.21, pp 2795-2'96.
20.Andersson N, Long term effects of methyl isocyanate, Lancet,
3, 1989, pp 1259.
June
21.Jana S, Phadke A, Sadgopal M., A preliminary outline of a pilot
model of a comprehensive health care for the gas victims, Medico
Friend Circle, Mimeo.
22.Medico Friend Circle, Communication Strategy in
Friend Circle, 1985, Mimeo.
Bhopal,
Medico
_________________________________________ SPECIAL ARTICLES
Health Impact of Bhopal Disaster
An Epidemiological Perspective
.
X
I
Thelma .\arayan
77ze chemical accident at Bhopal has been an experience of a public health emergency caused by a technological
disaster, a disaster which overwhelmed the capacity of individuals, physically and psychologically. Because of
the numbers involved and its complexities it also overwhelmed the capacity of the macrosystem, that is, the social
and administrative structures to respond. An epidemiological perspective and method of study is vital to under
standing the pattern and distribution of the adverse outcomes in the community and can provide a variety of data.
The article, in two parts, uses an epidemiological perspective to appraise and review available literature concern
ing the health impact of the disaster and discusses methodological issues relevant to an epidemiological approach
to the study of such a disaster.
[The paper is published in two parts. The second part will appear next week. References are appended to pan two.]
I
Introduction
THE world’s most serious disaster in the
chemical industry which occurred at Bhopal
tragic instance of the adverse impact
of chemical agents on human health. The
health profession has historically more
experience and expertise in dealing with
biological and physical agents of disease.
Experience with chemical agents was pre
viously limited to small groups of workers
in specialised occupations. Health problems
arising therein were dealt with by specialised
occupational health teams. With rapid
growth of the chemical industry, there has
been an increasing use of a variety of
chemicals in activities of daily life as well
as in agriculture. During the past decade
there has been a growing realisation that the
adverse impact due to human interaction
with chemical agents is now spreading
beyond the confines of the workplace, to the
environment and the public in general. In
cidents at Bhopal (methyl isocyanate + ?),
Seveso (dioxin), Mexico (butane) and
Vietnam (Agent Orange) have demonstrated
dramatic instances of these adverse effects.
These events are often considered unfor
tunate, uncommon, freak events or accidents.
However, they represent the tail end of the
distribution of the more common, less
serious, leaks, injuries and minor health ef
fects resulting from exposure to chemicals.
The long-term effects of lower dose and/or
chronic exposure to several chemicals in use
are at present unknown. However, there is
accumulating evidence of the adverse effects
of some of them, e g, the impact of pesti
cides on the environment and theii effects
on animals and man through the food chain.
The increasing use of potentially harmful
chemicals, the conditions in which they are
manufactured, the health and safety regula
tions adopted and implemented are closely
linked to economic and political factors
operating at a national and international
level. People living and working in condi
tions of material poverty bear the brunt of
Economic and Political Weekly
the most adverse effects, because for them
employment under any conditions is a neces
sity for survival. The poor also carry a
double burden—suffering from the diseases
of poverty, viz, malnutrition and inefections
along with the modern diseases of industria
lisation. A balance sheet approach of costs
and benefits to people has to be used in
evaluating the role of chemicals in this
context.
Responsibility for the safety of workers
and communities and the prevention of
technological disasters require the involve
ment of professionals and decision-makers
from several fields. More importantly it calls
for commitment and political will by wider
forces in society. Public health physicians
could contribute by using epidemiologic
skills to study the health effects of these
agents. This would help provide a firm basis
of knowledge about possible effects on
health, which could then be used for creating
awareness and for policy-making. This has
already been recognised and interest in en
vironmental epidemiology, which includes
the above group of agents has been grow
ing. Being a new area of enquiry, the limita
tions of the existing tools of research, have
also to be kept in mind.
The chemical accident at Bhopal has been
an experience of a public health emergency
caused by a technological disaster. The
World Health Organisation has defined a
disaster as “an event that suddenly over
whelms the capacity of the normal system
to respond” [Wasserman, 1985]. Though
used to describe natural disasters like ear
thquakes, floods and volcanoes the defini
tion could also apply to technological
disasters. In Bhopal, the disaster
overwhelmed the capacity of individuals,
physically and psychologically. And because
of the magnitude of the numbers involved
and its complexities it also o/erwhelmed the
capacity of the macrosystem, i e, the social
and administrative structures to respond.
Technological disasters are very complex and
require specialist intervention. Besides the
possibility of causing external bodily harm,
August 18, 1990
they may also act at a cellular and bio
chemical level causing a disruption in physio
logical functioning leading to unknown
pathological states.
Exposure of the population to toxic
chemical vapours during the Bhopal disaster
has resulted broadly in three adverse out
comes: mortality, morbidity and disability.
An epidemiological perspective and method
of study is vital to understanding the pattern
and distribution of the three adverse out
comes in the community. Epidemiological
studies and population profiles can provide
data which could be used for various objec
tives, viz,
(a) to substantiate/support, disprove or
provide clues for aetiological hypothesis.
(b) following from the above, to help in
directly in deciding upon rational therapeutic
interventions and in initiating secondary and
tertiary preventive measures where possible.
(c) to plan health services, including
rehabilitation, for the affected people.
(d) to provide supportive evidence in
court, regarding extent of injury, in claims
of compensation for the victims.
In the context of an epidemiological
perspective of the health impact,.one must
initially consider all available information
in broad categories of the epidemiologic
triad of agent, host and environment and
also in terms of time, place and person. In
the Bhopal situation, there were and still are
several limitations in attempting this, since
there are big ‘knowledge gaps’ about the
chemical agent/s of exposure and also about
the possible outcomes on human health.
These will be considered in greater detail
later.
The situation in Bhopal is also complex
in other respects. The incident has enormous
medico-legal implications. There has been
a delay in publication of results of ongoing
studies. It has therefore not been easy to get
adequate published references from standard
scientific journals. For the purpose of this
study a wide variety of secondary sources
of information have been used to build up
an epidemiological profile.
1835
II
Health Impact
structure. They also felt the presence of MIC
unknown chemicals. These drawbacks in
in the atomsphere by a sense of irritation in
carrying out medical work with the victims
their eyes. Due to experience with previous
have been reflected in the reporting of the
minor leaks they were able to recognise the
When studying the health impact of the
clinical findings and also in the treatment
presence of MIC by its irritant effects. Water
Bhopal disaster, we are faced with a situa
given.
tion where the cause of the presenting com
(b) Details of the number of fatalities and was sprayed around the point of leakage, as
in the presence of water MIC converts to less
of those affected are not precisely known.
plex of symptoms and signs is partially
harmful products. At 12.15 am indicators
Because of the suddenness and magnitude
unknown even at present. The long-term ef
showed that pressure in MIC tank 610 was
fects on human health are also unknown.
of the disaster, mass burying/cremation of
shooting up and by 12.30 am it went beyond
There is an urgent necessity to understand
bodies (human as well as animal) was car
the maximum on the scale, i e, 55 psig. The
ried out on an emergency footing, to avoid
the toxicology and pathogenesis of the
temperature indicator was also beyond its
agent/s involved so as to be able to provide
further public health problems. In the con
range, i e, +25*C. The safety release valve
ditions of disaster and panic, with many of
rational therapeutic care and if possible to
popped out and a gaseous cloud was seen
initiate secondary and tertiary preventive
the staff themselves affected, routine ad
coming out of the stack which was 120 feet
ministrative structures could not cope with
measures. Data needed would include facts
high. The siren was sounded around 12.30
the need for rigorous documentation vital
about the clinical presentation of the disease
am for a short while after which only the
for future treatment and compensation of
complex, the pathophysiology of the af
internal factory alarm was continued accor
victims and for the understanding of the
fected and related organ systems, the analy
ding to the routine practice followed in the
epidemiology of the aftermath. Different
tical chemistry and toxicology of the
factory. Water was sprayed to neutralise the
sources, therefore, give varying estimates
agent/s.
MIC but could not reach the height from
of the numbers who died and who were
The role of the epidemiologist would be
where the gas was emanating. Around 03.00
affected.
to provide information about:
(c) Because of the medico legal implica am the safety release valve of the tank is
— the distribution of the new disease com
reported to have sat back and the gas stop
tions of the disaster a certain degree of
plex in the population,
ped coming out of the tank.
administrative overcaution built up in the
— the characteristics of people who manifest
Meanwhile, around 12.45 am people in
months following the exposure and results
these adverse health effects,
Jaya Prakash Nagar 100 yards south of the
of studies of morbidity, toxicology, etc, con
— the various circumstances which may
plant, woke up choking, coughing and with
ducted by various research groups of the
predispose to the development of adverse
a burning sensation in their eyes, nose and
government and the company were not made
effects,
throat—reported by the victims “as if chilli
available to the medical community for
— the morbidity attributable to the exposure
powder was in the air’’.
scientific debate.
as separate from pre-existing levels of
At Bhopal’s 1,200 bed Hamidia Hospital,
(d) other factors which affected studies in
morbidity in the community by com
about 3 km from the factory, the first pa
the early phase were: (1) Mass exodus of
parison with control groups of similar
tient reported at 1.15 am and then they came
people from the affected areas away from
age/sex structure and socioeconomic
in thousands. It was around 3.00 am that the
Bhopal, during ‘operation faith’ twelve days
status,
first deaths due to the gas leak were reported.
— to provide data relating different symp following the exposure, when the remaining
There was a stampede as the populace began
MIC in the plant was ‘neutralised’. The peo
toms and signs to different degrees of
fleeing the city. People died in their homes,
ple subsequently returned to Bhopal over a
exposure.
in the hospitals, and on the roads even up
— to understand the natural history of the period of time. Hence there is a variability
to some distance away from Bhopal.
in the baseline population in the different
• morbidity over time
This was the starting point for continuing
studies; (2) Migration outside and into the
Descriptive Epidemiology
morbidity and mortality in the exposed
affected areas altering the population at risk.
An attempt has been made to build up a
population over the next few days and weeks.
Most of the affected areas being shanty
picture of the descriptive epidemiology of
Standard medical therapeutic practices were
towns, many people had their roots in
the event and its aftermath from available
adopted. However, it was the experience of
villages and towns outside Bhopal. A pro
sources of information. At the outset some
local medical practitioners that the exposed
portion of people migrated back to their
of the limitations encountered by groups in
hometowns or villages or elsewhere for treat
people came repeatedly to the clinics with
volved in carrying out medical work with the
ment, jobs or for other reasons. Similarly,
a variety of symptoms and signs affecting
victims or in studying the health impact
several organ systems, apparently unrelated
relatives of the victims also came into
must be considered.
to each other. This continued beyond weeks
Bhopal to care for their families. This sort
(a) There was a lack of authentic infor of social support during times of stress is
into months.
mation regarding the chemical composition
very common in india. It has been claimed
Ten days following the disaster it was an
of the cloud of vapours that escaped that
nounced, that as a safety measure, remain
that a large number of unaffected people
night. The leak occurred from a tank con
ing MIC in the two other tanks 611 and 619
migrated into the exposed areas to claim
taining methyl isocyanate following an ex
were to be neutralised by conversion into
compensation. Studies have not substan
plosive runaway reaction. Very little was
carbaryl. This created a panic and despite
tiated this claim. The occasional case
written (and possibly known) about MIC,
reported must be the exception rather than
assurances of complete safety, there was an
its reactions in different circumstances or its
exodus of people from the vulnerable locali
the rule; and (3) invasion by lawyers and
toxicology, in standard textbooks or jour
other people created confusion and distrust
ties. On December 13, 1984, 1,00,000 people
nals. The company did not disclose infor
left the city. Many took their animals too.
among the people This may affect the repor
mation that it had accumulated in the pro
By the next day a quarter of the city’s
ting of the history/symptoms to extents that
cess of registering for the commercial pro
population had fled. Many hospitalised
would depend on the degree of trust/rapport
duction of MIC. Thus medical professionals
created between the people and the research
patients also left. Cases of injuries and
and research workers were handicapped by
accidents in the virtual stampede during the
teams.
ignorance about the identity and properties
fleeing of the city, occurred on both occa
of the agent whose effects they were trying
Time
sions, adding to the morbidity related to the
to study and treat.
The leakage occurred on the night of 2/3
disaster. The second exodus further aggra
Speculations regarding possible agents
December 1984. The leak was first noticed
vated the situation as it interrupted treat
ranged from MIC, phosgene, carbon mono at 11.30 pm in the MIC production area.
ment, resulted in physical and psychological
xide, cyanide, cyanogenic substances and a
Workers noticed some dirty water spilling
stress in those already affected and was also
combination of all the above and/or other
from a higher level in the MCI production
an additional financial burden.
1836
Economic and Political Weekly
August 18, 1990
Generalising broadly, the event could be
described as an exposure of a population to
an extremely toxic air borne chemical agent,
with sharp localisation in place and time It
resulted in a large excess of deaths and
disease frequency in the exposed population.
This is characteristic of an explosive, acute,
point epidemic However there is evidence
of continuing or persistent morbidity and
suggestions of an excess mortality in the ex
posed population. Reasons for this are not
completely understood. Several possible
mechanisms have been proposed and will be
considered later.
Place
Bhopal has a population of about
8,00,000. The UCIL plant was located in the
northern fringe of the city, adjacent to ar.
existing residential area and barely 2
kilometres away from the railway station.
Some squatter settlements did grow up
around the Carbide plant after it was opened
in the late 1960s. But some of the areas worst
affected by the gas leak had been inhabited
for many years before the Carbide plant
opened.
The high vapour density of MIC along
with the conditions of atmospheric inversion
that winter night caused the cloud of gas to
move down and stay close to the ground. The
vapours spread slowly in the atmosphere due
to the low wind velocity. All these factors
resulted in the population being affected
greatly. The gas is reported to have spread
over an area of about 40 sq km and affected
people seriously as far as 5 to 8 km down
wind. Classification of areas into seriously
affected and less seriously affected were
made on the basis of crude post-exposure
death rates in different localities. This was
done by the state government. The most
seriously affected areas were Jaya Prakash
Nagar, Kazi Camp, Chola Road, Chandbad,
New Kabbad Khana, Sindhi Colony and
Railway Colony. The two lakes of Bhopal
are said to have averted a larger tragedy as
MIC converts to less harmful substances in
contact with water.
In studies of the Bhopal disaster, compari
sons of place would have to be done between
relatively small distances away from the fac
tory, to test a dose response effect of varying
degrees of exposure on the outcome. Geogra
phical distance however would be only one
among other indicators of exposure as will
be discussed later. Despite known limitations
of ascertainment and precision, routine
sources of data regarding mortality by area
would initially have to be used. Results of
the few population based epidemiological
studies would also be able to provide addi
tional information. Preparation of maps.
showing the distribution of deaths could be
drawn. Relating these numbers to the deno
minator, viz, the population who were ex
posed and hence at risk, would give crude
death rates following the exposure, according
to geographical area or locality. Baseline
data of the population available from the
census, electoral rolls or even by the surveys
1838
pear to be direct extrapolations from na
tional figures. This would be very inadequate
data for a thorough understanding of the
aftermath.
Bancrji et al [1985] have described the
socioeconomic profile of the study popula
Person
tion as follows: Muslims: 30 per cent, Lower
This aspect will be discussed in terms of
castes: 20 per cent, Backward castes: 18 per
the population at risk, its demographic and
other characteristics. The picture of mortali-’ cent. Income of Rs 150/head/month (i e,
ty and morbidity will be described in later
relatively well off): 10 per cent. Housing:
Kutcha (without brick and cement): 70 per
chapters.
(a) Population at risk: Estimates of the cent, pucca (well built/concrete): 30 percent;
total population exposed to the toxic gas or
Presence of holes in the structure: (allowing
the “population at risk” for the derivation
air entry) 50 per cent.
of mortality and morbidity rates are 2,00,000
Patel et al [1985] found the population to
according to the state government and
be predominantly Muslims and Harijans in
UNICEF. Results from epidemiological,
JP Nagar and Tamilians and Maharasht
community based studies [Patel et al, 1985
rians in Anna Nagar. They belonged to the
and Nagrik study, 1985] using control groups
lower socioeconomic class—the percentage
10 km away from the factory, suggest that
of skilled workers being less than 10 per cent.
even the control groups were mildly affected
The range of occupations included daily
by the exposure This indicates that the basis
wage labourers, construction workers, beedi
for defining the ‘exposed population’ needs
rollers, cobblers, railway and factory
further substantiation. This will be dealt
employees, domestic workers, self-employed
with again in the discussion on the exposure
artisans and potters.
variable
The profile is of a population, the majori
The factor of post-exposure migration'
ty of whom belong to the lower socio
into and out of the exposed localities would
economic class. The poor housing condi
have also affected the composition of the
tions would have offered no protection from
population that risk. Andersson et al [1985]
the toxic chemicals in the atmosphere.
observed at the more seriously affected had
(c) Community awareness of hazard
gone back to their hometowns or. villages.
potential of plant: Most people had no idea
Sathyamala C [1986], found that in a
about the hazardous nature of the plant
population of 8159 surveyed in September
operation. Bancrji et al [1985] report that the
1985, 43 people (0.52 per cent) moved in
population were not told earlier of the
after the gas leak and 41 (0.50 per cent) had
potential hazard of the plant. Nor were they
moved out. Both the above movements
aware of preventive measures to be taken in
would result in an overall dilution effect or
case of a leakage, e g, use of a wet cloth,
underestimation of morbidity. Though
moving in a direction away from the wind,
quantitatively this may not be of a large
not running, etc. Unfortunately most of
order (1 per cent in the above study) it must
them ran in the direction of the wind carry
be kept in mind that the qualitative dif
ing the gas and were further exposed. Patel
ference may be important if those who were
A et al [1985] found that 8.3 per cent of the
seriously ill had gone away.
population in JP Nagar and 0.08 per cent
New births into the population and deaths
in Anna Nagar took safety measures at the
(fully, partly or not attributable to the ex
time of the disaster. Most of these reported
posure) would also alter the baseline popula
to having used blankets/wet towels over the
tion. Since households have been generally
face by instinct rather than due to prior
used as the sampling units in the studies con
knowledge. The workers in the plant knew
ducted so far, this factor has not been con
of these precautions and all those in the
sidered at the sampling stage. However it
night shift escaped unhurt, except one.
would alter the number and composition of
(d) Pattern of utilisation of health ser
the baseline population and would affect the
vices: Banerji et al [1985] found that the
calculation of rates.
utilisation of health services by the study
Patel et al [1985] extrapolating from
population after the exposure was as follows:
prevalence rates of morbidity have estimated
Hospital
40.2 per cent
that, of the exposed population about 70,(XX)
Camps
46 per cent
would be suffering from serious health ef
Dispensaries
2.5 per cent
fects while 45,000 would be suffering
General practitioners
25 per cent
moderate to mild effects.
Registered medical practitioners 2.5 per cent
9.1 per cent
(b) Demographic characteristics: UNICEF Institutions outside Bhopal
officials [Agarwal A, 1985] estimate that, of
There is an overlap as some people utilised
the affected population: 75 per cent are slum ■ more than one type of service. These fin
dwellers, i e, from the lower socioeconomic
dings are an indication that when studying
strata; 80 per cent are Muslims; 40 per cent
the distribution of disease in the community,
are children below the age of 15, 10 per cent
data collection would need to be population
are elderly and 20 percent are women in the
based to get true picture of morbidity. When
reproductive age group. The basis of this
using hospital or clinic based data one would
analysis is not known. It was probably done
have to keep in mind selection bias caused
as an estimate for planning and administ
by selective attendance of patients. Possible
rative purposes. The demographic data ap
determining factors for this could be severity
conducted after the disaster by governmen
tal agencies, could be used to calculate age
and sex standardised mortality rates for dif
ferent areas.
Economic and Political Weekly August 18, 1990
of illness, accessibility of service, social class Nagar (15). The department of information
-46.7/1,000 and Kencht Chola -35.7/1,000.
of the affected persons and so on.
and publicity of the state government had
Their study found the crude post-exposure
(e) Impact on income: Patel et al [1985] documented the deth rates to be 23.4/1,000
death rate for the three localities together to
found that 65 per cent of wage earning in and 3.2/1,000 respectively in the same areas.
be 33.19/1,000 (see Table 1).
dividuals in the exposed group experienced It appears that there is a gradient of mor
There seems to be a wide variation in
a drop in income ranging from 20 per cent tality according to the degree of exposure.
crude death rates derived from the various
to 100 per cent with a median of 50 per cent. This is another reason why direct extrapola
studies as well as in those stated by the
In the controls, only 9 per cent reported a tion of rates from any particular study/area
government. Possible reasons for this could
drop in income in the range of 20-55 per to the total affected population may be
be:
cent. This occurred due to physical ill-health misleading.
(a) differences in levels of ascertainment,
reporting, etc
resulting in occupational disability.
Banerji D et al [1985] conducted a survey
(b) due to factors related to study
in the affected areas, between January 6 to
design—sample size, sampling methods, etc
Ill
15, 1985. Using a sampling frame of 68,000,
(c) real differences in different localities
they randomly selected a 6.66 per cent sam
Mortality
reflecting varying levels of exposure to toxic
ple (1 in 15 households), and administered
a semistructured questionnaire by trained in gas.
Exposure-Related Mortality Rates
The methods used in enumerating deaths
terviewers. They enumerated 82 dead and 5
There is uncertainty as to the exact
would also play a role in accounting for dif
missing (presumed dead) in 700 households
number of people who died. In its petition
ferences between studies in post-exposure
in the severely and moderately affected areas.
in court, the government has claimed 1,700
The exact denominator has not been men death rates. Andersson et al [1984] have men
dead. This is based on death certificates
tioned that they calculated death rates as the
tioned in their preliminary report, to be able
issued/deaths recorded by government
number deceased/number exposed. Other
to calculate rates. They extrapolated the
authorities. The Indian Council of Medical
studies have not stated what they have con
number to their sampling frame of 68,000
Research report (1985) states- that about
sidered and used in the numerator and
to yield 1305 dead. From this study the crude
1,200 people ditd in hospital wards. They
denominator. The different studies were con
death rate for the combined population of
estimate the total death figure to be about
severely and moderately affected commu ducted at varying time intervals following
2,000. The maximum number of deaths were
the exposure. We do not know the time
nities is 19.19/1,000 population. The exact
recorded in JP Nagar, Kazi Camp, Kenchi
period used in the different studies as cut
area covered by the study has not been
Chola and Railway Colony These areas ac mentioned.
off points in the enumeration of deaths
counted for 777 deaths. They quote a study
Besides the caution mentioned earlier attributable to the exposure.
done soon after the disaster, in which 300
regarding extrapolation of rates, it appears
From an aetiological point of view, as well
families consisting of 968 males and 863
that combining rates from different loca as for the victims’ families to receive ade
females were surveyed. 47 deaths in males
lities, e g, severely and moderately exposed quate compensation, it is crucial to try and
and 35 deaths in females were recorded, i e.
to give an overall rate may mask important achieve greater precision in enumerating
the crude post-exposure death rate for this
deaths. It is important dlso to analyse
differences in mortality rates.
population was 48.55/1000 population for
Sathyamala C [1986], surveyed 3 exposed exposure related mortality rates taking into
males and 40.55/1000 population for
localities to study the impact of the exposure consideration age, sex, locality in which they
females. The maximum mortality was in the
on the outcome of pregnancy. The basis of present at the time of the disaster and degree
0 to 5 year and abo\e 60 year age group.
selection was the post-exposure mortality of exposure.
Most deaths occurred within 48 to 72 hours
rates as given in later unpublished data from
Demographic Characteristics
of the disaster. No details are given of exactly
the study by Banerji et al. These were as
how long after the disaster this study was
follows: JP Nagar -65.3/1,000, Kazi Camp
Further details of the study by Banerji et
done, from which population the families
Table 1: Post Exposure Mortality Rates—Summary from Different Sources
were drawn, what the method of sampling
was or details of the age structure of the
Sampling
Area of
Crude Post
Study Group/ Population/
Time of
population or the dead.
Method
Study
Study
Exposure
Investigator
Sample Size
Andersson et al [1985], in an
Death Rate
epidemiological study, conducted during the
first 10 days after the disaster, found the
crude death rate derived from households
in the worst affected population based
cluster to be 3 per cent or 30/1,000 popula
tion (death rates being calculated as number
deceased/number exposed). They have stated
that this data would confirm estimates of
a total of 2000-2500 exposure related deaths.
Random sampling methods were not used
and exact location of study areas have not
been mentioned. However extrapolation of
rates from localised study areas to the total
exposed population should be made with
caution. Reasons for this will be apparent
when summing up the results from the
various studies conducted.
Patel A et al [1985], in another popula
tion based, cross-sectional study, using
statistical methods for sample size deter
mination and random sampling methods,
found that the crude death rate was 86.6/
1,000 population in Jaya Prakash Nagar (01)
and 7.9/1,000 in the control area of Anna
1840
MP State
Government
ICMR
9
9
300 families
(968 males +
863 females)
?
Andersson
et al
? number in
each cluster
?
Patel A
et al
148 exposed
138 controls
Random
sampling
Banerji
et al
700 families
Systematic
sampling
Sathyamala
8165 persons
Random
sampling
Early post
disaster
Shortly
after
disaster
JP Nagar
Anna Nagar
10 days
post
exposure
3 months
post
'exposure
Worst
affected
cluster
JP Nagar
Anna Nagar
23.4/1000
3.2/1000
48.5/1000
(males)
40.5/1000
(females)
3 per cent or
30/1000
9
86.6/1000
7.6/1000
Severely +
moderately
affected areas
JP Nagar
Kazi Camp
Kenchi Chola
9 months
JP Nagar
post exposure Kazi Camp
Kenchi Chola
together
1 month
post
exposure
Economic ajid Political Weekly
192/1000
65.3/1000
46.7/1000
35.7/1000
33.8/1000
August 18, 1990
al [1985] are given here as it describes'the
ed some information of use. However the
bronchi and trachea were red in colour and
age/sex and socioeconomic profile of the
results have not been published or made
the lumen was filled wjjh white tenacious
dead.
available.
material. Microscopic examination showed
(a) Males accounted for 60 per cent of the
Many say that the official numbers are
severe tracheitis and bronchitis with denuda
deaths, which they commented was an im
underestimates of the true figures of mor tion of the epithelium in some sections and
portant and unexplained finding. Majority
tality. Other estimates have been given rang necrotising bronchiolitis in some There was
of these were in the age range of 2 to 20
ing from 5,000-10,000 [Agarwal, 1985].
marked congestion and thickening of the
years. As a first step in interpreting these dif
However most of this data is anecdotal and
alveolar septa. The alveoli were filled with
ferences it is important to take into con
hence difficult to interpret.
albuminous fluid. There was very little
sideration the set ratio and age distribution,
Regarding mortality in the months follow evidence of secondary infection.
i e, the population structure, of the popula
ing the disaster, but attributable to the ex
In the second week while grossly and
tion at risk. As mentioned before, standar
posure, a state government official has stated
microscopically the lungs continued to be
dised mortality rates would be more inter
that during the first year on an average 15
the seat of primary change, there was a
pretable
such deaths were occurring per month
gradual transition in the pathological
(b) There was one death per household in [Diamond, 1985]. Whatever the basis and
changes. Characteristic cherry red colour of
49 households, two deaths/household in 11
validity of this statement it raises the impor the blood, heavy oedematous darkly reddish
households, three deaths/household in 4
tant question of the need to evolve a reliable
lungs and varying degrees of oedema of the
households and one household had 4 deaths.
method to take count of these attributable
brain continued. Acute desquamatous
There is a need to analyse these deaths in
excess deaths.
changes in the trachea and main divisions
terms of degree of exposure.
of the bronchi persisted. There were varying
The number of excess abortions and still
(c) In an attempt towards determining the births should also be added to the death toll.
degrees of bronchiolitis, bronchopneumonia
degree of exposure it was found that: 75 per
To summarise, therefore, the main features and infiltration of the alveolar spaces by
cent of the dead were among those who ran
polymorphonuclear cells.
of mortality in the data reviewed are:
on foot, 23.5 per cent among those who
In the acute phase there was oedema of
(1) Number of deaths: estimates range
remained at home while none who used a
the brain and congestion of the leptomenfrom 1,700-2,500 ->5,000.
vehicle died. This is related to the finding
(2) Exposure related death rates: varies in inges. In a few cases, the liver showed a mild
that 73 per cent ran, 21 per cent stayed in
degree of fatty change which can be either
different studies and in different localities.
their house and 6.3 per cent used a vehicle
(3) Area distribution: severely affected incidental or secondary to anoxia conse
This is plausible because besides direct
quent to pulmonary changes.
areas—JP Nagar, Kazi Camp, Kenchi Chola
exposure to the toxic chemical laden at and Railway Colony.
In the third week the respiratory tract
mosphere those who ran also inhaled deeply
(4) Sex distribution: apparently an excess showed the same appearance, though the
and had an increased rate of respiration thus
lungs were relatively reduced in size and
in males.
getting exposed to more of the toxic gas.
(5) Age distribution: excess in under 5 and weight. However they were still reddish and
(d) Among the dead the socioeconomic over 60 age groups (age/sex estimates based
exuded a lot of fluid from cut surfaces.
profile is as follows: 56 per cent lived in
A striking feature in some cases was that
on crude rates)
houses with large holes, the proportion liv
(6) Socioeconomic class distribution: on opening the thoracic or abdominal
ing in kutcha houses was higher, the propor lower socioeconomic classes most affected.
cavities, viscera which was normal in colour
tion belonging to the lower and backward
(7) Excess abortions and still births rapidly acquired a reddish tinge on coming
castes was significantly higher, the propor occurred.
in contact with the atmosphere. There was
tion of Muslims was similar to that in the
(8) Continuing mortality attributable to variable involvement of other viscera.
study population, i e, those who died were
Brains, which were uniformly heavy and
exposure needs to be considered.
the poorest of the poor. The few rich who
oedematous, showed either uncal grooving
came within the sweep of the cloud of toxic
or tonsillar herniation with compression of
IV
chemicals did not suffer as much damage
the cerebellum by the tentorial edge. In a few
Autopsies
“because of their well built houses, healthier
cases the liver showed severe congestion. The
bodies and possession of/access to transport".
Autopsies were conducted at the Medico spleen though markedly congested was
(e) The study hypothesises that there Legal Institute based at Mahatma Gandhi
shrunken in size and the capsule was wrinkl
would have been an underestimation of
Medical College, Bhopal. Findings have ed. The kidney showed extreme congestion
deaths because of underreporting of deaths
in the cortex and medulla. The heart con
been reported in the ICMR reports (March
among the homeless and destitute who
tained blood clots which were cherry red
and May 1985) and are described in some
would have been the most exposed and
detail here as they are of relevance to under with some chicken fat like material. The liver
vulnerable. An estimate of 3,000 shelterless
showed haemorrhage all over. The capsule
stand the pathology produced in the human
in Bhopal has been made [Agarwal, 1985].
of the liver was found to be separated and
system by acute, severe exposure.
Many of these people used to live around
could be easily pulled off.The gallbladder
the railway station which was directly in the
was distended. The stomach and intestines
First Three Weeks
line of the cloud of toxic chemicals.
had haemorrhages in the submucosa of the
The Tata Institute of Social Studies,
In the first week, the usual postmortem
wall. The spleen was found to be softened.
Bombay, conducted a door-to-door survey
lividity or cyanosis was not present, but there The kidney showed haemorrhages.
regarding exposure, mortality, socioeconomic
was a pinkish discolouration. Conjunctiva
Histopathologically, the lungs showed
status, etc, the results of which were to
were red. Hypostasis was present all over the congestion and oedema. The bronchial
become the basis for relief, compensation
body and was not restricted to the depen lumen was full of exudate. The trachea
and long-term treatment. But its total tally
dent parts. A common finding was the showed superficial ulceration and loss, of
of 1,021 dead, even less than the officially
presence of thick, tenacious, foamy froth cilia. Muscle fibres in the bronchial wall
counted bodies caused it to lose credibility.
covering the nose and mouth.
showed fragmentation. The kidneys showed
The survey failed to cover 600 exposed
Pathological changes were present in the
necrosis of the proximal tubules. Micro
families in which deaths could have occur
entire respiratory tract. Lung weight was two thrombi were present The liver showed cen
red. It could not enumerate 315 families who
to three times the normal. The lungs were trilobular congestion, patchy necrosis and
had migrated outside the city after the
waterlogged and had a cherry red colour.
widening of the central.veins. Heart show
dioarr and. 286 families who had their
They showed congestion, haemorrhage and ed interstitial oedema and nacrosis. Atrophy
houses locked. The findings of the study,
consolidation. The vessels were filled with of the malpigian capsule was a consistent
even with its limitations, would have provid
thick, viscid, dark cherry red blood. The finding in the spleen. The cornea showed
Economic and Political Weekly
August 18, 1990
1841
denudation of the epithelium. The thymus,
testis and ovaries showed no changes. Multi
ple lesions were common. Sections of the
lungs of still bom showed no abnormalities.
They quote the case of a woman who had
manifested MIC effects and subsequently
recovered. She died of hyperpyrexia follow
ing a Caesarian section in the third week of
March 1985. On autopsy (on March 29,
1985) lungs showed congestion, oedema and
haemorrhage, and the small bronchioles
showed obstruction. There was no pontine
haemorrhage. The electron microscopic fin
dings from autopsies showed loss of lining
membrane of the epithelial cells in lungs.
Type 11 pneumocytes were present indicating
that capacity for regeneration was not totally
lost. Red cells looked different—they had
lost their electron opacity. This could be
because haemoglobin is lost or a change has
occurred in the structure of the haemo
globin. Several areas showed zones of ac
tivated fibroblasts. Some lungs showed
secondary bronchopneumonia. The brain
showed presence of siderosomes. Neurones
showed flocculent opacity indicating necro
sis. Examination of one placenta showed loss
of microvilli on the maternal side of the
syncitial trophoblast.
V
Morbidity: Clinical Findings
A profile of the morbidity caused by the
exposure has been compiled from the follow
ing sources of information:
(a) The two reports by the Indian Council
of Medical Research (ICMR) in March and
May 1985 describe the clinical picture and
results of laboratory investigations in the
acute and subacute phases. These observations
were made by staff of the local Mahatma
Gandhi Medical College at its attached
Hamidia Hospital as well as by specialists
sent in from other parts of the country.
Several research projects were set up by the
two organisations in the initial phase for
long-term follow up of the victims. However
further reports of their findings or progress
are not available.
(b) Studies done by non-governmental
groups. These include research teams from
academic departments of universities, inde
pendent professional groups and voluntary
agencies. The clinical picture of morbidity
is described first followed by the epidemio
logical studies. Comments on the strengths
and limitations of the data are interspersed
with the description. There will be a further
discussion of methodological issues later.
The pattern of morbidity varied over time
For the purpose of this report the acute
phase has been considered as the first two
weeks post exposure The subacute phase is
from'two weeks to four months and beyond
that period is the chronic or long-term phase
This classification is arbitrary and partly
artificial to help understand the clinical pic
ture over time The most striking symptoms
and signs with which most people presented
immediately after the disaster or in the acute
1842
phase were related to the eyes and respiratory
[1985] states that people initially complained
tract. There were also a wide variety of
of sudden onset of difficulty in breathing,
clinical symptoms related to different O' tans
coughing and in some cases, pain in the
and systems. A description of the clinical
chest. On auscultation, many had bilateral
findings in the acute and subacute phases
crepitations. X-rays revealed interstitial
■ pulmonary oedema, alveolar type oedema,
follows.
pneumonitis, hyperinflation of lungs and
collapse of surrounding area. Rapid deaths
acute and Sub-Acute phases
following exposure probably resulted from
The Eyes-. Mittal [ICMR, 1985] reported
massive pulmonary oedema and associated
the following eye conditions in patients from
hypoxia.
the hospital OPD and wards of Hamidia
A Bang [1985] in the survey mentioned
Hospital. 8,000 patients were seen here in the above, found that about 25 per cent of the
first 24 hours, and 34,000 patients were population in JP Nagar had respiratory
treated in the first few weeks. Patients symptoms. A large number, even those with
initially corpplained of a severe burning/ minimal respiratory symptoms had coarse
foreign body sensation in the eyes, blurring crepitations and rhonchi. Many of the ‘mild’
of vision, profuse lacrimation, and difficulty cases were either not attending clinics or
in opening the eyelids. On examination there were not being given a thorough clinical
was lid oedema. Sixty to seventy per cent had examination. He pointed out that with in
superficial keratitis and conjunctivitis. adequately designed studies and poor docu
Superficial ulceration of the cornea in the mentation the real epidemiology of morbidity
interpalpebral region was observed in several may be missed. He also observed that the
cases. Many had punctate keratitis in the expected tide of secondary infection did not
lower sector. Corneal pathology was mainly
follow the initial period of chemical pneu
confined to the epithelial layers, rarely monitis. Reasons for this were not under
penetrating the stromal tissues. They observ stood. At the community level, antibiotic
ed that children had fewer ocular problems. cover was either not given or was too inade
Eyes of nearly all the patients returned to quate for most of the affected persons and
near normal in a week’s time with healing hence could not explain the phenomenon.
of the lesions. Detailed investigations did not There are also anecdotal observations that
suggest involvement of the posterior chamber.
dead bodies of people/animals discovered a
There was no evidence of blindness or day or two after the disaster were not decom
deterioration in vision.
posing. On experimental studies [ICMR,
Andersson et al [1984] reported findings
1985] MIC was found to have a bactericidal
in 10 hospitalised patients on the eighth day effect.
post exposure. All had discrete superficial
Andersson et al [1985] observed that
lesions, usually in a band across the inter respiratory distress was most marked in the
palpebral region with the typical whorling community cluster “second in distance from
pattern of new epithelial growth. No limbal the factory”, affecting 20 per cent of the
necrosis or abnormal endothelium was
population. Many were too disabled by
detected. Their findings were in keeping with
breathlessness to move more than a few steps
the report given above.
or even to talk.
Andersson et al [1984] also reported fin
S R Kamat ct al [ICMR, 1985] noted on
dings from a study of community based
24 subjects, (a self-selected group who had
clusters, two weeks post exposure. The exact
gone to Bombay for treatment shortly after
location and distance of the clusters from
the disaster), that lung function tests sug
the factory were not specified. They reported
gested restriction, reversible obstruction and
that over half the community demonstrated
defects in oxygen exchange. Blood gas
eye signs which could be attributed to the
analysis revealed anoxia, compensatory
exposure. These were mainly interpalpebral
respiratory alkalosis, raised carboxyhaemo
injection and signs of healing epithelium.
globin and methaemoglobin. They reported
Fundal changes, mostly venous dilatation
evidence of lymphoid granulations in the
were more common in the exposed. There
throat.
was no difference in the age standardised
They later reported findings from an ex
visual acuity between exposed and unexposed
tensive evaluation of pulmonary function of
groups.
82 patients (also self-reporting to Bombay).
A Bang [1985] reported that in the week
X-rays in 78 were suggestive of interstitial
after the disaster a quick and crude commu pneumonitis. This was corroborated by
nity survey in Jaya Prakash Nagar (100 yards
blood gas and lung function studies.
from the factory) revealed that about 50 per
Methaemoglobin levels were raised in 63 out
cent of the population had eye symptoms.
of 80 and was stated to be suggestive of in
The Nagrik study [1985], found that 80
terstitial alveolitis. Pulmonary function tests
per cent of people within 1 km of the fac indicated central airway obstruction. A large
tory had ophthalmic symptoms, as did 60
majority of the 82 also showed some restric
per cent of those at 2 km and 40 per cent
tive defect. Needle biopsies in five cases
of those at a distance of eight km. This
revealed evidence of interstitial fibrosis.
revealed a gradient of effect as well as the
Later the case group seen at KEM hospital,
fact that exposure occurred even up to 8 Km
Bombay expanded to 113 people. They were
away.
people from the middle class, living in well
Respiratory System-. The ICMR report
built houses two km away from the factory,
Economic and Political Weekly
August 18, 1990
who had voluntarily presented to the
hospital 8—53 days post exposure.
Their symptoms were as follows: breathless
ness on exertion—95 per cent; persistent dry
cough—97 per cent; irritation of throat—66
per cent; chest pain—68 per cent; vomit
ing—42 per cent; muscle weakness—22 per
cent, and altered consciousness—28 per
cent.
The findings on investigation were: low
vital capacity of lungs—27 per cent ( 60 per
cent of normal); impaired oxygen uptake—
55 per cent; central airway obstruction—43
per cent; respiratory alkalosis—59 per cent;
and low oxygen pressure in the blood—23
per cent. Though providing good clinical in
formation this is a highly sei f-selected sam
ple, not representative of the community.
Vijayan [ICMR, 1985] in a study of
pulmonary function on 129 people earned
out in January-February 1985 noted that 70
per cent of cases had abnormal ventilatory
functions on spirometry. He measured forced
vital capacity, forced expiratory volume at
the end of one second and forced expiratory
flow rate at BTPS. He had classified ex
posure status as severe, moderate and mild
and noted that all those with abnormal
pulmonary function had severe or moderate
exposure Pulmonary function was studied
in 129 cases—approximately 40 per cent of
those who complained of respiratory symp
toms had ventilatory impairment, 12 per
cent had restrictive lung disease, 6 per cent
obstructive airway disease and 22 per cent
obstrucnve-cum-restrictive defect. Venti
latory defects were not observed in patients
with mild exposure to toxic gas.
The ICMR report (1985] states that of 35
patients in whom blood gas analysis was
done 23 severely exposed patients had
arterial oxygen tension (Pa02) less than 60
mm Hg, i e moderately low levels. Mode
rately and mildly exposed patients had
normal Pa02. Low arterial carbon dioxide
tension (less than 35 mm Hg) was observed
in 12 cases. It was stated that these results
indicate significant alteration in blood gases
and suggest alteration in oxygen carrying
capacity of the blood.
Narayanan [ICMR. 1985] reported, from
experience in a 30-bedded hospital set up ad
jacent to the factory and hence more accessi
ble to the affected people, that the exposed
populations were suffering from recurring
respiratory problems. They also complained
of inability to perform accustomed physical
activity. They had tachycardia and severe
tachypnoea. The haemoglobin level was nor
mal or raised. On blood gas analysis, PaO2
and PaCO2 were moderately low, PvO2 was
moderately low and PvCO2 very.high and
2,3 DPG (diphosphoglycerate) levels were
also raised. These findings suggested a defect
in oxygen transport and tissue anoxia.
The ICMR report [1985] slates that even
two months post exposure, nearly 4Q per cent
of patients attending the hospital presented
with respiratory symptoms of breathlessness,
cough and in some cases fever. Persistent
tachypnoea was a characteristic feature In
Economic and Political Weekly
some patients, symptoms were out of pro
portion to clinical and radiological obser
vations.
It has been reported that many of the
delayed deaths were preceded by severe
respiratory distress.
Haematology: Ram Singh [ICMR, 1985]
reported initial haematological findings, 15
days-after the exposure. There was haemo
concentration and leucocytosis. There was
no evidence of coagulation disorders. Ap
proximately 25 per cent of severely exposed
cases, reporting to hospital, had haemo
globin levels above 14 gm per cent and 33
per cent had raised eosinophil counts (above
20 per cent).
The ICMR report [1985] describes another
series of 237 cases investigated during the
first two weeks. Polymorphonuclear cells
were increased in 35 per cent of cases, 52 per
cent had raised lymphocyte counts, 19 per
cent had eosinophilia in excess of 20 per
cent, and 15 per cent had haemoglobin levels
above 14 gm per cent.
The ICMR report [1985] quotes a study
finding of a 20-60 per cent reduction of the
free amino groups in the haemoglobin of
persons exposed to the toxic gas.
Gastrointestinal System: The ICMR
report stated that patients also presented
with nausea, vomiting and burning in the
stomach. Endoscopic examination revealed
superficial gastritis and oesophagitis. A
small proportion had hepatomegaly.
