MEDICAL SERVICE VOL. 41 No. 3 MARCH-1984.pdf
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the ^economics of food safety • immunization : tunisia means business •
healthy mothers—healthy children • what a healthy child needs • mothers
first > message from d g of who S public interest litigation # under
standing diphtheria
vol 41
no 3
march 1984
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medical
service
official house journal
of the catholic
hospital association of India
"the love of Christ
urges us" 2 cor 5 :14
vol 41
no 3
editorial board
dr c m francis •
dr ravi narayan
dr prem chandran john
dr daleep mukarji
mr augustin veliyath
fr george lobo sj
prof george joseph
dr paul neelamkavil
fr edwin m j
editor
contents
1
editorial
2
the economics of food safety
lawrence d smith
3
immunization : tunisia means business
nedd willard
4
healthy mothers—healthy children
jitendra tuli
5
what a healthy child needs
prof michel manciaux
6
mothers first
mark a belsey
7
message from dr h mahles, director general of
the who for world health day 1984
8
public interest litigation
p d mathew
9
understanding diphtheria
2
fr john vattamattom svd
cover design
p m isaac bangalore
10 chai news and notes
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-11OOO1
printed at kalpana printing
house new delhi-110016
march 1984
5
10
15
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19
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25
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"Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"
EDITORIAL
The Easter joy
By the time this reaches you, you will be busy with preparation for the
big feast of Easter. The season of lent is a time of preparation, in prayer,
fasting and penance. Then comes the Joy of Easter I However, during this
Easter time let us reflect a little and see how far this joy is a reality to
millions of people in the world and particularly in our own country. Christ
came to this joy to all and not only to a few. But the situation in the world
today is so alarming that many a million cannot think of this joy. The
reason is because a few want extra joys and comforts at the cost of many.
Let us try to see this year's Easter in a new perspective. A true’ Easter
joy can come only through a true conversion of heart. Our fasting and
penance will have no meaning unless it is coming from the conversion of
hearts. Isaiah has this to say about fasting. "The truth is that at the time of
your fast you pursue your own interests and oppress your workers. Your
fasting makes you violent and you quarrel and fight. Do you think this kind
of fasting will make me listen to your prayers ? When you fast you make
yourselves suffer; you bow your heads low like a blade of grass, and spread
out sack cloth and ashes to lie on. Is that you call fasting ? Do you think
I will be pleased with that ? The kind of fasting I want is this, remove the
chains of oppression and the yoke of injustice and let the oppressed go
free. Share your food with the hungry and open your homes to the
homeless poor. Give clothes to those who have nothing to wear.......... *'
(Is. 58 : 3-7)
There is no ambiguity in these words to see what is expected of us.
This is all the more meaningful today when we see different kinds of
bondage and oppression in which millions of people in our country are
doomed. Guidelines were given regarding fast and abstinence, by the
CBCI during the last general body meeting. More could have definitely
be given along the lines what Isaiah has to say about true fasting. Con
crete steps need to be taken. True fasting cannot be restricted to lenten
season alone. This must be a life time commitment.
What is the type of fasting that we have to undertake in this country :
When millions of innocent children are killed before they could see the rays
of light ? When 33000 children below the age of 5 years die every day
in developing countries? When 17 millions of our children in India are
condemned to hard labour in inhuman conditions ? When hundreds of
thousands of children are condemned to work, sometimes even more than
12 hours a day in tea stalls, restaurants etc. to get a paltry sum of 2-3
rupees a day ? When 3 children die every minute in our country of diar
rhoea which could easily be prevented ?
When more than 300 million
people in our country alone will have to go to sleep every night with a
hungry stomach ? When millions of our brethern in this country has no
roof over their head except the wide sky ?
We could go on mentioning a few more. That is reality which we face
everyday. Against this reality we have to view our fasting and our Easter
joy. We can participate in the Easter joy only if we are prepared to be
disturbed at these realities, it sounds a litttle bit odd. But the extent of
sharing of the Easter joy by millions of our suffering and oppressed
brethern will depend on the extent of the willingness from the part of the
privilaged ones to be disturbed and to do something about it. Let this
Easter be an occasion for each one of us to have a real conversion of our
hearts and thereby to do something concretely to fight against injustice and
oppression wherever they are found especially if and when we oursleves
are responsible for injustice and oppression some times. That is the real
conversion of heart. That is true fasting and penance as Isaiah would have
it I And that will bring true Easter Joy for ourselves and for others.
EMPLOYMENT
WANTED A RESIDENTIAL DOCTOR FOR A NEWLY CONSTRUCTED
HOSPITAL in Tamil Nadu from June 1984 onwards. Interested doctors may
contact directly :
The Superior General
Presentation Convent
Coimbatore 641 001
Tel : 24780
SEMINAR CUM RETREAT FOR SISTER-DOCTORS
:
Theme
"Human and Spiritual Growth
Experience"
Through
Clinical
Amar Jyothi, Portiunculla Capuchin Ashram Kattappana 685 508, Idikki Dist, Kerala
Venue
Date
.
14th—21st May 1984
Course Director
:
Fr. Felix Podimattam OFM Cap.
Course Fee
:
Rs. 120/- (subsidised)
Eligibility
:
For sister doctors (only for those who did not attend
the former courses)
Language
:
English
Seats
:
30 only
Last date of registration
:
April 30, 1984
For application form etc. please write immediately to :
The Executive Director
Catholic Hospital Association of India
CBCI Centre, Goldakkhana
New Delhi 110 001
Tel : 310694/322064
The Economics of Food Safety
—Lawrence D Smith
Most people in developed countries asso
ciate food contamination with an occasional
"upset stomach" or with a still rarer major
outbreak of food poisoning, as occurred re
cently in Spain when hundreds were made
seriously ill by adulterated cooking oil. It is
seldom appreciated just how widespread
food contamination is in both developed and
developing countries, nor how tremendous
are the costs it imposes on society.
was a considerable financial loss to the ex
porters, many of them in developing count
ries; but had these foodstuffs been consumed
within the United States, the economic
consequences of the resulting food-borne
illnesses could have been even more severe.
No one has yet attempted a global es
timate of these costs, but the sums involved
are likely to be astronomical. The total bill
would have to include the value of crops and
animal products wasted or destroyed as a
result of contamination; the costs of controll
ing and treating the problem at source; the
cost of treating diseases induced by food
contamination; and the loss of output or
earnings resulting from illness, disability or
premature death as a result of consuming
contaminated food.
From the individual consumer's point of
view, it is important to distinguish between
the desire and the demand for safe food.
Most people, whether rich or poor, would
prefer to have safer food. This is a desire.
However by "demand" an economist means
the quantity of a food that a person is
willing, and has the money, to buy. To the
economist, food safety is just like any other
item or service which can be purchased for
money.
Such limited information as is available
gives some idea of the sums involved. A
WHO Report has estimated that in 1977, the
economic cost to the Federal Republic of
Germany attributable to salmonellosis in
humans and food animals was 240 million
Deutsche Marks or 4 Marks per head of the
population. Of course, salmonellosis was
not the only form of food contamination, nor
was it necessarily the most important.
In the three months from January to
March 1980, the United States Food and
Drug Administration rejected US$65 million
of imported food on safety grounds—and
this is one of the few governments which
publicaly records such figures. The result
March 1984
Food safety improvements
inevitably
involve costs. So one much debated question
is whether the individual consumer or the
government should pay for them.
