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/OH- 13-13
RF_WH_11_13_PART_2_SUDHA
TOTAL
HEALTH
CAKE
PROJECT : 1974 - 75
REPORT
on
FAMILY
HEALTH
PROBLEMS
in a rural society
27" Sonarpur P.S., 24-Parganas district, West Bengal^/
GUIDE REPORT
( April 1976)
TOTAL HEALTH CARE PROtEECT
■
FAMILY
1974-75
REPORT OH
HEALTH PROBLEMS IH A RURAL SCCIETY OF
WEST BENGAL
Jntxo_duc_tipn ».
On national level social welfare planning
measures are
currently manifold and with respect to the
same serious attention is being laid more and more increa
singly upon various health problems of the people at large.
Though search for reliable information about national
health is continuing from long past, (particularly since
the publication of the momentous Report of Bhore Committee
in 1946), a new approach has lately been emphasised to
tackle health problems of the country. This approach
urges that the family as a whole should be the focus of
attention in the matter of health and family welfare
services and moreover, health activities must also adopt
a family rather than an individual approach.
Importance of this approach is, of
course, not unknown to those who are professionally
concerned with the conditions and processes of both
health and disease. That ’family’ has to be taken as
'functiona.l unit' in making the facts about the disease
more intelligible and its course more manageable has
already been strongly pointed out in the international
circles of medical profession. As a matter of fact, it
has been claimed that better progress in health field
depends upon 'clearer conceptions of the identifiable
2
functional units' which would provide greater knowledge
and better control. Since the 'family' happens to be the
smallest but certainly not the least important social
unit for coping with disease, one cannot miss to concentrate
on family - based health information in understanding the
nature and magnitude of health problems in general.
There is now emerging within the medical
profession a more systematic concern for the personal and
social factors in illness and eventually, the need for
exploration of some sociological variables in health and
disease is becoming urgent. Study of Family -based incide
nces of disease by social group (community) is expected to
provide insights into health problems of the stratified
rural society at large. With this objective in view the
present report has been written.
Precisely speaking, the report attempts
to reveal the following issues:
(a)
the nature and magnitude of incidences
of disease among the rural as well as semi-urban families
residing in a rural society,
(b)
the differential incidences of family
morbidity among different communities (social groups) of
a rural society in
contrast to those of a semi-urban
society,
(c)
the dominant disease-groups which
create widely diffused health problems on family level in
rural or semi-urban society,
(d)
the Family Incidence Rates :
of the
most frequently reported diseases among different rural as
well as semi-urban communities (social groups).
3
2.
Material and Method &
A comprehensive survey on "Basic Health
Services" was carried out in 1374-75 in eleven villages
and two semi-urban areas (sections of Rajpur municipal
town) of Sonarpur R.S. 24-Barganas, West Bengal.
Selection of villages and semi-urban
areas was not at random. Rather, selection of the survey -
area was made with certain purposes. As A.D. Charitable
Hospital which is located at Elachi, (a semi-urban section
of municipal town
and
of Rajpur, ) has been catering medical
hospital needs of the local people since mid -I960
it was felt that a household to household enquiry should
be attempted to know the impact area of the Hospital.
So
what extent the local inhabitants had taken health services
from A.]). Hospital? Who were the people who ha.d taken
relatively more medical help from the Hospital? What was
the morbidity condition in the locale of the Hospital? What
forms of treatment the local people lately followed usually
to cure diseases? To what level
the rural people were
conscious to go for modern medicines in tackling health
hazards? These are some of the thoughts which prompted
the household enquiry in question. Satisfactory evidences
were hardly found to meet the initial queries and eventually
a pilot but exploratory study to probe into the queries
was brought into a resolution. But for such exploratory
study eleven villages which are situated within 5 miles
radial distence from Elachi (urban section of Rajpur town)
and again, which form a compact but continuous area of
habitation around Elachi, were chosen. As these villages
4
were within easy reach of A.D. Hospital
of Elachi, it
was expected that relevant information which would be
|>
available from the rural people would be quite heHjful to
offer due answers to the initial queries and again, such
information would help to plan better action-programmes
of health services in complete agreement with local health
condition and medical needs. In additions, residents of
Elachi and those of another semi-urban section of Rajpur
town, namely, Jaggadal were also chosen for making a
comparative study with rural residents. Health and disease
aspects of local society were to be examined in general
and accordingly the given sample of rural and semi-urban
settlements of Sonarpur P.S. were selected to constitute
the a,rea of survey-operation. Selection of villages and
semi-urban habitats was purposeful to accomplish the
proposed pilot survey. Under the circumstances, it is
needless to say that the residents of the selected
habitats do not stand to represent the general characteris
tics of the local residents of'24-Parganas district as
a whole.
The survey attempted to make complete
enumeration of all households of each village or semi-urban
area by canvasing a ’Family Schedule For Basis Health
Services'. In this schedule requis^e information about
the following items was sought from each household, the
head of the household being taken generally as reference-points
1)
Identification particulars of each
area of survey and again, of each household; 2) Demographic
particulars of each constituent member of a household,
with special reference to religion, marital status,
5
el£k
education status, occupation and vaccination records;
5) Illness suffered by each member of a household within
one year prior to the date of enquiry; 4) Concept about
occurrence of disease in family, 5) Mode of treatment for
each disease of each affected family member; 6) Type of
Hospital services taken by the family, with particular
reference to A.I). Charitable Hospital (located in Eladii
section of Rajpur town); 7) Particulars of environmental
sanitation with specific reference to source of water
supply, sullage disposal, disposal of refuse and latrine
facility; and 8) Family Planning activities.
Total number
of households which did
ultimately furnish satisfactory information about the
desired items of query in the areas of survey was 5459.
The distribution of sample families by community (social
groups) over the sample villages and semi-urban areas of
Sonarpur P.S. has been shown in Table A. These 3439
families comprise the basic source of the core materials
of all cases of physical sickness. Cut of the total
families the Hindus stood for 62 percent. The Muslims
explained for 35 percent cases, the rest being the
Christians.
Head and/or a senior member of the
Household was asked to enumerate those diseases-minor or
major-from which any member might have suffered during
last twelve months from the date of enquiry. Kames of the
diseases and the affected persons were recorded immediately
and subsequently ancillary information about concept and
6
mode of treatment of each kind of sickness was noted.
Though complete reliance was placed on the declared
statement about different diseases in a family, yet there
was the inescapable effects of recall lapse and unintentional
omission of old instances of sickness. Nevertheless, records
about a substantial volume of sickness per family could be
gathered from the survey. In the field every attempt was
made to verify the reported disease by relevant documents.
But in many cases such documents were not found. Truly
speaking, in a number of cases field investigators had to
rely fully on the declared verbal statement of the informants.
In spite of such fa limitations, each aid every household
under investigation yielded sufficient positive information
about diseases of one kind or other.
Incidences and causes of illness of sick
members per family were transcribed and then causes of
illness were codified as per World Health Organization's
(WHO) International Classification or Diseases, in doing
so,
the nomenclature that has been given by WHO under Tabuler
List of Inclusion and Four Digit subcategories has been
utilized for the present study to classify the reported
diseases under appropriate Disease-groups,
A total of 17 disease-groups has
been
considered to include the reported cases of sickness per
family under proper category. After ascertaining the
group-position of a disease the place of the family that
had reported the disease concerned had been marked against
the appropriate broad disease-group. Whatever might be the
7
frequencies of one or more than one disease in a family occurences
of this or that specif ic&s disease, had been counted once in
determining the position of the family against the diseasegroup concerned. By this method the position of a family under
one or more than one group wirhin seventeen disease-groups
had been located.
Family incidence Rates of different
disease-groups have been calculated by the following method:
No. of Families affected by a particular disease-group
100 X-------------------------------------------------------------------------------------------Total Number of Families
Family
Incidence Rates of different disease-groups ha.ve been
calculated separately for each village and each semi-urban area
as well as for rural and semi-urban areas as a whole.
The seventeen disease-groups (WHO categories)
have been abbreviated as.. follows:
Group I: IPD (infective and
Parasitic Diseases)
Group II: N (Neoplasms)
Group III: ENMD (Endocrine, Nutritional and Metabolic Diseases)
Group IV: DBBO (Diseases of Blood and Biood-forming Organs)
Group V: HD (Mental Disorders)
Groups VI: DNS (Diseases of Nervous System and Sense Organs)
Group VII: DOS (Diseases of Circulatory System)
Group VIII: DRS (Diseases of Respiratory System^
Group IX: DDS (Diseases of Digestive System)
Group X : DUGS (Di seases of Urino-genital System)
Group XI: OPCP (Complications of Pregnancy, Child birth and
the Puerperium)
8
Group XII: DST (Diseases of Skin and subcutaneous Tissues)
Group XIII: DUCT (Disease of Llusculo-skeletal System and
Connective Tissues)
Group XIV: CA (Congenital Anomalies)
Group XV: DPNM (Certain Disease of Peri-natal Morbidity and
Mortality)
Group XVI: SILO (Symptoms and Ill-defined Conditions)
Group XVII: ACV: (Accidents, Poisonings, and Violence)
On the basis of religion-affiliation of
the head of household the household concerned has been
classified under three social groups (communities),
namely, Hindu, Muslim and Christian. Again, on the basis
of community - affiliation the family incidence rates
of disease-groups for each broad social group have been
calculated to point out differential disease-prevalence
and thereby health problems in the given rural or semi-urban
society.
The disease-group which has included
larger entries of diseases as reported by the given
families and thereby has yielded higher Family Incidence
Hate has been treated as Dominant disease-group. By tills
definition four Dominant di sease-gi-oups could be identified
in the survey area, irrespective of its rural or semi-urban
character.
Family-based information about incidences
of various types of disease has received principal focus in
the course of analysis that has been followed in the present
study. Such information has further been examined in terms
of community (social group) affiliation of the families.
Table A. Distribution of families by social group (community)
over different villages and semi-urban areas
surveyed in Sonarpur P.S., 24-Parganas, West Bengal,
1974 - 75
Village /
Semi-urban area
(1)
Social group (community)
affiliation of the family
0 HR1S T I2iK
MUSLIM
HINDU
(4)
(3)
(2)
Total
Family
' (5) ’
1. Bonhoogly
505
348
55
708
(24.8)
2. Chowhati
549
13
-
562
(19.7)
155
-
1
156
(5.5)
128
-
51
179
(6.3)
5. Jagannathpur
15
178
-
193
(6.7)
6. Jayenpur
67
28
1
7. Kumarkhali
158
204
-
8. Kusumba
6
118
-
96
(3.4)
362
(12.7)
124
(4.3)
9• Nischintapur
75
2
-
10. Eamchandrapur
143
27
-
8
221
-
(1609 )
(108 )
224
(1139 )
3CI'5
69
289
1
-
513 x
70
(12.0)
-
583
(100.0)
1209
(35.1)
108
(3.2)
3439
(100.0)
3. Dingalpota
4.Hogalkuria
11. Ukhila
ALL VILLAGES
53’6
1.Elachi
2.Jaggadal
All Semi-UEBAN AEEAS
(88.0)
ALL AEEAS
2122
(61.7)
(2.7)
170^
(5.9)
229
(8.0)
3'2>
2856
(100.0)
(50.3)
290
(49.7)
9
5.
important Findings:
A)
In the area of Survey the incidences of
Infective and parasitic diseases (IPD) were reported in
highest order by the families, irrespective of their rural
or semi-urban living. Among the rural families the family
incidence rate (FIR) for the disease-group I (IPP) was as
high as 60% and interestingly enough, among their semi-urban
counterparts such rate was almost of the same order (59%>)«
That high FIR for the disease-group I did vary a little
between rural and semi-urban settlements of Sonarpur p.s.
was of immediate interest to reflect upon the key-source of
health problems in the local society. (Table 1)
When as high as 60% of the total families
(>439) of the survey-area declared that one or other kind
of disease that has been identified under group I (IPP),
prevailed among their constituent members during the reference
period in question, it is not difficult to realise that
major health-distrubing force was significantly generated
alone by Infective and parasitic diseases. This force was
equally penetrating in both rural and urban surrounding of
Rajpur town.
In spite of the above general state of
development which was associated with ill-effects caused by
infective and parasitic diseases on family health, the impact
of these diseases was not found to have spread uniformly over
the villages under survey. Family incidence rate (FRl) of
disease-group I (IPP) happened to fluctuate between as high
as 100.0% (village KUSUMBA) and as low as 26.0% (village CHOWHATI).
10
Moreover, in another four villages, namely UKHILA( FIR: 99/9,
Jagannathpur (FIR: 97/9, Kumarkhali (FIR: 90/9, Ramchandrapur
(FIR: 82/9, and Nischintapur (FIR: 75/9 family incidence
rate for disease-group I was difinitely of high order. It
is, thus, clear that a little more that one-half of the total
rural habitats under examination was seriously exposed to
damaging effects of various infective and parasitic diseases.
Rid these villages form any endemic area for infective and
parasitic diseases around Rajpur town? Convincing answer to
this query may be formulated in the light of the fact that
of all rural families (1717) which reported about occurrences
of diseases of Group I (IFF), the families (1060) of the said
six villages only, taken together, accounted for as good as
62 percent. Such a high rate of incidence of infective
and
parasitic diseases on family level in a relatively smaller
area is a significant pointer to rural health problems
at large.
In contrast, relatively a low family incidence
rate for infective and parasitic disease-group in village
Chowhati was quite a thought-provoking affair. This village
sheltered 562 families and of these families only a little
more than one-fourth reported illness due to one or more
kind of diseases falling under Group I. In village Hogalkuria
FIR for disease-group I (IPR) was found to be 57/9 Thus the
families of these two villages appeared to have suffered
relatively less detrimental influence of the principal
health-affecting diseases of the area. In the remaining
three villages, namely, Bonhoogly,Pingalpota ai d Jayennur,
the families concerned were affected by the diseases of
Group I relatively moderately, FIR being X varying from
11
(Bonhoogly) to 53/ (Jayenpur).
As far as the semi-urban areas of Rajpur
municipal town is concerned, impact of infective and parasitic
diseases on families concerned were not at all insignificant.
It is interesting that as high as 67 out 100 families of
ELACHI reported sickness due to the said diseases. In spite
of the fact that both Elachi and Jagaddal constitute two
important sections of the only municipal town (RAJPUR) of
Sonarpur P.S., 24-Parganas district, 59 percent of resident
in
families were as late as/1974-75 under the grip of various
infective and parasitic diseases.
All the more, over-all PIRs of
Bisease-
group I (IPS) for both rural and semi-urban families of the
survey-area were observed to be on matching strength. Boes
this fact mean that town (urban)-or rural-living on the part
of the
affected families exercised no discriminating
influence on infective and parasitic diseases to affect
volume of
sickness? . In general, it may be observed that
the families under study did suffer health-problems very
largely due to various infective and parasitic diseases.
B)
Next in order of importance the diseases
of Respiratory System (DRS: Group VIII) prevailed in the
survey-area. But such diseases on family level were reported
relatively more in semi-urban areas of Rajpur town. Here
out of every 100 families as good as 39 evinced occurrence
of one or other kind of disease related to the disease-group
VIII. In contrast, the rural families complanied about incidences
of the diseases of respiratory system in only 29 percent cases.
12
From this general picture of development it seems that rural,
open-air living of the families concerned, had some discri
minating role to influence events of illness due to respiratory
system-linked diseases. In any case, family healths problems
created by different diseases of the Group VIII were not
insignificant in both rural aid semi-urban areas of Sonarpur
P.S. and accordingly, appropirate health care measures to
prevent and cure such diseases are still needed for the
<
welfare of the local society.
Village Jagannathpur maintained a distingui
shed position in having relatively the highest family incidence
rate for disease-group VIII. In this village as high as 63
out of every 100 families reported one or other kind of
disease related to respiratory system. Next was the position
of
village Nischintapur (FIR: 49%) where about one-half all
families suffered health problems due to the diseases of
Group VIII. Family incidence rates of the disease-group
VIII for the families of four villages, namely, Ukhila (35%),
Kumarkhali (35%), Chowhati(34%) 2nd Bonhoogly (32%) were
noticed to vary within a small range. It appears that the
families of these four villages had faced more or less
similar experiences of health problems which might have
generated by the diseases of respiratory system (Group VI11J
in the area.
That the families of each one of these four
villages suffered health problems due to respiratory diseases
relatively significai tly lesser than the families of either
village Jagannathpur or hischintapur is, indeed, an interesting
fact. This was more so in the case of the remaining villages.
In this respect village Ramchandrapur struck a distinction
in presenting family incidence rate of diseases of respiratory
system in the lowest order (16 percent). Thus, FIR of
d±
13
disease-group VIII (DRS) is observed to vary fzzom a high
63 percent to a low 16 percent. This signifies that the
effect of respiratory system-linked diseases was not uniformly
present over the villages and thereby the rural families had
differential experiences of health problems due to such
diseases.
In semi-urban areas of Rajpur tov/n families
of ELACHI reported relatively more cases of illness due
to respiratory system-linked diseases. Here 42 out of every
100 families had health problems under the influence of
respiratory diseases. But in Jagaddal 37 percent of total
290 families declared incidence of one or other disease of
Group VIII. It seems that respiratory system-related diseases
caused health problems on family level relatively more in
Elachi than Jagaddal. The RIRs of disease-group VIII (diseases
of Respiratory System) for the tov/n families are found to
stand in closer proximity of the FIRs of the same disease-
group for the families of villages like Ukhila, Kumarkhali,
Chov/hati or Bohhoogly. Thus, the families of these particular
semi-urban and rural areas of
Sonarpur P.S., 24-Parganas
district happened to experience similar stress and strain
in taking care of their health problems generated by the
diseases of respiratory system.
0)
Third important disease-group is related to
the disease of Skin and subcutaneous tissues (Group XIlX.
In both rural and tov/n areas this disease-group (DST) yielded
family incidence rate in almost similar order. In total
number of rural families (2856) 22 percent reporrea occurrence
of skin-linked diseases and in tov/n area, on the other hand,
22.5 percent of the total number of 585 families showed
cases of illness under similar diseases. Thus, a consistency
14
between rural and urban rates is observed in the incidences
of diseases falling under the disease-group XII. moreover,
it becomes evident that the families of both rural and semiurban areas of Sonarpur P.S. suffered infective and parasitic
diseases in highest order, diseases of respiratory system in
higher order, and skin-linked disease in high order. These
three disease-groups were, noduubt, the principal
sources of
health problems for the families in general. Relative decreasing
order of importance of these three disease-groups (l, VIII
and XII) was uniformaly maintained by both rural and town
families. Such state of development in health-area should at
once be highlighted.
With respect to this particular disease-group
XII (DST) village Kumarkhali occupied a distinguishing place
as 40 out of every 100 families residing in the village reported
incidences of skin disease of one kind or other. This family
incidence rate happend to be 18 points above the over-all
rural rate. In the village the diseases of Group I (IPD)
and Group XII (DST) were relatively more mentioned by the families
concerned. Next was the position of village Nischintapur
where the FIR of disease Group XII is observed to be 38 percent.
Other family incidence rates of skin-linked diseases which
are worth mentioning are 34 percent (village Hogalkuria) and
31 percent (village Kusumba) and 50 percent (village bl Aila).
Lowest family incidence rate of the disease-group XII was
yielded by village Jagannathpur (3 percent). Thus, it is quite
clear that the families of the villages under survey did not
suffer health strees iinifox'maly under the influence of diseases
of skin and subcutaneous tissues (Group XII).
In semi-urban areas ELACHI gave family incidence
rate of disease-group XII as 22 percent and the same was
slightly higher for Jagaddal (23 percent).These rates are
15
definitely higher that those obtained for only four villages,
namely Chowhati (17z») , Pingalpota C15%), Bonhoogly (145J)
and Jagannathpur (3$). For the rest of eleven villages the rates
were found to be higher than those observed for either of
two semi-urban settlements of Rajpur town. In general it may,
thus, be thought that the rural families were
relatively more
exposed to skin-related diseases than tszsn town families.
Though over-all rates of disease-group XIl(BST) did not
vary markedly between rural and semi-urban settlements,
yet it was the rural families which are found to face
health problems due to these skin-diseases more extensively.
The last important disease-group (XVI) is
a group of all Symptoms and Ill-defined conditions of physical
sickness (SILO). Occurrences of such symptoms and ill-defined
conditions were extensively frequent in both rural and town
families. Physical sickness by a single or multiple causes
was reported by the families in very large number of cases,
but such sickness could not be identified with any specific
disease-group in question. Physical sickness due to s headache,
fever, pain, cough, loss of appetite and so on was very, very
often mentioned by the families and they have been clustered,
as per WHO classification, under one broad disease-group,
namely, Symptoms and Ill-defined conditions. It appears that
all the families-rural or semi-urban-had the same experiences
many
of /by frequently-occurrmhg minor physical ailements which
donot demand generally any serious medical surveillance. These
diseases may be taken as household disease of common happening.
Eventually family incidence rates of all Symptoms and Ill-defined
conditions of physical sickness were as high as 87> in rural
and 94% in town areas of Sonarpur P.S.,24-Parganas district.
16
It is thus clear that in the survey-area
predakinance of infective and parasitic diseases has to be
merited with all seriousness. Then, the health problems
generated on family level by diseases of respiratory system
need due medical attention. Third important source of health
stress in f amLlies-rural or urban-was related to occurrences
of diseases of skin and subcutaneous tissues. 60 percent of
total 3439 families (.rural and urban combined) reported inci
dences of infective and parasitic diseases. Again, 30
percent of these 3439 families complained about physical
illness due to attack of various diseases of respiratory system.
On the other hand, 22 percent of the same 3439 families yielded
information aout health hazards due to different diseases of
skin and subcutaneous tissues.
•L';)
In the backdrop of this morbidity condition
an attempt has been made to sift out the most commonly
first
reported disease or diseases under each one of the aboyV three
dominant disease-groups. In disease group I (infective and
•parasitic diseases) though a number of diseases which was
reported on family level, has been included, yet two particular
diseases, namely, Dysentery and Diarrhoea were frost frequently
mentioned by rural and semi-urban families. It has been
observed that family incidence rate of disease-group I for
rural families as a whole is 60 percent and out of this 60
percent as good as 31 percent reported incidences of dysentery
and diarrhoea only. In semi-urban
areas of Rajpur town the
family incidence rate of infective and parasitic diseases
is 59 percent and out of this 59 percent families as good as
19 percent reported about occurrence of dysentery only
(Table 2.)
17
Thus, it is noticed that in the survey area as
a whole dysentery as an infective and parasitic disease
has been reported mostly. When out of every 100 families
as good as seventeen gave declaration that they suffered
form a single disease of
dysentery, one can visualise
what alarming health situation was prevailing in both
rural and town areas of Sonarpur P.S. as late as in 1975.
It is interesting to focus that family incidence
rate (FIR) of dysentery disease was not of the same order
in between village and town areas. FIR of dysentery for
semi-urban families was 19 percent against only 16
percent found for rural families. Two semi-urban settlements,
namely, . ELaCIII _and Jagaddal, are part _and parcel of the
municipal town .of Raj pur and yet they evinced the distrubing
_fact ..that _their_resident-families suffered hea 1th .problems
due_to attack of dysentery relatively more intensively
than their. counterparts__living in rural environment. The
semi-urban families did not report diarrhoea, to be a most
commonly-occurring disease.
Row for the rural area it is observed that in
four out of 11 villages of all the infective and parasitic
diseases reported on family level, diarrhoea was more
often mentioned. These four villages are Hogalkuria,
Kumarkhali, Kusumba, and Ukhila. But in the remaining
seven villages the disease of dysentery was pointed out
most frequently by the families concerned. Biarrhorainiested families were found relatively highest in village
Kusumba where 66 out of 100 families reported this
particular infective arid parasitic disease. Next was the
position of village Kumarkhali where 57^ of resident
families gave information about diarrhoea. Village Ukhila
18
and village Hogalkuria presented family incidence rates
of the disease of diarrhoea only as 47% and 12% only.
Dysentery was
not mentioned as a commonly occurring
disease by the families of these four villages.
In Kusuniba cent Percent families were found to
have suffered from one or other kind of infective and
parasitic disease (Group I), but diarrhoea as a single
major disease of Group I was claimed by as high as 66
percent of total families. On the other hand , in village
Kumarkhali 90 percent of total resident families reported
incidences of diseases of Group I and again, 57 percent of
the same families of the village were found to have
suffered from diarrhoea as a single source of infective
and parasitic diseases. In village Ukhila family incidence
rate (FIR) of infective and parasitic disease was 99% and
such rate for the disease of diarrhoea only was as good as
47% . For fillage Hogalkuria FIR
of infective and parasitic
diseases was relatively lower (37%) and accordingly, FIR
of diarrhoea was also very low (12 percent).
To what extent the families of these foui
*
villages only could distinguish between an attack of
diarrhoea and dysentery could not be ascertanied during
survey and as such true cases of dysentery might have been
underreported. For undea/eporting or misreporting dysentery
as a most commonly reported disease was not obtained
among the families of these four villages in sharp nnunf
contrast to their counterparts living in adjacent seven
villages. It seems that many cases of dysentery in these
four villages of Kumarkhali, Kusumba, Ukhila and Hogalkuria
night g have been reported as cases of diarrhoea only.
19
Among the remaining seven villages where the
families had declared dysentery as the most commonly
occurring infective and parasitic disease village
Ramchandrapur and village Jagannathpur deserve special
attention. In Ramchandrapur 82 out of every 100 resident
families reported one or other kind of infective etc,
diseases and of these 100 families as high as 54 percent
complained health hazards dyeto a single infective disease
of dysentery . Such a high FIR for
dysentery is a significant
pointer to the prevailing health condition in the local
rural society. On the other hand, 97 percent of total
families living in village Jagannathpur had one or other
kind of infective and parasitic diseases amongst their
constituent members and again, 47 percent of these families
reported disease of dysentry only. As a single infective
and parasitic disease dysentery happened to create health
problems on family level more glaringly
in the given two
ire villagessK of Sonarpur P.S., 24-Farganas district.
In this very respect position of village h'ischintanur
and village Jayenpur was not at all bright. In the former
village 75 out of every 100 families showed incidences of
infective and parasitic diseases and of these 100 families
as good as 44 reported infection from only dysentery
disease. In the latter village family incidence rate of
inf.ctive etc. diseases was .fairly
high (55‘/), such rate
for dysentery disease only was very significant (52>).
Incidences of dysentery in these two villages can not be
belittled, rather they should be given importance as
seriously as one must offer to village Ramchandrapur oi’
village Jagannathpur.
20
I
In the remaining three villages, namely,
lingalpota, Ohowhati and Banhoogly reporting of only
dysentery as a most frequently-occur?iPg infective and
parasitic disease was made by the families concerned of
each village in lesser volume, family incidence rate
being ranging between 20 and 15 percent. It appears that
these three villages suffered relatively in lesser order
from dysentery induced health problems than the rest of
the villages in question. In any case, the very presence
of dysentery in seven out of 11 villages under survey is
certainly alarming. In conjunction with the incidences
of dysentery in semi-urban areas of Sonarpur P.S., these
infective and parasitic diseases demand immediately
appropirate medical and
public heaL th measures for the
welfare of the lo cal people.
It may rightly be surmised that environmental
sanitation in the local area, under stpdy is not
satisfactory
enough to negate appreciably the wide spread of several
kind of infective and parasitoc diseases and particularly
dysentery and diarrhoea. Family
health problems are
accoi-dingly not insignificantly voluminous in both rural
and semi-urban (town) life. More than one-half of the
total families under examination was exposed under
several infective and parasitic diseases (especially
dysentery) and this single event is strong enough to point
out what medical welfare activities are at once to be
launched to protect the people from health hazards and
family stress.
21
In the second dominant group of diseases of
respriatory system two specific diseases of cold and flu
had most frequently been referred to by the families. In
semi-urban settlements the disease of cold only was most
frequent. Family incidence rate (FIR) of diseases of
respiratory diseases (Group VIII) for semi-urban families
is found to be 59 percent and for the same families FIR
of disease of cold alone was 52 percent. It becomes,
thus, evident that in the occurrence of respiratory
diseases on family level it was the disease of cold which
generated health problems in large majority cases among
town families. Any other relatively more serious respiratorjr
diseases like peneumonia, asthma , pleurisy and like so
whre not reported by most of the families of both semi-urban
and rural settlements. Cold ha.ppened to be a common
household disease in tin survey area. Such type of disease
was declared
relatively more by town-bred families than
their rural counterparts (Table 5)-
In general, 51 percent of total 5439 families
enumerated in Sonarpur P.S. did n complain about physical
sickness due to some respiratory diseases. And of these
families as good as 19 percent showed incidence of cold
only on family level. In town area 52 percent of 585
families reported about the lone disease of cold and
in contrast, 17 percent of 2856 rural families.recorded
about the same disease. The difference between semi-urban
and rural rates for the disease of cold should be especially
noted. If widespread occurrence of the disease of cold
is taken to be any indicator of bodily deficiency in
respiratory system, then proper medical attention in this
direction is urgently needed for especially the town-bred
22
families of Rajpur. It is more true for the families of
Jagaddal where 33 out of 100 families had ti’ouble of cold
disease. Incidences of the disease of cold were not
n insignificant in ELACH1 (50 percent.)
In the villages, families of Chowhhti stood
in closer proximity to semi-urban families in having
incidences of cold-disease among 32 percent cases. Like
Chowhati in another set of five villages, namely, Bonhoogly,
JJingalpota, Hogalkuria, Jayenpur, and Ramchandrapur, only
the disease of cold had been reported to be the most
commonly occurring disease under the disease group VIII.
In the remaining five villages the families concerned
declared disease of flu as the most commonly occurring
disease of respiratory system. Family incidence rate of
flu only is observed to be 14 percent in rural areas.
In semi-urban areas the disease of flu
was not the most commonly occurring disease. With respect
to total 3459 sample families the disease of flu happend
to occur., in only 11 percent cases.
Among the five fillages where the families
had reported 'flu' as the most commonly occurring disease
under the diseage-group VIII (DRS), village Jagannathpur
attracts immediate attention. Here the family incidence rate
(FIR) of only 'flu'-disease has been found to be 62.7%.
In this village the over-all FIR of diseases of Respira.tory
system (Group VIII) was 63.2%. Under the situation it
becomes clear that the rural families of Jagannathpur
suffered almost fully from attack of 'flu'-disease.
What wasthe possible reason for such high rate of 'flu'-disease?
A thorough medical probing among the constituent members
of the families of the village can only answer the problem.
23
In this respect next came village Ilischintapur
where 48 out of 100 families coraplanied about illness due to
'flu'. The over-all family incidence rate of disease of
respiratory system was observed to be 49$ in this village
and the lone disease of 'flu' explained as high as 48$
of total cases of respiratary diseases . This state of
affair is serious enough to urge for immediate medical.
intervention. Both Jagannathnur and ^ischintapur require
special medical attention to root out high incidence rate
of ^flu_'-disease which posed definitely serious health
problems to the local families and their inhabitants.
In the remaining three villages, namely,
Ukhila, Kumarkhali and Kusumba, the incidences of 'flu'-
disease
were not insignificant. In Kumarkhali 33 out
of every 100 families reported 'flu' as the most commonly
occurring disease, while in Kusumba it was 27$. But in
village Ukhila family incidence rate of the disease of
flu was slightly higher (35$). Further, in Ukhila Fl£
of diseases of Respiratory system happended to be 35-4$
and 'flu' alone explained for 34.9$ of the local families.
Thus, it is observed that the villages which were more
disturbed by health problems created by the diseases of
respiratory system were actually having the particular
disease of 'flu' as the most prevailing one among all
diseases of the xsaid System.
For the third dominant grouppf diseases of
Skin and subcutaneous tissues iDST) the families of both
rural and semi-urban settlements under survey had reported
only the disease of 'itch( as the most commonly occurring^
one. Family incidence rate (FIR) of the disease of 'Itch'
only for rural families as a whole was 16 percent. This
24
rural rate was slightly higher than semi-urban rate(l4
percent). In general, the Fills of diseases of Skin and
subcutaneous tissues were not very high in the area of
survey (rura.1 FIR: 22.2; • and semi-urban FIR: 22»5b-)
Eventually, the FIRs of the lone disease of 'itch' could
The very
not be very impressivevfinding of 'itch' as the most
commonly occurring skin-linked disease among the families
suggests that the diseases of skin night not be a source
of serious health problem to the families in question
(Table 4)
In the background of the above situation
special attention was drawn by two villages, namely,
Kumarkhali and Rischintapur. In the former village as
good as 40 out of every 100 resident-families reported one
of
or other kind/Skin-disease and in the latter village 58/)
of total families evinced the presence of such disease.
On the other hand, villages of Hogalkuria and Kusumba
occupied the next important position in showing family
incidence rates in the order of 34/) and 51)) respectively.
In contrast, village Jagannathpur showed relatively the
minimum incidence of skin-linked diseases, FIR being
only 5 percent. Apparently it appears that the families
of the villages in question had differential experiences
about skin-linked diseases. Famiry incidence rates varied
from a high 40 percent to a low 5 percent.
In semi-urban settlements of ELACHI and
Jagaddal the families reported occurrence
of skin-related
morbidity in 22;) to 23/) cases. This rate was almost similar
to the over-all rural as well as semi-urban rates (22;)).
In any case it becomes clear that not more than one-fourth
of total families surveyed faced health stress from skin-linked
disease
25
To go into the details of the incidences of
different skin-linked diseases on family level it has
keen found that of all kinds of diseases the disease of
'itch' was referred most frequently by the families. In
rural areas out of every 100 families when 22 percent
reported skin-related diseases, 16 percent refered to
'itch' only as the most frequent skin-disease. Similarly,
in semi-urban areas out of every 100 families when 22
percent showed pereence of one or other kind of skin-
related disease, 14 percent claimed only 'itch' as the
most commonly occurring disease. In this respect, special
mention is made for the village Ramchandranur where the
families did not refered 'itch' as the most frequently
occurring skin-ailment, but the disease of 'dermatitis'
was reported. Here out of every 100 families 15 showed the
incidences of 'dermatitis 'only and 27 reported skin-disease
of various types (including 'dermatitis').
For the fourth and last dominant disease-group
namely, Symptoms and Ill-defined conditions (Group XVI), it
may be pointed out that in the survey area 88 out of every
100 families did experience one or other kind of sickness
effected by some physical trouble. Such sickness could
not be properly explanied by or ii identified with any
organic disorders. Accordingly, it was found that sickness
due to 'fever' or 'cough' was very widely mentioned. For
this disease-group of Symptoms and Ill-defined conditions
of feodily sickness nothing definite can, thus, be pointed
out.
So far emphasise has been given on those
diseases and disease-groups which were found relatively
more dominantly present among the families-rural or urban-of
Sonarpur P.S,,24-Farganas district. Eventually useful
26
knowledge about current diseases and health problems in a
society located in a rural environment (not far from the
Metropolitan City of Calcutta) can be roped in. Family
incidence rates of the most commonly reported diseases
as well as the disease-groups can be estimated from the
survey findings . Trends of development in health area
which were shown by the families under examination are
expected to throw light on rural health problems in general.
Volume of family sickness per human settlement could be
examined from these findings which were, of course, limited
by recall lapse, underreporting, misreporting and other
circumstantial factors. Health information which is obtained
from the present study can hardly be available from other
sources.
Incidences of infective and parasitic
diseases, diseases of respiratory system or disease of
skin and sub-cutaneous tissues have been found to occur
more expansively in the survey-area and to cal J. immediate
attention to the diseases of these disease-groups only
is not to imply that no effort should be made to tackle
diseases of the remaining disease-groups under reference.
Occurrences of different diseases which have been included
in each one of the remaining disease-groups were relatively
lesser in magnitude and as such these disease-groups
have not been diseussed separately.
Nevertheless, in this respect one important
point has to be highlighted . It was found that none of
the families in either rural or semi-urban areas had
reported any disease which falls, as per V/HO classification,
under any one of the following disease-groups: (i) Neoplasms
(Group II); (ii) Mental disorders (Group V); (iii) diseases
27
of Urino-genital system (Group X); (IV) Congenital anomalies
(group XIV); and (V) diseases of peri-natal morbidity
and Mortality (Group XV). These disease-groups go completely
unrepresented. Such state of affair is really difficult
to explain. Either the families did curly not experience
any health hazards due to any disease comming under the
above five groups, or these disease-groups had suffered
from recall lapse or under-reporting. Third possibility
may be that the families concerned did not bother to
reports those diseases which would come under these five
specific groups. But it is certainly significant to note
that both rural (2856) and semi-urban (585) families
behaved in similar manner in not reporting any disease
of any one of these five disease-rgroups. How such
consistent behaviour in between rural and urban families
could arise with reference to these five disease-groups
only? It seems that only a futher probing in-depth can
furnish a clue to this Query.
Another important issue is revealed by the
findings as noted in Table 1, that the family incidence
rates af each disease-group for rural and semi-urban
families maintain more or less a consistency in most of
the cases. Divergences of low order a.re, of course, not
absent between rural and semi-urban rates of (l) Endocrine,
Nutritional and Metabolic disease-group (Group III/: EMD):
(2) Disease group of Nervous system
and sense organs
(Group VI/ :DNS); (5) Disease group of Digestive system
(Group: IX‘- DDS); and (4) Disease group of the Musculo
skeletal system and connective Tissues (Group : XIII:
DMCT). In these disease-groups the semi-urban rates were
always higher than the rural rates. But the
■ • over-all
family incidence rate of each one of these four diseasegroups was initially low either in rural or town area
and as such these rates have not been offered that much
of importance which was given to those four dominant
28
disease groups mentioned earlier.
Incidentally, it may be noted that family
incidence rate (FIR) of the diseases of Digestive system
(Group: IX) was 9 percent in semi-urban areas against
3.5 percent available for rural areas. That semi-urban
FIR of disease-group IX was more than double the rural
rate is a fact of immediate interest
to those who are
concerned with medical and public health measures in the
local society.
F)
Family incidence rates (FIR) of four dominant
disease-groups have been examined above in some details
with reference to the rural and semi-urban families in
question. Bow an attempt has been made to classify the
families by community (social group)-affiliation, and thereby
to study community-wise family incidence rates of the
disease-groups concerned. It is presumed that though these
communities have different ways of life and living
(culture) and different mental dis osition towards health
care, the families belonging to different communities
would be affected alike by the diseases and thereby the.
stress of health problems.
With respect to the rural areas as a whole
family-incidence rate of infective and parasitic diseases
(group I) happended to be 60 percent. But among the rural
ill slim families as high as 81 out of every 100 cases
reported the diseases of the Group I against what was
evinced by the Hindu families l48>). Shus,The Christian
families reported relatively the lowest rate (34 perc nt).
Thus, pf_all the rural families the Iluslim families were
found to have relatively more health
.o-oblems caused by
the infective andparasitic dis ases than the non-Uuslim familie
29
Moreover, it is known that the diseases like
Dysentery and diarrhoea were the most commonly reported
diseases among the rural families and accordingly, it is
not difficult to visualise that it was the Muslim families
.which suffered relatively most from these two particular
infective and parasitic diseases in Sonarpur ■‘•'.8. (Table6).
That the Muslim families of semi-urban areas
suffered also relatively in greater degree from infective
and parasitic diseases (Group I) is evident form the fact
that 7’1 out of every 100 Muslim families reported incidences
of the given diseases in sharp contrast-to 58y only yielded
by the Hindu families. Thus, in both rural and town areas
of all the three communities the Muslim Community alone
showed the highest family incidence rate of the Diseasegroup I (IT’D). On the other hand, it is also observed that
the rural Hindu families evinced relatively lower family
incidence rate of the Disease-group I than their counterparts
living in town area. Community-wise differential rates as
available from the findings of Table 6, constitute a significant
pointer to understand different levels of development in
health conditions among the local dwellers . That volume of
sickness per family due to infective and pavasitic diseases
was more intensive among the Muslims in com-parison to the
Hindus or the Christians of the survey-area is a ca-pital
knowledge. This knowledge would greatly help in the formulation
of appropriate strategy of health welfare programmes and
actions.
In this respect attention is drawn to the
Muslim families of the following villages since all the
families of the villages reported to have suffered from one
of other kind of infective and parasitic disease (especially,
a
dysentery or d^frhoea): 1) Jagannathpur, (2) Kumarkhali,
30
5) Kusumba, 4) ukhila. Family incidence rate was 100$ or
a very little less than cerf percents Among the Hindu counterpart;
of these village family incidence hates of infective and
parstic diseases fluctuated between a high 100$ (village
Kusumba) and a low 67$ (village Jagannathpur). Truly speaking,
three villages of Kusumba, Kumarkhali and '^khila seemed to be
the worst-affected area as far as intensive occurrences of
infective and parasitic diseases were concerned. Irrespective
of their community (social group)-wise affiliation, the families
of these three villages had to endure the impact of infective
and parasitic diseases like dysentery ox- diarrhoea most
intimately as well as extensively.
On the other hand, the Hindu families of the
following villages were found to report relatively more
cases of infective and parasitic diseases (Group I) then their
Muslim counterparts: 1) Nischintapur, and 2) Ramchaidrapur.
In village ITischintanur
the Hindu families yielded relatively
higher family incidence rate (73/J), the same was only 50>
among the Muslim families. In villa.ge Ramchandranur the
Hindu rate for the disease-groupl was a little higher (83$)
than the Muslim rate (78$). The lowest family incidence
rate of infective and parasitic diseases (Group I) was
evinced by the Hindu families of village Ohowhati (25$)
and again, by the Muslim families of village Bonhoogly (50$)
or village ITischintapur (50$). That the lowest Muslim rate for
infective and parasitic
Hindu x
ate
*
diseases was double than the lowest
was sigularly significan t to stress the fact
that the. Muslim families of tue survey-area formed the mo st
extensively affected' group to suffer health hazards.
With respect to the second dominant disease-
group V1II (Respiratory system-linked diseases)it has been
found that 29$ of rural families and 39'/’ of semi-urban
31
families reported such diseases. In rural area among all the
families (2856), a sizable magnitude of Muslim families (38£>)
showed relatively more cases of respiratory system-linked diseases
(especially the diseases like cold and flu) than their hindu
(31/0 or Christian (13/0 counterparts. Like the highest family
incidence rate (FIR) of infective and parasitic diseases, here
again the Muslim families presented the highest FIR of diseases
of respiratory system. But, in this very respect the difference
(7-3/0 between i.iuslim and Hindu rates for respiratory system-linked
diseases was not as high as was found for the difference (35.8;0
between the rates of infective and parasitic diseases. It is
significant to note that the i.iuslim families of txie villages
under study suffered most from both infective and parasitic
diseases and diseases of respiratory system. Hext was the
position of the Hindu families and the Christian families
occupied the third position in order of importance.
On the other hand, among all town families it was
the Hindu families which presented highest (FIR) family
incidence rate (40^) for the diseases of respiratory system and
next was the position of the Christian families (FIR): 59;-').
Here the town families bel' nging to the Muslim community evi-mged
the lowest FIR (30/0 for diseases of respiratory system. Never
theless, the range of variation between the given rates was
within a narrow limit (40
to 36/0. This shows that the
semi-urban families, irrespective of their community (social
group) affiliation, did suffer on more or less similar level
the problems of health which were caused by various diseases
or respiratory system ^especially by the disease of cold),.
One point is stressed here that in reporting incidences of diseases
pf respiratory system the Muslims families occupied the last
position in order of importance in contrast to their rural
counterparts.
32
Examining community-wise family
incidence rate
(FIR) for diseases of respiratory system over the villages it
is observed that the Hindus of the following four villages evinced
higher FIR than what was shown by their non-Hindu counterparts:
(l) Village Chowhati, 2) Village Hogalkuria, 3) Village Kumarkhali,
and 4) Village Kusumba. In these villages the Hindu rates varied
from a high 50% (Kusumba) to a low 29% (Hogalkuria), where as
the Muslim rates fluctuated between as high as 55% (Kumarkhali)
and as low as 15% (Chowhati), On the other hand, the Muslims
of the following four villages presented higher FIR for diseases
of respiratory system than that was offered by their non-Muslim
counterparts: l) Village Bonhoogly, 2) Village Jagannathpur,
3) Village Ramchandrapur, and 4) Village Ukhila. In these four
villages the Muslim rates varied from a high 64% (Jagannathpur)
to a low 55% (Bonhoogly). But the Hindu rates were from a high
53% (Jagannathpur) to a low 10.5% (Ramchandrapur,1. over these
four villages in question.
Thus, it is clear that in the villages occurrences
of diseases of respiratory diseases (especially the diseases
like cold and flu) had a wide fluctuations over both Hindu and
Muslim fanilies and thereby the families had differential expe
riences of respiratory
system-linked health problems within
the close bound of their specific community-enclosure. That
the families belonging to different communities (social
groups) suffered from respiratory system-linked diseases in
unequal magnitude is immediately highlighted.Community-wise
variations in the incidences of either infective and parasLtic
diseases or diseases of respiratory system are quite evident.
Such variations have'to be given due weightage in any family
health welfare plan and /or programme that may be envisaged
for the inhabitants of the locality.
55
V/ith reference to the third domonant disease group
(XII/)
of skin-related diseases it has already been pointed
out that rural and semi-urban family incidence rates varied only
very little (22.2%-: rural ad 22.5^: urban). But in both rural
and town areas the Muslim rates for the disease-group XII were
definitely higher than the Hindu rates. The rural Muslim rate
(25'.) was, on the other hand, much lower that the urban Muslim
rate (40k). But the Hindus of rural and town areas maintained
an equal rate (20,-). There is no doubt that the Muslim families
suffered in general most from skin-linked diseases, especially
from the disease like itch.
It is quite significant that the Muslim rate for
skin-linked diseases as found in town areas, was double than
that evinced by the Hindu families of the same areas. Y.Iiy the
Muslim families alone of town areas suffered skin-linked diseases
in such high degree?IJroper medical probe into this specific
problem is imperative to have a satisfactory clue. In villages
community-wise variation in family incidence rates for skin-related
diseases was, of course, of low otder. It seems that the Muslim-
families of town area had in general been exposed more to physical
ailments under influence of skin-linked diseases Yespecially
'itch') than their Hindu counterparts.
In the following three villages the Muslim families
yielded higher family incidence rate (FIR) for skin-linked.
diseases than the Hindu families: 1) Village Chowhati, 2) Village
Kumarkhali, 5) Village Ramchandrapur. The Muslim rates over these
four villages varied widely. Village Kumarkhali s is especially
noted since 51 out of every 100 Muslim families of the village
reported such diseases and it was the diseases of 'itch' which
34
prevailed most. In this village the Hindu fanilies offered FIR
for skin-linked diseases as only 26;^. In village Chowhati the
Muslim rate (460) was much higher them the Hindu rate '■17;>),
But in village Ramchandrapur the Muslim and the Hindu rates
were very close. It appears that the Muslim families of villages
Kumarkhali and Qhowhati require special mddical attention to
tackle physical sickness under skin-related diseases.
On the other hand, the Hindu families of the following
two villages were found to offer higher family incidence rate
for skin-linked disease: 1) Village Hogalkuria and 2) Village
Jayenpur. In Hogalkuria when 54 out of 100 Hindu families reported
occurrence of skin-related disease (especially 'itch’), 31.50
of the Muslim families hadx the sufference from the same' diseases.
Hext, in Ja^nnur village 290 of total Hindu families evinced
skin-linked diseases against 250 of Muslim families. This shows
that in these two villages the Hindu and the Muslim families
faced on more or less similar level the
experiences of health
problems generated by various diseases of skin and subcutaneous
tissues '■Group XII).
In general, it may be stated that the Muslim families
of rural areas of Sonarpur P.S., 24-Parganas district, faced
health problems under the impact of infective and parasitic
disease like dysentery and diarrhoea more than their Hindu or
Christian counterparts. This state of affair was also true in
the Cases of respiratory system-linked diseases like cold and
flu or in the cases of skin-linkec: diseases linked itch. For
these three distinct but dominant disease-groups the Muslim
families in the given villages evinced always highest family
incidence rates. These rural Muslim families were followed
next by the rural Hindu fanilies in order of importance. The
rural Christian families offered in general the lowest fami 1y
incidence rates for the said three dominant disease-groups.
35
Thus, the need for the study of incidences of most frequently
occurring diseases in villages by community (social group)afiiliation of the families concerned becomes very much pressing.
Family incidence rates (FIR) of different diseasegroups or of the most -frequently reporting diseases under any
broad disease-group as have been presented above, require to be
evaluated in consonance with what has been obtanied for different
communities (social groups) of the local stratified society.
Thsee two sets of family incidence rates are complementary to
each other and a proper investigation of these rates would
certainly provide greater insights into the nature and magnitude
of the health problems which prevailed lately among the people
of the survey area in 24-Parganas district or for that matter
of the State. These rates
would be some useful indicators in
the field of health planning. Priority of medical as well as
public health care can be fixed on the basis of higher or lower
family incidence rate obtanied for
a particular dis ease-rgroup
and again, for a particular community (social group). The findings
of family health problems as available now, are expected to help
the organization of medical help and public health care among
the
local inhabitants in terms of their geographical location,
community affiliation and family incidence rate for different
diseases and physical sickness.
4.
CONCLUDING OBSERVATIONS:
The present discourse has been made with 'Family
Health' as an important goal of approach to ongoing national
programmes on public health. Precisely speaking, the role of
family (classified by its social affiliation) in national
health has been highlighted here. The need of treating the
family as a whole as the focus of attention in the matter of
health and family welfare services has been stressed and eventuall
a family rather an individual approach has gained importance in
36
the analysis of
available health data.
Health surveys have already been
accepted as some significant tool to generate flow of
useful health information. Inspite of many limitations
the present survey had truly yielded substantial
volume
of such information which, on the other hand,
would help in more than one way the plan and programme
of health-services envisaged for the area in question.