Neurological System: ICMR reported that
immediately after the disaster severely af
fected cases showed varying grades of loss
of consciousness ranging from mild to deep
coma. The main presentation in'children was
coma. They report that in a study of neuro
logical disorders in the affected population,
128 adult subjects were screened and revealed
the following: neuromuscular weakness 1,
right hemiplegia 1, hearing loss 2, tremors
and vertigo 2. The method of selection and
source of cases has not been mentioned, nor
w hether a standardised method of examina
tion was used.
Andersson et al [1984] reported that those
who fell unconscious had few or no eye
symptoms or signs on recovery. They also
found that collapse and unconsciousness
was noted in the cluster second in distance
from the factory and not in the others. No
quantitative data has been mentioned, to see
if the difference is significant. This obser
vation suggests that different patterns of
morbidity may occur in different clusters.
Bharucha [ICMR, 1985] reported initial
observations of coma, tremors and paralysis
in some cases soon after the gas leak. No
recognisable patterns of neurological dis
orders were present five months post ex
posure, though many people complained of
general weakness.
In the 113 affected people seen at the
KEM Hospital, Bombay, neurological con
ditions such as sensory motor loss, tremors,
loss of consciousness, irritability and depres
sion were found in a significant number of
cases.
August 18, 1990
Psychological Disorders: Sethi [ICMR,
1985], reported that of 168 cases of mental
disorders treated in special clinics, the ma
jority were neurotic disorders, viz, neurotic
depression, anxiety neurosis and hysteria.
Psychotic disorders were rare Women under
45 years were predominantly affected.
S R Kamat, et al [ICMR, 1985] reported
on psychometric evaluations carried out on
68 self-reporting cases: 22 showed evidence
of depression and 19 showed evidence of
cognitive defects with poor memory per
formance
C
The team from the National Institute
of Mental Health and Neuro-Sciences
(NIMHANS) found a large community load
of mental ill-health following the disaster
[ICMR, 1985]. They reported that approxi
mately 10-12 per cent of those affected, who
visited community based general practice
clinics, were presenting with psychiatric
manifestations. Symptoms of anxiety and
depression were foremost. Sleep distur
bances, nightmares, gas phobia, feeling ol
hopelessness and grief reaction were com
mon. Families of the affected population
were finding it difficult to cope with the
stressful situation. This is an area needing
further study, as the NIMHANS team noted
that long-term after effects have been
reported in previous man-made disasters.
Outcome of Pregnancy. The ICMR report
(March, 1985] -reported findings of 97
women who had delivered. Among them
there were still births—5 (5.15 per cent);
abortions—17 (17J percent) i e, total preg
nancy wastage of 22.7 per cent; congenital
anomalies (minor)—3. Most babies were full
term but with low birth weight, 2 kg on
average In terms of development the babies
appeared normal. The mother's weight was
40-45 kg.
In the ICMR report [May, 1985], Dabkc
described the results of 645 pregnancies: still
births—8, abortions—67. congenital abnor
malities (minor)—9, and low birth weight—
29.8 per cent. They stated that these were not
in excess of those expected in a normal
population. Rates are calculated by relating
the numerator to a given population, i e, the
denominator in a given time period (usually
a year). Hence no comments about normality/
abnormality can be made from the above
data. Comparison with control groups and
if possible with national and regional rates
should also be made.
Reproductive System: R Bang and
M Sadgopal [1985] studied the impact on
women’s reproductive health two months
post exposure. Fifty-five women were ex
amined in Ob/Gynae field clinics in two of
the affected slums—94 percent of these had
leucorrhoea, 79 per cent pelvic inflam
matory disease and 46 per cent had excessive
menstrua! bleeding. Women also gave a
history of suppression of lactation, im
potence in the husbands, abortions and still
births. This provided a clue that there were
adverse effects on reproductive health, par
ticularly women's health, which needed fur
ther investigation. They admitted limitations
1843
of the lack of a control group and small
sample size. However there was also the pro
blem of a self-selection in clinic based data.
Therapeutic Trials
Medical management of patients with eye,
lung, CNS, gastrointestinal and other pre
sentations was symptomatic and followed
standard practice. This approach did prove
life saving and offered some degree of relief
to many. However, wing-*he passage of time,
it was observed that patients kept coming
repeatedly either with persistent symptoms
or relapses following a remission.
While it was acknowledged that some of
the long-term, multisystemic symptoms
could be explained as being due to the after
effects of severe lung damage, ICMR scien
tists [ICMR, 1985] suspected the presence
of systemic toxicity. Autopsy findings, labo
ratory investigations and a rapid literature
search lead to the hypothesis of an enhanced
cyanogen pool in<he body resulting from the
exposure either by direct inhalation of
cyanide or more likely by the breakdown of
MIC within the body. The detailed rationale
for this has not been reported.
Autopsy findings had shown arterialisation of venous blood giving a reddish tinge
to internal organs and tissues. Carboxy
haemoglobin and methaemoglobin were not
detected. However, samples from ail victims
showed twin bands of oxyhaemoglobin. It
was demonstrated that MIC could produce
a reddish colour when mixed with blood.
Urinary thiocyanate levels were found to be
higher in the exposed population. Smoking
and/or exposure to smoke, and the eating
of certain foods, e g, cabbage, spinach,
cassava, etc, are known to enhance the
cyanogen pool and result in increased excre
tion of urinary thiocyanate (which is used
as an indicator of cyanide exposure). Rosling
[1986] summarised the mechanism of detox
ification of cyanide in the body as follows—
cyanide is trapped in the erythrocyte frac
tion of the blood and is convened to the less
toxic thiocyanate in the presence of sulfur.
This conversion is normally attributed to a
reaction with thiosulfate catalysed by the en
zyme rhodanase. Thiocyanate is then ex
creted in the urine. Intravenous administra
tion of sodium thiosulfate is known to in
crease the capacity for detoxification of
cyanide.
The toxic effects of cyanide result from
impairment of the mitochondrial respiratory
chain by inhibition of the mitochondrial
enzyme, cytochrome oxidase. Studies
[ICMR, 1985] have shown that pure MIC
had no effect on cytochrome oxidase, but its
degradation products did. This results in
under-utilisation or non-utilisation of
oxygen at the cellular level.
Based on the hypothesis of an enhanced
cyanogen pool resulting from the exposure
to toxic gases, sodium thiosulfate was ad
ministered to some patients as an antidote
[ICMR, 1985]. It was stated that this resulted
in marked clinical improvement and a sig
nificant increase in PvCO2 in both central
Economic and Political Weekly
and peripheral veins indicating better utilisa
tion of oxygen by the tissues.
A double blind study using sodium
thiosulfate and glucose was conducted. Of
30 patients, 15 each were given two injections
of sodium thiosulfate or glucose. Urinary
thiocyanate levels were determined at ihreeand five-hourly intervals and compared to
the baseline level before the injection. In pa
tients given sodium thiosulfate there was an
8- to-10 fold increase in excretion of thio
cyanate in the urine in a significantly large
number—in 10 out of 15 patients. Only one
of the 15 receiving glucose injections showed
such an increase. Criteria for selection into
the study have not been stated.
Subsequently, Narayanan [ICMR, 1985]
reported that of 230 cases treated, complete
records were available for 167 (87 men, 69
women and 11 children). Symptomatology
before commencing treatment was breath
lessness and/or general weakness/tiredness.
In 29 patients these symptoms were present
at rest. While in 132 they were elicited by
moderate exercise. Following administration
of sodium thiosulfate, 9 showed no improve
ment while there were varying degrees of im
provement in the rest over different periods
of time. Details of how the analysis was done
has not been slated. There were 1() cases of
adverse reactions—five with feverishness and
one each of skin rash, transient venospasm,
a sense of heat over the body, exaggerated
reflexes and loss of memory.
On the basis of these studies, a recommen
dation to use thiosulfate
the therapeutic
agent for the victims was made. Indications
and contraindications for use, dosages for
different age groups and details regarding
administration were spelt out.
H Chandra [ICMR, 1985) reporting on
the results of sodium thiosulfate in over
2,000 cases stated that it was “found to give
beneficial results’’. It is not possible to com
ment on this. Anecdotal reports of dramatic
cures have also been reported.
N P Mishra [ICMR, 1985] reported on a
trial of sodium thiosulfate treatment with
120 cases and 100 suitably matched controls.
Only results of clinical observations were
recorded as there were no facilities for blood
gas analysis. Urinary and serum thiocyanate
levels were studied. Urinary thiocyanate
levels of controls were in the range of 0.5 to
5.65 mg which is much more than 0.6 to 0.9
mg which has been suggested as the normal
range. He therefore doubted the utility of
determining urinary thiocyanate levels. He
studied clinical findings such as dyspnoea,
chest pain, general aches and pains, fatiguea
bility, pain in the abdomen, appetite, pulse
rate, lung signs and subjective feelings. All
these were given an arbitrary score so that
in the worst cases the score totalled to 100.
Results showed that in the 100 cases given
sodium thiosulfate: 60 showed a decrease in
score, 19 had an increase in score, and 21
showed no change. The trial was carried out
double blind. An important finding was that
the greater the initial score before therapy,
the smaller was the reduction of the score
August 18, 1990
after therapy. There were very few cases with
side effects. These were feverishness, skin
rash, sense of heat all over the body—all of
which were relieved by antihistaminics.
Urinary thiocyanate levels were estimated in
60 cases. The mean value before therapy was
1.068 + 1.03 and after therapy 1.46 + 1.113.
The basis for selection of cases and controls
has not been specified. No comparison bet
ween cases and controls has been given
regarding response to sodium thiosulfate
administration or regarding urinary thio
cyanate levels.
The data reported regarding all the studies
done is inadequate for a thorough appraisal.
It is also known that levamisole was used in
a few patients as an immunomodulator.
Controlled clinical trials should be perform
ed for treatments being tried, as only then
will a scientific evaluation of their efficacy
be possible
Discussion of Clinical Findings
From the above account it is apparent that
tremendous effort has gone into the clinical
management of the thousands of patients
who poured into the dispensaries and i
hospitals following the disaster. Medical
staff w-orked round the clock, many of them
suffering from effects of exposure them
selves.
The description reveals the involvement of
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1845
several organ systems in the body. This oc
curred even in the acute phase though it was
then masked by the severity of the effects
on the eyes and respiratory system.
The Environmental Health Criteria 27
[1983] states that few of the non-biologic
agents have unique effects on health and
conversely the effects considered may often
be related to a wide range of factors.
Therefore many aspects of the situation
should be taken into account in trying to
understand etiology and mechanism of
action.
In spite of receiving medical treatment
people kept returning to the clinics with
histories of persistent symptoms or with
relapses following remissions. Recent studies
and clinical experience provide evidence of
chronic effects.
It was not possible to fit the apparently
unrelated symptoms and signs with which
people were presenting into definite
diagnosis. In the toxic oil syndrome which
occurred in Spain clinical observations in the
acute and chronic phase showed features
resembling those of well known disease en
tities, but the combined clinical picture and
pathology findings were unique and sug
gested that the syndrome was new
[Grandjean and Tarkowski, 1983]. A similar
situation is seen in Bhopal. Here, unlike in
Spain the exposure is much more delineated
in time and place. Though the exact com
position of the chemicals causing morbidity
and mortality is not fully known, there is
certainly about it being MIC and its
breakdown products or metabolites. It is the
first instance of human exposure to such
high concentrations of these chemicals. The
event has resulted in a pattern of morbidity
which probably comprises a new disease
complex.
It has been observed that maintenance of
records for individual patients regarding
clinical presentation and treatment were a
casually under the acute emergency condi
tions. This is a lacunae both for the future
treatment of the individual patient as well
as for a thorough understanding of the pat
tern of morbidity caused by the disaster.
A number of medical professionals and
researchers have documented the general
clinical picture with which the affected peo
ple presented to the clinics at varying periods
of time after the disaster. This does provide
very valuable qualitative information about
the cases seen and investigated.
The approach in the documentation
reviewed has been focused mainly on the in
dividual ‘case* and on specific organs and
systems. Some of the limitations of tills
approach are: (a) Because only people who
voluntarily attended*clinics were considered
there is n self selection in the patients seen
and documented. This ‘selection bias’ would
result in the picture of morbidity not being
representative of the morbidity in the com
munity. However it would still provide
descriptive information about the morbidity
produced in those individuals.
1846
From the'estimated 2,00,000 people c / ^sed or at risk only a proportion would h ve
utilised the government health services on
which most of the ICMR reports were based.
Banerji et al [1985] have documented this.
Other possible health services that people
may have utilised are as follows: medical
relief camps set up by a variety of voluntary
agencies, local private practitioners or
registered medical practitioners, special
health schemes of which they were members,
e g, ESI hospitals, railway health services,
etc, health services outside Bhopal, other
systems of medicine/healing prevalent in
India, e g, ayurveda, unani, siddha, homoeo
pathy, etc, some may have utilised several
systems of medicine or some may not have
utilised any service.
Factors affecting utilisation of services
would include accessibility in terms of
finance and distance, severity of illness,
tolerance of symptoms, mental health status
and the beliefs and culture of the people.(b) Cases reported only represent indivi
dual patients and cannot be related to'a
population to derive rates. Morbidity rates
besides providing an estimate of the magni
tude of the problem and its distribution in
the population, could also help one to iden
tify priority groups for treatment and care.
(To be concluded)
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Economic and Political Weekly
August 18, 1990
Health Impact of Bhopal Disaster :'
An Epidemiological Perspective
Thelma Narayan
The chemical accident at Bhopal has been an experience of a public health emergency caused by a technological
disaster, a disaster which overwhelmed the capacity of individuals, physically and psychologically. Because of
the numbers involved and its complexities it also overwhelmed the capacity of the macrosystem, that is, the social
and administrative structures to respond. An epidemiological perspective and method of study is vital to under
standing the pattern and distribution of the adverse outcomes in the community and can provide a variety of data.
The article, the first part of which appeared last week, uses an epidemiological perspective to appraise and
review available literature concerning the health impact of the disaster and discusses methodological issues rele
vant to^an epidemiological approach to the study of such a disaster.
VI
Review of Epidemiological Studies
THERE have been very few epidemiological
studies about the health impact of the
disaster. Reports that are available have been
of studies conducted by non-governmental
groups. They provide important information
about the type and distribution of morbidity
in the community. The methodology and
findings of these studies will now be describ
ed in some detail. Findings from the popu
lation-based, cross-sectional study by Banerji
et al have been discussed earlier in the sec
tion on mortality.
General Morbidity
(I) Andersson et al [1984] conducted a
survey in the first fortnight (December 11-17,
1984) “to assess possible long-term visual
disability among survivors”. The sample
comprised of 8 clusters of households,
selected in different localities which had
received varying degrees of exposure. Tvo
localities of similar socioeconomic status, 15
and 17 km away from the factory, were
selected as the control groups. Details of
location of the exposed groups are not
known. The sample size consisted of 261 ex
posed and 91 unexposed individuals. The
sample size and distribution of the popula
tion in each cluster is not knowm. It was
stated that the sample size was restricted
because of shortage of time before the
exodus from Bhopal during Operation Faith,
which disrupted daily life for some weeks.
Assumptions to determine sample size have
not been mentioned. It was observed that
the worst afflicted families had left by the
time of the survey leading to an under
estimation of effect. Method of sampling
has not been mentioned—it was probably
not randomly done Three ophthalmologists
(one with an interpreter) were the inter
viewers. An attempt to maintain uniformity
was made—standard questions, method of
examination and simplified nomenclature
was used.
The findings are: The post exposure death
rate (which was specified as the number of
deceased/the number exposed) in the.worst
Economic and Political Weekly
affected cluster was 3 per cent. There were
differences in symptoms between the various
clusters or exposure groups: burning of eyes
and throat and coughing were the most fre
quently mentioned symptoms; vomiting was
the third most frequently mentioned symptom
in clusters close to the factory; further away
choking and shortness of breath was higher;
collapse and unconsciousness was reported
only in the cluster second in distance from
the factory—among those unconscious,
there were few or no eye symptoms, upon
recovery; signs of respiratory distress were
most marked in this cluster affecting about
20 per cent of the community; over one half
of this cluster demonstrated eye signs; fundal
changes were more common in the exposed
group especially venous dilatation; there was
no case of blindness, irreversible eye damage
or difference in age standardised visual acui
ty; there was a significantly higher propor
tion of people with active eye infection in
the unexposed communities (5 per cent as
compared to 1 per cent)—it was stated that
this was possibly due to widespread use of
antibiotics in the week preceding the survey
(absence of secondary infection was observed
by Bang in the respiratory system); there was
a similar incidence (this should be pre
valence) of Bitot’s spots in the exposed and
control groups reflecting a similar nutri
tional status in the two groups; and there was
evidence of fairly widespread trachoma in
all the groups, though very few active cases
were seen.
Andersson et al [1985] reported on a twomonth follow up in the clusters mentioned
above. Among the exposed excluding one
cluster to which they had ‘no access’ the
follow up rate was 50 per cent. In both the
exposed and non-exposed groups only 36 per
cent (131/360) were located and reexamin
ed. This is a very high drop-out rate. No in
formation has been given about the baseline
or known characteristics or attempts to
follow up the dropouts. The clusters were
enlarged and 490 people were examined. No
information is given about the new ex
aminees, viz, regarding their distribution ac
cording to localities, their demographic
structure, method used for their selection.
August 25, 1990
etc. Hence data will have to be interpreted
with caution. The findings were:
There were no cases of blindness, decrease
in visual acuity or defect in colour vision.
There were no corneal scars in the original
group but six scars which could impair
vision were detected in the new examinees.
It was not slated whether these were attri
butable to the disaster. There was regression
of the early healing seen in the first examina
tion. There was one case of persistent
unilateral corneal oedema and three with
complaints of persistent excess watering in
an otherwise quiet eye.
A Patel et al [1985] conducted an
epidemiological study of the general health
status of the exposed people (see Tables 2-4).
It was a population-based,’cross-sectional
study, using an exposed and a control group.
The study was conducted three months after
the disaster. Post exposure mortality rates for
the different localities, as given in publica
tions by the state government, were taken as
indicators of the degree of exposure. Jaya
Prakash Nagar, 100 yards from the factory
in the direction of the wind that fatal night,
had an exposure mortality of 2.34 per cent
and was chosen as the study population.
Anna Nagar, 10 km from the factory with
an exposure mortality of 0.32 per cent, was
used as the control group. Both areas were
comparable with respect to housing, sanita
tion and economic status of the population.
Study results showed that mortality rates
were useful indicators of exposure. However
the crude mortality rates found in the study
population were much higher than those
reported in the government publication. The
study findings were: JP Nagar - 86.6/1,000
population, Anna Nagar - 7.9/1,000 popula
tion. Post disaster hospitalisation rates were
also found to indicate differences in ex
posure: JP Nagar - 30 per cent, Anna Nagar
- 0.72 per cent. Sample size determination
was made on the assumption that morbidity
would be 15 per cent in JP Nagar and 5 per
cent in Anna Nagar. With a 5 per cent level
of significance and 90 per cent power, a sam
ple of 180 persons in each group (exposed
and control) was chosen. Persons of both
1905
sexes, more than 10 years of age were
studied.
Numbering of all the households to pro
vide a sampling frame was already done by
the ICMR and the same was utilised in this
study. As random selection of individuals
was not possible, a random selection of 50
household units was made to yield the
required sample size.
A house-to-house survey was conducted.
This consisted of the following: (a) a detailed
history’ on a predesigned questionnaire. Non
standardisation or pretesting of the ques
tionnaire has been accepted as a limitation,
and was reported not to have been done
because of shortage of time, (b) general
clinical examination of all the systems, the
parameters for which had been defined, (c)
pulmonary function tests using Morgans
electronic spirometer set at BTPS. A trained
investigator, with experience in field-based
studies carried out the tests, (d) estimation
of haemoglobin percentage (e) open-ended
questions on the people’s perception of the
health senices available after the disaster.
Information about training of the inter
viewers has not been given. They were not
blind to the hypothesis as this was not possi
ble in any of the studies conducted in that
situation. Group meetings were conducted
in the community to obtain consent. The
people were informed about the research
group—that they were not related to the
government nor were they providers of ser
vices, nor involved with the claims for com
pensation. This would reduce the possibi
lities for ‘compensation malingering’ as
claimed by some. It was found that members
of the particular sample chosen had not
been included in any of the other studies
being conducted, thus ruling out the possi
bility of the learning effect or Hawthorne
effect.
The two populations were comparable
with respect to age and sex structure, body
surface area, history of chronic disease and
smoking. The exposed were slightly better
off socioeconomically than the controls.
There was a rather high non-response rate
of 29 per cent in the exposed group and 15
per cent in the control group. However
available information about the non-responders was collected. Their age and sex
structure was similar to the responders and
50 per cent or more of them were exposed.
Sixty and 50 per cent of non-responders in
the exposed and control groups respectively
were out of town, while 25 per cent were
away for work. There were no refusals.
Repeated visits were made in the time
available to maximise the response rate (the
investigators were a group of people who
had come from different parts of India and
were not resident in Bhopal). It has been
argued that sinceuhe actual difference in
morbidity was much greater than the 10 per
cent assumed in sample size calculations, a
smaller sample size would have demonst
rated a difference and non-response may not
make such an impact. Nevertheless the high
non-response would have altered the process
of random selection and it must be kept in
1905
mind that the non-responders may differ
from the responders with respect to the out
come following the exposure in unknown
and variable ways, e g, as stated by
Andersson el al if the more seriously ill were
among the non-responders there would be
an underestimation of effect.
Briefly the study findings are as follows:
Prevalence rates of 26 symptoms were
measured ip the exposed and control group
at the time of the study. Tests to see if the
differences were statistically significant were
done.
The following 15 symptoms were found
to be highly significantly different, being
higher in the exposed group: cough with ex
pectoration, breathlessness on usual exer
tion, chest pain/tightness, blurred vision/
photophobia, fatigueability, weakness in the
extremities, muscle ache, headache, tingling/
numbness, loss of memory, nausea, abdomi
nal pain, flatulence and anxiety/depression.
The following six symptoms were signi
ficantly different: dry cough, breathlessness
at rest, watering of eyes, skin problems,
bleeding tendency and impotence.
The following five symptoms were not
significantly different: fever, blood in
sputum, jaundice, vomiting, blood in vomit
and malaena.
As many as 63 per cent reported all the
important symptoms. Only 2.7 per cent
reported exclusively pulmonary symptoms,
while 35.14 per cent did not report any
pulmonary symptoms. Every person in the
exposed group reported at least one serious
symptom,’ but quite a few in the control
group did not report any.
There was a significant difference in the
number of attacks of respiratory infections
in the month preceding the study. In the ex
posed group it was often described as a con
tinuous respiratory problem. It was said that
this could be a supportive finding to indicate
a state of lowered resistance or immunity
Exposed women had a significantly higher
rate of abnormalities of menstrual flow,
alteration in the length of the cycle.
dysmenorrboea and leucorrhoea. The sample
was too small to report on abortions and still
births. Fifty per cent of exposed mothers in
the exposed group reported failure of lacta
tion or a decrease in milk output post ex
posure, compared to 11 per cent in the con
trols. Impotence in m erfwas reported by 8.1
per cent in the exposed group and 0.72 per
cent in the controls.
On examination: There was no difference
in the resting pulse and respiratory rates. The
mean haemoglobin per cent in both males
and females was significantly higher in the
exposed group. There was no case of
cyanosis. This was stated to be a significant
negative finding in view of the findings of
87 per cent with breathlessness on exertion,
the raised haemoglobin concentration and
that extensive lung damage was expected Jo
have occurred. 9.4 per cent of the exposed
had crepitations and rhonchi in the chest,
as against 2.1 per cent in the controls
(P<0.025). This rate was also stated to be too
small to account for the much higher rate
of breathlesspess on exertion.
There was a statistically significant dif
ference in pulmonary function tests in bo4^
sexes in the age groups of 15-45 and 45-WF
years. The difference in other age/sex
categories were not significant. However
there were only a small number of observa
tions in these categories. The mean values
of FEV1 and FVC and the FEV1/FVC ratio
in all age/sex categories were diminished in
JP Nagar compared to Anna Nagar. The
15-45 and 46-60 age groups showed a resin-'
tive pattern while the over 61s had n
obstructive pattern. It was stated that ine
control population was also minimally ex
posed, thereby diluting or masking the effect
of the exposure.
Women’s Reproductive Health
R Bang [1985] conducted a study of the
status of women’s reproductive health three
months post exposure. This followed the
earlier survey of a small number of women
Table 2: Comparison of Symptoms Reported by Individuals in JP Nagar and Anna Naga.
(Expressed in percentage. Numbers-of cases are shown in brackets)
SI
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Symptoms
Dry Cough
Cough with expectoration
Breathlessness at rest
Breathlessness on usual exertion
Chest pain/tightness
Weakness in extremities
Fatigue
Anorexia
Nausea
Abdominal pain
Flatulence
Lacrimation
Blurred vision/photophobia
Loss of memory for recent events
Tingling/numbness
JP Nagar
(Per Cent)
Anna Nagar
(Per Cent)
27.70 (41)
47.29 (70)
10.13 (15)
87.16 (129)
50.00 (74)
65.54 (97)
81.08 (120)
66.21 (98)
58.10 (86)
53.37 (79)
68.91 (102)
58.78 (87)
77.02 (141)
45.27 (67)
54.72 (81)
14.49 (20)
23.91 (33)
2.89 (04)
35.50 (49)
26.08 (36)
36.95 (51)
39.85 (55)
2826 (39)
16.66 (23)
25.39 (35)
25.36 (35)
42.62 (58)
33.40 (53)
11.59 (16)
20.28 (28)
P Value*
(a)
P<0.01
<0.001
<0.025
«0.001
<0.001
0.001
0.001
0.001
<0.001
< <0.001
<<0.001
< < 0.01
«0.001
<<0.001
<<0.001
•(a) P Values were calculated by x“ method.
Source: Patel A and Patel A [1985]. The Bhopal disaster aftermath: an epidemiological and
sociomedical survey.
Economic and Political Weekly
August 25, 1990
in the two affected slums (refer to section
On morbidity). The sample consisted of 114
womerun two severely affected areas and 104
women in a -control area (see Table 5).
Reasons for selection of sample size have not
been given. Selection of the sample was from
community based ob/gynae clinics. This in
troduces the problem of self selection as
women with ob/gynae problems would be
expected to attend these clinics. These cases
cannot be related to any population or
denominator. Hence epidemiological extra
polations from these case studies cannot be
made. It is not known if standardised ques
tionnaires or examination schedules were
used. The findings of the study were
reported in Thble 5. The differences are all
highly significant (P <0.001).
The results shown are from a smaller
subset of the original sample, as pelvic
examination could not be performed in some
women due to various reasons like pregnancy,
not being married, and refusals, i e, a selec
tion at this stage has also occurred. However
in spite of the limitations mentioned and
also because similar factors of self selection
occurred for both the exposed and control
groups the difference between them is large
enough to suggest real differences in the two
groups and point to the need to study this
area. Other studies, subsequently, too have
reported similar findings [Patel et al, 1985
and Sathyamala 1986].
In the exposed group there was a history
of spontaneous abortion in seven, still birth
in four, threatened abortion in one and in
complete abortion in one after the gas leak.
No women in the control group reported any
of these adverse outcomes of pregnancy.
Severe pallor was found in 37 (36 per cent)
of the control group but only in 3 (3 per
cent) of the exposed group. This corresponds
to the finding of an increase in haemoglobin
percentage in the exposed population found
in other clinical and epidemiological studies.
Outcome of Pregnancy
Sathyamala C [1986], conducted a comiunity based study of pregnancy outcome,
10 months post exposure (see Tables 6-8). A
large sample was needed to detect significant
differences in rates of abortion and still
birth. The sample size took into account a
non-response rate of 25 per cent which had
been found in earlier studies. A total popula
tion of 8,165 people in 1,632 households were
surveyed. Details regarding assumptions to
determine sample size, power of study, etc,
were not reported. Three exposed localities
(bastis) were selected on the basis of post
exposure morbidity and/or mortality rate.
These were as follows:
JP Nag ar - mortality rate 653/1000, mor
bidity rate 66 per cent
Kazi camp - 46.7/1000, 54-60 per cent
respectively and
Kenchi chola - 35.7/1000, 91.9 per cent
respectively.
These figures were taken from later, un
published analysis of the study by Banerji
et al. The sampling frame provided by the
Economic and Political Weekly
ICMR was utilised and random sampling of
households done. A ‘historic control’ was
utilised, i e, history of pregnancy outcome
in the year preceding the disaster, in the same
population was used as a comparison. This.
was chosen on the basis of studies carried
out elsewhere which demonstrated an abor
tion recall of 82 per cent accuracy even after
a lapse of 10 years. This may have lead to
an under-reporting m the controls and an
overestimation of the difference between the
groups.
A pre-tested questionnaire was used.
Methods used to train interviewers and to
avoid interviewer bias have not been men
tioned. The definition of abortion, missed
periods and delayed periods used for the
purposes of the study have not been men
tioned. Misclassification between the three
could possibly occur. The findings were: The
non-response rate was 22 per cent, within the
limits of what had been considered in sample
size determination.
There were 275 live births and 13 still
births in the population after the gas leak.
The birth rate .was stated to be 33.68/1000
population and was said to be comparable
with :he national binh rate. However births
for only 10 months were taken to calculate
the rate. Normally a period of 12 months
is used and hence the rate calculated would
be an underestimation. It is also the crude
binh rate, not being standardised for the age
and sex structure of the population. The still
birth rate post exposure was found to be
47.27 1000 live births. However live and still
binhs together should be taken in the deno
minator. The rate then is 45.25/1000 births.
No comparison with national, regional or
study based still binh rates has been made.
The overall spontaneous abortion rate
after the gas leak w-as 370.96 which was
statistically very significantly higher than the
spontaneous abortion rate of 32.178 before
the gas leak.
A second important finding is that the
rate of spontaneous abortions in women
who conceived after the gas leak is again
statistically highly significantly greater than
the abortion rates before the gas leak. The
increase being about 5 times greater than
before the gas leak.
The overall foetal death ratio was statis
tically significantly increased in the year
following the gas leak in comparison to the
previous year.
While past obstetric history, parity, period
of gestation at the time of abortion, etc, w-ere
measured they were not taken into considera
tion in the analysis. These are important
interactive and confounding variables.
Changes in regularity of the menstrual cycle,
delayed and missed periods, length of cycle •
and type of flow, were also found to be.
statistically significantly different before and
after the gas leak.
Case Referent Study of Watering
of Eyes
Andersson et al [1986] conducted a case
referent study of persistent eye watering. An
eye hospital started in Bhopal in response
to the disaster was used as the source of
cases and controls. Tvo consecutive retros
pective series of clinical records were drawn
for outpatients on whom exposure data were
available. This would be a source of selec
tion bias as it is probable that exposure
status may not have been recorded equally
in the exposed and non-exposed groups. The
method by which exposure was assessed and
recorded has not been mentioned. The fin
dings were:
Table 3: Comparison of Significant SymptomsReported by Individuals in JP Nagar and
Anna Nagar
SI
Noi
Symptoms
JP Nagar
(Per Cent)
Anna Nagar
(Per Cent)
P V^lue*
(a)
1
2
3
4
5
6
Sk:n problems
Bleeding tendenev
Headache
Muscle ache
Impotence
Anxiety/de pression
29.05 (43)
9.45 (14)
66.89 (99)
72.97 (108)
8.10 (12)
43.92 (65)
11.59 (16)
2.89 (04)
42.02 (58)
36.23 (50)
0.72 (01)
10.14 (14)
<0.01
<0.025
<0.001
<0.001
< .05
«0.001
Notes-- Numbers of cares are shown in brackets.
’ (a) Values were calculated by X2 method.
Table 4: Comparison of Non-Significant Symptoms Reported by Individuals in JP Nagar
and Anna Nagar
SI
Ncl
Symptoms
1 Blood in- sputum
2 Fb-er
3 Jaundice
4 Bleed in vomit/stcci/malena
5 Vomiting
JP Nagar
(Per Cent)
Anna Nagar
(Per Cent)
P Value*
(a)
10.13 (15)
27.70 (41)
0.67 (01)
12.16 (18)
11.48 (17)
7.24 (10)
28.98 (40)
00
10.14 (14)
5.79 (08)
NS
NS
NS
NS
NS
Notes'. Numbers of cares are shown in brackets.
’*a) P Values were calculated by x2
Sourer. Patel A and Pirel A [1985].
August 25, 1990
1907
Gas exposed people were three times more rabbits. A dose ranging study in human
lenses were incubated with MIC.
likely to present with watering eyes (odds
volunteers has been referred to by the
Salmon et al [1985] reported that at low
rario -OR- 2.96, 95 pe; cent confidence in ACGIH (American Conference of Govern
concentrations in rats MIC caused severe
terval -CI- 2.3 • 3.4) and nearly 4 times
mental Industrial Hygienists). There were no
sensory irritation with slow, irregular
mere likely to present with watering and at
effects at 0.4 ppm but exposure to 21 ppm
breathing and the production of a sedative
least one other irritant symptom (burning,
was unbearable.
effect. At higher concentrations this was
itching, redness) (OR 3.8, 95 per cent CI 3.12
Mention has been made of the intense ir
masked by arousal resulting from respiratory
- 4.4). There was no association between ex ritation caused to eyes, nose and the throat.
distress. Eye damage was always confined
posure and refractive errors (OR 1.16, 95 per
Kimmerle and Eben [1964], studying MIC
to the epithelia! layer with most severity at
cent CI 0.83 -1.9).
toxicity by inhalation exposure, observed
intermediate exposures suggesting that at
There is no explanation for the symptom
that it was highly irritating to skin and
high doses some protective response was
of persistent watering of the eyes. The report
mucosa and that it produced pulmonary
evoked. Urinary thiocyanate levels in the ex
suggests tear film instability due to long «dema. There was little published material
posed were lower than in the controls. They
term effect of exposure on epithelial matura on the effects of sublethal doses, dose
observed a dose dependent response and
tion or abnormality of the mucus compo
response and metabobc/chemical breakdown
supported the use of death rates and in
nent of the tear film which is derived from
products of MIC.
cidence of pulmonary damage as a crude in
the epithelium itself and from conjunctival
Post-Disaster. Several toxicological studies
dex of exposure in epidemiological studies.
goblet cells.
on different animal models have been con
Nemery et al [1985] reported that at very
In summary, the epidemiological investi
ducted after the disaster. Because of the
high concentrations (10 mg/L for 15 mins)
gations conducted have studied different
short life span of the animals used, each
50 per cent of the rats died. The lungs were
aspects of the health impact of the disaster
animal year being equivalent to several years
enlarged with air. Gross oedema or haemor
at different points in lime (see Table 9). They. of human life, an estimate of long-term ef rhage was present only in 2 rats killed after
vary in methodology used and critical com fects of exposure can be made relatively ear exposure. The mam effects of low concen
ments regarding this aspect have been given
ly. Experiments and pathological investiga trations of MIC on the respiratory tract was
above. They were conducted in difficult cir tions not ethical or permissible to be con to injure the proximal airways with littk
cumstances and despite some methodo ducted on humans can also be performed.
alveolar injury. At high concentrations lu^|
parenchyma was also damaged with resultu™
logical limitations they all record very
The main limitation of animal studies
serious effects on the health of those expos however, in general is that extrapolation of
interstitial and alveolar oedema, inflamma
ed. They support clinical findings of multiresults to humans has to be made with caution and haemorrhage. Though there was
systemic and long-term effects. However,
non because of the differences in the
complete destruction of bronchiolar epithe
some of the important findings from these
biological systems. Another limiting factor
lium, repair took place. However despite
studies, that may provide clues for enology,
to be borne in mind in this particular case
rapid resolution, they found isolated foci of
if followed up are:
s that in all the animal experiments con more recent injury in animals killed 2-3
weeks after exposure. They found MIC to
(A) The varying pattern of morbidity in ducted so far, only pure MIC has been used
as the agent of exposure. In Bhopal under
be a respiratory irritant, i e, both a sensory
clusters at different distances away from the
the prevalent conditions of high pressure and
factory in the acute phase. This was not just
(stimulation of nerve endings in the nasal
temperature and in the presence of catalysts
mucosa) and pulmonary irritant (impact on
in magnitude of effect, but there were quali
ether chemical reactions could have occurred
tative differences of differing symptomato
lower respiratory tract).
with the formation of other chemicals.
Ferguson et al [1936] im mice experiments
logy (Andersson et al) in different clusters.
However the advantage is that these experi also found MIC to be a potent tenrery and
This points to the possibility of the role
ments can indicate lesions attributable to
pulmonary irritanL They have coaridcrablc
played by different chemicals. Follow up
MIC. They can be used to support/explain
studies should look at different clusters over
experience in working with isocyanates and
epidemiological observations and similarly
have found MIC to be the most potent
time.
pulmonary irritant they have tested in the
(B) The presence of a percentage or pro epidemiological data can provide clues for
experimental work. The objective of both
isocyanate series. They found that the RD
portion of individuals with multisystemic
endeavours together being to explain
50 (the concentraikm evoking a 50 per cent
symptoms in the absence of lung disease
znechanisms/pathogencsis to the extent
decrease in the respiratory rate) and the RD
(Patel et al) in the sub-acute phase. This sug
necessary for rational interventions in the
50 TC (the RD 50 in tracheally cannulated
gests that severe lung damage may not ac
treatment and/or rehabilitation of victims
mice) was separated only by a factor of 1
count for all the chronic effects.
Thus a concentration capable of evoking
(C) Significantly higher adverse outcome and in the prognosis of their condition.
The method of MIC exposure used in
tense sensory irritation of the eyes, nose and
of pregnancy in exposed women conceiving
animal studies has been by inhalation, with
throat is close to that capable of inducing
after the disaster, compared to controls.
doses varying between experiments, They all
pulmonary irritation. MIC is thus classified
Congenital abnormalities also need to be
med to simulate the possible dose range that
as a respiratory irritanL They found it to be
studied. This very serious observation points
could have existed during the Bhopal
seven times more potent than chlorine.
to the presence of continuing toxicity.
disaster.
Luster et al [1936] found a steep dose
Infants, pre-school and school age children,
Harding et al [1985] reported the develop response for toxicity. During 90-day recovery
a vulnerable group, have not been studied.
ment of lens opacities or cataracts when rat
studies epithelial injury generally resolved,
Respiratory disability has not been studied
at the population level. Natural history of
Table 5: Findings
R Bang*s Study
the morbidity and the excess mortality that
Chi Square
Exposed
Control
continues to occur also remain to be studied.
Group
Group
VII
Experimental Studies
Pre-Disaster. Data on the toxicology of
MIC was scarce at the time of the disaster.
Median lethal doses in animals were availa
ble, e g, it was 5 ppm for 4 hours by inhala
tion in the rat In another experiment a dose
of 62.5 ppm for 4 hours killed all the expos
ed rats. Corneal injury has been recorded in
1908
Total no studied
114
Pelvic exam done
72 (63%)
Leucorrhoea
65/72 (90%)
PID
57/72 (79%)
Cerv erosion/endocervicitis
54/72 (75%)
Excess menstrual bleeding since exposure 27/87 (31V»)
Suppression of lactation
16/27 (59"7.)
104
52 (50%)
14/52 (27%)
14/52 (27%)
23/52 (44%)
1/81 (13%)
2/16 (12%)
_
—
51.67
34.67
1139
26.19
10.17
The differences are all highly significant (P < 0.001).
Economic and Political Weekly
August 25, 1990
but prominent fibrosis devdoped in the walls
of the major bronchi. They reported no in
jury to the spleen, liver, kidney, thymus or
brain. Haematological values except for
slightly increased haematocrit were within
the normal range. They found humoral im
munity to be unaffected. In spite of a 30 per
cent suppression in T cell lympho-proli
ferative response they found host response
resistance not affected.
Fowler and Dodd [1986] studied rats, mice
and guinea pigs. Gasserl [1986] observed
that this study was the most comprehensive
inhalation study of MIC to date. It was produced some years before the Bhopal disaster
under private contract 48 with Union Car
bide but was not published until 1986. It pro
vided evidence of bronchiolitis obliterans in
guinea pigs (only) exposed to 10.5 and 5.4
ppm MIC for six hours. They also noted
dose related lesions in the respirator)’ tract.
No deaths occurred in animals exposed to
I or 2.4 ppm MIC. The majority of deaths
for 10.5 and 20.4 ppm occurred through post
posure day 3; at 5.4 ppm deaths occurred
^roughout the 14 days. Deaths were at
tributed to pulmonary vascular alterations.ICMR studies {1985] found that the cherry
red appearance of the blood could be due
to the direct action of MIC (by carbamylation) and need not necessarily be due to
cyanide or carbon monoxide. Carbon
monoxide poisoning was ruled out. Analysis
of human tissue by gas chromatography in
dicated the presence of monomethylamine.
On animal studies they found that MIC had
an LD 50 dose of 85 mg in mice, but with
thiosulfate therapy it shifted to 195 gms. For
Table 6: Rate of Spontaneous Abortion
BEFORE AND AFTER GAS LEAK
After
Before
404
310
Total conceptions
No of abortions
13
115
32.178/1000 370.96/1000
Abortion rate
conceptions conceptions
rats the figures were 270 and 344 respectively.
Normal rabbit lungs weighed 6 gms, follow
ing MIC exposure they weighed 29 gms and
had a large number of haemorrhagic pat
ches. When given sodium thiosulfate im
mediately after MIC exposure the lungs
weighed 24 gms but the appearance was nor
mal. With pure MIC they also found a dose
dependent response in the respiratory tract.
They found that MIC had bactericidal
activity.
Salmon [1986] also reported that MIC
could produce a reddish tinge to blood.
However differences could be detected on
spectrometric analysis.
Varma et al reported adverse effects on the
oestrus cycle and fertility in male and female
mice.
Gassert et al [1986] reported on a
14-monlh follow up of rats exposed to MIC.
Two exposed rats died at 6 and 8 months
following sudden onset of respiratory dis
tress. Six rats killed at 14 months revealed
a history of mild respirators infections. Mild
interstitial fibrosis in the peribronchiolar
region was present in all exposed rats. A
notable finding was that MIC exposed
animals had four times the amount of lym
phoid aggregates found in control animals
adjacent to the bronchiolar airways. A mild
infiltrate of eosinophils-was present in the
bro? chiolar mucosa. Eosinophil and lym
phoid infiltrates were found in the mucosa
of the conjunctiva of the eyelids and pcrilimbal regions. They state that long-term
changes in the eyes and lungs may result
from a single two-hour exposure to acute
sublethal doses of MIC vapours and that the
immune system is most.probab!y directly in
volved. They suggest that lymphoid
hyperplasia may be due to persisting ex
posure related antigens or to an increased
susceptibility to other immunostimulating
agents following Ml£ exposure
Thus animal experiments reveal that MIC
is extremely toxic on inhalation—being a po
tent respiratory irritant. Chronic morbidity
,ble7: Abortion Rate in Conceptions before GL Aborted before GL and abortion Rate
in Conceptions after GL
Conception
BGL
Abortion
BGL
Abortion
Rate
Conception
AGL
Abortion
AGL
Abortion
Rate
13
32.178/1000
Conceptions
310
45
145.16/1000
Conceptions
404
(BGL-before gas leak, AGL-after gas leak).
Table 8: Foetal Death Ratio before and after Gas Leak
Quarter
January-March
April-June
July-September
Number
Delivered
(LB + SB)
30
87
56
1984___________
Number
FD
Aborted
Ratio
2
12
3
6.66
13.79
5.35
Number
Delivered
1985
Number
Aborted
FD
Ratio
76 •
77
94
27
24
20
35.52
31.16
21.27
(LB - live births, SB - still births; FD ratio - foetal death ratio).
Note: The foetal death ratio has not been defined but appears to be the number of abortions
per 100 live and still births.