Thus poor people in low-income countries
may desire safe food. But they may have a
low demand for it, because they have decided
that buying safe food, or buying the means
to obtain safe food, is unlikely to be- good
"Value for money".
At the lowest income levels, people may
prefer to spend any extra money on buying
more food of the same quality, rather than
less food of a higher quality, since their main
priority is to stem hunger. In many circums
tances it may be difficult to buy safe food
cheaply or in small quantities. In some
African countries, pasteurized milk can only
be purchased in very expensive cartons. Yet
a cheap carton would bring safe milk within
the reach of many more consumers.
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Some low-income people may think that
"safe" products are of little use if the rest of
the environment cannot be controlled. There
may seem to be little sense in buying a
hygienical ly prepared powdered food if the
water that has to be added to it is highly
polluted.
Finally, the very poorest members of
society, particularly in low-income countries,
may be almost indifferent to food safety,
because in the marginalised role they play in
society they remain completely ignorant of
the benefits associated with safe food.
Food safety, or rather its absence, is yet
another aspect of the poverty problem. As
incomes rise and educational levels improve,
so the desire for food safety is likely to
increase, and with it the demand. Highincome people spend a much lower propor
tion of their income on food than poor
people; consequently they can easily afford
to purchase higher quality and safer food
than poor people.
However, just because poor people cannot
afford to spend their own money on food
safety, governments should not ignore their
responsibilities in this area. Within their re
source limits, they should seek cost-effective
methods of improving food safety that are
suited to the economic, social and cultural
environment and to the food systems in
which food contamination occurs. Let us
look more closely at the three major food
systems.
Low-income rural food systems
In rural areas of low income countries,
where a large proportion of the world's
population lives, the food system tends to be
very simple. Most people grow their own
food or buy locally grown food. Only a few
essential items such as salt and spices origi
nate outside the area, and nearly all food is
prepared with in the home.
March 1984
One major food safety problem stems
from the inadequate drying and storage of
staple foodstuffs. This can lead to aflatoxin
contamination—the growth of a fungal mould
which is strongly suspected as a cause of
liver cancer. Poor practices of handling and
preparing food within the home represent
another problem. Fuel is becoming increas
*
ingly scarce in many rural areas (partly as a
result of deforestation) and may have com
promised some of the traditional cooking ’
practices which helped to maintain food
safety. There is considerable ignorance about
the cause of enteric and diarrhoeal diseases
and the extent to which these may be trans
mitted in foodstuffs, and about such matters
as personal hygiene and appropriate food
safety.
So those who live in the countryside have,
on the whole, to be taught food safety. This
is best done as an integral part of primary
health care programmes, and as a component
of agricultural and integrated rural develop
ment programmes. Traditional methods of
food preparation may need to be modified
to suit new circumstances, and research may
be required into more effective ways of dry
ing and storing foodstuffs.
Low-income urban areas
In the main cities, rhost foodstuffs now
have to be purchased. The food chain is
frequently long, and a complex, fragmented
food system develops which involves numer
ous intermediaries.
With rapid population growth, the volume
of business expands. The central wholesale
markets, vital for the orderly distribution of
large and fluctuating quantities of variable
quality produce, frequently become congest
ed and increasingly insanitary.
The retail distribution system consists of
a multitude of low-volume outlets—including
public markets, shops and itinerant street
7
vendors—which reflect the economic realities
of low-income city life. Consumers need
neighbourhood shops as they cannot afford
to travel far for shopping; retailers are poor
and can only finance a small volume of trade;
and retailing offers a minimal livelihood to
many people who cannot obtain employment
in the modern business sector. But, of
course, this extremely competitive structure,
with its low cost and minimal services, often
gives rise to poor standards of food hygiene.
This is especially true of street vendors who
prepare cooked foods. Large quantities of
food may be prepared several hours before
being consumed, and may then be held in
conditions which encourage rapid microbial
growth. Food processing is often carried out
by small firms operating in inadequate pre
mises.
Furthermore, the consumers themselves
often have to live in squalid conditions. Lack
of ready cash may oblige them to cook food
only once a day, and. to leave some of itin
the pots to be consumed later. In high am
bient temperatures this can rapidly become
contaminated.
How can food safety standards be impro
ved in these situations? Solutions which
ignore the economic realities and constraints
are unlikely to succeed. Banning street ven
dors or strictly limiting their numbers would
inflict considerable hardship on lower-income
people in general. Strict supervision of all
retailers is virtually impossible, given their
large numbers and itinerant habits. Medical
examinations of food handlers are costly and
do not guarantee the detection of more than
a small proportion of carriers of pathogens;
screening for pathogens in stool specimens
is not cost-effective.
Raising market fees in order to finance
sanitary or infrastructure improvements may
encourage traders to move their businesses
into the streets, thus only making the situa
8
tion worse. The higher fees would probably
be passed on to low-income consumers.
In such a situation, it seems sensible to
concentrate policing efforts on minimising the
likelihood of deliberate food adulteration and
the sale of obviously contaminated food. But
most resources should be devoted to health
education : educating food handlers to
appreciate the financial benefits they would
derive from minimising food losses as well as
showing them where their moral responsibili
ties lie, and educating consumers by incor
porating food safety as an integral part of
primary health care. At the same time, lowcost food processing and preparation techni
ques incorporating food safety need to be
developed and introduced. And these will
call for methods of financing improvements
to the infrastructure which do not put an
undue burden on low-income consumers.
High-income areas
fn many ways, the potential for achieving
food safety is greater in high-income areas
and countries. The food system is more
integrated, a high proportion of food being
retailed through supermarket chains. Most
foodstuffs are packaged, especially the pro
cessed products.
To operate successfully, supermarkets need
regular supplies of uniform products of
known quality. This requires close integra
tion or coordination with processors and
producers, and the institutibn of quality con
trols backed up by laboratory testing for
contaminants. Because both supermarkets
and processors tend to operate on a large
scale, they can afford the expenses involved
in quality control. Even on a voluntary basis,
a reasonably high degree of food safety
would probably be maintained in this part of
the food distribution system.
In developed countries, moreover, govern
ment and local authorities can afford the
Medical Service
finance and manpower to police the system
and consumers can afford to pay the costs
of inspection services. Indeed, by identifying
and monitoring the critical aspects of food
production and processing only, there could
probably be a reduction and redeployment of
public resources with a negligible impact on
food safety.
Given this situation, it might seem surpris
ing that food safety problems still remain a
serious problem in high income countries.
One problem is that with large-scale produc
tion and far-flung distribution, and break
down in quality control can have substan.
tial repercussions. Furthermore, food safety
frequently breaks down within the home;
many people forget, or are ignorant of, basic
food hygiene practices and re-education is a
recurrent need.
However, the major problem seems to
concern the catering trade, which is still
frequently fragmented. Most food contami
nation problems arise from inadequate cook
ing and food-holding practices. Substantially
more education and policing will therefore
be justified in this area, with much stiffer
penalties for food safety abuses.
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CASV-5W-I04
March 1984
Immunization: Tunisia Means Business
Nedd Willard
*
The landrover bounded over a large rut
and came to a stop in a small clearing in the
middle of the heavily wooded forest. The
driver sounded the horn.
Slowly, through the grove of oak trees,
people began appearing. Most were mothers
or grandmothers, carrying a child in their
arms, but some were children themselves
with small brothers or sisters clutched in
their grasp. They knew why the landrover
had come and, holding green "health pass
ports," they walked up to the vaccinators in
this wooded and mountainous part of Tuni
sia.