This information reflects immedately upon family
distribution of diseases and the same may be thoroughly
utilized to guide forward planning of health services.
The present findings of the su rvey provide comprehensively
with the much-needed knowledge about disease prevalence
on family level. It is felt that family-based distribution
of disease in conjunction vi th population - based distribution
of disease would certainly strengthen the very base of
the data on national health. Moreover, these two types
of distribution would be complementary to yield Setter
health statistics. Importance of the present discourse
has therefore to be merited in the light of the above
issues. It is strongly hoped that the present family
based health statistics shall eventually help to
incuOQate new attitudes to the administration of health
services as a whole in the country.
World Wealth Organization had already
stressed seriously upon the need of new approaches in
health statistics (WHO Tech. Report, No. 559, 1974)•
In this new approach emphasis has been laid on new
types of health statistics which can no longer be just
concerned with the quantity and population distribution
of disease. New orientation of attitude towards environmental
37
factors in disease and health and again, an inclination to
see patients as members of family and community groups
have lately been urged. Many health indicators are in
vouge to-day but those which embrace not only measures
of morbidity of the population but also measures of those
social (including economic)characteristics that are the
determinants of levels of morbidity, are, no doubt, more
useful, With reference to particular population groups
such useful health indicators are desired to be employed
more. The present study has, indeed, taken the patients
as members of family and community groups of the locality
and proceded to offer a kind of health statistics which
was not concerned with population distribution of disease.
To assist in the formulation of health care plans for
families and/or communities of a rural society the
present study may have a role to play.
Family incidence rates of different
diseases in the local communities have been measured to
indicate volume of sickness per hundred families. The
rates were not uniformly manifested bjr the communities.
There existed noticable variation in the incidences of
different diseases on family as well as community level
Adequate knowledge about such family incidence rates is
hardly available. This knowledge may be fruitfully used
to develodsome health indicators which serve to provide
a real guide to the social and medical action plan for
the people in question.
The present study reveals that infective
and narasitic diseases caused highest family incidence
rate in the area and especially the diseases of dysentery
38
and diarrhoea were more frequent to affect he. 1th of the
family members. Dominance of these diseases was marked in
both villages and town. Rural or urban living of the
families has no special discriminating role to play in
effecting greater or lesser incidences of infective and
parasitic diseases. But within the villages prevalence of
such diseases did nary to indicate that some of these
were running relatively higher risk of exposure.These vi-lHage.
villages/are Jagannathpur, Kumarkhali, Kusumba, Nischintanut
and Ukhila. The families of these villages should get
highest piority for proper medical care. To draw attention
to these five villages should not imply that other villages
dcjnot require such care. Villages in general demand
proper medical help for rooting out the diseases once for
all. Muslim families of these five villages were, on the
other hand, affected
relatively more with infective and
parasitic diseases like dysentery and diarrhoea. The Muslim
community of the area constitutes the focal point for
immediate health services.
Family incidence rate of diseases of
respiratory system happened to be in second highest order
in both rural and semi-urban areas. Of these diseases
incidences of cold and flu were most frequently reported
on family level. Among the members of the families the
diseases of respiratory system ranked second in order of
importance. Rural or urban living of the families did matter
little to influence higher or lower spread of these diseases
among their members. But among the villages there existed
variations in family incidence rates for respiratory systemlinked diseases. In this respect the families of village
59
Jagannathpur, village Ilischintapur, village Kumarkhali, tn d
village Ukhila may be again referred as relatively more-
affected group. In these villages prevalence of the
disease
of flu was very marked. In the remaining villages the disease
of cold was more frequent on family level. Thus, it becomes
clear that the local families had mostly ± either cold or
flu as prevailing disease among them and. accordingly whatever
approximate medical attention
is required to tackle these
diseases has to be organised early in the very interest of
the progress of local health welfare. One additional point is
made here. She town families showed relatively higher
incidences of the disease of cold than their rural counterparts
and naturally they can not be left behind in the plan and
programme of necessary health services for respiratory
system-linked diseases.
Biseases of skin and subcutaneous tissues
had a place of thirdd importance among the rural or town
families. It is pointed out here that of various kind of skin
diseases the families in question reported the disease of
itch most frequently. This was t\u£?e for both rural and semi-
urban settlements. It seeds that skin-linked diseases were
not posing as a potent source of any serious health problems
to the local families. With their existing way of life and
living under .tropical condition the members of the families
are expected to suffer from 'itch' and remedy for which needs
generally no serious medical survillience. In suite of this
fact the families of the following villages may need proper
medical care for curing trouble of 'itch': 1) Kumarkhali,
2)
Nischintapur, 5) Hogalkuria, and 4) Kusumba. In these
villages 50 to 40% of families reported physical sickness
due to 'itch'. In town area the families affected with skin
disease like 'itch' was of course, not high.
1 v*
40
Family incidence rates of disease-group
other than the above three dominant groups were low and as
such no detailed discussion has been made here . But these
rates should not be overlooked, since they indicate to what
extent the members of the families-rural or urban-^were
exposed to various kinds of physical illness and morbidity
condition. Here attention is especially drawn to the family
incidence rates for (a) diseases of digestive system, and
2) diseases of muculo-skeletal system. Both the rates were
decidedly higher in town area and this indicates that town
families need greater medical care to tackle their health
problems generated by the diseases of these two diseasegroups (IX and XIII) only.
in human society the family remains ever to
be a part of the individual and the individual is an integral
part of the family . And as such any sick person is never
alone in his/her suffering and no diseased person is an
isolated individual. In this, social situation whatever
assesment of health condition on the strength of individual
sick person may be made, the same
can hardly depict family
centered dimension of health problems. In any attempt for
forward planning for health services in any population group
as has
lately been urged by the World health Organization,
adequate knowledge about
Family Health problems is sine
qua non. In this direction the present study indicates a
useful methodology in examining the role of
community and /or national health.
pa:
family in
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AJH- 13 J3
TOTAL HEALTH CARE PROJECT 1974-1975
REPORT ON
FAMILY HEALTH PROBLEMS IN A RURAL SOCIETY OF
WEST BENGAL
Introduction
On national level social welfare planning measures are
currently manifold and with respect to the same serious
attention is being laid more and more increasingly upon various
health problems of the people at large. Though search for
reliable information about national health is continuing from
long past (particularly since the publication of the momentous
Report of Shore Committee in 1946), a new approach has lately
been emphasised to tackle health problems of’the country. This
approach urges that the family as a whole should be the focus
of attention in the matter of health and family welfare services
and moreover, health activities must also adopt a family rather
than an individual approach.
Importance of this approach is, of course, not unknovm
to those who are professionally concerned with the conditions
and processes of both health and disease. That ’family' has
to be taken as a 'functional unit’ in making the facts about the
disease more intelligible and its course more manageable has
already been strongly pointed out in the international circles
of medical profession. As a matter of fact, it has been
claimed that better’ progress in health field depends upon
'clearer conceptions of the identifiable functional units'
which would provide greater knowledge and better control.
Since the 'family' happens to be the smallest hut certainly
not the least important social unit for coping with disease,
one cannot miss to concentrate on family-based health
information in understanding the nature and magnitude of
health problems in general.
There is now emerging within the medical profession a
more systematic concern for the personal and social factors in
illness and eventually, the need for exploration of some
sociological variables in health and disease is becoming
urgent. Study of Familv-based incidences of disease by
social group (community) is expected to provide insights into
health problems of the stratified rural society at large. With
this objective in view the present report has been written.
.../2
: 2
precisely speaking, the report attempts to reveal the following
issues:
2.
(a)
the nature and magnitude of incidences of diseases among
the rural as well as semi-urban families residing in a
rural society,
(b)
the differential incidences of family morbidity among
different communities (social groups) of a rural society
in contrast to those of a semi-urban society,
(c)
the dominant disease-groups which create widely diffused
health problems on family level in rural or semi-urban
society,
(d)
the Family Incidence Rates of the most frequently reported
diseases among different rural as well as semi-urbah
communities (social groups).
-Material and Method
A comprehensive survey on "Basic Health Services" was carried
out in 1974-1975 in eleven villages and two semi-urban areas
(sections of Rajpur municipal town) of Sonarpur P.S. 24-Paraganas,
Vest Bengal.
Selection of villages and semi-urban areas was not at random.
Rather, selection of the survey area was made with certain purposes.
As A.D. Charitable Hospital which is located at Elachi, ( a semiurban section of municipal town of Rajpur,) has been catering medical
and hospital needs of the local people since mid-1960 it was felt
that a household to household enquiry should be attempted to know
the impact area of the Hospital. To what extent the local
inhabitants had taken health services from A.D. Hospital? Who
were the people who had taken relatively more medical help from the
Hospital? What was the morbidity condition in the locale of the
Hospital? What forms of treatment the local people lately followed
usually to cure diseases? To what level the rural people were
conscious to go for modern medicines in tackling health hazards?
These are some of the thoughts which prompted the household
enquiry in question. Satisfactory evidences were hardly found to
meet the initial queries and eventually a pilot but exploratory
study to probe into the queries was brought into a resolution.
But for such exploratory study eleven villages which are situated
within 5 miles radial distance from Elachi (urban section of Rajpur
town) and again, which form a compact but continuous area of
habitation around Elachi, were chosen. As these villages were
within easy reach of A.D. Hospital of Elachi, it was expected that
relevant information which would be available from the i'ural people
would be quite helpful to offer due answers to the initial queries
.. ./3
and again, such information would help to plan better action
programmes of,health services in complete agreement with lowal
health condition and medical needs. In addition, residents
of Elachi and those of another semi-urban section of Rajpur
town, namely, Jaggadal were also chosen for making a
comparative study with rural residents. Health and disease
aspects of local society were to be examined in. general and
■accordingly the given sample of rural and semi-urban
settlements of Sonarpur P.S. vzere selected to constitute
the area of survey-operation. selection of villages and semiurban habitats was purposeful to accomplish the proposed
pilot survey. Under the circumstances, it is needless to say
that the residents of the.selected habitats do not stand to
represent the general characteristics of the local residents
of 24-Parganas district as a whole.
The survey attempted to make complete enumeration of
all households of each village or semi-urban area by canvassing
a ’Family Schedule For Basic Health.Services’. In this'
schedule requisite information about the following items was
sought from each household, the head of the household being
taken generally as reference-point;
1)
Identification particulars of each area' of survey
and again, of each household;
2)
Demographic particulars of each constituent member of
■a household, with special reference to religion, marital
status,, education status, occupation and vaccination
records; ■ . •
. .
. '■
3)
Illness suffered by each member of a household within
one year prior to the date of enquiry;
4)
Concept about occurrence of disease in family,
5)
Mode of treatment for each disease of each affected
family member;
6)
Type of Hospital services taken by the family, with
particular reference to A.D. Charitable Hospital
(located in Elachi section of Rajpur town);
7)
particular's of environmental sanitation with specific
reference to source of water supply, sullage disposal,
disposal of refuse and latrine-facility; and
8)
Family Planning activities.
Total number of households which did ultimately furnish
satisfactory information about the desired items of query in
.. ./4
5 4 :
the areas of survey was 3439. The distribution of sample
families by community (social groups) over the sample
villages and semi-urban areas of Sonarpur P.S. has been
shown in Table A. These 3439 families comprise the basic
source of the core materials of all cases of physical sickness.
Out of the totaTTamilies the Hindus stood for 62 per cent.
The Muslims explained for 35 per cent cases, the rest being
the Christians.
Head and/or- a senior member of the Household was asked
to enumerate those diseases ~ minor or major - from which any
member might have suffered during last twelve months from
the date of enquiry. Hames of the diseases and the affected
persons were recorded immediately and subsequently ancillary
information about concept and mode of treatment of each kind
of sickness was noted. Though complete reliance was placed on
the declared statement about different diseases in a- family,.
yet there was the inescapable effects of recall lapse and.
unintentional omission of old instances of sickness.
Nevertheless, records about a substantial volume of sickness
per family could be gathered from the survey. In the field
every attempt was made to verify the reported disease by
relevant documents. But in many cases such documents were
not found. Truly speaking, in a number of eases field investi
gators had to rely fully on the declared verbal statement of
the informants. In spite of such limitations, each and every
household under investigation yielded sufficient positive
information about diseases of one kind or other.
Incidences and causes of illness of sick members per
family were transcribed and then causes of illness were
codified as per world Health Organisation’s (WHO)
International Classification of Diseases. In doing so, the
nomehclatul’e“fTiaTTTas been given by “HO under Tabular list of
Inclusion and Four Digit subcategories has been utilized for
the present study to classify the reported diseases under
appropriate Disease-groups.'
A total of 17 disease-groups has been considered to
include the reported cases of sickness per family under proper
category. After ascertaining the group-position of a
disease the place of the family that had reported the disease
concerned had been marked against the appropriate broad
disease-group. Whatever might be the frequencies of one or
more than one disease in a family occurences of this or that
specific disease had been counted once in determining the
position of the family against the disease-group concerned.
By this method the position of a family under one or more than
one group within seventeen disease-groups has been located.
.../5
: 5 :
Family incidence Rates of different disease-groups
have been calculated by the following method:
No. of families affected by a particular disease-group
100 X__ _ _____________________
Total Number of Families
Family Incidence Rates of different disease-groups have been
calculated separately for each village and each semi-urban
area as well as for rural and semi-urban areas as a whole.
The seventeen disease-groups (WHO categories
)
*
abbreviated as follows:
have been
GroupI:
IPD (Infective and Parasitic Diseases)
Group II:
II ( Neoplasms )
Group III:
ENi-lD (Endocrine, Nutritional and Metabolic Diseases)
Group IV:
DBBO (Diseases of Blood and Blood-forming Ox’gans)
Group V:
KD (Mental Disease)
Group VI:
DNS (Diseases of Nervous System and Sense Organs)
Group VII:
DCS (Diseases of Circulatory System)
Group VIII: DRS (Diseases of the Respiratory system)
Group IX:
DDS (Diseases of the Digestive System)
Group X:
DUGS (Diseases of Urino-genital System)
Group.XI:
CPCP (Complications of Pregnancy, Child Birth and
the Puerperium)
Group XII:.. DST (Diseases of Skin and subcutaceous Tissues)
Group XIII: DMCT (Disease of Musculo-skeletaJ System and
Connective Tissues)
Group XIV:
CA (Congenital Anomalies)
Group XV:
DPIiH (Certain Disease of Peri-natal Morbidity and
Mortality)
Group XVI:
SILC (Symptoms and Ill-defined Conditions)
Group XVII: ACV: (Accidents, poisonings, and Violence)
On the basis of religion-affiliation of the head of house
hold the household concerned has been classified under three
SOCial CTOUTIR fnnnw»nv><+’,»"'
-------"
6
Christiano Again, on the basis of community - affiliation
the family incidence rates of disease-groups for each broad
social group have been calculated to point out differential
disease-prevalence and thereby health problems in the given
rural or semi-urban society.
The disease-group which has included larger entries of
diseases as reported by the given families and thereby has
yielded higher Family Incidence Rate has been treated as
Dominant disease-group<, By this definition four Dominant
Tisease-groups could be identified in the survey area,
irrespective of its rural or- semi-urban character.
Family-based information about incidences of various
types of disease has received principal focus in the course
of analysis that has been followed in the present study. Such
information has further been examined in terms of community
(.social group) affiliation of the families.
.../7
s 7 :
ble A.
Distribution of families by social group (community)
over different villages and semi-urban areas surveyed
in Sonarpur P.S., 24-Parganas9 west Bengal, 1974-1975.
VHlage/S«mi-Urban Area
717
Social Group (Community)
affiliation of the family
MUSLIM
CHRISTIAN
HINDU
Total
■
(5)
......... w
........ ..... (3)....
1 ■ ■ 74)
Family
Bohoogly
305
348
55
Chowhati
549
13
-
Dingalpota
155
-
1
Hogalkuria
128
-
51
Jagannathpur
15
178
*
Jayenpur
67
28
1
Kumarkhali
158
204
Kusumba
6
118
iiischintapur
75
2
-
Ramehandrapur
143
27
-
8
221
708
(24.8)
562
(19.7)
156
(5.5)
179
(6.3)
193
(6.7)
96
(3.4)
362
(12.7)
124
(4.3)
77
(2.7)
170
(5.9)
229
(8.0)
(1609)
(53.6)
(1139)
(39.9)
(108)
(3.8)
2856
(100.0)
Elachi
224
69
-
Jaggadal
289
1
293
(50.3)
290
(49.7)
AU. SEMI-URBAN AREAS
513
(88.0)
70
(12.0)
—
583
(100.0)
ALL AREAS
2122
(61.7)
1209
(35.1)
108
(3.2)
3439
(100.0)
Ukhila
ALL VILLAGES
■
: 8 :
3.
Important Findings
A)
Im the area of Survey the incidences of Infective and
parasitic diseases (IPD) were reported in highest order by the
families, irrespective of their rural or semi-urban living.
Among the rural
families
*
the family incidence rate (FIR) for
the disease-group I (IPS) was as high as 60$ and interestingly
enough, among their semi-urban counterparts such rate was almost
of the same order (59$‘). That high FIR for the diseasegroup I did vary a little between rural and semi-urban
settlements of Sonarpur P.S. was of immediate interest to reflect
upon the key-source of health problems in the local society.
(Table 1).
When as high as 60$ of the total fa milies (3439) of
the survey-area declared that one or other kind of disease that
has been identified under group I (IPD), prevailed among their
constituent members during the reference-period in question,
it is difficult to realise that major health-disturbing force
was significantly generated alone by Infective and parasitic
diseases. This force was equally peneti'ating in both rural
and urban surrounding of Rajpur town.
In spite of the above general state of development which
was associated with ill-effects caused by infective and
parasitic diseases on family health, the impact of these diseases
were not found to have spread uniformly over the villages under
survey. Family incidence rate (FRI) of disease-group I (IFD)
happened to fluctuate between as high as 100.0$ (village
KUSUMBA) and as low as 26,0$ (village CHOWHATI). Moreover,
in another four villages, namely UKHILA (FIR: 99$), Jagannathpur
(FIR: 97$), Kumarkhali (FIR: 90$), Ramchandrapur (FIR: 82%),
and Nischintapur (FIR: 73$) family incidence rate for diseasegroup I was difinitely of high order. It is, thus, clear
that a little more than one-half of the total rural habitats
under examination was seriously exposed to damaging effects
of various infective and parasitic diseases. Rid these
villages form any endemic area for infective and pai’asitic
diseases around Rajpur town? Convinving answer to this query
may be formulated in the light of the fact that of all rural
families (1717) which reported about occurrences of diseases
of Group I (IPD), the families (1060) of the said six villages
only, taken together, accounted for as good as 62 per cent.
Such a high rate of incidence of infective and parasitic diseases
on family level in a relatively smaller area is a significant
pointed to rural health problems at large.
In contrast, relatively a low family incidence rate for
infective and parasitic disease-group in village chowhati
was quite a though-provoking affair. This village sheltered
.../9
J 9 ;
562 families and of these families only a little more than onefourth reported illness due to one or more kind of diseases
falling under Group I„ In village Hogalkuria FIR for diseasegroup I (IP])) was found to be 37%. '"Thus the“families of these
two villages appeared to have suffered relatively less
detrimental influence of the principal health-affecting diseases
of the area. In the remaining three villages, namely,
Bonhoogly, Bingaipota and Jayenpur, the families concerned were
affected ‘by’ tHe “diseases of Group"! relatively moderately,
FIR being x varying from 45% (Bonhoogly) to 53% (Jayenpur).
As far as the semi-urban areas of Rajpur municipal town
is concerned, impact of infective and parasitic diseases on
families concerned were not at all insignificant. It is
interesting that as high as 57 out of 100 families of Rlachi
reported sickness due to the said diseases. In spite of tEe
fact that both Elachi and Jagaddal constitute two important
sections of the""bnly "municipal’’ town (RAJPUR) of Sonarpur P.S.
24-Parganas district, 59 per cent of resident-families were
as late as in 1974-75 under the grip of various infective and
parasitic diseases.
All the more, over-all FIRa of Bisease-Group I (IK))
for both rural and semi-urban families of the survey-area were
observed to be on matching stx
ength.
*
Poes this fact mean that
town (urban or rural) living on the part of the affected on
families exercised no discriminating influence on infective and
parasitic diseases to affect volume of sickness^
*
I11 general,
it may be observed that the families under study did suffer
health-problems very largely due to vax'ious infective and
parasitic diseases.
B)
Sext in order of importance the diseases of Respiratory
System (DRS: Group VIII) prevailed inThe survey^>area.~Bur
such diseases on family level were reported relatively more
in semi-urban areas of Rajpur town. Here out of every 100
families as good as 39 envinced occurrence of one or other
kind of disease related to the disease-group VIII. In contrast,
the rural families complained about incidence of the diseases
of respiratory system in only 29 per cent cases. From this
general picture of development it seems that rural, open-air
living of the families concerned, had some discriminating role
to influence events of illness due to respiratory systemlinked diseases. In any case, family health problems created
by different diseases of the GroupVIII were not insignificant
in both rural and serai-urban areas of Sonarpur P.S. and
accordingly, appropriate health care measures to prevent and cure
diseases are still heeded for the welfare of the local society.
.../10
: 10 s
Village Jagannathnur maintained a distinguished position
in having relatively the highest family incidence rate for
disease-group VIII. In this village as high as 63 put of every
100 families reported one or other kind of disease related to
respiratory system. Next was the position of village Nischintapur
(FIR: 49/) where about one-half all families suffered heal th pro'STems
due to the disease-group VIII . Family incidence rates of the
disease-group VII for the families of four villages, namely, Ukhila
fx55?0, Kumarkhali (35/), flhqwjiati (34',0 and Bpnhoogly (32/) were
noticed to vary within a small range. It appears that the families
of these four villages had faced more or less similar experiences
of health problems which might have generated by the diseases of
respiratory system (Group VIII) in the area.
That the families of each one of these four villages suffered
health problems due to respiratory diseases relatively significantly
leaser than the families of either village Jagannathpur or
Nischintapur is, indeed, an interesting fact. This was more so in
the ease of the remaining villages. In this respect village
I'amchandrapur struck a distinction in presenting family incidence
rate of diseases of respiratory system in the lowest order (16
per cent). Thus, FIR of disease-group VIII (DRS) is observed
to vary from a high 63 per cent to a. low 16 per cent. This signifies
that the effect of respiratory system-linked diseases was not
uniformly present over the villages and thereby the. rural families
had differential experiences of health problems due to such, diseases.
In semi-urban areas of Rajpur town families of ELACHI
reported relatively more cases of illness due to respiratory
system-linked diseases. Here 42 out of every 100 families had health
problems under the influence of respiratory diseases. But in Jaggadal
37 per cent of total 290 families declared incidence of one or other
disease of Group VIII. It seems that respiratory system-related
diseases caused health problems on family level relatively more in
Elachi than Jaggadal. The FIRs of disease-group VIII (diseases
of Respiratory System) for the town families are found to
stand in closer proximity of the FIRs of the same disease-group for
the families of villages like Ukhila, Kumarkhali, Chovrhati, or
Bonhcogly. Thus, the families of these particular semi-urban and
rural areas of Sonarpur P.S., 24-Pnrganas district happened to
experience similar stress and strain in taking care of their
health problems generated by the diseases of respiratory system.
C)
Third important disease-group is related to the disease
of Skin ano subcutaneous tissues (Croup XII). In both ruraT and town
areas tHIs disease-group "(PS T) ~7ielded family incidence rate in
almost similar order. In total number of rural families (2856)
22 per cent reported occurrence of skin-linked diseases and in town
area, on the other hand, 22.5 per cent of the total number of 583
.../Il
S 11 8
families showed cases of illness under similar diseases. Thus,
a consistency between rural and urban rates is observed in the
incidences of diseases falling under the disease-group XII,
Moreover, it becomes evident that the families of both rural
and semi-urban areas of sonarpur P.S. suffered infective and
parasitic disease's"~in"'£i'ghest order, diseases of respiratory
system in higher" ord errand skin-lTnked disease £n~high order.
These three disease-groups were, no doubt, the principal sources
of health problems for the families in general. Relative
decreasing order of importance of these three disease-groups
(I, VIII and XII) was uniformaly maintained by both rural and
town families. Such state of development in health-area should
at once be highlighted.
With respect to this particular disease-group XII (DST)
village Kumarkhali occupied a distinguishing place as 40 out
of every 100 families residing in the village reported incidences
of skin disease of one kind or other. This family incidence
rate happened to he IS points above the over-all i-ural rate.
In the village the disease of Group I (IPD) and Group XII (DST)
were relatively more mentioned by the families concerned.
Next was the position of village Nischintapur where the FIR
of disease Group XII is observed to be 38 per cent. Ohter family
incidence rates of skin-linked diseases which are worth mention
ing are 34 per cent (village Hogalkuria) and 31 per cent (village
Kusumba) and 30 per cent (village Ukhila). Lowest family
Incidence 1’ate of the disease-group XII was yielded by village
Jagannathpur (3 per cent). Thus, it is quite clear that the
families of the villages under survey did not suffer health
stress uniformly under the influence of diseases of skin and
subcutaneous tissues (Group XII).
In semi-urban areas EIACHI gave family incidence rate of
disease-group XII as 22 per cent and the same was slightly
higher for Jagaddal (23 per cent). These rates are definitely
higher than those obtained for only four villages, namely
Chowhati, (17%), Dingalpota (13%), Bonhoogly (14%) and
Jagannafhpur (3%). For the rest of eleven villages the rates
were foun<iTo be higher than those observed for either of two
semi-urban settlements of Rajpur town. In general it may,
thus, be thought that the rural families were relatively more
exposed to skin-belated diseases than tmm families. Though
over-all rates of disease-group XII (DST) did not vary markedly
between rural and semi-urban settlements, yet it was the rural
families which are found to face health problems due to these
skin-diseases more extensively.
D)
The last important disease-group (XVI) is a group of all
Symptoms and Ill-defined conditions of physical siokhbss (SILC).
.../12
: 12 :
Occurences of such symptoms and ill-defined conditions were
extensively frequent in both rural and town families. Physical
sickness by a single or multiple causes was reported by the fam
ilies in very large number of cases, hut such sickness could not
he identified with any specific disease-group in question.
Physical sickness due to headache, fever, pain, cough, loss of
appetite and so on was very, very often mentioned by the
families and they have been clustered, as per WHO classification,
under one broad disease-group, namely, Symptoms and Ill-defined
conditions. It appears that all the families-rural or semi-urban
had the same experiences of many by frequently-occuring minor
physical ailments which do not demand generally any serious
medical surveillance. These diseases may be taken as household
disease of common happening. Eventually family incidence rates
of all Symptoms and Ill-defined conditions of physical sickness
were as high as 87$ in rural and 94$ in town areas of Sonarpur
P.S., 24-Parganas district.
It is thus clear that in survey-area predominance of
infective and parasitic diseases had to be merited with all
seriousness. Then, the health problems generated on family
level by diseases of respiratory system need due medical
attention. Third important source of health stress in families
rural or urban was related to occurences of diseases of skin
and subcutaneous tissues. 60 pci’ cent of total 3439 families
(rural and urban combined) reported incidences of infective
and parasitic diseases. Again, 30 per cent of these 3439
families complained about physical illness due to attack of
various diseases of respiratory system. On the other hand,
22 per cent of the same 3439 families yielded information about
health hazards due to different diseases of skin and subcutaneous
tissues.
S)
In the backdrop of this morbidity condition an attempt has
been made to sift out the most commonly reported disease or
diseases tinder each one of the above first three dominant diseasegroups. In disease group I (Infective and parasitic diseases)
though a number of diseases which was reported on“ family level,
has been included, yet two particular diseases, namely, Dysentery
and Diarrhoea were most frequently mentioned by rural and semiurban families. It has been observed that family incidence rate
of disease-group I for rural families as a whole is 60 per cent
and out of this 60 per cent as good as 31 per cent reported
incidences of dysentery and diarrhoea only. In semi-urban areas
of Rajpur town the family incidence rate of infective and parasitic
diseases is 59 per cent and out of this 59 per cent families as
good as 19 per cent reported about occurence of dysentery only
(Table 2.)
Thus, it is noticed that in survey area as a whole dysentery
./13
13 ;
as an infective and parasitic disease has been reported mostly.
When out of every 100 families as good as seventeen gave decla
ration that they suffered from a single disease of dysentery,
one can visualise what alarming health situation was prevailing
in both rural and town areas of sonarpur P.S. as late as in 1975
It is interesting to focus that family incidence rate (FIR)
of dysentery disease was not of the same order in between village
and town areas. FIR of dysentery for semi-urban families was
19 per cent against only 16 per cent found foi- rural families.
•Two semi -urban settlements, namely, ELA.CHI and JAG APPAL, are
part and parcel of the municipal town of"R^-puF~anI"ye-F' tlTey
evlp.cod~The disturbihg~fact' ifiat fFelr resident-families suffered
health px^oblemenSue to attack oiHjysentery relatively more ~~
’
InTonsIvqly3Than "their counterparts living In rural' environment.
The seml-v’rEaii families did not report diarrhoea to be a most
commonly-occurring disease.
Now for the rural area it is observed that in four out of
11 villages of all the infective and parasitic diseases reported
on family level, diarrhoea was more often mentioned. These fourvillages are Hogalkuria, Kumarkhali« Kueumba, and Ukhila. But
in the remaining seven villages the diseas e of dysentery was
pointed out most frequently by the families concerned. Diarrhoeainfested families were found relatively highest in village
Kusufcba where 66 out of 100 families reported this particular
infective and parasitic disease. Next was the position of village
Kumarkhali where 57$ of resident families gave information about
diarrhoea. Village Ukhila and village Kogalkuria presented
family incidence rates of the disease of diarrhoea only as 47$
and 12$ only. Dysentery was not mentioned as a commonly occurring
disease by the families of these four villages.
In Kusumba centper cent families were found to have suffered
from one or other kind" of infective and parasitic disease (Group I)
but diarrhoea as a single major disease of Group I was claimed
by a high as 66 per cent of total families. On the other hand,
in village Kumarkhali 90 per cent of total resident families
reported incidences of diseases of Group I and again, 57 per cent
of the same families of the village were found to have suffered
from diarrhoea as a single source of infective and parasitic
diseases. In village Ukhila family incidence rate (FiR) of
infective and parasitic Sisease was 90$ and such rate for the
disease of diarrhoea only was as good as 47$. For village
Hogalkuria fir of infective and parasitic diseases was relatively
lower (37$) and accordingly, FIR of diarrhoea was also very low
(12 per cent).
To what extent the families of these four villages only
could distinguish between an attack of diarrhoea and dysentery
could not be ascertained during survey and as such true cases
of dysentery might have been under reported. For under reporting
or misreporting dysentery as a most commonly reported disease
was not obtained, among the families of these four villages in
.../l 4
s 14 :
sharp contrast to their counterparts living in adjacent seven
villages. It seems that many cases of dysentery in these four
villages a? Kumarkhali, Kuswnba, Ukhila, and Hogalkuria might
have been reported as cases oi diarrhoea only.
Among the remaining seven villages where the families had
declared dysentery as the most commonly occurring infective
and parasitic disease village Ramchandrapur and village
."agannathpur deserve special attention. In Ramchandrapur 32
out of every 100 resident-families reported one ox- other kind
of infective disease etc, diseases and of these 100 families
as high as 54 per cent complained health hazards due to a single
infective disease of dysentery. Such a high FIR for dysentery
is a significant pointer to the prevailing health condition in
the local rural society. On the other hand., 97 per cent of total
families living in village Jagannathpur had one or other kind
of infective and parasitic diseases amongst their constituent
members and again, 47 per cent of these families reported disease
of dysentery only, as a single infective and parasitic disease
dysentery happened to creat health problems on'family level more
glaringly in the given two villages of sonarpur P.S., 24Farganas district.
In this very respect position of village bischintapur and
village Jayenpur -was not all bright. In the former tillage
73 out of every 100 families showed incidences of infective and
parasitic diseases and of these ICO families as good as 44
reported infection from only dysentery disease. In the latter
village family incidence rate of infective etc. disease was
fairly high (53/-), such rate for dysentery disease only was
very significant (3'2;'). Incidences of dysentery in these two
villages can hot be belittled, rather they should be given
importance as seriously as one must offer to village Ramchandrapur
or village Jagannathpur.
In the remaining three villages, namely, Ringalpota,
Chowhati and Banghoogly reporting of only dysentery as
a
*
most
frequently-occurring Infective and parasitic disease was made
by the families concerned of each village in lesser volume,
family incidence rate being ranging beWeen 20 and 13 per cent.
It appears that those three villages suffered relatively in
leaser order from dysentery indiced health problems than the
rest of the villages in question. In any case, the very
presence of dysentery in seven out of 11 villages under survey
is certainly alarming. In conjunction with the incidences of
dysentery in semi-urban areas of sonarpur P.S., these infective
and parasitic diseases demand immediately appropriate medical
and public health measures for the welfare of the local people.
.../15
: 15 :
It may rightly be surmised that environmental sanitation
in the local area under study is not satisfactory enough to
negate appreciably the wide spread of several kinds of
infective and parasitic diseases and particularly dysentery
and diarrhoea. Family health problems are accordingly not
insignificantly voluminous in both rural and semi-urban (town)
life. More than one-half of the total families under exam
ination was exposed under several infective and parasitic diseases
(especially dysentery) and this single event is strong enough
to point out what medical welfare activities are to be launched
at once to pi’otect the people from health hazards and family
s *0 j? ess«
In the second dominant group of diseases of respriatory
system two specific diseases of cold and flu had most frequently
been referred to by the families. In semi-urban settlements
the disease of cold only was most frequent. Family incidence
rate (FIR) of diseases of respiratory diseases (Group VIII)
for semi-urban families is found to-be 39 per cent and for the
same families FIR of disease of cold alone was 32 per cent. It
becomes} thus, evident that in the occurrence of respiratory
diseases oxi family 14vel it was the disease of cold which
generated health problems in large majority cases among town
families. An y other relatively more serious respiratory
diseases like peneumonia, asthma, pleurisy and like so were
not reported by most of the families of both semi-urban and
rural settlements. Cold happened to be a common household
disease in the survey area. Such type of disease was declared
relatively more by town-bred families than their rural counter
parts (Table 3.)
In general, 31 per cent of total 3439 families enumex’ated
in Sonarpur p.S. did complain about physical sickness due to
some respiratory diseases. And of these families as good as
19 per cent showed incidence of cold only on family level. In
town area 32 per cent of 583 families reported about the lone
disease of cold and in contrast, 17 per cent of 2856 rural
families recorded about the same disease. The difference between
semi-urban and rural rates for the disease of cold should be
especially noted. If widespread occurrence of the disease of
cold is taken to he any indicator of bodily deficiency in
respiratory system, then proper medical attention in this
direction is urgently needed for especially the town-bred
families of Rajpur. It is more true for the families of Jagaddal
where 33 out of 100 families had trouble of cold-disease.
Incidences of the disease of cold were not insignificant in E1ACHI
(30 per cent).
,
In the villages, families of Chowhati stood in closer
/16
: 16 ;
proximity to semi-urban families in having incidences of
cold-disease among 52 per cent cases. Like chowhati in another
sei of five villages, namely, Bonhoogly, pingalpota, Hpgalkuria,
Jayenpur and Ramchandrapur, only ¥he disease of cold had been
reported to be the most commonly occurring disease under the
disease group VIII. In the remaining five villages the families
concerned declared disease of flu as the most commonly occurring
disease of respiratory system. Family incidence rate of flu
only is observed to be 14 per cent in rural areas.
In semi-urban areas the disease of flu was not the most
commonly occurring disease. With respect to total 3459 sample
families the disease of flu happened to occur in only 11 per
cent eases.
Among the five villages v;here the families had reported
’flu’ as the most commonly occurring disease under the disease
group VIII (DRS), village Jagannathpur attracts immediate attention.
Here the family incidence rate (FIR) of only ’flu’-disease has
been found to be 62.7%. In this village the over-all FIR
of diseases of Respiratory system (Group VIII) was 63.2%. Under
the situation it becomes clear that the rural families of
Jagannathpur suffered almost fully from attack of 'flu'-disease.
What was the possible reason for such high rate of *
flu ’disease? A thorough medical probing among the constitutent
members of the families of the village can only answer the
problem.
In this respect next came village Nischintapur where 48
out of 100 families complained about illness due to ’flu’.
The over-all family incidence rate of disease of respiratory
system was observed to be 49% in this village and the lone
disease of ’flu’ explained as high as 48% of total cases of
respiratory diseases. This state of affair is serious enough
to urge for immediate medical intervention. Both Jagnnathpur
and Nischintapur require special medical attention to root out
High inciSence'rate ~of fTIuT-disease which posed definitely’11
serious health problems to ’tKeTTocal families and their inhabit
ants .
In the remaining three villages, namely, Ukhila, Kumarkhali
and Kusumba, the incidences of ’flu’-disease were net insignifi
cant. In Kumarkhali 33 out of every 100 families reported ’flu
*
as the most Commonly occurring disease, while in Kusumba it was
27%. But in village Ukhila family incidence rate of the disease
of flu was slightly higher (35%). Further, in Ukhila FIR of
diseases of Respiratory system happened to be 35.4? and ’flu'
alone explained for 34.9% of the local families. Thus, it is
.. ./17
7I
? 17 :
observed that the villages which were more disturbed by health
problems created by the diseases of respiratory system were
actually having the particular disease of ’flu' as the most
prevailing one among all diseases of the said System.
For the third dominant group of diseases of Skin and sub
cutaneous tissues (DST) the families of both rural and semiurban settlements under survey had reported only the disease
of 'itch
*
as the most commonly occurring one. Family incidence
rate (FIR) af the disease of 'Itch
*
only for rural families as
a whole was 16 per cent. This rural rate was slightly higher
than semi-urban rate (14 per cent). In general, the FlRs of
diseases of Skin and suncutaneous tissues were not very high
in the area of survey (rural FIR: 22.2% and semipurban FIR: 22.3$)
Eventually, the FIRs of the lone disease of ’itch’ could not
be very impressive. The finding of ’itch
*
as the most commonly
occurring skin-linked disease among the families suggests
that the diseases of skin might not be a source of serious
health problem to the families in question (Table 4).
In the background of the above situation special attention
was drawn by two villages, namely, Kumarkhali and Nischintapur.
In the former village as good as 40 out'of every 100 resident
families reported one or other kind of skin-disease and in the
latter village 38$ of total families evinced the presence of
such disease. On the other hand, villages of Hogalkuria and
Kusumba occupied the next important position in showing family
incidence rates in the order of 34$ and 31$ respectively.
In contrast, village Jagannathpur showed relatively the minimum
incidence of skin-linkeo~3iseases, FIR being only 3 per cent.
Apparently it appears that the families of the villages in
question had differential experiences about skin-linked diseases.
Family incidence rates varied from a high 40 per cent to a low
3 per cent.
In semi-urban settlements of ELACHI and JAGADDAL the families
reported occurrence of skin-related morbidity in 22$ to 23% cases.
This rate was almost similar to the over-all rural as well as
semi-urban rates (22%). In any case it becomes clear that not
more than one-fourth of total families surveyed faced Health
stress from skin-linked diseases.
To go into the details of the incidences of different
skin-linked diseases on family level it has been found that of
all kinds of diseases the disease of 'itch
*
was referred most
/frequently by the families. In rural areas out of every 100
families, when 22 per cent ieported skin-related diseases, 16
per cent referred to ’itch’ only as the most frequent skin
disease. Similarly, in semi-urban areas out of every 100
' families when 22 per cent showed presence of one or other kind
,../18
: 18 :
of skin-belated disease, 14 per cent claimed only ’itch
*
as
the most commonly occurring disease. In this respect, special
mention is made for the village Ramchandrapur where the families
did not refer ’itch’ as the most frequently "occurring skin
ailment, but the disease of ’dermatitis
*
was reported. Here
out of every 100 families 1? showed the incidences of ’dermatitis
only and 27 reported skin-disease of various types (including
’dermatitis’).
For the fourth and last dominant disease-group namely,
Symptoms and Ill-defined conditions "T^x-oup XVI), it may be
pointed out that in the'survey area 88 out of every 100 families
did experience one or other kind of sickness effected by some
/'physical trouble. Such sickness could not be properly explained
by or identified with any organic disorders. Accordingly, it
/ was gound that sickness due to ’fever’ or ’cough’ was very
/ widely mentioned. For this disease-group of Symptoms and Illdefined conditions of bodily sickness nothing definite can, thus,
be pointed out.
So far emphasise has been given on those diseases and
disease-groups which were found relatively more dominantly
present among the families-rural or urban of Sonarpur P.S.,
24-Pai’ganas district. Eventually useful knowledge about
current diseases and health problems in a society located in a
rural environment (not far from the Metropolitan City of
Calcutta) can be roped in. Family incidence rates of the most
commonly reported diseases as well as the disease-groups can he
estimated from the survey findings. Trends of development in
health area which were shown by the families under examination
are expected to throw light on rural health problems in general.^
Volume of family sickness per htoan settlement could be
examined from "These findings which were, of course, limited by
recall lapse, wider reporting, inis reporting and other circum
stantial factors. Health information which is obtained from
the present study can hardly be available from other sources.
Incidences of infective and parasitic diseases, diseases
of respiratory system or disease of skin and sub-cutaneous
tissues have been found to occur more expansively in the
'survey-area and to call immediate attention to The diseases of
these di3ease-groups'~~only Ts~not to~impTy that no. effort should
be made to tackle diseases of the remaining disease-groups under
reference, Occurrences of dTfTerenT"diseases whIcK~nave been
included in each one of the remaining disease-groups were
relatively lesser' in magnitude and as such these disease-groups
have not been discussed separately.
.../19
• 19 :
Nevertheless, in this respect one important point has to
be highlighted. It was found that none of the families in
either rural or serai-urban areas had reported any disease which
falls, as per WHO classification, under any one of the following
dissase-groups; (i) Neoplasms (Groupll); (ii) Mental disorders
(Group V); (iii) diseases of Urino-genital system (Group X);
(iv) Congenital anomalies (Group XIV); and (v) diseases of
peri-natal morbidity and mortality (Group XV). These diseasegroups go completely unrepresented. Such state of affairs is
really difficult to explain. Either the families did truly not
experience any health hazards due to any disease coming under
the above five groups, or these disease-groups had suffered
from recall lapse or under-reporting. Third
possibility
*
may
be that the families concerned did not bother to report those
diseases which would come under these five specific groups. But
it is certainly significant to note that both rural (2856) and
semi-urban (583) families behaved in similar manner in not
reporting any disease of any one of these five disease-groups.
How such consistent behaviour in between rural and urban families
could arise with reference to these five disease-groups only?
It seems that only a further probing in-depth can furnish a clue
to this query.
Another important issue is revealed by the findings as noted
in Table 1, that the family incidence rates of each diseasegroup for rural and semi-urban families maintain more or less
a consistency in most of the cases. Divergences of low order
are, of course, not absent between rural and semi-urban i‘ates
of (1) Endocrine, Nutritional and Metabolic disease-group
(Group III) (ENMD); (2) Disease group of Nervous system and
sense organs (Group VI) (DNS); (3) Disease group of Digestive
system (Group IX) (DDS); and (4) Disease group of the f4usculoskeletal system and connective tissues (Group XIII) (DMCT).
In these disease-groups the semi-urban rates were always higher
than the rural rates. But the over-all family incidence rate
of each one of these four disease-groups was initially low
either in rural or town area and as such these rates have not
been offered that much of importance which was given to those
four dominant disease groups mentioned earlier.
Incidentally, it may be noted that family incidence rate
(FIR) of the diseases of Digestive system (Group IX) was 9
per cent in semi-urban areas against 3'i5''per cent available for
rural areas. That semi-urban FIR of disease-group IX was more
than double the rural rate is a fact of immediate interest to
those who are concerned with medical and public health measures
in the local society.
F)
Family incidence rates (FIR) of four dominant disease-groups
./20
: 20 :
have been examined above in some detail with reference to the
rural and semi-urban families in question. Now an attempt has
been made to classify the families by community (social group)
affiliation and thereby to study community-wise family incidence
rates of the disease-groups concerned. It is presumed that
though these communities have different ways of life and living
(culture) and different mental disposition towards health care,
the families belonging to different communities would be
affected alike by the diseases and thereby the stress of health
problems.
With respect to the rural areas as a whole family-incidence
rate of infective and parasitic diseases (group I) happened to
be 60 per cent. Bui among the rural“Muslim families as high
as 81 out of every 100 cases reported the diseases of the Group I
against what was evinced by the Hindu families (48%). The
Christian families reported relatively the lowest rate (34%).
Thus, of all the rural families the Muslim families were found
to have relatively more health"problems^ caused' by the infective
and parasitic diseases thanTTlie^non-MusTim families.
Moreover, it is known that the diseases like Dysentery
and Diarrhoea were the most commonly reported diseases among
the rural families and accordingly, it is not difficult to
visualise that it was the Muslim families which suffered relatively
most from these two particular infective and parasitic diseases
in Sonarpur P.S. (Table 6).
That the Muslim families of semi-urban areas suffered also
relatively in greater degree from infective and parasitic diseases
(Group I) is evident from the fact that 71 out of every 100
Muslim families reported incidences of the given diseases in
sharp contrast to 58% only yielded by the Hindu families. Thus,
in both rural and town areas of all the three communities the
Muslim community alone showed the highest incidence rate of the
Disease-group I (IPD). On the other
*
hand, it is also observed
that the rural Hindu families evinced relatively lower family
incidence rate of the Disease-group I than their counterparts
living in town area. Community-wise differential rates as
available from the findings of Table 6, constitute a significant
pointer to understand different levels of development in health
conditions among the local dwellers. That volume of sickness
per family due to infective and parasitic diseases was more
Intensive among the Muslims in comparison to the Hindus or the
Christians of the suryey-area is a capitaj~~knowledi<<e~7 This
knowledge would greatly help in theT'.'ormulation ofappropri ate
strategy of health welfare programmes and actions.
In this respect attention is drawn to the Muslim families
.../21
: 21 :
of the following villages since all the families of the villages
reported to have suffered from one or other kind of infective
and parasitic disease (especially, dysentery or diarrhoea):
(1) Jagannathpur, (2) Kumarkhali, (5) Kusumba, (4) Ukhila.
Family incidence rate was 100% or a very little less than cent
per cent. Among the Hindu counterparts of theqe village faiaily
of infective and parasitic diseases fluctuated "between a high
100% (village Kusumba.) and a low 67% (village Jagannathpur).
Truly speaking, three villages of Kusumba, Kumarkhali and
Ukhila seemed to be the worst-affected areas as far as intensive
occurx’encGE of infective and parasitic diseases were concerned.
Irrespective of their community (social group)-wise affiliation,
the families of these three villages had to endure the impact
of infective and parasitic diseases like dysentery or diarrhoea
most intimately as well as extensively.
On the other hand, the Hindu families of the following
villages were found to report reTativSy more cases of infective
and parasitic diseases (Group I) than their Muslim counterparts:
(1) Nischintapur, and (2) Ramchandrapur. In village hischintapur
the Hindu families yielded relatively higher family incidence
rate (73%), the same was only 50% among the Muslim families.
m village Ramchandrapur the Hindu rate for the disease-group I
was a little higher (83%) than the Muslim rate (78%). The
lowest family incidence rate of infective and parasitic diseases
(Group I) was evinced by the Hindu families of village Chowhati
(25%) and again, by the Muslim families of village Bonhoogly
(50%) or village Nischintapur (50%). That the lowest Muslim
rate for infective and parasitic diseases was double "than the
lowesf~HlnSu rate was singularly"significant_ to stress the fact
that the Muslim famiTIes~6T~;SEesurvey~area formed the most
'expensively affected- group to suTfer hO.lth hazardsT~”
With respect to the second dominant disease-group VIII
(Respiratory system-linked diseases) it has been found that 29%
of rural families and 39% of semi-urban families reported such
diseases. In rural area among all the families (2856), a
sizeable magnitude of Muslim families (38%) showed relatively
more cases of respiratory system-linked diseases (especially
the diseases like cold and flu,) than their Hindu (31%) or
Christian (13%) counterparts. Like the highest family incidence
rate (PIR) of infective and parasitic diseases, here again the
Muslim families presented the highest FIR of diseases or respiratory
system. But, in”this very respect the difference (7.3%) between
Muslim and Hindu rates for respiratory system-linked diseases
was not as high as was found for the difference (33.8%) between
the rates of infective and parasitic diseases. 1$ is significant
to note that the i-luslim families of the villages under study
suffered most from both infecTive and parasitic diseases and
diseases of~respTfatory system. Next was tHF^position of the
.../22
: 22 :
Hindu families and the Christian families occupied the third
position in order of importance.
On the other hand, among all town families it was the Hindu
families which presented highest (FIR) family incidence rate
(40$) for the diseases of respiratory system and next was the
position of the Christian families (FIR) (39$). Here the town
families belonging to the Muslim community evinced the lowest
FIR (36$) for diseases of respiratory system. Nevertheless,
the range of variation between the given rates was within a
narrow limit (40$ to 36$). This shows that the semi-urban
families, irrespective of their community (social group)
affiliation, did suffer on more or less similar level the
problems of health which were caused by various diseases or
respiratory system (especially by the disease of cold), One
point is stressed here that in reporting incidences of diseases
of respiratory system the Muslim families occupied the last
position in order of importance in contrast to their rural
counterparts.