Economic and Political Weekly
August 25, 1990
and a continuing increase in mortality has
been reported in the exposed animals. The
studies suggest three possible mechanisms
by which this may occur: (a) due to long
term sequelae of severe lung damage caused
by the direct toxic or irritant effects of the
chemicals, (b) due to damage to the im
munological system, (c) due to systemic toxi
city caused by mechanisms as yet unknown.
VIII
Discussion
The discussion on methodological points
will cover the following areas: a) the ex
posure variable, b) the population at risk,
c) the health outcomes, d) confounding
variables and e) sources of bias.
Exposure Variable
Results from the few early studies con
ducted, together with experience of physi
cians and social workers in Bhopal and toxi
cological studies in animals indicate that the
exposure has resulted in long-term adverse
effects on health. These findings point to the
need for long-term follow-up of the victims.
As a first step valid measurements of ex
posure need to be evolved.
(a) Defining Exposure. It is necessary in
the conduct of epidemiological studies in
Bhopal to have a working definition of the
exposure variable. Indicators or measures of
the degree of exposure are also needed to
estimate posable dose-dependent responses
in the outcome variables of mortality, mor
bidity and disability.
Previous studies have used the following
as indicators of exposure: post-exposure
mortality rates in defined localities as
reported by the state government study fin
dings have shown that these did provide a
rough estimate of exposure in different
localities. The rates found in the studies
were, however, much higher than the rates
reported by the government. Issues'concerning mortality rates have been discussed
earlier. A combination of death in the family
or exposure-related mortality rates along
with grades of morbidity as a measure of
exposure; one study found that immediate
post-exposure hospitalisation rates were also
related to the degree of exposure.
(b) Variability in Exposure. Epidemiological
studies reveal that control areas 10km away
from the factory have been mildly exposed.
Studies have also shown a variability in the
picture of morbidity in different localities
as well as variability in individuals or groups
of people living in the same locality. Besides
differences in individual susceptibility ac
counting for some of the variability, both
the above observations suggest that the
factor of ‘exposure’ needs to be considered
more carefully. The two important issues to
be considered are: the area and hence the
population exposed may be larger than the
accepted 2,00,000, several variables which
determine the exposure level for an
individual—results from the various studies
have indicated that these are: (1) distance
1909
from the factory at which the individual was
at the time of the disaster, taking into con
sideration the direction of the wind; (2) type
of housing: pucca (well built), kutcha
(without brick and cement), presence of
gaps/holes letting in air (3) action taken at
the time of the disaster, viz, a) measures of
exposure to the atmosphere: kept all doors
and windows closed and remained indoors,
opened doors and windows, stayed in the
house, went out, remained in the area; (b)
measures of exertion: left area, walked, left
area, ran, left area, cycled, left area, used
motorised transport; (c) use of neutralisi ng/protective measures: used a wet cloth
over the face, covered face with a blanket,
went in a direction opposite to that of the
wind.
Thus a single parameter by itself, e g,
distance away from the factory, may not
reflect the true exposure status of the in
dividual which would also depend on other
actions that the person took at the time of
the disaster. This could be one of the reasons
to explain the variability in mortality and in
the pattern and degree of morbidity in dif
ferent individuals even in the same locality.
Other-factors like age, level of nutrition and
general resistance, presence of other diseases,
etc, would also play a role. All the above will
have to be considered in studies of morbidity
as well as in determining priority groups of method—in this case blood samples wilt be
people who would need greater care and needed—have the drawback of increased
follow up.
nonresponse. Besides this, increased costs,
(c) Exposure at individual and population the need for investigators who have requisite
level: Mortality rates could be a measure cf skills, the availability of laboratory facilities,
exposure to classify localities and areas, i e, etc, will have to be considered. Studies car
they could be used as indicators of degree ried out so far have shown that the use of
of exposure at the population level. While crude morbidity and mortality rates have
the other factors outlined above could be served as markers of degree of exposure.
used as measures of the exposure status of Salmon et al [1985] have confirmed this on
individuals.
the basis of experimental studies. With a lit
(d) Measurement (assessment) of ex tle refining as suggested above, standardisa
posure: History taking is the traditional tion and pretesting, questiqnnaires could
medical method of determining the exposure continue to be used to measure the degree
status of an individual. However in Bhopal of exposure.
a large population has been affected. Several
studies into the health effects will need to
POPULATION AT RISK
be conducted over a long period of time and
several interviewers will be involved. To en
The population at risk would comprise all
sure comparability between studies and con those who were exposed to the agent and
sistency over a period of time, a standard, who could potentially manifest adverse
repeatable and valid method of determina health outcomes as a result of the exposure.
tion of exposure should be used. A standar It would form the denominator in calcu
dised questionnaire, using the factors lating exposure-related rates of morbidity
discussed earlier would provide a simple, in and mortality for the population. Various
expensive, non-invasivc tool of investigation. subgroups of this population could also be
There have been attempts to develop studied, e g, according to age, sex, socio
biological markers of exposure, e g, an economic status, degree of- exposure, etc.
tibodies or enzyme-related makers. They are Epidemiological profiles for groups broadly
still in the experimental stage and will have classified as severly, moderately and mildly
to be field-tested. However, any invasive exposed could be built up. Factors discuss
Table 9: Summary of Epidemiological Studies Conducted in Bhopal —Methodological Aspects
Time
Investigator
Focus
of Study
r Andersson
ct al
Eyes, general Population December
1984, and
morbidity
based,
February
clusters +
controls, +2 1985
month follow
up
2 D Banerji
et al
Mortality,
general
features
3 R Bang
Clinic
Women’s
reproductive based case
series in
health
exposed +
control
areas
4 A Patel
et al
General
health
5 Sathyamala
6 Andersson
ct al
1910
Type of
Study
Person
Sample
Size
Severely +
moderately
+ mildly
exposed
areas
General
population
261 exposed, Opportuni- 64 per cent
91 unexposed sue sample, at follow up
persons
i e, as many
as could be
examined
Severely + General
moderately population
exposed
areas
FebruarySeverely
' WomenMarch 1985 exposed + reproductive
control
age group
areas
Population January
based, cross- 1985
sectional
Population
based, cross
sectional,
exposed +
’control
areas
Outcome of Population
based,
pregnancy
crosssectional,
historic
control
Watering
of eyes
Place
700
households
114
exposed,
104 unexposed
persons
March
1985
Severely
exposed +
control
areas
General
population
>10 yrs
of age
180
persons
in each
group
September
1985
3 severely
exposed
areas
Pregnant
women
out of
general
population
8165
persons
in 1632
households
November
Eye
Case
1985hospital
control,
record based January 1986
989
Eye
patients
from general
population
Sampling
Method
Study
Instrument
NonResponse
3 ophthal
mologist in
terviewers,
attempts to
maintain
uniformity in
history
taking and
examination
Pre-designed
Random
?
sampling
question
naire, trained
investigator
Self selected Pelvic exam 1 gynae
sample,
not done
cologist in
women
in 43.2
vestigator,
attending
per cent
routine
field based
history
Ob/Gyn
taking and
clinical exam
clinics
Random
29 per cent Pre-designed
in exposed, questionnaire
sampling
15 per cent with defined
in control
parameters,
group
? training of
investigators
Random
22 per cent • Pre-designed,
sampling
pre-tested
question
naire,
? training of
investigators
Those with
recorded
exposure
status
—
Economic and Political Weekly
Hospital
case’
records
August 25, 1990
ed under exposure vanable will have to be
considered.
Numbering of all the households to create
-a sampling framework was done shortly
after the disaster. Since a relatively small
population has been affected arid there is a
need for long-term follow-up, a population
register or case registers could be maintained
on computer after a census of the exposed
population.
This would provide a good base for
follow-up studies.
Health Outcome
(a)
Mortality rates/standardisation:
exposure; and latent period, which is the
(d) Misclassification of exposure status or
period after causation before the disease is
of outcome (if the diseased condition is un
detected.
diagnosed or misdiagnosed) will enhance or
decrease the association depending on the
Early studies may thus miss still evolving
disease conditions which could be picked up
direction of the misclassification. In Bhopal
by prospective longitudinal studies or epide this is very likely when using routine sources
miological monitoring systems.
of data, as many medical professionals deal
(c) Complementary causes or predisposing ing with a previously unknown situation,
factors would play a role in the development
have tended to use the nearest known
of the disease outcome by increasing th.- diagnosis to fit the presenting symptoms and
signs. This re-emphasises the need to have
susceptibility of individuals. People with a
larger set of complementary causes would
a working definition of the outcome for
need a smaller dose of exposure to complete
documentation and study.
a sufficient cause and result in a diseased
(e) The non-response rate has been found
condition [Rothman 1986]. Exposure to the
to be quite high (20-29 per cent) in all the
toxic chemicals may unmask or exacerbate
studies conducted in Bhopal. Besides alter
existing disease, e g, chronic bronchitis,
ing the sample size this would also affect the
asthma, TB, etc These would be considered
composition of the sample, depending on
confounding factors in the analysis of
the characteristics of the non-responders.
studies. But, from the point of view of the
Allowance for non response should be made
health condition of the people and for the
in determination of sample size and also in
provision of health care services, their
budgeting for time and finances to allow for
presence would cause the individual to be
more intensive follow-up of a percentage of
placed in a priority group.
the non-responders.
The number of deaths following the dis
aster would have to be related to the exposed
population to derive crude rates. These could
be standardised for age and sex by com
parison with a standard population of
similar socioeconomic status, and Standar
dised Mortality Ratios (SMRs) could be
calculated. The time period during which
oaths are enumerated would have to be con
(f) Observer bias leading to a bias in
Confounding Variables and Sources
sidered in the calculation of exposure-related
history-taking, recording, interpretation of
of Bias
^nortality rates. As with morbidity this could
Socioeconomic status is closely related to findings or in diagnosis may occur. The fac
be calculated for the acute, subacute and
tors that play a role specifically in Bhopal
exposure and to outcome and would be a
long-term phases. Rates for different
are: Those who believe that all is well in
confounding factor. Stratification in design
localities should also be calculated.
Bhopal try to underplay or explain away the
or group matching could be used to account
These rates could be calculated using
symptoms of the people. This is evident in
for this. Age and sex would also have to be
routine sources of data. However in the
the attitude of many who attribute every
considered. In the Bhopal situation, smok
longitudinal study, life table analysis could
symptom to the presence of chronic diseases
ing, exposure to smoke or air pollution in
be done There should be a good reporting
or as psychosomatic symptoms or as com
the home (cooking on smoky fires) or at
system for deaths in the exposed and control
pensation malingering. On the other hand
work, nutritional status, presence of chronic
populations. Staff and investigators should
those who-believe that a conscious anti
diseases, e g, TB, trachoma, asthma, chronic
be trained in the use of the Internationa)
people crime has been committed in Bhopal
bronchitis would be interactive factors which
Classification of Diseases and if necessary
may let their beliefs affect reporting or
would have to be measured and allowed for
suitable standardised criteria could be evolv
interpretation of what the people say.
in the analysis.
ed for the classification of deaths. Autop
The above factors could be reduced by the
Several sources of bias have to be con
sies should be preformed in a sample of
training of interviewers and in the use of
sidered: (a) Stewart [1985] has raised the
deaths among the exposed group, as is the
blind techniques when possible in certain in
issue of ‘survivor bias’ in follow up studies
requirement in any medico legal case
vestigations, e g, in reading X-ray films, etc.
(a) Assessment criteria: This has been the of survivors of the atomic bomb explosion
in Hiroshima and Nagasaki. This could oc Keeping investigators blind to exposure
first time that a whole population has been
status is not possible
cur in any cohort of people surviving a
exposed to high concentrations of these
(g) Measurement bias would be important
major catastrophe The parent population
chemical agents. The exposure has, there
loses a high proportion of vulnerable indi to keep in mind especially when using in
fore, resulted in a group of symptoms and
strumentation for lung function tests. Stan
viduals—the very young, the old and the
gns which together do not fit easily into
dardised instruments and techniques are
sick. Thus when comparisons of mortality
ktablished disease entities. This new disease
available The instruments should be cali
are made with a control group in follow-up
raomplex would have to be named appro
studies there will be an underestimation of brated and maintained to give accurate and
priately, e g, the ‘Bhopal Toxic Gas Syn
reliable readings over a period of time
the effect. One may get a normal death rate
drome1. For the purpose of epidemiological
in the survivors, though it may actually be
studies working case definitions of this
Suggestions
slightly raised. This is similar to the bias
disease complex would have to be developed.
Several research projects, involving
caused by the “healthy worker effect” in
This would have to be done based on the
different specialities, are being undertaken
studies of occupational groups. This factor
clinical experience of medical professionals
in Bhopal and elsewhere, on various aspects
would have to be kept in mind in long-term
treating the exposed population together
of the disaster. As outlined earlier there is
studies in Bhopal.
with the help of epidemiologists to ensure
a need for supportive epidemiological
(b) There would be a selection bias in studies, especially those that are population
simple, standard criteria which can be ap
hospital or clinic based studies due to self
plied in the field. It would basically com
based.
selection of people attending these services.
prise of groupings of characteristic symp
In Bhopal a cohort of people have,
With the plurality of services and factors of been exposed at a point of time to chemical
toms and signs.
(b) There may be a lag period between the accessibility this would be important in
agents. There is a need to study:
Bhopal. The utilisation of health services in
exposure and some pathological conditions
(1) the range of health effects stemming
the subacute phase as reported by Banerji
which have not as yet manifested. Rothman
from the exposure,
et al [1985] shows that this occurs.
[1985] states that one must allow for the
(2) the natural history of these health
following: a biologically appropriate induc
(c) Bias due to migration of people into effects.
tion time during which a sufficient cause
and out of the population, new births and
An epidemiological study is basically an
becomes complete. This may be quicker for
deaths, all of which would affect the baseline exercise in quantifying disease occurrence
heavy exposures and slower due to interac
population have been considered earlier in and using a logical method in deriving intion with other factors for lower doses of
the report.
ferences/explanations to account for varia
Economic and Political Weekly
August 25, 1990
1911
to be used. These would include question
be done locally, with details of the baseline
naires, clinical examination, lung function
population. Differences in the prevalence of
tests, etc. The parameters to be measured at
symptomatology between the exposed and
entry and follow-up should be specified.
control groups, as found in previous studies,
should be used for the calculation. The level
Numerous studies of diseases of the respi
ratory system and its risk factors have been
of statistical significance and power required
for the study should be decided. The high
conducted. Instruments which are valid and
reliable are available. Three standard ques
non-response rate as found in previous
tionnaires Have been developed for the study
studies and possible dropout rates should be
of respiratory epidemiology by the British
considered.
Medical Research Council, US National
To ensure representativeness and to avoid
Heart and Lung Institute (NHLI) and the
bias, population based, random sampling
should be used. With this method the pro American Thoracic Society. A suitable one
could be combined with general health ques
bability of selection into the sample is the
tionnaires. Standardised methods for spiro
same for all individual units. Though the
metric lung function tests are also available
sampling framework has been set up, it
Random hnd systematic sources of error in
could be rechecked keeping in mind the
measurenient must be minimised.
discussion of the population at risk. The
(8) Other factors to be considered are the
method used in the cross-sectional and
training of investigators, pilot testing and
longitudinal studies would have to be a
planning for the follow-up of a percentage
house-to-house survey.
of non-rcsponders.
Community meetings as in the study by
(9) Analysis: In a longitudinal study an
Patel, et al, should be conducted with the
unbiased estimate of the relation between ex
people to inform them of the study, discuss
posure and outcome is obtained. The relative
with them the need for continued study,
risk (incidence rate in the cxposed/incidence
reasons for random sampling, etc.
(3) Ethical aspects: Obtaining consent rate in the unexposed) and absolute risk (in
from study participants and maintenance of cidence rate in the exposed-incidence rate in
the unexposed) can be calculated. It would
confidentiality of patients records should be
be more useful to work out person years of
planned for.
(4) Study population: Besides the general risk and calculate the force of mortality/
morbidity or the instantaneous mortality/
adult population, ’infants, preschool and
school age children should also be con morbidity rate The risk of developing a
particular outcome (dcath/diseasc) can be
sidered. This group has not been studied in
estimated for a variety of initial charac
the studies reviewed. The advantages of this
teristics, c g, distance from factory, action
group are that they would have had no
Longitudinal Study'-. A cross sectional
taken at the time of disaster, main presen
serious exposure to smoke (though passive
study should form the baseline for a pros
ting symptom in the acute phase etc.
smoking would have to be considered) and
pective, longitudinal study. Important points
(10) Difficulties: Dropouts causing attntion
occupational pollutants. Chronic disease
in the conduct ‘of a longitudinal study are
of the sample are to be expected. Every ef
now considered.
would also be minimal. Their respiratory
fort to get a good follow-up should be made
systems are also more sensitive to insults
(1) Objectives: The hypothesis should be
which makes it easier to detect adverse ef Substantial loss to follow-up may raise
explicitly stated. There is a need to define
doubts the validity of the results as bias
fects. It has been found that children can
the time period of the study. This would be
would be introduced if the loss is correlated
carry out spirometric lung function tests
selected based on biologic assumptions of
with both exposure and disease.
the disease outcome and its relationship with
from about seven years and can manage a
It is important also to maintain consistent
the exposure. The broad objectives could be:
single measurement of PEFR at five years
criteria and techniques for measurement
(a) to study the prevalence/incidence of [Florey and Leeder 1982].
the ‘Bhopal toxic gas syndrome’.
(5) Control population: An unexposed or throughout the study period. This is in vics
(b) to relate symptoms/signs observed at minimally exposed population is needed for of the fact that turnover in staff and
availability of newer instrumentation and
the start or appearing during the course of
comparison. It should be comparable in
the study, to various aspects of the exposure
terms of broad socio-economic characteri techniques will occur over time. *
A longitudinal study is also a major
(c) to study the natural history of the stics. It would provide an estimate of disease
conditio?—its severity, fatality, the impact
rates expected to occur in the absence of undertaking in terms of resources—per
sonnel, facilities, finances, etc. The
of therapy, etc.
exposure
Other specific areas to be studied are
(6) Measuring the exposure and outcome seriousness of the situation, however, de
mand this effort, which would be best con
(a) the percentage of exposed individuals
variables: The main issues regarding these
ducted under the auspices of the state health
with multisystemic symptoms and signs in
variables have been discussed. Working
authorities and the ICMR.
the absence of lung findings, (b) levels of
criteria/case definitions for the assessment
urinary' thiocyanate in the exposed and con
of exposure and outcome need to be defined.
Multiple or Serial Cross-Sectional Studies:
trol population, (c) prevalence of psychiatric
Several types of outcome can be observed,
Difficulties inherent in the conduct of cohort
disorders in the two groups, (d) outcome of
e g, post exposure mortality, specified studies have led to the use of multiple cross
pregnancy’ in the years following the disaster.
decrease in lung function, onset and fre sectional studies. This would be carried out
The specific parameters of these outcomes
on random samples of the population at dif
quency of respiratory infections in addition
would have to be evolved locally.
to those mentioned under specific objectives.
ferent points in time. In Bhopal they would
(2) Sample: Small clusters in different
be able to show if there are changes in
Sub-classification into definite, probable and
localities could be selected to be able to study
prevalence from one survey to another.
possible ‘cases’ could be made. Criteria and
the variation in outcome in the different
methods of assessing the exposure and out However, since the same individuals would
localities. Other aspects of the exposure
not be followed up, the natural history of
come variables should be the same in both
variable would also have to be measured in
the disease will not be studied. Changes in
the exposed and control groups.
the individuals in these clusters.
(7) Examination techniques: Simple, valid, population structure in the intervening
Sample size determination would have to
period could cause a change in the measure
repeatable, field tested instruments will have
tions in disease distribution by relating them
to putative causes. In this particular situa
tion, where the exposure has defined time
and place characteristics, though the com
position may be uncertain, observational
follow-up or longitudinal studies seem
logical. Here the study population are
selected with reference to their exposure
status.
The application of case control studies,
where the study population are selected with
reference to their disease status, would be
limited. The disease outcome in Bhopal, is
not a well defined entity and is still evolving.
The prevalence of what has occurred, is not
rare, but affects 30-60 per cent of the severely
and moderately exposed population. Also,
a large proportion of the local population
of similar socioeconomic background have
been exposed to the agent, to some degree.
Cross sectional studies in the subacute
phase have provided prevalence rates of
various symptoms and have also indicated
areas of importance. A repeat cross sectional
study could give prevalence rates of symp
toms and signs post exposure. It could pro
vide age sex and area specific distribution
of thje “Bhopal toxic gas syndrome”. Rela
tionships with respects of the exposure
variable could also be tested. Cross-sectional
studies using exposed and control groups,
a variant of case control studies, could be
used for analytical purposes, to study the
relationship between symptoms or groups of
symptoms and exposure.
1912
Economic and Political Weekly
August 25, 1990
of outcome. The sampling method, method
of data collection and analysis and response
rate should be comparable at each examina
tion. Comparison of mean values of fre
quencies of variables such as age and sex
could give an idea of changes occurring in
the population structure. Sample sizes will
be larger than for cohort studies because the
greater power of tests of difference between
paired observations in the same individual
cannot be exploited [Florey and Leeder
1985]. Independent non-governmental
groups could probably undertake this study
design.
A detailed longitudinal study with inten
sive efforts to obtain a good response rate
and follow-up need be done only for a small
sample of the exposed cohort. The setting
up of an epidemiological monitoring unit
should be considered for the entire exposed
population. This would be based on routine
records from hospitals and health centres
regarding admissions and deaths. It would
necessitate the building up of an efficient
system of recording, reporting and analysis.
A special census of the exposed population
could be conducted and a method of iden
tification of exposed individuals evolved.
The system would be able to pick up impor
tant changes in morbidity or mortality on
which appropriate action could be taken.
IX
Conclusion
The Bhopal disaster has been a human
tragedy of immense dimensions. The suffer
ing caused is incalculable. Important tasks
remain ahead for the provision of the best
possible care for the victims and for the
prevention of such events in the future.
There is a need, first, for the measure
ment, understanding and documentation of
the impact of the disaster on the health of
those exposed, so as to be able to provide
rational care It is necessary also to docu
ment the seriousness of the effects so as to
iresent an easy erasure from human memory
of the event. Epidemiologic skills could help
in this effort as described in this report.
At the present time it is known that similar
small-scale ‘technological disasters’ occur
frequently. Larger scale disasters could also
occur. Hence, along with the deeper causes
of these disasters being tackled, there is a
need to have a strategy to deal with such
events.
Outlines for this are as follows:
It is necessary to have epidemiological
data for an adequate understanding of the
effects on human health. This would include
data regarding the numbers and demogra
phic structure of the population at risk, the
age/sex/area distribution of the fatalities if
they occur, and similar data regarding
morbidity.
Through collaboration between clinicians
and epidemiologists, it would be necessary
to evolve simple, standard criteria for assess
ment and documentation of morbidity.
Similarly, a method to assess exposure
needs to be evolved.
Economic and Political Weekly
Collaboration and communication bet
ween administrators, service providers and
researchers is important.
Close contact and communication with
the affected people is the most important
factor. In the absence of this, one could easi
ly slip into esoteric, theoretical exercises,
which are meaningless to the problem at
hand.
These efforts have to be seen in the con
text of the broader issues raised by such
events. In Bhopal, these would include: the
economic relationship between multina
tionals and countries of the third world
which determine factors like technologies
and safety systems used; the exploitative
relationship with the workforce and the local
community to maintain high profit margins;
the siting and safety systems of hazardous
chemical plants; legislation regarding and
implementation of safety controls; the
workers, and communities, right to informa
tion; the role of pesticides; and the accep
table limits to the chemicalisation of our
world. The true causes of the disaster and
the scope for preventing such events in the
future, lie in the matrix of these issues.
(Concluded)
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i
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■1913
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Ibid, (1985): ‘Minutes of the Review Meeting
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Economic and Political Weekly
August 25, 1990
Lay, Community and Worker ‘Epidemiology’ - An Integrating
Strand in Participatory Research
Andrew Watterson
Introduction
Effective public health should be based on the World Health Organisation (WHO) principles
of‘upstream’ health interventions to prevent the development of avoidable diseases, rather
than focus on ‘downstream’ medical interventions to treat preventable diseases. The
achievement of such an approach should therefore rest on decision-making underpinned by
the precautionary principle.
The precautionary principle depends as much on informed social, economic and political
decision-making as it does on science and medicine. Indeed for the famous medical
practitioner, Rudolph Virchow, medicine was ‘applied politics’. Central to the approach is a
need to assess the purpose and impact of any developments that might impinge on health in
terms of environmental factors - be they personal, social or physical. In this context the first
step in protecting public health should be the prevention of approval of dangerous substances
or processes - be they in food, water, air, for domestic, leisure or workplace use. This should
be achieved through rigorous toxicology or other scientific and technological testing.
In this context ‘lay/worker/community’ activity for the good of the public health has a part to
play in the process of vetting substances, processes, materials, buildings, factories and other
tjpes of plant and installations. We have witnessed globally the over-confidcnce of scientists,
regulators and politicians in the past when dealing with potential public health problems: their
inability to deal with uncertainty, their failure to take data gaps seriously when carrying out
risk assessments, their failure to go beyond very narrow risk assessments and skewed cost
benefit analyses which constantly favour capital over community and workers. Some
communities live with the consequences of the failure of such approaches daily - whether in
India and Pakistan, or Nigeria, China, the USA, the UK, Italy, Belarus, or Ukraine.
Lay/worker/community action on public health issues can highlight these failures and bring
important precautionary approaches to bear effectively on decision-making.
A case study - risk mapping on a grand scale
The Women’s Environment Network (WEN) breast cancer survey with local community
groups illustrates how communities themselves can explore possible health issues and look at
ways to promote health supported by NGOs (WEN 1999). Appendix A contains some of the
maps that the women developed. The UK has been top of the world league for several years
on deaths from breast cancer in women. Local community groups have found in the east of
England that they have some of the highest breast cancer mortality rates in the country,
especially for women in younger age groups. The official response was to ignore these facts.
The women themselves did not and organised a variety of means to investigate the problem
and raise awareness of the disease - and the fact that perhaps at best only 40 % of all cases of
the disease have established causes. They asked what role environmental factors could play in
the disease and why so little data were available about environmental exposures and
environmental risks related to breast cancer (Watterson 1995). The WEN breast cancer project
has provided a community based means for such factors to be explored that may complement
or possibly question some of the conventional tools used by epidemiologists.
These participator}' studies now draw on Geographical Information Systems (GIS) approaches
but their roots lie in the risk mapping activities of workers in a Fiat plant in Italy many years
ago. The maps so prepared of course rely on worker/community knowledge of processes and
procedures rather than managerial and ‘expert’ assessments that may sometimes reflect the
theory rather than the real practice of processes and chemical usage. Appendix B shows risk
maps prepared by Canadian factory workers.
WEN and other NGOs represent the prudent decision-makers, the precautionary principle
advocates in the public health field, although this is only part of what can be a polarised
picture on tackling environmental risks as Diagram 1 below reveals.
Diagram 1: Community environmental epidemiology and toxicology: models of
environmental policy and practice
Technological optimists
1.
-
"EXPERTIST"
l small pox
(asthma
(asbestos
(endocrine disrupters
( aluminium sulphate water pollution
( lead in petrol
( CFCs in fridges
2.
-
White coat syndrome.
Laws irrelevant.
No freedom of information.
"Paternalist".
LEGAL
Science and law-led and operationalised by politicians
"unholy alliance"?
No need to enforce laws as experts solve problems.
paradoxically often a non-enforced model.
PARTICIPATIVE MODEL - non expertist
(uses community
(environmental
(toxicology.
-
Non jargonistic.
Community as partners in (epidemiology and
standard setting/vetting.
Minimum legal standards.
Right to information.
"Matemalist".
[Source: Costanza 1992; Watterson 1994a]
Prudent decision-makers
These different philosophies underpin the different approaches to risk and to epidemiology.
Prudent decision-makers who use lay epidemiology approaches are searching for public
health data showing there are no major risks associated with hazards: the burden of proof lies
with the manufacturer/govemment to show processes are ‘safe’. The approach is informed but
not dictated by science and scientific methods and recognises the limits of science. This is
‘the prove it’s safe’ position.
Technological optimists rely on the ‘scientific method’ and on the null hypothesis. They look
for evidence that a process or product is hazardous and with clear and calculated risks and
assume no hazard and no risk often when data are lacking or limited. This is ‘the prove it’s
dangerous’ position The next section deals with how lay epidemiology has developed and
how it engages with the technological optimists.
2
Origins of lay epidemiology
To determine the nature of ‘lay epidemiology’ it is first necessary to explore conventional
epidemiology a little. Epidemiology has been defined as:-
'The study of the distribution and determinants of health and disease related conditions
in populations. It is concerned with both epidemic (excess of normal expectancy) and
endemic ( always present) conditions ...The basic premise of epidemiology is that
disease is not randomly distributed across populations'.
(M Shenker in LaDou 1997)
Comprehensive epidemiology studies, if done on a large enough scale, over a long period of
time and with designs that exclude bias may prove very effective ways of assessing disease
causation in populations. This is, however, a very' expensive process. It is also fundamentally
limited because, although such studies may inform decisions - through exploring correlation
between exposures and diseases, though not identifying individual disease causes - on other
potential public health risks, they simply do not prevent diseases and disasters in the study ■
being undertaken. Effectively they close stable doors after horses have bolted or shut the cage
after the tiger has escaped. Toxicology and engineering are meant to be ‘secure stables and
cages’ - we know that they are not.
Like most professional groups, epidemiologists do not like to discuss their failures in public.
Some epidemiologists criticise commentators for using positive studies to dam materials and
processes and point out that such studies are often not capable of proving something is not
risky. However, such epidemiologists may be silent on the limitations of epidemiological
studies that show no risks from a hazard exist. This is called ‘negative epidemiology’.
Negative epidemiology
‘ “The prevailing view" is usually subjective in science’ according to Hcmbcrg. Hence the
following basic problems sometimes occur in epidemiology to produce ‘negative’ results, but
such results are effectively inconclusive and do not prove processes and materials are safe.
Table 1: Limits of‘negative’ epidemiology
1.
2.
3.
4.
5.
No studies carried out
Studies too small to have statistically significant results
Studies poorly designed and not sensitive
Problems with validity of control groups
Follow up periods insufficient for effects to materialise or materialise fully or follow up
incomplete
6. Accuracy of exposure data needed
7. Wrong exposure categories are studied
8. Exposure is too low and/or too short
9. Measures of morbidity are crude
10. There are random errors
11. Wrong or irrelevant morbidity indicators are used
(Source: based on Sven Hemberg 1992)
The science of epidemiology, viewed as so critical to the development of ‘academic’, rigorous
and high status public health medicine, has replaced clinical case studies as the most effective
and credible science for sorting out disease clusters. The view of clinical cases is generally
3
that they are statistically limited sources of information. However, non-epidemiological data.
linked to clinical cases or observations, have sometimes resulted in very effective actions. For
instance the links between exposures to soot and cancer came from Percival Potts’ clinical
observations and case reports in the late 18th century. The links between exposure to vinyl
chloride monomer and the rare liver cancer, angiosarcoma, came through primary care
physicians near a US chemical plant connecting clinical cases. The ‘Back to Sleep’ campaign
in the UK which cut ‘sudden infant death’ rates came from observational studies, not
conclusive physiological studies that could explain mechanisms of mortality (DOH 1998:61).
In the 1920s and 1930s, Sir Thomas Legge who was an early user of‘sentinel’ events to
trigger investigations of health hazards, ( Legge 1934:25-29) used observational data from
workers to identify hitherto relatively unknown risk. For instance, he visited a docks site
where the dockers themselves had linked work with a hard wood to ill-health cases in their
members.
Trade union identification of workplace hazards
Workers have always used observations, knowledge of ‘sentinel’ events - sometimes single
warnings or one worker presenting with an unusual or hitherto unnoticed disease - and varied
data to make risk assessments of their workplaces and recognise occupational diseases.
sometimes well ahead of medical and scientific investigators in those workplaces. The table
below illustrates this clearly.
Table 2: Successful trade union recognition of occupational diseases
INVESTIGATOR
Alfred Greenwood. Glass Bottle
Makers Secretary 1891 using
social insurance records
Local w oodworkers trade
union secretary observing
workforce 1900s
South Wales Dockers Union
secretary observed pitch dust
exposure of briquette workers
Sheffield Occupational Health
Project 1990
HAZARD
cataracts in glass workers
ACTION
1900s: compensation but no
action on the process.
Narcotic effects of African
boxw'ood through slowing heartbeat
Substitution with safer woods
as best available local exhaust
ventilation still created dust inhaled
by workers
1927 finally recognised as an
industrial disease for briquette
workers
The project team found more
cases tn one small Sheffield
factory than were recorded for the
nation in official records
The centre revealed gross under
reporting of the disease
skin cancer known for
centuries in tar workers
chrome ulceration
Local unemployed centre in
mucous membrane disease in
Sunderland 1994
engineering worker
[Sources: Legge 1934, Watterson 1999]
Rapid appraisal
One approach that now encapsulates much of lay epidemiology is ‘rapid appraisal’.
‘Rapid appraisal is primarily a methodology which provides timely, relevant information to
decision-makers on pressing issues they face in project and programme setting (Kumar 1994
cited by Ong 1996:3). Hence it can be a diagnostic tool or an agent for change or both. It
does, however, not necessarily draw on communities in the appraisal as lay epidemiology
always would. Communities, whether geographic or workplace-based, should be public health
decision-makers as well as the politicians and scientists. The methods that rapid appraisals
deploy are very familiar to those engaged in lay epidemiology and might include a number of
elements.
4
Table 3: Elements of rapid appraisal
Mixtures: mapping matrices, focus groups, time lines and trend analysis and faster than
‘conventional methods’
1. Field work emphasis
2. Reliance on learning directly from local people
3. Semi-structured, multi-disciplinaiy, flexible , innovative approaches
4. Focuses on ’insights, hypotheses, best bets rather than final truths or fixed
recommendations’
[Source: Ong 1996:2]
The key steps in the process would include those outlined below.
Step 1 defines purpose, identify target groups and agencies.
Step 2 identifies leader/team to conduct rapid appraisal.
Step 3 organises workshops.
Step 4 entails fieldwork, observation, secondary data collection, interviews.
Step 5 includes data collection and analysis.
Step 6 prioritises needs.
Step 7 feeds back to community and discusses possible actions.
Step S develop a programme of change.
Step 9 evaluates the work and, if necessary, redefine priorities.
Step 10 explores a second rapid appraisal or a view of future based on the first appraisal
(Ong 1996:9)
Participator) research
This draws on lay epidemiology and rapid appraisal techniques to involve communities
actively in the appraisals rather than simply being the passive subject of the appraisal. This
entails opening up the research process to ensure communities and workers can influence any
changes proposed as a result of the research undertaken.
Table 4: The benefits of participatory research
exposing unrecognised levels of disease
studying subjective symptoms in an effective way, for instance ME ,Chronic Fatigue
Syndrome (CFS), MCS, syndromes, ULDs, asthma, occupational stress
• low cost way of identifying a wide range of exposures to possible disease causes and
outcomes through interactive approaches able to deal with rapidly changing situations
• increasing capacity of communities and workers to involve themselves in public health
• recognising and using knowledge and experience of communities in identifying particular
health risks
• new approaches to conceptualising knowledge
• enhancing the potential for action outcomes from research findings and raising awareness
of policy-makers linked to an identification of key local concerns
(Source: adapted from Loewenson 1996)
•
•
Table 5 : Weaknesses of participatory research
•
•
aim to identify community perspectives may mean no precise quantification of a particular
problem occurs
may provide inaccurate perspectives although there is major difference between lay
perspectives and lay epidemiology eg malaria examples and CHD work.
Lay epidemiology
6
This should be a major strand of participatory research although it is often neglected as it
sometimes appears too difficult to mount and potentially open to challenge by regulators and
scientists. The uses of the technique are many and various and do not simply relate to the
investigation of a health hazard and the scientific proof of correlations and causes of diseases.
They also contain important community, individual, political and social elements (Watterson
1994b, Popay and Williams 1994 and 1996).
Table 6: Benefits of lay epidemiology
•
•
•
•
•
•
•
Inform communities about public health problems and solutions
Involve communities in public health policy and monitoring of solutions
Sustain communities and individuals dealing with a common problem requiring
community solutions
Empower communities and individuals in an organisational and possibly social setting
Change attitudes, approaches, sources of data, possible solutions to public health problems
Educate professionals through lay groups about new or different public health
perspectives and vice versa
Campaign for positive change
Definition of lay epidemiology
'...the process by which lay persons gather statistics and other information and also direct
and marshal the knowledge and resources of experts in order to understand the epidemiology
of diseases.'
(Brown 1989)
Table 7: Principles of lay epidemiology - tools, mechanisms, techniques
These may include methods that:• appear ‘easy’ but are not in terms of data gathering
• sometimes observational - different types of data differently used
• generate similar data to that used by epidemiologists and toxicologists but perhaps more
comprehensive, more up to date, more relevant, more current, better informed .
• are qualitative - records and histories that may be used in conventional epidemiology but
given different weighting here. Problems exist already about recall, about job
categorisation and about location and length of exposure and exposure levels in
conventional epidemiology. Records of incidents, accounts of exposures, details of
suspected adverse effects may all be more richly documented in lay epidemiology than
some other sorts of epidemiological study.
The types of questionnaire that may be used in lay epidemiology studies are illustrated by the
Vinatex study (see Appendix C) where the ex-workers organised, planned and partially
implemented a study of workers exposed to PVC to try to track a range of health effects
possibly linked to workplace exposures to vinyl chloride monomer (VCM), a gas used to
make PVC. The workers themselves, in conjunction with an NGO, produced questionnaires,
conducted interviews and gathered data. The questionnaires were modelled on those used by
government departments and international agencies to protect the study from accusations of
using ‘subjective’ data gathering methods. The results were analysed by a university in
conjunction with the ex-workers group. The study has raised major questions about under
estimates of the ill effects of VCM exposure.
Data collection in lay, community and worker studies may also come in other forms, some of
which would be readily recognised and accepted by conventional epidemiologists. These
7
approaches are illustrated, to some extent, by the Indonesian pesticide studies carried out
recently on behalf of the FAO by Helen Murphy and her colleagues (Appendix D). These
methods include recruiting local health workers and key community activists to gather data
through observation and interviews using house, locality and body maps and also
questionnaires comprehensible and quickly understood by the local population in which the
study was being conducted.
Table 8: Strengths of lay epidemiology
•
•
•
•
•
•
•
•
•
•
•
•
•
•
draws on qualitative and quantitative research methods for generating a rich mix of data
relatively cheap to do, draws on local data, can relate to many people pooling knowledge.
draws on a socio-participative/participative model
transparency in study design, execution and analysis
open
inclusive
empowering
recognises uncertainty
positive
if wrong, ‘will do no harm’
relatively easy to do
complements and may test other methods
links in to current international and national agendas relating to WHO Charter on
Environment and, involving locals communities in their health care. Health inequalities,
wanting of problems without waiting for disaster to occur
links workers and communities
The approach offers, in some instances, a better way forward because:• it goes beyond the rhetoric of transparency and empowerment
• it may link with “health alliances” concept
• data may be more accurate and experiences and subjective symptoms may
be more readily analysed
Table 9: A better way forward for lay epidemiology
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
methodological difficulties
resistance or ignorance of professional scientists
may be restrained by lack of funds
training and information issues
lack of credibility
lack of rigour
too rough and ready
lack of access to data
lack of resources
lack of tools tried and tested to analyse data
size of sample and numbers and times of exposures
visibility
response from other groups
associations not causes demonstrated (as for conventional epidemiology)
problems of proving random/causal clusters (as for conventional epidemiology)
lack of good data on exposures, effects etc. (as for conventional epidemiology)
8
Forms of conventional and lay epidemiology
Lay epidemiology may come in several and sometimes hybrid forms and is sometimes totally
excluded from conventional epidemiology studies. For instance:1. Epidemiologists design, carry out, analyse and present the study.
2. Epidemiologists design, study and train and use lay staff to carry out survey.
3. Epidemiologists invite lay people to contribute to design of study protocol. Lay staff carry
out questionnaire surveys and interviews.
4. Epidemiologists analyse and present data.
5. Epidemiologists invite lay people to contribute to study design. Lay people carry out
surveys. Epidemiologists, with lay people, analyse and present results.
6. Lav people identify problem and invite epidemiologists to investigate the problem. Back
to(l).
7. Lay people identify problems, involve epidemiologists. Joint protocol is drawn up. Back
to (3) and (4).
8. Lay people identify problem, involve epidemiologists. Joint protocol. Lay people and
epidemiologists jointly investigate problem and analyse results. Joint presentation of
results.
The best approach is contained in number 7 above but this may also the most difficult to
achieve because of resistance, apathy or ignorance from health professionals. Compromises
along the way may need to be negotiated.
Ways forward
The benefits of lay, worker and community-led health studies are enormous. How can they be
introduced more widely and supported more clearly? The following approaches may help the
process. Strengthen the means available for social, economic or geographical communities to
participate and indeed initiate lay/community epidemiology and toxicology projects both on
suspect hazards and on industrial and other processes:
• by ensuring that 'no cost' freedom of information about disease and prevention arc
available at community level.
• by ensuring easy access to such information.
• by creating information systems that disseminate information rather than restrict
information because communities do not know what information is available or are only
given information if they ask very specific questions.
• by re-educating health workers in community epidemiology principles and techniques.
• by incorporating the need to involve communities in the monitoring, review and audit of
pollutants into the new training of health and technical staff in public and private sectors.
• by all regional health authorities, trusts, local authorities, commercial bodies adopting the
WHO Charter on Environment and Health with a commitment to implement its principles
and practice (Appendix E). Public Health Medicine Departments in health authorities
around the country should have a key role in this process as should community health
councils.
• by central and local government and other funding agencies ensuring that lay/community
epidemiology is built in as a requirement for any research grants or programmes which
involve working on communities or health hazards affecting particular groups.
9
by the adoption of cleaner production and toxics reduction methods, again based on
community/worker input and audit on environmental hazards and the precautionary
principle.
References
Costanza R and Cornwell L (1992). The 4P Approach to dealing with Scientific Uncertainty.
Environment 34.
Department of Health (1998). ‘Quantification of the Effects of Air Pollution on Health in the
United Kingdom1. Committee on the Medical effects of Air Pollutants. HMSO, London.
LaDou J (ed) (1997). Occupational and Environmental Medicine. 2nd rev. ed. Appleton Lange,
California.
Legge T (1934). Industrial Maladies. Oxford University Press, Oxford.
Ong BN (1996). Rapid Appraisal and Health Policy. Chapman and Hall, London.
Popay J and Williams G (eds) (1994). Researching the People’s Health Routledge, London.
Popay J and Williams G (1996). Public Health Research and Lay Knowledge. Soc Sc Med
42:759-768.
Watterson AE (1994a). International attitudes to organophosphates. Farmers’ Ill-Health
and OP Sheep dips. Proceedings of the conference held on 26 March 1994 at Plymouth
Postgraduate Medical School, Plymouth, UK.
Watterson AE (1994b). Whither lay epidemiology in occupational and environmental
health? Journal of Public Health Medicine 16:270-274.
Watterson AE (1995). Breast Cancer and the Links with Environmental and Occupational
Carcinogens: Public health dilemmas and policies. Centre for Occupational and
Environmental Health, De Montfort University, Leicester.
Watterson AE (1999). “Why we still have ‘old’ epidemics and ‘endemics’ in occupational
health" in Daykin N and Doyal L. Health and Work: critical perspective.
Macmillan, Basingstokel07-126.