This quiet spot represented one of the
most remote links in the national expanded
programme on immunization (EPI). Tunisia's
programme was reaching more children all
the time. Moreover, the health workers had
iron-clad evidence that the vaccine they were
using was effective. Though a highly
developed country in many ways, Tunisia
still has a high rate of infant mortality and
must cope with infectious and parasitic dise
ases. Immunization, it was decided, offered
and excellent weapon, and often the only
one for fighting some diseases threatening
children. Therefore, in 1978, the Ministry
of Health made a momentous decision to
press ahead with a far-reaching immuniza
tion programme.
The role of WHO was modest but impor
tant. In 1979, the first Tunisian completed a
WHO training course in planning and mana
ging an immunization programme. Fourteen
other candidates followed and today the
Ministry of Health of Tunisia is fully able to
run its own training centres. By 1983, only
five years after the decision to strengthen the
immunization programme, Tunisia and WHO
are cooperating in a nation-wide review
which covers not only immunization but
other aspects of Tunisian primary health
care.
No more Mass Campaigns
Right from the beginning, tough goals
were set for the programme. The first was
to improve coverage to ensure that more
children were being vaccinated and fewer
overlooked. The next was to guarantee the
equality of the vaccine being used; and this
could only be done by setting up a "cold
chain". A cold chain is a system that ensures,
the potency of the vaccine by seeing that it
is kept at the correct, low, temperature from
the time it leaves the manufacturer until it
reaches the child. This system is under
constant surveillance.
A major strategic change was made
when the programme of immunization was
integrated into the routine activities of the
health care system, abandoning the mass
campaign approach of earlier years. Fitting
closely into the other services offered by the
general health care system, immunization
became a standard procedure rather than an
exceptional measure employed from time to
time.
A unique characteristic of the programme
was that it was constantly and carefully
evaluated as it went along, everywhere and
on every level.
• Information Officer in Charge of World Health Day, WHO Headquarters, Geneva.
10
Medical Service
Since 1982, almost every child born in
Tunisia has been registered with the local
authorities and presented with a green
"health passport". The passport has space
for information about the family, about the
weight and growth of the child and the
immunization received. Every visit to a
maternal or child health centre, a general
dispensary or district hospital offers health
workers a chance to check the book and give
needed immunizations on the spot.
Some populations are too remote even
to reach peripheral health services on a
regular basis. To make sure their children
are immunized, an ingenious system has
been worked out. Health authorities discuss
the situation with local village leaders who
indicate when would be the best time for
mobile health workers to visit their village.
Sometimes they indicate a "meeting point"
like the one in the forest. When the time
comes, parents and older children bring those
needing immunization and the job is done
on the spot. And the system works.
Nothing is perfect. However, in the case
of immunizations that require multiple doses,
the attendance of children drops at each
successive immunization. Also, there are
rarely more than the basic facts about immu
nization recorded in the "health passports
*'.
Too often, for example, the growth charts
remain as blank as. when they were issued.
This may be due to a lack of scales, or time
or simply to the fact that vaccinators are not
aware of how important this information
is.
Many mothers understand the importance
of immunization. But many others do not.
In some cases, it seems that the reason
parents bring their children to be immunized
is that they know that their children will
need the "health passport", with its record
of immunization, as an admission card to
primary school. More education is needed
March 1984
but, in spite of these shortcomings, the fact
remains that almost all of the newborn
children in Tunisia are being reached and
immunized; this is a remarkable achieve
ment.
Finding the Facts
One thing that strikes an observer is the
determined efforts of all the staff of the
Ministry of Health and the immunization
programme to find out how things are going
in the field. They are willing to face facts
and constantly try to improve weak links.
The cold chain, which ensures that vaccine
is still potent when given to children—some
thing still far too rare in most developing
countries—is a key to success. As early as
November 1981, working in collaboration
with WHO's EPI programme, it was decided
to run a nation-wide check to find out if
things were working out in practice. More
over, if the vaccine was being kept cold from
the moment it arrived from the manufacturer
until it reached the children, it would be a
sure sign that there was good organization
all along the line.
Means to evaluate the cold chain were
kept simple. A small card called a cold chain
monitor travelled with the vaccine as it went
along the cold chain. Any exposure to
temperature above 10°C or 38°F caused the
widow on the monitor to turn irreversible
blue, going from left to right the farther right
spread, the higher temperature the blue
stain it recorded.
At each link in the cold chain, at a dis
pensary for example, the location, tempera
ture and date were recorded on the monitor
card so that, at the end of the line, the
vaccinator had a complete history of the
temperature exposure and could decide whe
ther or not to use the vaccine. Then, the
cards were returned to the Ministry for a
country-wide analysis.
11
Staff were quickly trained to use the
monitors. Tunisia, with a population of
approximately 6,750,000 people has 700
immunization sites. During the study, which
lasted seven months, 863 cold chain
monitors were distributed.
Amazing success
Ninety-six per cent of the monitors that
were returned had a complete time and
temperature history from the moment they
left the vaccine manufacturer until they
reached the immunization sites. Results
were amazingly good. It was found that
24 per cent of the monitors reached their
destination with no break in the cold chain;
the temperature stayed below 10° C during
the whole period.
When the temperature in the cold chain
exceeds 10°C for a period of one hour to
eight days, the most heat-sensitive vaccine,
poliomyelitis, must be employed within three
months. This does not present any real
problem, even for polio, and 74 per cent of
the monitors reached their destination with
no more than this exposure.
Where the temperature has been allowed
to go over 10°C for 8-14 days, the polio
vaccine should be tested before using and
the other vaccines used up within the next
3 months. Only 2 per cent of the monitors
showed exposure to this extent. Finally,
no monitor was shown to have been ex
posed above 38°C which would have pro
bably rendered the vaccines useless.
Thus the cold chain was working, from
the airport, or the factory, along the road, all
the way to the most distant regions. Some
regions were doing better than others and
the cards proved to be a sensitive indicator
of this.
Surprisingly, instead of resisting the
"silent monitors", most members of the
12
programme welcome them. It was planned
to use them again with some modifications.
They would be simplified, making them
cheaper by half, and made more sensitive to
the duration of the temperature exposure.
The strongest benefit of the cold chain
monitors was not to collect data for the
central office but to allow mid-level person
nel to carry out self-evaluation and to
improve the standards of vaccine care on the
spot. And, as part of a team with a high
morale, they welcomed the opportunity.
The score-card so far
Although the first goal for covering the
child population was 50 per cent, the pro
gramme has already gone beyond that. By
1979, over 80 per cent of the children in
Tunisia had received BCG, and 60 per cent
had received the full series of both DPT
(diphtheria, pertussis and tetanus) and polio
immunizations.
Even though it is too early to be able to
show concrete results, first signs are that the
immunization programme is already making
an impact in mortality and morbidity. Diph
theria is being beaten back. The number
of cases in 1971 was 49, by 1981 the
number had dropped to 4 and in 1982 there
were only two reported cases in all of
Tunisia. Pertussis (whooping cough) is
becoming rare as a result of childhood im
munization.
Tetanus continues to be a serious prob
lem. Almost half of the cases occur among
the new-born. The total number of tetanus
cases has declined since 1971, when it was
43, to 27 in 1981.