Examining community-wise family incidence rate (FIR) for
diseases of respiratory system over the villages it is observed
that the Hindus of the following four villages evinced higher
FIR than what was shown by their non-Hindu counterparts:
(1) village Chowhati, (2) Village Hogalkuria, (3) Village
Kumarkhali, and (4) Village Kusumba. In these villages the
Hindu rates varied from a high 50$ (Kusumba) to a low 29$
(Hogalkuria), where as the Muslim rates fluctuated between as
high as 35$ (Kumarkhali) and as low as 15$ (Chowhati), on the
other hand, the Muslims of the following four villages presented
higher FIR for diseases of respiratory system than that was
offered by their non-Muslim counterparts: (1) Village Bonhoogly,
(2) Village Jagannathpur, (3) Village Ramchandrapur, and (4)
Village Ukhila. In these four villages the Muslim rates varied
from a high 64$ (Jagannathpur) to a low 35$ (Bonhoogly). But
the Hindu rates were from a high 53$ (jagannathpur) to a low
10.5$ (Ramchandrapur). Over these four villages in question.
Thus, it is clear that in the villages occurrences of
diseases of respiratory diseases (especially the diseases like
cold and flu) had a wide fluctuations over both Hindu and Muslim
families and thereby the families had differential experiences
of respiratory system-linked health problems within the close
bound of their specific community-enclosure. That the families
belonging to different communities (social groups) suffered
from respiratory system-linked diseases in unequal magnitude
is immediately highlighted. Community-wise variations in the
incidences of either infective and parasitic diseases or diseases
of respiratory system are quite evident. Such variations have
.../23
5 23 :
to be given duo weightage in any family health welfare plan
and/or programme that mgiy be envisaged for the inhabitants
of the locality.
with reference to the thiz^d dominant disease group XII
of ski.n-related diseases it has already been pointed out that
rural and semi-urban family incidence rates varied only very
litt/le (22.2>1:rural and 22.5$: urban). But in both rural and
town areas the Muslim rates for the disease-group XII were
definitely higher than the Hindu rates. The rural Muslim rate
(.25$) was, on the other, hand much lower than that of the
urban Muslim rate (40$). But the Hindus of rural and town areas
maintained an equal rate (20$). There is no doubt that the
Muslim families suffered in general most from skin-linked diseases,
especially Irom the disease like itch.
It is quite significant that the Muslim rate for skin-linked
diseases as found in town areas, was double than that evinced
by the Hindu families of the same area. Why the Muslim families
alone of town areas suffered skin-linked diseases in such high
degrees? Proper medical probe into this specific problem is
imperative to have a satisfactory clue. In villages community
wise variation in family incidence rates for skin-related diseases
was, of course, of low order. I|‘ seems that the Muslim families
of town area had in general been exposed more to physical
ailments under influence of skin-linked diseases (especially
’itch’) than their Hindu counterparts.
In the following three villages the Muslim families
yielded higher family incidence rate (FIR) for skin-linked
diseases than the Hindu families: (1) Village Chowhati,
(2) Village Kumarkhali, (3) Village Ramchandrapur. The Muslim
rates over these four villages varied widely. Village Kumarkhali
is especially noted since 51 out of every 100 Muslim families
of the village reported such diseases and it was the diseases
of ’itch’ which prevailed most. In this village the Hindu families
offered FIR for skin-linked diseases as only 26$. In village
Chowhati the Muslim rate (46$) was much higher than the Hindu
rate (17$), but in village Ramchandrapur the Muslim and the Hindu
rates were very close. It appears”!;hat'"the Muslim families
of villages Kumarkhali and Chowhati require special medical
attention to tackle' physical sickness under skin-related diseases.
On the other hand, the Hindu families of the following
two villages were found to offer higher family incidence rate
for skin-linked disease: (1) Village Eogalkuria and (2) Village
Jayenpur. In Hogalkuria when 34 out of 100 Hindu families
reported occurrence of skin-related disease (especially ’itch’),
31.5$ of the Muslim families had the sufference from the same
.../24
23
diseases, Next, in J^yennur village 29% of total Hindu families
evinced skin-linked diseases against 25% of Muslim families.
This shows that in these two villages the Hindu and the Muslim
families faced on more or less similar level the experiences
of health problems generated by various diseases of skin and
subcutaneous tissues jG-roup XII).
In general, it may be stated that the Muslim families
of rural areas of Sonarpur F.S., 24-Parganas district, faced
health problems under the impact of infective and parasitic
disease like dysentery and diarrhoea more than their Hindu or
Christian counterparts. This state of affairs was also true
in the cases of respiratory system-linked diseases like cold
and flu or in the cases of ~^f'n-linKed"'Slse'ases1 linked itch.
For these three distinct buT'Soailnani disease-groups the Muslim
families in the given villages evinced always highest family
incidence rates. These rural Muslim families were followed
next by the rural Hindu families in order of importance. The
rural Christian families offered in general the lowest family
incidence rates for the said three dominant disease-groups,
Thus, the need for the study of incidences“of most frequently
occurring diseases in villages by community (social group)affillation of the families concerned becomes very much pressing.
Family incidence rates (FIR) of different disease-groups
or of the most frequently reporting diseases under any broad
disease-group as have been presented above, require to be evaluated
in consonance with waht has been obtained for different
communities (social groups) of the local stratified society.
These two sets of family incidence rates are complementary to
each other and a proper investigation of these rates would
certainly provide greater insights into the nature and magnitude
of the health problems which prevailed lately among the people
of the survey area in 24-Parganas district or for that matter
of the State. These rates would be some useful indicators in
the field of health planning. Priority of medical as well as
public health care can be fixed on. the basis of higher or
lower family incidence rate obtained for a particular diseasegroup and again, for a particular oommunity (social group).
The findings of family health problems as available now, are
expected to help the organization of medical help and public
health care among the local inhabitants in terms of their
geographical location, community affiliation and family incidence
rate for different diseases and physical sickness.
4.
Concluding observations
The present discourse has been made with ’Family Health
*
as an important goal of approach to ongoing national programmes
.. ./24
: 24 s
on public health. Precisely speaking, the role of family
(classified by its social affiliation) in national health
has been highlighted here. The need of treating the family
as a whole as the focus of attention in the matter of health
and family welfare services has been stressed and eventually
a family rather an individual appraoch has gained importance
in the analysis of available health data.
Health surveys have already been accepted as some significant
tool to generate flow of useful health information. Tnspite
of many limitations the present survey had truly yielded substan
tial volume of such information which, on the other hahd, would
help in more than one way the plan and programme of healthservices envisaged for the area in question. This information
reflects immediately upon family distribution of diseases and
the same may be thoroughly utilized to guide forward planning
of health services. The present findings of the survey provide
comprehensively with the much-needed knowledge about disease
prevalence on family level. It is felt that family-based
distribution of disease in conjunction with population-based
distribution of disease would certainly strengthen the very
base of the data on national health. Moreover, these two types
of distribution would be complementary to yield better health
statistics. Importance of the present discourse had therefore
to be merited in the light of the above issued. It is strongly
hoped that the present family-based health statistics shall
eventually help to inculcate net/ attitudes to the administration
of health services as a whole in the country.
World Health Organization had already stressed seriously
upon the need for new approaches in health statistics (WHO
Tech. Report. No.559, 1974). In this net/ approach emphasis has
been laid on net/ types of health statistics which can no longer
be just concerned with the quantity and population distribution
of disease. New orientation of attitude towards environmental
factors in disease and health and again, an inclination to see
patients as members of family and community groups have lately
been urged. Hany health indicators are in vouge today but those
which embrace not only measures of morbidity of the population
but also measures of those social (including economic)
characteristics that are the detreminants of levels of morbidity
are, no doubt, more useful. With reference to particular popula
tion groups such useful health indicators are desired to be employed
more. The present study has, indeed, taken the patients as
members of family and community groups of the locality and
proceeded to offer a kind of health statistics v/hich vzas not
concerned with population distribution of disease. To assist
in the formulation of health care plans for families and/or
communities of a rural society the present study may have a role
to play.
.../25
: 25 :
Family incidence rates of different diseases in the local
communities have been measured to indicate volume of sickness
per hundred families. The rates were not uniformly manifested
by the communities. There existed noticeable variation in the
incidences of different diseases on family as well as community
level. Adequate knowledge on family incidence rates is hardly
available. This knowledge may be fruitfully used to develop
some health indicators which serve to provide a real guide to
the social and medical action plan for the people in question.
The present study reveals that infective and parasitic
diseases caused highest family incidence rate in the area and
especially the diseases of dysentery and diarrhoea were more
frequent to affect health of the family members. Dominance of
these diseases was marked in both villages and town. Rural or
urban living of the families has no special discriminating role
to play in effecting greater or lesser incidences of infective
and parasitic diseases. But within the villages prevalence of
such diseases did vary to indicate that some of these were
running relatively higher risk of exposure. These villages
arc Jagnnathpur, Kumarkhali, Kv.sum.ba, Mischintapur and Ukhila.
The families 6T these villages should get highestpriority for
proper medical care. To draw attention to these five villages
should not imply that other villages do not require such care.
Villages in general demand proper medical help for rooting; out
the diseases once and for all. Muslim families of these five
villages were, on the other- hand, affected relatively more with
infective and parasitic diseases like dysentery and diarrhoea.
The Muslim community of the area constitutes the focal point
for immediate health services.
'
Family incidence rate of diseases of respiratory system
happened to be in second highest order in both rural and semi
urban areas. Of these diseases incidences of cold and flu
were most frequently reported on family level. Amend the
members of the families the diseases of respiratory system
ranked second in order of importance. Rural or urban living
of the families did matter little to influence higher or lower
spread of these diseases among their members. But among the
villages there existed variations in family incidence rates
for respiratory system-linked diseases. In this respect the
families of village Jagannathpur, village Nischintapur, village
Kumarkhali, and village Ukhila may be again referred as a
relatively more affected group. In these villages prevalence
of the disease of flu was very marked. In the remaining villages
the disease of cold was more frequent on family level. Thus,
it becomes clear that the local families had mostly either cold
or flu as prevailing disease among them and accordingly whatever
appropriate medical attention is required to tackle these diseases
,../26
: 26 :
has to be organised early in the very interest of the progress
of local health welfare.
One additional point is made"here.
The town families showed relatively higher incidences of the
disease of cold than their rural counterparts and naturally
they can not be left behind in the plan and programme of
necessary health services for respiratory system-linked diseases.
Diseases of skin and subcutaneous tissues had a place of
third importance among the rural or town families. It is pointed
out here that of various kind of skin-diseases the families in
Question reported the disease of itch most frequently. This
was true for both rural and serai-urban settlements. It seems
that skin-linked diseases were not posing as a potent source of
any serious health problems to the local families. With their
existing way of life and living under tropical condition the
members of the families are expected to suffer from 'itch
*
and remedy for which needs generally no serious medical surveillance.
In spite of this fact the families of the following villages
may need proper medical care for curing trouble ’itch
:
*
1) Kumarkhali,
2) Hischintapur, 3) Hogalkuria, and 4) Kusumba. In these villages
30 io 40/ of families reported physical sickness due to ’itch
.
*
In town area the families affected with skin-disease like ’itch'
was of course, not high.
Family incidence rates of disease-group other than the above
three dominant groups were low and as such no detailed discussion
has been made here. But these rates should not be overlooked,
since they indicate to what extent the members of the families
rural or urban were exposed to various kinds of physical illness
and morbidity condition. Here attention is especially drawn to
the family incidence rates for (a) diseases of digestive system,
and (b) diseases of musculo-skeletal system. Both the rates were
decidedly higher in town areas and this Indicates that town
families need greater medical care to tackle their health problems
generated by the diseases of these two disease-groups (IX and XIII)
only.
In human society the family remains ever to be a part of
the individual and the individual is an integral part of the
family. And as such any sick perssn is never alone in his/her
suffering and no diseased person is an isolated individual.
In this social situation whatever assessment of health condition
on the strength of individual sick persons may be made, the same.J
can hardly depict family centered dimention of health problems, '
In any attempt for forward planning for health services in atay '
population group as has lately been urged by the World Health,/
Organisation, adequate knowledge about Family Health problem^3
is sine qua non. In this direction the present study indica/tes
a useful methodology in examining the role of family in comtmunJ+v
and/or national health.
'
y
TABLE 1 Family Incidence Rate* of different Disease-groups for the Families surveyed in villages and semi-urban
areas of Sonarpur P.S., 24-Parganas, V.est Bengal, 1974-75
Rural area (nsiae of the Village)
Diseasegroup(WH0
catagories)
(1)
r. ipd
■BonChowhooghly hati
(2)
(5)
44.8
26.0
Dingalpota
(4)
Hogal- Jagankuria nathpur
Jayeiipur
(5)
(7)
(8)
(6)
KumarkhalsL
37.4
0
97.4
0
53.1
0
89.3
0
0
0
0
0
Kusumba
Nisc- RamUkhhintg- chan- ila
pur
drapur
All
Rural
areas
Semi-Urban All
area
Semi
liiLA •“
Urban
CHI
LDAL areas
(9)
(10)
(11)
(12)
(13)
(14) (151
(16)
100.0
82.3
99-1
0
60.1
67.6
0
0
50.7
0
59.2
0
72.7
0
0
0
0
1.4
0
2.1
1.7
0
0.9
0
0
0
0
0
0
0.4
0
2.1
N
0
0
48.7
0
IIIENHD
1.9
1.5
0.6
IV DBBO
0.9
0
0
0
0
1.0
0
0
0
MD
1.7
0
2.3
0
0
0
0
0
0
0
0
0
VI DVS
1.4
1.4
3.2
0
0
13.5
0
0
0
4.7
0
1.5
2.4
1.7
VIIDCS
2.1
35.8
0.6
28.8
0
63.2
4.2
20.8
0
29.0
0
4.7
15.9
0
6.2
29.2
7.5
41.6
4.5
36.9
IX DDS
4.7
4.5
4.5
3.5
27.7
2.8
0
VIIIDKS
2.9
51.9
0
0.7
0
1.9
0
0
0
0
3-5
0.8
9-5
1.0
XI CPCP
1.7
0
3.1
2.1
7.6
X
0
0
XIIDST
14.1
12.8
XIIIDMCT
1.4
0
17.5
4.6
3.2
35.5
0
0
0
0
0
0
II
V
DUGS
XIV CA
XV DPNI-I
XVISILC
0
92.1
83.7
0
94.2
XVIIACV
0.5
1.4
0
85.5
0
No. of Fami
lies surveyed
708
562
156
179
35.1
0
0
15.3
0
0
0
3.1
0
27.1
40.1
0
0
0
0
0
0
45.6
0
94.8
0
88.1
0
86.5
0
100.0
0
1.0
0
0
0
83.5
1.2
193
96
362
124
77
170
Disease-groups»
IPD
I.
*
II.
Ni
EHMD:
III.
49.3
0
0
Infective and Parasitic Diseases (code 000-136)
Neoplasms (140-239)
Endocrine, Nutritional, and metabolic Diseases (240-279)
35.4
0
0
6.0
39.3
8.6
0
5.3
0.6
0
0
0
0
0
0.7
0
0.9
0
30.6
27.0
29-7
22.2
22.2
22.8
22.5
0
37.7
0
2.0
5.8
3.8
4.8
0
9.4
0
0
0
0
0
0
0
0
0
99.6
0
86.8
0
0
100.0 89.3
0
94.2
0
0.4
1.7
1.0
1.4
229
2856
293
290
585
0
0
- 2 -
BISKASE - CROUPS
Table 1.
IV.
DBBO
:
Diseases of Blood and Blood forming organs (280-289)
V.
MD
;
Mental Disorders (290-315)
VI.
MS
t
Diseases of Eervous System and Sense Organs (320-589)
VII.
PCS
;:
Diseases of Circulatory System (390-458)
VIII. DBS
;:
Diseases of Respiratory System (460-519)
IX.
DDS
;s
Diseases of Digestive System (520-577)
X.
BUGS
;i
Diseases of Urino-Genital System (580-629)
XI.
CROP
;i
Complications of Pregnancy, Child birth and the Puerperium (630-687)
XII.
DST
;:
Diseases of Skin and sub-cutaneous tissues (680-709)
XIII. SiCT
i:
Diseases of the i-iusculo-skeletal System and connective tissues (710-738)
XIV.
CA
;:
Congenital Anomalies (740-759)
XV.
DPiffii
!1
Certain Diseases of peri-natal morbidity and Mortality (760-779)
xvi. sue s1
Symptoms and Ill-defined conditions (780-796)
;:
Accidents, poisinings and viloence (8OO-999)
XVII. ACV
Family Incidence Rate = 100X number of families affected by the particular disease group
Total number of families
Family Incidence Rate of one of Four Cominant Disease-groups and the most frequently
reported diseased per disease-group in villages and semi-urban areas of Sonarpur P.S.
2.4-Parangas,. West Bengal, 1974-19.75.
Rural (R) Semi
Urban (U) area
Rate of Family Incidence
Infective and Parasitic
diseases-Group I
Most frequently reported
diseases of the Group I
(2)
Dysentery
Diarrhoea
(1)
(2)
(5)
(4)
1. Bonhoogly (B)
(l!o. of families! 708)
44.8
15.1
0
2, Chowhati (R)
(jo of families!
26.0
15.2
-
3. Bingalpota (R)
(jo. of familes
156)
48.7
20.0
*4 Hogalkuria (R)
(no of families
179)
57.4
*=
11.7
5. Jagannathpur (R)
(No of families! 193)
97.4
47.1
-
6. Jayenpur (R)
(No, of families.!
55.1
32.5
-
7. Kumarkhali (R)
(No. of families! 562)
89.8
-
57.4
8. fusumba (it)
(No. of families! 124)
100.0
-
66.1
*9 Nischintapur (R)
(No. of families: 77)
72.7
44.1
-
10. Ramahandrapur (R)
(No. of Families! 170)
82.J
53.5
-
11. Ukhila (R)
No. of families?
99.1
-
47.2
All Rural Areas
(ilo. of Families: (2856)
60.1
16.4
14.7
1. Elachi (U)
No. of Families!
67.6
15.2
-
(295)
2, Jagaddal (U)
No. of Families!
50.7
25.2
-
(290)
All Semi-Urban Areas
No. of Families: (585)
59.2
19.2
•
All Areas
(Rural + Semi-Urban)
Ho. of Families! (5459)
59.9
16.9
12.2
1.
562)
>6)
229)
TABLE 5
Family Incidence Rate of one Four Dominant Disease - groups and the most frequently
reported diseased per disease-group in villages and semi-urban areas of Sonarpur P.S.,
24-Parangas, West Bengal, 1974=1975
Family Incidence Rato of
Fa
Rural/
Semi-Urban
area
Diseases of
Respiratory
system (VIII)
Most frequently
reported disease
of the Group VIII
Cold
Flu
(2)
(3)
(4)
1. Bohoogly
51.9
26.8
-
2. Chowhati
55.8
51.8
-
5, Dingalpota
28.8
26.5
-
4. Hogalkuria
27.4
23.5
-
5» Jagannathpur
65.2
-
62.7
6. Jayenpur
20.8
7.3
-
7. Kumarkliali
35.1
-
52.6
8. Kusumba
29.0
-
26.6
9. Rischintapur
49.3
-
48.0
10» Ramchandrapur
15.9
12.9
11. Ukilia
35.4
-
34.9
ALL RURAL AREAS
29,2
16.8
15.6
1. Elachi
6
*
41
29.7
2. Jagaddal
36.9
33.4
-
ALL SEMI-URBAH AREAS
39.3
51.6
-
ALL AREAS
30.9
19.3
11.3
(1)
table 4
Family Incidence Bate of one of Four Dominant Disease-groups and the
most frequently reported disease per disease-group in villages and
semi-urban areas of Sonarpur P.S.; 24-Parganas, W. Bengal 1974-1975
Family Incidence Rate of
Rural/
Semi-urban
area
(1)
1*
Bonhoogly
Diseases of Skin and sub
cutaneous Tissues (Xxl)
Most frequently
reported disease of
the Group XII
Itch
SK.disease of
dermatitis
(2)
(3)
(4)
-
1
*
14
6
5*
2, Chowhati
17
5
*
10,5
-
J. Dingolpota
8
*
12
10,9
-
4. Hogalkuria
5
*
33
4
*
27
5*
3.1
2.6
-
27.1
1
*
27
-
40.1
40.0
-
8. Xusumba
30.6
4
*
27
-
9*
Nischintapur
37
7
*
5
*
32
-
*
20
iiamchandrapur
27.0
*
11
Ukhila
29.7
29,7
?
ALL RURAL AiibAS
22.2
16.2
8
*
0
* Elachi
1
*
22.2
-
-
22.8
11.4
-
3
*
22
14.4
0.6
Jagannathpur
6. Jayenpur
7*
2*
Xukarkhali
Jagaddal
ALL SEMI Urban akeas
*
12.9
In Elachi Skin disease of Abscess was reported most frequently
*
Inc* Hate: 3.4)
*
(Fam
TABLE 5
Family Incidence Rate of one of Four Dominant Disease-gj-oupg anfl ^he most
freouently reported disease per disease-group in villages and semi-urban
areas of Sonarpur P.S.; 24-?argana, W.^engal, 1974-1975
Family incidence Rate of
Rural
semi-urban
area
Symptoms and
Ill-defined
conditions(XVl)
(1)
(2)
(3)
(4)
1. Donhoogly
92.1
-
90.7
2. Chowhati
83.7
-
80.1
3. DingoIpota
Most frequently reported
disease of the Group XVI
Cough
Fever
94.2
46.8
-
4« hogalkuria
85.5
=
75.4
5. Hagannathpur
45.6
-
27.5
6. Jayenpur
94.8
-
66.7
7. Kumarkhali
88.1
75.4
-
8. Kusumba
86.3
6.4
-
9. Mischintapur
100.0
71.4
-
10. Ramachandrapur
83.5
-
-
il. ukhila
99.6
93.0
-
ALL RUTuiL ARhlAS
86.8
24.3
51.5
1.
Elachi
100.0
-
65.5
2.
Jagaddal
88.3
-
77.6
ALL SEMI URBAN AREAS
94.2
-
71.5
ALL AREAS
88.1
18. 9
54.9
X
BLACHI - PAIKPARA $’4'ARD XIV)
i Hindu.
J __ . .
\
■
Muslim Total;
t
:
t
i
i
i
! LI I
Im :
p I
je
?r •
i
i
i
i
i
Area :
Population :
Under :
995 Sq.Miles
1815
Siajpur Municipa
lity.
Post Office : Narendrapur.
P. S. :
Sonarpur.
West Bengal.
2
1
SI.No.
1.
Muslim
1.
336
2.
Ghosh
2.
75
3.
Paddaraj
3.
625
4.
Bihari
4.
110
5.
Kayesta
5.
104
6•
Ori a
0.
46
7.
Paul
7.
85
8.
Brahaman
8.
105
9.
Other (Nepali,
Belaspuri,etc) 9.
327
T
0
t
a
1
1813
Population chart of the Selected Villages.
1. Elachi - Paikpara
1.
1813
2. Jagadd al
2.
2194
3. South Jagaddal
3.
3805
. 4.
3150
5.
2000
6. Bonhoogly
6.
3000
7. Llkhila
7.
2142
8. Jaganathpur - Nichintapur
8.
1897
9. Kumrakhali
9.
3624
4. Poleghat
5. Rarachandrapur
Dinghntpota
SI.No.:
Names of the Village leaders.
Age.
Occupation
1.
Sri Gopal Oh. Ghosh
52
Business
9o
"
Ananda Mohan Chatterjee
40
Teacher
(Service)
3.
"
Anil Kumar Das
53
Business
4.
*’
San tosh Ku. Chatterjee
50
Business
5.
"
Sambhu Chatterjee
55
Business
Sl.Noi
Name of Remarkable Places (ISlachi - Paikpara)
1.
;
Si tala Monair
2.
:
Gafci baba than
3.
:
Ganga Bala
4.
;
Matri Mandir
5.
:
Amiya Charitable Hospital
6.
•
•
jilechl & Ramchandrapur Milan Sangha and
Free Primary School (V. B. F. P. School)
DlachiiDighi
7.
8.
1
Bibi Marzid
P1ST & PRBS3NT HI STORY.
Rlachl - Paikpara is a Village (7/ard) and ar the
guidance of Rajpur Municipality.
It is situated at a
distance of Four miles from the Rajpur Municipality.
Coming in contact with the inhabitants of the
village or ward (Rlachi-Paikpara I came to learn that
this village or ward was covered with thick bushes and
jungles fifteen years ago.
tion was not remarkable.
Then the number of popula
Cultivation was their only
They produced Paddy, wheat, jute, and jobs.
occupation.
Cows, sheeps, buffaloes and dogs were their domestic
Most of them were illiterate.
pets.
remarkable School and dispensary.
There were no
As communication
bus route was there.
But after the development of this area the
number of population of Hachi-Paikpara increased
rapidly.
Now there was no sign of bushes and thickets
at all in this area.
Nov.' different kinds of castes are
permanently living here,which have been mentioned in
Table No. '2'.
Nov/ doctors are available here to stand by the
people of this village with their medicine.
a permanent
twelve beded hospital is here.
Direct communication has been arranged in
between Rajpur and Calcutta.
There are Riekshawas and
Trucks in its surroundings.
By the side of this village
there runs the high way of Rajpur and Calcutta over
which trucks and buses are always plying.
By the side
of this village a dead gangss is here.
There are some kinds of social associations
in this village in the shape of clubs.. Mandir, Liar aid etc.
to make life more beautiful.
The locality is very large.
People :
Now its
I have studied the people
population is vast.
and found several castes living in the locality.
Paddaraj is dominant group of this village.
The people of this place are very simple
Most of the villagers of this
in their dresses.
village wear’ only a piece of cloth, lungi and dhuti.
The female members wear Shari and blouse.
Generally
the school going children wear shorts and bush shirts.
Huts, Lanes
and bye-lanes:
Most of the villagers are very poor.
are some pucca buildings in the village.
There
Most of
the villagers live in simple huts and cottages whose
walla are made of mud.
The roof of the huts and
cottages are covered by straws.
The huts are
arranged in a line by the side of the paces roads.
Almost all the hut§ of this village are situated in
Most of the huts do not have
a regular series.
The doors of the huts are very small.
windows.
Village
economy j
I should like to discuss economic condition
of th e vi Hager s.
There are three kinds of villagers in this
village.
Land holders,
(1)
(3) Day labourers.
(2) Service holders,
Land holders are not poor, they
are rich people and service holders are middle group,
they neither poor nor rich but combination of both.
But the day labourers are very very poor,
they are
in large number, most of the villagers are belonging
in this Group.
occupation.
They go without any particular
Most of the people are halffed and
have to starve.
Faith on
God and
Alla :
All villagers have faith on God or Alla.
A Gasi baba Marzid is here, it is very famous to
all the villagers.
xts naduli is very remarkable
to the patients of Haokta Amasaya, Nali etc.
All
castes are equally treated in the Gazi Baba Marzid.
Sources of
water and
the conditi on of
Lavatory
or Latrine :
Tube wells, little ponds (Soba) and Ganganali
are the main sources of water of these villagers.
Most of the villagers have .their own purchased tubewells and little ponds (doba).
Most of the villagers
bath in these ponds and utilise their tube-wells for
the purpose of drinking water.
Besides these, there ere some government’s
tube-wells in this village.
According to population
these are not sufficient.
Coming in contact with the villagers of the
village or ward (Blachi) I came to learn that the
•“avatory or Latrine is very in sufficient according
to total families of this village.
There are two kinds of Lavatories and -^atrines
in this area, one is Pacca (Building), 2nd is kache.
(hole).
In every educated or literate families have
their own pacea lavatory or latrine.
children utilise it.
Ihey and their
Some families, literate and
Illiterate both utilise or use the kacha lavatory or
latrine.
But most of the villagers (illiterate) use
they use the paddy fields, nearest field, etc. and
their children the village road, they are habituated.
DISEASE
Table 1.
*
IV
DBBO
V.
ND
VI.
DNS
:
VII.
DCS
:
VIII.
DRS
IX.
DDS
X,
DUGS
XI.
CPC?
XII.
DST
Mental Disorders (290-515)
:
Diseases of Nervous System and Sense Organs (520-589)
Diseases of Circulatory System (590-458)
:
Diseases of Respiratory System (460-519)
Diseases of Digestive System (520-577)
:
:
Diseases of Urino-Genital System (58O-629)
Complications of Pregnancy, Child birth and the Puerperium (65O-687)
:
DECT
XIII.
GROUPS
Diseases of Blood and Blood forming organs (280-289)
:
:
Diseases of Skin and sub-cutaneous tissues (680-709)
:
Diseases of the Kusculo-skeletal System and connective tissues (710-758)
Congenital Anomalies (740-759)
XIV.
GA
XV.
DPld'i
:
XVI,
SILC
:
Symptoms and Ill-defined conditions (780-796)
XVII.
ACV
;
Accidents, poisinings and viloence (800-999)
s
Certain Diseases of peri-natal morbidity and Mortality (760-779)
Family incidence Rate = 100X number of families affected by the particular disease group
Total number of families
TABLE 2
Family Incidence Hate of one of Four Cominant Disease-groups and the most frequently
reported diseased per disease-group in villages and semi-urban areas of Sonarpur P.S.,
24-Parangas, West Bengal, 1974-1975_____________________________________________________
Rural (R) Semi
Urban (u) area
Rate of Family Incidence
Infective and Parasitic
diseases-Group I
1.
Most frequently reported
diseases of the Group I
(2)
Dysentery
Diarrhoea
(1)
(2)
(5)
(4)
1. Bonhoogly (r)
(No. of families! 708)
44» 8
15.1
-
2. Chowhati (R)
(No of families!
26.0
15.2
-
5. Dingalpota (R)
(No. of familes
156)
48.7
20.0
-
4. Hogalkuria (r)
(No of families
179)
57.4
-
11.7
5. Jagannathpur (r)
(No of families: 195)
97.4
47.1
-
6. Jayenpur (r)
(No. of families:
55.1
52.5
-
7. Kumarkhali (r)
(No. of families: J62)
89.8
-
57.4
8. Kusumba (R)
(No. of families: 124)
100.0
-
66.1
9. Nischintapur (R)
(No. of families: 77)
72.7
44.1
-
10. Ramahandrapur (R)
(No. of Families: 170)
82.J
55.5
-
11. Ukhila (R)
No. of families:
99.1
-
47.2
All Rural Areas
(No. of Families:(2856)
60.1
I6.4
14.7
1. Elachi (u)
No. of Families:
67.6
15.2
-
(295)
2. Jagaddal (U)
No. of Families:
50.7
25.2
-
(290)
All Semi-Urban Areas
No. of Families: (585)
59-2
19.2
-
All Areas
(Rural f Semi-Urban)
No. of Families: (5459)
59.9
I6.9
12.2
562)
96)
229)
TABLE 5
Family Incidence Rate of one Four Dominant Disease - groups and the most frequently
reported diseased per disease-group in villages and semi-urban areas of Sonarpur P.S.
24-Parangas, West Bengal, 1974-1975
Fa
Rural/
Semi-Urban
area
Family Incidence Rate of
Diseases of
Respiratory
system (VIII)
Most frequently
reported disease
of the Group VIII
Cold
Flu
(2)
(3)
(4)
31.9
26.8
-
2. Chowhati
55.8
31.8
-
5. Dingalpota
28.8
26.3
-
4. Hogalkuria
27.4
23.5
-
5. Jagannathpur
63.2
-
62,7
6. Jayenpur
20.8
7.3
-
-
52.6
(1)
1, Bohoogly
7• Kumarkhali
35.1
8. Kusumba
29.0
9*
Nischintapur
49.3
-
26.6
48.0
10a Ramchandrapur
15.9
12.9
-
11. Ukilia
35.4
-
34.9
ALL RURAL AREAS
29.2
16.8
13.6
la Elachi
41.6
29.7
-
2. Jagaddal
36.9
33.4
-
ALL SEMI-URBAN AREAS
39. J
31.6
-
ALL AREAS
30.9
19.3
11.3
TABLE 4
Family Incidence Hate of one of Four Dominant Disease-groups and the
most frequently reported disease per disease-group in villages and
semi-urban areas of Sonarpur P.S.; 24-Parganas, V/. Bengal 1974-1975
Family Incidence Rate of
Rural/
Semi-urban
area
Diseases of Skin and sub
cutaneous Tissues (XII)
Host frequently
reported disease of
the Group XII
Itch
SK,disease
dermatitis
(2)
(5)
(4)
1. Bonhoogly
14.1
5.6
-
2, Chowhati
17.5
10.5
-
J. Dingolpota
12.8
10.9
-
4. Hogalkuria
53.5
27.4
-
5. Jagannathpur
3.1
2.6
-
6. Jayenpur
27.1
27.1
-
7. Kukarkhali
40.1
40.0
-
8. Kusumba
30.6
27.4
-
9. Nischintapur
57.7
32.5
-
20. Ramchandrapur
27.O
11. Ukhila
29.7
29.7
?
ALL RURAL AREAS
22.2
16.2
0.8
1. Elachi
*
22.2
-
-
2. Jagaddal
22.8
11.4
-
ALL SEl'H URBAN AREAS
22.5
14.4
0.6
(1)
*
12.9
In Elachi Skin disease of Abscess was reported most frequently. (Fam.
Inc, Rate: 5.4)
TABLE 5
Family Incidence Hate of one of Four Dominant Disease-gjoupg an(j ^he most
frequently reported disease per disease-group in villages and semi-urban
areas of Sonarpur P.S.; 24-Pargana, W.Bengal, 1974-1975
Family Incidence Rate of
Rural
semi-urban
area
Symptoms and
Ill-defined
conditions(XVl)
(1)
(2)
1. Bonhoogly
92.1
2. Chowhati
Most frequently reported
disease of the Group XVI
Cough
Fever
(5)
(4)
90.7
85.7
-
80.1
3. Dingolpota
94.2
46.8
-
4. Hogalkuria
85.5
-
75.4
5. Hagannathpur
45.6
-
27.5
6. Jayenpur
94.8
-
66.7
7» Kumarkhali
88.1
75.4
-
8, Kusumba
86.3
6.4
-
9» Nischintapur
100.0
71.4
-
10. Ramachandrapur
83.5
-
-
11. Ukiaila
99.6
95.0
-
ALL RURAL AREAS
86.8
24.5
51.5
1.
Elachi
100.0
-
65.5
2.
Jagaddal
88.3
-
77.6
ALL SEMI URBAN AREAS
94.2
-
71.5
ALL AREAS
88.1
I8.9
54.9
TABLE 6
Socila Group (community)-wise Family Incidence R§te of different Disease-groups
for the families surveyed in villages and semi-urban areas, W. Bengal 1974
DISEASE-GROUP
Social
group
(community)
1.
I
Hindu
40.5
1.6
Muslim
2.0
Christian
49.7
58.6
All Groups
III
IV
VI
(WHO CATAEGORIES)
VIII
VII
IX
X
XII
XIII
XVI
XVII
TOTAL
Families
305 (100.0)
1. Village Bonhoogly
(2)
(3)
1.5
1.0
5.6
29.6
5.5
1.6
14.1
0.5
91.2
2.5
1.4
2.6
55.6
4-5
1.4
14.4
2.3
95.1
0.7
.0
2.5
4.10
0.5
2.5
20.4
4.1
4.1
15.2
2.3
91.3
.0
55 (100.0)
44.8
1.9
1.70
I.42
•9
51.9
4.7
1.7
14.1
1.4
92.1
0.3
7<?8 (100.0)
Hindu
25.2
0.9
54.5
4.6
0.7
16.6
4.8
84.7
0.9
0
2.1
15.4
55.8
0
4.5
0
0.7
46.1
17.3
0
4.6
84.6
83.7
1.4
0
1.4
549 (ffiOO.O)
6I.5
26.0
1.5
0
1.4
2.2
Muslim
%oups
1.5
0
1.5
13 (100.0)
562 (100.0)
Hindu
48.7
0.6
0
5.2
X Village Bingalpota
0.6
28.8
4.5
1.9
12.8
5.2
94.2
0
(
*
155
100.0)
4. Village Hogalkuria
28.9
2.5
0
348 (100.0)
2,. Village Chowha ti
0
* 1 Christian family was also found in the village
Hindu
59-8
0
0
0
5.1
34.4
0
83.1
0
128 (100,0)
Christian
51.5
0
0
0
4.1
25.7
4.1
0
31.5
0
86.4
0
51(100.0)
All Groups
57.4
0
0
0
5.5
27.4
2.8
0
35.5
0
85.5
0
179 (100.0)
Hindu
66.7
0
0
0
X Village Jagannathpur
0
55.5
0
0
6.7
0
100.0
0
15
(100.0)
41.0
0
178
(1010.0)
45.6
0
195
(100.0)
Muslim
100.0
0
0
0
0
64.O
0
0
2.8
0
All Groups
97i4
0
0
0
0
65.2
0
0
3.1
0
•
TaHLE 6 (contd.)
Social
Group
(community)
•
B ■
DISEASE-GROUP (WHO CATEGORIES)
I
III
IV
VII
VI
VIII
IX
X
XII
XIII
XVI
XVII
1.7
0
67 (100.0)
0
1 (100,0)
96 (100.0)
TOTAL
Families
6. Village Jayenpur
(1)
(2)
Hindu
49.5
Muslim
64-3
Christian
0
1.7
4.7
•6.2
28.6
(3(
0
3.6
28.6
0
95.7
0
0
0
0
25.0
0
0
0
35.7
0
4.7
0
0
100.0
0
100.0
0
0
96.4
0
4.2
20.8
3.1
2.1
27.1
0
94.8
1.0
28 (100.0)
All Groups
55.1
0
1.0
15.5
Hindu
88.6
0
0
0
7. Village Kumarkhali
0
0
35.4
0
88.6
0
158
(ioo.o>
90.7
0
0
0
0
0
0
25.9
51.0
0
Muslim
0
87.7
0
2o4
(100.0)
0
0
0
0
0
0
40.1
0
88.1
0
362
(100.0)
All Groups
34.8
8.. Village Kusumba
Hindu
100.0
0
0
0
0
50.0
16®7
0
0
0
100.0
0
6
(100.0)
Muslim
100.0
0
0
0
0
28.0
15.2
0
32.2
0
85.6
0
118
(100.0)
All Groups
100.0
0
0
0
0
29.0
15.3
0
30.6
0
86.3
0
124
(100.0)
Hindu
0
0
0
9. Village Nischintapur
0
0
0
49.3
36.0
0
100.0
0
0
0
0
0
50.0
0
0
100.0
0
100.0
0
75
2
(100.0)
Muslim
75.5
50.0
All Groups
72.7
0
0
0
0
49.3
0
0
37=7
0
100.0
0
77
(100.0)
Hindu
83.2
2.1
0
2.1
2.8
10.5
5.6
0.7
26.6
9.1
84.6
0
143
(100.0)
Muslim
78.0
3.9
0
18.7
15.0
44.6
3.9
0
29.8
11.3
78.0
7.6
27
(100.0)
All groups
82.3
2.3.
0
4.7
4.7
15-9
5.3
0.6
27.Q
9.4
83.5
1.2
170
(100.0)
(100.0)
10. Village Ramchandrapur
TABLE 6 (ccntd.)
Social
Group
(community
DISEASE-GROUP (WHO CATEGORIES)
I
III
VI
IV
VIII
VII
IX
11 a Village Ukhila
(2)
0
12.5
C
X
XII
XIII
xviX
mi
0
0
0
100.0
0
8
(ifflO.O)
TOTAL
Families
(1)
Hindu
87.5
.0
0
0
0
Muslim
99.5
0
0
0
0
56.2
0
0
50.0
0
99.o
0
221
(100,0)
All Groups
99.1
0
0
0
0
55.4
0
0
29.7
0
99.6
0
229
(100.0)
Hindu
47.1
0.4
0.6
1.4
2.2
51.1
5.9
0.8
20.1
2.8
88.7
0.7
1609
(100.0)
Muslim
ao.9
0.7
0.7
1.7
1.1
5.0
1.0
84.1
0.4
54.5
0.9
0
1.8
2.8
5.7
0.5
2.8
25.5
Christian
58.4
15.0
21.5
0.9
88.0
0
1159
108
(100.0)
All Groups
60.1
o,9
6.2
29.2
5.5
0.8
22.2
2.0
86.8
0.4
2856
(100.0)
Hindu
51.2
2.1
0.4
1.7
4.5
*1 Muslim family was also found
0.7
22,8
5-8
88.2
1.0
*
289
(100.0)
Hindu
66.0
1.5
1.8
8.9
15. Semi-urban Elachi
10.5
0.9
45.5
16.5
6.5
100.0
1.8
224
(100.0)
Muslim
72.5
1.4
0,5
0
4.5
2.9
56.2
7.2
1.4
40.6
4.5
100.0
1.7
69
(100.0)
All Groups
67.6
1.4
0.5
2.4
7.5
41.6
9.6
1.0
22.2
5.8
100.0
1.7
295
(100.0)
Hindu
57-7
1.8
0.4
1.7
6.4
59.8
8.8
0.8
20.1
4.9
515
(100.0)
71.4
1.4
0
4.5
2.8
55.7
7.1
1.4
40.0
4.5
95.4
100.0
1.4
Muslim
1.4
70
(100.0)
All Groups
59.2
1.7
0.4
2.1
6.0
59.5
8.6
0.9
22.5
4.8
94.2
1.4
585
(100,0)
(5)
All Villages (Rural^1
(100,0)
12. Semi-urban Jagaddal
57.0
7.6
All Semi -urban areas (urban)
RN/agn,
APPENDIX A
1.
TOTAL HEALTH CARE PR03ECT
2.
Sponsored by Banerjee Charitable Try3t, Calcutta
3.
Family Planning Foundation, New Delhi
4.
PRELIMINARY CENSUS
5.
Narendrapur, wr parganas, West Benga.
6.
Tribe/Caste
7. Religion
„ u
( Owned
8. House j Rentec,
9.
village :
10.
Municipal/Panchayat
11.
T. L. No.
12.
Police Station
13.
District
14.
House Nq.
15.
Family No.
16.
SI. No.
17.
Name of Individual
18.
Sex
19.
Age
20.
Year of Birth
21.
Relation with Household
22.
Place of Birth
23.
Marital Status
: Codes : UM for unmarried; M for married; W for Widowed
D for divorced
I
25.
Illiterate
Literate
Standard
Occupational Status : Codes 5 E for Farmer; ED for Earning Department;
D for Dependant
Main
26.
OCCUPATION : (
( Subsidiary
27.
REMARKS
28. Recorder :
29. Date :
aprnioR a
% TOTAL HEALTH CARE PROJECT
2.
Spansoffad by Uansrjea Charitable “ruat» Calcutta
3.
Family Planning Foundation, New Delhi
4.
PRELIMINARY CENSUS
5.
Narendrapur, wr parganas, Ueat Bsnga.
6.
Tribe/Caete
7.
3.
Raligicn
( Owned
House J Renfced
9.
village t
10.
Municipal/Aandiayat
11.
T. L. No.
12.
Police Station
13.
District
14.
House f'b.
15.
Family No.
16.
Si. No.
17.
Name of Individual
18.
Sax
19.
Age
20.
Year of Birth
21.
Halation with Household
22.
Place of Birth
23.
Marital Status
* Codes s UM for tr.srarrled? M for married? U for Widowed
D for divorced
!
Illiterate
Literate
Standard
25. Occupational Status s Codes s E far Farmer? ED for Earning Department?
D far Dependant
f”ain
!
■■
Subsidiary
27.
REMARKS
28. Recorder :
29. Date i
append ex a
1.
total health care project
2.
Sponsored by Banerjee Charitable Trust, Calcutta
3.
family Planning foundation, Nau Delhi
b. PRELIMINARY CEiffiUS
5.
Narendrapur, str parganas, Wsat Denga.
6.
Tribc/Casto
7.
Religion
0. Hous® | RGntBd
9.
villaga *
1D. Runicipal/Rahchayat
11.
T.L. No.
12.
Police Station
13.
District
14.
House Nn.
15.
Family No.
16.
SI. No.
17.
fferao of Individual
18.
Sox
19.
Ago
20.
Year of Birth
21.
Relation tai th Household
22.
Place of Birth
23.
Marital Status
» Codes 5 UM for unmarried; H for married; U for Widowed
0 for divorced
!
Illiterate
Literate
Standard
25. Occupational Status 2 Cedes « E for farmer; ED for Earning Department;
D for Dependant
J Kain
26. OCCUPATION s i
! Subsidiary
27. flEPIARKS
28. Recorder s
29. Date t
fribtiiCaste :
House
leligion :
f Owned :
TOTAL HEALTH CARE PROJECT
( Rented ;
SPONSORED JOINTLY BY
BANERJEE CHARITABLE TRUST, CALCUTTA
FAMILY PLANNING FOUNDATION, NEW DELHI
PRELIMINARY CENSUS
NARENDRAPUR, 24 PARGANAS
WEST BENGAL
Village :
55b.
Municipal/Panchayet:
House No :
T. L. No.:
Family No. :
Police Station :
District:
APPENDIX B
1.
FAMILY SCHEDULE FOR BASIC HEALTH
2,
Name of the Hamlet
3.
Door No.
4.
Religion & Community
5.
M. No.
6.
Name of Panchayaf'
7.
Block
8.
Date of Surve/y
9.
Type of House s Pucca/Kutcha/Hut
10.
0wn House/Rented
11.
Name of the Owner
12.
Electrified • Yes/No.
13.
Schedule No.
14.
Name of Family Members
15.
Relationship
16.
Year of Birth
SERVICES
flj7. Sex
18.
Marital Status
19.
Education Status
20.
Occupation
21.
Residential status
Scar Marks of Pox marks
$
22.
NSEP
v
Date of vaccination
|
X
fiefee
X
X
Verification result
X
BCG
IX
I
P.V.
p y
Date
j
23.
P.V.
p y
If already vaccinated '..'hen
i/
- .•
If not,a. date of oVaccination
Whether children under 5 years had D.T.P
T
) 1
If not date of immunization ( II
( III
25. Remarks
contd.... 2/-
2
FA Fl ILY
PLANNING
1.
No.
2.
Eligible1 couple (Serial No. of Husband & Wife)
3.
No. of living children including those living elsewhere
4.
( Age
Youngest child (
\ Sex
5«
Date of nature of termination of last conception
6.
Whether husband or wife uses any F.P. method after last live birth
7.
If yes what F.P, Eethod used and when did he/she first start using it
after last live birth ? Where did he/she take it ? or if 1N' reasons.
{(Type of services
8. ACTIVITIES CARRIED OUtf
/
s
•
1. Education activities
2. Supply of cont raceptives
3. I.U.C.D.
4. Tubectomy
6. Vasectomy
6. Follow up
11 Round Date
( III Round Date
{ IV Round Date
9. Remarks
HOSPITAL SERVICES AND CONCEPT ABOUT 0 IS EASES jk TREATMENT
1.
Round
2.
Date of visit
3.
What is the concept
about occurence of
diseases in family
j
God-sent ?
)
Other occult reason ?
Scientific, e.g. intemperate habits, insanitary
\ environments, infection etc. etc.
3
ADH
4. Do they go to the Hospital
for treatment ? If, Yes
Other Hospital
Private Practitioner
Occujt
5. If No. what form of
treatment do they seek
(
Homeo Ayrvedic
)■
Local Herbal
How long visiting
6. A D H
What result
Has it changed their concept about helth
ENVIRONMENTAL SAN ITATION
1. PARTICULARS
I
II
III
IV
Source of water supply
Sullage disposal
Disposal of Refuse from House
lllatrine in the House
2. EXISTING CONDITIONS : Within the housa/public source
Type Overhead tahk with tap/distribution tap
Bore well/Open draw well/Other (Specify)
Soak pit/kitchen garden,/Cess pool/Strest drain
open stagnation/No Stagnation.
Method of disposal (Specify
Yes/No. If yes, type of latrines flush out/other
Is the latrins in use
If unused reasons for it
Is there Space for latrine construction: Yes/No
If yes, willingness to construct latrint Yes/No
If there is service type, willingness for its conversion
3. II Round
4. ACTION TAKEN lc RESULT
5. IV Round
6. Signature of Worker
III Round
APPENDIX B
1.
FAMILY SCHEDULE FOR BASIC HEALTH
2,
Name of the Hamlet
3.
Door No.
4.
Religion & Community
5.
M. No.
6.
Name of Panchayai
7.
Block
8.
Date of Survo/y
9.
Type uf House f Pucca/Kutcha/Hut
10.
Own House/Rented
11.
Name of the Ouner
12.
Electrified i Yes/Nn.
13.
Schedule No.
14.
Name of Family Members
15.
Relationship
16.
Year of Birth
SERVICES
47. Sex
18.
Marital Status
19.
Education Status
20.
Occupation
21.
Residential status
82» Sooe-Wacita
$
?
22.
NSEP
J
X
X
X
Scar Marks of Box marks
P.V.
Date of vaccination R y
Gate
Verification result
j
P.V.
R y
Date
IP already vaccinated when
(
(
If not, date of Vaccination
Whether children under 5 years had D.T.P.
) 1
If not date of immunization ( II
{ in
25. Remarks
contd....2/-
-« 2 !-
FAfllLV
1.
PLANNING
No»
2.
Eligible couple (Serial No. of Husband & Wife)
3.
Nou of living children including those living elsewhere|
,
Age
S
Sex
5.
Date of nature of termination of last conception
6.
Whether husband or wife uses any F.P. method after last live birth
7.
If yes what F.P-. Method used and when did he/ahe first start using it
after last live birth ? Where did he/she take it ? or if ’N’ reasons.
(Type of services
ACTIVITIES CARRIED 0
11
Round Date
III
Round fete
IV
Round Dets
1. Educationactivities
2. Supply ofcontraceptives
3. I.U.C.D.
4. Tubectomy
6. Vasectomy
6. follow up
9. Remarks
HOSPITAL. SERVICES ARD CONCEPT ABOUT DISEASES & TREATMENT
1.
Round
2.
Date of visit
3.
What is the concept
about occurence of
diseases in family
Cod-sent ?
Other occult reason ?