Women’s Environmental Network (199) Putting Breast Cancer on the Map. 87 Worship
St. London EC2A 2BE, UK
10
People’s Health Charter
Wc Ihc people of India, stand united in our condemnation of an iniquitous global
system that, under the garb of ‘Globalisation' seeks to heap unprecedented misery and
destitution on the overwhelming majority of the people on this globe This system has
systematically ravaged the economics of poor nations in order to extract profits that
nurture a handful of powerful nations and corporations. The poor, across the globe, as
well as the sections of poor in the rich nations, are being further marginalised as the)
arc displaced from home and hearth and alienated from their sources of livelihood as a
result of the forces unleashed by this system. Standing in firm opposition to such a
system we reaffirm our inalienable right to and demand for comprehensive health care
Lhat includes food security; sustainable livelihood options including secure
employment opportunities; access to housing, drinking water and sanitation: and
appropriate medical care for all; in sum - the right to Health For All, Now I
The promises made to us by the international community in the Alma Ata declaration
have been systematically repudiated by the World Bank, the IMF. die WTO and its
predecessors, the World Health Organization, and by a government that functions
under the dictates of International Finance Capital. The forces 'Globalisation' through
measures such as die structural adjustment programme are targeting our resources built up with our labour, sweat and lives over the last fitly years - and placing them in
the service of the global "market" for extraction of super-profits. The benefits of the
public sector health care institutions, the public distribution system and other
infrastructure - such as they were - have been taken away from us It is the ultimate
irony that we are now blamed for our plight, with the argument that it is our numbers
and our propensity to multiply that is responsible for our poverty and deprivation Wc
declare health as a justiciable right and demand the provision of comprehensive health
care as a fundamental constitutional right of every one of us. We assert our right to
take control of our health in our own hands and for this the right to:
•
•
•
•
•
A truly decentralized system of local governance vested with adequate power and
responsibilities, provided with adequate finances and responsibility for local level
planning.
A sustainable system of agriculture based on the principle of land to the tiller both men and women - equitable distribution of land and water, linked Io a
decentralized public distr ibution system that ensures that no one goes hungry
Universal access to education, adequate and safe drinking water, and housing and
sanitation facilities
A dignified and sustainable livelihood
A clcait and sustainable environment
«
«
A drug industry geared to producing epidemiological essential drugs at affordable
cost
A health care system which is gender sensitive and responsive to the people's
needs and whose control is vested in people's hands and not based on market
defined concept of health care.
Further, wc declare our firm opposition to:
»
•
o
•
o
•
•
•
Agricultural policies attuned to the needs of the ‘market’ that ignore
disaggregated and equitable access to food
Destruction of our means to livelihood and appropriation, for private profit, of our
natural resource bases and appropriation of bio-diversity.
The conversion of Health to tire mere provision of medical facilities and care that
are technology intensive, expensive, and accessible to a select few
The retreat, by the government, from the principle of providing free medical care.
through reduction of public sector expenditure on medical care and introduction
of user fees in public sector medical institutions^ that place an unacceptable
burden on the poor
The corporatization and commcricialization of medical care, state subsidies to die
corporate sector in medical care, and corporate sector healdi insurance
Coercive population control and promotion of hazardous contraceptive
technology which arc directed primarily at the poor and women
The use of patent regimes to steal our traditional knowledge and to put medical
technology and dnigs beyond our reach
Institutionalization of divisive and oppressive forces in society, such as
communalism. caste, patriarchy, and the attendant violence, which have destroyed
our peace and fragmented our solidarity.
In the light of the above we demand that:
1
The concept of comprehensive primary health care, as envisioned in the Alma Ata
Declaration should form the fundamental basis for formulation of all policies
related to health care The trend towards fragmentation of health delivery
programmes through conduct of a number of vertical programmes should be
reversed National health programmes be integrated within the Primary Health
Care system with decentralized planning, decision-making and implementation
with the active participation of the community. Focus be shifted from bio-medical
and individual based measures Io social, ecological and community based
measures
2.
The primary health care institutions including trained village health workers. sub
centers. and the PHCs stalled by doctors and the entire range of community
health functionaries including the 1CDS workers, be placed under the direct
administrative and financial control of the relevant level Panchayati Raj
institutions. The overall infrastructure of the primary hcallh care institutions be
under the control of Panchavats and Gram Sabhas and provision of free and
accessible secondary and tertiary level care be under the control of Zilla
Parishads, to be accessed primarily through referrals from PHCs.
The essential components of primary care should be:
•
Village level health care based on Village Health Workers selected by
lire community and supported by the Gram Sabha / Panchayat and the
Government health services which are given regulatory powers and
adequate resource support
•
Primary Health Centers and sub-centers with adequate staff and supplies
which piovides quality curative services al the primary hcallh center
level itself w ith good support from referral linkages
•
A comprehensive structure for Primary' Health Care in urban areas based
on urban PHCs. health posts and Community Health Workers under the
control of local self government such as ward committees and
municipalities.
•
Enhanced content of Primary Health Care to include all measures which
can be provided at the PHC level even for less common or noncommunicable diseases (e.g. epilepsy, hypertension, arthritis, pre
eclampsia. skin diseases) and integrated relevant epidemiological and
preventive measures
•
Surveillance centers at block level to monitor the local epidemiological
situation and tertiary care with all speciality services, available in every
district.
3.
4.
A comprehensive medical care programme financed by the government to the
extent of at least 5% of our GNP. of which at least half be disbursed to panchay ati
raj institutions to finance primary level care. This be accompanied by transfer of
responsibilities to PRIs Io nm major pads of such a programme, along with
measures to enhance capacities of PRIs to undertake the tasks involved
The policy of gradual privatisation of government medical institutions, through
mechanisms such as introduction of user fees even for the poor, allowing private
practice by Government Doctors, giving out PHCs on contract, etc. be abandoned
forthwith. Pailure to provide appropriate medical care to a citizen by public health
care institutions be made punishable by law.
5
A comprehensive need-based human-power plan for the health sector be
formulated that addresses the requirement for creation of a much larger pool of
paramedical functionaries and basic doctors, in place of the present trend towards
over-production of personnel trained in super-specialities. Major portions of
undergraduate medical education, nursing as well as other paramedical training be
imparted in district level medical care institutions, as a necessary complement to
training provided in mcdical/nursing colleges and other training institutions. No
more new medical colleges to be opened in the private sector. No
commodification of medical education. Steps to eliminate illegal private tuition
by teachers in medical colleges. At least a year of compulsory rural posting for
undergraduate (medical, nursing and paramedical) education be made mandatory,
without which license to practice not be issued. Similarly, three years of rural
posting after post graduation be made compulsory.
(>
The unbridled and unchecked growth ol the commercial private sector be brought
to a halt Strict observance of standard guidelines for medical and surgical
intervention and use of diagnostics, standard fee structure, and periodic
prescription audit to be made obligatory. Legal and social mechanisms be set up
to ensure observance of minimum standards by all private hospitals.
nursing/matemity homes and medical laboratories Prevalent practice of offering
commissions for referral to be made punishable by law. For this purpose a body
with statutory powers be constituted, which has due representation from peoples
organisations and professional organisations.
7.
A rational drag policy be formulated that ensures development and growth of a
self-reliant industry for production of all essential drugs at affordable prices and
of proper quality. The policy should, on a priority basis:
•
•
•
•
•
•
Ban all irrational and hazardous drugs. Set up effective mechanisms to
control the introduction of new drags and formulations as well as
periodic review of currently approved drugs.
Introduce production quotas & price ceiling for essential drags
Promote compulsory use of generic names
Regulate advertisements, promotion and marketing of all medications
based on ethical criteria
Formulate guidelines for use of old and new vaccines
Control the activities of the multinational sector and restrict their
presence only to areas where they arc willing to bring in new tcclmology
,
•
•
X.
Recommend repeal of the new patent act and bring back mechanisms
that prevent creation of monopolies and promote introduction of new
drugs at affordable prices
Promotion of the public sector in production of drugs and medical
supplies, moving towards complete self-reliance in these areas.
Medical Research priorities be based on morbidity and mortality profile of the
country, and details regarding the direction, intent and focus of all research
programmes be made entirely transparent Adequate government funding be
provided for such programmes. Ethical guidelines for research involving human
subjects be drawn up and implemented after an open public debate No further
experimentation, involving human subjects, be allowed without a proper and
legally tenable informed consent and appropriate legal protection. Failure to do
so to be punishable by law. All unethical research, especially in the area of
contraceptive research, be stopped forthwith. Women (and men) who. without
their consent and knowledge, have been subjected to experimentation, especially
with hazardous contraceptive technologies to be traced forthwith and
• appropriately compensated. Exemplary damages to be awarded against the
institutions (public and private sector) involved in such anti-people, unethical and
illegal practices in tire past.
9.
10.
11.
All coercive measures including incentives and disincentives for limiting family
size be abolished. The right of families and women within families in determining
the number of children they want should be recognized. Concurrently, access to
safe and affordable contraceptive measures be ensured which prot ides people.
especially women, die ability to make an informed choice. All long-term.
invasive, systemic hazardous contraceptive technologies such as the injectablcs
(NET-EN, Depo-Provera. etc.), sub-dermal implants (Norplant) and and fertility
vaccines should be banned from both the public and private sector. Urgent
measure be initiated to shift to onus of contraception away from women and
ensure at least equal emphasis on men's responsibility for contraception. Facilities
for safe abortions be provided right from die primary hcaldi center level
Support be provided to traditional healing systems, including local and homebased healing traditions, for systematic research and community based evaluation
with a view Io developing the knowledge base and use of these systems along
with modern medicine as part of a holistic healing perspective.
Promotion of transparency and decentralization in the decision making process.
related to health care, at all levels as well as adherence to the principle of right to
information Changes in health policies Io be made only after mandatory wider
scientific public debate.
12.
Introduction of ecological and social measures to check resurgence of
communicable diseases. Such measures should include:
•
•
•
13.
Integration of health impact assessment into all development projects
Decentralized and effective surveillance and compulsory notification of
prevalent diseases like malaria, TB by all health care providers,
including private practitioners
Reorientation of measures to check STDs/AlDS through universal sex
education, promoting responsible safe sex practices, questioning forced
disruption and displacement and the culture of commodification of sex.
generating public awareness to remove stigma and universal availability
of preventive and curative services, and special attention to empowering
women and availability of gender sensitive services in tliis regard.
Facilities for early detection and treatment of non-communicable diseases like
diabetes, cancers, heart diseases, etc. to be available to all at appropriate levels of
medical care.
14 Women-ccntcrcd health initiatives that include:
•
•
•
•
Awareness generation for social change on issues of gender and health.
triple work burden, gender discrimination in upbringing and life
conditions within and outside die family; preventive and curative
measures to deal widi hcaldi consequences of women’s work and
violence against women
Complete maternity benefits and child care facilities to be provided in all
occupations employing women, be they in the organized or unorganized
sector
Special support structures that focus on single, deserted, widowed
women and minority women which will include religious, ethnic and
women with a different sexual orientation and commercial sex workers;
gender sensitive services to deal with all the health problems of women
including reproductive health, maternal health, abortion, and infertility
Vigorous public campaign accompanied by legal and administrative
action against sex selective abortions including female feticide.
infanticide and sex pre-selection.
15. Child centered health initiatives that include:
Cort va- G G ■
1
Verbal Autopsy
Introduction
' At the Bhopal Peoples' Health and Documentation Clinic run by the Sambhavna Trust,
Verbal Autopsy (VA) is used as a method for monitoring mortalities related to the
/ December 1984 Union Carbide disaster in Bhopal. VA is a scientific method of proven
validity used for establishing the cause of death of individuals in a community. This is
• particularly usefill in situations where the proportion of deaths occurring under medical
' care are low and where no autopsies are carried out. This method has been successfully
employed in India, Bangladesh, Kenya, Nigeria, Philippines, Indonesia, Egypt, and
>■ ..'several other countries to determine the cause of death of individuals in various
circumstances.
The Technique of Verbal Autopsy
This method is based on the assumption that most causes of death have distinct symptom
complexes and these can be recognized, remembered and reported by lay people. It
- involves trained workers administering a questionnaire on the carer of the deceased.
Information is collected on the symptoms suffered by a panel of physicians individually
and independently for ascertaining the probable cause of death.
Appropriateness of VA in Bhopal
Since the official committee for recording exposure-related deaths was wound up in
December 1992, there is no official agency to monitor continuing exposure-related deaths
in Bhopal. Also, an overwhelming majority of these deaths occur in people's homes
resulting in autopsies rarely being conducted and often there being no competent doctor
to certify the cause of death. Medical records of the deceased prior to death are often
unavailable as they have had to be deposited with the compensation tribunals. Where
available these are often incomplete. Given such a situation, VA appears to be the most
appropriate method for monitoring exposure-related deaths in Bhopal.
■' How VA is carried out at the Sambhavna Clinic
■ The four fieldworkers conduct door-to-door surveys to identify households and question
carers of the deceased on the medical history and clinical symptoms suffered. Using
culturally appropriate language, the fieldworkers, all of whom are known in the
community, apply stringent criteria in the collection and recording of information.
Information is recorded on a questionnaire designed to elicit details of exposure to the
toxic gases, the health status of the deceased prior to and after exposure, medical
examinations and their results, treatment including duration etc. All fieldworkers have
■ been trained in interviewing skills, administration of the questionnaire and signs and
symptoms of diseases.
.<•
i. ’
The VA questionnaire
The 21 page verbal autopsy questionnaire (VAQ) begins with general, introductory
questions to determine the lifecycle of the deceased. An instruction sheet is used by the
fie|d workers as a guideline for administration of the questionnaire. The health workers
also confirm which medical records of the deceased are in the possession of the carer.
General questioning familiarizes the carer with the type of information to be collected
and enables the interviewer to create favorable conditions for the carer to speak openly
regarding personal and often traumatic details regarding the deceased.
Direct questions on symptoms existing prior to the gas exposure are asked to compare the
health status of the deceased in the post disaster situation. The health worker then begins
an open section in which the interviewee is invited to explain what happened in their own
words, details of the exposure, subsequent illness/es, and responses to treatment received
till the death of the deceased. The statement is recorded verbatim and serves as one of the
means to check the veracity of information given by the interviewee. With the use of
filter questions, specific recordings of the symptoms related to different body systems are
then made. Thus the health worker identifies a body system, e.g. the respiratory system
and encourages the carer to provide voluntary information on any particular symptoms,
e.g. breathlessness, cough, expectoration tightness in chest etc. Care is taken to ensure
that the interviewer docs not provide any direct or indirect suggestions during
questioning. The systems of the deceased, as the carer may be embarrassed or unaware of
the medical implications of certain symptoms such as recurrent nightmares. Information
on medical treatment received and documents related are also gathered.
Assessment of Verbal Autopsy Questionnaires
,
The filled VAQ is then sent to a panel of three physicians along with available medical
records of the deceased. The physicians in the verbal autopsy assessment panel write their
opinions on the probable cause of death of the individual and whether it is attributable to
the individual's exposure to the Union Carbide's gases. The doctors who are volunteering
their services in the assessment panel are:
Dr. U.N. Das (MBBS, MD) Chief, Division of Internal Medicine and Clinical
1 Immunology, L. V. Prasad Eye Institute, Hyderabad. He was awarded the prestigious
Shanti Swaroop Bhatnagar prize for his contribution to Medical Sciences in 1992.
. '■ ,.i.Dr. Ajitt Vigg (MBBS, DTCD, MRCP) Consultant physician and chest specialist at.
Apollo Hospital, Hyderabad. He is one of the members of the international panel for lung
1
cancer in India.
Dr. P.N.Rao (MBBS, MD, DM) Consultant Hepatologist and Gastro-enterologist,
i Mediciti Hospitals, Hyderabad.
,v;. ’
Dr. Daniel Chandramohan. Head of the Verbal Autopsy group at the London School of.
Hygiene and Tropical Medicine, UK is the advisor to the verbal autopsy project at.
Sambhavna Clinic. He lias made two visits to the clinic to review the work being carried.
out and has expressed satisfaction with the quality of work.
The final opinion on the probable cause of death and relatibility with exposure to Union
Carbide's toxic gases until just recently was given by Dr M. P. Dwivedi, former Director ■
,^'of the Bhopal Gas Disaster Research Centre (BGDRC) set up by the Indian Council of
Njedical Research (ICMR). The final opinion is arrived at on the basis of the level of
agreement among the three dependent medical options. In case all the three doctors in the
assessment panel opine that death has been caused due to exposure to Carbides' toxic
gases, the final opinion states that the 'most probable' cause of death is attributable to the
! December 1984 gas disaster. The final opinion states 'probable' in case two of the three
doctors agree on the nexus between exposure and subsequent death and 'possible' if only
one of the doctors in the panel mentions exposure as a probable cause of death. In case al|
three doctors opine that the disease or condition of death is not related to the person's
exposure to Union Carbide's gases in December 1984, the final opinion issued by the
Sambhavna Trust stales that the cause of death is unrelated to the disaster.
,t Validity of the method of Verbal Autopsy in ascertaining cause of death
The method of Verbal Autopsy has been found, through numerous studies carried out in
different pails of the world, Io have a positive predictive value in the range of 70% to
,l| 80% depending on the cause of death and age of the deceased. This range of validity has
been confirmed through comparison of opinions on cause of death as ascertained through
usual autopsies (post-mortem examinations) and that through Verbal Autopsy.
Verbal Autopsy Data
. I ' ■
The information collected through Verbal Autppsy up to March 31, 2000 is presented
below in Table - X
1
Deaths
recorded
Interviews
completed
Medica
1
autopsy
done
Verbal Autopsy
final opinion
Most
Probable
Probable
Possibl
e
Unrelated
to
exposure
. ’I
219
99
01
81
14
[17.28%
30
[37.0 %]
26
[32.1
%]
11
■
[13.5%] '
(So rA |A 6
*
__________
Information for a Change 1904 Franklin St. Suite 900, Oakland, CA 94612. tel:510.835.4692 fax:510.835.3017
rev. 07/99
WORLD WIDE WEB RESOURCES
ImpactResearch's List of Helpful Sites on the Web for Progressive Activists
The World Wide Web holds thousands of opportunities for progressive activists to use and strengthen their
campaign. We have compiled a list of sites we find particularly useful. Most of these sites are free, however,
we have noted those that do require a subscription or download fee. Please remember that the web changes
hourly and some of sites may have changed or simply disappeared. We have organized our list into the
following categories. Please cross check because there is overlap among the categories.
Catesorv
Search Engines and Databases
Tools with which to search die web as a whole, databases that search
publications.
Company Information
Specific company documents, stock information, business press. Both
private and public companies
Corporate Responsibility
Organizations that research, monitor and report on company behavior.
Generally applies to public companies.
Money and Politics
Sites of organizations that follow the money and/or legislation. Of
particular note is the Federal Election Commission Info site.
Labor
Lists sites with information on worker's rights, health and companies
labor record. Also includes organized labor research guides.
Environment
Large list of environmental databases tracking company behavior, toxins,
and networking opportunities.
Alternative Politics and Progressive Activism
Progressive reports clearinghouses and support organizations.
Government Information
Government and XGO sites with government information. Some sites
taken from above. Information on using FOIA.
We would like to thank Will Colette and the AFL-CIO for contributing.
The
symbol represents a site we finckparticularly useful.
Pace
I
3
5
6
7
8
10
12
Search Engines and Databases
All-in-One Search Page littn://www Allonescarch.com
“Over 400 of die Internet's best search engines, databases, indexes, and directories in a single site.”
Alta Vista http://allavista.digilal.com
We like to use Alta Vista to find information about a specific term or name (such as a person or hard to find
company). Alta Vista often turns up a whole stack of relevant links right at die top of the list. Its sources include
government and “public interest" sites. Be sure to place your specific term in quotation marks.
Christian Science Monitor Iitip://www.csmonitor.com
Complete archives back to 19S0 - free!
6 DejaNews http://www.dii inews.com
Searches Usenet newsgroup archives. Usenet newsgroups are international public discussion forums on a huge range
of subjects; Deja News archives approximately 15,000 newsgroups going back to 1995. Particularly useful for
tracking down movement information that may not show up on the Web. Caution: Usenet is a highly democratic
communications medium, and includes a full range of information, ideas, and opinion. Be sure to check your sources
before counting on tiie reliabdity of the information.
Dogpile http://www.dogpile om
Dogpile is a meta-search engine that runs your search on multiple search engines at once, and brings you back the
top responses from: Yahoo!, Lycos' A2Z, Excite Guide, GoTo.com, PlanetSearch, Thunderstone, What U Seek,
Magellan, Lycos, WebCrawler, InfoSeek, Excite, AltaVista. It's a good tool to use if you come up empty on
individual search engines Dogpile also olTers corporate searching through its Business Wires setting. Limitation:
search techniques that work on one search engine will not necessarily work well on Dogpile, due to variances
between the search engines.
DowJones News Retrieval hi Ip://www.diinieractive.com
Available on lhe web for a S69 yearly fee and a document charge of S2.95 to view anything more than a headline.
Only source for the Wall Street Journal full text.
Federal Web Locator http://w ww law.vill.edu fed-aeencv/fedwcbloc.html
The Federal Web Locator is a service provided by tire Center for Information Law and Policy and is intended to be
the one stop shopping point for federal government information on the World Wide Web.
HotBot http://www.holbot.ciHn
HotBot provides sophisticated search options in plain English, making it a quick and straightforward search engine
to use. An all around excellent search engine, and one that draws from key movement information resources. If
you’re looking for an organization's web site use HotBot’s "page title" option. HotBot also offers the option of
searching with the Lycos search engine.
InfoSeek Ultraseek hltp://ww w. infoseek, go.com
KnowX http://www.knowx.com
Search public records on businesses or people. Searches reasonably prices after peak hours. Charges for documents
range from SI - S7.
Librarians Internet http://sunsite.berkelev.edu/lntemetlndex/
Excellent source of "internet bibliographies".
Northern Light http://www.northemlight.com
Search over 130 Million Web pages and articles of more than 5,400 full text sources. Sources include some
alternative press. Service is free, but a charge from SI - 54 for articles from “Special Collection". Also has
Investext (stock market analysts reports).
2
(Search Engines and Databases, continued)
The Argus Clearinghouse him //aww,clearinghouse.net
“Provides a central access point for value-added topical guides which identify, describe, and evaluate Intemet-based
information resources.” Evaluates sites and is nicely organized in categories.
Yahoo http://www.vahoo.com
Extensive subject index, a good starting point if you are looking for a specific company, government agency, or
organization web site. Company information includes a profile, news, stock information, officers, number of
employees, contact information, web site. You can search Yahoo if you can't find what you want in subject indexes.
Yahoo also lets you search the Web with an Excite search engine.
3
Company Information
(see also Labor, Campaign Finance, Environment, Corporate Responsibility)
The Company’s own web-site “http://www.(company name, or abbev, or acronym).com”
Some contain a surprising amount of critical information useful for activists. You can find company web pages by
doing a title search in various search engines using the company’s name or CBS MarketV.'atch and Hoover’s often
provide links to company websites.
American City Business Journal http://www.amcitv.com
“American City Business Journals Inc. is the nation's largest publisher of metropolitan business newspapers, serving
40 of the country's most vibrant markets." Use pull down menu to choose city. Very helpful IF your city/region is
listed. Useful for information on private companies.
Annual Reports Gallery http://www.reporteallery.com
Annual reports on public companies available on line.
The Annual Reports Library http://www.zpub.com/sf/arl/
Annual reports of banks, foundations, mutual funds and public institutions from around the world can be ordered.
Cost of membership in the library is $75 a year for non-profits
i' CBS.MarketWatch http:/ ebs markctwalch com
Scroll to the bottom of the page to see the useful stuff, in particular the Insider Trading. Shows what the board
members are trading in a particular company, click on their name and see what other stock they own.
CEO Express http://www.ccoexpress.com
“Useful on stop shopping for links on company research, investing and IPO research. Statistics, Business News,
Daily News” (AFL-CIO)
CEO Information from Proxy Statements http://people.edgar-online.com/people
“EDGAR Online People searches SEC Filings by a person’s name or displays all people associated with a specific
company name.”
^■’CompanySleuth http://wv. w, companvsleiilh.com
“Company Sleuth scours the Internet for free, legal, inside information on the companies you select.” Updates you >.
daily via e-mail on the latest on the company you are interest in.
Corporate Information h tip//www.corporatein formation.com
“Provides great one-stop-shopping with links for doing research on private and public companies world-wide.”
(AFL-CIO)
Executive Pay Watch http://www.aflcio.org/paywatch/index.htm
Compares workers’ wages with their CEOs of Fortune 500 companies.
FDIC Institution Directory http://www.fdic.gov
“Financial information on FDIC-insured banks. Data includes: Assets and Liabilities, Total Deposits, Real Estate
Owned, Income and Expense, and Performance Ratios. Use for leverage in corporate campaigns - a company you
are researching might have money invested in a particular bank or a bank CEO may be on the board of directors cfthe company. (Notice “interstate branches” link when you find the bank of your choice.) Click on “Bank Data"
icon, choose “Institution Director" on lift hand side of screen. (Hint: faster ifjust tvpe I city, leave institution name
blank.)” (AFL-CIO)'
FortuneSOO http://cgi.pathfinder.com/fortune/fortune500/index.hm-il
Fast summary of Fortune 500 companies.
4
(Company Information. Continued)
f'FreeEDGAR http://www.frccfDCiAR.com
Free, unlimited access to indexed SEC EDGAR Filings. Also provides free alert service.
Guidestar hrtp: Awwnv.guidestar.org
A clearinghouse of information on nonprofit organizations presently including the activities and finances of more
than 650,00 nonprofit organizations. See full description under Government Information section.
Hoover's Corporate Information httr>:/Avww.hoovcrs.com
Database containing news articles, financial information and company overview. Must pay for expanded
information. Good for brief overview of company.
Investorama http://www.invcsiorama.com
An investor’s research tool. Scroll down and click: Reseath a Stock Online. "Provides links to more than 75 web
sites, with news, charts, quotes, financial statements, eammgs estimates, .industry reports, and other data for any
stock.”
Public Record Annual Reports http://www.prars.com/
Through this site you can order, at no charge, the annual reports and prospectus' or 1O-K's of over 3200 public
companies.
PR Newswire http://www.pr ewswire.com
Has press release news stories on companies. See Company News on left hand side of page. Good for private
companies.
U.S. Securities & Exchange Commission http://www.se: gov/
The Securities and Exchange Commission provides on-line copies of government filings made by publicly traded
companies. Beginning in 1997, the SEC has required all public companies to file electronically. Selective filings
are available back to 1994. Financial statements include: lOQ's; lOK’s and Proxies
Proxy Statements (or 14A’s): Issued when official notification is given by a company
to designated classes of shareholders of matters to be brought to a vote at a shareholders
meeting. Proxy vote; may be solicited for changing the company’s officers. Contains
executive compensation data.
10Q Statements: Provides quarterly financial statements, management discussion, legal
proceedings, changes in securities, defaults upon senior securities, submission of matters
to a vote of security holders, exhibits and reports on Form 8-K (major events).
10K Statements: Provides fiscal year financial statements, most of what appears in 10Q,
but, for year end. Contains description of business, properties, directors and executive
officers, security ownership of certain beneficial owners of management.
5
Corporate Responsibility
Citizens Index Mutual Fund Family http:/-www.efund.com/
Lists the holdings of Citizens Index Mutual Fund, described as "300 of the country's cleanest and most innovative
companies." Gives profiles of many of the companies and their positions on issues of social responsibility
i^CorporateWatch http://www.corpwatch.org/
Online magazine about transnational companies. Highlights their social, environmental and economic impact on the
world. Issue or campaign focused. Searchable archives. Environmental justice and labor are main focus. Provides
tips on how to research transnational companies.
Council on Economic Priorities http://ww-w.cepnvc.org/
SBW (Shopping for a Better World) is a database of companies with CEP ratings on issues of social responsibility.
In fact http'//www, infact.org/
Annual Corporate Hall of Shame posted on this site - top ten worst companies, usually focused dh an issue (e.g.
influence peddling in DC). Currently doing a major campaign against the tobacco industry.
Kinder Lydenberg Domini (KLD) Domini Social Equity Fund http:'www ilonmii.com
Fund of 400 companies that pass detailed social screens. Web site lists the 400 companies, explains the criteria for
each social screen, and provides links to activist organizations.
Kinder Lydenberg Domini (KLD) Socially Responsible Investing Links http:7www.kld.com/wlink.html
Links to SRI websites and resources (groups, investment management sites, fund information, banks)
Multinational Monitor httn-"www.esscntial.org'monitor/
Monthly magazine that tracks corporate activity. Focusing on the export of hazardous substances, worker health and
safety, labor union issues and the environment, particularly m the Third World Searchable database from 1992-.
Social Investment Forum http /'www socialinvcst org'
Site lists socially responsible mutual funds which belong to the Forum and provides monthly updates of their
investment performance from inception to the present
6
Money and Politics
Ballot Initiative Strategy Center hnp//w ww.hallot.org/
Western States Center project that tracks reactionary ballot initiatives around the country. Section “In Your State"
provides information by state and by issue (not updated since mid-1998). Resources section has archived articles on
ballot initiatives, bibliography and links to organizations and publications on the issue.
Center for Responsive Politics http://www.opensecrets.org/
Special reports on die correlation between the sources of lawmakers campaign funds and how they voted, as well as
industry and topical analysis to campaign contributions (for example, top ten agnbiz contributors). Have full text
archives of various CRP publications (Monday Morning Alert, Captial Eye, etc.) It can be searched by name of
congress member, by issue, or keyword (for example, company name). Also has contact information for locating
state campaign contributions.
Common Cause http://www eonimoncause.org/
Reports on industry links to campaign contributions and legislation.
Congressional Quarterly’s American Voter http:7www.campaignline.com/
Check up on your members of Congress, rate your representative!
Federal Electoral Commission Info http://www.tray.com/fccinfo/
FECINFO provides free public access to campaign contributions to federal representatives and candidates, and the
major national parties (soft money). Search by company (employer) and name. The main page is hard on the eyes,
stay focused on the left side of the screen. To search by candidate/rcpresentative click US HOUSE/SENATE
CAMPAIGN MONEY. To search by contributor use both LOOK-UP CONTRIBUTORS BY THEIR NAME (use
company name here, too), and CONTRIBUTOR OCCUPATION/EMPLOYER LOOK-UP. Clear instructions are
provided as you go along.
Follow the Money http:7wwi. followthemonev.org
National Institute on Money in State Politics website. Database on campaign contributions at the state election level
(not federal offices). Can seat ch across states and by issue for contributors as well as by candidate. Not
comprehensive (only 6 states for 1998 information) but the database is under continuous construction. One of very
few sites with this type of information.
Project Vote Smart http:'/wv.w, vote-smart.org/
Voting records, campaign finance data, issue positions, performance evaluations, biographical and contact
information on president and current members of congress. The amounts received by current office holders from
specific interest groups, such as agriculture, are shown back to the late 1980’s. Similar information on state
legislators, governors and non-incumbent candidates. Has a section under: Government & Politics - Issues Research the Issues, that pro\ ides a background on an issue with links to advocacy organizations working on that
issue. Vote Smart is non-paitisan and lists groups from left to right. They also provide links to Think Tanks and
Research Institutes.
Public Campaign http://www.publicampaign.org'
Provides links to publications and public interest groups which are involved in campaign finance reform, as well as
reports on the issue. Has full text archive of their publication linking contributions to legislative activity, “Ouch”
(which you can subscribe to via e-mail). No search engine.
StateNet http://www.statenet.com
State Net monitors 100% of all pending bills and regulations in the 50 states and Congress. There is a monthly
subscription fee of several hundred dollars, depending on how many services you want. (We subscribe to StateNet at
ImpactResearch)
Thomas http://thomas loc.gov/
Congressional web site that tracks bills (with full text and amendments, voting record), committee members, links to
state and municipal governments.
7
Labor
Company Research on the Wcb:A Guide for Union Activists
htto://www.afscme.org/afscme/wrkplace/corprsch.htm
AFSCME’s research guide with hyperlinks.
Department of Labor http://www.dol.gov/
US Department of Labor statutory and regulatory information. Labor related data. Under Wage and Hour Division
is the No Sweat Campaign that includes "Garment Enforcement Reports" listing wage violations of contractors and
the manufacturers doing business with them.
FAST Manual of Corporate Investigations http://www.fastaflcio.org
For S25 you can access Jeff Fielder’s Manual of Corporate Investigations. A must read for anyone engaging in a
corporate campaign.
LaborNet http: '.'www.igc.apc.org/labomct/
“The internet home for AFSME, the Teamsters, the United Electrical Workers ... and more," (with links to each
organization's own site). News features and a huge links list including points to sister-sites (PeaceNet, EcoNet, etc.),
which include hundreds of "conferences" (i.e. bulletin boards), containing information on topics of concern to
progressives.
LaborWEB (AFL-CIO homepage) htlp:''www.aflcio org/
Labor news, policy statements, and public document; economic research library with essays on selected economic
issues; and extensive links to other union sites.
National Labor Relations Board http://www.nlrh.gov
Full text of recent decisions. Click on Decisions. Either view a volume of decisions or us “search Instructions" link
to search by keyword.
Occupational Health and Safety Administration http://www.osha.gov
This government web site provides full reports of OSHA inspections. These include regular inspections and those
filed due to complaints or accidents. Violation, fines and descriptions of incidents arc available. You can get a
nation-wide record of a company or focus your search to specific plant. Click on LIBRARY, then
ESTABLISHMENT SEARCH. Be sure to check off Exact Match or you will get irrelevant information.
Sweatshop Watch http://www.sweatshopwatch.org/
Campaigns re the garment industry
8
Environment
i^CLEAR (Clearinghouse on Environmental Research and Advocacy)
http://www.ewg,org/pub/home/clcar/clear.html
Tracks Anti-Environmental Activities of Wise Use Movement. Searchable database of Wise Use groups by state,
staff, board members, and funding. Also contains database of air and water violations in your state (by company
name). Back issues ofCIearNcwsletter(1994-1997).
Communities for a Better Environment http://www.igc.org/cbe/cbe.html
Urban environmental health organization that fights industrial pollution and organizes to empower communities.
Major project on oil refineries.
Co-op America http://www.coonamerica.org/
National Green Pages database. Information on boycotts and sweatshops.
Envirolink http://www.cnvirolink.org/
Comprehensive listing of environmental resources. Search engine for locating environmental information (ex. enter
a company name for a list of articles and reports involving that company).
Environmental Defense fund Scorecard http://www.scorecard.org/cnv-releases 'us-man.tcl
Find detailed reports on chemicals released by more than 17,000 plants in the US. Search by company and location
(city, zip, county, state, etc.). Includes rankings of plant to industry.
Environmental Justice Network http://www.econet.apc.org/envitisticc/
People of Color Environmental Groups Directory, links to organizations, reports & articles, government resources,
African-American and Asian American resources, issues and action alerts.
Environmental Protection Agency http://www.cpa.gov
Home page. Envirofacts page provides search engine for all EPA databases (TRI, Superfund, etc.)
http://www cpa.gov/enviro/i'idex jjva.html. Able to search by zip code!
Environmental Protection Agency - SFIP http://www.epa.gov/oeca/sfi
Sector Facility Indexing Project database. Compliance and enforcement records for five industries (auto, pulp,
iron/steel, petroleum, nonfenous metals) in conjunction with information on chemical releases, spills, and
production capacity. This is aider Data Access link.
Greenpeace http://www grex npeace.org/
Good search engine using keyword.
International Rivers Network http: "www.irn.org'
Information on efforts to stop dam-building around the world. Good search engine.
League of Conservation Voters http://www.lcv.org/
Environmental scorecard on congress' performance, giving percentage ratings to each elected official. Recent
environmental votes are also highlighted
Pesticide Action Network http://wwwv.panna.org/panna
i/
“The Pesticide Information Service (PESTIS) is an online database that contains pesticide reform-related material,
including articles, newsletters, reports and action alerts. It includes almost everything that PANNA has published
plus materials from many other organizations such as the Northwest Coalition for Alternatives to Pesticides,
Washington Toxics Coalition. The Pesticides Trust (PAN Europe), Mothers & Others for a Liveable Planet,
Community Alliance with Family Farmers and more.”
Project Underground http://www.moles.org/ProjectUndergroiind/search new.cfm
Important source for information on the oil and mining industry. Nice searching capabilities.
9
(Environment continued)
/
4' Rachel's Environmental and Health Weekly http://www.rachel.org
Sign up for a free electronic subscription. Site searches the archives of this informative, important and cutting-edge
newsletter.
4" Right-to-Know Databases http://www.rtk.net/ v/
The Right to Know Network (RTK) provides free access to government information on toxic releases, toxic spills,
superfund sites and other environmental results of manufacturing/industry. You can search by company, industry or
geographic area. Once on the homepage, click DATABASES to the left of the screen, now you need to decide
which databases to search. A MASTER search will search all of the databases simultaneously.
10
Alternative Policies & Progressive Activism
Bay Area Progressive Directory http://www.cinf net-clieetham index.html
Alphabetical directory with ind.x by subject
Center for Campus Organizing http:;/www.cco.ora
Student activism, links to studc it groups and progressive groups
Center for Third World Organizing http- 'www,etwo org
x/
Issues and action in communities of color, training opportunities.
The Electronic Policy Network http://wwwepn.ora
Searchable database of articles and reports on social issues by wide variety of progressive think tanks (eg.. Citizens
for Tax Justice, Center for Policy Alternatives). Good resource for alternative policies. Links to these think tanks.
Environmental Support Center http://www.envsc.org
"Since 1990, the Environmental Support Center (ESC) has assisted almost 1300 local, state and regional
organizations working on envnonmental issues. ESC's goal is to improve the environment in the United States by
enhancing the health and well-being of these organizations. Our Training and Organizational Assistance Program,
Technology Resources Program . Workplace Solicitation Program, and new Environmental Loan Fund help these
vital environmental groups become better managed, funded and equipped."
Foundation Center hltp://ww a fdnccnlcr.org
How-to guides on grant writing, research foundations, and find their affiliate libraries.
Left on Line http://www.lol situreworld.com/
Z Magazine’s site to keep us Lefties up to date on the progressive point of view
National Freedom of Information Coalition http- www reporters.net nfoic
Links to resources on FOI, both by federal and by state.
National Organizers Alliance http://www.noacenir3l.on!
The National Organizers Alliance is a progressive support center for organizers. “NOA is a wildly diverse, beloved
community of progressive organizers to challenge, nurture and sustain us in our struggle for social, economic and
environmental justice."
Preamble Center http: www.preamble ore'
Progressive think tank - full text reports that examine social and economic justice issues (ex. Living Wage campaign
in Baltimore).
The Progressive Directory htlpi'www, igc.apc.org
Search IGC’s membership by topic and by organization’s name.
Public Citizen http://www.cili/cn org/
Consumer advocacy organization. Under their Freedom of Information Clearinghouse (Litigation Group page) they
have a finding aid to government records on the web.
United for a Fair Economy http:-/www.slw.org'
Progressive analysis of economic issues. Reports, tools for action, and newsletter.
11
Government Information
(see also Money and Politics)
The Electronic Activist httr www.berkshirc.net/~ifas/activist/
Directory of e-mail addresses of federal and state legislators and many media entities, listed by state. There are also
entries (e-mail or street addresses) for many departments of state government and some for local government.
U.S.Census Bureau -Tiger Map Service http://tiger,census gov
The main purpose of the TIGER Map Service project is to provide a good-quality, national scale, street-level
map to users of the World Wide Web. Can custom create maps with census information (income, race, etc.) Also,
can produce custom reports of detailed statistical information from the census.
Department of Labor Statistics http://stals.bls.gov/infohome.htnV
Economy at Glance has data on labor force, unemployment, eamings, productivity, Employee Cost Index, Consumer
Price Index, producer Price Index. Can be search by key word.
Environmental Protection Agency http://www.epa.gov
Home page. Envirofacts page provides search engine for all EPA databases (TRI, Superfund, etc.)
http://www.epa.gov/enviro/index java hlml. Able to search by zip code!
i" Federal Electoral Commission Info http://www.nay.com'fee info/
FECINFO provides free public access to campaign contributions to federal representatives and candidates, and the
major national parties (soft money). Search by company (employer) and name. The main page is hard on the eyes,
'stay focused on the left side of the screen. To search by candidate/rcprcsentativc click US HOUSE/SENATE
CAMPAIGN MONEY. To search by contributor use both LOOK-UP CONTRIBUTORS BY THEIR NAME (use
company name here, too), and CONTRIBUTOR OCCUPATION/EMPLOYER LOOK-UP. Clear instructions are
provided as you go along.
FREEDOM OF INFORMATION ACT
American Civil Liberties Union http://www.aclu org/library foi.i.html
Step by step guide for using the Freedom of Information Act.
Reporter’s Committee for Freedom of the Press http://www.rcfp.org'rcfp
Has on-line support assistance for filing FOIAs.
General Accounting Office Reports http://www.gao.gov
Full text of GAO reports from 1995 to present. Great source of information on wide variety of topics. Searchable by
subject.
Guidestar http://www.guidestar.org
A clearinghouse of information on nonprofit organizations presently including the activities and finances of more
than 650.00 nonprofit organizations. Enter the non-profit's name in <Charity Search> box. After reviewing the
retrieved list of nonprofits, click on your targeted organization and use your browser to print. Fill out IRS Form
4506-A, Request for Public Inspection or Copy of Exempt Organization Tax Form. Include the EIN (Employer
Identification Number) provided by Guidestar. Attach the Guidestar printout with your request to the appropriate
Internal Revenue Service Center. Within two to six weeks you should receive photo-copies of the non-profit's IRS
Form 990 with a fee for photocopying. The 990 has a wealth of information including the salaries of the top five
employees and outside contractors, and a list of officers and directors.
HPI Political Infrastructure (Harden Political InfoSystems) http://hpi.www.com/us50/index.html
Data by state, county’ and city. Has census data and maps, contact information for local officials.
^ National Association of Counties http://www.naco.org
Go to the "About Counties" link for local data. Has census data and maps, contact information for local officials,
links to “Model Programs" regarding such issues as criminal justice (searchable by topic or county).
12
National Library of Medicine imm .'www.nltn.nih.iiov
Search the NLM site is most useful. Lot's of good stuff on chemicals and their effects.
6 Occupational Health and Safety Administration him- www.osha.eov
This government web site provides full reports of OSH.A inspections. These include regular inspections and those
filed due to complaints or accidents. Violation, fines and descriptions of incidents are available. You can get a
nation-wide record of a company or focus your search to specific plant. Click on LIBRARY, then
ESTABLISHMENT SEARCH. Be sure to check off Exact Match when searching, other' :se you'll get inaccurate
results.
0 Right-to-Know Databases nty www.rtk.net'
The Right to Know Nelwoik (RTK) provides free access to government information on toxic releases, toxic spills.
superfund sites an other environmental results of manufacturing/industry. You can search, by company, industry or
geographic area. Once on the homepage, click DATABASES io the left of the screen, new you need to decide
which databases to search. A MASTER search will search al! of the databases simultaneously.
State and Local Government Information hum w ww ninerinlb com "true states him!
Click on a state site and see categories: Slate Home Page; Statewide Offices; Legislative .’udicial Exeeutive
Branch- Boards and Commissions Regional; Counties; Cities.
U.S. Security and Exchange Commission hum www'ec.aov
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13
Community Health I Environment Survey Skillshare (CHESS)
Date : 13 - 17'" August, 2001
Venue : United Theological College, No. 63, Millers Road, Benson Town, B’lore - 46
Registration Form
1. Name
2. Organisation represented
3. Address
Tel No.
Email :
4. Postal Address (If different from above)
Fax No.
5. Work background
6. Arrived on
7. Departure on
8. Accommodation required ?
By
(mode)
By
(mode)
Dates
At
(Time)
At
(Time)
12lh night
13,b night
14,h night
IS111 night
16,h night
11. Any special requests?
Date :
Place :
Signature
(Please fill in this form and return it to Registration Desk )
LIST OF PARTICIPATING GROUPS/ ORGANISATIONS /
CAMPAIGNS IN SKILLSHARE
Resource groups/personnel:
1. Nityanand Jayaranian,an independent journalist working on toxic issues for
over 5 years.
E mail: nily68(a>vsnl.com
2. Greenpeace, India:
Represented by Manu Gopalan, Navroz Mody,NirmalaKarunan,Michelle Chawla.