Polio received tragic national prominence
in a widespread outbieak in 1962 that was
only stepped by a mass campaign. Since
then, in spite of fluctuation, there continues
Medical Service
to be a downward trend. In 1976, there
were 12 cases of poliomyelitis. In 1982,
there were only six cases and coverage of
infants is increasing as part of regular pri
mary health care. Most cases of polio are
reported from children under two and that
is where a major effort is being made.
Measles was another disease that had an
epidemic flare-up as recently as 1981. It
presents a serious threat in Tunisia because
of the high rate of complication and the
frequent risk of death. The most dangerous
years are two to six and there is also high
risk from nine months to two years. There
fore, Tunisia is going to extend its proecttion of children with immunization against
measles.
Glowing results don't mean that there
aren't any problems. There are problem
areas connected with BCG vaccination which
does not seem to offer as complete a protec
tion as was once assumed. Also, cases of
polio still occur in children that have been
vaccinated. Research is going on to discover
where methods or vaccines could be
improved.
What does it cost ?
Health cannot be measured in terms of
money but money is a question that must
March 1984
be dealt with when weighing and compar
ing programmes. There is only a limited
amount to be spent, especially in developing
countries. Where should it best be spent ?
The Ministry of Health drew up a careful
accounting to find out what the EPI really
costs. Among the expenses are transport,
including fuel, upkeep, salaries, and price of
va ccine. The conclusion was that the basic
cost to immunize a child against the major
diseases—TB, diphtheria, tetanus and per
tussis, polio and measles—came out to be
less than USS 3. Surely a price worth
paying'!
Tunisia is a country that has a variety of
micro climates and scenery open steppes
rugged coastlines, large beaches and wood
ed mountains. The infant mortality rate is
still too high, but it is banking on public
and preventive health. The country has
now four medical schools, 19 paramedical
schools and 30000 health workers.
One thing is sure. Wherever you go in
Tunisia, whichever dispensary you visit, you
will find a clean, well-running fridge, stocked
with potent vaccines. There is a constant
flow of information and assistance going
back and forth from the periphery to the
centre. An important investment is being
made to ensure the most essential resource
a nation has...its healthy children.
13
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Healthy Mothers—Healthy Children
Jitendra Tuli
*
Built as a pleasure palace by a nobleman
over 150 years ago, the beautiful "Chatri"
still bustles with activity, but of a different
kind. In the red sandstone courtyard, a
mother carefully feeds her infant daughter
spoonfuls of oral rehydration solution inside
the ornate hall, where once the sounds
of music and ankle-bells filled the air. anot
her infant loudly wails in protest as he is
weighed. In another corner, a health educa
tor patiently explains the nutritional value of
green leafy vegetables to a young, pregnant
woman.
This is an everyday scene at the Rural
Health Centre in Ballabhgarh, about 45
kilometres from Delhi. Run by the Centre
for Community Medicine of the All India
Institute of Medical Sciences, the facility
caters to a population of 108 000 spread
over 100 villages in the State of Haryana.
Over the years, the Centre had expanded
and now has a small referral hospital attac
hed to it. "Apart from providing the sort of
services available at other health centres,
we are concentrating on the high-risk
pregnant women'', says Dr L.M. Nath, Pro
fessor and Head of the Centre for Community
Medicine, who on one of his periodic visits.
"Every Wednesday, we hold a clinic exclusi
vely for such women", he added. During
the week, the health educator and other staff
at the Centre use the opportunity of the
mothers' visit to explain other behavioural
factors that can ensure a healtheir life for
them and their children. This reinforces the
efforts put in by the health worker in the
village, who continues to be the first level of
contact for those in need of health care in
rural areas.
Infant mortality down
The success of this approach can be seen
in the fact that the maternal mortality rate in
the area served by the centre is less than one
per 1000; this is striking when compared to
the national average of over six per 1000.
As for the infant mortality rate, it is 58 per
1000 which is close to the target of 50 per
1000 to be achieved by the year 2000. And
there are even more ambitious goals ahead.
What is stressed repeatedly at this
Centre, and others like it throughout the
country, and the Region, is that only if
mothers are healthy can you have healthy
infants. Everyone is well aware that the
health of women generally, and especially
those about to be mothers, is crucial to the
birth and development of healthy children. In
several studies conducted in the Region, it
has been seen that the most important cause
of premature and low birth-weight deliveries
is the poor state of the mother's health.
Usually, the contributing factors were malnourishment and infections, including malaria
or other parasitic diseases.
These, therefore, are the areas that are
tackled first. In other primary health centres
some novel approaches to involve the
community are being tried out. For instance,
in a small village about 60 kilometres from
Gwalior city in Madhya Pradesh, Central
India, mothers-in-law clubs have been esta
blished where they are motivated to see
to it that their daughters-in-law eat the right
kind of food. Accrding to Dr Leela Phatak,
Director of the Birla Institute of Medical
Research in Gwalior, which runs four health
sub-centres in the lural areas, "the idea was
• Information Officer for the WHO South-East Asia Regional Office in New Delhi.
March 1984
15
to involve a very influential segment of the
population in helping improve the mothers'
health". It is well known that mothers-inlaw wield considerable influence in the
household, '‘so we thought it would be
ideal to have them as health educators". The
approach is working, and slowly a change
can be discovered in some of the attitudes of
these women towards eating habits, super
stition and spacing of pregnancies.
Mothers' health essential
Dr Nath, however, is quick to point out
that the success achieved in their programme
should not be seen only as a success of
health services intervention. "It is much
more than that. In fact, it underscores what
is now being increasingly recognized the
world over, that health development, to be
successful has to be a multi-sectoral effort.
Thus we see that health centres which are
adequately staffed and equipped are most
effective when there is provision for electri
city, water and education". As for material
resources, it is interesting to note that effe
ctive health care is provided at their health
centre for only Rs. 1 (or 10 US Cents) per
head.
The crux of effective care, says Dr Nath,
is time. "We make it a point to answer any
questions the visitor, specially mothers or
pregnant women may have. It is not just a
case of filling out forms and maintaining
records. We know that we are dealing with
rural folk who just do not have much time.
That is why, if a woman brings her child
here and later misses out on a further dose
of polio vaccine or other immunization, we
follow-up at home".
This approach is working and the mess
age is getting across to the people at last
that a healthy child and a healthy mother go
together. You cannot have one without the
other.
Courtesy: WHO
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16
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Medical Service
What a Healthy Child Needs
Professor Michel Manciaux
*
Development is the leading characteristic
of the child, who is a growing and cons
tantly changing individual. But the child is
more than just "the young of mankind," he
or she is a person right now, who lives the
present moment truly and intensively. "His
name is today", as the Chilean poetess
Gabriella Mistral put it so well. To meet
essential needs of children, day by day, is to
ensure their growth and harmonious develop
ment and therefore to prepare them for the
future.
The development of the child also means
health : there can be no satisfactory growth
or development if the child's health is chroni
cally impaired, for example by malnutrition.
People often ‘look for "indicators," positive
indices for describing and measuring health.
In childhood they are readily available :
measurements of weight and height gain ;
the acquisition at given ages of different sen
sory, motor and mental capabilities, are so
many milestones along the road to develop
ment, and also indicators of good health at
both the individual and community levels.
Sometimes
the
sequence
"needs,
demands, response" is used to study health
problems. This is hardly suitable for the
child, who is not accustomed to formulating
requests, at any rate in the terms familar to
us. It is up to the adults, particularly those
in charge of children, to know their needs
and the most appropriate way of responding
to them.