Scientific, n.g. intemperate habits, insanitary
environments, infection etc. etc.
-! 3 I-
ADH
4. Do they go to the Hospital
for treaticont ? if. You
Other Hospital
Private Practitioner
Occult
5.
If No. what form of
treatment do they seek
Homeo Ayrvedic
Local Herbal
How long visiting
What result
6. A D H
Has it changed their concept about helth
ENVIRONMENTAL SANITATION
1. PARTICULARS
I
II
III
IV
2. EXISTING CONDITIONS
Source of tester sipply
Sullage disposal
Disposal of Refuse from House
Katrine in the House
Within the housa/public source
'type Overhead tahk with tap/distribution tap
Hope usll/'Jpsn draw uell/Cther (Specify)
Soak pit/kitChen garden/Cess pool/Streat drain
open stagnution/Nc Stagnation.
Method of disposal (Specify
Yes/No. If yes, type of latrine: flush out/other
Is ths latrins in use
If unused reasons for it
Is there Space for latrine construction: Yes/No
If yas, willingness to construct latrint Yes/No
If there is service type, willingness for its conversion
3. II Round
4. ACTION TAKEN & RESULT
5. IV Round
6. Signature of Worker
III Round
APPENDIX a
1.
FAMILY SCHEDULE FOR BASIC HEALTH SERVICES
2„ Nans of the Haalst
3.
Door No.
4.
Religion & Coesnunity
5.
6*
7.
M. No.
Nat® of Panchayatt-
Block
B. Date of Surve/y
9. Type of House * Pucca/Kutcha/Hdb
10.
0«n Hsuso/Renteti
11.
Nam of ths Otncr
12.
Electrified 8 Yes/No.
13.
Schedule Ho.
14.
Name of Family Members
15.
Relationship
16.
Year of Birth
47. Sex
18.
Marital Status
19.
Education Status
33. Occupation
21. Residential status
M«9
aa» Seee"Merke<»^fl»M*frH
22. NSEP
|
|
Scar Marks of Pox marks
P.V.
j
Date of vaccination
X
X
X
|
Sate
Verification result
y
P.V.
R y
Date
lf already vaccinated whan
I
!
If not, data of Vaccination
Uhethor children undsr 5 years had D.T.P.
If not date of irwiunization (II
{in
25. Ramarks
cont d. ...2/-
FAMILY
PtfoKjffiG
1.
Ho.
2.
Eligible coqple (Serial Ho. of Husband & Wife)
3.
Ha. of living childrsn including those living alsetdisrej j.
4.
( Ago
Youngest Child (
\ Sex
5.
Date of nature of termination of last conception
z
6.
thather husband or wife uses any F.P. method after last live birth
7.
If yes what F.P. Method used anc when did ho/aho first start using it
after last live birth ? there did he/sho take it ? or if ’N
* reasons(Type of services
8. ACTIVITIES CARRIED OUT
1. Education activities
2. Supply of contraceotLues
3. I.U.C.D.
4. Tuboctofisy
6. Vasectomy
6. Follow up
I T. Round Date
III Hound Date
IV Round Date
9. Retoarks
HOSPITAL SERVICES AfJD ClEiCEPT ABOUT DISEASES & TREATMENT
1•
Round
2.
Data of visit
3.
idhat is the concept
about occurencs of
diseases in family
God-sent ?
Other occult reason ?
Scientific, o.g. Lntamparate habits, insanitary
environments, infection etc. etc.
3 3<
A OH
4. Do thoy go io the Hospital
for treatment ? If, Yes
Other Hospital
Private Practitioner
Occult
5.
If No, what form of
treatment da they sack
bfestso Ayrvedic
Local Herbal
(
Hou long visiting
| What result
6. A D H
{ Has it changed their concept about helth
environmental sanitation
1. PARTICULARS
8
I
n
III
IV
Source nf watar aqsply
Sullage disposal
Disposal nF Refuss Prexa House
Katrine in the House
2. EXISTING CONDITIONS s Within the htiuse/public source
Typo Overhead tahk with tap/distribution tap
Sara wall/Open draw wsll/Other (specify)
Soak pit/kltchsn gardsn/Csss pool/Street drain
open stagnation/No Stagnation.
Method of disposal (Specify
Yes/No. If yss9 typo of latrines Flush out/other
Is the latrina in use
If unused reasons for it
Is. thsro Spaas for latrine construction: VqbzNo
IF yes9 willingness to construct latrinl Ysb/Nd
If there is service typo, willingness for its con version
3„ U Round
4.
ACTION TAKEN & RESULT
5.
IV Round
6.
Signature of Worker
III Round
APPENDIX 0
1.
FAFiILY SCHEDULE FOR BASIC HEALTH SERVICES
2,
Warns of tha Hamlet
3.
Door iio.
4.
Religion 4 Comrwity
5.
R. fto.
6.
Name of Panchaya£f
7,
81oo?;
Bo Date of Suswyry
So Type of House s Puoca/Kutclm/Hut
1G. Qu?? Houss/ftented
11.
Name of ths 0;.jwr
12.
Electrifled : Yas/No.
13.
Schedule Ho.
14.
Name of Family Renters
15.
Relationship
16.
Year of Birth
u7• Sqx
1B. Rarital Status
19. Education Status
20.
Occupation
21.
Residential status
Scar Harks of Rax marks
22. KSEP
Date of vaccination
P.V,
s y
Verification result
P.Vo
y
Date
If already vaccinated whan
23. BCG
If not, data af Vaccination
Whether children under S years had D.T.P,
24. DTP
X
If not date of immunization
II
in
25. Retaario
contd....2/~
2.
•»*
fASlILY . PUymSIG.
io
Wo.
2»
3.
Eligible couple (Serial Wo. of Husband & UJifa)
»
Na. af living children including those living elsewhere (
4.
£ figs
Youngest child (
1 Sex
5.
Date of nature of termination of last conception
Go
Uiather husband or wife uses any F
P.
*
7.
If yas isihab F.P« Het hod used and whan did ho/she first start using it
after last live birth ? I4iera did ho/sha take it 7. or if ‘N’ reasons
*
8.
method after last live birth
1. Education activities
2. Supply of contraceptives
3. I.U.C.D.
4<> Tubectomy
6. Vasectomy
Go Follow up
ACTIVITIES CARRIED
\ 11 Round Dats
| III RkMnd ifetu
I IV Round Rats
9.
Remarks
H £S PIfA L SERVICES ARD ClgJCEPT ABOUT DISEASES & TREATfiECT
1o
feufiti
2.
Date of visit
3.
’Jhat is the concapt
about occurence of
diseases in fatally
Gad-sent 7
Other occult reason 7
SciontifiCi, a.g. interp crate habita> insanitary
environments, infection etc. etc.
-3 3 8.
A0H
4. Da they gato the Hospital
for treatment ? IF, Yas
1
Ofchoj? Hospital
{
Private Practitioner
Occujt
5. If Ho. tiftat form of
treatment do they soak
K®so3 Ayrvedic
Local Herbal
How long visiting
i
What result
6. A D H
t Has It changod their concept about he1th
EUVIROWOTA L SANITATION
1.
BuflTlCULARS
I
»
II
TIT
IV
2*
Source of water supply
Sullage disposal
Disposal of Refuse from Mouso
watrine in tte House
EXISTING CfJHDlTIOFffi 8 Within the hausa/pubile source
Type Overhead tnhk with tap/distrlbution tap
Darc tdoll/Open draw woll/Othar (Specify)
Soak pit/kitchen garden/Cess pocl/Street drain
open atagnation/No Stagnation.
Hathod of disposal (Specify
Y«b/Mo. If yes, type of latrine
*
Flush out/other
Is tho latrine in use
If unused reasons for it
Is there Space far latrine conatructioni Yes-'No
If yoB? willingness to construct latrtnt Ye»/Nb
If there is service typo, willingness for its eanwarsicn
3. II Round
4.
ACT ION TAXED & RESULT
S.
IV Hound
6.
Signature of Worker
III (Wtd
/j
/ffipO-7 cC
/
FAMILY
Name of the Hamlet
_
— M. No.
FOR
I
&
HEALTH
BASIC
Name of Panchayat
Block
-Type of House :
Own
Pucca / Kutcha / Hut.
,
’
SERVICES
....Date of Survey
-
House / Rented
Yes / No
Electrified :
Remarks.
Door No.
SCHEDULE
«
Eligible Couple
(Serial No. of
Husband & Wife.)
No. of living I
children
including |
those living
elsewhere
Whether
husband or
wife uses any
F.P. method
after last live
birth
TIVITIES CARRIED OUT
If yes what F.P. Method used
and when did he/she first start
using it after last live birth ?
Where did he/she take it ?
or if 'no’ reasons.
Type of Services
1
Educational activities •
2
Supply of contracepti' —
3
1. U.C, D.
4
Tubectomy
5
Vasectomy
6
Follow up.
II Round
Date
■
III Round
IV Round
Date
i Date
Remarks
i
37
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w vv - 3
REPRESENTING THE UNSEEN:
SYMBOLISM IN SOUTH INDIAN FOLK HEALING
Abs tract
The paper is about linguistic / cultural representation of the 'unseen' in folk healing
tradition in a south Indian village. The word kaatlhu is used to refer to a range of causal
agents, medium as well as to the ailments caused be these agents. Within the folk healing
tradition it has a unified essential underlying meaning: something invisible that afflicts
people - children, women, men and even an unborn foetus. It reveals how this society
grapples with representing reality and the limitation of language for such representation
as well as construction of folk medical knowledge in the society.
The specific intended meaning of the term kaatthu unfolds in actual usage with reference
to the context - the context accompanying physical symptoms, mental state of mind of
person afflicted with kaatthu, age and sex of the person and the entire cultural milieu in
which the language is generated and used. For an outsider it may be difficult to relate the
'order of words' and the 'order of things' to derive the meaning. The referral link between
the two is neither explicit nor uniform across all contexts.
Kaatlhu as a cause of and as a basis for typology of ailments straddles across both
material-rational and magico-religious realms. The physical qualities of wind, wind as a
medium carrying the unseen germs as well as the un-seeble malevolent spirits, which lurk
in dark abodes of emptiness are represented as kaatlhu. It represents both the causal agent
and the medium: the wind and the germs, the malevolent force and darkness. It also refers
to a range of physical ailments, mental temperaments caused by these causal factors.
Dealing with this complex symbolic construction throws up a number of interesting
themes to explore, firstly. the very complexity of this conception - Kaalthn. Secondly.
the problem of representing and translating reality across culture - from the filed to the
ethnographic notes. And, thirdly to understand organisation of folk medical knowledge
revealed through such conceptual categories. The paper aims to explore some of these
issues. It is largely based on fieldwork done in a village in Coimbatore district.
Dear Dr.Nalini
I would be presenting on Contraceptive use and women's status in Tamil Nadu. I am in the midlc of heavy
teaching session. 1 am not sure how much 1 would be able to write by the middle of Feb. I would try to the
best possible.
I would Ramila Bishl to get in touch with you if she is still planning to participate.
With warm regards
Nakkecran
kJ H - 5
PRESS RELEASE
Oct. 16, 2000
We. the undersigned, women’s organisations and health activists express our dismay,
concern and protest at the present trend of population policies in the country which are
self contradictory and profoundly anti-women There are two issues involved both linked
to each other. Firstly, the macro policy framework which is defined by the National
Population Policy 2000, and secondly, the contraceptive policy which concerns the
introduction of different types of contraceptives in the Government sponsored family
planning programme. At the outset, contrary to motivated propaganda against our
position, we would like to categorically state that we advocate family planning in the
interests of the poor and women in particular based on voluntary choice. We firmly
believe that women should have the right to decide the number of children they
want and access to safe and affordable contraception. We believe that women want
and need safe contraceptive choices which are user controlled and which cany no risks to
their health. We intend to meet the Union Health Minister with our concerns and
depending on his response, launch a countrywide campaign on the issues involved.
Contraceptive Policy
In their bid to meet population targets under the World Bank tutelage, and as part of the
liberalization' policies, the Indian authorities have in the past few years relaxed Drug
regulations in order to expedite the introduction of long acting, invasive, hazardous
contraceptives into India. Unchecked over-the-counter sales, misinformed doctors and
inadequate Post Marketing Studies are the harsh realities of this strategy which is poised
to subject millions of Indian women to contraceptives such as the injectables and subdermal implants, that will cause irreversible damage to their and their progeny's health.
The injectable contraceptive Depo-Provera was approved for marketing in India in 1993
without the mandatory phase 3 trials. This has marked a big victory for the parent
company Upjohn, the American multinational, who has gained access to the second largest
market without having to prove safety.
Women's groups, health groups and human rights groups throughout the country have
opposed the introduction of this injectable given the potential for abuse, inadequacy of
■research and the lack of accountability of pharmaceutical agencies. Conclusion from
analysis of major studies from all over the world now compels us to call for a complete
ban of injectable contraceptives from both the public (national family planning
programme) and the private sector (including the NGOs) in the country In no case they
should become a part of the Family Planning Programme.
Depo-Provera has been indicted for causing a climacteric-like syndrome (pre-mature
menopause), irreversible atrophy of the ovaries and endometrium (inner lining of uterus)
leading to permanent sterility, deaths due to spontaneous formation of clots inside blood
vessels (thrombo-embolism), two fold increase in acquiring HIV infection from an infected
partner as well as increased transmission from an infected woman to a non-infected
partner, a ten-fold increase in the birth of a Down Syndrome baby in women users, and
increased chances of death in children bom to women users. Increase in the risk of breast
cancer, cervical cancer including carcinoma-in-situ. in sub-groups of women are other life
threatening risks with Depo-Provera.
Upjohn company has deliberately suppressed and/or underplayed many of these serious life
threatening complications thereby misleading both the Drugs Controller of India and the
medical community. Many of these studies have been funded by Upjohn or directly carried
out by their bio-statistical division. Given the large body of scientific information that
already exists, going through the motions of another study as has been done as part of the
post marketing surveillance, a study that has flouted all ethical and epidemiological norms,
is an attempt to further mislead and misinform the concerned authorities.
We condemn this deliberate misrepresentation of information as unethical and
strongly urge the Indian government to ensure that such hazardous drugs are not
brought into the country. In addition to ail the dangers mentioned above, the
existing health infrastructure is not capable of providing the counselling and follow
up that is mandatory for such long acting contraceptives We warn the Government
against introducing either Depo Provera or Net-en, in any form into the family
planning programme.
Population policies
The Government of India had announced its Population Policy 2000 recently, as well as
set up a Population Control Commission. We believe this is a waste of public money and
will serve no useful purpose. Whereas in response to the widespread opposition from
different quarters, including women’s organisations, the population policy 2000 gives up
the earlier thrust on coercive disincentive policies, the Government still has an ambiguous
and self contradictory stand towards disincentives. For example the Bill to prevent those
with more than two children from standing for elections remains on the Government
agenda. Equally disturbing is the trend of State Governments to announce population
policies which are based on a system of disincentives which can only be termed as
draconian. It would appear that in the era of liberalisation State Governments are directly
negotiating with international funding agencies for loans which, as in the past, may include
conditionalities for polulation control at any cost. For example the Maharashtra
Government has announced that it will deprive the third child of rations through the PDS.
This when children have been dying of malnutrition in the State. In Rajasthan, Madhya
Pradesh and UP, the Governments have announced similar disincentives including denial
of access to Government schemes, Government loans, Government jobs—in other words
punishing the poor for their poverty. All the above State Governments along with Haryana
and Delhi have also passed legislation denying the right to those with more than two
children to stand for elections to panchayats and local bodies. Thus the Government has a
self contradictory policy—it talks of target free- no disincentives regime—while at the
same time it encourages State Governments to go ahead with such draconian measures.
Either there is a national approach or there is not—in which case let the Population
Commission be immediately wound up.
Signatories:
All. India Democratic Women’s Association, Sama, Jagori, Medico Friends Circle, Magic
lantern Foundation, Nirantar, Shodhini Network, Action India, Locost (Baroda), Drug
Action Forum (Karnataka), Saheli, Delhi Science Forum, Centre of Social Medicine and
Community JNU, Lawyers Collective, FORCES, RAH1, CREA, Ankur, Women’s Rights
Initiative, MARG, TARSHI, Pratidhi, Human Rights Law Network, Guild Of Service,
Centre for Social Research, AIWC, Navjyoti Delhi Police, Angaja Foundation
A LMa'A
L eT I'**! fW Ac-f1
A-j H' 1'
1
£) BJECTI VES
A heart sheltered by a roof,
linked by another heart, to symbolize life and love
in a home where one finds warmth, caring,
security, togetherness, tolerance and acceptance that is the symbolism conveyed by the emblem of
the International Year of the Family (IYF), 1994.
The open design is meant to indicate continuity
with a hint of uncertainty -. The brushstroke, with its
open line roof, completes an abstract symbol
representing the complexity of the family.
Proclamation of IYF
1. The United Nations General Assembly,
in its resolution 44/82 of 8 December 1989,
proclaimed 1994 as the International Year of
the Family. The theme of the Year is "Family:
Resources and Responsibilities in a Changing
World”.
2. In proclaiming the Year, the Assembly
decided that the major act! vities-for its
observance should be concentrated at the
local, regional and national levels, assisted
by the United Nations system. It designated
the United Nations Commission for Social
Development as die preparatory body and
the Economic and Social Council as the
coordinating body for the Year.
This document is based upon:
1994 Imemational Year of the Family,
“Building the Smallest Democracy at the Heart
Tlte objectives of IYF are to stimulate local, national and
international actions as part of a sustained long-term
effort to:
(a)
increase awareness of family issues among
Governments as well as in the private sector. IYF would
serve to highlight the importance of families; attain a
better understanding of their functions and problems;
promote knowledge of the economic, social and
demographic processes affecting families and their
members; and focus attention upon the rights and
responsibilities of all family members;
|
(b)
encourage national institutions to formulate^
implement and monitor policies in respect to families;
(c)
stimulate efforts to respond to problems affecting,
and affected by, the situation of families;
(d)
enhance the effectiveness of local, regional and
national efforts to carry out specific programs concerning
families by generating new activities and strengthening
existing ones;
(c) improve the collaboration among national and
international non-governmental organizations in support
of multi-sectoral activities;
(f) build upon the results of international activities^
concerning women, children, youth, the aged, thedisabled
as well as other major events of concern to the family
its individual members.
of Society" United Nations, Vienna, 1991.
CHECKLIST of activities for an effective
International Year of the Family 1994
The Vienna Non Governmental Organizations
(NGO) Committee on the Family, Vienna, 1990.
Available in alternate media upon request
'
’
Published by authority of the Minister of National
Health and Welfare
tgalemenl disponible en franjais sous le titre
J994 Annde inlernalionale de la famille
© Minister of Supply and Services Canada, 1992
C«L H21-114/1992E
ISBN 0-662-19636-8
1975
1979
1981
1985
1987
1990
1993
Women
Children
Disabled Persons
Youth
Shelter for the Homeless
Literacy
Aboriginal Peoples
The following principles underlie the IYF proclamation:
A.
The family constitutes the basic unit of society and
therefore warrants special attention. Hence, the widest
possible protection and assistance should be accorded
to families so that they may fully assume their
responsibilities within the community, pursuant to the
provisions of the Universal Declaration of Human
Rights, the International Covenants on Human Rights,
the Declaration on Social Progress and Development;
and tlie Convention on tire Elimination of All Forms of
Discrimination against Women.
B.
Families assume diverse forms and functions
from one country to another, and within each
national society. These express the diversity of
individual preferences and societal conditions.
Consequently, the International Year of the
Family encompasses and addresses die needs of
all families.
C. Activities for IYF will seek to promote the basic human
rights and fundamental freedoms accorded to all individuals
by the set of internationally agreed instruments formulated
under the aegis of the United Nations, whatever the status
of each individual within the family, and whatever the form
and condition of that family.
D.
Policies will aim at fostering equality
between women and men within
families and to bring about a fuller
sharing of domestic responsibilities and
employment opportunities.
E.
Activities for IYF will be
undertaken at all levels local, national, regional and
international; however, their
primary focus will tie at the
local and national levels.
3
IYF will constitute an event within a continuing process.
'J' Measures will be needed to ensure appropriate evaluation
of progress made and obstacles encountered both prior to and
during IYF, in order to ensure its success and adequate follow-up.
4
National Coordinating Organization
The national coordinating organization is a high-profile, influential
organization representing government, NGOs and (he private
sector. Mechanisms from previous International Years will help
this organization to plan, encourage and coordinate IYF activities.
NGO Support
To ensure crucial NGO
involvement and support for
IYF, NGOs should be wellrepresented in the national
coordinating organization.
Communication between
NGOs and government
agencies should be en
couraged and NGOs'
expertise recognized and
utilized.
Role of the Private
Sector
Family tics impact on the private
sector through employee
productivity and community
stability. The Pi ivate sector could
spread information through its
communication networks,
subsidize useful family services
and provide financial support for
IYF programs.
COMMUNICATION
Dialogue and communication with local and
grass-root level
Active partnership between government and
volunteer organizations, business and labour
Public awareness
of the IYF and
circulation of
infonpation on
international legal
instruments and
conventions
relevant to family
members
Review legislation
to clarify impact
on families
Encourage
academic research ,
on family matters
GENOA FOR EVERYONE
GOVERNMENTS
Pf Promote IYF with a solid action plan
p^f Integrate findings of former Years into
lYF’s action plan
pf Create an environment that promotes the
family
Pf Understand that socio-economic
decisions affect families
p^ Create programs to strengthen the family
as a focal point for social development
pf Considerhow misuse of resources and of
the environment affects present and
future families
[pj
2
VOLUNTARYORGANIZATIONS
r/ Organize discussions on family living
involving fathers and other male family
members
Pf Promote mutual help in times of need
PJ Train and support parents for self-help
groups
Pf Facilitate job access for disadvantaged
groups like die young, women, and disabled
persons
Pf Improve access to family services
NGOs
Encourage member participation in IYF
Organize a “Day for the Family"
Support activities which may improve
family life
Act as resource centre for information on
aspects of social development and work
conditions which affect families
Evaluate the organization’s objectives in
relation to the needs of families and
communities
P^ Create social and recreational opportunities
for families in lire neighbourhood
MEDIA/OP4NION LEADERS
SOCIAL SERVICES
Create a positive family atmosphere in
the media
pf Improve family health and well-being
Pf Piomote communication and non-violent
P|~ Promote awareness of family concerns
problem-solving
pf Use the “Families help families" model to
and issues
Pf Focus on destructive effects of substance
deal with social problems
pf Support the elderly living in the community
pf Strengthen the self-care ability of families
abuse on families and on preventive
family measures
Pf Produce special family inserts, pages,
pf Assess social security measures to ensure
programs, films
their adequacy for healthy family life
Pf Encourage a pro-family climate in
paintings, music, sculpture, literature
Pf Ensure that IYF focuses on the needs of
families in industrialized and in
developing countries
.
FAMILY ORGANIZATIONS
pf Monitor government activities on basic
social services
pf Support all families in difficult
circumstances
Pf Include in the “Rights of the faftiily"
the rights of women victims of domestic
and social violence
pf Campaign for the rights of the child, in
particular the right to a permanent
substitute family and to the child's
heritage
Develop awareness of the diversity’of
family structures and functions and of
the diversity of roles within the family
FAMILIES
EDUCAT1ONAL/RESEARCH
pf Involve families in all educational plans
pf Use educational network to discuss
family needs
pf Encourage family-centred activities in
health and education, taking into account
single-parent families
pf ‘Provide special education sessions for
families with special needs
pf Encourage research on the role of
families in various cultural and social
contexts
pf Develop family councils to make
decisions
pf Respect the capacities, dignity and
needs of all family members
pf Stress the responsibilities of all with
regard
to
the
children
and
disadvantaged members of the family
Enhance the feeling of togetherness
through gatherings, shared meals and
leisure activities
pf Motivate all family members to share
effectively all household and other
responsibilities
G
THE \ YA MILY with jts diverse forms and functions, is a positive
—'
and essential unit in society, to be appreciated, to be
supported and to be protected.
7
The VOLUNTARY HEALTH ASSOCIATION OF KARNATAKA-(VHAK) is
a secular, non-profit federation of over 156 Voluntary
Organisation in Karnataka, working in the field of health
and community development.
VHAK strives to make health
a reality for all, the people of Karnataka especially the
unreached and to the needy.
VHAK fulfills these objectives primarily through health
Education and Training and by providing information to the
target groups.VHAK provides platform for all the Vol
agencies to come together and explore the possibilities of
strengthening the Health Care delivery system through
Works hops/Seminars/Dialogues for improving the quality and
services of health care.
VHAK campaigns on relevant and important
health issues
to ensures that a people oriented health policy is brought
about and effectively implemented.
VHAK also works to
sensitise the larger public towards a scientific attitude
on health.
VHAK.
&>. 60.
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iicr;vjic'...->oo OOi.
Introduction
Strengthening families as basic units of society
Far from being sialic, families are dynamic units engaged in an intertwined process of
individual and group development. They can be viewed from three different perspectives, f irst,
a family can be seen as a biological unit whose members are linked together by blood ties; this
relationship is often institutionalized through marriage or sanctioned by an equivalent relationship
and describes the kinship between mothers, fathers and their children. Secondly, a family can be
seen ms a social unit consisting of a number of people, who usually live together in the same
household and share different developmental tasks and social functions. Thirdly, a family can be
seen as a psychological-unit defined around the personal feelings and emotional bonds of its
sincnibcrs. In a psychological conception of families, children who have moved out, or even dead
’parents, may still be considered part of the family.
k
In many parts of the world, owing to various social, political and economic changes, families
’arc undergoing tremendous stresses that weaken (heir ability to care for their members. There is
a global recognition of the need for societies to support families in their important functions. The
International Covenant on Economic, Social and Cultural Rights (General Assembly resolu
tion 2200 A (XXI), annex), in1 article 10, provides that "the widest possible protection and
assistance should be accorded to the family, which is the natural and fundamental group unit of
society, particularly for its establishment and while it is responsible for the care and education of
dependent children".
Families require a com prehensive and, at the same time, synthesizing social policy approach,
as they provide the fullest reflection, al the grass-roots level, of the strengths and weaknesses of
a country’s social welfare environment.
Objectives of the International Year of the Family
The General Assembly, in its resolution 44/82, proclaimed 1994 as the International Year of
Mie Family (IYF). The objectives of IYF arc to stimulate local, national and international actions
^as the starting-point of a sustained long-term effort:
(a)
sector;
To increase awareness of family issues among Governments as well as in the private
(b) To strengthen national institutions to formulate, implement and monitor policies in
respect of families;
(c) To stimulate efforts to respond to problems affecting, and affected by, the situation of
families;
(d) To enhancc'lhc effectiveness of local, national and regional efforts to carry out specific
programmes concerning families;
(e) To im prove the collaboration bet ween national and international organizations in support
of multisectoral activities;
(f) To build upon the results of international activities concerning women, children, youth,
the aged and the disabled, as well as of other major events of concern to the family or its
individual members.
1
In formation material
In addition to a quarterly bulletin (The Family) and an Occasional Papers Scries on family
issues (currently available only in English), the IYF secretariat has published a brochure in English,
French and Spanish and posters in the six official languages of the United Nations. Guidelines on
the use of the IYF logo are also available in the six official languages. Other useful materials are
listed in annex I.
Voluntary Fund for the International Year of the Family
Limited financial support for IYF and its family-specific activities is available from the
Voluntary Fund for IYF. The Fund will support operational elements of the programme for IYF,
particularly in the developing countries, and promote research studies and the exchange of
information on family issues. Project proposals elaborating the objectives, activities, intended
beneficiaries, budget and amount of support requested may be submitted to the IYF secretariat.
Pledges of contributions to the Fund, as well as requests for funding for 1 YF-spccifie projects can
be sent to the Coordinator for IYF.
Contributions to the Fund, with an indication that they arc for the Voluntary Fund for l^r,
can be deposited in:
.
•
United Nations General Trust Funds Account (No. 015-004473) at the Chemical Bank,
New York 10017, United States of America, or
»
United Nations Contributions and Revenue-Producing Income (Dollar) Account
(No. 01 12 -75005/00) at the Creditanstalt - Ban kvcrcin, Schotlcngassc 6, A -10 1 0 Vienna,
Austria.
National focal points for the International Year of the Family
Governments have been asked to identify an agency and contact person to serve as a focal
point to liaise with the IYF secretariat in preparing for IYF. With the assistance of the focal point,
information from the IYF secretariat can be distributed to all the governmental and non
governmental organizations and other groups involved within each country. In some eases,
countries may wish to appoint a focal point before a formal national coordinating committee is
established to ensure a regular communication flow. It is important that the focal pojjjt
subsequently joins the formal national coordinating committee lo ensure continuity, allhough^K
is not always the ease.
■
National coordinating committees
Governments are invited lo establish a national coordinating mechanism of persons with an
interest in the family, such as a national coordinating committee for IYF, to plan, stimulate and
coordinate activities by governmental and non-governmental agencies. Governments arc requested
to inform the IYF secretariat of the steps being taken to establish these coordinating committees
and of any plans to maintain or disband the national focal point.
In establishing a coordinating mechanism, Governments may draw on their experience in the
coordination of other international years, such as the International Women's Year (1975), the
International Year of the .Child (1979), the International Year of Disabled Persons (1981) or the
International Youth Year: . Participation, Development, Peace (1985).
In order to accomplish its objectives, a national coordinating mechanism for IYF should have
adequate political influence and high public visibility. Some Governments have nominated the
President of the Republic, the First Lady, or some other eminent person as (he chairperson or the
honorary president of the national coordinating committee.
2
Many Governments find it useful to nominate a large coordinating body of members with
diverse influence and resources. In
* this kind of cooidinating committee, the coordinating and
advisory functions arc emphasized. It is also advisable to appoint a small working subcommittee
from among the members of the coordinating body to ensure the efficiency of tbc preparatory
work. Another approach is to limit the membership of the coordinating committee and to establish
several working subcommittees for specific purposes.
Functions of a national coordinating committee
Some of the functions of a national coordinating committee arc described below.
Coordination of local and national activities
In order to use its resources effectively, the committee should act as a coordinating body for
till governmental and non-governmental activities related to IYF. It should also serve as tin
information source for all activities at the local and national levels. An attempt should be made
to coordinate, or facilitate tbc coordination of, activities of all other groups at a local level who arc
working on IYF.
The relationship with local coordinating bodies should include a strong two-way
communication flow to boost the information provision and reporting functions of the national
coordinating committees. National coordinating committees should also promote the exchange of
information between local organizers and groups to avoid duplication of effort and to enrich the
overall field of activity.
Promotion of I YF
The committee should provide an effective channel for the promotion of IYF at the local and
national levels, involving both governmental and non-governmental organizations. It should
generate and support activities for IYF and sensitize public opinion on family-related issues and
problems, which will necessitate a strong partnership between the national coordinating committee
and the national media.
'
Elaboration of a national programme
The committee should elaborate and implement a national programme for the preparations
for, and observance of, IYF, including suggestions for the improvement of the situation of
families, and setting of priorities, as well as tin agenda for action.
Review of the situation of families and family policy
On the national and local levels, there is a need to review and assess the situation of families,
identi fyi ng speci fic issues and problems. A Iso, family policies should be monitored and evaluated,
including various governmental and non - governmental programmes of direct and indirect concern
to families.
Research on the family
The committee should promote, coordinate and, i f possible, undertake research on the family.
It would be beneficial if the committee or another suitable body could serve as a depository for
national information and data relating to the family.
3
Incorporation of programmes for the family into national development strategies
For a long-lasting effect, il is critical lo develop strategics lo incorporate new or existing
family programmes into national development plans. This process may require more time than is
available for the preparations for IYF in 199'1, but il should be begun as part of (he effort lo
develop long-range plans to strengthen and support families. This process is elaborated in more
detail in the sections below.
Coordination of national and local activities
Involving all interested parties
To ensure the widest possible participation and impact, it would be advisable to invite all
interested parties to be involved in the preparations for and observance of IYF.
regional and national circumstances, these might include:
According lo
,
(a) Governmental bodies dealing with social affairs, health, education, housing, employment,
or other areas of concern for families;
1
(b) Non-governmental organizations active in the fields of family, children, youth, women,
men, the elderly and the disabled, as well as any other associations interested in family affairs; ’
(c)
Private-sector groups with an interest in supporting family ties, or in providing services
for families as'customcrs, clients or employees.
Working groups may be established for sped fie purposes, such as preparing a publication or
organizing an event. These groups should report to the coordinating committee to ensure an
efficient division of labour and flow of information.
Facilitating the exchange of information
The national coordinating committee has a pivotal function in ensuring a regular flow of
information on IYF to, from and between interested participants.
This process also encompasses providing regular reports on national activities to the IYF
secretariat and, in turn, receiving and disseminating information on activities in other countries.
National coordinating committees will generally require enough logistical and operational^
support lo collect, store and disseminate information from and to the international, national and
local levels,
I
Promotion of the International Year of the Family
One of the primary tasks of the coordinating committee is to plan the phases and ways in
which the public should be informed of IYF and sensitized to family questions, 't he experiences
derived from earlier international years might prove helpful. A high level of visibility is needed
to attain the goals of IYF and a substantial preparatory process is needed lo publicize the activities
planned during-IYF.
In addition, the committee should be prepared to devote time to planning promotional and
awareness-raising campaigns. Separate approaches may be required; for example, to raise
awareness of uniqiie family issues at the national level or of the importance of families to the
national society as distinct from the objective of raising awareness of IYF as an international event.
Special efforts may be required lo ensure that information on IYF is accessible to all groups in the
national society, which may mean, for example, making material available in the language of
minority populations, in Braille or as cassettes.
4
Il may also be important to assess the current state of public information and opinion on
families, including the identification of popular misconceptions and stereotypes.
Sensitizing public opinion might be undertaken in phases. The first phase might be to alert
the media of the proclamation of 1YF and to seek their expertise and cooperation. National,
regional and local media, in the form of television, radio, newspapers or journals, have a wide
public exposure and provide useful channels for information dissemination.
The second phase might be to seek the cooperation of different organizations, associations,
schools, libraries and other interest groups in distributing in formation as well as in collecting it,
for example in the form of questionnaires.
The third phase might be the implementation phase in which forums for public discussion
might be established and information disseminated. Information on family policies, problems
concerning families, IYF events and other materials should be distributed widely. A most
important target group would be decision makers, both al the local and national levels.
Elaboration of a national programme
For effective planning, it is advisable to make a step-by-step agenda with a timetable and
clearly slate the organs and persons responsible for each item. The items could be divided, for
example, into three categories: (a) existing programmes; (b.) special events or short-term projects;
(c) new initiatives.
In elaborating a national programme, it is also advisable to distinguish between short-term
goals (increasing awareness of family issues by organizing events, disseminating information) and
long-term goals (reviewing, restructuring or enhancing existing programmes and initiating new
ones) to formulate and implement policies in respect of families. Both tasks arc demanding and
necessitate planning and the setting of priorities. Ensuring complementarity and continuity in
drawing up the short-, medium- and long-term agenda is an important aspect of such planning.
Local and national target areas
In addition to (he global objectives of IYF set out in the introduction above, national goals
that are specific to local cultures and concerns arc envisaged for each country and each region.
The concept of the family differs in each culture and the needs and problems of families may vary
(substantially even within the same country.
In order to select target areas, it may be important to identify:
.(a)
(b)
(c)
(cl)
Different types of family found in society;
Sources of information on families;
Sufficiency of information on families;
Type of misinformation or assumptions existing regarding families;
(e) Forms of support that families need;
(f) Whether laws concerning families arc consistent with the International Covenants on
Human Rights, the Convention on the Elimination of AH Forms of Discrimination against
Women (General Assembly resolution 34/180, annex) or the Convention on the Rights of the Child
(General Assembly resolution 44/25);
(g)
Availability of approprial'c'subsidies or reductions in favour of families;
(h)
Sufficiency and appropriateness of non - financial programmes to support families;
(i) Whether existing programmes and services arc complementary, harmonized and
coordinated;
(j)
Appropriate mix of services;
5
(k) Problems in the delivery and administration of existing services;
(I) Kind of services or training needed to strengthen and support the functions of families;
(m) Most urgent needs to be met;
(n) Major obstacles (economic, legal, social, historical, institutional, psychological) against
progress;
(o) Changes that have been introduced, and whether similar services could be developed,
or more innovative and appropriate ways of proceeding;
(p) Best mechanisms for designing and testing new approaches;
(<]) Persons, groups and organizations needed for cooperation;
(r)
•
Most effective combination of existing resources.
In order to accomplish the national objectives, both short-term and long-term actions arc
likely to be needed. All the activities of IYP should be complementary and contribute to attaining
the selected goals.
Setting priorities for short-term goals
,
The most important short-term goal would be to create and increase awareness of the
importance of families to social progress and development. The situations and needs of families!
should be widely discussed and information on family issues should be gathered and disseminated
widely. Besides substantive activities, promotional activities should be considered; for example,
organizing special days and events for families; involving children and the public in various
contests and innovative activities (selling posters, badges, casy-to-rcad materials etc.); and
encouraging municipal and village authorities to organize special events.
Depending on local needs or traditions, activities to meet short-term goals might include
some of those, listed below (see also annexes II and 111):
Arranging events
•
°
Organizing congresses, seminars, meetings and discussions on family issues
Organizing special "family days” (when family members might visit the workplace,
participate in festivities and have free access to amusement parks etc.) or family reunion
days'(when families arc encouraged to get together)
•
Organizing demonstrations on behalf of families, or whatever seems innovative amh
suitable to create a positive atmosphere towards families
’
Disseminating information
•
Issuing booklets, brochures, articles, posters, postcards, badges etc.
•
•
Cooperating with the mass media on issues concerning families and family policies
I folding meetings with parents and "open house" in different social services centres and
offices dealing with family affairs
•
Involving employers in the publicizing of family services or policies of benefit to
employees
"
Activating discussion
6
•
Arranging public polls, inquiries, voles on different family subjects such as (he roles of
spouses, parents, siblings and children, and the relationships between in-laws
•
Organizing children’s competitions in drawing, essay - writing etc.
•
•
Holding debates and publie discussions
Producing a television scries on family matters
The priority of activities as well as their timing needs careful consideration. If the
coordinating committee is able to set up working groups or cooperate with special interest groups,
considerably more could be accomplished than if the committee alone were responsible. There arc
usually numerous professional associations and groups that might be interested and to which some
of the tasks could be delegated. Similarly, it is important to identify resources that exist to support
activities of all types and at all levels, and to canvass these resources. One way of giving the widest
possible visibility to IYF is to incorporate a family theme in the existing programmes and future
activities of all interested organizations.
Setting priorities for long-term goals
Beyond the activities prior to and during 1994, (he ultimate objective for IYF is to improve
the situation of families permanently and to strengthen their ability to fulfil their functions, which
requires careful and long-term planning. One of the most important prerequisites for effective
long-term planning would be a report on the current status of families. This statc-of-the-family
report could be prep'ared by holding a series of expert group meetings culiminating in a national
conference at which recommendations and conclusions would be developed. These could then be
published and distributed to legislators, policy makers, practitioners and researchers to be used as
a basis for long-term planning. A longer term approach might involve establishing a national
research’program me on family issues.
It is proposed that the goals and target areas should concentrate on supporting families and
their proper functioning rather than on examining symptoms of malfunctioning; for instance,
programmes should be oriented towards enriching spousal relationships rather than towards
diminishing the amount of divorces. Goals should also be concrete enough to allow for an
evaluation to determine if they were reached or not. (Examples: update the Marriage Act to
provide for more equality between spouses; lengthen parental leave, and make it applicable and
feasible for fathers as well; establish day-care centres for the children of shift workers; provide
courses on "Responsible fatherhood" and "Home economics"; develop a curriculum and centres
devoted to the prevention of family violence; introduce curricula on "Preparation for family life".)
Review of the situation of families and family policy
In order to decide on the priorities for long-term goals, an overview of the situation of
families is needed. One useful model for determining the long-term needs of families would be
to consider if the functions of families arc being sufficiently strengthened and supported. Some
functions of a family arc that il:
(a)
Establishes emotional, social and economic bonds between spouses;
(b)
Provides a framework for procreation and sexual relations between spouses;
(c)
Gives a name and status to family members, especially to children;
Provides for basic care of children and, in many cultures, of aged and disabled relatives;
Facilitates the socialization and education of children (and parents);
Protects family members;
(g) ()l fer.s emotional caie, affection and recreation Io its members;
(h) Provides services and resources for its members.
(d)
(c)
(f)
The functions of the family and ways of supporting them arc set out in annex IV.
7
On the national level, it should be determined whether or not each function is being
supported effectively by such means as: (a) family policies and legislation; (b) benefits anil
subsidies; and (c) services and training.
Different sub-themes for IYF could be developed from the issues highlighted below,
following an identification of the most urgent needs of families in the community concerned.
Establishing emotional, social and economic bonds between spouses
Marriage and equivalent relationships give the two partners a new role in the new family:
that of being a spouse. Constant efforts throughout the years arc usually required to develop a
warm and well-functioning spousal relationship, whether it is .established through traditional
rituals, formalized marriage or cohabitation.
In some countries, the legal age of marriage for females is as low as 12 or 14 years; sometimes
minimum legal ages arc not enforced. Only 22 countries have granted equal rights to both sexes
in matters of marriage, divorce and family property.
Examples of issues needing reconsideration
LAWS AND POLICIES. Do the existing marriage laws protect children from having to
contract a marriage early in life? Do the laws grant equal rights to both sexes, especially in
matters of marriage, divorce, inheritance and family property? Is there any need to sensitize
public opinion-to the roles of spouses?
BENEFITS. Do benefits or lax reductions support lhe institution of marriage?
benefits promote equality between spouses?
Do such
SERVICES. Is sufficient guidance given in selecting a partner? Do young people receive
enough information on family issues or education on family life? Is there a need for
programmes on enriching spousal relationships or for divorce mediation?
Providing a framework for procreation and sexual relations between spouses
The maintenance of appropriate levels of population renewal is crucial to the survival of any
society. The health of children is directly affected by their mothers’ health and nutrition during
pregnancy and infancy. Research has shown that (he health of both women and children can be
significantly improved by spacing births al least two years apart, avoiding pregnancies before the
age of 18 and limiting the total number of pregnancies to four. Since families arc the institutions
charged with the responsibility for procreation, many countries provide some form of monetary
compensation for the care of children.
Scxuality'also has a vital function as a connecting link between (he spouses even when seen
as distinct from procreation. Intimacy and satisfying sexual roles’ for both partners may also need
to be learned and promoted.
8
Examples of issues needing reconsideration
LAWS AND POLICIES. Is the existing legislation on procreation (c.g. on the possibility of
abortion, in vitro fertilization) updated and consistent with the interests of the persons
concerned, as well as the society or culture? Do the existing norms of sexual roles satisfy
both sexes?
BENEFITS. Arc there sufficient ways of financially supporting pregnancy and parturition
(e.g. in (he form of parental leave, free or subsidized care)? Arc families adequately
compensated for the economic burden of raising children?
SERVICES. Are adequate health services and emotional support available for pregnancy and
parturition? Would sexual counselling, information on reproduction for youth, or family
planning programmes be needed? What kind of programmes on "Responsible fatherhood"
would be appropriate in the cultural context?
Giving a name and status to family members, especially children
Usually, children born in wedlock automatically inherit the name of the family and
associated legal rights (e g. to inherit family properly). Un fortunately, the right to inherit docs not
apply to females in all countries. Children born out of wedlock should also have the same rights
as those of other children. Likewise, adoption laws should give adopted children rights equal to
thosq of biological children.
Examples of issues needing reconsideration
LAWS AND POLICIES. Arc all children accorded equal rights concerning the name, status,
or property of the family regardless of (heir sex? Do adopted children or children born out
ol wedlock enjoy the same rights as other children? Arc the laws on guardianship updated,
for example, alter a possible divorce; is joint custody possible for those who would want it?
Arc adoption laws in line with Declaration on Social and Legal Principles relating to the
Protection and Welfare of Children, with Special Reference to Foster Placement and
Adoption Nationally and Internationally (General Assembly resolution 41/85, annex)?
BENEFITS. What responsibilities do fathers have to provide financial support to children
born out of wedlock? Is there any public funding available in cases where the father is
unknown or is tillable to pay? Do tax laws promote the provision of support and protect
beneficiaries?
SERVICES. Is there any service or legal aid to assist in matters of guardianship, name
giving or the legal status of children? Arc the adoption process and adoption agencies
functioning properly, and arc they operating in accordance with international standards?
Providing for basic care of family members
The basic care of children and other family members is a-crucial task for the family.
Without the care provided by the family, many of the sick, disabled and elderly would not be cared
for. However, families need slipport for this task and the burden should be more evenly shared
by all family members than was the ease before, as care has typically been the responsiblity of
women alone. In many cultures, the former traditions of child care no longer exist or, owing to
altered family structures or external forces, arc no longer able to operate. In declining extended
family systems, for example, older relatives may not be able to transfer their knowledge to younger
generations. Parental education is also needed. Where both parents work outside the home,
9
nurseries and kindergartens as well as flexible work arrangements would greatly faeililatc the
integration of basic care and other responsibilities.
Examples of issues needing reconsideration
LAWS AND POLICIES. zXrc the laws on custody, responsibilities and rights of children and
parents updated? Arc the responsibilities and rights of families as compared with those of
society well defined? Do both partners receive equal treatment in regard to the custody and
financial support of children in the case of separation or divorce?
BENEFITS. Arc there economic possibilities for parents to stay al home to take care of
infants, or when a child is ill? Is it possible for those in need to receive subsidized day-care
assistance? Do families receive any benefits or housing aid,'especially for caring for aged or
disabled family members? Arc adequate housing facilities available for families?
SERVICES. How arc parents trained for the basic care of their children? How accessible is
guidance and information? Arc adequate and safe day-care facilities available? Where do
families obtain help if the burden of care is temporarily too heavy?
Facilitating the socialization and education of children (and parents)
Everywhere the socialization of children is considered so important that societies have taken
part in jt, providing schools and other forms of education. Even during a recession, it would be
short-sighted to reduce these efforts, since education is the main way of building for the future
of the child and society. The level of education of girls has a direct correlation to the future health
of the family, family size and spacing, as well as to its economic well-being.
The special educational needs of children with physical, mental, emotional and cognitive
disabilities, children of recent immigrants, of minority groups, aboriginals and low - income groups
have to be met.
Examples of issues needing reconsideration
LAWS AND POLICIES. Do all children regardless of their sex, economic situation or
physical condition have a right to education? Is basic education available for adult;; who
have not completed their primary or secondary schooling? 1 low do educational policies or
curricula affect the home life of families?
BENEFITS. Arc there ways of financially supporting education (c.g., in the form of free
schools, books, equipment, travel, school meals etc.)? Arc families supported to a level that
their children can attend school free from the responsibility to earn a living?
SERVICES. Arc nurseries and schools inspiring, innovative and attractive? In addition Io the
formal curriculum, are children encouraged to explore and practise empathy, human dignity,
equality and social justice? Is there a need for education programmes for parents? Are
schools, kindergartens located where they arc needed? Do their operating hours reflect and
respect the needs of families? Arc mechanisms in place that establish communication
between parents and teachers?
Protecting family members
People look to their families for shelter and one of the vital functions of the family is
provide protection for its members. Unfortunately, in stressed families this function might be
endangered. Family violence has been largely hidden and has only recently been dealt with openly.
10
It is the responsibility of society Io support families in creating a secure place for all its members.
Various preventive programmes have proved effective all over the world. The pervasive problem
of crime is also an imposing challenge and source of stress for many families. Numerous examples
exist where families can be active in reducing their likelihood of being victims of crime. Families
may also be important partners in reducing crime in local communities.
Examples of issues needing reconsideration
LAWS AND POLICIES. Do national child protection laws meet international standards?
Are any of the different types of violence inside the family legally sanctioned? Arc they
adequately controlled? Are there laws and policies that help enforce non-violent ways of
upbringing or problem-solving? Is the public fully aware of their human rights with regard
Io dignity and sexual sei I ■ regulat ion?
BENEFITS. To prevent domestic violence, arc there, for instance, adequate housing
programmes or means of financial support for families in crisis situations?
SERVICES’. What kind of prevention programmes would be appropriate? Arc shelters,
emergency telephones; legal advice and guidance available for troubled families? What kinds
of care and therapy would be needed for troubled individuals and families? Arc educational
and other forms of assistance available to families to reduce their risk of victimization by
crime? Arc families involved in crime prevention schemes?
Providing emotional care, r.ii'ection and recreation to family members
By defining the roles and behavioural models of family members, society greatly affects the
emotional atmosphere of families. There arc numerous old but still practised customs (c.g. in the
form of proverbs) that define the roles and relationships between family members. There tire also
several myths, which arc constantly being strengthened through the mass media, concerning
motherhood, fatherhood, and the roles of wife, husband and children. These written or implied
norms can have an enormous impact on people’s behaviour.
Examples of issues needing reconsideration
LAWS AND POLICIES. Do the present social customs regarding family life and the roles of
family members satisfy the needs of all concerned? Arc the emotional and psychological
needs of family members recognized in policy or law?
BENEFITS. Arc there provisions for free or subsidized counselling, health-care facilities or
leave for burdened families or family members? Arc employers encouraged to provide
family support services or to recognize the impact of work-related demands and stresses on
family life?
SERVICES. Do family members need any kind of sensitization or training in order to
provide emotional cate for each other? Arc there any services for family counselling or
family therapy? Do services exist in preventive mental-health care? Are community
recreational facilities appropriate to the needs of families and do they help families to spend
leisure time together?,
11
Providing services and resources for family members
By defining the goals of social and economic policies, societies define the role of the family
as the provider of resources for its members. There arc often crucial differences between
government policies for the distribution of public funds to individuals and families. The fewer
social benefits and public services there arc available, the more the welfare of the individual
depends on the resources of the family and the prevention of different risk situations.