Manu is from and is working in Kerala, paricularly in Eloor among the
communities affected by industrial pollution. Navroz is from Kodaikanal,-and is
currently involved in the campaign against Unilever to clean up its mercury
pollution in Kodaikanal and assess and remediate the damage to its worker’s
health.
E mail: mango^foru(ri vsnl.net, navrozmofe’vsnl.net
3.
Community Health Cell (SOCIIARA), Bangalore:
Represented by Dr.RaviNarayan, Dr. Mohan Isaac,Dr. Rajan Patil .Dr.Praveen
and Lalit Narayan.
Associated members of CHC in Skillshare:
Dr.Girish(MSRMC),
Dr. Unnikrishnan(OXFAM), AS Mohammed(SJANMS).
A volumtary health organisation and community health resource and policy centre
working closely with the governments and communities to improve health and
access to health care. Also involved in training health workers to empower
communities at grass root level.
E mail: tnarayantirvsnl.com
socharaQi vsnl.com
Address: 367, Srinivasa Nilaya, Jakkasandra 1st Main, 1st Block, Koramangala,
Bangalore 560 034.
Phone: 080 5531518/ 5525372
4.
Occupational Health and Safety Centre, Mumbai
Represented by Dr. Murlidhar V and Vijay Kanhere
Dr. Murlidhar V is a Mumbai based doctor with experience and interest in
community health surveys and environmental health issues. Vijay Kanhere is a
labour activist who has worked for the compensation of workers in industry.
E mail: murlidharvtu1 vsnl.com
sujvij(h vsnl.com
webmastcrrh'ohscmumbai.org
Address:6, Neclkant appartments, Gokuldas Pasta Road, Dadar(E), Mumbai-400
014
Phonc(O): 766 0178, (R)886 8329
5.
Regional Occupational Health Centre, Bangalore
Represented by Dr. Rajmohan(Dircctor), Dr. Krishan Murthy(Organic Chemistry)
and Mr. Rajan.
Branch of National Institute of Occupational Health , Ahmcdabad
Address: Ground Floor, Central Library Block, BMC Campus, Bangalore-560
002
6.
Toxics Link, Delhi
Represented by Rajesh Rangarajan
Email: lld^iita’vsnl.com
Cr-t Ar-Cu.
7.
Dr.Rakhal Gaitonde, Dr.Subashri Gaitonde,
CMC,Vellore.
Campaign Groups
1.
Thanal
Conservation
Network,Thiruvananthapu ram:
Action
and
Informatin
Represented by Usha.S, Sridhar R, Rajasree VV
A community oriented organisation working on conservation issues and toxic
related issues. Cuurently engaged in a community RIGHT TO KNOW campaign
in Eloor, Kerala and a proposal to move Kovalam toward a zero waste model.
Email: thanal @ md4.vsnl.net.in
shreepadreO'sancharnet.in
Address: Post Box No: 815, Kawdiar, Thiruvanthapuram, 695 003, Kerala
Phone: 0471 311896
2.
Paryavaran Suraksha Samiti, Gujarat
Represented by Anand Mazgaonkar or Rajni Dave or Swati Desai
A Voluntary self help organisation working primarily in South Gujarat on a
variety of issues, including Industrial Pollution and RIGHT TO KNOW.
Email: pss(<dnarmada.net.in
Address: 37/1, Narayan Nagar, Chandui chowk, Rajpipla-393145, Narmada
district, Gujarat
Phone: 02640-20629
3.
Citizens for alternatives to Nuclear energy (CANE)
Represented by Kavitha BS
A Bangalore based NGO working aganist radioactive pollution.
E mail: kavaythriQ'vahoo.com
aravindakdcisco.com
Address:#390, 5th main, 12th cross, West of Chord Road, 2nd stage,
Mahalakshmipura, Bangalore-560 086
Phonc:080-3592059/60
4.
Mines, Minerals and People(MMP)
Represented by Bhanu, Praveen Mote, Mahalakshmi
MMP is a national network of mining- affected communities and community
groups and working with meining affected communities in any manner.
E mail: samatha@satyam.net.in; mmpindia@hd2.dol.net.in
Address: 1249/A, road No. 62, Jubilee Hills, Hyderabad- 500 033. Phone: 0403542975/6505974
5.
Sambavna
Represented byR VT Padmanabhan
A Bhopal based voluntary organisation engaged in delivering holistic medical
services to gas affected people. Has undertaken several pioneering initiatives in
the field of community health, particularly in the context of communities affected
by industrial pollution.
E mail: sambavna@bom6.vsiil.nct.in
6.
Palni Hills conservation Cominitcc
Represented by Kanan
A NGO based in Kodaikanal fighting for the cause of workers affected in
Mercury factory of 1ILL.
E mai!:kanan@vsnl.com
7.
Endosulfan Spray Protest Action Commitee, Kerala
Represented by Dr. Sripathy Kajampady
Espac was formed at Perla, Kasargod by local farmers and the affected people
to fight the aerial spraying of endosulfan and they have ben very sucessful in
bringing this issue to a larger media and people’s attention.
E-mail: shrecpadic(o sanclianicl.in
Address:C/O Kajampady Nursing Home, P.O. Perla-671 552, Kasargod District,
Kerala. Ph:895088
p./fowv
8.
PaKyaVanni Malineekarana Virudha Samiti,Kerala
Represented by Jose V J
PMVS is a local group of activists fighting the pollution issue in the Eloor and
Edayar belts of the River Periyar, where there are about 250 industries of all sorts
mainly chemical.
E-mail: lhanal@vsnl.com
'Tud.lyCL
Address: Periyar Malineekarana VifegSte Samiti, Eloor Depot, Udyogmandal
P.O. ,Kochi, Kerala. Ph.98460-13483
9.
Chintan Environmental Research and Action Group
Represented by Bharathi Chaturvedi
A Delhi based NGO working on environmental issues, particularly waste/and
toxics.
E mail: bharatieli(mholniail.com
Address: 238, Siddharta enclave, New Delhi-110 014. Phone:0091-11-338 1627
The Community Health I Environment Health Survey Skillshare
(CHESS)
CHESS - A CHC process initiative, 13 - 17th August 2001.
A. BACKGROUND.
A polluted environment will manifest itself in the form of health disorders amongst
human and other living populations exposed to the polluted environment.
Based on numerous cases around the country, common sense evaluation clearly confirms
that industrial pollution has damaged community health. However, the specific nature of
the damage or its extent remains unknown. As a result, community health has hardly
influenced pollution policy. The indications that this is the case is evident:
1. Pollution legislation aims at controlling pollution rather than preventing it.
.2. Pollution legislation merely prescribes norms that legalise pollution.
.3. What is legal is not healthy. Pollution norms are prescribed based on an
assumption of assimilative capacity of nature rather than on facts that point to the
cumulative nature of the most deadly kinds of pollutants and their risks to
community health.
4. Polluters remain unpunished for their pollution and effects on community health.
Importance of Community Health Surveys
Citizens and community groups need to be able to identify environmentally-caused health
disorders, and the sources of environmental disturbance(s) that cause such disorders. This
is important for several reasons:
1. Ensuring that the "Polluter Pays": The Polluter Pays principle is important not
merely as a deterrent for further or future pollution, but also in the context of
recovering the ecological debt owed to the communities of living beings and their
future generations. Ecological debt goes beyond the fiscal and requires a deeprooted sense of apology by the polluter for the damage caused by its actions.
1. Mobilising the Community: Often health disorders within a community are seen
at a family level, with people blaming the compromised health of their family
members on fate or accident. Many of the subtler effects - learning disorders,
immune system depression, reproductive or gynecological anomalies - are
noticeable as trends only when seen at a community level. Mapping the health of
a community brings home the fact that the fate of the community as a whole is
linked to its environment.
2. Preventing Future Harm: Armed with the knowledge that certain kinds of
industries and pollution can cause community wide health effects, communities
can play a more active and informed role in deciding the course of their
communities' development. Combined with an operational understanding of the
Precautionary Principle, such knowledge can help in preventing the setting up of
polluting industries.
3. Countering Govcmmcnl/Industry: Community health surveys need not be
conclusive in establishing cause-effect relationship between environmental
disturbance and health disorders. They need to sufficiently appeal to the common
sense of the community members and the public to be able to challenge the
baseless assertions by Govemment/induslry that a community's ailments have
nothing to do with the pollution they are subject to. Health surveys can help
reverse the burden of proof, with communities demanding industries and
governments to establish beyond doubt that their polluting activitics/industrics arc
not related to the community's health problems, or will not cause health disorders.
5. Health Care Needs: Health surveys also allows for better understanding of the
health care needs of communities living in environmentally disturbed areas. Such
an understanding is crucial to designing the health care interventions necessary
for the community members.
I
B.
AIM:
Equipping Communities and campaigners to deal with Health Surveys:
C.
OBJECTIVES:
•
To create a multidisciplinary resource base of medical practitioners, community
activists and toxicologists capable of conducting community health surveys in
communities subject to industrial and environmental pollution;
•
To promote interaction between community activists and community health experts to
facilitate a discussion aimed at understanding the limitations and strengths of
community health surveys;
•
To understand the role of community health surveys in campaigns against industrial
pollution.
D.
THE SKILLSHARE (ORIGINAL PLAN)
The skillshare would discuss the following elements:
1. Toxicology
2. Pollution & Community Health
3. Design and Implementation of Health Surveys - Resource Implications (costs,
personnel, time etc)
4. Understanding the strengths and limitations of community health surveys
5. Using Community Health Surveys for campaigning.
6. Resources and resource sharing opportunities.
7. Case Studies
Participants
Community activists, medical practitioners from affected communities, occupational
health doctors/activists, community health doctors/activists, toxicologists, lawyers.
Discussions have been held with community Health Cell, Bangalore, the functional unit
of the Society for Communilty Health Awareness, Research and Action to facilitate an
interactive, participative skillsharc that will address these aims and objectives.
(This background is a modified version of an earlier note circulated by Nityanand
Jayaraman and Manu Gopalan.)
The Community Health—Environmental Survey Skillshare- 2: 26-28111 July, 2002.
The Background
A polluted environment will manifest itself in the form of health disorders amongst
human and other living populations inhabiting it.
Based on numerous cases around the country, common sense evaluation clearly confirms
that industrial pollution has damaged community health. However, the specific nature of
the damage or its extent remains unknown. As a result, community health has hardly
influenced pollution policy.
The indications:
1.Pollution legislation aims at controlling pollution rather than preventing it.
2.Pollution legislation merely prescribes norms that legalise pollution.
3.What is legal is not healthy. Pollution norms are prescribed based on an assumption of
assimilative capacity of nature rather than on facts that point to the cumulative nature of
the most deadly kinds of pollutants and their risks to community health.
4.Polluters remain unpunished for their acts and communities seem to be forever in the
wait for their rightful rehabilitation and compensation.
Importance of Community Health Surveys:
Citizens and community groups need to be able to identify environmentally caused health
disorders, and the sources of environmental disturbances that cause such disorders. This
is important for several reasons:
Ensuring that the "Polluter Pays": The Polluter Pays principle is important not
merely as a deterrent for further or future pollution, but also in the context of recovering
the ecological debt owed to the communities of living beings and their future generations.
Ecological debt goes beyond the fiscal and requires a deep-rooted sense of apology by the
polluter for the damage caused by its actions.
Mobilising the Community: Often health disorders within a community are seen at a
family level, with people blaming the compromised health of their family members on
fate or accident. Many of the subtler effects - learning disorders, immune system
depression, reproductive or gynecological anomalies - are noticeable as trends only when
seen at a community level. Mapping the health of a community brings home the fact that
the fate of the community as a whole is linked to its environment.
2.
3. Preventing Future Harm: Armed with the knowledge that certain kinds of industries
and pollution can cause community wide health effects, communities can play a more
active and informed role in deciding the course of their communities' development.
Combined with an operational understanding of the Precautionary Principle, such
knowledge can help in preventing the setting up of polluting industries.
4. Countering Government/ Industry: Community health surveys need not be conclusive
in establishing cause-effect relationship between environmental disturbance and health
disorders. They need to sufficiently appeal to the common sense of the community
members and the public to be able to challenge the baseless assertions by
Government/industry that a community's ailments have nothing to do with the pollution
they are subject to. Health surveys can help reverse the burden of proof, with
communities demanding industries and governments to establish beyond doubt that their
polluting activities/industries are not related to the community's health problems, or will
not cause health disorders.
5. Health Care Needs: Health surveys also allows for better understanding of the health
care needs of communities living in environmentally disturbed areas. Such an
understanding is crucial to designing the health care interventions necessary for the
community members. Women and Children are seen as especially vulnerable in certain
environmental stress conditions. Health surveys can help ascertain the nature of the broad
problem and help address their specific needs/concerns.
Historical Context:
Keeping the above in mind , Chess, Community Health Environmental SurveySkillshare started on August 13,h, 2001 at United Theological College, Bangalore
involving a small group of individuals and organization. All the participants were present
in time and really enthusiastic about the program. Since it was a small group of about 40
people and that the groups would be together for the next 5 days, a personal introduction
round was included. This broke the initial barriers of unknown and created a added sense
of familiarity to the entire meeting. This was followed by the scheduling of the entire
event It was important to know the different campaigns of the participants, the extent of
their invovlvement and their reuqirements. There has been some meaningful activity in
the hotspots as a result of that interaction. We have had our fair share of problems too.
But all of it has helped us to improve our understanding of how to handle the tense and
desperate situations we encounter as we go about performing health surveys.
Ever since there has been a constant urge for us to get back together evolving a clear
framework for action in the various pollution/radiation hotspots we work in.
Some of the issues and topics covered in detail were :■ The aerial spraying of “Endosulfan”, a POP pesticide, on cashew plantations, in
Kasargod, a district in North Kerala by Usha. S, from Thanal Conservation and
Action Committee from Trivandrum, Kerala. The highlighted problems as part of
her presentation were - little knowledge of toxicology and its effects on human
body; Not being able to relate the medical problem in community to anything in
particular initially; Later, the onus of proving the endosulfan as the problem was
thrust upon the local people.
■ The Kodaikanal issue about Mercury was narrated by Mr. Mahendra Babu, an ex
worker in HLL’s thermometer plant in Kodaikanal and now the president of ex-
List of Participants - CHESS II
Survivors,Community-based activists and individuals:
Bangalore :
1. A S Mohammed (SJANMS)*
AS Mohammed is the Asst. Professor of statistics and demography in the Department of
Community-Medicine, St. John's Medical College and has been involved in numerous
studies and reports on health care and evaluation. He is a society member of CHC.
Address: Department of Community Health, St. John’s Medical College,
Bangalore- 560 034
Phone: 080-2065043
Email: aa.sjmc@vsnl.com
2. Gururaj Budhya (TIDE)
Having worked with different environment groups and movements, his strength lies in
bringing people together from diverse background. Also a member of environment
journalist group in Karnataka. A strong networker in Karnataka.budhyag@hotmail.com
Mobile:0-9844069634(M) Phone: 080-3315656/3462032
3.Dr. Girish Rao
Dr. Girish Rao is an Associate Professor of Community Medicine in M.S. Ramaiah
Medical College, Bangalore with a longstanding interest in all aspects of hospital waste
management. He is also an Associate of CHC.
Address: Faculty of Community Medicine, M.S. Ramaiah College, MSRIT Post,
Bangalore- 560 054
Phone: 080-3600968
Email: girishrao@hotmail.com
4. Mahalakshmi Parthasarathy
Mahalakshmi is working with mining struggle groups. She is also involved with legal and
media advocacy and information documentation.
Email: pmahalak4hmi@yahoo.com
5.Mohan
Trade Union Movement Researcher, Bangalore.
6.Dr. Rajan Patil
Dr. Rajan is an epidemiologist and is presently a Research/ Training Assistant in CHC
with a special interest in vector bourne diseases. He has been involved with creating an
interactive science teaching module on mosquitoes and their control.
Email: rajanpatil@yahoo.com
7.Dr. Ravi Narayan
Dr. Ravi is the Community Health Advisor of CHC with professional interest and
training in public health, industrial health and preventive and social medicine. Earlier as
an Associate Professor of Community Health at St. John’s Medical College he worked on
occupational hazards of the tea industry and the health effects of agricultural
development.
Email: tnarayan@vsnl.com
S.Dr.Thelma Narayan is the present coordinator of CHC. She is an epidemiologist with a
doctorate in public health policy. She has been involved as a resource person for studies
on the Bhopal health disaster and is currently a member of the Karnataka Government
Task Force on Health and Family Welfare.
Email: tnarayan@vsnl.com
9. Prakash
T
fighting GE crops
ICRA. Bangalore
10. DR. Unnikrishnan P V
OXFAM
Media Strategist and specialist in Disaster Management. Email: unnikru@vsnl.com
11 .Dr. Venkatesh
Dr. T. Venkatesh is the Professor of Biochemistry at St. John’s Medical College and the
Director of ’Project Lead Free’ of the George Foundation. He is also the head of the
National Referral Centre for Lead Poisoning in India.
Address: Department of Biochemistry and Biophysics, St. John’s Medical College,
Bangalore- 560 034
Phone: 080-5532146/ 2065058
Telefax: 080-6640293
Email: venky_tv@hotmail.com
12. Viswambhar Pati
Indian Scientists against Nuclear Weapons, ISANW, Bangalore
Pati has been very active in the mobilization of citizens’ groups across Bangalore city
against the nuclearisation of India. He is teaching at the Indian Statistical Institute,
Bangalore.
Bhadravati
13. Dr. Narendra Babu
Local resident of bhadravati. Dr.Babu takes time, out from his clinic to participate
in Save tungabhadra federation’s work, a forum fighting against the pollution of River
Tungabhadra due to Mysore Paper and Pulp Industry and the mining work around
Kudremukh. He was involved in a study related to health impact due to pollution of
bhadra river around kudremukh mining area.
#9845226678(M)
#08282-66690 ®
Verghese Cleatas
14.
Project Director, Vikasana
An organization working for 10 years on the issue of environment with presence in 45
villages.Has taken up the issue of pollution and its effect on community through
awareness programmes; with wide outreach to about 8000 students, running environment
awareness programme in schools.Facilitating the process of promoting traditional herbal
medicine. Running three model herbal gardens. Also has taken out books in kannada
literature
P.B.No: 23
Tarekere - 577228
Chikmangalore; Karnataka
# 0826-422500/422570/423739
email: vikasana_ngo@sify.com
Bhopal:
15. Nishant:
As a community researcher Nishant has worked exhaustively in Bhopal doing a health
survey of children born to exposed parents as opposed to unexposed ones to the gas
tragedy. His new survey has become an innovative stick to beat the Indian Government
with, for the survivors of the disaster.
16.Satinath Sarangi - Sambhavana
B 2 - 302, Sheetal Nagar,
Berasia Road, Bhopal; Ward
An M Tech in Metallurgical Engineering, Satinath came to Bhopal a day after the disaster
and has been involved with relief, rehabilitation and issues of justice for the Bhopal
victims since then. He is one of the Founder Members of the Bhopal Group for
Information and Action that carries out documentation, research and publications. He is
also actively involved with legal actions as well as national and international campaigns.
Emaiksambha vana@vsnl.com
Chennai:
Nityanand Jayaraman
17.
Nityanand is an independent journalist working on toxic issues for over 5 years.
Address: 218, 6lh Main, 6lh Cross, Rajarajeshwari Nagar, Bangalore-560 098
Phone:080-8601033
E mail: nity68@vsnl.com
Rajesh
18.
Rangarajan
Toxics Link, Chennai.
tlchennai@vsnl.net
Rajesh has been working on the issue of municipal waste in the city of Chennai as part of
Toxics Link.
Delhi:
Achin Vanaik
19.
Campaign for Nuclear Disarmament and Peace CNDP)
Achin is a writer-activist fighting for nuclear disarmament and peace in these troubled
times
20. Ananthapadmanabhan
Ananth is the Executive Director of Greenpeace India. He had been teaching school
children for more than a decade. He also spent a few years in the Environment Division
of a leading financial institution.
Email: anantli@dialb.greenpeace.org
21. Dr. Arun Mitra
Indian Doctors for Peace and Democracy (IDPD)
The Indian affiliate of the International Physicians for Prevention of Nuclear War
idpd2001 @yahoo.com
22. Bejon Mishra
Consumer Voice, New Delhi
23.
Bharati
Chaturvedi
Coordinator of Chintan Environmental Research and Action Group.
24.Bidhan Chandra Singh
Bidhan is a trainee campaigner with Greenpeace India.
Email: deogharbiddu@hotmail.com
25.
Divya
Raghunandan
Divya is a trainee campaigner with Greenpeace India.
Email: r_divya@hotmail.com
Madhumita Dutta
26.
Toxics Link Delhi, New Delhi.
mdutta@vsnl.com
27.
Manu
Gopalan
Manu is a toxics campaigner with Greenpeace India.
Email: manu.gopalan@dialb.greenpeace.org
28. Nidhi Jamwal
The Centre for Science and Environment 41, Tughlakabad Institutional Area, New Delhi110062.
Ph: 011 -6081110,011 -6083699,fax:O11 -6085879
email:cse@sdalt.emet.in
29.
Nirmala
Karunan
Nirmala is the Administration Manager of Greenpeace in India.
Email: nirmala.karunan@dialb.greenpeace.org
30. Ravi Agarwal
Senior Environmentalist and Director, Srishti, New Delhi
Email: srishtidel@vsnl.net.in
31.Sanjiv Gopal
Sanjiv is currently a trainee campaigner with Greenpeace India.
Email: sanjiv.gopal@dialb.greenpeace.org
Dodbalapur :
32. Dayanand Gowda
A Youth group trying to respond / protest against Bangalore mysore Infrastucture
corridor project. They have been active against cutting trees; they have also performed a
cycle yatra. Fighting pollution due to the Goggo Factory in Doddebalapur, near
Bangalore, Karnataka.
Janadhwari Yuva Vedika, Opp. Masjid Kumbarpet,
Doddebalapur-561203 #080-7626450 ®
33. Prakash R.
Fighting pollution due to the Goggo Factory. Prakash is from the affected village near
Gogo factory; a village panchayat member
Doddebalapur, near Bangalore, Karnataka.
Village : Aradeshhalli, Doddebalappur
#080-8464251-®
34.Sadhana
Village : Aradeshhalli, Dodbalapur
Land owner, having 100 acres of land around the area of dodballapur. Most of the land ,
water source has been contaminated by Gogo factory.
Edayar:
35. Salim VA
Fighting pollution due to Binani Zinc’s Jarosite Pond in Edayar, Kerala
Valiangadi, Binanipuram(PO),
Edayar, Emakulam,-6835021
# 0484-555592
Eloor :
36. VJ Jose
Jose was working in Cochin spreading awareness about Road safety and First-Aid tips
with Emakulam Rural Action Force. Now he is an active volunteer of Greenpeace-India.
Involved in mobilizing the local community using education material and films from the
Greenpeace library. He has also been instrumental in environmental monitoring of the
river Periyar.
Ph:0484—545314
37. VV Purushan
Purushan is the community leader of Periyar Malineekarana Virudha Samithi, a
community based organization involved in pollution prevention through direct actions in
Eloor. the largest industrial estate in Kerala.
38. Adv.Daisy Thampi
practices Environmental Law in Kerala.
Email:dait5@yahoo.com
39.
Remya
A college student extremely keen to work on health issues in Eloor
40. Shakeer
A long-time activist with the Periyar Malineekarana Virudha Samiti, Shakeer has been
instrumental in putting together the key actions of the group in Eloor.
Gudur:
41. Gangi Reddy V
Rural reconstruction and development society, Gudur (A.P)
The organization is fighting for the rights of dalits/adivasis. The struggle os also against
illegal mining and pollution due to mica mining. RRDS went to the court against a
industrialist, who took lease of tribal village and tried evacuate it.
Sydapuram 524407
Nellore Dist. (A.P)
#08621-87096
Gujarat:
42. Michael Mazgaonkar
Besides being a long-time activist with the Paryavaran Suraksha Samiti, he has been
working on a wide variety of environmental and other social problems in Gujarat.
Email :pss@narmada
43.Swati Desai
Swati desai’s work involves trying to mobilize affected communities along a 200km
stretch from Vapi to Mehsana in Gujarat on issues of ground and surface water
contamination, hazardous solid waste, air pollution, health effects and TNCs.
pss @ narmada.net. in
Harihar Polyfibres :
44.Mr. Hiremath
Samaj Parivartana samudaya
Ranibennur, Karnataka (HPF)
SPS is a voluntary organization working on the issue of environment with presence in
Karnataka, MP and Orissa.SPS and reputed national institutes have conducted studies on
pollution of Tungabhadra river due to release of effluents of Harihar PF. Facilitated the
formation of Tungabhadra parisar Samiti, a local group of 20 villages; actively
encouraged fisherwoman/man to file cases, against HPF; filed P1L in the High Court,
which resulted in a order asking HPF to take corrective measures to control pollution.
sr_hiremath@hotmail.com
sr_hiremath@rediffmail.com
45.Shahnaz
Samaj Parivartan Samudaya
Hazaribagh:
46.
Dr.Jemma
She works with the Tribal population in the mining area on the issue of their failing
health system. Runs a clinic in the area.
Ph: 06546-32476/31128
Hyderabad :
47. A . Kishan Rao
President, Patancheru Anti Pollution Committee
He was formerly a lecturer and also a medical and health officer. He is a resident of
Patancheru and has observed the ill-effects of pollution very closely. He says, now I can
see the effects of pollution on my family members.Author of book called “A hell on earth
“, and was also involved in a health survey around the area. Medical environmentalist and
activist Dr.Rao has been taking up the cause of the victim of pollution at patancheru for
more than a decade to different fora’s.
Yashodhara hospital, 12-5, srinagar colony,
Patancheru - 502319, Medak Dist. (A.P.)
48. Narasimha Reddy
Executive director, Centre for Resource Education
A voluntary organization based in Hyderabad working on issues related to agriculture,
sustainable development, environment protection and other related rural and urban issues.
Narasimha reddy is a person committed to struggle on the issue of pollution due to
industries around Hyderabad . Passion to bring people and organization together with
strong networking capacity.
email: creind@hd2.dot.net.in
49. Dr. Sagari Ramdas
5O.Ashalatha / Satheesh - Anthara
Anthra is an NGO started by women veterinarians and works primarily with poor
farmers, dalits, adivasis, particularly women. It works to strengthen people’s livelihoods
by improving the health & production of livestock and poulry in the wider context of
natural resource management and sustainable development.
Anthra works in AP & Maharastra and in AP the major work areas are the districts of
East Godavari, Visakhapatnam and Medak and also several other districts. Dr.Sagari
Ramdas is the Director of Anthra in Andhra Pradesh.
Major Components of work:
• Action research on indigenous knowledge of rural communities on livestock
rearing
• Participatory planning, Evaluation, and monitoring for development interventions
• Training of village level animal health workers
• Policy advocacy
Publication of educational materials
Email: anthra@hd2.vsnl.net.in
040-7113167/7110977
Jadugoda :
51 .Ajitha Susan George:
She has been instrumental in performing a health survey focusing on women’s health in
Jadugoda. In Naomundi she is working on indigenous systems of medicine. Email:
jsr_ajithasg@sanchamet.in
Ph: 06596-33501
0657-220266
Kaiga-Bangalore:
52. Vishnu Kamath
Citizens for Alternatives to Nuclear energy (CANE), Bangalore.
Y.B
53.
Ramakrishna
Kalpakkam :
54. Dr.Ramesh
Kodaikanal :
55 .Daniel Francis
Daniel is a machine orperator in the Mercury Thermometer Plant of Hindustan Lever Ltd.
in Kodaikanal.
56.
Kanan,
Palani Hills Conservation Council
Kodaikanal.
Email: kanan@vsnl.com
57. S.A. Mahindrababu
One of the members of the Ex Mercury Employees Association and are fighting for
cleanup of the mercury and better compensation for the workers in Kodai.
58. Navroz Mody
Toxics Campaigner of Greenpeace fighting Mercury Pollution in Kodaikanal and PVC in
Cudallore and Mettur.
Email: navroz.mody@dialb.greenpeace.org
Mangalore :
59.Professor Mohan
Roshini Nilaya School of Social Work Mangalore-575002
sswroshni @ vasnet.co. in
He teaches Social Work at Roshni Nilaya School of Social work, Mangalore.
60. Student
Roshini Nilaya
61.Student
Roshini Nilaya
62.Upendra Hosbet
Runs a computer institute, actively working on the issue of environment since a decade.
He says that they are against any Mega projects . Has organised protests against
Cogentrix
#478499/478488
upendra_hosbet@hotmail.com
63.Organic farmer
Mumbai:
64.Deepika D’souza, Coordinator, Human rights law network.
Dr. Murlidhar V
Activist working on the issue of Industrial pollution in Angul, NALCO area. Was part of
a study which was undertaken to know the impact Industrial pollution on Human health,
Animal health, Crop and Vegetation in Angul talcher region.
Raichur :
75. Somshekhar
Samuha
#08536-668213/14
Thiruvananthapuram :
76. Jayakumar C.
Jayakumar is the coordinator of Thanal Conservation Action and Information Network.
thanal@vsnl.com
77.Dr. R. Sukanya
She is a faculty member in Achutha Menon Center for Health Science Studies,
Trivandrum and teaches epidemiology for the Masters in Public Health Students.
Address: AMCHSS, Sree Chitra Institute for Medical Sciences and
Technology .Trivandrum
Phone:0471-524240
Email: sukanya@sctimst.ac.in
Usha
78.
S. is involved in environmental education among students and studies and
campaigns among farming communities on chemicals in agriculture.
thanal@vsnl.com
Vellore :
79.Dr. Rakhal Gaitonde and Dr. Subhasri Gaitonde
Dr. Rakhal is doing his post graduation in Community Medicine in CMC, Vellore. He
has a special interest in peoples movements and using epidemiological skills in activism.
Dr.Subhashri is an obstretician and gynaecologist in CMC, Vellore.
Address: 636-B, PG Quarters, CHAD, Bagayam, Vellore
Phone:0416-260988
Email: subharakhal@yahoo.com
Warangal:
80. Sarvodaya Youth Organisation
81. Dr.
List of organizations participating in CHESS-2
1. Alternative Law Forum, Infantry Road, Bangalore.
He is a Mumbai based doctor with experience and interest in community health surveys
and environmental health issues.
E mail: murlidharv@vsnl.com
66.Saba Khan
Nirmala Niketan, School of Social Work,
Mumbai
67.One more representative from Nirmala Niketan
68. One representative from TISS
Orissa :
69.
Anjana:
Nari Surakhya Samiti, Angul
Involved in issues relating to women’s empowerment, displacement due to mining and
organising the mining workers to fight for their rights.
she is a part of the women and mining network, working as coordinator of Nari Surakya
Samiti.
70.
Bhakto
Mohanty
Convenor North Orissa.OMAPAN
Working as a development worker and activist since 15 years in mining area of north
orissa in kendujhar district. He is active member of the people’s movement in
Gandhamardan Iron ore mining area in kendujhar.
71.Kailash nayak
Mayurbhanj, OMAPAN.
72.Manas Jena
OMAPAN, Bhubaneshwar, Orissa
Network of people’s action group; has presence in all the mining areas in orissa. Their
main focus is to organize small groups of affected people to put up a fight against the
injustice due to mining. This is done through education awareness, building on the
campaign to right to information
#0674-555797
deveini@rediffmail.com
73.
Raimani
Devi
Sukhinda
From a village in Sukhinda mining area. A primary school teacher.activist also volunteers
her time with a local voluntary organization working in the area.
74.Sisir tripathy
Angul, Direct Action Group
Represented by Chitra.
Email: alfbrum©
2.
Anuniukti
Sourendra Gadekar, Sanghamitra Gadekar <anumukti@gmx.net>
Association of Consumer Action on Safety and Health
3.
(ACASH), Mumbai.
Servants of India Society, SVP Road, Gurgaum, Mumbai.
Ph: 022-3886556 ??
Ban Asbestos Network India
4.
Dr. TK Joshi<tkjoshi@vsnl.com>
Campaign for Nuclear Disarmament and Peace (CNDP),
5.
Achin Vanaik.
6.
Center for Environmental Communications (CEC)
Mr. J. John/REP
7.
Center for Indian Trade Unions- CITU
Mr. PK Ganguly<citu@vsnl.com>
8.
Centre for Resource Education
Hyderabad,
Mr.Narasimha Reddy.
9.Centre for Science and Environment
Nidhi Jamwal,
Tughlakabad Institutional Area, New Delhi-110062.
Ph: 011-6081110,011-6083699,fax:011-6085879
email:cse@sdalt.emet.in
10.
Chintan Environmental Research and Action Group, Delhi
In: Bharathi Chaturvedi
Chinlan is a Delhi based NGO working on environmental issues, particularly
waste and toxics.
Address: No. 17, Jangpura Market,
2nd floor, above Om Hotel, New Delhi 110 013
Phone: 011-3381627/ 4314478
11.Citizens for Alternatives to Nuclear energy (CANE), Bangalore
In: Vishnu Kamath,
CANE is a Bangalore based NGO working aganist radioactive pollution.
Address: #390, 5th main, 12th cross, West of Chord Road, 2nd stage,
Mahalakshmipura, Bangalore-560 086
Phone:080-3592059/ 3592060
E mail: kavayathri@yahoo.com , aravinda@cisco.com
12.
Community Health Cell, Bangalore
In: Dr. Ravi Narayan, Dr. Thelma Narayan, Dr. Rajan Patil,
CHC is volulntary health organisation and community health resource and policy
centre working closely with the governments and communities to improve health
and access to health care. Also involved in training health workers to empower
communities at grass root level.
Address: 367, Jakkasandra 1st Main, 1st Block, Koramangala, Bangalore-560 034
Phone: 080-5531518/ 5525372
Telefax: 080-5525372
Email: sochara@vsni.com
13.
Consumer Action Group
In: Shoba Iyer
No.7, 4lh Street, Venkateshwara Nagar, Adyar, Chennai-600020.
14.
Consumer Voice
F-71,Lajpat Nagar-II, New Delhi-110024
ph:011-6918969,011-6315375
fax:011-4620455
In: Bejon Misra: 9811044424
Email: bejonm@hotmail.com
15.
Endosulfan Spray Protest Action Commitee, Kerala
ESPAC was formed at Perla, Kasergod by local farmers and the affected people to
fight the aerial spraying of endosulfan and they have been very sucessful in
bringing this issue to a larger media and people’s attention.
Address: c/o Kajampady Nursing Home, P.O. Perla-671 552, Kasargod District,
Kerala
Phone: 895088
E-mail: shreepadre@sancharnet.in
16.
Greenpeace India
In: Nirmala Karunan, Navroz Mody, Ananthapadmanabhan, Divya Raghunandan,
Bidhan Chandra Singh, Manu Gopalan, Sanjiv Gopal.
Address: J- 15, Saket, New Delhi- 110 017
Phone: 011 -6962932/ 6536716
Telefax: 011-6563716
Email: manu.gopalan@dialb.greenpeace.org
17.Human Rights Law Network,
In: Deepika D’souza, Sunita Dubey,SHWETA AND SUNIL SCARIA
Engineer House, 4 Floor, 86,Bombay Samachar MArg, Mumbai-400023.
Ph: 022-2217078/2204948
Fax: 022-2220822/2227233
18.Indian Doctors for Peace and Democracy (IDPD)
The Indian affiliate of the International Physicians forPrevention of Nuclear War
In: Dr.Arun Mitraidpd2001@yahoo.com
19.
Indian Scientists Against Nuclear Weapons (ISANW)
Vishwambhar Pati
20.
Janadhwari Yuva Vedika
opp. Masjid, Kumbarpet, Doddeballapur-561203.
Mr. Dayanand Gowda.
21.
Mines, Minerals and People(MMP)
MMP is a national network of mining- affected communities and community
groups
and working with mining affected communities in any manner.
Address: 1249/A, Road No. 62, Jubilee Hills, Hyderabad- 500 033
Phone: 040-6505974
Telefax: 040-3542975
Email :mm_p @ satyam.net. in
Niketan
Nirmala
22.
School Of Social Work
Mumbai
23.Occupational Health and Safety Centre, Mumbai
In: Vijay Kanhere, Dr. Murlidhar V. and Dr.Veena Murlidhar.
Address: 6, Neelkant Apartments, Gokuldas Pasta Road, Dadar(E), Mumbai-400
014
Phone: 022-766 0178
Email:_webmaster@ohscmumbai.org
Website: www.ohscmumbai.org
24.OXFAM
Dr. Unnikrishnan PV.
Palni
25.
Hills Conservation Council
In: Kanan.
A NGO based in Kodaikanal fighting for the cause of workers affected in
Mercury factory of HLL.
Email: kanan@vsnl.com
26.
Patancheru Anti Pollution Committee
A . Kishan Rao
President
Yashodhara hospital
12-5, srinagar colony, Patancheru-502319,Medak Dist. (A.P.)
Doctor at patancheru, was involved in health survey around the area
42. Fedcot
Exnora
43.
Fair
44.
Expected Outcomes from CHESS II
- “The " Manual on Lay Epidemiology " will be a good guide for NGO's to act upon
locally and identify problems cuased by processes that are damaging to the health of the
workers and the population. The POISON free Earth CD will be useful as well for
those of us dealing with toxics issues . But again all these matters in the vernacular
languages will have better effect on the affected workers and population. I do not know
how much of the survey's can be carried out by NGO's themselves . As all of us have our
own agenda and idiosyncracies - may be it is good to have the medics and para medics
do the work.
What about setting up a lab that will also detect known toxics and
help any one with suspicion on various pollutants and toxics.
There was some talk about this some time early in the day of the Hg
issue but has been lost in the din of media exposure i guess.”- Kanan, Palni Hills
Conservation Council
-“The CD and the guide will be very useful. We may advertise the availability through all
possible channels once it is ready. There will be many people who will be interested for
the same.
ALF and training of lawyers: I personally believe that this is a good idea. It may be a
good idea to explore the possibilities of "skillshare" for lawyers and law students,
together or separately. The idea of a team (to move around) is interesting, but will require
lot of efforts, energy and management. Needless to say, we are NOT into soft and easy
work.” - Dr. Unnikrishnan PV Oxfam
- “Well right after the skillshare I did the Sukhinda trip (the report of which I have sent to
you/Hex Chrome ) attending the skillshare did guide me thru it.. Here can I add that it
would be a good idea to have a focus meeting on the effects of toxics on children, (
exposure routes, effects) it would be of help as we have been witness to child labour in
the mines/quarries . How about also adding on a veterinary perspective because most of
the mining areas have come to understand that the livestock to is invariably effected/it
would be of help if we understand this better. Here would like to mention an organisation
Anthra /Yakshi It would be good if they too are included in the next skiilshare. It was a
shared concern at the last skillshare that we include workers groups too in the next one,
who are concerned about their own health in the context of polluting processes and
34.Samvada
303, II Floor,Rams Infantry Manor, Infantry Road, Bangalore.
Ph:080-5580585
In: Benson Isaac
Email: samvada@vsnl.net
Srishti,New Delhi.
35.
Ravi Agarwal
36.
Thanal
Conservation
Thiruvananthapuram:
Action
and
Information
Network,
In: Usha S., Sridhar R. and Rajasree V.V.and Jayakumar C.
Thanal is a community oriented organisation working on conservation issues and
toxic related issues. Currently engaged in a community Right to Know campaign
in Eloor, Kerala and a proposal to move Kovalam toward a zero waste model.
Address: Post Box No: 815, Kawdiar, Thiruvanthapuram, 695 003, Kerala
Phone:0471- 311896
Email: thanal@md4.vsnl.net.in , shreepadre@sancharnet.in
TISS
37.
Mumbai
38.Toxics Link, Chennai/Delhi
In: Rajesh Rangarajan, Madhumita Dutta
Address: 8, 4th Street, Venkateshwara Adayar, Chennai- 600 020
Phone: 044-4460387
Telefax: 044-4914358
Email: tlchennai@vsnl.net/tldelhi@vsnl.com
39.
Vikasana / REP
Verghese Cleatas, Project Director
An organisation working on the environmental issues. They are closely working
with the community around Terikere (mysore paper and pulp industry); mainly
focussing on awareness in the locality
P.B.No. 23
Tarekere-577228
Chikmangalore; Karnataka
# 0826-422500
# 422570/423739
vikasana_ngo@sify.com
40.
Institute of miners health, nagpur
Dr. SK DAVE,
Pasumai
41.
Thayagam
Paryavaran Suraksha Samiti, Gujarat
27.
In: Swati Desai and Michael Mazgaonkar
PSS is a voluntary self help organisation working primarily in South Gujarat
on a variety of issues, including Industrial Pollution and Right To Know.
Address: 37/1, Narayan Nagar, Chandni Chowk,
Rajpipla-393145, Gujarat
Phone: 02640-20629
Email: pss@narmada.net.in
Periyar
28.
Malineekarana Virudha Samiti(PMVS),Kerala
Purushan Eloor
PMVS is a local group of activists fighting the pollution issue in the Eloor and
Edayar belts of the River Periyar, where there are about 250 industries of all sorts
mainly chemical.
Address: Periyar Malineekarana Virdha Samiti, Eloor Depot, Udyogmandal P.O.,
Kochi, Kerala.
Phone: 98460-13483
E-mail: thanal@vsnl.com
29.
Roshni Nilaya School of Social Work
Social Work Department
30.
Rural Reconstruction and Development Society
Gangi reddy. V
Sydapuram 524407
Nellore Dist. (A.P)
#08621-87096
31.
Samaj Parivartan Samudaya
Mr. Hiremath
sr_hiremath@hotmail.com
sr_hiremath@rediffmail.com
Has been working on the issue of industrial pollution since a decade
32.
Sambhavna
In: Satinath Sarangi
Sambhavna is a Bhopal based voluntary organisation engaged in delivering
holistic medical services to gas affected people. It has undertaken several
pioneering initiatives in the field of community health, particularly in the context
of communities affected by industrial pollution.
Address: Sambhavana, Berasia Road, Bhopal
Email: sambavna@bom6.vsnl.net.in
33.Samuha
Raichur.
Somshekhar
cancer.
The questionnaire survey was conducted by a group of Burnham residents called
'Parents Concerned About Hinkley' and analysed by Dr Chris Busby who, over the
past two years, has found high cancer mortality in the
town. This differs from all previous studies as it
examines the number of people reporting cancer in a
questionnaire.
The survey confirms Dr Busby's findings published two
years ago (1) showing that breast cancer deaths in
North Burnham electoral ward were double the national
average. It also exposes other high cancer rates not
available from the Office of National Statistics from
which he drew his earlier conclusions.
Dr Busby said, "This is the first citizens' health
survey of this sort in the UK and I applaud the group
for their very hard work. They were forced to go down
this road as the Health Authority refused to publish
its figures. Now we see a picture confirming my fears
that Hinkley discharges are responsible for severe
health problems here. All the epidemiology points to
that conclusion."
Dr Busby's work has been testing the hypothesis that
radioactive particles discharged into the sea are
deposited on the local mudbanks, blown downwind and
inhaled by residents on a chronic basis, triggering
the cancer. This theory is supported by the survey
which shows over half of those diagnosed with cancer
have hobbies involving the sea, eg water-sports or
digging for bait on the beach. Out of ninety five
people with cancer going back to 1989, forty-nine
(52%) took part in sea connected activities.
Fourteen of the cancer group had outdoor jobs (15%)
and twelve ate local fish or shell-fish regularly
(thirteen per cent). Twenty per cent (20.7%) of the
cancer sufferers were smokers, which is less than the
twenty seven per cent average of smokers in the UK
('Action on Smoking' figures) or the 35per cent of
hospital cancer patients who are smokers.
The survey sponsors, Stop Hinkley, are currently
campaigning against a new nuclear power station
proposed for Hinkley and together with 'Parents
Concerned About Hinkley' held an opinion poll in
Burnham in January on the subject. Eighty three per
cent of Burnham residents said they did not want
another nuclear plant.