It is customary to divide the basic needs
of every human being into physical, biological
and psychological needs. Such a distinction
is practical but somewhat artificial : breast
feeding, for example, is beneficial, not only
because the mother's milk is perfectly adap
ted to the nutritional needs of the.infant, but
also because it strengthens the bonds of
affection between child and mother and leads
to highly-, rewarding exchanges, "inter
actions," which are difficult to replace.
The need for life
It is the physical needs which are easiest
to understand, if not to meet. They essen
tially relate to shelter, food and clothing.
Elementary as they are, they are far from
being met for all the world's inhabitants at
all ages of life. Children are often the first
victims of natural catastrophes and also of
the man-made disasters we call famine, con
flicts between adults, and wars. .The child's
first need is truly the need for life, for the
survival which is essential not only for the
continuation of the species but also for the
development of family planning programmes,
which are acceptable to parents only when
they are convinced that the children already
born have good chances of survival. The
modern world sometimes seems to forget
this need—the most important of all—to
judge by the 12 million children who die
each year before their birthday : yet is would
take very little to save most of them.
As to the psychological and social needs,
they have been the subject of many studies
and a variety of observations in the last 20
years. In order to develop to the full.
• Professor of Public Health and Social Medicine at the Faculty of Medicine, Nancy, France.
March 1984
17
children need love and security, new ex
periences, encouragement and stimulation
and, very early in life, responsibilities they
can cope with. There is nothing new in all
this, and the countless generations which
went before us managed to find out what
was good for the young of mankind. But
the social upheavals of recent decades have
in all countries overturned the traditions
deprived from human experience. So it is
just as well to remind parents, educators,
helath professionals dealing with children,
and the decision-makers of what is good for
the overall health of children, for their happy
development in today's world. Through
observation and a detailed analysis of new
situations, both in the industrialized countries
and in the developing world, novel methods
must be devised for meeting these needs in
new and changing contexts.
A good example is provided by the early
socialization of the child. In many countries
more and more children are being entrusted
earlier than ever, and for longer periods than
ever, to institutions which look after them and
educate them. Instead of shaking our heads
at this state of affairs, which is no doubt
irreversible anyway, would it not be better to
try to derive from it the greatest benefit for
the child, by providing adequate training for
those in charge of him and, above all, by
18
creating educational cohesion between the
natural family and these child-care structu
res ? This is easier when the community
itself—village, neighbourhood, group of
families—helps to set up and run these insti
tutions. The parents do not feel strangers
there and are less tempted to abdicate their
responsibilities to the professionals who they
think, wrongly in most cases, know better
than they do what is best for their child.
One last word about the world we live
in. It offers its inhabitants many opportuni
ties and at the same time many risks. The
first and foremost beneficiaries of everything
we can do to increase the opportunities—of
socioeconomic and cultural development,
health, peace—and to reduce the risks—of
pollution, poverty, ignorance, disease and
war—will be the children of today and
tomorrow. The needs of the world's children
are not merely a list of requirements which
we have to try to meet in order to guarantee
them the best chance of optimum develop
ment : they are rights which the United
Nations formally recognized in 1959 and
which have been ratified by all countries of
the world. It remains to put them into prac
tice, and that is by no^means the easiest of
tasks : but the future of the world depends
upon it.
Courtesy : WHO
Medical Service
Mothers First
Mark A. Belsey
*
The birth of a child represents considera and by delaying a young woman's first pre
ble investment—of love, of energy and of gnancy until she is physically and socially
expectations by the parents and by society mature enough to cope with it.
Breast-feeding is one of the simplest and
as a whole. The death, disablement or cur
tained potential of an infant taxes the current safest ways of ensuring adequate spacing of
generation and denies future resources to births. Unfortunately, it is on the wane in
the community. The deaths every year of many places which means that there is a
need to use such techniques as the pill
17 million children under five are tragic,
(hormonal contraceptives), IUDs and barrier
especially as almost all of these deaths are
methods for longer periods of time. The
preventable. However, the human loss is
even larger than that. Worse in many ways consequences of this decline in breast-feed
ing could be dramatic. For example, if the
is the aftermath of survival on weakend
children who may be stunted or live in blind duration of breast-feeding in Bangledesh
were to decline from the current average of
ness : such children may drag out painful
lives crippled by polio or be mentally retar thirty months to less than six months, as is
already happening in many urban areas of
ded because of a poorly managed delivery.
It is our most urgent task to limit this suffer Latin America, then the use of other contra
ceptive methods would have to increase from
ing and death and, given the determination,
9 per cent, as it is at present, to 52 per cent
we have the means at hand to do so. Health
care systems, as they are now run, too often just to maintain the current fertility pattern.
fail to meet the needs of mothers and child A newborn's legacy
ren, the most vulnerable group in every
A newborn's weight when it is born is a
society.
legacy for health in infancy and childhood.
Until recently, before the dawn of the
It may provide a boost; or it may be handi
concept of primary health care, the usual
cap which can exten'd for years and represent
response of health authorities to the stagger
a threat to the infant's health. Where low
ing problems mentioned above has been to
birth, weight is common, affecting up to 20
demand more resources, to equip more hos or even 30 per cent of the newborn, as many
pitals with more advanced technology, and
as one-third of such infants die soon after
to train still more doctors and nurses. There birth and another one-third may perish during
was a growing feeling of dependency in the
infancy. This is a result of their increased
society, a feeling of helplessness that looked
vulnerability to infection and malnutrition.
to physicians and high technology as the only
Even one-third of those tiny infants who
ways to deal with the problems of childbirth
manage to make it to childhood have less
and infancy. Today, there has been a shift capacity for attaining full growth and deve
in approach towards primary health care, and
lopment. Life for the low-birth-weight infant
mothers and children will be the first to bene begins with a serious handicap.
fit from it.
Therefore, families and society should see
Action to promote and protect children that each child has a fair legacy by ensuring
begins even before pregnancy, for example that women receive sufficient and varied
by such measures as wide spacing of births,
food during pregnancy. They should be
with intervals of two to three years at least,
allowed rest and not forced to do heavy
• Chief of the Unit of Maternal and Child Health, WHO Head Quarters, Geneva.
March 1984
19
physical labour. Finally, conditions such as
anaemia, still all too common among preg
nant women in developing countries, should
be prevented or treated.
a small bar of soap, and by stressing the
need for cleanliness, tetanus of the newborn
and sepsis could be reduced by as much as
95 per cent.
• "Modern" hospital practices developed in
highly industrialized societies often owe more
to the convenience of doctors than they do
to sound scientific data. Many traditional
practices are now being rediscovered as
technically sound. For example, delivery in
a squatting position, still common in many
countries, allows, for an easier delivery with
less risk to both mother and infant, than the
supposedly "modern" way, with the mother
lying on her back.
Immunizing all women of reproductive
age against tetanus would make this disease
as much of a rarity in developing countries as
it is in developed ones.
Dangerous traditional practices
Delaying the first feeding of an infant, and
separating it from the mother after delivery, is
another dangerous practice that has crept
into many countries. On the contrary, putting
the infact to the mother's breast immediately
after birth helps to contract the mother's
uterus and control bleeding. Breast milk
itself contains protective substances and
antibodies that protect the infant against
germs that are present in the environment.