E.vrzm/>/c.r of issues ne.ciling reconsideration
LAWS AND POLICIES. Is there an equitable division of labour for both sexes in the
household and in the labour market? Arc there regulations to facilitate the integration of
work and family life? What is considered to be the responsibility of society to support
families in need? Are family members that participate in family enterprises al forded the
same state protection and services as other employees?
Is family-based production
recognized in economic policy or in development incentive programmes?
BENEFITS. Arc there adequate allowances, benefits, lax reductions or subsidies to support
families in the performance of their functions? Arc benefits programmes harmonized and
complementary?
SERVICES. Should children or newly-weds be trained in home economics? Arc there
services for families when they cannot manage their daily tasks because of illness, disability,
age or the number of children? Arc there adequate housing facilities for families, youth and
the aged? Is housing appropriate to the variety of family forms that exist in the society or
culture?
Research on the family
Collecting data on families
Collecting data on families and family policy might be an important national priority of 1YF.
Material may be made readily available to the public through publications or press releases.
Governmental, community or regional census offices, as well as numerous service agencies
and family-related organizations, collect census and other data on families. With the cooperation
of these organizations, such data could be used for the purposes of 1 YF. I lowcvcr, they often fail
to elucidate several important issues concerning families especially when more detailed or
substantial information would be needed. Universities and research centres might be able to help
on more detailed issues and libraries or government information services might publicize and raise
awareness of existing sources of information.
Information might be developed on the existing forms of support to families; (he types of
benefit and their use, as well as the services available to families, the types of client and possibly
some of the parameters of such benefits or services. The history of laws concerning families and
the benefits that they receive as a proportion of the gross national product arc also of interest.
Promoting research
It is important to promote research on families, their forms, functions and needs for support.
In cooperation with universities and research institutes, for example, the national coordinating
committee should support studies and projects on such issues. (See annexes II and IV.)
Because census or other official data arc often collected on the basis of households, special
efforts might be taken in the collection of information on families, since there arc certain
12
differences between these two concepts. This might involve gathering new and different data, or
developing methodologies and capabilities to reconfigure existing data. It may also involve the
development of longitudinal files Io follow families through their life Cycle.
Follow-up to the International Year of the Family
After 1YF, it would be advisable to follow up the situation of the families al regular
intervals. These situation reports may be more effective if they arc developed on a regular
schedule that is known to policy makers and other interested groups. Has there been tiny change
in the laws, benefits and.services concerning families? What kinds of new programmes and
projects have been established? During the design phase of programmes and services, plans should
be developed that would allow lor rigorous evaluation.
Recorris should also be kept during the introduction of new initiatives to allow for their
evaluation from design to implementation. Often the success or failure of a programme depends
on how it is undertaken. Such process evaluations also provide useful information for those
attempting to replicate successful programmes, or even in developing programmes to address
different problems or to meet specific to local conditions. Because the actual content of
programmes (i.c. specific benefits or services for national or local needs) is likely to vary between
countries, knowledge on the process of design and implementation is often more transferable than
the actual programmes themselves.
Another problem concerns the lack of evaluation research in the area of social policies tint!
the failure to assess (he impact of such policies on families. This deficiency can itself have a
profound impact on families as regards income security, health or housing and has several causes.
First, families, generally, have not been at the forefront of the social policy debate. Secondly, the
orientation of much social policy has been focused on the particular needs of individual family
members rather than on families as a whole. Finally, many of the methodological tools that arc
used in evaluation research are often not adequate to the complex task of assessing policy impacts
on families. Including family impact assessments as a standard or legally required feature of the
national planning process for social or economic development would be an important, durable and
ongoing contribution Io the objectives of IYF.
13
Annex I
SAMPLE RESOURCE MATERIALS
Checklist of Activities for an Effective International Year of the Family 1994 produced and
distributed by the Vienna NGO Committee on the Family. Copies arc available in English, French,
German and Italian from:
NGO Executive Secretarial - IYF
An dcr Hulben 1/15
A-1010 Vienna, Austria
Telephone: 513 86 87
Telefax: 512 16 38 75
Family and Society: Family Thesaurus - Australian Family Studies Indexing Terms I99J
The third edition of the Thesaurus to be produced and distributed by:
••
Australian Institute of Family Studies
300 Queen Street
Melbourne 3000, Victoria
Australia
International Directory of Innovative (Family) Progrants For further information contact:
Information Services Directorate
National Center for Social Policy and Practice
750 First Street NE
Washington, D.C. 10002
United States of America
Telephone: (202) 408-8600
International Year of the Family: 1994 A guide to action planning produced by Health and
Welfare Canada and available in English and French from:
Federal Coordinator
International Year of the Family
Department of National Health and Welfare
Room 956, Jeanne Mance Building
Tunncy’s Pasture, Ottawa, Ontario KIA OK9, Canada
Telephone: (613) 957-7303/05
Telefax: (613) 952-74 17
The IYF secretariat would welcome receiving suggestions and information on plans and
programmes, as well as requests for information or material, al (he following address:
IYF secretarial
Centre for Social Development and Humanitarian Affairs
P.O. Box 500
A -1400 Vienna
Austria
Telephone: (431) 21 131 4223
Telefax: (431) 237 497 or (431) 232 156
14
Annex II
A COMPILATION OF SUGGESTED THEMES AND SUB-THEMES
-
The family
A basic unit of society
Promoting the rights and responsibilities of individual members
A milieu for caring for the vulnerable
A seed-bed for gender equality
A point of convergence for social policy
Providing the psychological foundation of the future
Agents and beneficiaries of development
A resource for the social integration of the disadvantaged
A matrix for improving the quality of life
Family services and the training needs of service providers
The role of families in community ami rural development
Agents ami beneficiaries of development at the local level
The basis for a people-oriented approach to development
Creating community-based family-life support centres
Agents for preserving human values, cultural identity and historical continuity
The impact of industrialization, urbanization and modernization on families
An ally in education for till
A partner in environmental protection
Understanding socio - cultural and political assumptions behind national family laws
Creating legislation supportive of family
?\ touchstone for human rights
Promoting equal rights for all family members
Promoting democratic principles and practices within families
IYF
Taking national, regional and international action on behalf of families
Enhancing awareness of family issues
Building upon the achievements of the International Year of the Child, the International Year
of Disabled Persons, the International Youth Year: Participation, Development, Peace, the
World Asscipbly on Ageing and the United Nation Decade for Women: Equality,
Development and Peace
Promoting values and behaviour patterns benefiting all family members
Building the smallest democracy al the heart of society
Empowering families
Providing legislation, policies, programmes and services
Improving national capabilities to meet family needs
Spousal relations
Spouses: a basic subsystem in families
Fostering new roles for men
Towards a more equal sharing
Sexual relations
*
bet ween spouses
15
•
•
•
•
•
Balancing the economic and social power ol spouses
Legal rights of spouses in marriage anil divorce
Promoting women’s equality
Education in family life
Conflict resolution in relationships
•
•
•
•
•
•
Family planning
Informed choices on fertility
Safe motherhood
Spacing births
Promoting responsible parenthood
Safe in fancy
Procreation
Providing children with status and a name
•
•
•
•
•
•
Equal rights for all children
Fathers and children born out of wedlock
Support for adoptive and foster families
Possibilities for joint custodial care and obstacles
Parental relationship after divorce
Needs of single-parent families
Basic care of family members
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Well-being and protection of children
Promotion of primary health care
Breastfeeding
Improving skills in responsible parenting
Meeting the health and nutrition needs of all family members
Psychological growth of the child
Child development and the father’s role
Child and maternal health and the family's role
Prevention of disabilities
The family and disabled family members
The elderly and the family
Agriculture and food production and the family unit
Shelter and the family
Food security and the family
Preventive care for basic needs and the family
Family well-being in times of economic constraint
Socialization
•
•
•
•
•
•
•
16
The family and cultural identity
Child development through family development
The family as an interacting system
Parents learning from their children
The family and the teenager
Literacy: a primary requirement for families to adapt to changes
Prevention of drug and alcohol addiction and rehabilitation: the role of families
Supporting families to prevent crime and delinquency
Cooperation of schools and parents
Educating youth for family life
The family: the foundation for learning and education
Pro lection of family members
Caring for youth
Prevention of family violence and sexual abuse
Shelters and services for troubled families
Programmes for child protection
Caring for vulnerable family members
Prevention of crime and delinquency and the role of families
Drug prevention and rehabilitation and the role of families
Reunification and the well-being of migrant and refugee families
Family resources for the protection of the environment
Emotional care of family members
Preventive mental health care and the role of families
'rhe family and new role models
Coping with dissonance in the family
Services supporting families in crisis situations
Special needs of refugee anil migrant families
Mediating intcrspousal conflict
Ameliorating the effects of divorce
Problem-solving in families
Adjusting to parenthood
Providing services and resources for family members
Drawing on family resources and strategics to alleviate poverty
Reducing the impact of economic adjustment policies on families
Promoting the equal sharing of household and parental responsibilities
Promoting equal access to employment
Balancing work and family responsibilities
Protecting poor families
Meeting the housing needs of families
Promoting the economic self-reliance of families
Providing support networks for single-parent families
The family as an income-generating enterprise
The caring role of the adult child
Assessing the impact on families of policies, programmes and services
Concepts, indicators and statistics on the family
Promoting research on family issues
17
/t/i/iex HI
EXAMPLES OF PLANNED NATIONAL ACTIONS
•
Establishment of working groups to identify 15 priority subjects regarding (he family and
to formulate plans of action on: violence, living space, housing, employment, youth, older
persons, compensation for contributions, disability, family forms, special burdens, legal
system, health, society, media, and education
(Austria)
•
Under the national coordinating committee, seven subcommittees arc operating to meet
government priorities in: public relations, fund-raising, legislation, education, research,
health, social services and programmes
(Barbados)
•
•
A public awareness campaign
Seminars, studies and programmes focusing on health and nutrition
(Bolivia)
•
.
•
•
•
•
•
Establishing and funding a non - profit corporation to administer I he preparations for and I he
observance of IYF
A comprehensive communication strategy on IYF, television programmes, publications in
Braille etc.
Publishing, through (he National Statistics Agency, a series of reports on the social and
economic characteristics of families
Publicizing family-related policies of the Government for its employees through workshops,
conferences and publications
International support to (he IYF secretariat, Vienna
Educational materials for Canadian schools
(Canada)
•
The council will advise the President on policy measures and supervise and coordinate plans.
The national committee, chaired by the First Lady, includes prominent personalities aniL
representatives of non - governmental organizations. Congress will de til with fam ily issues o I’
specific relevance al the Inter-American regional level
j
(Colombia)
"
•
National priorities in the areas of: health and social protection; the rights and responsibilities
of families; the concept and structures of family; the family and education; older poisons in
the family and society; the family and the environment; and the family and the economic
situation have been assigned to working subcommittees, which will recommend specific
national actions to be undertaken
(Cole d’Ivoire)
•
A conference entitled "The role of the family in the 1990s'' is to be documented in a catalogue
containing the report of the conference as well as follow-up ideas and proposals
(Denmark)
•
A programme to help care for families living in extreme poverty
(Ecuador)
18
A ministerial - level committee will explore family issues in the fields of health, welfare and
security, national education and religion, labour, culture, and equality
Private-sector and public-sector committees have been established to recommend how IYF
can be observed
Research and studies on the situation of families
Publications, promotional activities
(Hungary)
A commemorative postage stamp
A state - of-the-family report
Research on the impact of poverty and unemployment on the family
Seminars and training workshops on family care lor prolcssionals, paraprofcssionals and
voluulcers
Expert group meetings.
(Israel)
A repot I on the situation of families and family policy
Arranging conferences and seminars for in-depth discussions on family-related issues
Publishing booklets that promote the importance of family life among children and youth
A family day
An exhibition of photographs on family life
Establishing an honours programme intended to encourage innovations for families
A rock concert for youth
A brochure for young couples
(Luxom bourg)
Research on family structures and child development as well as health care for mothers and
children
Conferences, seminars anil workshops on family-related issues
Posters, pamphlets and advertisements
(Malaysia)
Priorities in health, education, social security, marriage and family life
(Maldives)
Specialized campaigns to promote IYE among family organizations, social development
agencies, associations of older persons, youth, children and trade unions
(Mauritius)
Round tables, cultural competitions and encounters concerning the family
Symposia, debates, regional encounters
Studies on families
A national federation of organizations involved in family issues
A national family charter
(Morocco)
Socialization of children
Family demographic trends
Violence in relationships
(Netherlands)
Creation of committees for the observance of IYF al the stale and local levels
Workshops, seminars, public lectures
Media presentations
National family week (held since I‘>84)
(Nigeria)
19
•
Recommendations for policies and programmes lo strengthen solidarity and Io promote the
development of the Philippine family as the foundation of the nation
(Philippines)
•
•
•
•
Promotional campaigns in the media
Research and studies
Hosting international conferences
Analysis of existing legislation
(Poland)
•
•
•
Preparation of a report on the current situation of the Portuguese family
Publication of a study on the problems of families
Creation of an IYF commemorative medal
(Portugal)
•
Issues related to women, youth, the elderly and the family
(Senegal)
•
•
•
Donation of booklets in Spanish to (he IYF Secretariat
Study of the situation of the family nationally
Seminar on local and regional experience in dealing with family issues
(Spain)
• . , Enhancing public awareness of the importance of the family and family issues, as well as the
role of women in the family
(Thailand)
•
•
•
Publication of a scries of research publications
Local organizing groups
Films and special events
(Turkey)
•
•
Film festivals and artistic exchanges
Priority issues in: family law; cultural identity and continuity; family budgets; health; drug
addiction
(U krainc)'
•
Primary focus on nutrition, education and health
(Venezuela)
20
/I/in ex /I7
WAYS OF SUPPORTING '1 UK FUNCTIONS OF THE FAMILY
Ways of support
1'undions of (he family
Laws and policies
(c.V(//n/,/c5)
Benefits
Services
(examples)
(examples)
Establishing bonds between
spouses
Laws and customs
related to marriage
and divorce, roles of
spouses
Marriage assistance,
lax reductions
Family education,
divorce mediation
Procreation and sexual relations
between spouses
Laws and policies on
abort ion, customs on
Maternity allowances,
parental lca.se,
Maternity health
centres, midwives,
family size, roles of
spouses
lax reductions,
housing support
family planning, family
training
(living children a name and
Laws on names,
fatherhood and
adoption
Allowances paid by
the father and by the
Slate
Legal advice, adoption
advice
Basic caje of children (and
re la Iives)
Laws and customs on
care of 1 he children
Child allowances
lid neat ion of parents,
well - baby clinics,
nurseries
Socializ.ition and education of
children (and parents)
Laws on education,
traditions and
educational policies
Tree or subsidized
schools, free materials
and meals
Kindergardens, schools,
family and child
guidance centres
Protection of family members
Laws on child
Subsidized housing,
supported activities
protection, criminal
laws on violence
Providing emotional care and
recreation to family members
Customs on family life
and the roles of family
Providing services and resources
for family members
Child protection
services, therapies,
shelters
Subsidized leave for
family members
Family counselling,
therapies
Norms of living and
Allowances and
I lomc-hclp services
division of labour
within the household
benefits
members
.
21
The VOLUNTARY HEALTH ASSOCIATION OF KARNATAKA (VHAK) is
a secular, non-profit federation of over 156 VoluntaryOrganisation in Karnataka, working in the field of health
and community development. VHAK strives to make health
a reality for all, the people of Karnataka especially the
unreached and to the needy.
VHAK fulfills these objectives primarily through health
Education and Training and by providing information to the
target groups VHAK provides platform for all the Vol
agencies to come together and explore the possibilities of
strengthening the Health Care delivery system through
Workshops/Seminars/Dialogues for improving the quality and
services of health care.
VHAK campaigns on relevant and important
health issues
to ensures that a people oriented health policy is brought
about and effectively implemented.
VHAK also works to
sensitise the larger public towards a scientific attitude
on health.
1
The family - at the heart of
health and human development
rom the dawn or human history,
the family has been at the heart of
human development. The family
is the first emotional and social
support mechanism we experience,
our first teacher, our first'hcalth care
provider. And it is usually the women
in the family who assume
responsibility for each of these
essential functions. Whether the
extended family of several generations
living in the same household, the
nuclear family of mother, father and
their children or the single parent
family, what unites them all is love,
partnership, a set of common values
and a vision of the future. Modem
times have spawned radical changes
which challenge the .capability of
families to fulfil their functions. Some
changes have been positive - modern
medicines combined with public
health interventions such as sanitation,
clean water and immunization have
reduced the toll of infectious diseases
and permitted many families to
emerge from the shadow of death and
disease. Other changes, however, such
as industrialization,' urbanization.
environmental degradation, migration
and war place great strain on the
family’s ability to protect its members.
Poverty, which affects mote than half
of the world's population, is the most
damaging, for it marginalizes even
more those who tire.most vulnerable the mother and the child.
Rapid urbanization and migration
are creating vast cities where the
provision of services cannot keep pace
with the influx of inhabitants.
F
Overstretched health infrastructures,
inadequate sanitation anil water
supply, and industrial pollution all
have adverse health consequences.
Meanwhile, depopulation of the
countryside leads to a breakdown in
social structures as youngsters move to
the cities in search of employment.
Political and economic turmoil
generates huge flows of migrants and
refugees deprived of traditional
sources of social and economic
Dr lomris liiimcn, Direr lor ol WHO s Division ol fomily
sustenance, with resulting heavy stress Health.
on the family.
Times of great social upheaval
have always resulted in major changes
in family life. Very often it is the
young who represent the most radical
The great challenge for public
bieak with traditional values and
health is to seek ways to empower
families to do well what they do best,
whose behaviour gives rise to greatest
and this requires the support oflhe rest
concern. Sexual mores change, access
of society. Families arc centra! to
to harmful substances such as tobacco
human development, but they cannot
and psychoactive drugs increases, and
do the job alone; a positive
the elders of the family feel that their
authority and wisdom arc ignored. But relationship between families and the
changing behavioural patterns can also health sector is essential.
Tire International Yearoflhe
be positive as young people develop
Family in 1994 reminds us all of the
coping strategies and seek new
crucial importance of the family in
avenues lot self-fulfilment in
maintaining an optimal level of
education and employment.
physical, mental and social health for
There arc contradictions within all
its members, to the ultimate benefit of
family structures. The family can be a
all of us. ■
shelter, a system of mutual solidarity
and support: or it can be restrictive,
hindering individual and social
development, even providing the
setting for child abuse, sexual abuse,
battering and homicide.
SOURCE: ‘WORLD HEALTH' - NOV-DEC. - 1993 ISSUE.
Tomris lurmen
Vittorio Cigoli & Wilma Binda
Some families manage to
cope with illness on their own;
others may have few or no
resources. In those cases, only
external help - from properly
alert health personnel - can
find the appropriate resources
and solutions. ■
| jj' or all of us, the most significant
relationships anil fundamental
11 experiences of life occur within
the family. The family setting is
therefore the natural framework for
matters concerning health: yet only in
the last few years has the importance
of the family to individual and
collective health been gaining
recognition. If the family’s role is
important in keeping its members
healthy and protecting them from
disease, that role becomes essential
when it comes to treating,
rehabilitating and assisting them
during illness; indeed, the success of
every cure or course of treatment, of
every therapeutic or health-giving
prescription, depends on the family.
This consideration should lead to a
greater involvement ol’Tltc family in
health care, in accordance with the
model of community medicine
. .
outlined by WHO at the 1978 AlmaAta Conference, in which the family
was seen as an clement of primary
health care with an active, responsible
and participatory role. Unfortunately
the family is still seen by health
Greater imol.emenl ol lonnlres in health core would benelil everyone
systems as something on which to
unload all of the patient’s problems,
especially in the case of people with
chronic or terminal illness.
For a correct analysis of the link
between family dynamics and the
issue of health and illness, we suggest
that two essential points should be
borne in mind.
1. Understanding health and illness
in the family
Common perceptions of health and
illness among individuals or families
reveal close links with the quality of
the relationship between family
members. Psychosocial studies relate
the health of the individual closely Io
the type of family in which he or she
lives, to its dynamics, functioning and
quality of life. The kind of
relationship an individual has with
people closest to him or her (family.
relatives, friends) is very important lor
his or her own well-being. I lealth is
seen as a condition of this well-being.
certainly in physical terms, but cvcn^
more in relational terms, since a
"
harmonious family life, or, on the
contrary, the existence of acute
conflicts and tension, will affect (he
well-being or illness of the family
members.
Il is therefore vital for health
personnel to focus attention on the
different ways in which families,
considered as groups with their own
history and culture, try to help their
own members in coping with various
aspects of life, especially health. Here
health is understood as physical and
interpersonal well-being, with its close
connection to stressful events,
including illness, and all the
foreseeable and unforeseeable
situations including sufferings,
demands for care and attention.
disruption of a hard-won equilibrium.
and even doubts and self-questioning.
Also when families tire changing and
medical sciences arc developing
rapidly, all these changes and
developments must take into
consideration and eventually co-exist
with the social ramifications of health
- and the possible threats Io it - which
different generations in the family all
share.
2. Relations between families and
the health care system
In most Western countries the health
system docs not seem Io give enough
consideration to what the care of a
sick person really entails, so that the
“illusion of a doctor-patient reality in
medical practice” prevails. This
illusion obscures the multifaceted
aspect of people’s relationships, which
involves on the one hand the entire
family structure of the patient, and on
the other the health care system, of
which the doctor is an integral pail.
Take, for example, those who arc
physically and mentally handicapped,
mostly entrusted to parents and
relatives, or elderly people who cannot
cope alone and arc looked after
mainly by daughters and daughtersin-law. In other situations the family
connection is completely ignored and
all the problems of family life arc
forgotten, leaving health - and illness
-within the narrow framework of the
doctor patient relationship.
Collaboration in protecting or
restoring health between (he patient,
the family and the health earc system
has been described as a "therapeutic
triangle" - an expression which
clearly reflects the reciprocal
influence ol all three patties. Within it.
there can be collaboration which
promotes health, when the family
members support the prescribed
tieatment or. on the contrary, a
negative closing of ranks that can
hinder the solution of the problem.
If a paediatrician has a good
rapport with a child patient but not
with the mother, it is obvious that
treatment might not be completed or
not even slatted al all. The same can
also happen, in our expeticncc. when
a physician treating a num with
diabetes docs not encourage the wife
to prepate proper diets to control his
blood sugar level, l ite "therapeutic
triangle" Ilins shows how essential it is
for health personnel Io have speciHc
training to improve their analytical
capacity, their understanding, and
their ability to deal w ith (he needs and
realities of all those involved in the
relationship.
Harmony within lhe family - an imporlonl element in
ell being
Guiding principles
These two factors can be seen as the
guiding principles that control often
tumultuous family relationships.
particularly during such stressful
events as serious chronic or terminal
illness, so disruptive of family life. On
such occasions, families have a
particularly hard time and need till the
resources available. Each family deals
with these problems in its own way
and in its own time. Some families
manage completely on their own,
while others have lew or no obvious
resources. Sometimes the cohesion of
the family is lost and each member is
left alone to light his or her own
battle. In those cases, only external
help - from properly alert health
personnel - can find the appropriate
resources and solutions that can bring
meaning and value to such
experiences. In this way both the
individual and the entire family, even
amidst suffering anil hardship, can
rediscover health as interpersonal
well-being. E
/Wessoz Villone Cigoh is Professor ol Social
Psychology ol the Iacuity ol Lducalion,
Catholic University ol Brescia, holy, and o
Member ol the Board ol Directors of lhe
Catholic University ol Milon Dr Wilmo Bindo
is Researcher ol lhe locally ol lducalion.
Catholic University ol Milan, largo A. Geinelh
I. 20123 Milon, holy.
4
The family of tomorrow:
a message from a world-famous author
m wl'l tei ■ i’.1 ’"jn.'w mu ,t ga. ■"wmiMtmww mm
Iii order to be successful, the
family ought to embrace
several generations, since it is
essential for the young and
the less young to live
together, understand one
another and help one another.
I have no doubt that the
future will see the "extended"
family being recreated, in the
sense that it will not be based
simply on the nolion of blood
relations but rather on ties of
affection.
he future seems likely to see a
crucial change in the role of the
family, which will become the
initial training centre where people tire
apprenticed for life in society.
Even more vital will be the revival
of what used to be called the
“extended” family, which knits
together basic family units. This "joint
family" comprising relatives in the
broadest sense was what constituted
Chinese and Indian society in the past.
I myself had the good fortune to live
in one of those “large” families - good
groundwork for being able to adapt
very easily to the most varied settings
and personalities. Better still, I come
from a complex family, mixed
Chinese and European, so that 1 was
never trapped within one single
culture or forced along one single
In order to be successful, this
path; consequently 1 can lake the
“family space" ought to embrace
broad view that the whole world
seems like one vast family... Distrust
several generations, since it is
and fear have no part in it, and there is essential for the young and the less
Let me say again - Ixxausc it it^^
no need for protection, litis large
young to live together, understand one crucial - that the extended family cWF
resolve at a stroke all the problems of
family is not a fortress but rather an
another and help one another. Within
access route to everyone and thus the
a family at its basic level, the child can unequal talents ;md unequal success
true cradle of society.
be lonely. In the bosom of the
which otherwise arouse that
1 have no doubt that the future will extended family it will never be
devastating emotion - human egoism.
sec this large “extended” family being lonely, because if the mother is absent The function of the family is to level
recreated, in the sense that it will not
there will always be the grandmother,
out inequality. ■
be based simply on the notion of
the sister, the cousin or the aunt. Thus
blood relations bul.ralhcr on tics of
the child is not fixated exclusively on
affection. When the young people of
its mother since the very notion of
North America tried in the 1960s Io
motherhood is itself extended. The
form such communities, they failed
future will undoubtedly rediscover
because all who were not of the same
this family-community structure,
generation were excluded... Yet
particularly since technological
advances make it possible for a lot of
children yearn to belong to a great
Extracted, with the permission ol Mrs I lan
family; one has only to sec the gangs
work to be done at home, thus
Suyin, horn les yeux de demoin (The eyes of
of youngsters in the streets of our big
avoiding useless and exhausting
tomorrow}, published by Christian de Lloilillol
Pans, 1992.
travelling.
cities to measure this need.
T
Mental health matters too!
Anula D. Nikapota
A child who is healthy is
physically well and also
hoppy, growing and
developing well according to
his or her age. The child
mental health programme in
Sri Lanka encourages health
workers to watch for families
and children under stress.
[I j vX rogrammcs for child and family
t.Jw' health have for several years
H
included specific tasks and
training related to child development
and mental health. Identifying the
problems in this field led to the
realization that promoting child
development needs not one but many
different inputs and-the use of several
different strategics.
The child mental health
programme in Sri Lanka is
implemented by the Family 1 Icalth
Bureau in the Ministry of I Icalth, with
the support of UNICEF. Coordination
with other relevant agencies.
particularly the training institutions for
primary health care, has helped to
nurture and extend these new inputs.
One early innovation was to
introduce the concept of the integrated
nature of health, growth and
development. In other words, a child
who is healthy is physically well ;tn,d
also happy, growing and developing
well according to his or her age. One
strategy selected was to include in the
growth chart of each child a few
selected developmental milestones
such as walking, talking and
understanding simple requests. This
A hoppy child is more likely Io show normal growth and development.
served Io create awareness of this
concept among parents, families,
communities and health workers.
Health workers were taught about
children's developmental needs and
about ways of discussing with parents
how to promote development by
fulfilling those needs. For example.
one young mother who was very poor
and had two young children was upset
because she could not provide the
kind of toys that would help her child
to leant; she had read that this was
important. I Icalth workers routinely
visit homes with young children, and
her own health worker had established
a good relationship with her and
presently learnt about her worries. The
health worker was then able to build
up the mother’s confidence in Iter own
ability to help her children’s
development through play and
learning during day-to-day activities,
using ordinary objects for play.
Another aspect of the programme
of particular value in certain areas
involves identifying children who arc
slow developers, are under acute stress
or have behavioural problems. Some
of these inputs arc similar to those in
other parts of the world.
Risk factors at home
A unique feature of the programme is
the introduction of the concept of
routinely monitoring the home
environment for risk factors. Such risk
factors were identified during research
which in fact used the health workers
as research assistants. This part of the
progiainmc is still regarded as more of
a project, although it has been
accepted for use nationally.
The purpose of this monitoring is
not merely to identify family
problems. The real reason for this
approach is that there are always
families where educating them or
“telling them what to do" is not
sufficient because - for a variety of
reasons - they find child care stressful
or more than they can easily cope
with. This is a common experience in
health-related field work in many
cultural settings.
Working with such families - that
is, helping families to improve their
mental health and functioning so as to
cope and care better for their child - is
very much part of clinical practice for
child and family mental health. So it
seemed entirely appropriate.^
introduce a similar concept into the
primary health care programme for
child and family health.
The risk factors include those that
arc likely to be associated with child
care problems such as a very young
mother, poor spacing (more than two
children under 3 years old), lack of
interest in the child, or a mother who
finds understanding health messages
difficult. In addition, there may be
evidence of poor coping from
whatever reason, such as poor
organization in the home. 01 of
specific problems such as severe
marital discord, mental illness in
parents, alcoholism and drug abuse.
abject poverty, or trauma due to the
conflict situation in die country. Sadly,
the last factor is all loo predominant in
some communities al present.
Health promotive behaviour
Training materials have been
developed which emphasize the basic
principle of working with these
families, which is for the health
worker to approach the issue of
meeting children's needs by looking at
die families' problems, as well as their
resources, and working with them to
achieve, step by step, health
promotive behaviours in their daily
life.
A mother was unhappy and
resentful dial her husband was
drinking heavily. The couple
quarrelled every day and the children
became increasingly worried by this.
The mother told the health worker,
who had known the family since the
Playing is learning, lhe toys don't have Io be expensive
youngest child was born and who was
aware that the family had durable
strengths: the husband did care for the
family, and the couple did care for
each other.
She explained to the wife how she
could use those strengths by perhaps
being less irritable with het husband
even when she might feel he had let
her down. The health worker also got
on well with the husband and so was
able to talk to him about his hopes for
the children - at the same time using
this opportunity Io point out that his
drinking was upselling the children.
Gradually the situation did improve.
and the health worker went out of her
way to praise all the family for (heir
efforts.
Any programme has Io lie
evaluated to judge whether its efforts
ate really leading to improvement. In
the case of this programme in Sri
(
Lanka, such tasks as are described
here are still not as familiar - and
hence arc not performed as
extensively in the field - as are tasks
related to immunization or nutrition,
for example. Those concerned with
the programme, however, feel that
these inputs, and particularly work
with families and children under stress
or having problems in coping, will
significantly enhance child and family
health. H
Di Anuki D Nika/rota is o consultant in Child
and Adolescent Psychiiiliy al lhe Brixton Child
Guidance Clinic, 19 Boston Water lane.
London SW2 INU. England She hr is also
hoiked ns a UNICLI consultant with lhe child
mental health programme in Sri lanko
Bothtirne: a hoppy occasion lor mother and child.
Towards Healthy
Families
Healthy families — which are physically, emotionally and
spiritually whole — are the foundation on which a healthy
' society is based
is an undisputed fact that
healthy families make a healthy
society and those who work to
wards building a healthy society
should start with families. Health.
as many have come to realise now.
is wholeness — the physical, emo
tional and spiritual well-being ol a
person, without which fullness of
life is not possible. Unfortunately
the “family" has become an en
dangered institution, and Is slowly
becoming the mechanised, emo
tionless society portrayed by
Aldous Huxley In his satirical
novel, A Braun Npw World.
Modernisation, development and
so-called progress seem tube shak
ing the ver,’ foundations of our
families as well as our value sys
tems. Rapid changes
taking place make us
feel that we are" stand
ing between two worlds
— one dead and the
other powerless to be
bom". Caught between
changing values, ideas
and ideologies, many
seem to be losing their
balance. I would like to
concentrate on the “Val
ues Of dine Family".
Without a sound value
system there cannot be
a healthy family.
The most visible sign
of the decline and disin
tegration of a family as
an institution is the
alarmingly increasing
rate of divorce. At least
one out of every three
marriages end up In di
vorce In most developed
countries. Incompatibil
ity between tire husband
and wife, cited as the
commonest cause of di
vorce, Is often only an
euphemism for selfish
ness and self cenlrcdness. Both
partners ask what they can gel out
of marriage and never bother to
find out what they can put into It.
Both arc more conscious of their
rights than their responsibilities.
The absence of faithfulness. Integ
rity and moral convictions, takes
many marriages to the brink of
disaster. No marriage can survive
without mutual love and respect,
commitment and a spirit of give
and lake. If both the husband and
tire wile share the same basic val
ues. they arc likely to have a good
and lasting marriage — no matter
how vast their differences are on
other things.
The best and the most impor
tant tiring parents can give to their
children is a sound value system.
Value is a rather abstract term but
can be clearly rcllcctcd in our
choices and priorities. A fact we
often forget is that a person's value
system starts developing in his
Infancy, lari us not forget I he words
ot wisdom, “Train up a child in the
■ way he should go and when he is
old he will not depeuifrom it “ (Prov.
22:6). At ever/ stage of the devel
opment of a child, the parents are
to guide the child to do what God
has equipped him or her with, to
serve God and to teach what is
right and wrong and encourage to
pursue what is pure and Just.
Tire relationship between par
ents and children is undergoing a
tremendous change. Parents do
not have the time to train their
children. With both parents work
ing, children are often neglected at
tire spiritual and emotional levels
while all their material needs are
met. In their anxiety to provide for
children, parents often forget to
impart to them the most Important
thing to which Jesus referred, when
he told Martha, “But one thing is
needed and Maiy has chosen that
good part which will not be taken
away from her". In our pursuit of
worldly riches and security — very
often more for our children than
CMJI
SOURCE:^QMJI Journal/Vol.8 No.l., January-March 1993.
FEATURE
for ourselves — we fail to give them
what they need and want most —
ourselves and our tune. Those of
us whose children have grown up
and left home should try to answer
this interesting question, "if you
had a chance to do it all over again,
what would you do differently?" I
am sure many would simply say
that they would spend more Lime
with their children.
In tills context, I often rcmemuer the story of a little boy with a
small cut on his finger. The child
wanted to show this to his fattier
who was deeply immersed in the
business page of a newspaper.
“Daddy, see this”, the child kept
saying, but the father never looked
up.
Having failed to draw his
father’s attention the child went
away disappointed. Lateronlnthe
day, the father asked him that he
had wanted to tell him earlier. The
boy showed him the scratch on tire
finger. “Well, I couldn't have done
anything about it, could I?" re
marked the father. “Butyou could
havesald ’Oh’," said theson. Very
happy and
healthy families, all
communication channels
should be open between
parents and children
often all we can do as parents is to
say “oh" and be with our children
when they need us. To build happy
and healthy families, all commu
nication channels should be open
between parents and children.
"Values arc caught rather than
taught.." When wc preach one set
of values and our lifestyles reflect
another, is It surprising that our
children get disillusioned and con
fused? Wc fail miserably when we
teach ethics, morality and spiritu
ality and seek earthly possessions
and materia] comforts. Wc ask
them to "lay up” lheir treasures in
heaven while they see us franti
cally trying to lay up our treasures
on earth! When we lie or withhold
truth when it is expedient, when
wc climb social ladders without
heeding whom we step over or
knock down, when we are totally
insensitive to the needs of the poor
and the downtrodden around us,
but say long prayers for people
who suffer in the war-torn places
of the Middle Eastand the starving
children of Sudan, how do you
expect your children to react?
“Seek ye first the kingdom of
God," said Jesus, “and all these
tilings will be added unto you." In
modem phraseology, Jesus is ask
ing us to get our priorities right. A
family with the right priorities and
right values is a spiritually and
emotionally healthy family. Many
parents as well as children com
plain about the 'generation’gap’ —
that they do not understand each
other or arc on different wave
lengths. However, if parents and
children have the same values and
priorities, they can agree or dis
agree on minor issues, like the
type of clot! ics they wear, the length
of their hair,die type of music they
listen to, etc, but when moral ques
tions are Involved, they are likely
to take the same stand.
'ITic cliched expression, a family
that prays together stays together,
reveals a great truth. Meaningful,.
common family prayer which is
more than aritual brings the mem
bers together and brings stability
to the family. There are bound to
be problems, disagreement and
discord In every family at times,
but if all the members can kneel
down before God with one accord
and surrender themselves com
pletely to Him, peace and harmony
can be restored.
Aley Jacob
Aley Jacob is convenor of CMAI's Medical
Records
Training
Committee,
St
Stephen's Hospital, Delhi.
CMJI
OF
CHANGE
INDIA TODAY profiles ordinary people across the country living in relative obscurity
who through their selfless action have brought extraordinary changes in our lives and
the way ive do things. In doing so. these quiet revolutionaries have demonstrated that it
is possible to bring change even in the most dismal situations if one has the will to do so.
hesitate to take for want of time or caring. The road to change. as
they found out. is strewn with thorns. It is a long and winding one.
always uphill. But their journey Ims already made a remarkable
difference
to the lives of the people they wanted to help.
Il-'E is suffering, the Buddha
Most of these helping hands are ordinary people. A
said, enunciating the first of his sweeper.
An unemployed technician. A retired clerk. A per
four Noble Truths, in India, it is sonnel officer in a company. A banker. A high school teacher.
a reality that troubles us z\ housewife. They are neither rich nor powerful. Philosopher
whichever street we live on. Kahlil Gibran would describe them as ''those who have little
wherever we go. Homeless chil and give it all''. And they give all not because they want recog
—they still live in relative obscurity—but because their
dren imploring motorists at nition
concern comes from deep within.
traffic lights for a few paise even
These people are India's quiet revolutionaries. They are
as their tender lungs breathe in noxious fumes. The what Mahatma Gandhi would have culled "determined spirits
sick dying for want of medical care. One-third of In who are fired by an unquenchable faith in their mission '. Such
dia’s populace going to bed hungry every night. people. Gandhi had opined, can change the course of history.
They do that by understanding that there are no simple an
Able-bodied men sitting idle, their life ahead as bar swers
to complex problems such as eradicating poverty or en
ren as their fields. For millions in the country, the suring sustainable development. They avoid using social band
flame of hope is but a flicker.
aids that cover the wound without treating the underlying
cause. They realise that there tire no shortcuts to change and
As citizens of this country, there is much I hat each of us can
that nothing comes without a struggle. You can't get a crop
do io prevent that flame from being snuffed out. Or to help it
burn more brightly. Yet those of us who are better off appear without sowing it first.
Their secret, if there is any. is that they prefer to act as a
paralysed by the enormity of the problems confronting the
country. We inure ourselves to the surrounding misery. It does catalyst to stimulate the process of change. They empower
people
with the knowledge and the means to improve their
twinge our conscience occasionally. But we soothe it by writing
lives. Without seeming to do so. they actually
a cheque to a local charity. Or throwing a few
work to a plan. They first win the community
coins into battered tiffin carriers. Usually we
over through some concrete improvements.
do nothing more. Let someone else pick the
The row to
And once the people sense that they have the
dying off the roads. Let orphans fend for
power to make the difference, the movement
themselves. Let the Government look alter
CHANGE. AS THEY
gathers a momentum of its own. They also ex
the poor. After till, aren't we paying our taxes?
FOUND OUT. IS
hibit patience to overcome setbacks and to en
Even if we did want to do something, we
dure prolonged battles. And all of them are in
ask ourselves: Where do I begin- it is nor
STREWN WITH
curable optimists.
mally followed by another question: Can I re
THORNS. [T IS A
In most cases, there are no yardsticks or
ally be of much help? In his poem Roiul Net
Taken. Robert Frost hints at the answer:
profit graphs to measure the change they have
LONG AND
brought about. How do you quantify the joy of
Two roads diverged in a wood, and IWINDING ONE.
I took the one less travelled by.
orphaned children who have found places v. here
people actually care for them- Or the benefit be
And that has made all the difference.
ALWAYS UPHILL.
stowed on a farmer by teaching him how to har
The people, whose profiles appear in the
ness scarce water- Or the effort to generate a
following pages, took die path that all of us
By Raj Ciiingaita
iMH \ run\\
I
COVER STORY
ries. The centre delected she had leprosy and cured her. The
only visible scar was a claw-hand syndrome that many cured
leprosy patients suffer from. This was later rectified by a 30minute surgery. Says Suhasini: "Earlier, no one would marry
me because they knew I had the disease when they saw my
hands. Now. at least I have a fair chance."
What makes New Hope different from the numerous cen
tres for helping leprosy patients that have come up over the
years is its innovative approach. Rather than housing patients
in leprosy colonies, they believe in educating villagers about
how easily thediseasecan be cured and getting them tocare for
the patients in their homes. Part of the reason for thisapproach
is that Rose has experienced the pain of such isolation. Both his
parents were cured leprosy patients but were forced to stay in a
lepers' colony, shunned by society, in Andhra Pradesh. To en
rol in a regularschool. Rose had to leave home and live in an or-
community spirit Io remove garbage from the streets?
These grassroots Samaritans would in fact rival the or
ganising abilities of any of the country's top corporate chief
executives. They demonstrate extraordinary leadership qual
ities and vision. They make themselves redundant by teach
ing people how to help themselves. They are willing to learn
from their mistakes. And they are not content only to revolu
tionise their minds. They have the strength and courage to
change their lives, and the lives of other people. They arc like
karnuuioiiis who prefer to enlighten themselves through ac
tion rather than meditation.
These are not human beings having a spiritual experience.
They fall into the category of what management guru Wayne
Dwyer calls “spiritual beings having a human experience".
They are truly angels of change.
,
ELIAZAR ROSE
Redeeming their
Tomorrows
By Raj CtlENGAlTA in Maniguda
IS favourite saying is: My name is
Today. With good reason. For, as
Eliazar Rose, 35, a technician
turned social worker, says: "We
cannot saj' to the leprosy patient
standing naked in front of us, to
the disabled child, to the expec
tant mother—Tomorrow. Their need is Today,
whether we have a budget for them or not. Their
outstretched hand is forToday.”
I'or the past decade, the urgency of their need has guided
his actions, for someone who grew up knowing what it means
to be hungry and who had no money to fund his higher educa
tion, this philosophy has helped Rose do an
enormous amount in a relatively short span
“Ican’tturn
of lime. Enter the sprawling 3 5 acre New
I lope Leprosy Trust complex that he and his
AWAYTI IE NEEDY
group of workers have set up in Maniguda. a
WITH THEIR
remote taluk in Orissa's Rayagada district.
and you get <m idea of just how much.
OUTSRETCHED
What began as a tiny rented out-patient
HANDS, SAYING
clinic for treatment of leprosy patients has
today grown into a major centre for health
THAT 1 DON’T HAVE
care and social development. So impressive
MONEY. DO MY
has its track record been that it became the
first ngo in the state to be given permission to
WORK ANDIKNOW
manage a surveillance, treatment and eradi
God will do his.”
cation programme for leprosy. The centre’s
work covers 1,876 villages in the area and
has already cured more than 3.000 villagers
of I he disease and is currently treating 2.500 more.
Apart from that, I he complex houses the only reconstruc
tive-surgery unit in the slate for these patients where opera
tions arc performed free of cost. Suhasini. an 18-year-old tribal
girl from a nearby village, was one of its most recent beneficia-
I
plumage. His mother had to resort to begging to send him
money. Rose’s wife Ruth, whose parents were also leprosy pa
tients. had to live away from her parents too.
After Rose finished his course at a local industrial-training
unit, and to bide time before he found a regular job. he helped
missionaries with leprosywork.lt was then that begot deeply in
volved. With India harbouring four million leprosy patients—a
third of the world's total—the problem is enormous. The real
task lay in removing the stigma and the fear the disease evokes.
Rose realised that if a dent had to be made, it was important to
create awareness among the people about how easy it is to treat
t he disease. That is now one of the main missions of his trust.
To carry out this mission, the trust employs tribal girls and
gives them bicycles to go from house to house, both to educate
womenfolk about the disease and to delect any new cases. Says
Dr Rajnikanth Mishra, who had set up the out-patient clinic
with Rose in Maniguda 10 years ago: "By employing their own
girls as motivators, we were training the community in han
dling lhedisease. Even if we leave tomorrow, the knowledge re
mains with them."
But New Hope docs not restrict itself to treating only lep
rosy patients. Rose also found that the elderly suffer from
cataract and young children from night blindness. Maternity
facilities for this tribal belt, adjoining the notoriously back
ward Kalahandi district, were almost non-existent. So, in the
New Hope centre, Rose encouraged villagers to come in for a
BEACON OF HOPE: Rose, drawing on his own bitter and painful experience of isolation, has helped battle the stigma
and fear t hat leprosy evokes by creating awareness among the people about how easy it is to fight the disease
COVER STORY
wide variety of treatment including removal of cataracts and
even assisting in complicated pregnancies. All this went a long
way in helping to reduce the stigma against associating with
leprosy patients Says an appreciative Upendra Prasad Ilota.
the block development officer for Maniguda: "They arc an ex
tremely dedicated team and even we seek their help to get to
some remote areas."
Rose and his trust help people in numerous other ways.
They train children afflicted with polio to make callipers so
that they could be gainfully employed. They have helped
women form a co-operative bank where each contributes a ru
pee a day and takes out loans in turns. The trust has popu
larised the concept of community gardens to enable villagers
to produce concentrates of vitamin /\ cheaply.They run a free
school in Vizianagarain. in neighbouring Andhra Pradesh, for
children whose parents are leprosy patients.The list is endless.
Friends warn Rose that he is taking on too much. But his
logic is simple: "I can't turn away the needy by saying I don't
have the money. 1 do my work and I know Clod will do his." And
somehow the money needed for the work pours in. The trust
now receives funds from a host of foreign agencies involved in
supporting health care and development in poor countries.
And the annual budget is close to Rs 40 lakh. But Rose’s re
ward is. as he puls it. "to see a child who has suffered so much
smile again. 1 can't ask fora better thanks".
M.B. NIRMAL
Cleaning up
their Act
By G.C. SlIP.KHAR in Madras
T'S Sunday morning at Border
Thottam, a downmarket locality
in Madras. It presents a dismal
sight with its lanes clogged with
derelict, rusting lorries and stink
ing drains. Suddenly, dozens of
youth armed with brooms arrive
on the scene and in a Hurry of activity start clearing
t lie heaps of garbage lying uncleared for months. A
group of girls, in green and white uniforms, follows
suit and gives lips to the residents about cleanliness.
About 20 women, also members of the group. are cleaning
an open sewer with bare hands when an old resident Hings
some garbage on the road. She receives cold stares, but is un
apologetic and glowers in return. "Let me speak to her." says a
middle-aged man. stepping forward. "This is your road, as im
portant asyourhouse.” he explains. adding that boys cleaning
up the muck are her neighbours and resorted to this as they
could nolongerput up with thecivicauthorities'neglect. "Will
you also enrol as a member?" the man asks. "Sure, why not?
And what should 1 do?" enquires the lady.
Exnora International has one more member and its
founder. M.B. Nirmal. 52. has won yet another convert to
cleanliness. Founded in 1989. the citizens' initiative has
nearly L000 branches across the country today, thanks to its
simple agenda: Use citizens to sort out citizens' problems. And
the first citizen of this highly successful effort is without doubt
Nirmal. "M.B. stands for Muck and Broom, the first is our en
emy and the second our weapon, more powerful than the
AK-47."explains Nirmal with a laugh.
The Fxnora habit has caught on because its effect is clearly
evident: no overflowing garbage bins wail for the rare corpo
ration lorry in Madras. They have been replaced by what the
organisation calls "mobile dustbins", which a "street beautifier". pedalling a tricycle cart, clears every morning.
Nirmal says that Exnora collects 20 per cent of the 3.000
tonnes of garbage that Madras generates daily. And it provides
service to all tiers of society—from the posh st reels of Indira NagarandNungambakkamtolheslumsof Venkatapuram. Film di
rector Mani Rat namandhiswifeSuhasiniandwriterSivasankari
are active members in their area. And so are hundreds of house
wives, students and retired persons who devote al least an houra
day toExnora work. "Wearcnot rivalsof thecivicauthorities. Our
id
bl
ite
ly
ole
GARBAGE UNCLE: Nirmtil’s people’s initiative has nearly 3,000 branches across the country
today, and its success is due to its simple agenda of using citizens to solve citizens' problems
efforts are microcosmic because we still need the corporation to
haul t he tonnes of garbage and build roads." says Nirmal.
The plan toslartUxnora (Excellent. Novel. Radical ideas) oc
curred to Nirmal, an officer in the Indian Overseas Bank, while
he was still posted in Hong Kong. Initially, it was meant to be a
forum to lap ideas from NRIs in their fields of specialisation and
apply them for the betterment of the community. But when a
bout of gastroenteritis gripped the slum dwellers around his
house in Madras. Nirmal decided to take the message of clean
liness to the people of the city. And Civic Exnora was born.
The project was launched in an upper-tniddle-class local
ity. covering just two streets. "Though the residents were sore
about the pilinggarbage, they were not very enthusiastic about
calling someone to collect it," recalls Nirmal. But once they
witnessed the streets being cleaned regularly. participation in
FIRST IS OUR
ENEMY ANDTHI
SECOND OUR I
creased.' Nirmal tackled the hesitant
ones patiently—when they balked at
WEAPON. MOR
paying Rs 10 a month to t he "beautifier"
as salary and for his vehicle mainte
POWER1TI1.TI1A
nance. he would only say: "No problem.
THEAK-47." '
just give us your garbage. We need that."
z\ month later, the subscription would
be paid, with arrears.