In a report from the DTI published in the New
•
•
*
■
•
•
"
11:00 to 1:30pm: Session 4: Final Session of Lay Epidemiology in small
groups.
1:30 to 3:00pm: Lunch
3:00 to 4:30pm: Campaign Context and Strategy: Presentations on
campaign background: “The Way Ahead”: Campaign Ideas Brainstorm. A
framework for a campaign strategy discussion
4:30 to 5:00pm: Tea and snacks.
5:00 to 7:30pm: Campaign Session -2: Small Groups interactions cum
brainstorming on Toxics and Health campaign strategy with: —
Surviving Radiation/Attacking UCIL-NPC—Pesticides and Health —
Industrial Estates and Worker/ Community health— Mining and
community/worker health
7:30 pm onwards: Dinner
9:30 pm: Post Dinner Meetings in Small Groups.
28/7/2002
■
•
*
"
•
■
■
■
8:30am-10:30 am: Campaign Session-3: Back in the large forum: Sharing
of small group learning of campaign strategy
10 am to 10:30:Tea & snacks
10:30 - 1:00 am: Campaign Session 4: Large Forum Campaign strategy
discussion continues: ’’Common Objectives and Collective Action”:
Discussion on Draft Axn Plan of year-2 begins
1:30-2:30pm: Lunch
2:30-4:00pm: Axn plan and Roles and Responsibilities
identified.
Statement of Collective Concern read out. Budget and resource Raising
discussed
4:00 - 4:15pm: Tea and Snakes!
4:15 to 4:45pm: Travel to Coles Park
4:45 to 6:30pm: Public activity... reaching out to Bangalore.
ANNEXURE1
EMAIL CORRESPONDANCE ON UNIQUE HEALTH SURVEY IDEAS IN THE
TOCHESSTWO DISCUSSION GROUP....
From: davey garland <ihunderelf@yahoo.co.iik>
Subject: [DU-WATCH] Unique health survey implicates Hinkley Nuke power station
Date: 7/14/2002 12:18:17 AM
Unique health survey implicates Hinkley A group of committed parents has conducted
a unique doorstep survey of its own community and discovered appalling levels of
cancer just five miles from
Hinkley Point nuclear power station. A report analysing the responses of some 1,500
people shows cervical and kidney cancer at over five times the national average with
four times the average leukaemia
diagnoses and double the national rate for breast
Scientist last week, the government has suggested
compensating local communities for 'perceived
disbenefits' of new nuclear build. Jim Duffy, the
group's coordinator said, "We are certainly witnessing
some severe disbenefits of living under a nuclear
power station and the government should surely
compensate these individuals and their families for
shortening their lives. But a new power station must
be completely off the agenda now. People prefer their
health to any amount of money”
Jim is also concerned about the stance of local health
officials. He had asked Somerset Health Authority at
the start of the survey how many cases of leukaemia
existed in Burnham and was told 'none' but the survey
revealed four cases. He said, "Our distrust of the
Health Authority cannot be overstated."
Dr Busby was recently shocked when, using the Data
Protection Act, he uncovered internal health authority
papers with Burnham cancer statistics. In an email,
the health authority described a 'quick and dirty'
study they had put together but had made a basic error
leading to lower the apparent cancer risks. The
population figures for the year 2000 were wrongly
applied to a ten year study that ended in 1998. This
according to Dr Busby falsely deflated the apparent
cancer incidence due to the increase of both the
general population and the elderly population giving a
higher expectation of cancer.(2)"
He said, "The authorities now should meet with me and
agree the terms of a study in which all parties can
have confidence."
Dr Busby will announce the full findings of the survey
and its implications in a public meeting at the
Princess Hall in Burnham-on-Sea at 7.30pm on July
18th.
A demonstration will take place at 11am on the
Saturdays either side of the public meeting on Burnham
Beach to draw attention to health risks from the
polluted shoreline.
Jim Duffy 01984 632109 M: 07968 975804 E:
stophinkley @aol. com
Stop Hinkley Coordinator
Chris Busby 01970 639315 E: christo@cato5.demon.co.uk
Green Audit
Julie Gilfoyle 01278 794788 M: 07971 744372
Parents Concerned About Hinkley
Table 1: (correct on 11th July '02 in advance of the
final report but subject to updating)
These preliminary results show cancer INCIDENCE not
mortality. This gives a tighter correspondence to
environmental causes and confirms the findings of
local cancer mortality studies Dr Busby has undertaken
over the past two years (1).
Cancer
Findings Nos expected Relative
Risk+ Significance*
Cancer incidence in a six year period from 1996-2001:
Kidney cancer 5 cases
1.26
3.96
poisson .01
Cervical cancer 3 cases
0.54
5.6
poisson .01
Breast cancer 16/17 cases
8.1
1.97 / 2.1
poisson .004
Leukaemia
4 cases
1.46
2.73
poisson .05
Cancer incidence over four years: 1998-2001
Kidney cancer 5 cases
0.84
5.95
p .001
Cervical cancer 2 cases
0.36
5.6
p .01
Breast cancer
9 cases
5.4
1.7
p .08
Leukaemia
4 cases
0.96
4.09
p .02
+ Relative risk or multiplier of national average, eg
RR 5.6 means 5.6 times the national average or more
accurately, times the expected number, weighted for
age and other factors.
* Statistical significance is proportionally higher
with a lower poisson factor, eg a poisson factor of
.01 means 1 chance in 100 of this occurrence randomly.
P .001 is one chance in a thousand.
All the above figures are statistically significant.
Table 2:
Figures for All Cancer diagnoses: The 'doorstep
survey' showed a reduction going back in time,
probably due to the death of those diagnosed in
earlier years or their commitment to in-patient health
care. For this reason the study examines only the last
six years in detail.
Year:
2001 2000 1999 1998 1997 1996
1995 1994 1993 1992 1991
Cases:
15
12
8
8
10
7
6
4
2
4
3
1990 1989 1988 1987 1986 1996-1971
I
3
3
1
0
4
Expected cases per year: 11.
(1) Dr Chris Busby, Breast Cancer and Proximity to
Hinkley Point Nuclear Power Station, April 2000. Green
Audit, Aberystwyth.
(2) Call for fax copies of Health Authority internal
email and regional press coverage.
G 3/^G-
(CHESS 2)
26-28- July, 2002.
The Background
G
V-
Stone Crusher Creating Health Hazads and Environment Pollution in
Dharmasala Tahasil Area of Jajpur District in Orissa, India,
REPORT AT A GLANCE FOR SEMINAR ORGANISED BY GREEN
PEACE & CHESS AT A.S.F., HYDERABAD ON 03-01-2003
-
50 Black stone quarries where blasting is going on and Hundreds of stone
crusher units in the area.
-
Out of which 80% are under Dharmasala Tahasil area.
-
Most affected villages and Crusher units around - 200.
AFFECTING HEALTH
For mother and children & Older People.
Creating serious infectious diseases and people are suffering day by day.
MAN MADE DRAUGHT
Productivity of cultivable land is coining down day by day due to dust
deposited on the land. In near future no production will come out and no
solution for this---- ?
Initiated by PREM in Association with Villages level sanghas and affected
people.
Reported by - Adv. R.C. Ray and Dr.P.K.Sahoo.
PREM, At/Po.- Jaraka, 755050, Dist. - Jajpur, Orissa, India.
•
In the meanwhile a team of Green Peace Organization under the
leadership of Manu Gopalan has visited and taken stock of the
situation regarding the stone crusher units and granite quarries in
Dharmasala and Badachana area on 21-12-2002.
THE PREM, JARAKA’S CRUSHADE AGAINST STONE CRUSHER
POLLUTIONS IN JAJPUR DISTRICT, ORISSA, INDIA
The magnitude of pollution emanating form stone crusher units has
reached menacing height in Jajpur District. Most of the crusher units have been set up
near the black stone quarries surrounded by villages and beside the N H 5 and Express
high way From Chandikhole to Jarka beside the N H 5 and Chandikhol to Duburi
beside in express high way one can see the cluster of stone crusher. Almost all the
crusher units have been set up with the only intention of profit making at any cost
sacrificing the environment protection act 1986, the norms stipulated by the state
pollution control board and labour and employment department. These crusher units not
only makes dust rain on the villages and other habitat ional areas making the total
atmosphere of the locality hazy but also engender death, diseases like T. B, ASTHMA,
COLD, and skin disease and crop loss. These units make fierce air, water, soil and sound
pollution affecting human beings, animals and plants. Of the 5 hundred crusher units in
Jajpur district, 80% these crusher units are under Dharmasala Tahsil and the rest 20% are
in Darpan, Sukinda and Jajpur Tahasil.
(A)
MOST AFFECTED VILLAGES DUE TO STONE CRUSHER UNITS
There are 28 crusher units set up beside N H 5 in Mouja Rathia surrounded by the
villages Rathia , Jalsukha, Batmanda.Tikara sahi,Sankari Diha, Avaya pur, Utarasasana,
Dakhina Sasana, Tara pur etc.
Air, water, soil and sound pollution have affected the life and property.
Agriculture has been affected seriously. Almost all the children of the locality have been
laid up with cold and cough. Five/six people have been affected by T.B. The dust has
polluted the water of the wells and ponds. Approximately 200 acres of paddy field have
been affected continuously and yielded less which may cause manmade draught and
which has no solution.
Ten crusher units between Chandikhol to Rathia beside-NH. 5 affecting the
villages of Sarai, Sundaria of Jaraka G.P., Neulapur, Gopalpur and Sidipur of Neulapur
G.P., Kadala ofHaridaspur G.P. The effect of the pollution is same as above. Fifty acres
of agricultural land have been affected seriously.
From Chandikhol to Mandia beside the express highway there are more than 150
crusher unit affecting village of Arhua, Kolha Bhadanga and Nanpur or Arhua G.P.,
Haridashpur, sribandhpur, Kadala of Haridaspur G.P., Pakhar, Mandia, Biribati, Solei,
Telore, Nakua, etc., villages of Pakhar G.P. Two from the village Mandia, fifteen from
the village Nanpur have been died of T.B. Most of the people affected by T.B., Asthma,
U.R.T.I., cold and cough. Two hundred acres of agricultural land badly affected.
Thirty crusher units near Bajabati Hill with two mega crusher units by Agrawall
and L&T Company affect Bajabati, Kanpur, Antamalia, Khunta, Muraripur, Thanual,
Immamnagar & Gangadharpur affected. Two hundred acres of agriculture land water air
polluted badly including infants and school going children.
One hundred crusher unit from Mandia to Baghua Hill beside the express
highway affecting mahisara, Daulatapur of Mahisara G.P. Bhuban, Badamadhupur,
Chadeidhara, Barada, Ragadiposi of Gadamadhupur, baulamar, Baramana,
Ramachandrapur of Boulamala G.P., Samasunderpur, Balisahi, Anjira, Chakradharpur &
Bounsadola of Chakradharpur G.P. In the village Bounsadhal four people have been died
of T.B and many others are affected. Air water highly polluted including house damaged
by blasting.
(B) Agriculture predominately paddy is badly affected due to dust rain on the paddy field
and also during flowering season the dust particles remaining inside make rice
inedible. Families’ depending solely on agriculture suffer badly.
(C) Fatal diseases like T.B. Asthama and other U.R.T.I. are growing among the children
mothers and older people in the area including the poor silent observers in the area.
(D) Labourers employed by the crusher units are almost all from the district of Keonjhar,
Mayorbhanja & Bhadrak. Labourers are preferred from distant places to be exploited by
employing day and night for more than 12 hours in inhuman and .unhygienic condition
without giving heed to labour laws and norms. Child labourers are also seen employed.
Filthy shades in the vicinity of the crusher units are provided to those innocent stocks.
Fifty percent of labour force are affected by U.R.T.I., G.I.T.I. and its allied diseases and
are inclemently driven back to their homes with their on certain living condition. Crusher
units neither use sprinklers nor other pollution control measures to arrest dust as a result
the labourers, their children are seen bathed in dust. Fifty percent of the labour force
being women are also affected by immoral trafficking.
(E) In these crusher concentrated areas wine and other narcotic business is growing by
leaps and bounds which affect the social relations and moral standards.
(F) The people rights environmental movement (PREM) is the one and only organization
in Jajpur District which have been tirelessly endeavoring, awaring and fighting against
these crusher units in the district under the leadership of Adv. Ramachandra Ray, the
President of the organization.
From the year 1990 the members of the organizations have been looking into affected
villages and drawing the attention of both the administration and the department of
environment and have met oddities and hardships created by the crusher owners and their
goons. Delegates consisting of the members of PREM and other important personalities
have met Chief Ministers, Environment Ministers successfully and also written to
Governors and Chief Justice of Orissa High Court. The marathan effords yielded no
results. Seminars, public meetings, dharanas, road blockade have been variously
organized by PREM, Jaraka. High dignitaries like former Justice Lingaraj Rath and
M.L.A. Dharmasala have also joined our moment in one occasion by attending the public
meeting organized in the premises of Dharmasala Mahavidalaya.
Ultimately the President of PREM, Adv. Ray sought the intervention of the
Hon’ble Lokpal and Hon’ble Lokpal in his historic order in Lokpal case No. 35G/2000
directed Collector, Jajpur to take action against the illegal crusher units. But the district
Administration defied the order of the Hon’ble Lokpal. Finding no way out the president,
PREM also filed a PIL bearing No. OJC 5749/2000 in Orissa High Court under the
pioneer ship of Adovate Ray a number of PILs also have been filed in Orissa High Court
to save the affected people and take action against illegal and unauthorized crusher units.
Justice delayed is much felt vis-a-vis our knocking at the door Orissa High Court. In the
meanwhile crusher owners have also filed a number of cases in Orissa High Court and
stayed any anticipated action by the Government.
An appeal is made to OXFAM, Orissa on behalf of the members of the PREM,
Jaraka to join us in our noble tasks and responsibility to save life and laws - the
endangered life and law due to illegal and polluting stone crusher units in Jajpur District
of Orissa State.
AN APPEAL
An appeal to all intellectuals,
local bodies, individuals,
environmentalists to be a part of a burden till date with us------ towards a pollution free
society.
PREM
At/po- Jaraka-755050
Dist-Jajpur
Orissa, India
Phone. 06725- 273006,273448
Adv. RC.Ray
President
DR. P. K. SAHOO
Secretary
Initiated by Prem in association with Village level organizations and community
people.
From the year 1990 the members of the organizations have been looking into affected
villages and drawing the attention of both the administration and the department of
environment and have met oddities and hardships created by the crusher owners and their
goons. Delegates consisting of the members of PREM and other important personalities
have met Chief Ministers, Environment Ministers successfully and also written to
Governors and Chief Justice of Orissa High Court. The marathan effords yielded no
results. Seminars, public meetings, dharanas, road blockade have been variously
organized by PREM, Jaraka. High dignitaries like former Justice Lingaraj Rath and
M.L.A. Dharmasala have also joined our moment in one occasion by attending the public
meeting organized in the premises of Dharmasala Mahavidalaya.
Ultimately the President of PREM, Adv. Ray sought the intervention of the
Hon'ble Lokpal and Hon’ble Lokpal in his historic order in Lokpal case No. 35G/2000
directed Collector, Jajpur to take action against the illegal crusher units. But the district
Administration defied the order of the Hon’ble Lokpal. Finding no way out the president,
PREM also filed a PIL bearing No. OJC 5749/2000 in Orissa High Court under the
pioneer ship of Adovate Ray a number of PILs also have been filed in Orissa High Court
to save the affected people and take action against illegal and unauthorized crusher units.
Justice delayed is much felt vis-a-vis our knocking at the door Orissa High Court. In the
meanwhile crusher owners have also filed a number of cases in Orissa High Court and
stayed any anticipated action by the Government.
An appeal is made to OXFAM, Orissa on behalf of the members of the PREM,
Jaraka to join us in our noble tasks and responsibility to save life and laws - the
endangered life and law due to illegal and polluting stone crusher units in Jajpur District
of Orissa State.
AN APPEAL
An appeal to all intellectuals, Rj-ndfnir-S'agenctes. local bodies, individuals,
environmentalists to be a part of a burden till date with us
towards a pollution free
society.
PREM
At/po- Jaraka-755050
Dist-Jajpur
Orissa, India
Phone. 06725- 273006,273448
Adv. R.C.Ray
President
DR. P. K. SAHOO
Secretary
Initiated by Prem in association with Village level organizations and community
people.
(E 3-^ Ip ■
'. ►►LETTERS
could be seen differently from other
including pesticide hazards. I requested
occupied water bodies.
(l.mes.m Io piovide us with all the mfor
VIDI.H UPADHYAY
Partner. Enviro Legal Defence Firm
NOIDA, Uttar Pradesh
ViVII
More than debates
My heartiest congratulations to the
Down To Earth (dte) team that brought
up the important issue of the ‘War over
diy lakes’ (June 30, 2002; Vol I I, No 3)
to the fore. Being a lawyer by profession,
I can appreciate how right interpreta
tion and administration of law is
absolutely crucial in addressing this
issue.
I believe that encroachment of water
bodies is al the heart of the problem in
Ahmcdabad While the story in DTE suc
cessfully brings out this point in very
clear terms, some more words can be
said about a phenomenon that is com
mon to rural areas as well. Il is impera
tive that this question is addressed in
its entirety. This was brought home
strongly when 1 had occasion to speak to
villagers from Chitrakool, who arc
steadfastly opposing the district admin
istration’s order to clear constructions
over ‘water bodies’.
While you rightly point out that “we
need to devise strategics for each specific
water body”, it should not preclude
efforts to arrive at an agreed policy posi
tion on the larger question of encroach
ment of natural resources, including
water bodies. I also feel that policy
framers and lawmakers should not see
the Ahmcdabad case as an overarching
conservationists vs builders, or even an
environment vs development issue.
Here, taking a cue from what you
said, we need specific approaches for
each water body that requires protec
tion. In fact the High Court of
Allahabad, in one of its decisions last
year (the decision is now overruled by
the Supreme Court), suggested that
water bodies which have been irre
versibly altered by duly authorised con
structions, by changes in land use under
lawfully given permits, and by lime,
|
2
| Down To Earth • October 15, 2002
Ignorance or misinformation?
I found your article on endosulfan com
prehensive and well-investigated. Since
you mentioned the visit of S Gancsan,
member of the pesticides association, to
Community Health ('ell (cue), 1 would
like to add something more. The con
versation with Gancsan was basically
around the industries’ concern about
‘misinformed activists’ campaign
against endosulfan, which they say is a
‘relatively sale pesticide alternative’
today. As a health liaining and polii y
action group committed to community
health concerns and action initiatives, I
informed him that we were neither anti
industry nor anti-pesticide per se, but
pro people’s health. Our concerns and
interests are around any evidence of
dangers to community health. Also, as
an occupational health consultant, 1
have been interested in this issue ever
since I conducted an extensive study for
the Indian Council for Medical
Research (icmr) on occupational health
hazards of lea plantation workers,
mation the associ.ilion/induslry had
about endosulfan, which he promptly
gave me in a note.
Over the last lew months (wo of our
younger team members, Anur 1’raveen
and Rajkumar Natarajan, have done
a detailed literature review, which
revealed either the ignorance of the
industry or a deliberate misinformation
campaign by them.
Al the end of the last month, we
facilitated a very interesting threeday ‘community health environment
skill share’. Over 100 professionals and
activists got together from all over
the country Io share their concerns
about pesticides, mines, industrial
hazaids
and
oilier
environmental
hazards, and explore ways and means
ol studying them and collecting health
evidence. We had the unique privilege
of a presentation by H N Saiycd,
director of the National Institute of
Occupational Health (nioii), who
summarised the findings of their
study on endosulfan in Kasaragod. They
have submitted their findings to the
National Human Rights Commission
(Nt IRC). The findings not only substan
tiate the literature review wc have
compiled in cite, but is also a sound,
Why this farce?
With regard to in-use vehicle emission
inspection and the issue of'pollution under
control’ certificates, the government and
other concerned agencies have been ignor
ing the central issues:
® Is every vehicle being inspected at the
specified frequency?
• Are the equipments calibrated? What is
the quality of emission measurement?
• Who is ensuring the above two?
• What happens Io failed vehicles? 1 low it
is ensured that these vehicles come for reinspection after necessary repairs? Is it left to
chance apprehension of offenders? What is
the role of the transport department in this
regard?
In the absence of any mechanism to
ensure the above, the whole exercise is farci
cal, and ineffective in controlling pollution.
Tor a number of years, many experts
and agencies have advocated establishment
of centralised inspection centres, where
most of these issues can be addressed.
If the whole exercise were done al a few
central inspection centres, the inspection
could be belief supervised ami the pro
gramme implemented in more meaningful
ways.
There is no point in specifying new stan
dards every other day when implementation
continues to be shoddy. Why is that the gov
ernment cannot establish these centres? Is
the cost so huge that the Delhi government
will collapse under the burden?
A number of the present procedures
appear to be, at best, gimmicks. Especially
practices like photographing number plates
under inspection with hidden cameras. Why
hidden cameras? Why not openly? At any
rate, activity at the front of the vehicle is not
of any import.
The question is: what is happening at
the tailpipe end ol the vehicle? I low many
LETTERS
scientific evidence-based contribution
to the controversy. As a contribution to
people's science, I think Down To Earth
should formally write to NHRC and NIOH
(on behalf of your readers and the
affected victims of the endosulfan disas
ter) to release this report, and make it a
public document to support the right to
information.
RAVI NARAYAN
Community Health Cell Advisor
CHC, Bangalore
Problems and solutions
I am a resident of MCD Colony in Delhi.
This colony borders a marshy area,
which in the past has acted as a valuable
part of Delhi’s ecology. In times of mon
soons, it acts as a useful water run-off in
case the water level in the Yamuna
crosses the danger mark. The marsh also
contains a diversity of birds, which are
slowly declining in number.
Over the years, land-filling opera
tions had reduced the size of the marsh,
though not to any considerable extent.
Lately, however, the land-filling opera
tions have started again. This time, fly
ash is being deposited barely 50 metres
away from our colony. No precautions
are being taken to cover it. As a result,
even if the lightest of winds starts blow
Quick note
We are one of the largest manufacturers of earth moving machinery, such as bull
dozers, excavators, mining shovels, walking draglines, to name a few. So far, we
have been using an emulsion type water-soluble coolant in our machine tools, like
lathes drilling machines, milling machines etc. This has to be replaced with fresh
coolant once a fortnight since it gets contaminated with metal powder, dust and
other shop-floor pollutants. If the machine is not used for more than 50 hours, the
coolant disintegrates and gets infected with bacteria due to stagnation. At present,
the used coolant is being thrown into the large open fields where our products are
being tested. We have tried hard, though without success, to get information on
how to dispose of this coolant in a better, more environment-friendly manner. Is
there a method that is more practical and economical?
IM PRABHU KUMAR
Bharat Earth Movers Limited
Kolar Gold Fields, Karnataka
We publish this letter in the hope that our readers might have some information on
this matter.
ing, our bouse is filled with fly ash. It is a
veritable nightmare
As you know well, fly ash chokes the
lungs and depending on the duration of
the winds, we are hard-pressed to
breathe. It enters through closed doors
and windows, and for the past six
months, has made life hell for the resi
dents of the colony. I subscribe to Down
To Earth and have followed your stories
with interest and admiration. I now
request you to come to the aid of the
residents of our colony. This operation
endangers not only our well-being but
that of all residents in Delhi.
ANIRUDH BURMAN
a_burmani2rediffmail.com
vehicles are coming in for inspection? How
many of them get certificates without an
inspection? How many vehicles are being tested
correctly?
These are the questions that transport and
environment control agencies should ask them
selves. Asking questions would be, one hopes, a
beginning of sorts.
B P PUNDIR
pundirQiitk.ac. in
There have been news reports stating
that production of fly ash in our country
is annrnrtmarely 100 million tonnes per
year. If this were better utilised, it could
actually work to protect the environ
ment. Cement companies who use fly
ash do so to suit their convenience, usu
ally only because they are close to power
stations. A suitable form of subsidising
transport would make it available to
cement factories far away from power
stations. Also, building codes should
clearly specify that only fly ash is to be
used for read making and in the making
of bricks cntil all of supplies of fly ash
used. Qay should not be used because it
removes valuable soil required for agri
culture. 11 should also be made manda
tory to use fuel-efficient kilns, such as
those used in China, the design of which
is being popularised by Development
Alternatives.
G SHANKAR RANGANATHAN
gs.ranganathan@ho.ionxchng.co.in
Cool down
It is very difficult to trace the origins of
the Earth, but based on literature, one
could say that the Earth originated
about 4,600 million years ago. The Earth
has taken all these years to attain a
thickness of about 100 km of crust layer,
about 1,900 km of mantle layer and
about 3,000 km of core layer. Magma
from the core layer finds its path to the
surface of the earth through weak joints
in the substrata (beds) of the mantle and
crust layers. This process causes the
material surrounding the region of
magma eruption in the mantle region to
resettle. This further causes the crust
layer to adjust itself. The adjustment
causes a movement that is felt on the
surface of the Earth as an earthquake.
Annually, there are about 800-1,000
earthquakes in various parts of the
world. As of today, the Pacific Ocean is
one of the most earthquake-prone
regions in the world. This region, in
fact, is also referred to as the ‘ring of
fire’. Going by this logic, one could
arrive at an approximation of the day
when there will be no more earth
quakes. Considering the time that it has
take to form the present thickness of the
upper crust and mantle region, the time
October 15, 2002 • Down To Earth |
3
|
'8 h -
CIxe.SS-11
Prop-work Discussion Paper-IV
Dale: 2 S-ltf' J uh', 2 tv2. Ve;:::c: ' ir.har. Bangalore.
A. BACKGROUND:
A polluted onv.ironmcnt will manifest itself in the form of health
disorders amongst human and cthei living populations inhabiting it.
Based on numerous cases arcuno. the country, common sense evaluation clearly confirms that industrial
pollution has damaged community health. However, the specific nature of the damage or its extent remains
unknown. As a result, community health has hardly influenced pollution policy. The indications that this is
A'.e
j.s e-.xden^:
3.'ihac is legal is not healthy. Pollution norms are prescribed based on an assumption of assimilative
capacity ci nature rather than on facts that point to the cumulative nature of one most deadly kinds of
wlxuLaats anu then risks lc cccri unity health.
4.Polluters remain ur.punloh^d for their pollution and effects on community health.
2. Mobilising the Ccnsamity: Often health disorders within a community are
seen at a family level, with people blaming the compromised health of their family members on fate or .
accident. Many cf the subtler effects - learning disorders, immune system depression, reproductive or
gynecological anomalies
- are noticeable as trends only when seen at a community level. Mapping the health of a community brings
home the fact that the fate cf the community as a whole is linked to its environment.
3. Preventing Future Harm; Armed with the knowledge that certain kinds of industries and pollution can cau.se
community wide hearth e‘tacts,
communities can pity a more active and informed role in deciding the course of their communities'
development. Ccmbined with an operational
understanding of
rx ecexuLxo.uar y Principle, such knowledge can help in
preventing the setting up cf polluting industries.
c~o7?nng
nci'i^try Comm-u-' ? r.v health surveys need not be
conclusive m establishing cause—effect relationship between environmental disturbance and health disorders.
The'7 need to ?"fftientl'* atoeal to the common sense of the community-,z members and the public to be able to
cha' ' ang-o r.hp h>--ss assertions hv Governmpnt/i ndustry that, a community's ailment.s have nothing to do with
the pollution they are subsect to. Health surveys can help reverse the burden of proof, with communities
demanding industries and governments to establish beyond doubt that their polluting activities/industries
are not related co the community's health problems, or will not cause health disorders.
5. Health Care. Heeds: Sealt?. surveys c.loc allows fox better understanding of the health care needs of
communities .living i:. cnvnurimcntally disturbed areas. Such ar. understanding is crucial to designing the
r.eilth care interventions necessary for the community members.
Historical- Contest:
Keeping the above m mind, a small group of individuals and organizations met in Bangalore from the 13’“ to
the 17"" cf August,2001. There has been some meaningful activity in the hotspots as a result or that
-delete'. u:..
have L«u uui fair share or problems Luc. But all or it has helped us to improve our
unuer s earning or now to hantle tne tense and desperate situations we encounter as we. go abouu pc£iOimmy
Tver since there has beer, a constant urr,e for us to get back together evolving a clear1 framework for action
2_?-, the various oolluticn-'radiation hotspots we work in.
2.>
Equipping Coiuxcmitics -and caiAjpaignczs to d«al with.
<" •
OBJECTIVES :
••
create ticisc rlir.acy resource bu.ce cf medical practitioners,
coruaurn: •.■ acr;.vi5LS
catab_e of conducting community health surveys m communities subject
Indus lx j.<t a. d-.u
11:.-e. .
x x utx on;
- 1\ promote
urm:d tt
1. .
.--unity activists and community health experts to facilitate a discussion
t~:;dr:.- ?•.: 1 rmWvic.m and strengths of commun.ity health surveys;
./a-tIaCLa;..
r Tr ur-dor stand •_?..? rele cf .'.mrunrty health surveys in campaigns against
D.
THE CHESS-II SKILLSHARE
I..-.' ckx11
- .■.: d d d.'c-i -c *
industrial pollution.
A PRC POSE? rLAN)
oxics/Kactid tion ano Heaxth' issued axong two streams of thought.
?. ■'■"5 7" and
eTrentaf: on of Health Surveys - Rennurae Implications
: costs, personnel, time etc)
II. Caxsoaign Statcgy of Regional campaigns and a potential National campaign
1. Understanding the strengths and limitations of community health surveys
Participants:
Community active?. me:i_cai practitioners from affected communities.
occupational health occtors.'activists, community health professionals/ activists, toxicologists, lawyers,
workers, trade-unions, consumer groups, farmers, farmer-ebe's and researchers.
PROPOSED AGENDA.
DAY ONE: 2S/7/2002:
9 —- ICam:
Registration and Tea.
10 am to 1:30 pm: Sharing the work of individuals and groups and expectations out of the skillshare.
1:30 to 3:UCpm: Lunch
3:00 to 5:10pm: Lay Epidemiology-one day skillshare
session 1:
Small intro presentations:
1) Coimuiini ty Health Cell
2) Elizabeth Guillctte
3) (Anyone else?)
5: 0*0 to 5:30 era Tea
5’30 to 7;30r-m.’ Lay Er>-idpanio 1 nerv in 3 sme.ll-crou'os-workshot*
mode: Session 2
S:QQprz: Cultural. Evening + Kclcaoo Dinner.
DAY TWO; 26/7/2002:
9am-10:30am: Lay Epidemiology: Session 3: in small groups
10 : 30-11: GOeun: Tea
11:00 tc 1; 3Cpm: Final Session of Lay Epidemiology in small
groups
1:30 to 3:C0pm: Lunch
3:00 to 4:30pm:
Campaign Context and Strategy +
"The Way Ahead": Campaign Ideas Presentations
4:30 to 5:00pm: Tea and snacks.
5:00 to 7:30pm: Cccrr-aicm Session —2:
Snail Groups interactions cum brainstorming' on Toxics and Health caapaign strategy
-----------
Pesticides and Health
Legal action to address Corporate
------———
------
Womens' Health issues in hotspots
0- Censuzrer C"y — ~l~gn (???)
Worker Health Remediat-ion/Liability
-------
Community Health Surveys
------
ZCcdia as an instrument oT the campaign.
------- water and public Health
------ and any other issues people want to work on..
7:30 rs" onwards: Theatre in th® WELL and songs with food*
DAY THREE:2 7/7/2002
9 aa-10:30
Campaign Session-3: Work in Small groups continue...
10:30-11:00 am: Tex
11:30 - 1: jv arv Cccrpaign Session 4: Small groups wind up their day-long strategy discussion
1:30 -3:0 Opn. Lunch
o : uO — 3:2Cy..:
Small groups come in the larger forum.
Shariiiy of insights into tlio national campaigns.
DAY FOUR: 2S/7/2CC2
9 am-10:30 am:
"Common Objectives and Collective Action"
10:30-11;GO am: lea
11:CO - 1:30 am:
Action Bion for Year 2 of CHESS: Roles
2:30 - 3:30 pm: Statement of Collective Concern
3:30 - 4:00 pm:
Discussion on Budget and Resource-raising
4:00- 4:30 pm:
individuals and Organisations taking key responsibilities.
{Release the statement of collective concern)
Sur~^ivors, Ccmmunity-bc.jcd activists and individuals participating c'.rtc-ri according co base 1 ssaric r. ar.ci put
ir. alphabetical srs-rjupaat-aa) :
Z Bangalore:
i .AS l.o named {SJAAMS)
AS Mohasced is she Asst. Professor of statistics and demography in the Department of CommunityM . me, St. Tchr.'s Medical College and has been ir
d ... num rous studi s
alth
care and evaluation. He is a society member of CHC.
Addresr: Cep?.:—err. ol Covr.inity Health, Sr. Torn's Medicai College, Bangalore- btU U34
Phone:
‘ - 2 0 6 5'? -• 3
Email: -a . -7 mt Svsr.l_._c. cm
2
. G’<i“i.'s.* Eudhya
Phon:-: OSO-3315656'3462032
3.Dr. Girish Rao*
7- ;• n ~- 7?«r. •? an Associate Professor of Community Medicine in M.S. Ramaiah Medical Collene,
Bangalore with a Longstanding interest m all aspects of hospital waste management. Ee is also an
Associate of CHC.
Address. Zaculiy of Community Medicine, M.S. Ramaiah College, M5RIT Foot, Bangalore- 560 034
Phone; OSO - 36C0>68
Email: yn-i.-.?.mG?.cc.v....il. com
4.Mohan*,
Un 1 nr.
vement Resea?:cher, Bangalore.
o.Nagar Bobby*
Institute of Socio Economic Change.ihas been working on development issues in 124 villages for 13
years no.-.’
7.Dr. Ragan Patil . an epi d*»n>1 o! ngi st and is prespnt.ly a Research/ Training Assistant in CHC with a
.rpor:a' *. >■ fp’'=st ir '.’p.cr.or hourne diseases. He has been involved with creating an i nteract.i ve science
teaching mooule on mosquitoes and tneir control.
sTr.ai 1:
id :c.-.-Jc.. coir
8.Dr. Ravi Kar&yan
as
cr.e Community Health Advisor of CHC with professional interest and training in
public healcn,
ixiduocnal hea.Lth and preventive and social medicine.
Earlier ao an Associate
Profcocor of C.::o-.ur.iiy Health
ic. Cohn/ o Medical College ho worked on occupational hazards o£ the
tea ir.duitry and t?.c t.cilth effects of agricultural davclcpmont.
Eriai 1: - ' y ■- / -•- -
9.Sachin
• •onn's •••r»aica.‘
30.Dr Thnlrw Narayan •" ‘ • f-a’pnt ; no »'di na tor or CHC. She i r. an op i derm ol og-> st with a doctor at/- ■’•
pc ’■' ■ n ”■ -.'th : .•
She vs ’'opr .nvcJvpd as a resource person for studies on the Bhopal health
the Karnataka Government Task Force on Health and Family
Welfare.
imtilv"r. 1 . ccr.
DR. Unnikriahnan -V.
Dr
Vor..'-o
ct Biochemistry at St
College
D\recto:
Biots:
13. Viswambhar Pati* / Prof. Sanjay Biswas*
Indian Scientists against Wndear Weapons, TSANW, Bangalore.
I Z sHOPAL:
1-a . KlaiioUC:
Al a o -r._c. i--=searcher Nishant has worked exhaustively in Bhopal doing a health survey of children
Irrr. tc ixu-ocd lu__.._l ar oppcocd to unexposed ones to the gt\s tragedy.
15.
Satinath Scran-- :
Email: saabhavanaQvsnl. com
me sheer:
111
16.
Manas Jena
deveini § r edi f ma il.com
17.
Adv. T Menan* practices Environmental law m Chennai.
18 .Nityanand Jayararaan
„vc.:.. _s <=;• _:.:.be;;e.’.d‘=.’1 c journalist working on toxic issues for over 5 years.
Address; —, .tr. Mai-.'., •>tx*. Cross,
zajesrivrazi xagar, Bangalcre-S’iO 090
Phone: 0 30-3 0113 3
E uKiil: ic- nSg •- .•lu.cmii
V Delhi:
PO.Achin Vanaik
Campa: g-’ tor '.'no’’ear Disarrsamfint and Peace CNDP)
21. Ananthapetamaneibhan
Anant?; is the Executive Director of Greenpeace India. He had been teaching school-children for more
tr.an a decade. He also spent a few years in the Environment Division of a leading finantial
institution.
Email: ananth@dialb.greenpeace.org
22. Dr.Arun Mitra*
Inaian lectors rsr Peace and Democracy (IDPD)
ihe ir.diar. affiliate cf the international Physicians for Prevention of Nuclear war idpd2001Qyahoo.com
2 3. Adv. AsliOx Agu <ai« al *
24 .Bo-’cn
rh**"
S" -.sumcr Voic^
25.Bharati Chaturvedi
26.Bidhan Chandra Sxnch
New Delhi
coordinator of Chintan Environmental Research and Action Group.
• -
.
■ ‘
:
.
27 .2ivy a Kayhunandan
.
’
28 J John*
. .
. ztor
t1 •6‘SYip'B<
•■
l
•
.
•
•
113.
•
-
• gI J
lenter for Environmental Communications-CEC, Delhi,
29. Dr. 1K ceshi^
San Asbt=-?r c;~* r.< India
30 j•’ll"2jb■■ —■ Dxitta
■ - •- • -.
~
■■ Delhi, New Delhi■ mdutta @vsnl. ccm
31
Gordian
y?n’‘. I? - toxic? caro?.irrner with Greenoeace India■
;
1 argdi a i b.grap.npp.acQ. arg
32. Nidhi Jamsral/ Sur.ita. Naxain*
The Centre icu S2ier.ee and Environment, 41,
Zughlakabad Institutional Area, New Delhi-110062.
Ph: 011-6081110,011-6083699, fax:011-6035879
email : csQcsdalt. err.et. in.
3 . Nimala Karunan
■ a Administration Manager ot Greenpeace in India.
Email: nirmala kaj nan
. gj em •. .
3
?h: off: 211-6512 3 SC;?.oni: 011-6593282; fax: 011-6659391
have been active against cutting trees; the'/ have also performed a cvcle vatra. Fichting pollution
due to the Goggo Factor^ in Doddeba.lapur, near Bangalore, Karnataka..uanadhwar-i Tuva Vedika, Opp. Masjid Knrnharpor.,
Doddebalapur-561203
?080-7626450-r
41. Prakash R.
pollucic-n due uo the Goggo Factory. Prakash is from the affected village near Gogo factory;
/.Mi-.s ’> i?si.-
43. Selim VA*
Fighting po.ilution due ro Binani Zinc's -Jarosite Pond in Edayar, Kerala.
Va i 1 ar-garii , Bi namptjrarn (PO) , F.dayar, F.rnakul am,-6R35021
9 0484-555592
VZII Eloor:
44.VJ Jose, Jose was working in Cochin spreading awareness about Road safety and First-Aid tips with
Ernakulam Rural Action Force. Now he is an active volunteer of Greenpeace-India. Involved m
mobilizing the local community using education material and films from the Greenpeace library. He has
also been instrumental m environmental monitoring of the river Periyar.
' ?.or~ur:: y .'ader or Periyar Ma Lin.eekarana -.u ruaha
• ■
ii
« rei
ugh di rec t act i or
larges: inous t r i a 1 estat ~ r n Ke ra 1 a.
«b.w jfurusnan
■
•••
•
, a
.
■
, ths
TX
47. Gang.x reddy. V
A’ura^ .-■ecor^tri’ct ion and L’evei opmen t Society
i>yo.?.puram c_ t —U
Ke1lore Disc. <A.P)
= 08 62.1-6:096
49.Ar.tmd J-tzg-’orJcmr* 49 .Michael Mazgaonkar*50 Rohit Prajapati* 51.Swati Dcsai*s work involves trying
~ ~ mcbilizt affected communities along a 200km stretch from Vapi tc Mehsana in Gujarat on issues of
y.------- •"-• •
-.->••■ o ’.-=t.o.v
~ -' on, hazardous .°r;?d waste, air pollution, health effects ano
* '• s . '? ? ? -n ~ r~ ■" ■■.. ner . in
PSS, 3uj r . pssSr ■
.ne .J n
Hyderabad:
54. -A . Kisham Rao
F
.
Poliucion Commitc«
56. Prof. K. Purusottam Roddy
’-si dent
Osmania university/ teachers association
k wubhaais r § r edi f fma ii.com
activist and campaigner has done phd on related issue (toxics)
Zill Jadugcda:
54. Ghanshyan Biruleje*
Tharkhandis Organisation Against Radiation (JOAR)
In: -•.•..■e-z) /.30009
l±iUiii i A i: "u__ KillX. 1: ci
XV Kodaikanal:
57.Damol Rrancis* is a machine orperator in the Mercury Thermometer Plant cf Hindustan Lever Ltd. in
Kcdaixanai.
58 .Kar.£1X2-, Palam Hills Conservation Council, Kodaikanal.
xi’k.a j_ :
rk.&..<in<v — n.t ■ k.om
59.S.A. Mabimdrababu* and 16 K. Gopalakrishnan* are members of the Ex Mercury Employees Association
and are fighting for cleanup of the mercury and better compensation for the workers in Kodai.
oO.r'avroz Mody
Toxics CarpaTgrer of Greenpeace fighting Mercury Pollution in Kodaikanal and PVC in Cudallore and
*<e L L i r EjiHil. 2ii‘y’\.«Z il-xi; T
iicciJpr.iCe.C'f^
69 Dr. Venkatesh Murthv
I.oca 1 doctors running rhpi?- own clinic and nursing hem® at bhadravati Inysnrp paper And pulp mill )
Also involved m a study related tohealth impact in kudremukh mining area
.
70.Varghese Cieatas
Project Director
Ar. cru«.:.j£.tLtr. -.viking or. the. issue of environment . they are closely working with th community
around t-erikerc Mysore paper and pulp industry); mainly focussing on awareness m the locality
71. Mehel'-kshmi Parthasar^thy is working with mining struggle grow?. She is also involved with legal
and media advocac-’ and information documentation.
Email: rgnahalaJcshmit^yahoo. com
72.Zavd.er Dias’/ 33.Ravi Rcbbaprcqada*, Mines, Minerals and People
Ema x x : :rrur'r.tvs’.l ■ i.-jt
21X1 Raichur:
74. S errshekhar
SalUtlhd
- 3333 €-663213.- 14
2 more persons from caichur , depends upon how they call a meeting and what comes out of it. I will
re
—ni~sor.>-a □. rfoj. v’cxi.iO’uO group in T%aichur
TXT T T’nJ. rwer,>-n t r >■ pv r am •
75. iTayakumar C.
s ma
t harr. I
coord: na r.nr
of
Thana 1
Ccnserva hi on
Action
and
Information
UPtwork.
-5” 1 ,
7 6. Raj ar rec V.V.
.involved m Ihanal’s activities on pollution and toxicity and is specifically
working on hospital waste management. chanaKgvsnl.com
77.Sridhar
is involved ir. campaigns against industrial pollution in Elect and Mavoor in Kerala. 5e
82-105 Any person you feel may be irsportant to invite?
31;?-..-.?*. Cr*.'*sri Si-.?.-. is traveling an -ne hotspots inviting community persons and community-based
camoaiir.ei's for the meerinc,
2. Alternative Law Forum, Infantry Read, Bangalore.
zc-rif,?’--;-;
Gtir.ra.
3 . Anuzzukti
Soui-ndra Gadekar, Sanghamitra Gadekar <anumukciQgnix.net >
4. Association of Consumer Action on Safety and Health(ACASH), Mumbai.
S
ran:
I.......................... ', SVJ? Rc id,
:x i im, Mum} ii .
Ph: 122-33I6E36
7
Center for Environmental Communications (CEC)
9. Center for Indian Trade Unions- CITU
Mr. PK Ganguly<cituSvsni.com>
5.