Keeping the infant with the mother also
allows the infant to build protection to germs
in the hospital environment. Therefore, plac
ing newborns in the supposedly safe, hygie
nic environment of a separate nursery may
actually be placing them at greater risk to a
variety of germs which are increasingly pre
valent in hospitals.
But this is not to say that all traditional
practices are good or even safe. One-half
to one million infants die each year of
tetanus as a direct consequence of the way
in which the umbilical cord is cut and treated.
By providing the traditional birth attendant
with a simplified kit, consisting of a razor
blade, two cord ties, clean gauze squares and
20
Sharing responsibility
Supported by the health systems with
information and appropiate technologies,
families, and this includes the fathers, can
share much of the responsibility for seeing
that a child is growing up correctly. The use
of rehydrating salts for home-based therapy
can make a dramatic impact on the mortality
from diarrhoeal diseases, in the case of
fever, a child’s mother is usually in the best
position to decide whether it is serious
enough to require the advice and treatment
of a health worker or can be managed at
home with sponging and making sure that the
child gets enough food and fluid. Parents
should know how important it is to keep
feeding children during illness because this
prevents the onset of malnutrition which so
frequently follows bouts of acute diarrhoea
or respiratory disease in children. Severe
cases of malnutrition can lead to blindness.
Monitoring the growth of children by
using a simple chart enables parents and
health workers to spot inadequate growth
and take action. The failure of a breast-red
infant under six months to gain enough
weight, for example, can often be traced to
the use of supplementary foods that are con
taminated and cause diarrhoea. The failure
to gain weight after six months may be due
to constant infections and the parents' belief
that they should stop feeding the child during
illness. It may also be the result of not be
ginning to start supplementary feeding soon
Medical Service
enough. It may be neeessary for health
workers to decide the cause but, when used
by parents, the growth chart can act as a
warning signal.
It is vital to stress that the full responsi
bility for dealing with mother and child health
does not rest with families alone. Individual
can do just so much but their efforts must be
helped through the provision of adequate
Immunization against diphtheria, pertussis,
health care available on all levels. This
tetanus, poliomyelities, measles and tuber
includes being able to supply the essential
culosis can provide a strong shield to protect
drugs that are needed to preserve health and
infants and children. These diseases are prevent death. Moreover, on a larger scale,
kijlers in their own right but, even when they the environment, which is the responsibility of
do not prove to be fatal, they undermine a those at all levels, should be modified in
child's health, making it more liable to death or such a way as to make it an ally of health
disability from respiratory diseases and mal
rather than an enemy. The most striking ex
nutrition. Prevention of these diseases by ample of this is the provision of safe water
vaccination is a simple and relatively cheap to replace the present insufficient water
technique, but it requires good organisation supplies which are the causes of so much
to ensure that enough children are protected
illness and death in developing countries
and that the vaccine used is effective by around the world.
being kept at the right temperature from the
time it leaves the laboratory. Equally impor
The foundation of adult health is laid
tant is convincing mothers of the necessity
down in childhood and adolescence. The
for bringing their children in for vaccination.
foundation of child health is laid down during
the
period of pregnancy and soon after birth.
The health of ' children today is the
Damage incurred during or after childbirth
measure of quality of the next generation. It
requires a serious investment now, by the may handicap a child for life in many ways.
mother, the family and the health profes Therefore it is up to mothers and fathers, as
sionals of this generation. All have a role to well as health systems using the primary
play, and mothers and children will profit best health care approach, to ensure a fairer
if they form an integral part of the web of chance for every child who is born.
health promotion measure that include every
one in society.
Courtesy: WHO
Children are not born by chance. There is always a moment of choice-and
the choice is never in the child's own hands. It is adults who decide and it
is culture, and sometimes economic insecurity, that influences their decisions.
Fear also plays its part—fear that some of the children born will die before
they grow up, fear that there will be no one to add to the family's meagre
earning power. But if parents really do their best to care for their first—and
wanted—child, why should the child die? Health services are improving; and
people must use them. But parents can do a lot to protect their children.
And if this gives each newborn baby a better chance of survival, does it
make sense for so many babies to be born? It is a cruel insurance against
preventable loss.
March 1984
21
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Message from Dr. H. Mahler Director-General of the
World Health Organization for
WORLD HEALTH DAY, 1984
Children's Health—Tomorrow's Wealth
The theme affords an occasion to convey
to a worldwide audience the message that
children are a priceless resource, and that
any nation which neglects them would
do so at its peril. World Health Day 1984
thus sportlights the basic truth that we must
all safeguard the healthy minds and bodies
of the world's children, not only as a key
factor in attaining health for all by the year
2000, but also as a major part of each
nation's health in the twenty-first century.
The investment in child health .is a direct
entry point to improved social development,
productivity and better quality of life. Since
men and women themselves are not only the
object, but the most important resource and
subject of socio-economic development, the
focus on child health is a developmental
issue at all times and for all countries; thus
children's health is tomorrow's wealth.
Care for the child's health starts even
before conception, through postponement of
first pregnancy until the mother herself has
reached full physical maturity, and through
spacing of births. It continues from coception on, through suitable care during pregn
ancy, childbirth, and childhood. In the deve
loping countries, the child must be protec
ted by all means available particularly from
the mortal diseases. Diarrhoeal diseases
represent an everpresent and recurrent
menace; the widespread use of oral rehydra
tion therapy by mothers in their homes can
save every year millions of young lives thr
oughout the world. A number of infectious
diseases that kill or maim children can be
prevented by effective immunization. Acute
respiratory infections also take a heavy toll
and have to be adequately treated. All this
implies making the best use of primary
health care in communities.
March 1984
The romantic image of the mother isolated
with her child in a closed, loving, caring
circle does not reflect the true situation.
What happens in the immediate family and
community around the mother and child,
and even far away in the world, can have
direct impact on the health and security of
both of them. It must be remembered that
all advice given to mothers should be in a
context that makes positive action possible.
It is pointless to recommend the use of clean
water if none is available, or to suggest boil
ing the water to make it safe if there is no
fuel to do so. The mother and child need to
be placed in an environment that will ensure
their health by protecting the overall setting
in which they live, which means providing
clean water, disposing of waste and helping
to improve shelter. Moreover, nothing can
diminish the importance of good food,
enough food, and proper nutrition, not only
for children but for their mothers.
Beyond the immediate physical needs are
the equally important needs for love and
understanding which stimulate the healthy
development of the child. Good health for
mother and child is a measure of a society's'
capacity for caring; but their health cannot
be improved in isolation, or through the
mother's efforts alone. The environment
must be employed to support health; society
must allow the mothers the time they heed
and a pause from crushing work and poor
diet. Improved education, health and the
social status of women in general is a funda
mental key to the health of children and
society as a whole.
The emergence of new health problems
of mothers and children both in developed
and developing countries, including those
who live in urban slums, should be kept in
23
mind; so too should the problems of "over
development", such as abuse of technology,
and medication, and over-professionalization
of health care of mothers and children,
particularly in the developed world.
Better health services have to be made
accessible to all who need them. The con
cept of primary health care among others has
called attention to three important issues.
The point of first contact between individualsin this case mothers and children—and those
responsible for health care has been neglec
ted; too much seems to have been spent on
high technology, often limited to the capital
cities, whereas little care was available for
the population at large. Closely related to
this is the concept of equity, with a basic
level of health care as the right of all people,
not only the better-off or the urban populaz tions or one class in society. And, finally,
to make this possible, individuals and com
munities must participate in health. Child's
health is the responsibility of the individual
or of the family, especially the mother, but
the particular role of governments is to
provide necessary support which will make
it possible for parents, families and commu
nities to fulfil their own responsibilities to
children’s health for example by providing
maternity leave, child care.