But it required all of Nirmal's tact and ingenuity to expand
the scheme. In T. Nagar. for instance, when the residents of a
particular street refused to join, he urged the president of lite
local Exnora to open his badminton court to the kids of the I ■
area. A month later, the parents had joined Exnora. Explains |
Nirmal: "Children are the most effective campaigners for |
cleanliness. Grown-ups feel that if it is an issue that concerns ! 1
'
|
children, it should be serious."
A similar positive attitude is apparent in his approach towards the civic authorities. "Nirmal would first thank them for
t heir earlier help and then unveil the problem. In most cases, it
would work." says V.N. Subramanian. a former marketing ex
ecutive and now a consultant with Exnora. The corporation
authorities often view the group as an interloper but that has
not deterred Nirmal from taking his problems to officers al all
levels. "1 sec every obstacle as a stepping stone," he says.
This approach has instilled confidence in a growing number
of people, who see Exnora as a forum for addressing their com
plaints. Nirmal now has to tackle problems such as lack of water.
housing and even ration cards. Also. Exnora has spawned a host
of progenies—Tree Exnora. Marriage Bureau, Speakers' Club ,
Naturalists' Club. Blood Donors’ Club and even a Bhajan Club.
Civic Exnora. though, remains Nirmal’s prime passion.
"Carbage Unde", that's what many children call him.
Nirmal likes it.
BADRI NARAINPANDEY
Striking Back
at Terror
By EaRZAND Ahmed in West Cliamparan
I,THOUGH it is noon, the thick fog
enveloping Bakhri. in Bihar’s
West Cliamparan district, has not
lifted. The armed gang of dacoits
waiting on the outskirts of the vil
lage sees it as an opportune time to
launch an attack. But the}' are in
for an unpleasant surprise.
As I hey move into st rikc. instead of petrified vil
lagers. they encounter a veritable army of people.
The gang beats a hasty retreat with the villagers in hot pursuit.
One of the dacoits who is caught is beaten mercilessly.The four
others who escape arc. however, unlikely to ever attack Bakhri
again, for they have experienced the power of the Gram Rak
sha Dal (village-protection force).
Just four years ago. such resistance would have been un
thinkable. Then lawlessness reigned supreme in this district
bordering Nepal. Dacoits regularly raided villages, kidnapping
people, looting valuables and raping women. In 1986. the po
lice even launched a special drive called "Operation Black Pan
ther". but with little success.
Il was around this time that Badri Narain Pandey. 55. a re
tired clerk from the Army Medical Corps, decided it was time to
act. He recalls that in his village, Siswa-Basantpur. people were
so terrilled that "no one dared open the doors before eight in
the morning and locked them up before sunset". Pandey ini
tially gathered a few villagers to form a shiihiili julhtlui (suicide
squad I. collected all licensed armsand administered an oath Io
them that they would sacrifice their lives for the security of the
villagers. And a new movement had begun.
The members of the squad look turns at keeping round-theclock vigil on the village. They identified members of the dacoit
gangs, their contacts and informers from among the villagers
and first tried lorcfornitricm.Tho.se who refused to listen were as
saulted and ousted from the village. The idea worked. Soon such
shahidi julhthas were formed in all neighbouring villages with
Pandey as sanc/udak (coordinator). “Members of these shcdiidi
jaililllas arc in fact aQRT(Quick Reaction'learn) that can react to
thesituationina Hash.” says Amar, convenor of theSamajikSodhevam Vikas Kendra, which is based in Siswa-Basantpur.
Eor the movement to gain a firm foothold. Pandey realised
that there had to be greater village involvement. Thus began the
concept of Gram Raksha Dal whereby from each village people of
all ages and castes got themselves enrolled and underwent armed
training under the guidance of Pandey and his band of dedicated
men. In the past five years, more than 3 7 5 such village-protection
forces have been set up. covering more than 60 per cent of West
RUSTIC SHERIFF: Pandey s initiative to organise selfdefence forces in the village helped them thwart dacoits
ers
as!ch
’
()fficialsareevcn willing to overlook some of the village-pro
Champaran district. So powerful have these groups become that
the dacoit gangs have been forced to withdraw into the jungles tection forces' unconventional methods that al times overstep
of the l()0-km-long Someshwar Hills range along the Indo- the law.They concede that villagers have been using illegal guns
against criminals. While there are only 9.500 licensed arms in
Nepal border. Amrik Singh Nimbran, deputy inspector genera!
the district, Pandey’s forces have acquired more than I 6.000
of police, acknowledges this: “Pandey’s efforts are laudable.
weapons. But since these are used for self-defence, the local auHe was able to mobilise villagers to fight criminals. Without
Ihorities have not initiated legal action or disarmed them.
t he people’s cooperation, no anti-crime drive can succeed.’
In many encounters, the protection forces
Initially, thedistrictadministrationandthe
have had bloody dashes with criminalsand have
police, which had failed to provide security to
killed about 70 of them. But officials acknowl
the people, viewed Pandcy’s efforts with suspi
"Bytraining
edge that sincedacoils are rarely convicted, in
cion and refused to cooperate. But an enlight
quiries into such encounter deaths arc not pur
ened district police superintendent, AbTl IE VILLAGERS
sued too vigorously. The ruthlessness displayed
hayanand, saw the idea’s potential and started
T0FIGI1TTHE
by the dacoils may be partly responsible for this.
providing Pandey and his men with moral and
Last fortnight, when a village. Narkalia Done.
logistic support. Now Brajesh Mchrotra. the
DACOITS
refused losupply rice, goatsand women lot hedadistrict magistrateof Champaran, says: "Anew
THEMSELVES. WE
coits. they struck back and killed 1 5 people.
kind of cooperation between thepeopleand the
After the massacre. Chief Minister l.aloo
police is emerging and this is good."
AREM0VING
COVERSTORY
Prasad Yadav announced that a new operation would be
launched to flush out criminals from West Champaran. But
the announcement was greeted cynically by most villagers.
Instead, they preferred to rely on their own village-protec
tion forces. That is a measure of the faith and credibility
evoked by the army that Pandey has helped build.
SAD1IANA MUKHERJEE
Giving Respect
A Chance
By RUUHN BaNHR|I:.E in Calcutta
HE 10O-ycar-old building in a
corner of the serpentine Dayal
Mitra Lane in Calcutta is de
pressingly dilapidated. The stair
case is falling apart. The rooms
are dark, dank and smelly. But
unmindful of the setting, some
gaudily dressed girls chatter in high spirits. Halfnaked children loiter around while nattily dressed
visitors pop in occasionally to pick a girl and
disappear into one of the cavernous rooms for a while.
Il's well into the night, and the predominantly middle
classneighbourhood in Calcutta's Rambagan locality.on the
edge of Sonagachi—the city's biggest red-light area—has
long gone to bed. The inmates of the brothels situated along
side ordinary homes are in bed too, but for a different reason.
The light glows in the room of Sadhana Mukherjee, RS.
inmate of one such brothel. Till two years ago. she sold her
body to make a living. But now she spends her time charting
out a belter and healthier future for those still in the trade. As
the convenor of the Mahila Samanyay Committee (msc)—
which has a third of the city’s 1 7,000 sex workers as mem
bers—she is involved in diverse activities such as minimising
the risk of sexually transmitted diseases (stds), ending (he
area's pernicious tkuki system and ensuring that the children
of these hapless women do not end up in the profession.
"Ours is a struggle for gaining dignity," says Mukherjee.
Forced into prostitution at the age of 15. none would know
better than her the debasement and the depravity that these
women suffer. And she has her hands full.Two months ago.
local loughs attempted to extort huge sums from the prosti
tutes in Kalighat. The MSC retaliated by organising a protest
rally and petitioning the local police station for an end to the
menace. Taken by surprise, the dadas beat a hasty retreat.
"Prostitution is our profession and we have every right to
live like everybody else." argues Mukherjee. She has demonstrated that if the workers unite, they can effectively light to
improve their lol. For instance, in collaboration with the All
India Institute of Hygiene and Public Health (.-\iiiii
*n),
Mukherjee and her band of work
ers have made major strides in re
ducing the incidence of std among
'()URS IS \
*
sex workers by educating them on
the need to use condoms. Says Dr
ST RUGG1T. l-OR
Sarajit Jena, aiihph's programme
GAINING DIGNITY.
coordinator: “But for selfless
DIFFERENT APPEAL: Mukherjee and her hand of dedicated workers have shown that if
sex workers unite, they can effectively fight any force and improve their condition
SAI0AL DAS
Prostitution is
OUR I’ROITSSION
AM) \\ E 1IAVE
COVER STORY
women likeSadhana. we would have made little progress."
Recently. theMSC won a major battle when il managed to
register its co-operative by forcing the state Government to
waive the requirement that members be of "good moral
character". Mukherjee is making noises, as she puts il. on
other fronts too. One is Io convince the local authorities Io li
cense their profession. which would end harassment by both
policemen and pimps. So far. no one is listening, but as
Mukherjee says: "The noise has to grow into a roar before we
finally get heard."
KINKRI DEVI
Fighting for
Green Hills
By RaMESH VlNAYAK in Sirmaur
T first sight the denuded hills of
Sangrtihu, Himachal Pradesh.
seem nodifferent from anywhere
else in the I limalayas. Relentless
deforestation, caused bj' lime
stone quarrying, scars
the landscape. Yet. go to
the local school. You might see a frail
woman talking to an open-air class. She
speaks of her memories of lush forests
and of the need to stop the damage done to the
countryside. With a rare passion and commit
ment. Which is what has made a difference.
This is Kinkri Devi. 5 5, who in the past
decade, has taken on the limestone quarriers re
sponsible for much of the damage. And so far she
is winning. As Jecvni Devi, a local resident.
points out: "We were sleeping till now. She has
raised our voice."
In Sirmaur. limestone quarrying has been big
business, especially since environmental concerns
forced the closure of Doon Valley quarries. But it
played havoc with the local ecology and the local
lifestyle. Quarrying led to the reduction of forest
cover, the contamination of water supply, reduc
tion of the availability of firewood and degradation
of agricultural land. For Kinkri, a widow who
works as a part-time sweeper and for whom life has
been a struggle, the impact was painfully obvious.
It was a workshop organiser! by a local Ntto in
1987 that inspired Kinkri to write a letter to the
high court. When there was no response, she sat
for two weeks in front of the court till it agreed to
take up the issue. Initially, the 48 mine owners of
Sirmaur dismissed il as a blackmail attempt. But
the contempt was short lived. The court soon im
posed a blanket ban on blasting, though it was
GUTSY GREEN: Kinkri has successfully battled
the influential limestone quarriers in the area
partially lifted later. Finally. in 1991. il ordered (besetting up
of a high-powered committee of experts and government of
ficials and directed il to visit the mines every' six mon ths to en
sure that there was no damage being done to the environ
ment. The court also directed the Ministry of Environment
and Forests to undertake a complete study of the impact of
mining out he region, which is being conducted presently. At
least half-a-dozen mines have already been closed down and
reforestation efforts are on.
For Kinkri. who realises the power of the mining lobby.
this is not enough. She says: "They have money and I only
have will power." Now she is busy spreading the gospel of /wliarpaam (hills and water), she is also busy mobilising locals
for regeneration of the mining sites.
Iler enthusiasm is infectious. Not only the local people
but also the bureaucracy and the mine-owners themselves
arc full of admiration for Kinkri. P.C. Dhiman. deputy com
missioner of Sirmaur, says: "Her initiative has snowballed
into a major environmental issue."
Admits V.K. Walia, a leading mineowner: “Bui lorherinlervention we
, X|.( nvM..RS
would have been lethargic about
the environmental damage due to
I I.WE MONEY AND
quarrying. ’
1 ONLY HAVE WILL
More important. Kinkri has
POWER. Bl T NOW.
raised I lie level of awareness
of these issues in the entire com
MY 1! VITI.ETO
munity and made them vigilant.
S \\ ETI IE HILLS
Al the school in Sangraha the
HAS BEEN TAKEN
HP BY 01 HER
COVER STORY
kids arc determined that "Humcin bhi iJunijiivuniii kc HifC a
waaz iillumec chuhiije. (We too should raise our voice for
the environment).’’
In September. Kinkri went to the Beijing Women’s Con
ference—to learn and to leach. She does feel some salisfaclion:“McriI(i(l(ii<d)(<urIo(jHiil(i(lni/i(’/i(1in. (My bat tic has been
taken up by other people as well)." And who knows—the hills
of Sangraha may once again look lush with deodar.
—with ABIIINAV KUMAR
AMOD KANTI!
Guardian of
the Streets
By Ciiaru Lata Joshi in New Delhi
RIES of “namaste Bhaiyaji", and
a sea of faces, hair straggled.
eyes twinkling, engulfs Amod
Kanth. as he steps into a shed in
west Delhi's Kathputli colony.
Kanth. 47. is not the additional
commissioner of Delhi Police
anymore. 1 leis in his other avatar, that of a foster
brother, parent and guardian to nearly 5.000
street children: rag pickers, shoe-shine boys.
vendors and beggars. And as he lings four-year-old Elaichi.
I’ray.is the west Delhi outfit of Kanlh’s organisation for
neglected children—it is clear that these children arc his
main concern.
A concern which has slowly transformed into practical
aid forminorsin Delhi. Seven years ago. Ami pa m I’rayaswas
started as a contact centre for juvenile delinquents with just
25 children as members. Today, with I 7 units scattered in
various slums across the capital, the ngo provides non-formal education, vocational guidance, medical services and
mid-day meals to close to around 3.000 street children. And
the numbers arc growing.
So is the financial aid. What began as a joint collabora
tion of the Delhi Police. Delhi School of Social Work and
Shramik Vidya Peeth. with a small University Grants Com
mission aid of Rs 60.000. is now a professional ngo. assisted
among others by the British High Commission. Save the
Children Fund and Child Relief and You. This year, its budget
went up to Rs 2 5 lakh.
Moreover, from being purely a day-care rehabilitation
centre. Anupam Prayas ison its way to establishing the cap
ital's first shelter for homeless children, a project funded by
the Planning Commission’s recent grant of Rs 1,5 crore.
"We’ve come a long way.” says Kanth. reminiscing about the
shacks provided by the Municipal Corporation of Delhi.
However, there's no lime for complacency or mouthing
platitudes. The action-oriented approach is something
Kauth has grown up with. Al 22. heslarled a college for trib
als in the Naxalile-infcsled Jamshedpur area of Bihar, and
rounds of all the centres and settling niggling problems.
These, incidentally, range from ensuring that the two med
week—have complete supplies to
looking into l he profile charts of the
THE HUMAN FACE: Kanth. a police officer, is the driving force behind a movement that
provides shell er, non-formal education and mid-day meals to nearly 3,000 street children
BHAWAN SINGH
"There is
TOO MUCH'I HAT
STILL NEEDS TO
BE DONE EOR
THESE CHILDREN.
We’ve: at best
MADE ONLY A
VERY SMALL
DENT.”
COVER STORY
children leach centre maintains a health- and family-back
ground profile card of each registered member).
The Anttpam Prayas model revolves around certain cardi
nal principles, most of which are based on Kanth’s personal
understanding of the situation: a clinical elimination of child
labour is not feasible, so alternative employment should be
provided: the child is the best agent of change, so he should
never be taken away from his natural ambience: and finally. a
child's needs are very basic, hence, the first step should be ful
filling them.
With voluntary psychologists and counsellors on board.
the process of identifying a child's aptitude and skills is made
simpler.The courses available range from beauty training, em
broidery. tailoring and block printing to bookbinding, auto-repairsandcandlemaking.'T'rotn being rag pickers, sonteof our
girls are now working in the best beauty parlours in the city."
says Bulbul, project manager. Jehangirpuri.
1'ive-year-old Mukesh. a rag picker from Patel Nagar in cen
tral Delhi, while picking at hisdnlclirnvn/kmch. tells Kanlh that
he prefers domlh bread, "because we get a boiled egg with it".
"There's just too much that needs to be done. We've made a
very small dent.” regrets Kanlh. But for the millions of street
children—official estimates show that nearly 80 million chil
dren are oulof the school system in the country, half of whom
are labourers—blooming like some deadly nightshade on the
fringes of society, people like Kanlh spell hope.
RAM LAL BH ALL A
Drumming up
Benevolence
By RaMESI I VlNAYAK in Amritsar
RESSED in white khadi and an
Amritsar! cap, carrying a drum
and a grey bag with his name and
mission painted on the side, a
slight, elderly figure wends his
way through the bustling Amrit
sar bazaar. Look again, carefully.
An ordinary man. yes, but with an extraordinary
mission. His piercing voice, rising frequently above FATHER TERESA: Bhalla s success in collecting funds for
the market's clamour, says it all: “Daan maiig riha victims of terrorism isdue to his unquestionable integrity
liui Rum l.al lihalla I.iihoremilhi, viilhwa aiirlan te besahara
bachchiun dr lui/re (Rum Lal Bhalla LahorewtiHa seeks dona
tions for widows and orphans)." The response is immediate.
Shopkeepers, passers-by. even rickshawallahs reach out.
pressing money, sometimes small change, into his hands.
"Shiikii/imi iliiatu (thanks, donor)” is the humble response.
For the 101 -year-old Bhalla—known as the FalherTeresa
of Amritsar—this is a part of his daily routine since 1986. in
tile course of which he traverses through I he city collecting re
lief for the families of victims of terrorist violence. The first
contribution was his own—two instalments of his monthly
pension. He has collected almost Rs 12 lakh so far. which
makes him the single largest contributor to thcShaheed Parivar Fund—managed by the Jalandhar-based lliml Sumachar
group of newspapers—which provides relief to the kin of vic
tims of terrorism in Punjab, jammuand Kashmir and theantiSikh riots of 198-1.
What has made this humble town-crier's (one who makes
public announcements to the beat of a drum) mission a suc
cess is his undoubtable honesty and transparency of his ac
counts. Says Shyam l.al. a shopkeeper: "The faith that each
rupee collected by him reaches the needy is cent percent." A
view that is corroborated by Vijay Kumar Chopra, editor oil he
lliiiilSiuiuichui group: "Not only is he scrupulous to the penny.
but people also have immense faith in his campaign." Which
is saying a lot for the integrity of a person who subsists, with
his wife, on his freedom-fighter's pension of about Rs 2.000
PRAMOD HUSHKARNA
THAT INSPIRES
per month. Asa mat ter of fact. Bhalla st ill sets
those killed by terrorists. Bhalla. who worked
ME TO CARRY'ON'
apart Rs 100 from his pension as a personal
town-crier during the freedom struggle
contribution to the relief fund. Also, as Laxtni
and even after Partition, decided to use his an
WITH THE
Kanta Chawla. the local bjp MI,A, points out:
tiquated profession to start his selfless cam
"But for his grassroots approach, the small
MISSION. A LOT
paign. Says Dm Parkash Soni. the city’s
donor would not have had a chance to donate
mayor: "W hat he has done for succour to ter
HASTO BE DONE
to this cause."
rorism-hit families is far more credit able than
But for Bhalla, it hasn’t exactly been abed
BEFORE MY LEGS
the contribution of high-profile social organi
of roses. At the height of terrorism in Punjab,
sations." z\ fact that is also reflected in the rev
EML ME."
he received threats from extremists and was
erence the beneficiaries of his efforts hold him
even beaten tip in 1987, an attack which left
in. Says Gurcharan Kaur of Amritsar, whose
his hearing seriously impaired. That, and failing health
husband was killed bj’ terrorists in 1990: Tor unfortunate
notwithstanding, he still carries on undaunted. "A lot has to people like us, he is next to God."
be done...before my legs fail me." he says in a voice choked
What sets apart Bhalla from other fund collectors isalso the
with emotion.
fact that despite a perceptible decline in public sympathy for
In I he '80s, moved by tales of suffering of the families of victims' families, his appeal still endures and he collects on an
COVER STORY
average. Rs JOO daily. AsOm I’ushkarna, a local shopkeeper,
puls it: "People donate money to him not out of pity but re
spect." Bhalki. with hischaract eristic modesty, says: “It is the
people’s failh that inspires me Io carry on with the mission
against I he odds of old age."
And so. everyday. I his old man sets out on his noble cru
sade, covering between 5 and <S km on fool, refusing Io accept
even a glass of waler from his donors. But for how long?
Bhalla knows: “It is a mission until death."
HIRASINGH MARKAM
Small Savings,
Big Difference
By Bharat Di-sai in Bilaspur
AXM1 Bai, a tribal woman from
Bilaspur district in Madhya
Pradesh, is waiting for her fam
ily members to return home
from the fields. She measures
four kg of rice to cook, then
takes out a handful and puts it
away in an earthern pot. Offering to the gods? No,
a step towards a loan to help her son "set up a bicycle-repairing shop"
l;or the Gondtribalsof Bilaspur. a handful of rice goes far
these days. And all because of Hirasingh Markam. 54—
schoolleacher-turned-social activist—who started the
Gondwana Bank (on) movement about three years ago. In
the tribal's almost hand-to-mouth existence, savings were
then out of the question. As for loans, their only source was
the local moneylender, whose 1 percent a day interest rale
left most indebted for life.
Hitler Markam. II saving money was a problem, he told
the tribals to save rice instead. Making women the target of
his ‘small savings' campaign, he encouraged them to save a
little rice from their family's daily quota, organised to sell it.
and then opened accounts for them in on to deposit the
moneyearned. Or. he advised, the tribals could save a rupee
a day and deposit the total at the mouth-end.
Once a member's deposit touched Rs 1.000. he became
entitled to a loan, which at 24 percent interest rate per an
num was st ill low by local loan.shark standards. Markam ap
plied another idea. Keeping in mind the low 52 percent loan
recovery rate of public-sector banks, he hired a team of
agents to recover money for the bank on a commission basis.
'fhe result: In an area where district co-operatives barely get
back 6 i per cent of the money lent out. he recovers almost
85 percent of his loans.
An example is Sadaram Markam. A tailor till 1993. he
now owns a cloth shop at Ratanpur—oil's headquarters—
bought from the Rs 90.()(>() he borrowed from the bank. I le
has already returned Rs 5 6.000. "If 1 repay quickly, "he says,
TRIBAL BANKER: Markam is transforming the lives of
tribals through his innovative banking system
“some other person can get a loan."
And therein lies Markam’s contribution. More than I he
progress he has brought into the lives of I he tribals, what he
has contributed to is a change in their way of thinking. Sav
ings are no longer foreign and loans not a temporary tidingover of a crisis. Says Markam: "I don't give loans for feasts.
The aim is to make them economically independent."
The figures tell their own tale: starting from a deposit of
Rs 1.800 in 1992. the bank now lias cash up to Rs 55 lakh.
and 6.500 members. Says District Collector Manmat Kumar
Raul: "We got intersted when Markam started collecting
money and decided to investigate, but his work is genuine."
And so is the man. Slightly built, clad in a dhoti. Markam.
a native of Tiwartha village, has no pretensions of grandeur.
His bank. too. operates out of an unassuming office and a
secretary constitutes the entire staff.
II. in fact, is a product of an idea that came to him from
the Gujarati community, '"fhe secret of their success is the
community helping the individual." he says. Always quick
to act on his plans—he once tumped into politics, he says, in
censed at a politician's drinking
habits—he decided to open a bank.
and has not looked back since. Com
pletely devoted. he has no I line even
“My.\iiss.\(;i:is
for his family—his wile, two sons
simbi i:: Givi: mi:.\
and a daughter have met him just
twice in the past year.
I’lS ITlil.OI' HUT.
But Markam’s contribution ex-
COVER S'I'O RY
and the heavy expenditure on weddings.
Not everybody is pleased though, particularly the up
per castes. whose dominant position is threatened by the
growing tribal empowerment.Undaunted. Markam has
other plans, including the “political reawakening" of the
tribals. I le intends to hand over cb completely to the Gone!
community once its membership becomes one lakh, and
move on himself—among other things to "gondwana
soaps, gondwana agarbattis and a gondwana university".
It is not lime to rest yet.
—wiih sii.\i.ini langer
RAJAN PAUL
Creating new
Entrepreneurs
ByM.G. RADltAKKISHANin Ernakulam
OST people would have losl in
terest in life after that tragic ac
cident. But not Rajan Paul. The
52-year-old mechanical engi
neer. who was para lysed from
neck downwards 1 2 years ago
after an accident in Doha. Qatar.
todiiy runs a successful small-scale industry from
his house in Kizhakkambalam, 2 5 km east of Ernakulam in Kerala, which provides employment
to over 6.000 people. In I he process il Inis emerged ns a role
model lor solving the unemployment problem of the state.
I'orPaul, whose accident virtually left him helpless phys
ically. coining to terms with his disability would have been an
achievement. Hut to have helped so many others tiespile it
demonstrates his iron willpower. Initially, dire necessity had
been the driving force. After the accident, most of his savings
were spent in search of cure. So. in 198 3. when Paul’s friend
C.P. Philipose. a mechanical engineer, suggested that the two
start an industry ivilhout a factory, machinery oreveti work
ers, he grabbed the chance.
Since Kerala is known lor its militant labourunions.thelwo
hit on the idea of training villagers to make products and then
buying it from them. Collecting Rs 5.7 lakh from friends, they
set up Sevana lilectrical Appliances Pvt Ltd at Kizhakkambalam to manufacture plastic-bag-sea ling machines.
To begin with, Sevana trained two unemployed youth in
manufacturing these machines.The stipulation was that af
ter training they would assemble the components supplied
by Sevana at home. "Initially, it wasdiffieutl toget trainees.”
recalls Philipose. "But when the villagers saw there was
money to be made, they Hocked to us.” Within two years.
more than a hundred families became involved.
Today. Sevana has more than 200 home units which pro
duce 3 S types of sealing machines. "None of the home units is
bound to be our exclusive suppliers. This flexibility is the core
oft he Sevana model." says Philipose. Bach of the.Sevana fam
ilies makes an average of Rs 2.SOO it month. "I make al least
Rs 3.SOO a month and am not un
employed foreven a dtij'," says ().|.
Thomas, an n t diploma holder who.
e
along with his family members.
tih:\t\ii re
makes transformers for Sevana. The
company itself, which had been
BROl (HIT
making losses, turned the corner in
me back
liit:
1989. The profits have grown from
"Wim
ro
COVER STORY
ils 1.4 lakh in 1989-90 to Rs 2 5 lakh in 1994-95.The com
pany exported machines worth Rs 4 lakh in 1995 and is pro
ject inga target of Rs lOlakhin 1996. Recently, it was awarded
the Canadian Standards Association certificate—the first
The Sevan.i model is beginning to catch up. al least in
Kizhakkambalam, where several similar units have come up
and now provide employment to a filth <>l lhepanchayats’pop
ulation. Today it boasts of the highest number of small-scale
units in the state. Meanwhile, other companies have begun to
manufacture products like medical equipment. rubber-sheet
drying machinesand steel knives based on theSevana model.
"Among the panchayats in this area. Kizhakkambalam has
the least number of unemployed per-
[ • 'W
K.V Alias, former panchayat president
and cti(m) member.
The company has also demon
HAVE MAiX'/\( ;r.i)
tom a ke a 1 a rge d i lie re n ce." To g i ve em
ployment loso many persons won Id require an investment of Rs 6.000 crore
in the conventional sector. In a stale
where land is the scarcest commodity.
But Tin: artistes
7\l.l. THAT
ARTl’ROM DYING.
swer,” points out M.V Nainboothiri,
chief general manager. Smail Indus
tries Development Bank of India, Kur
ARI. STII.I.Till.
POOREST OE
THE POOR." ..
Sevanamay be difficult Io replicate
on a larger scale because, as Paul Anthony, state industries di
rector, says: "It is too informal and flexible for an organised sec
tor." Buteven Anthony regards the effort asa major solution to
what he calls "the slate's pathological industrial backward
ness”. It is only a small measure of Paul's incredible fightback
against such daunting odds.
—with v.k.santosii kumar
MADAVED1MAHAYANA
An Epic
Revival
By AMARNATH K. Menon in Nizamabad
E was barely five when he saw it
the first time in his native
Lakkora, a village in the Nizamabad district of Andhra
Pradesh. The verve and grace of
the colourfully decked perform
ers, enacting epics like the Ramayan and Mahabharat had held him spell
bound. Now, 50 years on, Madavcdi Narayana. a
science teacher, has lifted the vibrant folk art,
known as Chiiulu Hhagavathain. from the brink of extinction
to nationwide recognition.
The unique dance drama perfected by a small group.
which ranks lowest among the state’s Scheduled Castes, had
ART SAVIOUR: Narayana has helped revive an ancient
folk art that was dying because of lack of support
almost vanished before Narayana stepped in. "All I havedone
is prevented this earthy folk-art form from dyitig.” says the
modest Narayana, now headmaster at a secondary school in
Armoor town near Nizamabad.
That itself is no mean achievement. The artistes, who
move in troupes from village to village, can do little on their
own to preserve the art form. They subsist on the meagre
earnings from their performances, usually in the form of
grain and some cash.The entire family takes part in portray
ing episodes from the Ramayan. the Mahabharat and regional folklore. Annually, they move along well-defined
routes through rural areas for all but four months—March
through June—in a year.
The shows are held during the day as the only equipments they can afford are musical instruments—the harmonium, inriclniigiiiii and cymbals. Among the distinctive
features are the ornaments made from bark and soft wood.
which is first cured fornearlysix months.The C/iuidn artistes
design and make the ornaments themselves. Another hallmark is the yellow turmeric paste they apply on t heir faces.
Money, or rather the lack of it. however, was an endemic
problem till Narayana with his meagre resources became a
generous patron. He helped them organise shows in several
towns and invited Kuchipudi dance maestro Nalaraja Ramakrishna to watch them perform in Nizamabad in 1979.
i.xm aky
u. >•>■
* • isiiia
!:■ I
I.
J,.q
:'i J
■
1 ii
iJ
ij
i;
ujj
i 11
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COVER STORY
"It was a turning point because an excited Ramakrishna
helped us document the movements and attire and make it
known to many outside." recalls Narayana. Soon, the artistes
were performing in Hyderabad al important dance festivals.
and even made it to the Apna Utsav in 1986.
Ramakrishna is all praise for Narayana’s efforts. "He helped
us discover this, the most ancient and classical form of song,
dance and music of t heTelugus. There is little else that we can
truly boast of as an original cultural form that goes back to the
pre-historic days.' he says. More important!}’, Narayana made
the artistes conscious of the true worth of their art. Says Chindula Shyam. one of the performers: "Narayana made us aware
of the value of what we were doing."
Even today, he is closely involved with the lives of the artistes.
I le keeps in touch with the 1,200-odd number in the district and
constantly recommends them for cultural shows. Says Shyam:
"Wherever we went, he used upall his leave from school tobe with
us and encourage us." By popularising the art form, he has also
helped build upan audience for them in many parts of the state.
Narayana is conscious of the limitations of his work. Many of
t he art isles work as farm hands and do petty jobs in the country
side. They cannot spare funds even for practising their art. Says
Narayana: "The artistes arc. even today, the poorest of the poor."
1 lelamentsthal themandarinsof culturein Delhi and in thestate
Government have not provided the artistes any monetary sup
port which could have helped them concentrate on their art.
Narayana is now pushing bureaucrats to set up an institu
tion to preserve as well as develop and propagate this art form.
But he is yet to find an audience receptive to his pleas.
HARNATHJAGAWAT
A Man For
All seasons
By Ud.AY Mai II IRK AH in Panchamahal
IS work is very much in evidence as
you drive through the rocky hills of
Panchamahal in Gujarat. Lush
green farms, soothing oasis in the
dry, brown terrain now dot much
of the district, a backward area of
Gujarat. They are symbols of the
dramatic transformation that Harnath Jagawat, 58,
a former personnel officer in a private company, has
brought in one of the country's most arid regions.
Before Jagawat. along with his wife Sharmistha. began
work in Panchamahal and the adjoining districts of Banswara and Jabhua in Madhya Pradesh, tiiese areas were
perennially drought prone. The rains failed with depressing
regularity, impoverishing the people—largely tribals depen
dent on agriculture or forests. Even when they did come.
much of the rainwater drained away because the villagers
could not afford to build storage dams.
The Jagawats concentrated their efforts on harvesting wa
ter. (lathering a team of like-minded individuals and tapping
into die philanthropy of the Mafatlals, for whom Jagawat
worked, they began small. They set up a foundation called
Sadguru wh ich started by building check dams and mini-lift ir
rigation schemes in several villages. While they provided the
money, they got the villagers to build I he dam themselves. And
then entrusted the management and maintenance of these
projects to the villages.
Seeing their success, other organisations and even the gov
ernment started backing their effort with funds. Today, apart
from receiving funds from the state Government. Sadguru is
one of the only two voluntary bodies in the country which gets
an annual aid of Rs 3 crore from the European Union. Besides
this, it also gets Rs 2 crore a year from Norway.
The only reason money Hows in with such ease is that
the foundation has plenty of work to show for it. In the past
20 years, it has built 120 lilt-irrigation projects. 90 check
dams and recharged 10.000 wells, bringing under irrigation
a total of 80,000 acres of land. "They have helped build
THE RAIN MAKER: Jagawat, with Sadguru members, used
ingenious ways to help villagers harvest Witter
more, and in doing so have brought a silent revolution
to a parched land.” says A.VV.EP. David, Gujarat’s additional
sources. And the results are showing. Two years ago, Sadguru
helped build a 1 I O-metre-long dam at a cost of Rs 28 lakh in
Thunthi Kansi, a village in Panchamahal district. Today, it ir
rigates overa 1.()()() acres and allows them to grow three crops
a year. Earlier about 80 percent of the villagers used to migrate
as a boon for us."
Besides using ingenious methods to help villagers harvest
water, the foundation has begun extending its work toot her arThe trees arc fast-growing Nilgiris and Baboolslhal can be sold
for its wood and provide a livelihood for villagers when the
monsoons fail.
the dedication of the 100-odd members of the team.
from theTata Instituteof Social Sciences who
to less than 10 percent.
Moti Dhulia Garasia. 52. a resident of
IS ULTIMATI-I.Y
TO WIPEOUT
THE FACE OF
POVERTY FROM
THESE BACKWARD
DISTRICTS OF
OUR COUNTRY.
milled prolessionals
COVER STORY
study they have carried out. the area needs another 1,500
dams al a cost of Rs 70 crore. AndSadguru is planning to lake
up the task head-on. "Our plan is to ultimately wipe out
poverty from the face of these districts,” says Jagawat, with
determination. And judging from its track record, there is no
reason why the Sadguru foundation should not succeed.
AMULYA K.N. UEDDV
Doing More
With Less
By Stephen David in Pura
N YO N E w i t h h i s sc ien t i ft c t em per would have preferred a
well-paid job in the West.
Ainulya K.N. Reddy, 65, did
think that American universi
ties were the best place to be
in—in the early ’60s—when
he was hailed for hisdiscovcry of a new technique
in chemislty called chrono-ellipsometry and for
his book on electrochemistry. But a lecture on
"Poverty in India" which he attended during a trip back
home, changed his outlook. Il shattered his faith in the
Nehruvian dictum that more industrialisation equals less
poverty and made him a staunch believer in an alternative
pattern of capital-saving, labour-intensive technologies for
the rural poor which he subsequently developed.
The West’s loss has been India’s gain. I’or today. Reddy is
more famous for his rural energy centres that provide clean
water and belter electric illumination than for his accom
plishments in electrochemistry and inorganic physics. "I
spent too much lime in conventional science without think
ing of the rural folk who stood divorced from modern science
and technology," hesays a little ruefully.
The centre for Application of Science and Technology in
Rural Areas (astra), which Reddy started at the Indian In
stitute of Science. Bangalore, in 1974. has become the
bedrock of his movement to help the rural poor. Over the
years, a team of like-minded scientists drawn from various
disciplines have helped Reddy evolve fuel-efficient devices
like wood-burning stoves, solar ponds and brick- and tile
kilns that have created a mini-revolution in solving India's
rural energy requirements.
Among their more recent efforts is the development of a
cheap community biogas plant (cbi’) that may provide a so
lution to the state's enormous power shortage problem. I’or
starters, a CBI’ was set up in I 99 1 al Pura village in Tumkur
district, Karnataka. I’or the past four years it has helped the
village pump drinking water from a borewell and also lit up
their homes at a price that is half of that provided by I he griddriven state electricity board. "Before Reddy moved in with
his idea, we had to trek 2 km to fetch waler." says
Gangamma. a 5 5-year-okl resident of Pura.
Reddy and the asira team had made a detailed study of
the energy systems prevalent in Indian villages before em
barking on the project. “We chose
biogas as. traditionally. Indian vil
lages have large number of cattle.
rs
anti cattle wastes are biomass en
SAID 11’\\ \s
ergy sources." says Nirmala Das. a
scientist with asira. Armed with
OKAVTO.MAKIthese findings. Reddy plunged into
MISI AKKS A\l)
the design of a modified cur and
THE RIGHT TEMPER: Though Reddy is hailed in the West as a chemist of repute, al home
he is known for his low-tech solutions, like fucl-eflicient devices, to help rural areas
I I IKY TAI CUT
\n io si i:
THE MOTIVATOR: Bai is spearheading a movement to revive
BHANWARDA BAI
traditional healing systems and preserve knowledge of herbs
Going Back
to Nature '
trained village personnel to manage it “without relying on
scientists". 'Tor me I he efficient management by the village
development committee (vt>c) is a key element in I he success
of the I’ura rural energy centre." says Reddy.
The villagers have been enthusiastic because the voc
pays a villager 2 paisefor it kilo of dung and ret urns 60 gm of
manure for every kilo supplied. Every month, the vne reports
a net profit of Rs 200. "The I’ura energy centre is evidence
of theenormousenergy that is available in I he villages." says
Kunigal taluk Deputy TehsildarM. Chandrasekhariah.
There have been stumbling blocks on Reddy's way to
tackling rural energy and waler requirements. One of astra's earlier experiments with a cooking stove failed as
there were few takers for it. Says Chandramma. a resident
of I’ura: "The stove didn't conform to our traditional
design and was unsuitable for our needs." Reddy, in fact.
acts on such criticisms to work out viable energyefficient household appliances. "It is the villagers who
taught me Io look at development from their eyes." says
Reddy. "They said it is okay to make mistakes, unlike the
people who cheer when a satellite goes up and jeer when it
crashes into the sea."
The pace-setter rarely steps into ASTRA nowadays.
“When j'ou play a leader, you should also learn to let go. Let
them come up on their own." he says. A recent heart
surgery has upset Reddy's schedule slightly. But not too
much.'' My dream is to see a J 00 more villages operating a
I’ura-type energy centre in t he next five years." says Reddy.
who set up an Ntto, International Energy Initiative, two
years ago to link like-minded energy management institu
tions across the world. Hunched over a laptop, these days
Reddy is busy turning that dream into reality.
—wllli V.K. SANTOSH KUMAR
By Anjan Mitra in Udaipur
HILE the West is intrigued by al
ternative healing systems, in In
dia they tippear to be on the de
cline. A trend most evident in
Rajasthan which once boasted
the most effective herbal practi
tioners in lhecoimtry. As the vil
lagers turrfed to allopathy, the t/itnis or traditional
village doctors became a dying breed. Their vast
knowledge of herbs and their cures were slowly
being lost to posterity.
That's when Bhanwarda Bai. 38 and a "Class XI fail"
decided to reverse this decline. Bai. who had begun social
work when she was only 16. went about it systematically.
She formed the Jagaran Jan Vikas Samili and with funds
from cry. made a survey of the practising yunis in the region.
Iler findings were depressing. Only -It) of them could be
identified, their ranks depleted by poverty and apathy.
Also, deforestation had affected the availability of the rare
herbs they required.
Along wit h a band of workers, she began persuading the
remaining gunis to revive the guru-sliisliiju purainpuru that
COVER STORY
had sustained these traditions. Initially they were reluctant.
But gradually. Jagaran was able to persuade them to impart
their knowledge.Over the past few years, t hey have been able
tacking the first aspect of the problem—an nmviHingnc:
to promote village, district and stale level conferences where
they could meet and upgrade their skills.
The villagers too are returning to the gunis. Last year.
when the medicine given by the district administration for
ommended a decoction made from a plant called nahi. And it
proved more effective.
Bai uses such examples to remind villagers that "people
survived before antibiotics were known because the gunis
treated them". Shebelievesthat gunisareesscntialas they pro
vide a cheap and reliable system of medicine. Rampal Somani,
staledrugs director IzXyurveda), says: "The value of herbs and
roots has always been known but Bai has helped in reviving
their importance." The environmental message also goes
home. Says Dharamraj Meena. pradhan of 48 panchayats.
"Jagaran’s effort will help in conservation of forests as gunis
slowly disappeared with the forests." The battle to revive the
guni system is a protracted one. But it hasn't dissuaded Bai yet.
REHABILITATOR: for astute reeling under the drugs
menace, Vannizo lias shown the way to recovery
BHASKAR PAUL
SAflU VAMUZO
The Healing
Touch
By SlIBRATA NaGCIIODDIIURY in Kohiina
N November 24, Koko, a 28year-old Naga youth, celebrated
his'second birthday'. His second
year of a new life free from the
clutches of drug addiction, that
is. I looked to alcohol and a des
perate drug addict for years.
Roko wtts rescued by' the Naga Mother's Associa
tion (NMA)aud 1 he detoxification and
counselling centre it runs at Kohima
■■■■ -.
It’s
with the Kripa Foundation. And today he is
a grateful and enthusiastic counsellor at the
same centre.
itself. It began by mounting strict vigils on
TASK. WITHOUT
Roko had been one of thousands of vic
the peddlers, the key players in the drug net
tims of the drug plague that swept through
work.
and had them arrested by the police.
OFFICIAL HELI’
the North-east since the early '80s, afflicting
LACK
OF
FUNDS
a substantial section of the youth. The main
vehicles and suspected den:
reason was the area’s proximity to the drug
AND SHORTACE OF
laden Golden Triangle. Economic and social
gregations against drug addiction.
TRAINED PEOPLE.
problems, and a lax government machinery
"It's still an uphill task." says
only compounded theproblem. tint il a coura
STILL WE HAVE
funds and trained personnel. And an inability
geous woman. Sanu Vamuzo. wife of a lead
OUR SUCCESSES."
ing Nagaland politician, decided Io rein in the
problem. z\ personal trauma—with a son
port—likea livelihood. And the nagging prob
who underwent a drug problem—had given
her both the sensitivity and the motivation to do something.
recovering addicts. I lowever. the xma is today recognised as a
She collected a group of women, mothers like her. and with
major weapon against thedrugmenace.lt continues to gat her
momentum even as Vti
theirconcerted effort lheNMA wasborn, with her as president.
SCIENCE
WHAT MAKES YOU
L-JWHO YOU ARE
Which is stronger—nature or nurture?
The latest science says genes and your
experience interact for your whole life
By MATT RIDLEY
he perennial debate about nature and nurture—which is ?
tlie more potent shaper of the human essence?—is perennially re- r
kindled. It flared up again in the London Observer of Feb. 11, 2001. 3
revealed
: the secret
human
behavior
read
the
banner
headline,
environment
, notof
genes
, key
to
ourof,acts
. The
source
of
thea ;■5
story
was Craig
Venter,
the
self-made
man
genes
who
had built
private company to read the full sequence of the human genome in competi- I
tion with an international consortium funded by taxes and charities. That 5
sequence—a string of 3 billion letters, composed in a four-letter alphabet, con- »
taining the complete recipe for building and running a human body—was to ;
be published the very next day (the competition ended in an arranged tie). ?
The first analysis of it had revealed that there were just 30,000 genes in it, not 3
the 100,000 that many had been estimating until a few months before.
T
Illustrations tor TIME by Tavis Cobum
;tors can influence how easily a transcription
SCIENCE
Details had already been circulated to
journalists under embargo. But Venter,
by speaking to a reporter at a biotech
nology conference in France on Feb. 9.
had effectively broken the embargo. Not
for the first time in the increasingly bitter
rivalry over the genome project, Venter’s
version of the story would hit the head
lines before his rivals’. “We simply do not
have enough genes for this idea of biolog
ical determinism to be right,” Venter told
the Observer. “The wonderful diversity of
the human species is not hard-wired in
our genetic code. Our environments are
critical.”
In truth, the number of human genes
changed nothing. Venter's remarks con
cealed two whopping nonsequiturs: that
fewer genes implied more environmental
influences and that 30,000 genes were
too few to explain human nature, where
as 100,000 would have been enough. As
one scientist put it to me a few weeks lat
er, just 33 genes, each coming in two va
rieties (on or off), would be enough to
make every human being in the world
unique. There are more than 10 billion
combinations that could come from flip
ping a coin 33 times, so 30,000 does not
seem such a small number after all. Be
sides, if fewer genes meant more free
will, fruit flies would be freer than we are,
bacteria freer still and viruses the John
Stuart Mill of biology.
Fortunately, there was no need to re
assure the population with such sophisti
cated calculations. People did not weep at
the humiliating news that our genome has
only about twice as many genes as a worm’s.
Nothing had been hung on the number
100,000, which was just a bad guess.
But the human genome project—and
the decades of research that preceded it—
did force a much more nuanced under
standing of how genes work. In the early
days, scientists detailed how genes encode
the various proteins that make up the cells
in our bodies. Their more sophisticated and
ultimately more satisfying discovery—that
gene expression can be modified by experi
ence—has been gradually emerging since
the 1980s. Only now is it dawning on scien
tists what a big and general idea it implies:
that learning itself consists of nothing more
than switching genes on and off. The more
we lift the lid on the genome, the more vul
nerable to experience genes appear to be.
This is not some namby-pamby, middle-
Matt Ridley is an Oxford-trained zoolo
gist and science writer whose latest
book is Nature via Nurture
38
* intribute to evolution
I
Rat spine:
thorax has 13 vertebrae
irisiirf the promoters can lead to dramatic
ieniarid where genes are expressed. Various
Chicken spine:
thorax has
vertebrae
Altered
promoter
Python spine:
thorax
Slightly different
promoters lead to
big differences
in the expression
of the same gene
SCIENCE
of-the-road compromise. This is a new
understanding of the fundamental build
ing blocks of life based on the discovery
that genes are not immutable things
handed down from our parents like
Moses’ stone tablets but are active partic
ipants in our lives, designed to take their
cues from everything that happens to us
from the moment of our conception.
For the time being, this new aware
ness has taken its strongest hold among
scientists, changing how they think about
everything from the way bodies develop
in the womb to how new species emerge
to the inevitability of homosexuality in
some people. (More on all this later.) But
eventually, as the general population be
comes more attuned to this interdepend
ent view, changes may well occur in areas
as diverse as education, medicine, law
and religion. Dieters may learn precisely
which combination of fats, carbohydrates
and proteins has the greatest effect on
their individual waistlines. Theologians
may develop a whole new theory of free
will based on the observation that learn
ing expands our capacity to choose our
own path. As was true of Copernicus’s observation 500 years ago
that the earth orbits the sun,
there is no telling how far
the repercussions of this
Girls raised in FATHERLESS
new scientific paradigm ,
HOUSEHOLDS experience
may extend.
J
To appreciate what has I
happened, you will have to I puberty earlier. Apparently, the
abandon cherished notions I change in timing is the reaction
and open your mind. You I
of a STILL MYSTERIOUS set of
will have to enter a world in ■
which your genes are not 1
genes
to their ENVIRONMENT.
puppet masters pulling the
strings of your behavior but
Scientists
don’t know how
puppets at the mercy of your behavior, in which instinct is not the
many SEIS OF GENES
opposite of learning, environact this way
mental influences are often less reversible than genetic ones, and nature is
designed for nurture.
Fear of snakes, for instance, is the most
Before we dive into some of the other
common human phobia, and it makes good
evolutionary sense for it to be instinctive. scientific discoveries that have so thor
Learning to fear snakes the hard way oughly transformed the debate, it helps to
would be dangerous. Yet experiments with understand how deeply entrenched in
monkeys reveal that their fear of snakes our intellectual history the false dichoto
(and probably ours) must still be acquired my of nature vs. nurture became. Whether
by watching another individual react with human nature is bom or made is an an
fear to a snake. It turns out that it is easy to cient conundrum discussed by Plato and
teach monkeys to fear snakes but very dif Aristotle. Empiricist philosophers such as
ficult to teach them to fear flowers. What John Locke and David Hume argued that
we inherit is not a fear of snakes but a pre the human mind was formed by experi
disposition to learn a fear of snakes—a na ence; nativists like Jean-Jacques Rousseau
and Immanuel Kant held that there was
ture for a certain kind of nurture.
Early Puberty
1
40
TIME, JUNE 2,2003
such a thing as immutable human nature.^
It was Charles Darwin’s eccentri.j
mathematician cousin Francis Galton who
in 1874 ignited the nature-nurture contro
versy in its present form and coined the
very phrase (borrowing the alliteration
from Shakespeare, who had lifted it from
an Elizabethan schoolmaster named Rich
ard Mulcaster). Galton asserted that hu
man personalities were bom, not made by
experience. At the same time, the philoso
pher William James argued that human be
ings have more instincts than animals, not
fewer.
In the first decades of the 20 th century,
nature held sway over nurture in most
fields. In the wake of World War I, how
ever, three men recaptured the social sciences for nurture: John B. Watson, who set
out to show how the conditioned reflex,
discovered by Ivan Pavlov, could explain
human learning; Sigmund Freud, who
sought to explain the influence of parents
and early experiences on
young minds; and Franz
Boas, who argued that the
origin of ethnic differences
lay with history, experience
and circumstance, not phys
iology and psychology.
Gallon's insistence on in
nate explanations of human
abilities had led him to es
pouse eugenics, a term he
coined. Eugenics was enthu
siastically adopted by the
Nazis to justify their cam
paign of mass murder against
the disabled and the Jews.
Tainted by this association,
the idea of innate behavior
was in full retreat for most of
the middle years of the cen
tury. In 1958, however, two
men began the counterattack
on behalf of nature. Noam
Chomsky, in his review of a
book by the behaviorist B.F.