Centro for Resource Education
Hycie 1 a G-r.li,
10 . Contrc for Scionce. “.nd Environmont, 41,
..
t S . .'ri r c. 2 r..
Tughlakebar “ns"? tutional Area, New Delhi-110062 .
Ph: 2''
' '.' ',
1
3699, fax:"3 1-6085879
e~a i _; ise .• ::a.. “ . er ~ 1 . i r.
11. Chintan Firvi r—rr-.nr*-.^! Research and Action Groins, Delh*
In: Bharathi Charurvedi
Chmtan _s a Delhi based 1’30 ’.•'orking _n environmental issues, particularly waste and toxics.
Address: ?3c.
. .langpura Market., 2nd floor, above Gm Hotel, Mew Delhi 110 013
Phone:
i-l la Lt i', -:51447a
12.Citizens for Alternatives to Nuclear energy (CANE), Bangalore
In: Vxshiiu Kamacli, m*.'.;Lisa 5.3.
C.-in is a Bangalore based NGO working aganist radioactive pollution.
Address: ?39C, St?, mrin, 12th cross, West of Chord Road, 2nd stage, Mahalakshmipura, Bangalore-560
Phene: 08 0 - 319 2 •? -_ 9 / 3 592060
E mail:
.n.-.-, aravinoagcisco. com
13. Ccramunity Health Cell, Bangalore
nelma Narayan, Dr. Rajan Patil, Dr. Praveen Anur and Lalit Narayan.
janication and community liealt'n resource and policy centre working closely
immunities tc improve health and access to health care. Also involved in
wsatess: ■ - , . i-. .
■
Phone*
\
•c
--.'■* —•
Tol of ax:
■
Email: 5 ? - ra• .• r .•..re-
51;:a, Banoalore-Sv® 034
14. Consumer Action Group
■ .
.
•
•
rgod by 1<
-
il farmers and the affected people to figh-
17. Greenpeace India
In: r’xrmaia Karman, l.’avroz Mody, Ananthapadmanabhan, Divya Raghunandan, Bidhan Chandr.
Gopalan.
Address:
15, Sak^~,
Delhi- 110 017
Phone: 311 6562332/ 6;16"16
the a
laxgei .
Singh,
Aiaail: man.tt.yopalantS-ditub.grecnpcacc.org
21. Indian Scientists Agaxnst Nuclear Weapons (ISANW)
Vxshwcuabhax rd'.i, ?.to£. Saniay aims
22. Institiute of Socio-Economic Change
124 villages
23. u aziache tan a,
Klshtu: Pa?.-, Sa.'ivldXdr. Heude
O •’?
T-* n
r. /A****. -■ —. n r.
In: 3hanshva.T Birulun --0657
"A r-~4* 73 —>
4- n —. /.T<37. O \
730009
25 . Janadhwari Yuva Vadika
opn. T'apT.d, " i’~ha • r.<=r, Dnrideha 1 1 anur-561 70.3 .
Mr. Dayanand Gowda.
26. :<inaE, Minerals and People (MMP)
* i;: Mahaxak3:if.'u. rax ^i.rticixatriy, XrtVxex Dias
.’"1- i'j a nat.~-r.al network of mining- affected communities and community groups and
mtnxng a~fesccd -t.’r.xn:. .: a.iy manner.
1-ddrer. r; 12J£.A, P.ead
62, Jubilee Hills, Hyderabad- 500 032
Phone■
Telcf eiz :
Smail: T'.r- p < ■? : y " . r --7 . i r
27. National Law School of India- university
Bauu Mar i'.^w.
23 .Occunaticned. ■-■r>a~ th. »nd
Centre, Mumbai
t-n • -. f • -t :. • v-:r'r--rzi ~ >■
j '>■ '.<, ^nd Dr.Veena Murlidhar.
Address: '•.
’r ipa-r-r.a., Gokuiria.. Pa^ta Road. DadarfF), Mnmhai-4(1(? (’in
Phone: 022-‘tc
t
t ! : ;<^nma_25.er^or.2j:r.jL’^ai.org
Website: -.-.
■jr;ecr..vr ~ — j: -
working
30 .O.-rxinia university toichcrs association
31.Palni Hills Conservation Council
L
cause o£
’
: r-.c.cv.?'- ar natarchern, has been involved in health survey around “he area
>3.
'pfl-an suraksha Saxoiti, Gujarat
l.’i; Anand ^.azgaonkai; o.*.c.—■e'Scu. and Mxciiael Mazgaonkar
■33 is a vcl ...'.ca_ a-=~- help organisation working primarily in South Gujarat on a variety of
.ndxd__ .• -.--• > X-__ — wk-vxi ana ^vignc -■j .mow.
issues,
34.Periyar hialineekarana Virudha Samiti(PMVS) ,Kerala
Phone ■ ??
E-mail:
•?—1 ? - - 3
v
35. Pesticide Action Network- Asia Pacific
Dr. -c“o=o Dui-ano, Sarojeni Rengam
36. Roshni Nxlaya School of Social Work
Social
rk Department represented by Prof. Rita Narula
37.
Rural Reconstruction and Development Society
39. Sanibhavna
In: v.x. raomanabhan, Satinath Sarangi
ottiiu-?;?._s a bh-Gsl baaed voluntary organisation engaged in delivering holistic medical services
to gas affected people. It has undertaken several pioneering initiatives in the field or community
health, par< ;ulazly iu the context of communities affected by industrial pollution*
Ad'cic: dmr.c- .'m, Reracia P.cad, Bhcpal
Emcil: " —h cvr.cf 1". v.6 . '.’C’.'.l. r.21 . ir.
40. Saimaha,
Rai-chur.
Somshek?;ar
41.SiL/o-du, jtc, __ F'locr,Ra”j Inzantry Manor, infantry Roao, Bangalore.
. -C--> CKCrCCE
42. Srisbti,New Delhi.
Ravi Agarwal
43. Thanal Conservation Action and information Network, Thiruvananthapuram:
In: '.’S/.a 3., Sn-mar R. anu P.ajasree v . v .and vayakumar C.
Thanal is a community oriented organisation working on conservation issues and toxic related issues.
Currently cr.gagii m a m"unity Right tc Know campaign in Eloor, Kerala and a proposal to move
Z?.rscciGil.
Address:
"o:
Kamrar. Thiruvanthapuram. 69b 003, Kerala
Phone: . -• ~ 1 - ? . _y<
Email: char.al^T-54 ."-nl .net. in , s r. r ■= e p aa r e g s a n c h a r n e t. i n
45 Vikasan-s
Varghese Cleatas.. Purree:!-. Oirector
Ar or-.vm
ts nr wnrkirrv nn rh^ pnvi rnnniPr.N 1 ifsnup.R. They are clnsp' y working with thp community
Terikere mysore paper and pulp industry); mainly focussing on awareness in the locality
P.B. 'No.
23
Iarekere-57"228
Kmanca x or e ■ Aama _a.*£a
T 0 O — O “ ‘1 — — C k k
1.
BROCHURE:
Agenda of CHESS-2
ON LAY EPIDEMIOLOGY
Prepared bv Communityv Health Cell,Bangalore.
3. POISON FREE EARTH
A CD Compilation of all toxics-health literature Prepared by Greenpeace India for
public use.
4 . ELOOR TRI REPORT
Prepared by Greenpeace India as part of the RTK/Health campaign: Contains global
research on toxicity/health-effects and emergency response systems on all chemicals
used and released by 7 large industrial units in Elocr and Edayar.
5. DOCTOR-INTEREST reading on toxics and health.
Prepared by Greenpeace India as part of the P.TK/
Health campaign
6. CONSUMER/GENERAL INTEREST reading on toxics and health.
Prepared by Greenpeace India as part of the RTKz
Health campaign
7.Any Papers/Reports/Healtn-Surveys of relevance from skillshare
participants are welcome.
2.
MAYTtat.
"THE MANUAL at WORK":
PROCEEDINGS OF THE LAY EPIDEMIOLOGY SKILLSHARE
(DISTRIBUTION ONLY FOR PARTICIPANTS AND IPEN)
2)
"A NATIONAL CAMPAIGN?"
NOTES CH CAMPAIGN STRATEGY IN SMALL GROUP DISCUSSIONS
<DxSxKLbUxioH OriLI EOF. rril xCIPAHx.o)
LCICCi: FREE EARTH- VERSION 2
.'LDITICNS ON INDIGENOUS RESEARCH IN THE EXISTING RESEARCH; gOMPILATIQN
Briefing Questionnaire;
skill-shai'e personally, organisationally and in terms of your campaigns?
v
c i—5 pre?
pc: dealing witr. in your campaign?
'■■■
■ ■
■
i ] ikes to share with others
pr
during the Ski1' share?
■ none:
-ho
■■
••
..r~
# gacc: guide tor NGO's to
unon Iccil.'.'/ end :■/;■?■'?■ f” cron.'ens cuased by processes that are
■ j
»f
worxer
>ptt.Zati0n.
~ do nor know new much of the survey's can be carried out by NGO's
themselves . As all of us have our own agenda and idiosyncracies - may
be iz is good zo have the medics and para medics do the work.
Xizh money taking precedence over merit in all spares of life there
are not many from the nedicai field who would volunteer for the survey
.. wi'Lh
g up
lab that wi 11
ci :s a id
de ect : ;
vi various pollutants and toxics.
suj
Email : kan=nlvs~l, ?■?—_
Palni Hills Conservation Council
An extremely rooted organisation based in Kodaikanal fighting for various conservation issues
amongst which one of che most important is the cause or workers affected, in Mercury factory of HLL.
AltF and training of 1
yers:
r. i ins
f b
ieve th
idea. It may be •
•
; ' ■
■;
e the possibii ties
lor la.-.yers and !<.■ s ’. ..dents, Looethez ol separately.
a good
his
'
::
■
sh re"
Dr. Unnikrishnan PV
tE-mail: unnikrutlyahoo. com)
Co-ordinatcr: Emergencies; OXEAIi INDIA
Dr. unnikrishnan is currently a staff member of OXFAM India Trust and is working as a resource person
on disaster response including psychosocial consequences and human rights issues. lie was the editor
t..e Inma Dsiaster Report 2000 and earlier member of the Public Policy and Advocacy Unit of
7ol-:.~.ary Health .-.cociation. of India. He is also an associate of CHC.
address: '.dtsyi uhree, 4~.n A. Main, near Baptist Hospital, off Sellary Road, Hebbal, Bangalore- 560
Phone:
■ ■-'} 2 '4
-Er-l-.t-R 2012; ■JddVER.SITY IF GENEVA, GENEVA : (1-j'OBI.IE:
"■? 3"6
Well right az ter the skillshare I did the Sukhinda trip (the report of which I have sene to you/Hax Chrome )
atteiidiiiw the ^kiilsi'.are did u'uice lue thru it. .
duel.
exposure- routes
mines/gua rries
wnulrf
a ccod idea to have a focus meeting on the effects of toxics on children.
:* ■ it would be ot help/ as we have been witness to child labour in the
irnr cn a veterinary perspective because most of the ruining areas have come to understand.
; to is inveiiiably offected/it would bo of help if wo understand this bettor. Hero would
; crcunisutxcn /mthru /Yakshi am pasting their profile below it would, bo good if they too
;e
:a
How abou1
king on our campaigns across the country. unoerstanding
least produce a Statement of Collective Concern
fam being verry focussed.
'lei a
ejpo.
ne
Ilbid-P.
PPD (P;
b7
process?
lility'' being touted as the. panacea
II - I can send, you a Times of
the recent
Mines. Minerals and People (MMP)
communi
a.
groups and
working with
rniu:
Hyderabad- 500 0.
Phoi
-gal
\ggle
met an interesting group of dedicated people working on
Iso get r.
their website
am
y . ■
fed!ca1
a'
s
cne gooa pom
■- :.
■han
so while ;/e need to
•."■it ourselves to onevery use agrees so
san.
\e z.
may be
araas and loose
re discuss the mail later with
the
-n r - a
o r cr i i r. <-• t i o n r
k
.bin for our general
routes of exposure to the
various forms like
33!
btr
•h-
3-
5'
bl a
.cions.
xcupacional
.dus
share
he due he. a single external factor 1 ke endosulfan in
title external factors 1. .ke a mixture or pesticides like in Idukki or due to a waste
ivelcp a tool or set of tools co link disorders to the
community directly with locus on women and children.
ial area having a lit of all kinds of chemical industries
surroundings of
industries, rare
chlorine compound manufacturing un
lergistic actions is making this to.
lies affected by the
a;
iving around and exposed
.ted faccorv at Eloor whi;
m pesticide manufacturing units like
tanufacct es DDT, endosulfan, diclofol, and used
7.'.I
down?.
(food and nutrition data
chat we need co calculate general health or the people
momoaro
3. Wha-1
’ou dealing with
spray
same a .re a manuracc
ound niah ieve is
gr.iy poL.'.ut
u-iercnemj
30C
crushers.
Campaign ma
rgc
;amuaion
ices on nase lines nearer, survey conauceea arc
tn impacts cue
oeveiop an easy ro unaersuana none on the terms like genotox:
n purpo;
sab
Strengths and Weaknesses of the CHESS Process
ia5 percei’-ed .oy rhe CribSS-L parziczpanns/
:e
le^alble and knowledgeable
d
gram.
V'oda i katial
i envlronmenta.
shared."
/?nd inour ro n l^nni r>ct r.ommi
i on
he'lnfn'l.
ceratoge:
-■’■rh rov confidence about the work Z //ant
da and felt a .support system I was unaware of.
*
"Oucocanciijig ideao implanted and really began to re-unders rand many issues. "
0
’’dele to dan In managing environmental disasters. "
Weakness:
*
’’Several slow sessions. ’’
0
’’Sometimes repetitive within the same session."
o
"n*^r! more interactions with some resource oersons. "
5
”Case studies of actual surveys to outline the 'Dos <5 Don'ts' of surveys and studies would have been
&
"Headed proper izinie management. "
nrnvide riw tn certain nartic.inant-s like CA^JR to share t-he.i r eynerienr.es due ro
lack r.f
A 'peer review’ of a study presented by HLL team at CHC,
on workers in HLL Thermometer Factory in Kodaikanal
A.
B.
BACKGROUND
•
In August 2001, CHC organised a skill share for a number of environmental health
groups that were campaigning against certain environmental hazards in different parts
of India. The purpose of the skill share was to help campaigning groups study the
local health problems linked to the environmental hazard in a more scientific and
systematic way. The skill share was entitled Community Health Environment Survey
Skillshare (CHESS).
•
One of the case studies presented by a group from Kodaikanal was the problem of
Mercury related human and environmental hazards in and around Kodaikanal due to
improper hazard control and waste disposal processes of a local mercury thermometer
factory. As a preparation for the skill share a two member team from CHC (Dr.
Mohan Isaac, Professor of Psychiatry, National Institute of Mental Health and Neuro
Sciences (NIMHANS), Bangalore; and Dr. Anur Praveen, a young doctor volunteer of
CHC visited Kodaikanal and interacted with some of the ex-workers to make a
preliminary situation analysis.
1 heir preliminary report was circulated which
highlighted some of the findings and the need for a more rigorous scientific study.
•
A few weeks later, the Medical Adviser of HLL, Dr. Rajagopal contacted CHC, and
requested CHC to give them an opportunity to present the findings of a recent study
done on over 250 workers at the HLL factory. As a professional resource group
concerned about peoples and workers health, we welcomed this opportunity to
dialogue with the industry. We appreciated this as a sign of greater accountability and
transparency. This dialogue took place on 27lh November 2001.
THE PRESENTATION
•
Dr. T. Rajagopal - Corporate Medical Adviser; Dr. Premala Mascarenhas - Area
Medical Officer; Dr. H.V. Ravi Mohan - Occupational Health Physician; Dr. Anil South East Asia Business Manager; and Dr. Ashok - who deals with environmental
issues formed the HLL team that visited CHC on 27lh November 2001 to make the
presentation.
•
The CHC team included many of our associates who are also involved in occupational
and environmental issues. The team consisted of Dr. Ravi Narayan, Community
Health and Occupational Health Consultant, presently Community Health Adviser of
CHC; Dr. C.M. Francis, a physiologist - endocrinologist, also the retired Dean of St.
John's Medical College and presently Consultant of CHC; Dr. Mohan Isaac, Professor
of Psychiatry at National Institute of Mental Health and Neuro Sciences, Bangalore,
Dr. T. Venkatesh, Professor of Biochemistry, St. John's National Academy for Health
Sciences and heavy metal toxicity expert for South Asia; Mr. As Mohamed, Asst.
Professor of Statistics, Department of Community Medicine, St. John's Medical
College; Dr. H.R. Rajmohan, Director of Regional Occupational Health Centre,
Bangalore (branch of NIOH, Ahmedabad), Dr. Krishnamurthy, Senior Scientist of
ROHC and Dr. Sampath Krishnan, Fellow-Community Health, CHC and Dr. Anur
Praveen, a doctor volunteer, CIIC.
C.
•
In spite of an earlier request, the HLL team did not send us a report of the study in
advance as requested, but made a presentation at CHC, using overhead projection
sheets, summarising the background, the objectives, the methodology and the findings
and analysis of a survey of around 255 workers. These workers had showed up at the
visit of a 3 member medical team, in response to a newspaper announcement
requesting them to be present for a medical evaluation, a few months after the
operations in the factory had been closed.
•
The CHC team and associates raised queries and shared comments as the presentation
progressed. We again requested for a report of the study, since peer review is not
adequately effective if peers are just shown slides or OHPs in a presentation, which
nearly always has a constraint of time. However, though it was mentioned that we
would get a report, so far none has been received. We, therefore, invited all our team
members and associates to put down in writing the key issues and comments that they
have to make on the study. We hope to pass this on to the study organisers and to
others, who wish to assess and tackle the problem of human and environmental health
caused by the HLL factory.
PEER REVIEW AND COMMENTS
•
Handicapped as we are with the absence of the copies of the OHP sheets presented at
CHC by Dr. Rajagopal or any documented or printed report of the study - these
comments listed below' may be taken as issues of concern with the study design and
process of analysis, that may have affected the assessment of the actual problem. A
biological monitoring approach rather than an occupational health monitoring
approach seems to have predominated in the study design. The HLL team's response
to some of these points raised were:
i)
"we have that type of analysis" or
ii) "we shall look into that matter”,
but in the absence of a printed, circulated report it is difficult to say whether the
comment or criticism has been adequately responded to in the study or subsequent
analysis thereof.
1. The Sample - 'Opportunistic'
Any sample of workers that are based on those who show up on invitation of a
medical team visit - announced by letter or newspaper or whatever method is what in
epidemiological terms is called an 'opportunistic' or 'grab' sample. Extreme caution
has to be then taken to make any sort of judgement about the whole population of
HLL workers, past and present because extrapolation from an 'opportunistic sample'.
which has self-selection bias, is usually invalid.
2.
Occupational History - an important parameter not adequately considered
A more rigorous sampling method may have to be used or else using detailed
occupational health history the available sample may need to be subdivided into
'internal controls' for enhancing the comparisons. The 'opportunistic sample' may have
workers with different years of work experience in the factory and different jobs or
sections as well and these differences can be used to evolve subgroups. Clubbing
them together by age or any other parameter, disregarding the occupational history,
especially w'hen the exposure is occupational, is again not a rational method of
analysis. Clubbing previous employees, recent current employees and temporary
employees is also not a good procedure.
2
3.
Lack of clarity in study objectives:
a) It was not clear whether the study was based on any hypothesis egl. exposed -vscontrol or more exposed -vs- less exposed. All the data was clubbed together which
seemed to confuse the situation.
b) There was no attempt to link the biochemical parameters with clinical examination.
These were presented as different tables. So, whether there are correlations between
clinical findings and investigations or between exposure and health effects were not
clear.
4.
Inadequate use of data on health from Company records
Too much emphasis was put on the study conducted without adequate use of
supplementary information available with the industry, eg., Periodical monthly
monitoring, annual medical check up. occupational data. The data from the periodical
medical examination and the monthly urine examination for proteinurea. mercury level.
etc., were presented but not correlated. These need to be reviewed in greater detail.
5.
Absence of Exit interviews
Even though the 'turnover' of workers seemed to have been large, the management does
not seem to have had 'exit interviews' which would have helped to determine whether
'health reasons' were an important component of the decision to leave the job.
6.
Averages highlighted without range
The significance of the results especially values of urinary mercury were given without
any indication of standard deviations or 95% confidence limits. The significance of the
results could therefore have been assessed if standard deviations are also shown.
Averages are important but range of data within averages is also crucial.
7.
a) Further analysis of individuals with higher urinary mercury levels needed
The presentation highlighted the urinary of ex employees, present employees as well as
other workers. Some levels did exceed the prescribed levels. Who were these? What
was the exposure? What were the effects? What action was taken? This was not clear.
b) A close follow up of employees (who showed higher levels) and their levels analysed
separately would have indicated pattern of reduction. A meaningful occupational
break up like exposure versus urinary levels; or experience -vs- urinary concentrations
of mercury, levels -Vs- sex distribution (male/female workers and distribution of Hg
levels); age -Vs- Hg distributions; job processes -Vs- Hg urine distribution - would
have provided clearer occupational health status of employers.
8.
Quality control of Lab Tests not undertaken
The study does not seem to have followed external and internal quality control methods.
All tests were done by the same laboratory.
9.
Data to be analysed against all guidelines
The data should be looked at by existing recommended health based biological exposure
limits like WHO/ACGIH, EPA and NIOSH on an individual and group basis. This study
compared only WHO guidelines. The biological monitoring centred around urinary
mercury level prescribed by WHO/OSHA
Indian Factory' Act adopting OSHA
prescribed limit. Lower limits are nowadays used and this must be considered.
10.
Personal environmental monitoring rather than area sampling
a) Finally, in the monitoring of work environment, rather than area sampling representing
background mercury pollution, it would have been better to have attempted personal
monitoring as a better indication of concentrations in the breathing zone of the
workers. Also the details of job processes covered for air monitoring; levels existing at
mercury / non mercury' areas and / or environmental mercury at production / non
production sections - would provide meaningful comparisons and facilitate
understanding subjective concentration of air borne mercury levels at different job
processes and I or sections of the factory.
b) Also, as factory involves glass-processing (which generally involves heat), a picture of
work environmental heat parameters like DB. WB, WBGT would have provided not
only the extent of heat stress (if present) but also would have given an idea of work
environment air temperature which could be a critical factor for mercury to get
airborne in the environment.
Finally, while there are many other minor points that can be included in a spirit of peer
review and dialogue, we concluded that
• the study seems to have been undertaken in somewhat of a hurry'; without adequate focus
in planning and analysis to the occupational health principles involved in such a study.
• While it may have been a good beginning the analysis of the data must be done more
carefully, perhaps with some involvement of external peers and advisers who can help
this process - so that a more sound analysis of the problem can be made to help get further
clarity on the situation.
•
To begin with a circulation of detailed report of the study including objectives,
materials and methods, efforts at standardisation, findings and analysis and
discussion of findings should be done immediately in a true spirit of transparency
and accountability.
•
Occupational health hazards are not uncommon even with the best of efforts. The only
way forward to improve and protect workers health is to begin to look at the evidence in a
more interactive, participatory and holistic way so that there is:
>
>
>
>
•
clarity' of the problem,
careful monitoring of evidence, and
evidence based evolution of solutions.
HLL needs to set an example of corporate social responsibility in this matter.
HLL needs to set an example of corporate social responsibility in this matter.
[A summary based on notes provided by Dr. T, Venkatesh, Dr. H.R.
Rajamohan, Dr. Krishna Murthy and Dr. Ravi Narayan and Dr. C.M. Francis]
Community Health Cell, 367, Srinivasa Nilaya, Jakkasandra 1st Main,
Koramangala 1st Block, Bangalore - 560 034.
4
G
I
'
Z'r-Prop-work Discussion Paper-IV
_'.5-2#'/'J-.'Zy, 2002. Venue: Visthar, Bangalore.
BACKCHOUND:
A oolluted environment will manifest itself in the form of health
disorders amongst human and other living populations inhabiting it.
Based on numerous cases around the country, common sense evaluation
clearly confirms that industrial pollution has damaged community health.
mwever, the specific nature of the damage or its extent remains
known. As a result, community health has hardly influenced pollution
policy. The indications that this is the case is evident:
.Pollution legislation aims at controlling pollution rather than
preventing it.
Pollution legislation merely prescribes norms that legalise pollution.
3 What is legal is not healthy. Pollution norms are prescribed based on
•i." assumption*of assimilative capacity of nature rather than on facts
that point to the cumulative nature of the most deadly kinds of
Lutants and their risks to community health.
: 1 Inters remain unpunished for their pollution and effects on
co~’~unity health .
’
or Community Health Surveys:
Cw.izens and community groups need to be able to identify
environmentally-caused health disorders, and the sources of
• vironrne-.ital disturbance (s) that cause such disorders. This is
rtant for several reasons:.
Insuring- that the "Polluter Pays".- The Polluter Pays principle is
; variant not merely as a deterrent for further or future pollution, but
j‘.so in the context of recovering the ecological debt owed to the
:--munities of living beings and their future generations. Ecological
cube goes beyond the fiscal and requires a deep-rooted sense of apology
by the polluter for the damage caused by its actions.
sing the Community: Often health disorders within a community
at a . amily level, with people blaming the compromised health of
r family members on fate or accident. Many of the subtler effects :corning disorders, immune system depression, reproductive or
ecological anomalies
J
noticeable as trends only when seen at a community level.
Mapping
t■.•••alth of a community brings home the fact that the fate of the
as a whole is linked to its environment.
■ -eventing Future Harm: Armed with the knowledge that certain kinds
industries and pollution can cause community wide health effects,
—•.nicies can play a more active and informed role in deciding the
:o:: -se of their communities' development. Combined with ah operational
erstanding of the Precautionary Principle, such knowledge can help in
.-er.ting the setting up of polluting industries.
' nr .it eri ng Government/Industry: Community health surveys need not be
:.--.?l’jsive in establishing cause-effect relationship between
ronmental disturbance and health disorders. They need to
sufficiently appeal to the common sense of the community members and the
■?ub'.ic to be able to challenge the baseless assertions by
' rnment/industry that a community's ailments have nothing to do with
■■ : pollution they are subject to. Health surveys can help reverse the
of proof, with communities demanding industries and governments^
hi: c-h beyond doubt that their polluting activities/industries aw
related to the community's health problems, or will not cause health
: 'orders.
'...-.I th Care Needs: Health surveys also allows for better
■■•'/’.standing of the health care needs of communities living in
•
--onmentally disturbed areas. Such an understanding is crucial to
:
going the health care interventions necessary for the community
: ... t orical Context:
Keeping the above in mind, a small group of individuals and
organizations met in Bangalore from the 13th to the 17th of August,2001.
There has been some meaningful activity in the hotspots as a result of
eras interaction. We have had our fair share of problems too. But all of
it has helped us to improve our understanding of how to handle the tense
and desperate situations we encounter as we go about performing health^^
• ».’ " '.t e'
Tver since there has been a constant urge for us to get back together
evolving a clear framework for action in the various pollution/radiation
hotspots we work in.
AIM:
■5;
:■>
ipping Communities and campaigners to deal with
performing Community Health Surveys and
their subsequent effective campaign application
I
■ c■•:ea:e a multidisciplinary resource base of medical practitioners,
mmity activists and toxicologists capable of conducting community
.1.;’. surveys in communities subject to industrial and environmental
'ntion;
To promote interaction between community activists and community
■ ■ : th experts to facilitate a discussion aimed at understanding the
imitations and strengths of community health surveys;
- ? unde..,tand the role of community health surveys in campaigns
gainst
industrial pollution.
THfi CHESS-II SKILLSHARE
(A PROPOSED PLAN)
skillshare would discuss "Toxics/Radiation and Health" issues along
screams of thought:
Epidemiology" in practise,
lances I
in INDIA with campaign
•r,
' ' iJ.ution & Community Health
■■ ign -.nd Implementation of Health Surveys - Resource Implications
personnel, time etc)
■
.
C-xpaign Stategy of Regional campaigns and a potential
iiiiial campaign
. Understanding the strengths and limitations of community health
urveys
using Community Health Surveys for campaigning.
.
Resources and resource sharing opportunities.
.
Case Studies
. Action plans for regional and national work
.
Roles and Responsibilities
:.■. -• 1.1 cipants :
ommunity activists, medical practitioners from affected communities,
ccupational health doctors/activists, community health professionals/
ccivists, toxicologists, lawyers, workers, trade-unions, consumer
routs, farmers, farmer-cbo's and researchers.
ONE:
25/7/2002:
5 am- 10am:
Registration and Tea.
1.0am to 1:30 pm: Sharing the work of individuals and groups and
expectations out of the skillshare.
1:30 to 3:00pm: Lunch
3:00 to 5:00pm: Lay Epidemiology-one day skillshare
session 1:
Small intro presentations:
1) Community Health Cell
2) Elizabeth Guillette
3) (Anyone else?)
5:00 to 5:30 pm Tea
5:30 to 7:30pm: Lay Epidemiology in 3 small-groups-workshop
mode: Session 2
'■I: C0p—: Cultural Ever.ing + Welcome Dinner.
' 70:
26/7/2002 :
•
9am-10 :30am: Lay Epidemiology: Session 3: in small groups
10:30-1^:00am: Tea
11:00 to 1:30pm: Final Session of Lay Epidemiology in small
groups
1:30 to 3:00pm: Lunch
3:00 to 4:3 0pm:
Campaign Context and Strategy +
"The Way Ahead": Campaign Ideas Presentations
•1:30 to 5:00pm: Tea and snacks.
5:00 to 7:30pm: Campaign Session -2:
Small Groups interactions cum brainstorming on Toxics and
Health campaign strategy with:
------- Surviving Radiation/Attacking UCIL-NPC
------- Pesticides and Health
------- Legal action to address Corporate
Liability?
4|
------- Womens' Health issues in hotspots
------- A Consumer Campaign (???)
------- Worker Health Remediation/Liability
------- Community Health Surveys
------- Media as an instrument of the Campaign.
------- Water and Public Health
------- and any other issues people want to work on..
7:30 pm onwards: Theatre in the WELL and songs with food!
THREE: 27/7/20 02
9 am-10:30 am: Campaign Session-3: Work in Small groups continue...
10:30-11:00 am: Tea
'1:00 - 1:30 am: Campaign Session 4: Small groups wind up their
sy-lcr.g strategy discussion
1:30 -3:00pm:
Lunch
3:00 - 5:00pm: Small groups come in the larger forum.
Sharing of insights into the national campaigns.
-~;00
5:30pm: Tea and Snacks
.30 to 7:30pm:Group to group Meetings/consultations
■;3 0 to 8:30pm:Contemporary Dance in the Well!
Songs and Food!
9 .-..m-10.:3 0 am:
"Common Objectives and Collective Action"
10 : 3 0 -11:0 0 am: Tea
!7:00 - 1:30 am:
Action Plan for Year 2 of CHESS: Roles
1:30 -2:3 Oom: Lunch
2;30
3:30 pm: Statement of Collective Concern
\
Q —
* 0 0 *"") ^*1 ’
Discussion on Budget and Resource-raising
4 : 3 0 - 4 : 3 0 pm:
Individuals and Organisations taking key
responsibilities.
4.-30- 5 :00 pm: Tea and Snacks
3:00 tc 5:30pm: Travel to the City Centre.
5:30 to 7:00 pm: Launch of Raghu Rai's Exhibition on
Bhopal: Public Activity and Press Briefing.
(Release the statement of collective concern)
rvivors,Community“based activists and
= '■
: :
~~~
:: V 1 .. rclJ-S
'
■ ■
p 3.1? C 1. C 2. p 3. L. 1 II CJ
l*=
3~sorted according to base location
.1 p.:t I : alphabetical order (being updated) :
I Bangalore:
•U
l.AS Mohammed (SJANMS)*
AS Mohammed is the Asst. Professor of statistics and demography in
he Department of Community-Medicine,
St. John'-s Medical College
nd has been involved in numerous studies and reports on health
are and evaluation. He is a society member of CHC.
Address:
Department
of
Community
Health,
St.
John's
Medical
College, Bangalore- 560 034
Phone: 080-2065043
Email
aa . s jmc@vsnl. com
05
O
2.Gururaj Budhya
(TIED)
budhyag@hotmail.com
Mobile : 0-9844069634
(T)
. ,
Hckwa
Co h
Phone: 080-33t5656/3462032
.-..Dr. Girish Rao*
'r. Girish Rao is an Associate Professor of Community Medicine in
M.S.
Ramaia’n
Medical
College,
Bangalore
with
a
longstanding
interest in all aspects of hospital waste management. He is also an
Associate of CHC.
Address: Faculty of Community Medicine, M.S. Ramaiah College, MSRIT
'ost, Bangalore- 560 054
Phone: 080-3600968
Smail: girishrao@hotmail.com
4.Mohan*,
Trade Union Movement Researcher,
Bangalore.
of Socio Economic Change(has been working on development
124 villages for 13 years now)
. Ph||080-3217083
Praveen Anur is an intern from Kempegouda Institute of
Sciences, Bangalore who was a special volunteer with CHC
hSs Community Medicine posting and was primarily responsible
all
communications
and
facilitation
of
organisational
ions of CHESS-1.
““
anurpraveen@hotmail.com
1
7.Dr. Rajan Patil is an epidemiologist and is presently a Research/
Training Assistant in CHC with a special interest in vector bourne
diseases. He has been involved with creating an interactive science
teaching module on mosquitoes and .their control.
/
Email: raj anpatil@yahoo.com
8. Dr. Ravi Narayan .is the Community Health Advisor of CHC with
professional interest and training in public health,
industrial
health and preventive and social medicine. Earlier as an Associate
Professor of Community Health at St. John's Medical College h?
worked on occupational hazards of the tea industry and the health
effects of agricultural development.
Email: tnarayan@vsnl.com
|
St.
Road,
John's
Frazer
Medical
Town,
fO
3.Sachin D'souza
Sachin is a
final year medical student at
College, Bangalore
Address:
203-F,
Ranka
Plaza,
157,
Wheeler
angalore- 560 005
hone: 080-5090150
mail: mustardjuice@postmark.net
D»
p
M
...Dr. Thelma Narayan is the present coordinator of CHC. She is an
epidemiologist with a doctorate in public health policy. She has
beer involved as a resource person for studies on the Bhopal health
disaster and is currently a member of the Karnataka Government Task
Force on Health and Family Welfare.
Email: tnarayan@vsnl.com
CD
11. DE . Urttiikrishnan PV.
OX FAN
Dr.
12.
T. Venkatesh
Dr. Venkatesh
is the Professor of Biochemistry at St. John's
Medical College and the Director of 'Project Lead Free' of the
George Foundation. He is also the head of the National Referral
Centre for Lead Poisoning in India.
Address:
Department of Biochemistry and Biophysics,
St.
John's
Medical College, Bangalore- 560 034
Phone: 080-5532146/ 2065058
Telefax: 080-6640293
/•mail: venky tv@hotmail.com K
13.
V'swambhar Pati* /
Prof.
Sanjay Biswas*
Indian Scientists against Nuclear Weapons,
FHOPAI-;
ISANW,
■ ■=■0
Bangalore.
> CD
As a community researcher Nishant has worked exhaustively in Bhopal
doing a health survey of children born to exposed parents as
opposed to unexposed ones to the gas tragedy.
15.
Satinath Sarangi:
Sambhavana,
i 1J
B 2 - 302, Sheetal Nagar,
Beras la Road, Bhopal; Ward
An M Tech in Metallurgical Engineering, Satinath came to Bhopal a
day after the disaster and has been involved with relief,
rehabilitation and issues of justice for the Bhopal victims since
then. He is one of the Founder Members of the Bhopal Group for
information and Action that carries out documentation, research and
publications.
He is also actively involved with legal actions as
well as national and international campaigns.
-■mail ■ sambhavanafivsnl. com
: he Director of: Center for Environmental Communications-
han
-bestos Network India
i_csn i @vsnl. com
30.Madhumita Dutta, Toxics Link Delhi, New Delhi. mdutta@vsnl.com
; I. Mann Gopalan
Manu is a toxics campaigner with Greenpeace India.
Email: manu.gopalan@dialb.greenpeace.org
32.
Nidhi Jamwal/ Sunita Narain*
CO1
The Centre for Science and Environmental,
Tugh]...kabad. Institutional Area, New Delhi -110062 .
Ph: 011-6081110 , 011-6083699,'fax: 011-60858 79
email: cse@sda.lt. ernet. in
33.Mi rmala Karunan
k
Nirmala is the Administration Manager of Greenpeace in India.
Email: nf’rmala . karunan@dialb . greenpeace . org
34. Praful Bidwai
Campaign for Nuclear Disarmament and Peace CNDP)
35. PK Ganguly*
(T)
Secretary of the Center for Indian Trade Unions, CITU.
Email; citu@vsnl.com
36. Rahul Ram*
p
Tox.lcologist/Lead Singer- Indian Ocean.
S'7 . Ravi Agarwal
Environmentalist and Director,
Emai1: srishtidel@vsnl.net.in
Srishti,
fl: . ,f
■
'
J . '
New Delhi
38.Sanjeev Gopal
Sanjeev is currently a trainee campaigner with Greenpeace India.
Email: sanjeev.gopal@dialb.greenpeace.org
3 9. Dr SD Seth*
pr l-l <r-1 ef<- <
AIIMS National Poison Information Cell.
k—k. z
Ph: off:011-6512880;horn:011-6593282;fax:011-6859391
ijayanand Gowda
A Youth group trying to respond / protest against Blore mysore
rnfr.ist ucrure corridor project. They have been active against
cutting trees; they have also performed a cycle yatra. Fighting
pollution due to the Goggo Factory in Doddebalapur, near Bangalore
Karnataka.
Janadhwari Yuva Vedika, Opp. Masjid Kumbarpet,
Dodde ba1apur- 5 612 0 3
4080-7626450-r
41. Prakash R.
Fighting pollution due to the Goggo Factory. Prakash is from the
affected village near Gogo factory; a village panchayat member
Doddebalapur, near Bangalore, Karnataka.
Village Aradeshhalli, Doddebalappur
#080-8464251-1
42 . TM Sainuddfeen
Fighting pollution due to Binani Zinc's Jarosite Pond in Edayar,
Kerala
Thuttangil House, Edayar # 0484-540845.
43. Salim VA*
Fighting pollution due to Binani Zinc's Jarosite Pond in Edayar,
Kerala
Valiangadi, Binanipuram(PO), Edayar, Ernakulam,-6835021
# 0484-555592
V11,1 Eloor:
4L.VJ Jose, Jose was working in Cochin spreading awareness about
Road safety and First-Aid tips with Ernakulam Rural Action Force.
Row he is an active volunteer of Greenpeace-India. Involved in
mobilizing the local community using education material and films
from the Greenpeace library. He has also been instrumental in
environmental monitoring of the river Periyar.
45. W Purushan,
Purushan is the community leader of Periyar
(A)
Malineekarana Virudha Samithi, a community based organization
involved in
pollution prevention through direct' actions in Eloor,
the largest industrial estate in Kerala.
io.Aav.Daisy Thampi, practices Environmental Law in Kerala. '—
Ema.il: da i t5@yahoo. com
47. Gang! rcddy. V
QJ)
Rural Reconstruction and Development Society
Ngllore Dist.
#0862 1 -87096
(A.P)
48.Anand Mazgaonkar* 49.Michael Mazgaonkar*50 Rohit Prajapati*
Hl.Swati Desai*s work involves trying to mobilize affected
communities along a 200km stretch from Vapi to Mehsana in Gujarat
on issues of ground and surface water contamination, hazardous
solid waste, air pollution, health effects and TNCs.
pssk cmada . net. in
Pary/j'-aran Suraksha Samiti,PSS, Gujarat. pss@narmada . net. in
XT
r.arihar Polyfibres
52. Mr. Hiremath
Sa.maj Parivartan Samudaya
sr_hireraath@hotmail.com
sr_hiremath@rediffma.il. com
Has been working on the issue of industrial pollution since a
decade
- 3 . Dr
S • . Pawar
3 0835-8^742
shiva;p@hotmail.com
:TI
Hy d e r ab a d:
54. A. . Kishan Rao
? x's s .1 cl ent
Patancheru Anti Pollution Committee
Yashodhara hospital
12-5, srinagar colony, Patancheru--502319, Medak Dist. (A.P.)
Local doctor at patancheru , has been involved in health survey
around the area
55. Narasimha Reddy
Executive director
Centro for Resource Education
Hyderabad
email: creind@hd2.dot.net.in
56. Prof. K. Purusottam Reddy
Prsident
Osmania university teachers association
#7616115
kumbhamsr@rediffmail.com
activist
and campaigner has done phd on related issue
X TXT
54.
Jaducjoda:
Gr.mshyam Birules*
(toxics)
Jharkhandis Organisation Against Radiation
In: -(0657) 730009
55.
(JOAR)
Sourendra Gadekar*,Sanghamitra Gadekar*
Anumukti
anumukti@gmx.net
XIV
Kaiga-Bangalore;
56.Vishnu Xamath, Citizens for Alternatives to Nuclear energy
(CANE), Bangalore.
CA
XV
Kodaikanal :
57.Daniel Francis* is—a machine orperator in the Mercury
Thermometer Plant of Hindustan Lever Ltd. in Kodaikanal.
5 B. Kanarr*', Palani Hills Conservation Council,
Ema i1: kanan@vsnl.com
Kodaikanal.
59.S.A. Mahindrababu* and 16 K. Gopalakrishnan*
are members of the
Ex Mercury Employees Association and are fighting for cleanup of
the mercury and better compensation for the workers in Kodai.
60-Navroz Mody k )
Toxics Campaigner of Greenpeace fighting Mercury Pollution in
Kodaikanal and PVC in Cudallore and Mettur.
Email: navroz.mody@dialb..gicenpeacc.oig
61. Rita Narona*
Roshini Nilaya School o.E Social Work
Mangalore-575002
ft 262421(R)
sswrgshni@vasnet.com
Rita is teaching Social Work at Roshni Nilaya School of Social
work, Mangalore. She has conducted a Community Medicine Conference
recently and also coordinated a preliminary health survey in the
region.
52.Sylvester m Dsouza
Activist , campaigner,
ft 495046 ® 434803 (o)
tide@vsnl.com
(JJ
mobiliser prsently working with Tide
6 3. Up end r a Hosbet
Runs a computer institute, actively working on the issue of
environment since a decade. He says that they are against any Mega
projects . has organised protests against Cogentrix
■■ ' 8 4
784 88
•.:?••••• ' a bosketf»hotnia i 1. corn
MUfflba i ;
-’pika D' souza,
Coordinator,
Human rights law network.
Murlidhar V* is a Mumbai based doctor with experience and
interest in community
health surveys and environmental health
issues.
mail: murlidharv@vsnl.com
■5 6 .Dr.
Voena Murlidhar*
is a medical officer with 'Navi Mumbai
Municipal Corporation. Her work involves control/ surveillance of
epidemic diseases and campaigns such as Polio Eradication.
email
murlidharv@vsnl, com
/?A
67.'- .ay Kanhere* is a labour activist
cor-p-rsation of workers in
industry.
Sm.ai1: sujvij @vsnl.com
who
has
worked
for
the
9845226678
' 9 Dr. Vcnka i.nnh Murthy
:;r i sr i kar@red i. f fmai 1 . com
local doctors running their own clinic and nursing home at
bhadr vati (mysoro paper and pulp mill ) . Also involved in a study
tela' J tohealth impact in kudremukh mining area
70.Varghese Cloatas
Project Director
a-.
'/X a Scjrjai
An organisation working on the issue of environment . they are
"•oseiy working with th community around terikere (mysore paper and
pulp industry); mainly focussing on awareness in the locality
P.O. No.