Whatever can be done to ensure the
health and wellbeing of children helps to lay
the foundations of health in adult life and of
health for those children's children.
On the grounds of the WHO Constitution
and on our common grounds of humanity
even on grounds of common biological and
economic prudence, I appeal to you all to
make this World Health Day the occasion of
deep thought, and of irrevocable resolve to
construct a better society where the children
of the world will have a healthier life and a
better chance than we had to achieve more
of humanity's potential.
Courtesy: WHO
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LEGAL EDUCATION-6
Public Interest Litigation
P D Mathew
One of the best things that has happened
in the country in recent years is the develop
ment of Public Interest Litigation (PIL).
Until the emergence of PIL, justice was a
remote reality for the mass of illiterate,
underprivileged and exploited persons in the
country, most of whom are unaware of the
laws and their legal rights. Bonded labourers,
tortured persons,
undertrials,
contract
labourers and a host of others cou Id get on
justice since none could take up their cases
for lack of *locus standi'.
In various recent judgements the Supreme
Court has given a new interpretation to
locus standi by stating that all citizens
should have a right to enjoy life and liberty
guaranteed to them by the Constitution.
The Court enlarged the concept of locus
standi to include the rightful concern of
other citizens willing to espouse the cause
of their less fortunate countrymen.
The reason for enlarging the concept of
locus standi was that restricting it only to
the affected parties, deprived the weaker
sections of their Fundamental Right to
justice, since, because of illiteracy, poverty
and the high cost of litigation, the Courts
were beyond the reach of the poor. Hence,
anyone who is concerned about the ex
ploited has a right to approach the Courts
for redressal of the grievances of the poor.
Understandingly in some cases the
Supreme Court accepted the letters from
March 1984
the victims of injustice, and converted them
into writ petitions. The effect of it has been
quite noticeable and has helped to make
justice accessible to the lowest person as
never before.
What is Public Interest Litigation ?
Public Interest Litigation is a new type of
litigation initiated by the Supreme Court of
India to enable the poor and the vulnerable
sections of society to approach the High
Courts and the Supreme Court to enforce
their Fundamental Rights.
In the opinion of Mr. Justice P.N.
Bhagwati, who is the initiator of this new
type of litigation, Public Interest Litigation is
essentially a cooperative effort on the part
of the petitioner, the public authority and the
court to secure the observance of the Con
stitution and legal rights and privileges con
ferred upon the vulnerable sections of the
community and to reach social justice to
them. (From the judgement of Asiad
Worker's case)
What are the reasons for the Supreme
Court to promote Public Interest
Litigation ?
* The Court felt that today the protection
of law is easily available only to the
rich and the politically powerful.
The civil and political rights of the
people exist only on paper and not in
reality.
25
* The Supreme Court of India which is
used by the landlords, business
magnates, industrialists, etc. must be
come the Supreme Court for poor
and oppressed Indians.
* The poor and the illiterate are not able
to understand their legal problems and
to find redress through the traditional
type of litigation because of its high
cost, complicated and slow procedures.
Who are entitled to file PIL petitions ?
At present PIL petitions can be filed in the
Supreme Court under Article 32 or in the
High Courts under Article 226 of the Con
stitution by public spirited persons, lawyers,
social workers, journalists and voluntary
organisations on behalf of the poor or
members of the weaker sections of society.
This is possible because of the new scope
given by the Supreme Court to the concept
of locus standi.
What is locus standi ?
These Latin words signify the legal right
of a person to file a suit or conduct a litiga
tion in a court of law.
According to the traditional Anglo-Saxon
concept of locus standi only the person
wronged could sue for judicial redress. But
because of the prevailing socio-economic
conditions in the country where there is
considerable poverty, illiteracy, ignorance,
the Supreme Court felt that the traditional
approach will result in closing the doors of
justice to the poor and the deprived
sections of society. So it added a new
dimension to the doctrine of iocus standi.
According to the new interpretation, if the
legal rights of an individual or class of
persons are violated and, if by reason of
poverty or disability they cannot approach
the Court for judicial redress, any public
spirited individual or institution acting in
26
good faith, and not out of vengeance, can
move the Court for judicial redress.
Note
This decision on the iocus standi was
taken by the Supreme Court Constitution
Bench in the 'Judges Appointment and
Transfer Case and it was again confirmed in
the Asiad Worker's Case (AIR 1982 SC
1473-92).
Examples of PIL
1.
The case of the undertrials in Bihar
Ms. Kapila Hingorani (Advocate) filed a
writ in the Supreme Court in 1979, based on
a series of articles in The Indian Express
exposing the plight of about 29,000 Bihar
undertrial prisoners. Most of them had
served long periods of pre-trial detention.
This PIL helped the Court to release many
undertrial prisoners through its interim
orders.
2.
Bombay Pavement Dwellers Case
A writ petition was filed in the Supreme
Court in 1982 by the petitioner Ms. Olga
Tellis with the help of Ms. Indira Jaisingh
(Advocate) in the matter of the demolition
of hutments of 50,000 pavement dwellers
by the Municipal corporation of Bombay at
the alleged instance of the then Chief
Minister of Maharashtra. The demolition has
now been stayed by the Supreme Court.
The main argument of the petitioner was
that the order of demolition of hutments
infringed upon the Fundamental Rights of the
pavement dwellers under Article 14,19 and
21 of the Constitution, which guarantees a
citizen freedom of movement, trade and
profession.
It further argues that they have a right to
dwell on pavements so long as they do not
Medical Service
constitute obstruction to pedestrains and
vehicular traffic on the roads. It stressed
the responsibility of the State to provide
them with appropriate house-sites as close
as possible to their work place.
3. Case against the Superintendent of
the Agra Resettlement Home for Desti
tute Women
This case was brought to the Supreme
Court by two law teachers of Delhi. The
teachers sent the complaint about the Reset
tlement Home by post to the Supreme Court
as a Public Interest Litigation to ensure to
the inmates the right to live with dignity.
According to an enquiry report, the girls
have turned mentally ill, contracted T.B. and
venereal diseasese and they are all forced to
live in a crowded room. The Supreme Court
admitted the petition and appointed an
expert committee to study the condition of
the Resettlement Home and to recommend
means to make the administration of the
institution more effective to meet the welfare
needs of the inmates. Certain problems of the
girls of the institution were solved through
the intertm orders of the Court.
A similar petition regarding the inhuman
living conditions of the inmates of Delhi
Women's Home was filed in the Supreme
Court by a 3rd year student of the Law
Faculty of Delhi University and a social
worker.
4.
The Case of Naxalite Prisoners
A writ petition was filed by a journalist
on bahalf of four Naxalite prisoners of Tamil
Nadu for proper medical treatment. The
Supreme Court appointed Advocate Kapil
Sibal to appear on behalf of the prisoners.
The Court ordered that proper treatment
should be given to them in the Madras
General Hospital. It also ensured their right
March 1984
to privacy while talking to their relatives and
friends.
5.