Skinner, argued that it was
impossible to learn human
language by trial and error
alone; human beings must
come already equipped with
an innate grammatical skill.
Harry Harlow did a simple
experiment that showed that
a baby monkey prefers a soft,
cloth model of a mother to
a hard, wire-frame mother,
even if the wire-frame moth
er provides it with all its milk;
some preferences are innate.
Fast-fonvard to the 1980s and one of
Bie most stunning surprises to greet sci
entists when they first opened up ani
mal genomes: fly geneticists found
a small group of genes called the
hox genes that seemed to set
out the body plan of the fly
during its early develop
ment-telling it roughly
where to put the head,
legs, wings and so on.
But then colleagues
studying mice found
the same hox genes, in
the same order, doing
the same job in Mick
ey’s world—telling tire
mouse where to put its
various parts. And when
scientists looked in our ge
nome, they found hox genes
there too.
Hox genes, like all genes, are
switched on and off in different parts of the
body at different times. In this way, genes
can have subtly different effects, depend
ing on where, when and how they are
switched on. The switches that control
this process—stretches of dna upstream
of genes—are known as promoters.
Small changes in the promoter can
have profound effects on the expression
of a hox gene. For example, mice have
short necks and long bodies; chickens
have long necks and short bodies. If you
count the vertebrae in the necks and tho
raxes of mice and chickens, you will find
that a mouse has seven neck and 13 tho
racic vertebrae, a chicken 14 and seven,
respectively. The source of this difference
lies in the promoter attached to HoxC8, a
hox gene that helps shape the thorax of
the body. The promoter is a 200-letter
paragraph of dna, and in the two species
it differs by just a handful of letters. The
effect is to alter the expression of the
HoxC8 gene in the development of the
chicken embryo. This means the chicken
makes thoracic vertebrae in a different
part of the body than the mouse. In the
python, HoxC8 is expressed right from
the head and goes on being expressed for
most of the body. So pythons are one long
thorax; they have ribs all down the body.
To make grand changes in the body
plan of animals, there is no need io invent
now genes, just • •. there’s no need to in
vent new words to write an original nov
el (unless your name is Joyce). Aii you
need do is witch the saones on and
. '
t< "I ■
.
lenly. !,e>x- is
<ni tmuiisni u w .tew, Lu
ami small
evoluooiur.
- a-.
s a .,11 genetic
tin-: . ... st
SCIENCE
ter our understanding of human nature? a
Take a look at four examples.
S
language Human beings differ from chim
panzees in having complex, grammatical
language. But language does not spring fully
formed from the brain; it must be learned
from other language-speaking human be “o
ings. This capacity to learn is written into the S 5
human brain by genes that open and close a
critical window during which learning takes
place. One of those genes, FoxP2, has re
cently been discovered on human chromo
some 7 by Anthony Monaco and his
colleagues at the Wellcome Trust Centre for
Human Genetics in Oxford. Just having the
FoxP2 gene, though, is not enough. If a child
is not exposed to a lot of spoken language
during the critical learning period, he
or she will always struggle with
.
speech.
Divorce
LOVE Some species of ro- ;
If a FRATERNAL TWIN
vole, form long pair
gets divorced, there’s a
bonds with their mates, s
as human beings do. ?
30% CHANCE that his or her
I Others, such as the •’
twin will get divorced as well. I montane vole, have only ;
I transitory liaisons, as do '
If the twins are IDENTICAL,
■ chimpanzees. The dif- ■?,
however, one sibling’s divorce ■ ference, according to S'
Tom Insel and Larry
BOOSTS THE ODDSto
y Young at Emory University
in Atlanta, lies in the prok
45% that the other
moter upstream of the oxytocin- and vasopressin-receptor
will split
genes. The insertion of an extra
quence of a promoter or adding a new
one, you could alter the expression of a
gene.
In one sense, this is a bit depressing. It
means that until scientists know how to
find gene promoters in the vast text of the
genome, they will not learn how the recipe
for a chimpanzee differs from that for a
person. But in another sense, it is also up
lifting, for it reminds us more forcefully the development
than ever of a simple truth that is all too of- of a certain human behavior
ten forgotten: bodies are not made, they takes a certain time and occurs in a certain
grow. The genome is not a blueprint for order, just as the cooking of a perfect souf
constructing a body. It is a recipe for bak fle requires not just the right ingredients
ing a body. You could say the chicken em but also the right amount of cooking and
bryo is marinated for a shorter time in the the right order of events.
HoxC8 sauce than the mouse embryo is.
How does this new view of genes al-
ANCIENT
QUARREL
How much of
who we are is
learned or
innate is an
argument with
a fruitful but
fractious
pedigree
chunk of dna text, usually about 460
letters long, into the promoter makes th^\
animal more likely to bond with its mate™'
The extra text does not create love, but
perhaps it creates the possibility of falling
in love after the right experience.
It has often been sug
gested that childhood maltreatment can
ANTISOCIAL BEHAVIOR
Motnra We may be dest«ned to be bald, mourn
IVCllUI v our dead, seek mates, fear the dark
N|||*fl|tXk Butwe can also learn to love tea, hate
llUI UIIC polkas, invent alphabets and tell lies
IMMANUEL
KANT
FRANCIS
GALTON
KONRAD
LORENZ
NOAM
CHOMSKY
JOHN
LOCKE
His
philosophy
sought a
native
morality in
the mind
IVAN
PAVLOV
Math
geek saw
mental and
physical
traits as
innate
SIGMUND
FREUD
Studied
patterns of
instinctive
behavior
in animals
FRANZ
BOAS
Argued that
human
beings are
bom with a
capacity for
grammar
Considered
the mind of
an infant to
be a tabula
rasa, or
blank slate
Trained
dogs to
salivate at
the sound
of the
dinner bell
Felt we are
formed by
mothers,
fathers,
sex, jokes
and dreams
Believed
chance and
environs
are key to
cultural
variation
cregse an antisocial adult. New research by
Terrie Moffitt of London’s Kings College on
a grcup of 442 New Zealand men who have
been followed since birth suggests that this
is true only for a genetic minority. Again,
the difference lies in a promoter that alters
the activity of a gene. Those with highactive monoamine oxidase A genes were
virtually immune to tire effects of mistreat
ment. Those with low-active genes were
much more antisocial if maltreated, yet—if
anything-slightly less antisocial if not mal
treated. The low-active, mistreated men
were responsible for four times their share
of rapes, robberies and assaults. In other
words, maltreatment is not enough; you
I must also have the low-active gene. And it
\is not enough to have the low-active gene;
you must also be maltreated.
Ray Blanchard at the Uni
versity of Toronto has found that gay men
are more likely than either lesbians or
heterosexual men to have older brothers
(but not older sisters). He has since
.
confirmed this observation in 14
samples from many places.
Something about occupying a
womb that has held other
■
boys occasionally results
GENES may
in reduced birth weight,
switch one another on and off; they respond
influence the way people
a larger placenta and a
to the environment. They may direct the
greater probability of
respond
to
a
“
crimogenic
”
construction of the body and brain in the
homosexuality'.
That
womb, but then almost at once, in response
something. Blanchard
ENVIRONMENT. How else to
to experience, they set about dismantling
suspects,
immune
and rebuilding what they have made. They
explain why the BIOLOGICAL
reaction in the mother,
are both the cause and the consequence of
primed by the first male \,.•
children of criminal parents
fetus, that grows stronger
Will this new- vision of genes enable
^yith each male pregare ftmore likely than their
us to leave the nature-nurture argument
Bancy. Perhaps the immune
behind, or are we doomed to reinvent it
response affects the ex- 'KWfl
L ADOPTED children to
a
in every generation? Unlike what hap
pression of key genes during
pened in previous eras, science is ex
brain development in a way that
plaining in great detail precisely how
boosts a boy’s attraction to his own
genes and their environment-be it the
sex. Such an explanation would not hold
womb, the classroom or pop culture—in
pression
of
17
true for all gay men, but it might provide
teract. So perhaps the pendulum swings
important clues into the origins of both genes, known as the creb genes. They of a now demonstrably false dichotomy
must be switched on and off to alter con
homosexuality and heterosexuality.
nections among nerve cells in die brain
It may be in our nature, however, to
and thus lay down a new long-term mem
seek simple, linear, cause-and-effect sto
eries had hinted at the importance of this ory. These genes are at the mercy of our ries and not think in terms of circular
behavior,
not
the
other
wav
around.
Me
kind of interplay between heredity and
in :'’ch effects become their
environment. The most striking example mory is in the genes in the sense that it cau-.ition,
own causes. Perhaps the idea of nature
is Pavlovian conditioning. When Pavlov uses genes, not in the sense that you mherit
memories.
\
ia
nurture,
like the ideas of quantum
announced his famous experiment a cen- i
In this new view, .‘ lies allow the hu- ; mechanics md relativity, is just too
tury ago this year, he had apparently dis- ,
man
mind
to
team
remember,
imitate,
inicouriterintuiri
’e for human minds. The
covered how the brain could be changed ;
>rl
■
. t
rsel es in terms of nature
to acquire new knowledge of the world - pi ini langui ■
<-i ■ , n nr _ like our instinctual abiliin the case of his dogs, knowledge that a i instincts. Genas ..re no! yt-mpel r . ts or
blueprints.
nor
arc
v
just
th?
r
:
c.
is
o,
•
to
so
may be encoded in our
bell foretold the arrival of food. But now
we know how the brain changes: by the 1 heredity. Tiiey are .icii'.c ihi' iag l ie. ;!i . . ■ i. 'i.-. .
HOMOSEXUALITY
Crime Families
MANI. SC 0523 2003
FACT HIGHLIGHT
CASE NOTE HIGHLIGHT
IN THE SUPREME COURT OF INDIA
Writ Petition No. 302 of'2001 with C.A. Nos. 5355 to 5372, 5380. 5381. 5382. 5397 to
5450 of 2003 Arising out ofSLP(C) Nos. 7527-7528/2001, WP(C) No. 269/2001.
SLP(C)Nos. 10551/2001. 10583/2001, 10725/2001. 11002/2001. 10729/2001. 1231312314. 2001. 10996/2001, WP(C) Nos. 316/2001,315/2001, SLP(C) Nos. 12259 2001.
13595/2001. 13398/2001. 13430/2001, WP(C) Nos. 329/2001,362/2001.363/2001.
258/2001, SLP(C) Nos. 14547/2001, 14686/2001, 10189/2001, WP(C) Nos. 403/2001.
395.2001. SLP(C) Nos. 16477/2001, 16483/2001, 18020/2001. WP(C) No. 420/2001.
SLP(C) Nos. 17247/2001, 17497/2001, 16892/2001, 18557/2001, 18554/2001. WP(C)
Nos. 438.2001.475/2001,507/2001, 508/2001. SLP(C) Nos. 19211 2001. 19139/2001.
WP(C) No. 495/2001. SLP(C) No. 19244/2001, WP(C) Nos. 567/2001. 560/2001.
559 2001.561 2001,538/2001, 539/2001,579/2001, SLP(C) Nos. 22309/2001.
22278 2001.447/2002. 12779/2001, WP(C) No. 19/2002, SLP(C) Nos. 22574/2001.
22672 2001. WP(C) Nos. 30/2002, 32/2002, SLP(C) Nos. 497/2002. 13185/2001.
2188/2002. 1020/2002, 17156/2001. WP(C) Nos. 1/2002,49/2002,50/2002,79/2002.
SLP(C) Nos. 1768/2002, 856/2002. 1483/2002. 1820/2002,3028/2002.2022/2002.
2237/2002. 22524/2001, 18636/2001,3214/2002. 4409-4411/2002. WP(C) Nos. 94/2002.
130,2002. 93/2002. 127/2002. 144/2002, SLP(C) Nos. 5374/2002. 5517/2002.
6186,2002. WP(C) Nos. 169/2002, 168/2002, 128/2002, 177/2002, 112 2002. 71'2002.
91 2002. 178/2002. SLP(C) Nos. 6427/2002, 5207/2002, WP(C) Nos. 184.2002. SLP(C)
Nos. 6397/2002, 6466/2002, WP(C) Nos. 183/2002, 185/2002, SLP(C) Nos. 13156/2001.
18263/2001.6537/2002, WP(C) No. 68/2002, SLP(C) No. 6769/2002, WP(C) Nos.
430/2001.213.2002, 214/2002, 162/2002, 230/2002, 225/2002. 228/2002, SLP(C) Nos.
7542 '2002. 7392/2002, 7223/2002, WP(C) No. 254/2002, SLP(C) No. 8631'2002.
WP(C) Nos. 296/2002, 280/2002, 281/2002, 305/2002, SLP(C) Nos. 8632/2002.
91 13.2002, 8963/2002. 8547/2002, 9246/2002, WP(C) Nos. 317/2002, 309/2002, C.A.
No. 3629/2002. SLP(C) Nos. 10294/2002, 11755/2002, WP(C) No. 306/2002, C.A. No
4053/2002, WP(C) Nos. 341/2002, 342/2002, 395/2002, C.A. No. 4066'2002, WP(C)
Nos. 396/2002, 406/2002, C.A. Nos. 4501/2002, 4487/2002. WP(C) Nos. 402/2002.
336.2002. 424/2002, 355/2002, 381/2002, 380/2002. 430/2002, 431/2002. 421 2002.
404/2002. C.A. Nos. 5080/2002. 5081/2002, WP(C) Nos. 443/2002. 457/2002. 451/2002.
C.A. No. 5270/2002. SLP(C) No. 11810/2002, WP(C) Nos. 462/2002, 491'2002.
495/2002. C.A. Nos. 5902/2002. 5903/2002. WP(C) No. 278/2002. C.A. No. 7034 2002.
\VP(C) Nos. 612/2002, 574/2002, 607/2002. 240/2002. 655/2002, 676/2002, 677'2002.
547 202, 645/2002. 620/2002, 682/2002, 8/2003, 669/2002, 18/2003. 28/2003. 40/2003.
C.A. No. 2033/2003, WP(C) No. 63/2003, SLP(C) No. 3140/2003. WP(C) No. 121'2003.
123/2003. C.A. No. 2395/2003, WP(C) Nos. 149/2003, 193/2003, 195/2003. 204/2003.
155/2003, 161'2003, 188/2003, 245/2003, 247/2003, 248/2003. 250/2003. 257.2003.
268/2003. 270 2003, 277/2003. 281/2003 and SLP(C) No. 10673/2003
Nf?
rfh3
Ci £-6.^5. (A
Decided On: 30.07.2003
Appellants: Javed and Ors. Vs. Respondent: State of Haryana and Ors.
Hon'ble Judges:
R.C. Lahoti, Ashok Bhan and Arun Kumar, J.l.
Counsels:
Soli J. Sorabjec, Attorney General, S.B. Sanyal, R.P. Bhatt and P.P. Rao, Sr. Advs. Rishi
Malhotra. Prem Malhotra, Altaf Hussain, Ahil Sharma, Anil Karnwal, Vishal Malik, M.S.
Dahiya, Sanjay Sarin, Ashok Mathur, Arun Aggarwal, S.C. Birla, Kusum Chattdhary.
B.R. Kapur, Mukesh Kumar, Sunit Kumar, Artis Ahmed Khan. Bhava Dutt Sharma. B.S.
Chabar, Joyti Chahar, Vinay Garg, Suresh C. Gupta, A. Gurteshwar Sharma, Sanjay Pal.
Shashwati Sen. Kamal Mohan Gupta, Rachna Joshi Issar, Ajay Siwach, Jasbir S. Malik.
S.K. Sabharwal, Ramesh K. Haritash, Alka Rai, Goodwill Indeevar, Hari Shankar K.,
Ranbir Singh Yadav, Kailash Chand, Sarvesh Bisaria, Nidhi, R.R. Nagaraja, Sanjay
Garg, R.K. Tailwar, Y.P. Dhingra, Pannalal Syngal, M.L. Bakshi, S.S. Nehra. R.C. Kohli.
Monohar Singh Bakshi, Dipali Chauhan Debasis Misra, Mahabir Singh. Ajay Pal. Rakesh
Dahiya, Irshad Ahmad. A.P. Mohanty, Manoj Swarup, R.D. Rathore, K.K. Gupta, Jagjit
Singh Chhabra, Varinder Kr. Sharma, C.D. Singh, L.K. Pandey, Mushlaq Ahmad. Tara
Chandra Shanna, Neelam Sharma, Ajai Bhalla, Abha R. Sharma. Sunila R. Singh, R.C.
Pandey. S.K. Bansal, Savitri Bansal, Harbans Lal Bajaj, Lalita Kaushik (NP), .lagdish Kr
Agarwal, K.R. Punia, Santosh Singh, Vandana Singh, Rakesh Kumar Mudgal, J.S.
Maharalla, Rao Ranjit, Somvir Singh Deswal, M.P. Shorawala. Madhukar Agarwal. P.K.
Jain, Sandhya Goswami, M. Sharda, Raj Kumar Mehta, B.S. Mor, S.M. Hooda. Gain
Singh, R.C. Kaushik, Naresh Kumar, Rajiv Talwar, Naresh Bakshi, Pardeep Gupta, K.K.
Mohan, Shakeci Ahmed, Attar Singh, Vishwajit Singh, Praveena Gautam, R.P. Goyal.
S.K. Sinha. Shankar Divate, S.C. Patel, D. Mahesh Babu, Rekha Palli, C.l... Sahu, Surat
Singh, Ashok K. Mahajan, Rajesh Tyagi, Aparna Bhardwaj, Baldev Atreya. Praveen Jain,
P. Narasimhan, Bimal Roy Jad, Sunita Pandit, Jaswant Rajpal. M.M. Kashyap, Ugra
Shankar Prasad, Rohit Minocha, S.N. Bhat, N.P.S. Panwar, D.P. Chaturvedi. Rishiraj
Barooah, J.P. Dhanda, Rajrani Dhanda, Geetanjali Mohan, Vinay Kr. Garg, Kavita Wadia
(NP). Krishnan Venugopal, Uday N. Tiwary, Prasad Vijaya Kumar, Balram Das. K.G
Bhagat, Vineet Bhagal. Kamal Baid, Nipun Sharma, R.D. Upadhyay and Manish Singin i.
Advs. for appearing parties
Subject: Constitution
Catch Words:
American Decision, Arbitrariness, Attorney General, Attorney General for India. Census.
Civil Servant, Class Legislation, Concurrent List, Conscience and Free Profession.
Constituency, Constitution of India, Constitution of Panchayat. Constitutional Validity.
Cow Slaughter. Different Entries, Directive Principle, Directive Principles of Stale
Policy, Discharge, Discrimination, Discriminatory, Distribution of Legislative Power,
Educational and Economic Interest, Election, Eleventh Schedule, Existing Law. Freedom
of Conscience, Freedom of Conscience and Free Profession, Freedom of Religion.
Freedom of Speech, Fundamental Duties, Fundamental Duty. Fundamental Right.
Government Servant, Gram Panchayat, Guarantee, Hostile Discrimination. Interim Order.
Judicial Scrutiny. Law made by the Legislature, Legal Practitioner, Legislation.
Legislative Competence, Legislative Power, Legislature of the State, Level of Nutrition.
Liberty, Life and Personal Liberty, Migration, National Interest. Natural Justice.
Panchayat. Parliament, Personal Law, Personal Liberty, Policy Decision. Polygamy.
Propagation of Religion, Qualification, Reasonable Opportunity, Reasonableness.
Religious Belief, Remedy, Representation, Responsibilities of Panchayat. Right
Conferred. Right of Free Speech. Right to Freedom, Right to Life, Rule of Law. Service
Rule. Seventh Schedule. Social Justice, Social Order, Social Reform, Special Leave
Petition, Standard of Living, State Legislature, Slate List, Statutory Provision.
Sustainable Development, Test of Reasonableness, Uniform Law. Violation of Article.
Weaker Section. Welfare of the People
Acts/Rules/Orders:
Haryana Panchayati Raj Act, 1994- Sections 175, 175(1), 177(1) and 177(2);
Constitution of India - Articles 14, 19(1), 21,25, 25(2), 38, 47. 51 A. 243F , 243G and
246; Haryana Municipal Act. 1973 - Section 13 A; Representation of the People Act.
1951 - Sections 123(5) and 124(5); Criminal Procedure Code (CrPC) - Section 125;
Government Servants' Conduct Rules - Rule 27
Cases Referred:
Budhan Choudhry and Ors. v. The State of Bihar, (1955) 1 SCR 1045; The Slate of
Madhya Pradesh v. G.C. Mandawar, (1955) 2 SCR 225; The Bar Council of Uttar
Pradesh v. The Slate of U.P. and Anr., (1973) 1 SCC 261; Slate of Tamil Nadu and Ors.
\. Ananthi Ammal and Ors., (1995) 1 SCC 519; Prabhakaran Nair and Ors. v. State of
Tamil Nadu and Ors., (1987) 4 SCC 238; Lalit Narayan Mishra Institute of Economic
Development and Social Change, Patna etc. v. State of Bihar and Ors.. (1988) 2 SCC
433; Pannalal Bansilal Pitti and Ors. v. State of A.P. and Anr., (1996) 2 SCC 498: N.P.
Ponnuswami v. Reluming Officer. Namakkal Constituency, (1952) SCR 218; .lagan Nath
v. Jaswant Singh and Ors., 1954 SCR 892; Jyoti Basu and Ors. v. Debi Ghosal and Ors..
(1982) (1) SCC 691; Jumuna Prasad Mukhariva and Ors. v. Lachhi Ram and Ors.. (1955)
I SCR 608; Sakhawat Ali v. The State of Orissa, (1955) 1 SCR 1004; Mrs. Maneka
Gandhi v. Union of India and Anr. - (1978) 1 SCC 248; Kasturu Lal Lakshmi Reddy and
Ors. v. Stale of Jammy and Kashmir and Anr., (1980) 4 SCC 1; Air India v. Nergesh
Mcerza and Ors.. (1981) 4 SCC 335; Dr. M. Ismail Faruqui and Ors. \. Union of India
and Ors.. (1994) 6 SCC 360; Sarla Mudgal (Smt.), President. Kalyani and Ors. v. Union
of India and Ors.. (1995) 3 SCC 635; Mohd. Ahmed Khan v. Shah Bano Begum and Ors..
(1985) 2 SCC 556; Mohd. Hanif Quareshi and Ors. v. The State of Bihar. (1959) SCR
629; The State of Bombay v. Narasu Appa Mali, AIR 1952 Bombay 84; Badruddin v.
Aisha Begam, 1957 AL.I 300; Smt. R.A. Pathan v. Director of Technical Education and
Ors., 1981 (22) GLR 289; Ram Prasad Seth v. Slate of Uttar Pradesh and Ors., 1957
L.L.J. Il 172, AIR 1961 Allahabad 334
Disposition:
Petition dismissed
Citing Reference:
* Mentioned
** Relied On
*** Examined
Budhan Choudhiy and Ors. v. The State of Bihar .
1'he State of Madhya Pradesh v. G.C. Mandawar.
1 he Bar Council of Uttar Pradesh v. The State of U.P. and Anr.
State of Tamil Nadu and Ors. v. Ananthi Ammal and Ors.
Prabhakaran Nair and Ors. v. State of Tamil Nadu and Ors.
Lalit Narayan Mishra Institute of Economic Development
and Social Change. Patna etc. v. State of Bihar and Ors.
Pannalal Banstlal Pitti and Ors. v. State of A.P. and Anr.
N.P. Ponnuswamt v. Returning Officer. Namakkal Constituency.
Jagan Nath v. Jaswant Singh and Ors.
Jyoti Basu and Ors. v. Debi Ghosal and Ors.
Jumuna Prasad Mukhariva and Ors. v. Lachhi Ram and Ors.
Sakhawat Ali v. The State of Orissa.
Mrs. Maneka Gandhi v. Union of India and Anr.
Kasturu Lal Lakshmi Reddy and Ors. v. State of Jammy and Kashmir and Anr.
Air India v. Nergcsh Meerza and Ors
Dr. M. Ismail Faruqut and Ors. v. Union of India and Ors.
Sarla Mudgal (Smt), President. Kalyani and Ors. v. Union of India and Ors.
Mohd. Ahmed Khan v. Shah Bano Begum and Ors.
Mohd. Hanif Quareshi and Ors. v. The State of Bihar.
I he State of Bombay v. Narasu Appa Mali
Badruddin v. Aisha Begam.
Smt. R .A. Pathan v. Director of Technical Education and Ors.
Ram Prasad Seth v. State of Uttar Pradesh and Ors.
Case Note:
Constitution - Haryana Panchayati Raj Act, 1994 - Section 175. 177 - Constitution
of India - Article 14, 21,25, 38, 47, 51 A, 243 F, 243G, 246 - Valid its of Section 175( I)
(q) and 177(1) - Persons having more than 2 living children are clearly
distinguishable from persons having not more than 2 living children - These two
constitutes 2 different classes and classification is founded on an intelligible
differentia - Objects sought to be achieved is popularizing the famils welfare
programme and disqualification creates a disincentive - Number of children based
on legislative wisdom and the number is a policy decision - No fault can be found
with the state for having enacted the legislation the disqualification contained in the
Act is neither arbitrary nor discriminatory - Disqualification seeks to achieve socio
economic welfare and healthcare of the masses and is consistent with national
population policy - Disqualification on the right to contest an election by having
more than two living children does not contravene any fundamental right - Appeals
dismissed
JUDGMENT
R.C. Lahoti, J.
I. Leave granted in all the Special Leave Petitions.
2. In this batch of writ petitions and appeals the core issues is the vires of the provisions
ofSection 175(l)(q) and 177(1) of the Haryana Panchayati Raj Act, 1994(Acl No. II of
1994) (hereinafter referred to as the Act, for short). The relevant provisions are extracted
and reproduced hereunder: 175. (1) No person shall be a Sarpanch or a Panch of a Gram Panchayat or
a member of a Panchayat Samiti or Zila Parishad or continue as such who
(q) has more than two living children :
Provided that a person having more than two children on or upto the
expiry of one year of the commencement of this Act, shall not be deemed
to be disqualified;
" 177(1) 1 f any member of a Gram Panchayat, Panchayat Samiti or Zila
Parishad (a) who is elected, as such, was subject to any of the
disqualifications mentioned in Section 175 al lime of his
election;
(b) during the term for which he had been elected, incurs
any of the disqualifications mentioned in Section 175.
shall be disqualified from continuing to be a member and his office shall
become vacant.
(2) In every case, the question whether a vacancy has arisen shall be
decided by the Director. The Director may give its decision cither on an
application made to it by any person, or on its own motion. Until the
Director decides that the vacancy, has arisen, the members shall not be
disqualified under Sub-section (1) for continuing to be a member. Any
person aggrieved by the decision of the Director may. within a period of
fifteen days from the dale of such decision, appeal to the Government and
the orders passed by Government in such appeal shall be final :
Provided that no order shall be passed under this sub-section by the
Director against any member without giving him a reasonable opportunity
of being heard."
3. Act No. 11 of 1994 was enacted with various objectives based on past experience and
in view of the shortcomings noticed in the implementation of preceding laws and also to
bring the legislation in conformity with Part IX of the Constitution of India relating to
"The Panchayats' added by the Seventy-third Amendment. One of the objectives set out
in the Statement of Objects and Reasons is to disqualify person for election of Panchayats
at each level, having more than 2 children after one year of the date of commencement of
this Act, to popularize Family Welfare/Family Planning Programme (Vide Clause (m) of
Para4ofSOR).
4. Placed in plain words the provision disqualifies a person having more than two living
children from holding the specified offices in Panchayats. The enforcement of
disqualification is postponed for a period of one year from the date of the commencement
of the Act. A person having more than two children upto the expiry of one year of the
commencement of the Act is not disqualified. This postponement for one year takes care
of any conception on or around the commencement of the Act. the normal period of
gestation being nine months. If a woman has conceived at the commencement of the Act
then any one of such couples would not be disqualified. Though not disqualified on the
date of election if any person holding any of the said offices incurs a disqualification by
giving birth to a child one year after the commencement of the Act he becomes subject to
disqualification and is disabled from continuing to hold the office. The disability is
incurred by the birth of a child which results in increasing the number of living children.
including the additional child born one year after the commencement of the Act. to a
figure more than two. If the factum is disputed the Director is entrusted w ith the duly of
holding an enquiry and declaring the office vacant. The decision of the Director is subject
to appeal to the Government. The Director has to afford a reasonable opportunity of
being heard to the holder of office sought to be disqualified. These safeguards satisfy the
requirements of natural justice.
5. Several persons (who are the writ petitioners or appellants in this batch of matters)
have been disqualified or proceeded against for disqualifying either from contesting the
elections for. or from continuing in, the office of Panchas/Sarpanchas in view of their
having incurred the disqualification as provided by Section 1 75(1 )(q) or Section 177( I)
read with Section 1 75( 1 )(q) of the Act. The grounds for challenging the constitutional
validity of the abovesaid provision are very many, couched differently in different writ
petitions. We have heard all the learned counsel representing the different
petitioners/appellants. As agreed to at the Bar, the grounds of challenge can be
categorized into five (i) that the provision is arbitrary and hence violative of Article 14
of the Constitution; (ii) that the disqualification does not serve the purpose sought to be
achieved by the legislation; (iii) that the provision is discriminatory; (i\) that the
provision adversely affects the liberty of leading personal life in al! its freedom and
having as many children as one chooses to have and hence is violative of Article 21 of
the Constitution; and (v) that the provision interferes with freedom of religion and hence
violates Article 25 of the Constitution.
6. The State of Haryana has defended its legislation on all counts We have also heard the
learned Standing Counsel for the State. On notice, Sh. Soil .1. Sorabji, the learned
Attorney General for India, has appeared to assist the Court and he loo has addressed the
Court. We would deal with each of the submissions made.
Submissions (i), (ii) & (iii)
7. The first three submissions are based on Article 14 of the Constitution and. therefore.
are taken up together for consideration.
/.v the classification arbitrary?
8. It is well-settled that Article 14 forbids class legislation; it docs not forbid reasonable
classification for the purpose of legislation. To satisfy the constitutional test of
permissibility, two conditions must be satisfied, namely (i) that the classification is
founded on an intelligible differentia which distinguishes persons or things that arc
grouped together from others left out of the group, and (ii) that such (sic) has a rational
relation to the object sought to be (sic) by the Statute in question. The basis for
classification may rest on conditions which may be geographical or according to objects
or occupation or the like. [See : Constitution Bench decision in Budhan Choudhiv and
Ors. v. The State of Bihar, (1955) 1 SCR 1045]. The classification is well-defined and
well-perceptible. Persons having more than two living children are clearly distinguishable
from persons having not more than two living children. The two constitute two different
classes and the classification is founded on an intelligible differentia clearly
distinguishing one from the other. One of the objects sought to be achieved by the
legislation is popularizing the family welfare/family planning programme. The
disqualification enacted by the provision seeks to achieve the objective by creating a
disincentive. The classification does not suffer from any arbitrariness. The number of
children, viz., two is based on legislative wisdom. It could have been more or less. The
number is a matter of policy decision which is not open to judicial scrutiny.
The legislation does not serve its object?
9. Il was submitted that the number of children which one has. whether iwo or three or
more, does not affect the capacity, competence and quality of a person to serve on any
office of a Panchayat and, therefore, the impugned disqualification has no nexus with the
purpose sought to be achieved by the Act. There is no merit in the submission. We have
already slated that one of the objects of the enactment is to popularize family
Welfare/family Planning Programme. This is consistent with the National Population
Policy.
10. Under Article 243G of the Constitution the Legislature of a Slate lias been vested
with the authority to make law endowing the Panchayats with such powers and authority
which may be necessary to enable the Gram Panchayat to function as institutions of self
Government and such law may contain provisions for the devolution of powers and
responsibilities upon Panchayats, at the appropriate level, subject to such conditions as
may be specified therein. Clause (b) of Article 243G provides that Gram Panchayats may
be entrusted the powers to implement the schemes for economic development and social
justice including those in relation to matters listed in the Eleventh Schedule. Entries 24
and 25 of the Eleventh Schedule read:
24.
Family Welfare.
25.
Women and child development.
In pursuance to the powers given to the State Legislature to enact laws the Haryana
Legislature enacted the Haryana Panchayati Raj Act, 1994 (Haryana Act No. 1 I of 1994).
Section 21 enumerates the functions and duties of Gram Panchayat. Clause XIX (I) of
Section 21 reads:
"XIX. Public Health and Family Welfare(1) Implementation of family welfare programme."
The family welfare would include family planning as well. To carry out the purpose of
the Act as well as the mandate of the Constitution the Legislature lias made a provision
for making a person ineligible to either contest for the post ofPanch or Sarpanch having
more than two living children. Such a provision would serve the purpose of the Act as
mandated by the Constitution. It cannot be said that such a provision would not serve the
purpose of the Act.
I I. In our opinion, the impugned disqualification does have a nexus with the purpose
sought to be achieved by the Act. Hence it is valid
The provision is discriminatory?
12. It was submitted that though the Stale of Haryana has introduced such a provision of
disqualification by reference to elective offices in panchayats, a similar provision is not
found to have been enacted for disqualifying aspirants or holders of elective or public
offices in other institutions of local self-governance and also not in Stale Legislatures and
Parliament. So also all the States, i.e„ other than Haryana have not enacted similar laws.
and therefore, it appears that people aspiring to participate in Panchayati Raj governance
in the State of Haryana have been singled out and meted out hostile discrimination. The
submission has been stated only to be rejected. Under the constitutional scheme there is a
well-defined distribution of legislative powers contained in Part XI of the Constitution.
The Parliament and every State Legislature has power to make laws with respect to any
of the mattes which fall within its field of legislation under Article 246 read with Seventh
Schedule of the Constitution. A legislation by one of the States cannot be held to be
discriminatory or suffering from the vice of hostile discrimination as against its citizens
simply because the Parliament or the Legislatures of other States have not chosen to enact
similar laws. Such a submission if accepted would be violative of the autonomy given to
the Centre and the States within their respective fields under the constitutional scheme.
13. Similarly, legislations referable to different organs of local self-government, that is.
Panchayats, Municipalities and so on may be, rather are, different. Many a time they arcreferable to different entries of Lists I, Il and 111 of the Seventh Schedule. All such laws
need not necessarily be identical. So is the case with the laws governing legislators and
parliamentarians.
14. It is not permissible to compare a piece of legislation enacted by a Stale in exercise of
ils own legislative power with the provisions of another law, though pari materia it may
be. but enacted by Parliament or by another State legislature within its own power io
legislate. The sources of power are different and so do differ those who exercise the
power. The Constitution Bench in The State of Madhya Pradesh \. G.C. Mandawar,
(1955) 2 SCR 225, held that the power of the Court to declare a law \ oid under Article 13
has to be exercised with reference to the specific legislation which is impugned. I >
laws enacted by two different Governments and by two different legislatures can be read
neither in conjunction nor by comparison for the purpose of finding out if they are
discriminatory. Article 14 does not authorize the striking down of a law of one Stale on
the ground that in contrast with a law of another State on the same subject, ils provisions
are discriminatory. When the source of authority for the iwo statutes are different. Article
14 can have no application. So is the view taken in The Bar Council of Uttar Pradesh
v. The State of U.P. and Anr. (1973) 1 SCC 261, State of Tamil Nadu anc£Ors. \.
Ananthi Animal and Ors. (1995) 1 SCC 519 and Prabhakaran Nair and Ors. v. State
of Tamil Nadu and Ors. (1987) 4 SCC 238.
15. Incidentally it may be noted that so far as the Slate of Haryana is concerned, in the
Haryana Municipal Act, 1973 (Act No. 24 of 1973) Section 13A has been inserted to
make a provision for similar disqualification for a person from being chosen or holding
the office of a member of municipality.
16. A uniform policy may be devised by the Centre or by a State. However, there is no
constitutional requirement that any such policy must be implemented in one-go. Policies
arc capable of being implemented in a phased manner. More so. when the policies have
far-reaching implications and are dynamic in nature, their implementation in a phased
manner is welcome for it receives gradual willing acceptance and invites lesser
resistance.
17. The implementation of policy decision in a phased manner is suggestive neither of
arbitrariness nor of discrimination. In Lalit Narayan Mishra Institute of Economic
Development and Social Change, Patna etc., v. State of Bihar and Ors., (1988) 2 SCC
433. the policy of nationalizing educational institutes was sought to be implemented in a
phased manner. This Court held that all the institutions cannot be taken over at a lime and
merely because the beginning was made with one institute, it could not complain that it
was singled out and, therefore, Article 14 was violated. Observations of this Court in
Pannalal Bansilal Pitti and Ors. v. State of A.P. and Anr. (1996) 2 SCC 498. are
apposite. In a pluralist society like India, people having faiths in different religions.
different beliefs and tenets, have peculiar problems of their own. "A uniform law. though
is highly desirable, enactment thereof in one go perhaps may be counter-productive to
unity and integrity of the nation. In a democracy governed by rule of law, gradual
progressive change and order should be brought about. Making law or amendment to a
law is a slow process and the legislature attempts to remedy where the need is felt most
acute. Il would, therefore, be inexpedient and incorrect to think that all laws have to be
made uniformly applicable to all people in one go. The mischief or defect which is most
acute can be remedied by process of law at stages."
18. To make a beginning, the reforms may be introduced at the grass-root level so as to
spiral up or may be introduced at the top so as to percolate down. Panchayals are grass
root level institutions of local self-governance. They have a wider base. There is nothing
wrong in the State of Haryana having chosen to subscribe to the national movement of
population control by enacting a legislation which would go a long way in ameliorating
health, social and economic conditions of rural population, and thereby contribute to the
development of the nation which in its turn would benefit the entire citizenry. We may
quote from the National Population Policy 2000 (Government of India Publication, page
35):"Demonstration of support by elected leaders, opinion makers, and
religious leaders with close involvement in the reproductive and chi d
health programm greatly influences the behaviour and response patterns of
individuals and communities. This serves to enthuse communities to be
attentive towards the quality and converge of maternal and child health
service.s including referral care." "The involvement and enthusiastic
participation of elected leaders will ensure dedicated involvement of
administrators at district and sub-distinct levels. Demonstration of.strong
support to the small family norm, as well as personal example, by
political, community, business, professional, and religious leaders, media
and film stars, sports personalities and opinion makers, will enhance its
acceptance throughout society."
19. No fault can be found with the Slate of Haryana having enacted the legislation. It is
for others to emulate.
20. We arc clearly of the opinion that the impugned provision is neither arbitrary nor
unreasonable nor discriminatory. The disqualification contained in Section 175( 1 )(q) of
1 laryana Act No. 11 of 1994 seeks to achieve a laudable purpose - socio-economic
welfare and health care of the masses and is consistent with the national population
policy. It is not violative of Article 14 of the Constitution.
Submission (iv) & (v) : the provision if it violates Article 21 or 25?
21. Before testing the validity of the impugned legislation from the viewpoint of Articles
21 and 25. in the light of the submissions made, we take up first the more basic issue Whether it is al all permissible to test the validity of a law which enacts a disqualification
operating in the field of elections on the touchstone of violation of fundamental rights?
22. Right to contest an election is neither a fundamental right nor a common law right II
is a right conferred by a Statute. At the most, in view of Part IX having been added in the
Constitution, a right to contest election for an office in Panchayat may be said to be a
constitutional right — a right originating in Constitution and given shape by statute. But
even so it cannot be equaled with a fundamental right. There is nothing wrong in the
same Statute which confers the right to contest an election also to provide for the
necessary qualifications without which a person cannot offer his candidature for an
elective office and also to provide for disqualifications which would disable a person
from contesting for. or holding, an elective statutory office.
23. Reiterating the law laid down in N.P. Ponnuswami v. Returning Officer,
Namakkal Constituency (1952) SCR 218, and Jagan Nath v. Jaswant Singh and Ors..
1954 SCR 892. this Court held in Jyoti Basu and Ors. v. Debi Ghosal anti Ors.. (1982)
(1) SCC 691. - "A right to elect, fundamental though it is to democracy, is. anomalous!}
enough, neither a fundamental right nor a common law right. It is pure and simple, a
statutory right. So is the right to be elected. So is the right to dispute an election. Outside
of statute, there is no right to elect, no right to be elected and no right to dispute an
election. Statutory creations they are, and therefore, subject to statutory limitation."
24. In Jumuna Prasad Mukhariva and Ors. v. Lachhi Ram and Ors.. (1955) I SCR
608, a candidate at the election made a systematic appeal to voters of a particular caste to
vote for him on the basis of his caste through publishing and circulating leaflets. Sections
123(5) and 124(5) of the Representation of the People Act, 1951, were challenged as nitre
vires of Article 19( 1 )(a) of the Constitution, submitting that the provisions of
Representation of the People Act interfered with a citizen's fundamental right to freedom
of speech. Repelling the contention, the Constitution Bench held that these laws do not
stop a man from speaking. They merely provide conditions which must be observed if lie
wants to enter Parliament. The right to stand as a candidate and contest an election is not
a common law right; it is a special right created by statute and can only be exercised on
the conditions laid down by the statute. The Fundamental Rights Chapter has no bearing
on a right like this created by statute. The appellants have no fundamental right to be
elected and if they want to be elected they must observe the rules. If they prefer to
exercise their right of free speech outside these rules, the impugned sections do not slop
them. In Sakhawat Ali v. The State of Orissa, (1955) 1 SCR 1004. the appellant's
nomination paper for election as a councillor of the Municipality was rejected on the
ground that he was employed as a legal practitioner against the Municipality which was a
disqualification under the relevant Municipality Act. It was contended that the
disqualification prescribed violated the appellant's fundamental rights guaranteed under
Article 14 and 19( I )(g) of the Constitution. The Constitution Bench held that the
impugned provision has a public purpose behind it, i.e., the purity of public life which
would be thwarted where there was a conflict between interest and duly. The Constitution
Bench further held that the right of the appellant to practise the profession of law
guaranteed by Article 19(l)(g) cannot be said to have been violated because in laying
down the disqualification the Municipal Act does not prevent him from practising his
profession of law; it only lays down that if he wants to stand as a candidate for election
he shall not either be employed as a paid legal practitioner on behalf of the Municipality
or act as a legal practitioner against the Municipality. There is no fundamental right in
any person to stand as a candidate for election to the Municipality. The only fundamental
right which is guaranteed is that of practising any profession or carrying on any
occupation, trade or business. The impugned disqualification does not violate the latter
right. Primarily no fundamental right is violated and even assuming that it be taken as a
restriction on his right to practise his profession of law, such restriction would be liable to
be upheld being reasonable and imposed in the interest of general public for the
preservation of purity in public life.
25. In our view, disqualification on the right to contest an election by having more than
two living children does not contravene any fundamental right nor does it cross the limits
of reasonability. Rather it is a disqualification conceptually devised in national interest.
26. With this general statement of law which has application to Articles 21 and 25 both.
we now proceed to test the sustainability of attack on constitutional validity of impugned
legislation separated by reference to Article 21 and 25.
The disqualification if violates Article 21?
27. Placing strong reliance on Mis. Maneka Gandhi v. Union of India and Anr. (1978) 1 SCC 248. and Kasturu Lal Lakshmi Reddy and Qi s, v. State of Jammy and
Kashmir and Am. - (1980) 4 SCC 1, it was forcefully urged that the fundamental right
to life and personal liberty emanating from Article 21 of the Constitution should be
allowed to stretch its span to its optimum so as to include in the compendious term of the
Article all the varieties of rights which go to make up the personal liberty of man
including the right to enjoy all the materialistic pleasures and to procreate as many
children as one pleases.
28. Al the very outset we are constrained to observe that the law laid down by this Court
in the decisions relied on is either being misread or red divorced ol the context. 1 he lest
of reasonableness is not a wholly subjective test and its contours are lairly indicated by
the Constitution. The requirement of reasonableness runs like a golden thread through the
entire fabric of fundamental rights. The lofty ideals of social and economic justice, the
advancement of the nation as a whole and the philosophy of distributive justice economic, social and political - cannot be given a go-by in the name of run due stress on
fundamental rights and individual liberty. Reasonableness and rationality, legally as well
as philosophically, provide colour to the meaning of fundamental rights and these
principles are deducible from those very decisions which have been relied on by the
learned counsel for the petitioners.
29. It is necessary to have a look at the population scenario, of the world and of our own
country.
30. India has the (dis)credil of being second only to China al the top in the list of the 10
most-populous countries of the world. As on 1.2.2000 the population of China was
1.277.6 million while the population of India as on 1.3.2001 was 1,027.0 million (Census
of India, 2001. Series I, India - Paper 1 of 2001, page 29).
31. The torrential increase in (he population of the country is one of lite major hindrances
in the pace of India's socio-economic progress. Everyday, about 50,000 persons arc added
to the already large base of its population. The Karunakaran Population Committee
(1992-93) had proposed certain disincentives for those who do not follow the norms of
the Development Model adopted by National Public Policy so as to bring down the
fertility rate. It is a matter of regret that though the Constitution of India is committed to
social and economic justice for all, yet India has entered the new millennium with the
largest number of illiterates in the world and the largest number of people below the
poverty line. The laudable goals spelt out in the Directive Principles of Stale Policy in the
Constitution of India can best be achieved if the population explosion is checked
effectively. Therefore, the population control assumes a central importance for providing
social and economic justice to the people of India (Usha Tandon. Reader. Faculty of Law .
Delhi University, - Research Paper on Population Stabilisation. Delhi Law Review. Vol.
XXI11 2001, pp. 125-131).
32. In the words of Berland Russell, "Population explosion is more dangerous than
Hydrogen Bomb." This explosive population over-growth is not confined lo a particular
country but it is a global phenomenon. India being the largest secular democracy has the
population problem going side by side and directly impacting on its per capita income.
and resulting in shortfall of food grains in spile of the green revolution, and has hampered
improvement on the educational front and has caused swelling of unemployment
numbers, creating a new class of pavement and slum-dwellers and leading to congestion
in urban areas due to the migration of rural poor. (Paper by B.K. Rama in Population
Policy and the Law. 1992, edited by B.P. Singh Sehgal, page 52).
33. In the beginning of this century, the world population crossed six billions, of w hich
India alone accounts for one billion (17 percent) in a land area of2.5 percent oflhe
world area. The global annual increase of population is 80 millions. Out of this. India's
growth share is over 18 millions (23 per cent), equivalent to the total population of
Australia, which has two and a half times the land space of India. In other words. India is
growing at the alarming rate of one Australia every year and will be the most densely
populous country in the world, outbeating China, which ranks fist, w uh a land area thrice
this country's. China can withstand the growth for a few years more, but not India, w ith a
constricted land space. Here, the per capita crop land is the lowest in the w orld. which is
also shrinking fast. If this falls below' the minimum sustained level, people can no longer
feed themselves sand shall become dependent on imported food, provided there arc
nations with exportable surpluses. Perhaps, this may lead to famine and abnormal
conditions in some parts of the country. (Source - Population Challenge, Arcot Easwaran,
The Hindu, dated 8.8.2003). It is emphasized that as the population grows rapidly there is
a corresponding decrease in per capita water and food. Women in many places trek long
distances in search of water which distances would increase every next year on account
of excessive ground water withdrawals catering to the need of the increasing population.
resulting in lowering the levels of water tables.
34. Arcot Easwaran has quoted the China example. China, the most populous country in
the world, has been able to control its growth rate by adopting the 'carrot and slick' rule.
Attractive incentives in the field of education and employment were provided to the
couples following the 'one-child norm'. At the same time drastic disincentives were cast
on the couples breaching 'one-child norm' which even included penal action. India being
a democratic country has so far not chosen to go beyond casting minimal disincentives
and has not embarked upon penalizing procreation of children beyond a particular limn.
However, it has to be remembered that complacence in controlling population in the
name of democracy is too heavy a price to pay, allowing the nation to drift towards
disaster.
35. The growing population oflndia had alarmed the Indian leadership even before India
achieved independence. In 1940 the sub-Committee on Population, appointed by the
National Planning Committee set up by the President of the Indian National Congress
(Pandit Jawaharlal Nehru), considered 'family planning and a limitation of children'
essential for the interests of social economy, family happiness and national planning. The
committee recommended the establishment of birth control clinics and other necessary
measures such as raising the age at marriage and a eugenic sterilization programme. A
committee on population set up by the National Development Council in 1991, in the
wake of the census result, also proposed the formulation of a national policy. (Source Seminar. March 2002, page 25)
36. Every successive Five Year Plan has given prominence to a population policy. In the
first draft of the First Five Year Plan (1951-56) the Planning Commission recognized that
population policy was essential to planning and that family planning was a step forward
for improvement in health, particularly that of mothers and children. The Second Five
Year Plan (1956-61) emphasized the method of sterilization. A central Family Planning
Board was also constituted in 1956 for the purpose. The Fourth Five Year Plan (1969-74)
placed the family planning programme, "as one amongst items of the highest national
priority". The Seventh Five Year Plan (1985-86 to 1990-91) has underlined "the
importance of population control for the success of the plan programme..." But, despite
all such exhortations, "the fact remains that the rate of population growth has not moved
one bit from the level of 33 per thousand reached in 1979. And in many cases, even the
reduced targets set since then have not been realised. (Population Policy and the Law,
ibid, pages 44-46).
37. The above facts and excerpts highlight the problem of population explosion as a
national and global issue and provide justification for priority in policy-oriented
legislations wherever needed.