23
Tarekere-577228
Chikmangalore; Karnataka
ii 0826-422500
i
422570/423739
vika* jna ngo@_si_fy ■ com
Mahalakshmi
Parthasarathy is working
with mining
struggle
groups. She is also involved with legal and media advocacy and
informat ion documentation.
il: pmahaLakshmi@yahoo . com
&
72.Xavier Dias*/ 33.Ravi Rebbapregada*,
Email: mmpnorth@vsnl.net
XX
Mines,
Minerals and People
Philippines:
73. Dr. Roraoeo Quijano*,
Pesticide Action Network- Asia Pacific
XXI
Raichur:
74.
Somshekhar
->
0
■
Samuha
£08536-668213/14
2 more persons from raichur , depends upon how they call a meeting
and what comes out of it. I will be calling them ; mainly
representative of
various group in Raichur
x XII
Thiruvananthapuram:
75.Jayakumar C. is the coordinator of Thanal
and Information Network. thanal@vsnl.com
Conservation
Action
Rajasree
76.
V.V. is involved in Thanal's activities on pollution
and
toxicity
and
is
specifically
working
on
hospital
waste
management. thana.l@vsnl. com
\
77.Sridhar R. is involved in campaigns against industrial pollution
in Eloor and Mavoor in Kerala. He is also involved in the issue of
waste management and has worked on the socio-economic impacts of
the newsprint and pulp industries. thanal@vsnl.com
78.Dr. Sukanya,
Trivandrum.
Achyutha Menon Center for Public Health,
79.Usha S. is involved in environmental education among students
and studies and campaigns among farming communities on chemicals in
agriculture. thanal@vsnl.com
XXIII
_
Vellore:
SO.Dr.Rakhal Gaitonde and Dr.Subhasri Gaitonde
'
Dr. Rakh'al is doing his post graduation in Community Medicine in
CMC, Vellore. He has a special interest in peoples movements and
using
epidemiological
skills
in
activism.
Dr.Subhashri
is
an
obstretician and gynaecologist in CMC, Vellore.
Address: 636-B, PG Quarters, CHAD, Bagayam, Vellore
Phone: 0416-260988
Emai1:
XXIV
subharakhal@yahoo.com
Warangal:
(?)
81/82. Mr. Narasimha reddy* will be inviting two persons working on
the issue of pesticides
■I.''
~
:
Any p.’,r.«on you feel may be important to invite?
Singh is traveling all the hotspots inviting
■ y persons and community-based campaigners for the meeting)
---^
; r — °F..
r fating organisations
A yar ;cd in alphabetical order (a proposal)
■ .
TIMS National Poison Information Cell.
: '■ ■ b" Sil Seth.
,:ll- off: Oil 6 512 880 ; horn: 011 - 6 5 932 82 ; fax:011-6859391
Alternative Law Forum,
Infantry Road,
Bangalore.
Represented by Chitra.
Imail: alforum@
1 . Anumiikti
Sourendra Gadekar,
Sanghamitra Gadekar <anumukti@gmx.net>
- . ?• -?ft.-c.iafcion of Consumer Action on Safety and
Ho. a ’. . h (ACASH) , Mumbai.
Sex* >nts of India Society,
Ph: 322-3886556
SVP Road,
is.
Br-n Asbestos Network India
Dr.
T'< Joshi<tkjoshi@vsnl. com>
Gurgaum,
G. Campaign for Nuclear Disarmament
Praful Bidwai, Achin Vanaik.
7.
Mumbai.
and Peace
Center for Environmental Communications
Mr. J. John
for Indian Trade Unions- CITU
7.
Renter
Mr.
PK Ganguly<citu@vsnl.com>
,
Centre
for Resource Education
’•?< . Na rasirr.'-’.a Reddy.
10.
Centre for Science and Environmental,
Tn: Nidhi Jamwal,Sunita Narain.
Tughlakabad Institutional. Area, New Delhi-110062.
-h: 0'1-60811!0 011-6083699,fax:011-6085879
'i ' : cse@ sri-i ’«. e ’■■inr. . in
(CNDP) ,
(CEC)
11. Chir.tan
Delhi
Research
Environmental
and
Action
Group,
In: Bharathi Chaturvedi
Chintan
is a Delhi based NGO working on environmental
issues,
particularly waste and toxics.
Address: No. 17, Jangpura Market, 2nd floor, above Om Hotel, New
Delhi 110 013
Phone: 011-3381627/ 431.4478
12.Citizens
for
Alternatives
3
n cr s. 1 o v g
In: Vishnu Karnath, Kavitha B.S.
CANE
is
a
Bangalore
based
to
NGO
Nuclear
working
energy
aganist
(CANE),
radioactive
[>ol 1 III i <111 .
Addro-JG:
stage,
11390,
5l.h
main,
Mahalakshtnipura,
12th
cross,
West
oi
Chord
Road,
2nd
Bangalore-560 086
Phone : 080-3-.92059/ 3 5 92 060
mail:
kavayathr i.@yahoo . corn ,
aravinda@cisco . com
13. Community Health Cell, Bangalore
in: Dr.^Ravi Narayan, Dr. Thelma Narayan, Dr. Rajan Patil, Dr. Praveen
Anur and Lalit Narayan.
CHC is volulntary health organisation and community health resource and
policy centre working closely with the governments and communities to
improve health and access to health care. Also involved in training
health workers to empower communities at grass root level.
■'•dcrosn: 367, Jakkasandra 1st Main, 1st Block, Koramangala, Bangalore-560
Phone-. 080-5531518/ 5525372
Telefax: 080-5525372
sa11: sochara@vsnl.com
;4.
Consumer Action Group
in: Shoba
No. 7,
.
.
iiyor
4t.h Street,
Venka teshwara Nagar, Adyar,
Chennai - 600020 .
Consumer Voice.
F-71,Lajpat Nagar-II, New Delhi-110024
ph:0.11-6918969,011-6315375
fax:011-4620455
In: Bejon Misra: 9811044424
'•'nw i 1 : bojonmflhotmaJ I. . corn
16. Endosulfan Spray Protest Action Commitee, Kerala
ESPAC was formed at Perla, Kasergod by local farmers and the affected
people to fight
the aerial spraying of endosulfan and they have been
very succssrul in bringing this issue to a larger media and people's
attent ion.
r<:.irc;. ,
^!innc
i i ■
cyo Kajampady Nursing
, Kerala
395088
shreepadre@sancharnet . in
•: ■ ’-r.nnpr.ace
. .
Home,
P.O.
Perla-671
Kasargod
India
: N: rmala Karunan, Navroz Mody, Ananthapadmanabhan,
"•.dhan Chandra Singh, Manu Gopalan.
Address: J- 15, Saket, New Delhi- 110 017
Phone: 011-6962932/ 6536716
Telefax: 011-6563716
'
552,
Divya Raghunandan,
i 1 : inann.gopalan@dialb.grcciipcace.orR
,HvnV:n Rights I:aw Network,
i
' : Dor.pika D'souza, Sunita Dubey.
Tngin.House, 4 Floor, 86,Bombay Samachar MArg,
Ph: C.I."-22 i 7078/2204948
Fax: 022-2220822/2227233
Mumbai-400023.
\
. indiim Doctors for Peace and Democracy (IDPD)
The Indian affiliate of the International Physicians for
Prevention of Nuclear War
In:
Dr. A‘run Mi traidpd2001@yahoo . com
Indian Ocean,
:n: Rahul Ram
2 0.
I
New Delhi.
■ an Scientists Against Nuclear Weapons
Vishw. ibhar Pati,
Prof.
(ISANW)
Sanjay Biswas
In;; titlute of Socio-Economic Change
Tanga]ore
In: Mr Nagar Bobby.
lias been working on development issues in 124 villages for 13 years
now.
Phi) 080-3217083
2 3 . J an a c h e tan?.,
Kishan Hao, Santharam Ilegde
.24.
Iiarkhandis Organisation Against Radiation
In:
Gjnshyam Birulee -(0657)
2 :’ ,
730009
•/.' a nad 11 •■■■’ a.r i Yuv a Ve d i ka
cpp. Masjid, Kurnbarpet,
Mr. Dayanand Gowda.
. Hine?,
Doddeballapur-561203.
Minnrnls and People (MNP)
(JOAR)
Tn: Mahalakshmi Parthasarathy,Xavier Dias
[•IMP ■
r• j ona 1 network of mining- affected communities and community
croups and working with mining affected communities in any manner.
Address: 1249/A, Road No. 62, Jubilee Hills, Hyderabad- 500 033
Phone: 040-6505974
Telefax: 040-3542975
Email: mm p@satyam.net.in
27. National Law School of India- University
Babu Mathew.
^'.Occupational Health and Safety Centre, Mumbai
l.n: Vi jay Kanhere, Dr. Murlidhar V. and Dr.Veena Murlidhar.
Address: 6, Neelkant Apartments, Gokuldas Pasta Road, Dadar(E), Mumbai400 014
Phone: 022-766 0178
■■:m;;iJ : webmastergohsemumbai . org
Wnbsi r.u: www,ohsemumbai . org
IS.
OXFAM,
!)l< . Unn i k r i shtian I’V .
'O.Osmajiia university teachers association
Prof.
Purushottam Reddy
ll.Palni Hills Conservation Council
In: Hanan.
A NGO based in Kodaikanal fighting for the cause of workers affected in
Mercury factory of HLL.
Email: kanan@vsnl.com
32, Patancheru Anti Pollution Committee
A . Kishan Rao
Pros i dr:nt:
Yashodhara hospital
12-5, srinagar colony, Patancheru-502319,Medak Dist. (A.P.)
Local doctor at patancheru, has been involved in health survey
around the area
33. Paryavaran Suraksha Samiti, Gujarat
In: Anand Mazgaonkar, Swati Desai and Michael Mazgaonkar
PSS is a voluntary self help organisation working primarily in South
Gujarat on a variety of issues, including Industrial Pollution and Right
To Know.
Address: 37/1, Narayan Nagar, Chandni Chowk, Rajpipla-393145, Gujarat
Phone: 02640-20629
email; pss@narmada.net.in
34.Pcriyar Malinoekarana Virudha Samiti(PMVS)
Tn: onrush nr' Floor
,Kerala
Pi-’VS is a local group of activists fighting the pollution issue in the
-■
’li y.:r belts of the River Periyar, where there are about 250
ir.shsu
'-i all sorts mainly chemical.
I'eriyar Malineekarana Virdha Samiti, Eloor Depot,
bdyogrtiandal P.O., .Kochi, Kerala.
98460-13483
Phono:
1 :
“■
F-’3 tic ide Action. Network- Asia Pacific
35.
Dr.
thanal@vsnl ■ com
F
3 5.
loeo Quijano,
Sarojeni Rengam
Roahni Nilaya School of Social Work
Social Work Department represented by Prof.
Rita Narula
37. Rural Reconstruction and Development Society
Gangi reddy. V
Gydapu ram 524407
Nel lore Dist. (A.P)
•?0E621 - 87096
3«.
Samaj
Parivartan Samudaya
issue
of
industrial
pollution
since
a
(■■)
(fl
Mr. Hi remath
sr_hi ■ ema,fth@hotmail. com
sr_hi1 emath@red.i ffmail. com
been working on the
adc
In.- V.T. Padmanabhan, Satinath Sarangi
Sambhavna is a Bhopal based voluntary organisation engaged in delivering
holistic medical services to gas affected people. It has undertaken
several pioneering initiatives in the field of community health,
particularly in the context of communities affected by industrial
pollution.
Addresr: Sambhavana, Berasia Road, Bhopal
1-iai 1: s;ambavna@bom6 ■ vsnl. net. in
41. Saxuvada, 303, II Floor, Rams Infantry Manor,
Bangalore.
Ph:080-5580585
In: Benson Isaac
Email: samvada@vsnl.net
»
5 i sh t 1,. New De 1 hi .
Ravi ‘.qarwal
Infantry Road,
3 . Thanal Conservation Action and Information Network
'Th. i ruvanan thapuram:
In: Usha S., Sridhar 11. and Rajasree V.V.and Jayakumar C.
'canal is a community oriented organisation working on conservation
issues and toxic related issues. Currently engaged in a community Right
to Know campaign in Eloor, Kerala and a proposal to move Kovalam toward
a zero waste model.
Address: Post Box No: 815, Kawdiar, Thiruvanthapuram, 695 003, Kerala
Phone: 0471- 311896
Emai1: thanal@md4 .vsnl.net.in , shreepadre@sancharnet.in
44.Toxics Link,
Chennai/Delhi
In: Rajesh Rangarajan, Madhumita Dutta
Address: 8, 4th Street, Venkateshwara Adayar, Chennai- 600 020
Phone: 044-4460387
Telefax: 044-4914358
il: tlchennai@vsn.1 . net/tldelhi@vsnl. com
45.
V i ka sana
Varghese Cleatas, Project Director
An organisation working on the environmental issues. They are
closely working with the community around Terikere (mysore paper
and pulp^industry); mainly focussing on awareness in the locality
P.B. No.
23
Tarekere-577228
Chikmangalore; Karnataka
.7 0826-422500
422570/423739
vikasana ngo@sify.com
Summary of CHESS-1
List of Participants: CHESS-1
List of Participants: CHESS-2
Profiles of all organizations participating in CHESS-2
Expected Outcomes
Agenda of CHESS-2
MANUAL ON LAY EPIDEMIOLOGY
Prepared by Community Health Cell,Bangalore.
POISON FREE EARTH
A CD■Compilation of all toxics-health literature Prepared
by Greenpeace India for public use.
•■'LOOP TRI REPORT
Prepared by Greenpeace India as part of the RTK/Health
campaign: Contains global research on toxicity/healtheffects and emergency response systems on all chemicals
used and released by 7 large industrial units in Eloor
and Edayar.
. DOCTOR-INTEREST reading on toxics and health.
Prepared by Greenpeace India as part of the RTK/
Health campaign
CONS CRIER/GENERAL INTEREST reading on toxics and health.
Prepared by Greenpeace India as part of the RTK/
Health campaign
, Any F •" : ers/Reports/Heal th-Surveys of relevance from skillshare
- r tic.; i >an t s a r e we 1 come .
U MENT OU T I- UT :
1)
"THE MANUAL AT WORK":
PROCEEDINGS OF THE LAY EPIDEMIOLOGY SKILLSHARE
(DISTRIBUTION ONLY FOR PARTICIPANTS AND IPEN)
2)
"A NATIONAL CAMPAIGN?"
NOTES ON CAMPAIGN STRATEGY IN SMALL GROUP
DISCUSSIONS
(DISTRIBUTION ONLY FOR PARTICIPANTS)
. POISON FREE EARTH- VERSION 2
3)
ADDITIONS ON INDEGENOUS RESEARCH IN THE EXISTING
RESEARCH COMPILATION
'/ ’’
Questionnaire £
it do you expect out of the skill-share personally, organisationally
in terms of your campaigns?
-at toxic chemicals/products/processes are you dealing with in your
'•
’ cm?
'• . What experiences/ case studies / videos/ slides/ campaign material
would likes to share with others during the Skill share?
3.Any other ideas / suggestions not covered by above?
’lease provide your vital statistics!
Name of Individual/Organisation:
Name of representatives and your birthdays:
Current Postal Address:
Phone:
Fax:
Emai1:
Which mode of contact you prefer?
■ • rpts _f roin CHESS - 2 Responses till date..:
A
” Manual on I.,ay Epidemiology " will be a good guide for NGO's to
upon loyally and identify problems cuased by processes that are
ring co the health of the workers and the population.
•:
1
■ ’'O.ISON free Earth CD will be useful as well for
those of us
■ ng with toxics issues . But again all these matters in the
■■anular languages will have better effect on the affected workers
population. Availability of material on the web is also of
■ ted use - many ISP's are shutting down - a sign of
weakness for
web media .
not know how much of the survey's can be carried out by NGO's
'■:■■ selves . As all of us have our own agenda and idiosyncracies - may
is good to have the medics and para medics do the work.
money caking precedence over merit in all speres of life there
r'ot many from the medical field who would volunteer for the survey
■alth of population of those affected by toxics. After all it is
■vestment of these disorders that brings the medics the money ....
about, setting up a lab that will also detect known toxics and
any one with suspicion on various pollutants and toxics.
.
was some talk about: this, some time early in the day of the Hg
■ but has been lost in the din of media exposure i guess.
■:-v. ■■■■.:.. ,::s
Conservation Council
■’■n extremely rooted organisation based in Kodaikanal fighting for
various conservation issues amongst which one of the most important is
ihc cause. of workers affected in Mercury factory of HLL.
a shared concern at the last skillshare that we include workers groups
■: the next one, who are concerned about their own health in the context of
' : ng processes and irresponsible and reckless practices of industry. We
to act on this.
■ ; 1 think the Xavier would be of help, I will check with him
further for the mines minerals and People Convention there was one Dr
■■in who had come from CEC Delhi, he too can be of help.
brunt on corporate liability across various organisations this year, in
ontext of the WSSDlRiot- 10 summit) needs attention. How would we tie in
dd our key push to this process?
:: - definitely a very serious issue what with the "Corporate
:isi.bility" being touted as the panacea for all the problems. (Check the
(Human Face of Corporates ) by TERI - I can send you a Times of India
t )
I would like to be a part of this definitely but have to work it ouat...
aXshmi Parthasarathy
Mines, Minerals and People(MMP)
MNP is a national network of mining- affected communities and community
groups and working with mining affected communities in any manner.
Address: 1249/A, Road No. 62, Jubilee Hills, Hyderabad- 500 033
"honc : 0fo -6505974
Telefax: 040-3542975
Eiu ail: mm p@satyam.net.in
■ ■kshmi Parthasarathy is working with mining struggle sroups. She is also
vcd with legal and media advocacy and information documentation.
: pmahalakshmiQyahoo.com
sorry that I could not attend the meeting. I met an interesting group of
ated people working on slow poisons in our environment. Kindly get on to
website slowpoison.com. I will also get n in touch with them and pass on
n formation about the work going on at your place.
date I will be free in July 2002.
. Venkatesh
'
Dr. Venkatesh
is the Professor of Biochemistry at St. John's Medical
College and the Director of 'Project Lead Free' of the George Foundation.
fie is also the head of the National Referral Centre for Lead Poisoning in
India.
,‘ddress: Department of Biochemistry and Biophysics, St. John's Medical
College, Bangalore- 560 034
Phone: 080-5532146/ 2065058
Telefax: 080-6640293
; venky_tv@hotmai1.com
x***>r*><,****)l,M-*****************iV************-it*****)t***********)t**
nk there are some good points coming up.
' d r.ot discuss the matter with usha and sridhar so may be we
■ nd you one mail with more ideas if we could spend some time
.:.xx*********A *****************************************************************
'■ t:o hear ‘ rom you and about: the progress. The CD and the guide will be
useful. he may advertise the availability through all possible
:::: .::nols on
it is ready. There will be many people who will be
rested ior the same.
■
: '
training of lawyers: I personally believe that this is a good
I:. may be a good idea to explore the possibilities of "skillshare"
l ■.■lyers and law students, together or separately.
idea of a team (Co move around) is interesting, but will require lot
:f:i:orts, energy and management. Needless to say, we are NOT into soft
easy work ! I will be happy to discuss this further when I am in
lore (April 3rd and 4th week), if it is not too late.
'nnikrishran PV
(E-mail: unnikruQyahoo. com)
Co-ordi .ator: Emergencies; OXFAM INDIA
Dr. UnniKrishnan is currently a staff member of OXFAM India Trust and is
work! ■ as a resource person on disaster response including psychosocial
consciences and human rights issues. He was the editor of Che India
Ds i.aster Report 2000 and earlier member of the Public Policy and Advocacy
Unit of Voluntary Health Asociation of India. He is also an Associate
CHC.
Address: Vijaya Shree, 4th A Main, near Baptist Hospital, off Bellary
Road, HebbSl, Bangalore- 560 024
Phone: 080-3632964
CONTACT (FEB-APR 2002) UNIVERSITY OF GENEVA, GENEVA :(MOBILE: + + 41 78 876
5437) FAX:+41 22 789 24 17
? Z .• unnikrullvsnl. com
> kkkx x x
:
< x x x x x x k k k k x k k k k k k k k k k k x k k k k k k k * k k k k k k k k k * k k k k k -k k k x x *
. right a ter the skillshare I did the Sukhinda trip (the report of which I
sent t- you/Hcx Chrome ) attending the skillshare did guide me thru it..
:warenerr generation of the communities affected/NGO"s individuals working
; : the are.-... can this be clubbed with the mobilisation bid
can I add that it would be a good idea to have a focus meeting on the
Hliucts of toxics on children, ( exposure routes, effects) it would be of
as we have been witness to child labour in the mines/quarries
about also adding on a veterinary perspective because most of the mining
have come to understand that the livestock to is invariably effected/it
be of help if we understand this better. Here would like to mention an
■
inisaticn A.nthra /Yakshi am pasting their profile below it would be good if
' •'
too are included in the next skillshare.
t.hi-■ we also discussed the possibility of working on our campaigns
-across the ountry understanding common concerns and unifying issues. Me could
‘he least produce a Statement of Collective Concern
i:.; .r liked .. for starters-the Sukhinda issue?? (am being verry focussed;-
jcvne more time so i am sending this mail in between.
'
reus s health and community issues so while we need to
r.-tand the legal aspects we should limit ourselves to one
■
or legal expert may be Mohan if every one agrees so that
give us insight to the legal system than involve the networks
or many people.
: ' law groups has a focus as same as the workshop it will be
. otherwise the discussion will go in to areas and loose focus.
■■r: r.'ily reaching out on common issues is a area of concern we
■ lust wondering to take up a travel to all cashew areas and
n-w:/ork -with workers and community on the endosulfan issue
ray be we will have more to add when we discuss the mail later with
cdier folk- here
Jayakumar C.
qu t- r- Oma s o£ CHESS-1,
2001 as expressed by 5 participant
::
a r:sat ions
C.’
Thanal Conservation Action and Information network
C?- Occupational Health and Safety Center,
C3- ’aryava.-an Suraksha Satniti,
Mumbai
Narmada
C4-Citizens for Alternatives to Nuclear Energy(CANE)
1- Mines,Minerals and People(MMP)
1.what would you like us to cover in the Skill Share
(general)?
Cl a)Basic human physiology and interactions of the various systems
within for our general understanding,
b) The sequence that generally follows in the human body from the
- .ous routes of exposure to the health effects- acute and chronic and
after(and also we need to understand their various forms like genotoxic,
teratogenic, carcinogenic, etc.)
.Multiple
c)
factors or sources are sometimes blamed for the same
■'.a th problems seen, For e.g. In one informal health survey on
josulfan sprayed area in Kasargod we found a very high percentage of
tn having gynecology related problems- but many also revealed that
had Copoer-T implants and they were
relating their problems to
d) Synergistic effects of various chemicals/ chemicals and
^styles made causative linking difficult- simultaneously making it
._■■■ for the polluters to blame some other thing for the effects (
chewing nan, cigarette smoking, vehicular pollution, malnutrition,
. of iodine etc as possible reasons also)
a)
Factory act and its occupational and environmental
am: rications .
b) Workmen's compensation Act, ESI Act.
c) Disaster Management planning and antidotal treatment in case of
hhcal factory disaster, preparedness, training of local doctors and
c:'.working.
,0 Known impacts of air and water pollution.
b) Impacts of
constant exposure .
a) Methodology used for
'■
■
Health Survey.
a) Mining and health
b)Industrial Pollution and impacts on community
Occupational
c)
Health
would like us to cover in the Skill share
-gn)?
(Specific to your
t) A community having health disorders may be due to a single
internal factor like endosulfan in Kasargod or due to multiple external
actors like a mixture of pesticides like in Idukki or due to a waste
vmn and burning, How-will it be possible to develop a tool or set of
cc.'-.s to link disorders to the factors, especially when we
interact
'ith the community directly with focus on women and children.
b)People in the surroundings of industrial area having a lit of all
mnds of chemical industries
like fertilizers, pesticides,-chlorine and
hlorine compound manufacturing units, paper industries, rare earth
4
a-.'tory etc- their individual and synergistic actions is making this too
cmplex a problem. How would one look at health of communities in such
omplex conditions.
c) Plantation workers exposed to agro-chemicals over many years
nd their families affected by the same- directly and indirectly.
d) Workers and community living around and exposed to chemical in
esr.icide manufacturing units like the Hindustan Insecticides Limited
actory at Eloor which manufactures DDT, endosulfan, diclofol, and used
lanufacture BHC till 1997.
2-
a)
b)
c)
Noise induced hearing loss.
Occupational lung diseases
Hospital waste hazards and management.
a)
Bustacted
cancer in an area downstream carrying effluents.
b) Tn. .ct of heavy metals, organic chemicals on health.
a)
He
a
to calculate food and nutrition data in calories (food and
; on data are collected in grams)
Any
b)
specific indexes that we need to calculate general health of
people.
Healt.h
a)
effects of mining (specific mining cases listed in Q4-C5a)
;:•) effects
of mining on workers
c)affects on women workers(reproductive health)and community
ox..c chemicals/products/processes are you dealing with in your
a) Pesticide- especially organochlorines like endosulfan and
organophosphates like phorate. The health issues due to direct intake by
immunities exposed to aerial spraying and otherwise, workers involved
,n "graying, and also indirect intake from contaminated water or food
area*sprayed.
b) Pollution due to effluent and emission from pesticides factory
■inducing DDT, endosulfan, diclofol, and BHC (till 1997)
The HIL
ory lets out the effluents into a stream which contaminates large
:-ms of wetlands before draining into the river Periyar.
A Green peace
,iy fount 111 chemicals, 56 of which could be reliably identified, of
.•rich 39 wore organochlorines including DDT and metabolites, endosulfan
md breakdown products, HCH etc There are other highly polluting
factories in the same area manufacturing phosphate fertilizers (FACT)
ubber processing chemicals (Merchem) The study also found high levels
■' cadmium, chromium, zinc, copper and mercury in the same effluent
itream.
The stream is not being directly used for drinking water/ other
- noses now, but at least 300 families live
on its banks directly
.n'naling the pesticide smelling fumes emanating from the stream and
:onsuming coconuts, ducks, eggs, which smell of the chemicals.
2-
a)Noise
b)Cotton dust and chemical exposures causing lung diseases.
HIV, ’ Hepatitis B&C
c)
a) A cocktail of dyes, pharmaceuticals, intermediate chemicals etc.
b)Decentralized cottage level waste recycling of containers, drums,
sags containing chemicals.
:3
ajRadioactive Pollution
a)Coal,
bauxite,
uranium, mica,
limestone,
granite
•
b)Downstream industries
ushers, etc,)
(coalwasheries,
smelters,
refineries,
4. What experiences/ case studies / videos/ slides/ campaign material
would likes to share with others during Skill share?
C'; a) We would like to share the aerial spraying of endosulfan issue
in Kasargod and one
of the study related to health a survey done in a
village in Kasargod and findings collated out of a death register survey
from three villages.
b) We would like to share the Right to Know campaign and the issue
at the Industrial belt at Eloor, with slides
on the pollution
ri -<•(O
a) Compensation to workers for occupational lung diseases and noise
induced hearing
loss as per ESI Act
b) Compensation to workers
with radiation injury, accidents as per
workmen's compensation act..
Books
c)
on disability assessment, occupational diseases( in
schedule ITT of WC Act)
d) Books*on occupational HIV and hepatitis B&C . Antidotal
treatment in case of chemical disaster, experience of struggle by
Parivartan in chemical belt in Konkan.
C<a) Presentation using slides on Base lines health survey conducted
around kaiga.
b) Nuclear Power Plants and Public Health.
a) Videos: Jadugora* uranium,-Baplimalli bauxite (Orissa)
; Silicosis
b) Case studies: Mapoon story of Australia(indigenous people and
Aluminium companies)Story of Orissa-chromite areas, Environmental
?cts of bauxite and aluminium production in Brazil and Indonesia:
Resting Uranium- revealing health and environmental
risks, Mica in AP
C5 -
3.Any other ideas / suggestion not covered by above?
a) Can we think in terms of producing some fact sheets on health
. -:.s due to the chemicals discussed in this Skill share. This could
:ne of the outcome of the skill share.
b)Could it be possible to develop an easy to understand note on the
•
like genotoxic, teratogenic, carcinogenic and such other terms
' nh are commonly used to depict the toxicity of these chemicals.
a)Guidelines for impairment and disability assessment for
■."■sensation purposes.
b) Doctors' training and networking.
,-)How to do health surveys
on occupational health.
b) How to monitor industrial pollution
c) Critique of our existing health survey questionnaire.
.mgt.hs and Weaknesses of the CHESS Process
. c.-coi
:s :
'd by the CHESS-1 participants)
compilation of all the responses received from the participants in
iiQ'til S ;
"Great rocking- doctors, thorough, accessible and knowledgeable."
"Good comprehensive program."
"Concrete outcomes-ROHC-Kasargod, Kodaikanal."
"Gained knowledge about toxics and its environmental impacts.Did justice
to the phrase 'skillshare', a lot of information and material was
shared."
"Side sessions on strategy, toxics and input to planning commission were
helpful."
"A brilliant mixture of eager, committed environmental activists as well
s medicos, community health experts and scientists who made the 3-day
killshare very rich and worthwhile."
"The workshop provided a platform to bring the different activists groups
under one roof, which may give inspiration to our work."
"Good learning process for first timers."
"Created^nope that we together can do a lot against toxic burdens on our
body and environment."
"Met a very nice set of very good activists and concerned persons."
‘Hope for future common action increased during the meeting."
"Trusting, friendly atmosphere."
"Expertise of each group in its own field."
"Lots of resources, interaction."
"Easy going nature of interaction."
"Getting to know new, friendly groups on the same wave-length."
"S.r.-nngthed groups in formulating and conducting their own surveys."
-The unity and the commitment to a cause and to think locally and act
globally. "
"Learned a lot in the medical field."
"All the presentations were mind boggling and enriching."
"Sharing of experiences was an obvious strength. Translating this into
skills and action plans is the challenge."
"This- forum raised/brought out the deeper conflicts and larger issues
that we are all dealing with and has left us with a quite a bit to think
about."
"Exce'Lent sessions, good resource persons and information."
"Sharing experiences in industrial toxicity were very useful."
"Leg-: /medical opinions were also useful."
"Gained much more confidence about the work I want to do and felt a
support system I was unaware of."
"Outstanding ideas implanted and really began to re-understand many
issues."
"Help to plan in managing environmental disasters."
"Several slow sessions."
"Sometimes repetitive within the same session."
"Wanted more interactions with some resource persons."
"Case studies of actual surveys to outline the 'Dos & Don'ts' of surveys
and studies would have been helpful."
"Needed proper time management.".
"Didn't provide time to certain participants like CANE to share their
experiences due to lack of time. "
"Some participants needed more time to speak about their actions."
"Time allocation for subjects could have been done better."
"Should have taken a particular case for survey and done more practical
work together with the theory."
"Too little time for so much."
"Less number of groups so less experiences shared."
"Too little time."
"More political and ideological discourses would have been good."
"More affected community representation would have made it richer."
"Question oC time? "
; raAiNcrf’'
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INLAND LETTER CARD
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'"’SBES
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PINCODE
Third Fold
eEI HFh 3-lfn trai
WTO ffe
Sender’s Name and Address
Or. Sripathy Ka/ampady, m b-, b.s.
Medical Officer:
First Fold
KAJAMPADY NURSING HOME
PERLA - er I 552
4rs
™oo»e □□□□□□■
QFc invite. you to a
SKILLSHARE PROGRAMME
on ^Sunday, 2Ot&. ffanuaty 2002.
Subject : " Pesticide and Health
with special reference to chronic exposure."
Venue : Sri Shankara Sadana, Perla
Time : 7-00 Pm
Keynote Address : 08*.
F. QuijaBlO
Professor of Pharmacology & Toxicology College of Medicine,
University of the Phils. Manila, Philippines.
Member, Forum Standing Committee,
Intergovernmental Forum on Chemical Safety (IFCS)
Ufou.ii zSincetefy,
Dr. Shripathy Kajampady m.b.b.s.
Kajampady Nursing Home, Perla
Ph : (0499) 895088 (01
Dr. Y. S. Mohana Kumar m.b.b.s.
Kumar Clinic, P. O. Vaninagar
Ph : (0499) 866133 (Off) 860233 [ResiJ
Q/ou ate a/io invited to join, ui foi dinnex at S-q.5 jim.
fffie function wiff itaxt on time., fjfindly co-ojiexate.
N
A
Eitiiosiilfaie Spray Protest Action C-ommittee (JLSPA.C-)
QO Kajampady Nursing Home, Post: Perla , 671.552
January 14,2002
Dr Ravi Narayan
Community Health Cell
367Srinivas Nlaya
Jakkasandra , I Main ,
Koramangala , I Sock ,
Bangalore- 560 034
Dear Sr,
Jayakumar, Co-ordinator, Thanal, we understand, had discussed and
requested your co-operation to us in identifying the victims, damage assessment and
for giving us guidance as to hew to proceed in the issue further.
We would be grateful if you could kindly help us in the above matters and
oblige. As a first step, we invite yourself and your colleagues to our village on 20th
and 21s’ of Januaiy when Dr. Romeo F. Quijano, Professor of Toxicology and
Pharmacology at Uhiversity of Philippines.
Irritation for a talk by Dr Romeo io be held at Perla on 20th Sunday at & PM is
being sent by separate mail . We herewith extend a invitation to ycu all for the
function also.
Wishing to have your continued co-operation and valuable guidance to do
whatever little we can to reduce the pains of the hapless victims ,
y- Aravinda Yedamale
Chaiman
J CfCs?
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October 10th:
8.45 - 09.15 am
Beginning of the Day: Introduction to the groundwork done so far from CHESS, follow up
meetings and some of the thoughts brought out from such discussions, for consideration of
this group
Session III : Group Task in three or four smaller groups
09.30 am to 11.30 am [incl. Tea Break]
"What collective strategies to identify health problems, assess the damage, communicate the
same to the affected and the policy makers, and to launch a national campaign as a coalition
- who are the key targets?"
Session IV: Sharing of group work
11.30 to 1.00 pm
Sharing of group work in the plenary; Panel to respond to the discussions [Romy and Sarojeni]
1.00 pm -2.00 pm : LUNCH
Session V: Way Forward
2.00 - 3.00 pm
Way Forward: Broad National Strategy and Action Plans [incl. Roles and responsibilities]
3.00 - 3.30 pm
Any discussions required on organisational mechanisms, name foi trie coalition and 90 on
Last Session: Acknowledgements and winding up
3.30 - 4.00 pm
Acknowledgements and winding up of work done in the workshop
9th October 2002: Public Meeting in the form of a Panel Discussion
Theme: Pesticides and Health
• .
. .
Main Speaker: Dr Romy Quijano
- p
Panelists: Shri Murajjdharan, Shri Mohan, Shri .Narayan Reddy, Dr Prakash, Dr Ravi Narayan
i Dr Renee Borges, Dr Gururaj
________________________________
INDIA - PESTICIDES AND HEALTH MEETING : 8TH - 10TH OCTOBER 2002
INDIAN SOCIAL INSTITUTE, #24, BENSON ROAD, BANGALORE 46
PROGRAMME SCHEDULE
October 8th:
Arrivals and Registration in the morning - Registration starts at 10 am
Informal interactions and discussions upto lunch
2.00 - 4.00 pm
Introductions - all participants introduce themselves and their work briefly and highlight any
work / conditions related to pesticides and health in their area
4.15 - 5.03 pm: Three presentations of case studies -15 mts each
* Kasargod Endosulfan by ESPAC/Thanal
* Warangal Poisonings by Warangal
■ Bhatinda by Kheti Viraasat, Punjab
DINNER: 7.30 PM to 3.15 PM
8.15 pm -10.00 pm: Video Screening
Videos to be screened: Showers of Misery/ln God's own country/Living Dead on Endosulfan;
Elizabeth's Guillette's film from Mexico; Toxic Trail and so on
Session I : Introduction to the subject and setting the tone:Three Presentations
8.30 - 9.00 am : Welcome and Introduction to the workshop
9.00 - 10.30 am : Global Campaigns against Pesticides: SAROJENI RENGAM
10.30 - 10.45 am: TEA
10.45 - 11.30 am: India - campaigns [past and present]: JAYAN
11.30 - 01.00 pm: Pesticides and health - ROMY QUIJANO
01.00-02.00 pm: LUNCH
02.00 - 02 45 pm: Response to the Presentations in the morning
Session II : Moving into the details - the Indian Scenario
03.00 - 04.00 pm: Indian Regulatory Mechanisms and how the industry operates: KHUSHAL
YADAV, CSE
04.15 - 04.45 pm: Three Short Presentations, 15 minutes each
* Cardamon case study : USHA
Pesticides and Public Health [DDT - Karnataka experience]: Dr RAVI NARAYAN
- "Pesticides handling" [transporation, containers, household level use etc]: RAJESH
05.GO - "5.33 pm : "Why have we not been able to eliminate pesticides in India so far?"
PUBLIC MEETING: G TO 9 PM; DINNER - AFTER 9 PM
worker collective against the management. Hindustan Lever Limited has a
thermometer plant in Kodai (now de-funct after demonstrations from ex-workers
and Greenpeace) which is 100% EOU. The issue primarily raised was the health
problems related to their work , the lack of information regarding the ill-effects of
handling mercury, and lack of protective gear for workers.
One of the interesting events of Chess I, was the incidental participation of
Anibel F. Comelo, a student doing her PhD in London on Electronic wastes and
their management in developing and developed countries. She provided and
interesting insight into the electronic and recycling industry in US , which was
informative as well as myth shattering with respect to the USA being a model
country for occupational safety.
Anand of Paryananam Suraksha Samiti, Gujarat informed in about the industrial
pollution in Gujarat especially the Vapi to Baroda - 200 km stretch with about 275
industrial estates and 1800 small scale and medium scale industries. The main
problem in the region was the effluents from the industrial plants and its effect on
the general health of the people. The effluents were being drained into river and
other water bodies like the lakes, streams...
Mr. Joe, a volunteer with Greenpeace from Kerala spoke on the industrial
pollution in Udyogmandal - Eloor district in Kerala. This industrial area has about
250 factories, chief among them being HLL & FACT fertiliser factories. The
effluents from these plants were let out openly into the surrounding backwaters.
People in and around this area suffered from a wide variety of medical problems
and cancer was a common phenomenon in almost every household.
P. Mahalakshmi represented MMP. MMP is an association of individuals,
instituions and communities working for people affected by mining. They support
rural struggles, give technical and scientific expertisee and develop campaign
strategies. Rajulamma represented Samata from Andhra Pradesh is working with
tribals for their health and human rights.
Dr. Ravi Narayan, made a detailed presentation on Epidemiology - and it’s
aspects for the campaigns and common understanding.
Dr. Mohan Isaac’s, a Professor of Psychiatry in NIMHANS and Vice President of
SOCHARA, discourse on COMMUNITY HEALTH AND PSYCHIATRY Dr.
Mohan Issac, shared the experience of his Kodaikanal visit. His experiences and
talk on mental health scenario in India was an eye opener to most. Dr. Mohan also
outlined the importance to do an health survey with perspective of mental health.
Dr. Girish, Asst. Professor of Community Medicine from M.S.Ramaiah Medical
College held a panel decisions on Hospital Waste Management. In this a number
of interesting points were raised like- the heriarchy in health care industry like
between doctors and cleaning class, the neglect of occupational safety of lower
grade workers in hospitals, ignorance about the hazards of hospital wastes
amongst the nursing staff , etc. He also shared his experience in starting the
Malleshwaram Health Care Waste Management process involving all private
practioners and nursing homes in that area.
A panel chairman on another important aspect of community health namely
“Women’s Health” was also conducted. This session was chaired by Dr. Thelma
Narayan and Dr. Subha Rakhal. It turned out to be interesting and interactive and
various issues were discussed including irregularities of menstrual cycles,
miscarriages, and abortions were discussed with relevance to their environment
and occupation. The problem of gender bias in surveys and studies was also
highlighted with a reason to look into the reason in such future studies.
The last and one of the most important sessions involving the whole group was
the "What next session"
< HI SS
Subject: CHESS
Date: Thu, 31 Oct 2002 12:54:33 +0530
brom: Community Health Cell <sochara@vsnl.com>
I o: Sunil Kaul <scowlie@yahoo.co.in >, Abhay Shukla <abaysema@pn3.vsnl.net.in >,
Sukanya <sukana@sctimst.ac.in>, Ramakrishnan <r-ramakrishnan@mailcity.com >,
mutiidharv@vsnl.com
CC: Ananthpadmanabhan <ananth@dialb.greenpeace.org>,
Manti Gopalan <mangoforu@vsnl.net >, Nityanand <nity68@vsnl.com>,
Javan <thanal@md4.vsnl.net.in>, sujvij@vsnl.com
Oear CHESS manual contributors,
Greetings from Community Health Cell-CHESS, Bangalore and apology for
the delay in following up about the CHESS manual. We were waiting for
comments from different members.
1. CHC became quite involved with the endosulphan issue (Rajkumar
completed a video documentary on the endosulphan affected area and we
evolved a comparison~~EaB~le on what the industry says about endosulphan
and what the medical literature says).Look out for it in the next issue
of Down to Earth (CSE)
We were also involved in the Pesticide group meeting that took place in
IS I, Bangalore from 8-10 October (Rajah',” Praveen and Rajkumar attended)
including the public hearing on the 9th, the press conference on the
llnth and a visit by Dr Romy Quijano from Philippines at CHC on the
llnth.
2.
Having waited long enough we have now put the following
together:
1) Feedback from Sunil Kaul, Murali, Sukhanya and Dr Ramakrishnan and
others .
2) Rajan's original unedited draft-beyond CHESS 2
3/ Rajkumar's summary (For CHESS 2)
These attachments are sent to all of you.
3.
We now suggest following action to take this collective
process forward:
i) Sunil is being requested to be the chief editor of the manual because
his
suggestions are the best blend of science, pragmatism and field
reality.
ii) All of you should send contributions of chapters or additional
sections. The rule will be
a) simple language
b) Point wise or step by step presentation
c) Case studies or relevant examples of environmental health as box
items wherever possible preferably focussed on Indian experiences or
occupational health (Jayan, Nitty, Manujand perhaps even from the CHESS
network itself.
d) Focussing on what NGO activists or campaigners can do to establish
links, prima facie case, or preliminary situation analysis.
4. Remember we are not making them into epidemiologist's focussing on
complicated issues, costly interventions or discoverers of scientific
oroof or causal relationships. This is for academic and research
institutions like NIOH, ROHC, NEERI, Medical colleges and others to do
at the request of NHRC, ICMR, Supreme court etc on the basis of Public
Interest Litigation PIL.As campaigners they need to establish the
"problem" and demand for use of precautionary principle.
5. Elizabeth's manual is a very good and practical one but very focussed
on the pesticide type of problem. What we are evolving together is a
supplementary one to that which will serves the plural needs of a group
like CHESS and focuses on more than pesticides including mining
situation, industrial estates, other environmental hazards. Also it will
be a collective exercise building on plural experience as well. We have
to focus on the field work innovations that we have all done and not on
textbook or formal methodologies and descriptions. I am sure Sunil will
manage to edit all the contributors with this perspective.
1 of 2
10 31'02 1:46 PM
6. The time line is that all the pieces should come m by 30th Nov sent
to sun.il directly with a compy marked to CHC. A draft to be ready by
30th Dec.
7. We hope all of us will be able to meet at the Asia Social Forum in
Hyderabad^between the 2nd-6th Jan 2003 and find a little time to discuss
the manual as well.
CHC, Greenpeace, CHESS and others will coordinate a seminar on
environment and health at ASF which will have testimonies from 15-20
hotspots. This will be presented to a to a Peoples Health Movement
commission.Hope you are planning to be their
More details later.
Regards,
CHC-CHESS mannual team,
Thelma,Rajkumar,Raj an,Ravi.
CC. Anant, Manu, Nitty,Jayan,Vijay.
FnCHESS Manual Dr Suneel Kaul.doc
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