38. None of the petitioners has disputed the legislative competence of the State of
Haryana to enact the legislation. Incidentally, it may be stated that Seventh Schedule, List
Il - State List. Entry 5 speaks of'Local government, that is to say. the constitution and
powers of municipal corporations, improvement trusts, district boards, mining settlement
authorities and other local authorities for the purpose of local self-government or village
administration'. Entry 6 speaks of Public health and sanitation' inter alia. In Lisi 111 Concurrent List. Entry 20A was added which reads 'Population control and family
planning'. The legislation is within the permitted field of State subjects. Article 243C
makes provision for the Legislature of a State enacting laws with respect to Constitution
of Panchayats. Article 243F in Part IX of the Constitution itself provides that a person
shall be disqualified for being chosen as, and for being, a member of Panchayat if he is so
disqualified by or under any law made by the Legislature of the State. Article 243G casts
one of the responsibilities of Panchayats as preparation of plans and implementation of
schemes for economic development and social justice. Some of the schemes that can be
entrusted to Panchayats, as spelt out by Article 243G read with Eleventh Schedule is Scheme for economic development and social justice in relation to health and sanitation.
family welfare. Family planning is essentially a scheme referable to health, family
welfare, women and child development and social welfare. Nothing more needs to be
said to demonstrate that the Constitution contemplates Panchayat as a potent instrument
of family welfare and social welfare schemes coming true for the betterment of people’s
health especially women's health and family welfare coupled with social welfare. Under
Section 21 of the Act, the functions and duties entrusted to Gram Panchayats include
'Public Health and Family Welfare', 'Women and Child Development' and 'Social
Welfare'. Family planning falls therein. Who can better enable the discharge of functions
and duties and such constitutional goals being achieved than the leaders of Panchayats
themselves taking a lead and setting an example.
39. Fundamental rights are not to be read in isolation. They have to be read along with
the Chapter on Directive Principles of State Policy and the Fundamental Duties enshrined
in Article 5 I A. Under Article 38 the Stale shall strive to promote the welfare of the
people and developing a social order empowered at distributive justice - social, economic
and political. Under Article 47 the State shall promote with special care the educational
and economic interests of the weaker sections of the people and in particular the
constitutionally down-trodden. Under Article 47 the Slate shall regard the raising of the
level of nutrition and the standard of living of its people and the improvement of public
health as among its primary duties. None of these lofty ideals can be achieved without
controlling the population inasmuch as our materialistic resources arc limited and the
claimants are many. The concept of sustainable development which emerges as a
fundamental duty from the several clauses of Article 51A too dictates the expansion of
population being kept within reasonable bounds.
40. The menace of growing population was judicially noticed and constitutional validity
of legislative means to check the population was upheld in Air India v. Merges h Mceiza
and Ors. (1981) 4 SCC 335. The Court found no fault with the rule which would
terminate the services of Air Hostesses on the third pregnancy with two existing children.
and held the rule both salutary and reasonable for two reasons - "In the first place, the
provision preventing a third pregnancy with two existing children would be in the larger
interest of the health of the Air Hostess concerned as also for the good upbringing of the
children. Secondly
when the entire world is faced with the problem of population
explosion it will not only be desirable but absolutely essential for every country to sec
that the family planning programme is not only whipped up but maintained at sufficient
levels so as to meet the danger of over-population which, if not controlled, may lead to
serious social and economic problems throughout the world."
41. To say the least it is futile to assume or urge that the impugned legislation violates
right to life and liberty guaranteed under Article 21 in any of the meanings howsoever
expanded the meanings may be.
The provisions if it violates Article 25?
42. Il was then submitted that the personal law of muslims permits performance of
marriages with 4 women, obviously for the purpose of procreating children and any
restriction thereon would be violative of right to freedom of religion enshrined in article
25 of the Constitution. The relevant part of Article 25 reads as under:-
25. Freedom of conscience and free profession, practice and
propagation of religion. - (1) Subject to public order, morality and health
and to the other provisions of this Part, all persons are equally entitled to
freedom of conscience and the right freely to profess, practise and
propagate religion.
(2) Nothing in this article shall affect the operation of any existing law or
prevent the State from making any law (a) regulating or restricting any economic, financial,
political or other secular activity which may be associated
with religious practice;
(b) providing for social welfare and reform or the throwing
open of Hindu religious institutions of a public character to
all classes and sections of Hindus.
43. A bare reading of this Article deprives the submission of all its force, vigour and
charm. The freedom is subject to public order, morality and health. So the Article itself
permits a legislation in the interest of social welfare and reform which arc obviously part
and parcel of public order, national morality and the collective health of the nation's
people.
44. The Muslim Law permits marrying four women. The personal law nowhere mandates
or dictates it as a duly to perform four marriages. No religious scripture or authority has
been brought to our notice which provides that marrying less than four women or
abstaining from procreating a child from each and every wife in case of permitted bigamy
or polygamy would be irreligious or offensive to the dictates or the religion in our view .
the question of the impugned provision of Haryana Act being violative of Article 25 does
not arise. We may have a reference to a few' decided cases.
45. The meaning of religion - the term as employed in Article 25 and the nature of
protection conferred by Article 25 stands settled by the pronouncement of the
Constitution Bench decision in Dr. M. Ismail Farugui and Ors. v. L'nion of India and
Qi s., (1994) 6 SCC 360. The protection under Articles 25 and 26 of the Constitution is
with respect to religious practice which forms an essential and integral part of the
religion. A practice may be a religious practice but not an essential and integral part of
practice of that religion. The latter is not protected by Article 25.
46. In Sarla Mudgal (Smt.), President, Kalyani and Ors. v. Union of India and Ors.
(1995) 3 SCC 635. this Court has judicially noticed it being acclaimed in the United
States of Amercia that the practice of polygamy is injurious to 'public morals', even
though some religions may make it obligatory or desirable for its followers. The Court
held that polygamy can be superseded by the State just as it can prohibit human sacrifice
or the practice of Sati in the interest of public order. The Personal Law operates under the
authority of the legislation and not under the religion and, therefore, the Personal Law
can always be superseded or supplemented by legislation.
47. In Molid. Ahmed Khan v. Shah Bano Begum and Ors., (1985) 2 SCC 556. the
Constitution Bench was confronted with a canvassed conflict between the provisions of
Section 125 of Cr.P.C. and Muslim Personal Law. The question was: when the Personal
Law makes a provision for maintenance to a divorced wife, the provision for maintenance
under Section 125 of Cr.P.C. would run in conflict with the Personal Law. The
Constitution Bench laid down tw o principles; firstly, the two provisions operate in
different fields and. therefore, there is no conflict and; secondly, even if there is a conflict
it should be set al rest by holding that the statutory law will prevail over the Personal Law
of the parties, in cases where they are in conflict.
48. In tVIohd. Ilanif Quareshi and Ors, v. The State of Bihar. (1959) SCR 629. the
Slate Legislation placing a total ban on cow' slaughter was under challenge. One of the
submissions made was that such a ban offended Article 25 of the Constitution because
such ban came in the way of the sacrifice of a cow' on a particular day where it was
considered to be religious by Muslims. Having made a review of various religious books.
the Court concluded that it did not appear to be obligatory that a person must sacrifice a
cow'. Il w'as optional for a Muslim to do so. The fact of an option seems to run counter to
the notion of an obligatory duty. Many Muslims do not sacrifice a cow' on the Id day. As
it w'as not proved that the sacrifice of a cow on a particular day was an obligatory overt
act for a Mussalman for the performance of his religious beliefs and ideas, it could not be
held that a total ban on the slaughter of cow's ran counter to Article 25 of the Constitution.
49. In The State of Bombay v. Narasu Appa Mali, AIR 1952 Bombay 84. the
constitutional validity of the Bombay Prevention of Hindu Bigamous Marriages Act
(XXV (25) of 1946) was challenged on the ground of violation of Article 14. 15 and 25
of the Constitution. A Division Bench, consisting of Chief Justice Chagla and Justice
Gajendragadkar (as His Lordship then was), held"A sharp distinction must be drawn between religious faith and belief and
religious practices. What the Slate protects is religious faith and belief. If
religious practices run counter to public order, morality or health or a
policy of social welfare upon which the State has embarked, then the
religious practices must give way before the good of the people of the
State as a whole."
50. Their Lordships quoted from American decisions that the laws are made for the
government of actions, and while they cannot interfere with mere religious belief and
opinions, they may with practices. Their Lordships found it difficult to accept the
proposition that polygamy is an integral part of Hindu religion though I lindu religions
recognizes the necessity of a son for religious efficacy and spiritual salvation. However.
proceeding on an assumption that polygamy is recognized institution according to Hindu
religious practice, their Lordships stated in no uncertain terms-
"The right of the State of legislate on questions relating to marriage cannot
be disputed. Marriage is undoubtedly a social institution an institution in
which the State is vitally interested. Although there may not be universal
recognition of the fact, still a very large volume of opinion in the world
today admits that monogamy is a very desirable and praiseworthy
institution. If, therefore, the State of Bombay compels Hindus to become
monogamists, it is a measure of social reform, and if it is a measure of
social reform then the State is empowered to legislate with regard to social
reform under Article 25(2)(b) notwithstanding the fact that it may interfere
with the right of a citizen freely to profess, practise and propagate
religion."
51. What constitutes social reform? Is it for the legislature to decide the same? Their
Lordships held in Narasu Appa Mali's case (supra) that the will expressed by the
legislature, constituted by the chosen representatives of the people in a democracy who
are supposed to be responsible for the welfare of the State, is the will of the people and if
they lay down the policy which a Stale should pursue such as when the legislature in its
wisdom has come to the conclusion that monogamy lends to the welfare of the State, then
it is not for the Courts of Law to sit in judgment upon that decision. Such legislation docs
not contravene Article 25( 1) of the Constitution.
52. We find ourselves in entire agreement, with the view so taken by the learned Judges
whose eminence as jurists concerned with social welfare and social justice is recognized
without any demur. Divorce unknown to ancient Hindu Law. rather considered
abominable to Hindu religious belief, has been statutorily provided for Hindus and the
Hindu marriage which was considered indissoluble is now' capable of being dissolved or
annulled by a decree of divorce or annulment. The reasoning adopted by the High Conn
of Bombay, in our opinion, applies fully to repel the contention of the petitioners even
when we are examining the case from the point of view of Muslim Personal Law .
53. The Division Bench of the Bombay High Court in Narasu Appa Mali (supra) also
had an occasion to examine the validity of the legislation when it was sought to be
implemented not in one go but gradually. Their Lordships held - "Article 14 does not lav
dow n that any legislation that the State may embark upon must necessarily be of an allembracing character. The Stale may rightly decide to bring about social reform by stages
and the stages may be territorial or they may be community-wise."
54. Rule 21 of the Central Civil Services (Conduct) Rules, 1964 restrains any government
servant having a living spouse from entering into or contracting a marriage w'ith any
person. A similar provision is to be found in several service rules framed by the Slates
governing the conduct of their civil servants. No decided case of this court has been
brought to our notice wherein the constitutional validity of such provisions may have
been put in issue on the ground of violating the freedom of religion under Article 25 or
the freedom of personal life and liberty under Article 21. Such a challenge was never laid
before this Court apparently because of its futility. However, a few decisions by the High
Courts may be noticed.
55. In Badruddin v. Aisha Begam, 1957 AL.I 300, the Allahabad High Court ruled that
though the personal law of muslims permitted having as many as four wives but n could
not be said that having more than one wife is a part of religion. Neither is it made
obligatory by religion nor is it a matter of freedom of conscience. Any law in favour of
monogamy does not interfere with the right to profess, practise and propagate religion
and does not involve any violation of Article 25 of the Constitution.
56. In Smt. R.A. Pathan v. Director of Technical Education and Qi s. - 1981 (22)
GLR. 289. having analysed in depth the tenets of Muslim personal law and its base in
religion, a Div ision Bench of Gujarat High Court held that a religious practice ordinarily
connotes a mandate which a faithful must carry out. What is permissive under the
scripture cannot be equated with a mandate which may amount to a religious practice.
Therefore, there is nothing in the extract of the Quaranic text (cited before the Court) that
contracting plural marriages is a matter of religious practice amongst Muslims. A
bigamous amongst Muslims is neither a religious practice nor a religious belief and
certainly not a religious injunction or mandate. The question of attracting Articles 1 5( 1).
25(2) or 26(b) to protect a bigamous marriage and in the name of religion does not arise.
57. In Rain Prasad Seth v. State of Uttar Pradesh and Ors. (1957 L.L.,1. (Vol.II) I 72 AIR 1961 Allahabad 334) a learned single Judge held that the act of performing a second
marriage during the lifetime of one's wife cannot be regarded as an integral part of Hindu
religion nor could it be regarded as practising or professing or propagating Hindu
religion. Even if bigamy be regarded as an integral part of Hindu religion, the Rule 27 of
the Government Servants' Conduct Rules requiring permission of the Government before
contracting such marriage must be held to came under the protection of Article 25(2)(b)
of the Constitution.
58. The law has been correctly slated by the High Court of Allahabad, Bombay and
Gujarat, in the cases cited hereinabove and we record our respectful approval thereof.
The principles stated therein are applicable to all religions practised by whichever
religious groups and sects in India.
59. In our view, a statutory provision casting disqualification on contesting for, or
holding, an elective office is not violative of Article 25 of the Constitution
60. Looked al from any angle, the challenge to the constitutional validity of Section
175(l)(q) and Section 177(1) must fail. The right to contest an election for any office in
Panchayat is neither fundamental nor a common law right. It is the creature of a statute
and is obviously subject to qualifications and disqualifications enacted by legislation. It
may be permissible for Muslims to enter into four marriages with four women and for
anyone whether a Muslim or belonging to any other community or religion to procreate
as many children as he likes but no religion in India dictates or mandates as an obligation
to enter into bigamy or polygamy or to have children more than one What is permitted or
not prohibited by a religion does not become a religious practise or a positive tenet of a
religion. A practice does not acquire the sanction of religion simply because it is
permitted. Assuming the practice of having more wives than one or procreating more
children than one is a practice followed by any community or group of people the same
can be regulated or prohibited by legislation in the interest of public order, morality and
health or by any law providing for social welfare and reform which the impugned
legislation clearly does.
61. If anyone chooses to have more living children than two. he is free to do so under the
law as it stands now but then he should pay a little price and that is of depriving himself
from holding an office in Panchayat in the State of Haryana. There is nothing illegal
about it and certainly no unconstitutionality attaches to it.
Some incidental questions
62. Il was submitted that the enactment has created serious problems in the rural
population as couples desirous of contesting an election but having living children more
than two. are feeling compelled to give them in adoption. Subject to what has already
been stated hereinabove, we may add that disqualification is attracted no sooner a third
. hild is born and is living after two living children. Merely because the couple has parted
with one child by giving the child away in adoption, the disqualification docs not conic to
an end. While interpreting the scope of disqualification we shall have to keep in view the
evil sought to be cured and purpose sought to be achieved by the enactment If the person
sought to be disqualified is responsible for or has given birth to children more than tw
who are living then merely because one or more of them are given in adoption the
disqualification is not wiped out.
63. Il was also submitted that the impugned disqualification would hit the women worst.
inasmuch as in the Indian society they have no independence and they almost helplessly
bear a third child if their husbands want them to do so. This contention need not detain us
any longer. A male who compels his wife to bear a third child would disqualify not only
his wife but himself as well. We do not think that with the awareness which is arising in
Indian women folk, they are so helpless as to be compelled to bear a third child even
though they do not wish to do so. At the end, suffice it to say that if the legislature
chooses to carve out an exception in favour of females it is free to do so but merely
because women are not excepted from the operation of the disqualification it does not
render it unconstitutional.
64. Hypothetical examples were tried to be floated across the bar by submitting that there
may be cases where triplets are bom or twins are born on the second pregnancy and
consequently both of the parents would incur disqualification for reasons beyond their
control or just by freak of divinity. Such are not normal cases and the validity of the law
cannot be tested by applying it to abnormal situations. Exceptions do not make the rule
nor render the rule irrelevant. One swallow' does not make a summer; a single instance or
indicator of something is not necessarily significant.
Conchtsion
65. The challenge to the constitutional validity of Section 175( I )(q) and 177( I) fails on
all the counts. Both the provisions are held, intra vires the Constitution. The pro\ isions
are salutary and in public interest. All the petitions which challenge the constitutional
validity of the abovesaid provisions are held liable to be dismissed.
66. Certain consequential orders would be needed. The matters in this batch of hundreds
of petitions can broadly be divided into a few' categories. There are writ petitions under
Article 32 of the Constitution directly filed in this Court wherein the only question arising
for decision is the constitutional validity of the impugned provisions of the Haryana Act.
There were many a writ petitions filed in the High Court of Punjab & Haryana under
Articles 226/227 of the Constitution which have been dismissed and appeals by special
leave have been filed in this Court against the decisions of the High Court. The writ
petitions, whether in this Court or in the High Court, were filed at different stages of the
proceedings. In some of the matters the High Court had refused to slay by interim order
the disqualification or the proceedings relating to disqualification pending before the
Director under Section 1 77(2) of the Act. With the decision in these writ petitions and lh<
appeals arising out of SLPs the proceedings shall stand revived at the stage al which they
were, excepting in those matters where they stand already concluded. The proceedings
under Section 1 77(2) of the Act before the Director or the hearing in the appeals as the
case may be shall now be concluded. In such of the cases where the persons proceeded
against have not filed (heir replies or have not appealed against the decision of the
Director in view of the interim order of this Court or the High Court having been secured
by them they would be entitled to file reply or appeal, as the case may be, within 15 days
from the date of this judgment if the time had not already expired before their initiating
proceedings in the High Court or this Court. Such of the cases where defence in the
proceedings tinder Section 177(2) of the Act was raised on the ground that the
disqualification was not attracted on account of a child or more having been given in
adoption, need not be re-opened as we have held that such a defence is not available.
67. Subject to the abovesaid directions all the writ petitions and civil appeals arising out
of SLPs are dismissed.
L,J |979
Britain
RESEARCH ON HEALTH CARE AND THE FAMILY: A
METHODOLOGICAL OVERVIEW
*
H . (S
Theodor J. Lttman and Maureen Venters
Program in Hospital and Health Care Administration, School of Public Health.
University of Minnesota, Minneapolis, MN. U.S.A.
Abstract Despite increased interest on the part of behavioural scientists in the role of the family
in health and illness, empirical research has remained relatively limited, plagued by methodological
imprecision and minimal integration with family theory. Some of the major empirical problems involved
and potential areas for future research are examined in this methodological overview.
j^Although interest on the part of behavioural scientists ting. The fact that the family is a unit of illness because
^”in the role of the family in health and illness has it is the unit of “living" has been grossly neglected m the
increased greatly since the seminal efforts of Richard . development of statistical tools suitable for coping with
son in the mid-1940s [1], empirical inquiry has t (his set of problems, and in the provision of statistical data
remained relatively limited, plagued by methodologi- essential for an investigation of the individual as part of
the family in illness as well as health [9].
,
cal imprecision and minimal integration with family
In an earlier review [10], we explored the theoreti
theory. Nevertheless, a recent review of the current
$
state of the art has revealed a rather rich and insight- cal and conceptual dimensions of family health care
i
ful literature representing the contributions of a diver research; in this one. we will examine some of the
sity of fields and.disciplines [2].
major methodological problems involved and suggest
Over the course of the past two decades, the family possible avenues for future study.
has variously been treated not only as an indepeni dent, dependent and intervening variable, but as a
MODELS AND DESIGNS
, precipitating, predisposing and contributory factor in
Methodologically. research in the area of health
v/j the etiology, care and treatment of both physical and
j 1 i mental illness, as well as a basic unit of interaction care and the family has embraced a variety of designs
■; I and transaction in health care.
and techniques ranging from the use of demographic
On the whole, much of our early knowledge of the and census data [11] and household interview surveys
role of the family in health care has been the product [12] on one hand to model building and the explor
of cither broad-based, national or regional surveys. ation of innovative data collection procedures on the
or panel studies of subscribers to select pre-paid in other.
surance programs [3-8]. For the most part, attempts
<
at either longitudinal or intcrgcncrational analyses of
SOME EFFORTS AT MODEL BUILDING
"j^family health patterns and practices have been rclaHaggerty [13], for instance, has sought to examine
lively limited.
j
Noting the relative paucity of available data and the relationship of family functioning to disease, or
j
the need for more sophisticated statistical information dysfunction in the family and/or its members, through
.3 concerning the family and health care, the final report what is termed “family diagnosis”. Based on a general
N
of the World Health Organization’s Special Consul theory of family functioning, the proposed model
tation on the Statistical Aspects of the Family as a encompasses three major functional categories: (1)
past medical experiences and attitudes toward health;
Unit of Health Studies observed:
(2) internal functions, including relations to the family
In spite of its central position in society, the family has
of origin, internal role relations, family dominance.
been infrequently studied from the public health point of
child-rearing practices, etc., as well as the physical
,
view. The complex interrelationships between health and
environment;
and (3) external functions, c.g. social
the family virtually constitute terra incognita. In the form
presented or available, statistics loo often tell very little mobility, social isolation and recreational activities.
Since ratings are obtained for several family functions
about the family setting although this is undoubtedly a
major factor in. for example, the rearing of children and
without reference to known disorders, the technique
*
' the development and stabilization of adult personality. differs conceptually from the diagnostic labels of mal
;
Many of the strains and maladjustments which place an function (deficiency, dependency and deprivation)
>
increasing burden on pediatric, general medical, and psyused earlier by Miller et al., in the famous Newcastle
$
chiatric services can be understood and efficiently tackled
Study [14, 15].
only after due attention has been given to the family selIn a somewhat different vein, Andersen, in perhaps
one of the most ambitious efforts to date, has sought
to
explain familial utilization of health services
y
• Based in part on a paper prepared for a meeting of
through the development of a multi-faceted, behav
a special WHO Study Group on Statistical Indices of
ioural
model
involving
the
relationship
between
Family Health. February 17-22. 1975. Geneva, Switzer
predisposing, enabling and need factors and the use
land.
379
of health services [16]. Roghmann and Haggerty [17]
on the other hand have suggested the use of a “Flow
Model" for the study of how families and their
members, especially mothers and their children, trans
cend a sequence of days through various states of
stress, illness and utilization. Finally, Crawford [IS]
has proposed a fairly complicated, four-dimensional
paradigm for the analysis of the family and health
that seeks to take into consideration the relationship
of disease, state of illness, and the context of care.
Unfortunately, as with most efforts of this type, the
Haggerty and Andersen models, as well as those of
Roghmann and Crawford, still require more extensive
exploration and refinement. Moreover, the need for
greater integration with family theory remains. For
not only is systematic theory building needed to blend
with empirical observation to create testable hypoth
eses and meaningful models, but concepts need to be
formulated, clarified, and logically interrelated with
propositions of more general applicability.
The recent attempt by Klein [19] to explore the
applicability of Hill’s [20] ABCX model [A (the
event) interacts with B (the family’s resources), which
in turn interacts with C (the family’s definition of the
event) to produce X (the crisis)] to family adaptation
and response to chronic kidney disease, is a step in
the right direction.
VIEWING THE FAMILY IN HEALTH—THE
LONGITUDINAL APPROACH
Although the interrelationship of the family and
health is a fairly dynamic, ongoing process, most
family health care research has revolved around
cross-sectional data in which the family is viewed at
only one point in lime. While retrospective data can
recapture some of the processional dimension, the ac
curacy of such data is often distorted by the difficulty
of accurate recall. In order to broach this problem.
a number of innovative attempts have been made to
examine the role of the family in health care over
a more prolonged period of time.
Downes [21]. for instance, in one of the earliest
efforts along these lines, sought to explore the appli
cability of the longitudinal design to family health
care research in a study of chronic illness in the East
ern Health District of Baltimore. Maryland. Using
data derived from a study of 951 families over the
course of a five-year period, she noted that such a
design permits not only a description of the family
patterns of disease, and the growth and decline of
the family as a biologic, social and economic unit.
but it offers an opportunity to gain a belter under
standing of family attitudes toward health and illness
as well.
Such advantages aside, however, the longitudinal
approach is not without its problems. Foremost
among these is the rather high rate of attrition and
non-response. For instance, securing the family’s
long-term cooperation and commitment may be
much more difficult in such a design than when crosssectional data is used. Moreover, financial and
organizational costs may frequently prove prohibitive.
Finally, very long projects may be subject to prema
ture termination or incompleteness due to the unanli-
cipated death of cither the subjects and/or the investi
gator.
An effective alternative to the pure longitudinal
design, which lends to minimize many of its disadvan
tages while still providing insight into the process,
is suggested in Litman’s [22, *.J] imaginative use of
intergenerational analysis in the study of the family
and health care. Predicated on the pioneering work
of Hill and associates at the University of Minnesota’s
Family Study Center [24], the health attitudes,
beliefs, experiences, and practices of a sample of 201
nuclear families, comprising some 69 three-genera
tional lineages, all living within the Twin Cities (Min
neapolis-St. Paul) metropolitan area, were explored
in a multifaceted 15-month study. Data of both a
cross-sectional as well as a longitudinal nature were
obtained, as each family was interviewed five times
during the course of the project.
In addition to the development of such itfhvative
measures as a family Chronic Disease and ^ffte Dis
ease Index as well as a family index of specific preven
tive health practices, the study demonstrated the
applicability and value of intergenerational family
analysis to health care research. Such an approach,
it was noted, lends itself to not only an examination
of the interaction of family members but the totality
of intra-familial transactions within the context of
historical time as well. Moreover, as far as health and
health care are concerned, such a design facilitates
assessment of both the socialization of health atti
tudes, values and beliefs as well as the dynamic
aspects of the health behaviour of families and their
members within and throughout the three phases of
the life cycle.
Despite such efforts, as well as Davis’ [25] pioneer
ing study of family reaction to polio, longitudinal and
intergenerational analyses of family health problems
has remained limited.
THE FAMILY LIFE CYCLE
Similarly, while the family life cycle l^brovcn to
be one of the most fruitful approaches toWdcrstanding variations in family behaviour in general, its use
to explore, describe, explain and predict various
aspects of family health has not as yet reached its
full potential. Andersen ct al. [26], for instance, at
the University of Chicago, have found that the value
and type of health services used tend to follow a pre
dictable pattern of variation from one stage to
another as the needs of family members change
throughout the life cycle.
Such an approach may provide additional insights
into a number of other areas of family health as well.
including: variations in familial adjustment and abi
lity to cope with chronic disease throughout various
stages of the life cycle and/or the impact and reaction
of young families to the incidence of childhood dis
eases during the pre- vs post-school age period.
On the whole, the collection of reliable health infor
mation on the family unit is subject to a number of
difficulties including those involving respondent bias.
error and inaccuracy in recording. Of equal, if no1
P^aps evcn 8rcalcr importance, however, is the
problem of gaining access to systematic and uniform
sources of information on all members of the family
at a given time.
Over the course of the past few years or so a
number of attempts have been made to improve the
level of data collection and develop a set of research
protocols for use in family health care research. None
of these, however, has proven to be universally applic
able. For the most parMhe methods used in the col
lection of family related health data tend to be depen
dent upon the particular purpose of the study and
the availability and accessibility of the sources of in
formation.
NATIONAL CENSUS AND DEMOGRAPHIC DAT,\
While census surveys have proven satisfactory for
the acquisition of relatively crude demographic data
on the family and health, they tend to be insufficiently
sensitive to the more detailed analysis afforded
through the use of population sample surveys
[27.28]. Similarly, although national and regional
surveys such as those conducted by the National
Center for Health Statistics involving a continuous
sampling of the population provide useful demo
graphic and trend data for health planning, they again
are not sufficiently detailed nor accurate enough to
explore the health needs of family units.
Finally, while limited as a source of family data
and subject to inaccuracies of recording and recall.
such vital records as births, marriages, divorces and
deaths may be helpful in yielding insights into family
health experiences, relationships and trends. The re
striction of the data recorded in such official docu
ments to categories that arc clearly defined and un
ambiguous. however, may serve to mask other impor
tant information. For example, the mere recording
of "yes” or "no” to depict the presence or absence
of congenital abnormalities lends not only to lack
sufficient specificity as to the type of condition in
question, but may also serve to hide the degree of
seventy of the anomaly as well. Thus, in a recent
investigation of Down’s syndrome conducted at the
University of Minnesota. Venters. Schacht and Ten
Bcnscl [29]. using data drawn from birth certificates.
later verified for chromosomal analysis via individual
physician referral forms, found that there was a 79
per cent under-reporting of the condition (even
though Down’s syndrome is an easily medically
recognizable condition at birth) where the presence
of the abnormality had merely been recorded on the
certificate as “yes" or “no”, as compared to a 36 per
cent under-reporting when the identification of the
specific abnormality was requested.
health research except in terms of record linkage.
Such linkages. Glick [30] has noted, offer a number
of advantages over both the interview and observa
tion in the collection of family data. For instance.
not only are the basic data generally available in rela
tively uniform quality, but the information obtained
from different record sources may be cross-checked
to safeguard against errors of recording. In addition.
distortions that may arise in questioning persons di
rectly about previous events of a sensitive nature may
be avoided or at least minimized through the use of
matched vital records.
The utility of record linkages, however, may be
limited by the general inadequacies of physician and
institutional records for socio-medical research, the
lack of adequate vital records in some localities, the
restricted nature of the data available on the record.
as well as the potential loss of data for persons who
have moved from the study area.
The need. then, for a more extensive, nationwide
collection of morbidity and family data, involving a
variety of sources guided by an interdisciplinary effort
along the lines proposed by the 1976 WHO Study
Group on Statistical Indices of Family Health, seems
clear indeed [31].
HEALTH SURVEYS: THE PROBLEM
OF MEASUREMENT
(-Perhaps one of the most confounding problems
encountered in family health surveys has been the dif
ficulty in obtaining accurate information concerning
the health and related behaviour of various family i
members. While data furnished by the patient is nor- (
mally more reliable than that provided by an infor- i
manl [32, 33], the former’s age, incapacity or non- !
availability at the time of the study may necessitate
reliance on the use of another member of the family
as a source of informalion^As the central agent of
cure and care within the family setting, the wife
mother is frequently called upon to serve in this capa
city. But while probably the most knowledgeable and
accessible source of information about the family and
its members, she is not without her faults in this
regard.
Mechanic [34], for instance, found that mothers
under stress tend to report not only more symptoms
of illness for themselves, but for their children. More
over, mothers with less education tend to be more
fatalistic about illness and less concerned about
detecting and reporting it in their children. Similarly.
Cartwright [35] found that discrepancies in the wives’
estimates of their spouses’ symptoms as compared to
those of the husbands themselves constituted one of
the most serious problems encountered in the familial
study of morbidity.
Kosa [36], on the other hand, has observed that
HOSPITAL AND MEDICAL RECORDS
the general health of the family is comprised of so
For the most part, hospital and medical records many disparate events that their total recall or consis
arc maintained by institutions and practitioners as tent recording over a specified period of lime or
a record of the care, treatment and condition of their sequence is nigh on impossible. As a result, such
individual patients. Although such records may be accounts are frequently subject to both quantitative.
useful as a source of information concerning an indi especially number and length of illness, as well as
vidual’s illness or illness experience, they normally arc qualitative errors, including the under-reporting of
not collected nor stored by families or family units. actual events.
Such reports of family health may be further plaAs a result, they have only tangential value for family
Theodor J. Litman and Maureen Venters
gued by bias engendered by the normative values of ducted in 1966 under a grant from the Children s Bur
I medical relevance and social desirability. Kosa [37], eau. Originally conceived as part of a maternal and
for instance, found that mothers tended to invoke a child health project of the Connecticut State Depart
/1 selective censorship involving norms of relevance, ment of Health, the study sought to determine not
social_desirability, privacy and decency. in separating only the feasibility of using a mail questionnaire tech
reportable events and suppressing others. Moreover. nique for the collection of health related data but
: in response to questions concerning the temporal to:
aspects of health, their replies tended to be structured
in accordance with the implied reference and current
(1)
Test the feasibility of combining data from two
health status of the family member involved. As a independent sources (i.e. the Family Health Survey
result, data collected about the same family at differ and a more detailed 25% sample census) based upon
ent times or in reference to various aspects of health the matching of data for the same households;
and related behavior may not necessarily be corre
(2)
Gather meaningful data on utilization, health
lated. As a matter of fact, less than one-fourth of the status, family planning and child care;
mothers studied by Kosa were found to have reported
(3)
Design new health status indicators in the field
the number of health visits of their family members of maternal and child care; and
correctly, when verified against the medical record.
(4)
Test the feasibility of using health data derived
Interestingly enough, there appeared to be no evi from a small area survey as a component
health
dence that either number of children per family or information system.
their health status were significantly associated with
a tendency to under- or over-report clinic visits.
Unfortunately, while large amounts of data were
Andersen and Kasper [38], on the other hand, obtained on medical care utilization, health insurance
found that family size may well serve as a serious coverage and limitation of activity, the data output
source of measurement error in family-type health did not prove to be as extensive as originally hoped.
surveys where information is collected on all family Data on child care arrangements and morbidity, for
members at one time. The problem of recall, coupled instance, both of which have potential value as com
j>jwith the attendant fatigue and lessened motivation ponents of a health information system, proved to
of both the family-informant and the interviewer, they be inadequate for such use. Moreover, the suscepti
noted, may result in more conservative estimates of bility of mailed questionnaires to the under-reporting
J I the health service utilization of persons in large versus of both acute and chronic diseases as well as disabili
] small families.
ties raised (serious doubts as to their ability to provide
Finally, an equally if not more disturbing problem complete and reliable morbidity data.
that has continued to plague this area of empirical
More recently. Eichhorn [47] and associates at the
inquiry has been the relative inadequacy and lack of University of Purdue, using the family as a source
applicability of established measures of family func of data collection rather than the focus of analysis,
tioning to health care research. Unfortunately, despite developed a fairly extensive instrument known as the
considerable effort on the part of a number of family /Family Health Survey Questionnaire for use as part
sociologists to develop meaningful and appropriate of a health services data system. Among its purported
indicators [39.40], the measurement of family func advantages arc its relatively low costs due to the use
tion remains ill-defined and underdeveloped. To a of the telephone as a means of data collection; the
large extent, not only have such indices tended to provision of aggregate statistics useful fod^lcm-wide
be almost totally dependent on the use of proxy indi planning, management and evaluation: :Wvcll as the
cators with little or no independent or outside valida opportunity to obtain gross estimates of the need for
tion of their relation to reality [41]. but as Plcss and health services and their use. In addition, when pro
Sattcrwhilc [42] have noted, they have not adequately perly administered, the instrument may be used to
dealt with the multidimensional concept of family estimate not only the total volume of services con
function as a whole. Moreover, variables most di sumed by a population or its components, but the
rectly concerned with function may not necessarily discrepancy between the use of services (as measured
be identical with those related to health. Thus, while by the number of times a person visited a physician
extensive evaluation of the ability of such techniques or was hospitalized) and the need for services as indi
in the measurement of the interrelationship of family cated by disability days. As a matter of fact, a major
behavior and the etiology and cause of disability and focus of the instrument is the construction of just such
chronic illness has produced rather mixed results a discrepancy ratio.
[43], the various available measures of family soli
Unfortunately, however, a major shortcoming of
darity, cohesion, and integration have been found to the protocol, at least as far as family health research
be quite wanting in health care research, providing is concerned, is its over-reliance on the use of tele
neither the precision nor discriminatory power to phone sampling and only tangential focus on the
make adequate assessments [44,45].
family and family health per se.
HEALTH SURVEYS
Although still limited, a number of attempts have
been made over the course of the past few years to
improve the level of data collection in family health
research. One of the earliest efforts along these lines
was the New Haven Family Health Survey [46] con
HEALTH DIARIES
Another approach which seems to have overcome
some of the problems cited above in the acquisition
of socio-mcdical information on the family and its
health care is the health calendar or diary. Since their
Research on health care and the family
initial employment in studies in California
*
and
Canada, health calendars and/or diaries have been
used with considerable success in the study of family
health both in the United Stales and abroad. Roghmann et al. [4S], for example, in a sample survey
of 512 families residing in New York State (excluding
New York City) found such diaries provided an effi
cient and reliable instrument for recording a wide
range of family related health events. Similarly, the
use of such data collection procedures to gather medi
cal-social information about the families has been
reported in the Soviet Union [49].
Although admittedly subjective and susceptible to
imprecise description of events in non-medical terms.
such devices, Alpert et al. [50], have noted, have pro
vided not only a rich source of comprehensive health
information about the family not usually found in
medical records nor obtainable from patient recall.
but also documentation of the importance of many
non-medically attended symptoms including many
minor conditions and events in the evaluation of the
total health of the family unit that otherwise might
not have been brought to the attention of an inter
viewer. In addition, the sequence and clustering of
events over short time periods and their causal pro
cesses can be demonstrated, while the level of analysis
may be easily shifted from individual to the family
or community at large.
One of the earliest attempts to use the diary approach
in the study of health care was the 1949 California
Family Health Study which, as one of its main fea
tures. employed a specially designed Health Record
Booklet, kept by the family and supplemented by per
iodic monthly interviews [51.52]. Although intended
to be retained at home to record the family’s daily
health experiences, the booklets frequently were kept
at work by the study participants in fear that they
would forget to return them on the day of the fol
low-up interview. This resulted in some impairment
in the daily recording of the family’s health experi
ences. In addition, language difficulties, summer vaca
tions. fear of spoiling the booklet and indifference
tended to further deter complete record keeping. Des
pite such obstacles, however, the health booklet
proved to be not only an effective source of informa
tion. providing an extensive array of data on both
major and minor illnesses and routine health services.
but a meaningful approach to the study of family
health as well [53].
The day-to-day illness record or diary technique
was also successfully employed (primarily- as a
back-up reminder to the interview) in conjunction
with the Canadian Sickness Survey [54], No attempt.
however, was made to assess the relative merits of
the diary as an independent source of morbidity data
until 1952 and the California Department of Public
Health’s California * Morbidity Research Project
• The first systematic use of a health diary was probably
made in 1952 as pari of lhe San Jose Morbidity Survey.
In an effort to increase accuracy al minimal cost, an ela
borate.study was undertaken to compare lhe relative effec
tiveness of health diaries with household interviews. On
the whole, lhe relatively small increase in accuracy
obtained by the diaries did not appear to be justified by
lhe extra expenses incurred.
383
[55,56]. Using comparable subsamples of about 400
households, comprising some 1000 persons, the rela
tive merits of the diary vs the household interview
as a data collection technique were assessed over the
course of a threc-month period.
As expected, rather wide differences were found in
the rates of illness elicited by the two techniques, due
in large part to variations in the effects of memory
error. On the whole, almost twice as many episodes
of illness were reported in the diary as compared to
the interview. But while the diaries tended to generate
higher rates of illness for a calendar month than the
personal interviews, most of the variation was attri
buted to differences in the reporting of minor, un
attended, disabling, and nondisabling illnesses. More
over. although there was little evidence that the diary
elicited more complete reporting for one age-sex
group than another, the diary appeared to offer the
least advantage over the interview in obtaining infor
mation on the elderly.
On the other hand, the additional information
secured through the use of the diary was found to
be somewhat offset by its relatively higher cost (i.e.
initial placement plus follow-up assistance in diary
maintenance and return), its susceptibility to editing
and coding problems due to illegibility, respondent
misunderstanding and confusion over what was to be
entered, and the provision of insufficient information
to permit adequate classification.
Furthermore, while health calendars have generally
proven to be fairly efficient and reliable in recording
such everyday events as doctors’ visits, medication
usage, etc., they have not nearly been as successful
in assessing relatively rare events such as hospitaliza
tions or major life crises such as deaths in the family.
Such devices, moreover, have been found to be par
ticularly susceptible to the problem of sample attri
tion due to employment turnover and/or residential
mobility. For example, in the original California
study, in addition to a decline in record keeping over
the. course of the fivc-month study period, there was
also a sample loss of approximately 38% [57.58] as
well. Similarly. Kosa et al. [59] found that main
tenance of a health calendar over a period of six
months or more resulted in not only a loss of subjects
due to residential mobility but also an increase in
incomplete recording. For instance, health calendars
kept for four weeks were found to contain, on the
average, reports of twice as many symptoms per
family as those kept for six months. Those kept for
shorter durations, on the other hand, were more likely
to reflect symptoms of seasonal variation than those
kept for longer periods of time. Interestingly. Roghmann and Haggerty reported an increase in both re
spondent motivation and commitment to complete a
28-day calendar in return for a token payment (i.e.
10 dollars) for the time expended [60].
In addition to the problems of sample attrition.
high cost and high refusal rates, as well as insufficient
compliance with instructions, such self-initiated and
maintained reports are also subject to less reliable
classification of medical symptoms, diagnoses and
therapeutic interventions than that obtained through
the probing of a trained interviewer. Nevertheless, in
many cases these disadvantages may be more than
offset by the high yield of health data such as infor-
3S4
Research on health care and the family
Theodor J. Luman and Maureen Venters
niation on unattended and minor symptoms and
events, use of self-medications and home remedies,
how people perceive illness and present the symptoms
to their physician, as well as the sequence and cluster
ing of events over short periods of time not available
through other sources.
Yet despite their relatively higher yield (twice as
many episodes reported as compared with the inter
view) Kosa et al. [61] found that health calendars
proved to be no better a comprehensive nor reliable
indicator of the health of the family unit than either
a utilization questionnaire or a child health index.
Moreover, the health calendar appeared to be subject
to the same normative influences, as to what is
deemed to be important enough to be recorded and
what is not, as the interview. Some mothers, for in
stance, tended to exert a degree of censorship over
what was recorded, detailing only those symptoms
that met certain minimal requirements of severity and
duration. The latter, in turn, tended to vary with the
season.
In view of the various problems cited above, Hag
gerty [62] has suggested that health calendars and/or
diaries might be best utilized in conjunction with
other data collection techniques such as the home
interview and/or questionnaires. The former, it is
argued, lend themselves not only to easy recording
of events over time for the computation of descriptive
personal and family characteristics, and to the detec
tion of the clustering oftillness and visits within fami
lies. but also to the provision of time-series data for
the study of short-term family processes which, when
combined with interview data, hold promise of
greater thcorcliczil return for morbidity and utiliza
tion surveys.
SUMMARY AND CONCLUSIONS
While exploration into the area of family health
has involved a variety of techniques and designs and
has produced a number of promising insights as to
the role of the family and its members in time of
illness, much more remains to be done, including:
of family members in the care and treatment of insti
tutionalized patients.
(7) A phased program of study to help determine
and in what way, if any, certain structural and func
tional family characteristics may be related to health,
illness, accident and disease.
(8) Finally, there is need for more extensive longi
tudinal and intergenerational studies of the family in
health and health care, including the use of: (a) a
variety of data collection procedures; (b) different
types of family units of (c) varying cultural and class
characteristics.
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4/1 Bz2015
Chattisgarh Sterilisation Deaths - Survivors being harassed by State Government #Vaw | Kractivism
Vjh - I "S..
Chattisgarh Sterilisation
Deaths - Survivors being
harassed by State
Government #Vaw
Posted by : kamayani On : April 17, 2015
Category: Advocacy, Announcements, Human
Rights, Justice,Kractivism, Law, Minority Rights, Violence
against Women
* Justice delayed, denied
Author(s): Jyotsna Singh
Apr 30, 2015
Five months after 14 women died in sterilisation camps
inChhattisqarh, there is no sign of justice being delivered
to those who lost their kin. Rather, they are being
harassed for standing up for the truth
Women, who underwent sterilisation surgeries at a
government mass sterilisation camp, had to be admitted
to the Chhattisgarh Institute of Medical Sciences hospital
in Bilaspur for treatment (Photo: Reuters)
On november 10, news of 13 women dying and many
others landing in hospital after mass sterilisations in
Chhattisgarh made national and international headlines.
Subsequent investigations, including by Down
To Earth ("Operation Cover-Up", 16-31 December, 2014),
exposed state attempts to cover up the entire incident as
well as deep flaws in India's approach to family planning.
Five months on, no justice seems to have been done. In
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fact, evidence points to the state government being responsible for the
deaths.
The state government has repeatedly tried to shift the responsibility of
deaths and illness among survivors to non-state agencies, saying that the
drugs were contaminated with rat poison. But reports of the State Forensic
Laboratory, Raipur, show that the deaths were not caused by rat poison.
Viscera analyses of five of the 13 women who lost their lives at the
sterilisation camp did not find poison in the body of the deceased, says a
source who has a copy of the reports.
"Viscera report is the final word in forensic science in investigations of
deaths. The State Forensic Laboratory reports suggest the deaths have not
occurred due to any poison, let alone rat poison,'' says B L Chaudhary,
forensic expert at Lady Hardinqe Medical College, Delhi. All postmortem
reports suggest that the deaths occurred due to infection, caused by
unhygienic conditions and medical practices at the camp, he adds.
Test results of drugs used at the camp— Ciprocin 500 (contains antibiotic
ciprofloxacin) by Mahawar Paharma and Ibuprofen 400 mg (contains anti
inflammatory ibuprofen) by Technical Labs and Pharma—further expose the
callous attitude of the state government.
Soon after the incident, drug samples from the spot were sent to four
laboratories-government and private-to determine cause of deaths and
illness. The list includes the Central Drugs Laboratory (CDL), Kolkata, the
National Institute of Immunology, Delhi, Sriram Institute of Industrial
Research (SIIR), Delhi, and Qualichem Laboratories, Nagpur. All four
laboratories' reports, which are with Down To Earth, state that the medicines
used in the operations were substandard. "A tablet is defined as substandard
when it contains less than 80 per cent of what is claimed," explains an official
with the Central Drugs Standard Control Organisation (CDSCO), Delhi. Two
reports indicate toxicity.
SIIR tested 50 tablets of Ciprocin 500. The results showed that each tablet
contained only 295 mg, or 59 per cent, of ciprofloxacin. It also indicated
toxicity. Four of the five mice who were administered with the tablets died
within 24 hours. The laboratory conducted an additional test which showed
the presence of "zinc/aluminum and phosphide" or rat poison. Its report,
however, does not mention the amount, crucial to determine whether the
deaths happened due to rat poison. SIIR's test on Ibuprofane also shows that
the tablets were substandard, with 219 mg of ibuprofane, and contaminated
with rat poison.
Similarly, the report by the National Institute of Immunology, Delhi, shows
that after administering very high dose of Ciprocin 500 (500 mg/rat) the
animal
4/18/2015
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Chattisgarh Sterilisation Deaths - Survivors being harassed by State Government #Vaw | Kractivism
suffered from acute toxic shock and died. The same dose
of anotherstandard medicine Ciplox by company Cipla, did
not affect the rat adversely. A public health expert, on
condition of anonymity, says such high doses can be fatal
for animals. He points out that the women at camp did not
consume such high doses. "Amount is the key to the
mystery of deaths and illnesses," he says.
The report by Qualichem Laboratories established that the
medicines were substandard. It is silent on contamination.
The CDL report also shows that Ciprocin 500 contained
only 258.88 mg, or 51.78 per cent,of ciprofloxacin
claimed. CDL'sreport, however, does not mention
contamination with rat poison. "The Kolkata laboratory is
not even equipped to test for contamination of zinc
phosphide, or rat poison," says the CDSCO official. Why
did the state administration send samples to a laboratory
that cannot test for the probable cause of deaths espoused
by the state itself?
Lack of seriousness
The CDL report points to the lousiness of the Bilaspur Food
and Drug Administration, which had handed over samples
to the laboratory. While CDL received 200 tablets (10x20
strips), the official communication put the count as 1,000
(1000xlx500mg). CDL report also claims that the expiry
date of September 2016 mentioned on the strip did not
match with the expiry date of September 2015 mentioned
in the official communication. "Even though these details
do not affect the test results, it shows that the authorities
were not serious about the issue," says Sulakshana Nandi
of People's Health Movement, who has been fighting for
the rights of the victims.
Responding to Down To Earth's queries, R Prasanna, who
0 heads Health Department in Chhattisgarh, said, "We
cannot reveal anything as the matter is pending before a
judicial commission."
State harassment
The only serious step taken by the state government so far
is to set up a one-person Bilaspur District Sterilisation
Camp Judicial Inquiry Commission headed by retired
judge Anita Jha. But deposing before the commission has
been an ordeal for victims and their families. They had to
travel long distances at their own expense. Ramanuj Sahu,
for instance, had to travel 50 km twice to submit affidavit
on behalf of his wife. The commission did issue letters
urging women to file affidavits, but that was on March 3,
2015, the last date of the submission. Of 134 cases, only
51 have submitted affidavits. Most of the victims could
submit affidavits only after receiving guidance from
the Centre for Social Justice, a non-profit in Bilaspur.
Gayatri Suman Narang, who heads the non-profit, says,
"The government did not put any effort in collecting
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affidavits. The room was found closed on several occasions." To add to their
troubles, the commission since March 27 has started to cross examine those
who deposed.
The affidavits outline the way surgeries proceeded on the two days of the
camps. In one affidavit, a woman recounts how she gave thumb print on a
paper, but the contents were not read out to her. In another affidavit,
husband of a deceased woman says that he has not received the postmortem
report of his wife despite asking for it several times. He says the surgeon
reached the venue only at 3.00 pm, leaving little time for proper sterilisation
of 83 women in one day.
Apart from the judicial commission, the police is investigating the matter
based on FIRs of the deaths. "The state government has also initiated a
departmental inquiry into the matter, but it is biased as all the members are
from the health department," says Yogesh Jain, convenor of non-profit Jan
Swasthya Sahyog. "This is the reason, we have been demanding a clinical
inquiry since January." A clinical inquiry is done by a team, that includes a
forensic expert, epidemiologist, gynaecologist, toxicologist, microbiologist,
public health expert and local activists, and is considered unbiased. "But the
state government is yet to set up one," he adds.
The courts have also intervened in the matter. The Chhattisgarh High Court
took suomotu cognizance of the matter and has asked the state government
to submit a response. A public interest petition filed by Human Rights Law
Network, Delhi, is pending in the Supreme Court. The apex court, on March
21, blamed the government for being unprepared in the matter. The next
date of hearing is April 17, 2015.
http://www.downtoearth.org.in/content/justice-delayed-denied
http://www.downtoearth.org.in/content/justice-delayed-denied
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