Ban of harmful drugs
Dr. Vincent Panikulangara, Advocate and
General Secretary of Public Interest Law
Service Society (PILSS) Cochin filed a
writ petition in the Supreme Court in April
1983 seeking the ban of harmful and in
effective drugs. He pointed that a com
*
mittee appointed by the Government recom
mended the ban of 20 fixed dose combina
tions of drugs including some of the
commonly used drugs. This would work to
about two thousand drugs used in con
nection with several diseases. Some of
them are banned or are withdrawal from the
market in other countries. However, because
of the unethical practices of the multinational
drug companies such drugs continue to
exist in our country. The Hathi Committee
pointed out in 1975 that though there are
15000 drugs in Indian market, the basic
health needs of the country can be satisfied
by 116 drugs. Similarly from 1977 onwards
WHO has been pointing out that the basic
health needs of the developing countries
can be satisfied by less than 200 drugs.
The petitioner seeks an order from the
Court to ban the drugs that are found to be
harmful or ineffective on the ground that the
existence of such drugsin the market affects
his Fundamental Right to life under Article
21 of the Constitution of India. He also
points out that though the Directive
Principles of State policy cannot be enforced
by a court, Government actions contrary to
the Directive Principles of State Policy can
and must be prevented by judicial actions.
The Supreme Court has issued notice to the
Government of India, Drugs controllers of
the Union, all the States and Union Territo
ries and the organisations of the manufac
turers and the medical practioners to present
their views on the matter.
27
6.
Eviction of Gudalur Farmers
A writ petition was filed in the Supreme
Court against the State of Tamil Nadu by
a local advocate, Mr. M.J. Cherian, on behalf
of the poor farmers of Gudalur who have
been cultivating their lands for several
years.
The petitioner alleged that persons who
had for many years been cultivating the
land were sought to be summarily evicted
without adhering to the principles of natural
justice contained in the State Forest Act.
It was stated in the petition that the forest
officers and the police were committing
atrocities on the Gudalur farmers.
The Supreme Court ordered that there
should be no destruction of crops and no
forcible eviction of farmers in the Gudalur
Taluk in the Nilgiris district until further
orders.
7.
Bombay Hawker's Case
About 1,50,000 hawkers of Bombay
moved the Supreme Court and got a stay
against prosecution for carrying on trade on
the city's pavements. This write petition
was filed in 1981, by the Bombay Hawkers,
Union President and two women hawkers
who sell vegetables.
Counsels for the hawkers, Ms. Indira
Jaisingh and and Mr. V.J. Francis contended
before the Court that the refusal to grant
licences violated their Fundamental Rights
to carry on trade. They also challenged
certain provision of the Bombay Municipal
Corporation Act which conferred arbitrary
and unguided power to the police and
authorities to refuse licence.
8.
Madras Slum Eviction Case
In this case the Supreme court stayed
the demolition of hutments in the slum areas
of Madras city following a writ petition filed
28
by a local advocate and a professor of
social work against the State Government,
the Madras Slum Clearance Board and the
Corporation of Madras.
The Counsel argued that the slums may
create a certain amount of unhygenic con
ditions in the city but what is to be done is
to provide them with alternative accommoda
tion and not to throw them out on the
street.
9. Case for Giving Alternative Land to
Tribals
A writ petition was filed by Ms. Rambika
Gupta, MLA of Bihar on behalf of the
tribals in Bihar whose lands were taken over
by the Coal India Ltd. for the purpose of
mining.
The petitioner submitted that the lands
were being acquired by Coal India Ltd. at
times without recourse to legal formalities.
The acquisition of the tribals; ancestral land
without giving them alternative sites was
destroying the way of life of the tribals. The
acquisition was violative of the Fundamental
Rights.
The Supreme Court asked the State
Government to provide alternative lands in
a short time.
The Blinding of Undertrial Prisoners in
Bhagalpur Jail
I n this case the prison administration of
Bhagalpur Central Jail is alleged to have
gauged out the eyes of 31 undertrial pri
soners. The news item appeared in Sunday
Weekly (Calcutta) and was later given
publicity by the Indian Express. Ms. Kapila
Hingorani, a senior advocate, filed a writ
petition in the Supreme Court for violating
the Fundamental Rights of the prisoners
under Articles 14 and 21 of the Constitu
tion.
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The issues regarding the liability of the
State to pay compensation for the victims of
blinding and the need for taking action
against the officials responsible for the
blinding were raised in the writ petition.
Certain relief measures like medical treat
ment vocational training and maintenance
were taken at the expense of the State
government. The case is pending for its
final disposal.
The case of the Asiad workers
The Delhi Administration had employed
over one lakh labourers through contractors
for the construction of the Asiad projects.
The government agencies and the contractors
did not care for the observance of the
labour laws related to the contract workers.
They were not even paid the minimum
wage. The report of a free lance journalist
V.T. Padmanabhan of their exploitation by
the contractors which appeared in the
Mainstream (August 1981) accompanied by
a letter written by the president of people's
Union for Democratic Rights was sent to the
Supreme Court. The Court accepted the
letter and appointed ombudsmen to study
the working conditions of Asiad labourers.
The decision of the Court on this case was
a landmark judgement which enlarged the
scope of locus standi. Fundamental Rights
and liability of the State. For details of
the case please refer to page 33 of Legal
Education Series No. 8.
The Cases of Bonded Labourers
In the recent past several cases for the
relief and rehabilitation of bonded labourers
have been filed in the Supreme Court by
Bandhua Mukti Morcha. In ore of the cases
forty of the bonded labourers working in
Pichola in Bhiwani district have described in
a letter to the Supreme Court the miserable
conditions in which they were living. They
wrote 'We are all Adivasti Bhils; with great
March 1984
difficulty we are given wages from Rs. 3 to
Rs. 5 a day which is just enough for our food
rations. Drinking water is supplied once in
three or four days. Our huts are worse than
those used for keeping animals. We want
to go away from here now itself but our
master and his goondas tell us that we
cannot leave unless we pay back their loan
which is Rs. 2000 to Rs 8000 per family.
Our master enters our huts and molests our
young daughters and also beats them up.
Please save us.'
Swami Agnivesh, Chairman of the
Bandhua Mukti Morcha forwarded this letter
to the Supreme Court. A Division Bench
headed by justice P.N. Bhagwati appointed
two Commissioners—Mr. Jose Verghese,
Advocate, Supreme Court and a journalist—
to enquire into the conditions of these
labourers and report to the Court. The ex
penses of the Commissioners were met by
the Committee for Implementing Legal Aid
Schemes. Through the interim orders of the
courts several groups of bonded labourers
were released from the contractors.
Mr. Gobinda Mukhoty, Counsel of the
Bandhua Mukti Morcha has argued most of
the cases on behalf of the bonded labourers.
The Case of the Illegal Detention of
Oraon
The Case of Oraon, an undertrial prisoner
was sent to the Chairman of the Committee
for Implementing Legal Aid Schemes (Justice
P.N. Bhagwati) by the Legal Aid Committee
of Ranchi through a letter. This letter was
treated as a writ petition.
Bhoma Charan Oraon, an undertrial
prisoner was sent to the Ranchi mental
asylum in 1976 by the sub-divisional Magis
trate of Kunti, Bihar. Six months later, the
superintendent of the hospital informed the
Magistrate that Oraon was sane and fit to be
released, but no action was taken in spite of
29
reminders. Thus Oraon was in the mental
asylum for six years though he was sane.
In the order on 11th August, 1983, the
Court said 'No amount of money could com
pensate Oraon for the six years of "living
death" in the mental asylum'. But compen
sation is the only remedy we can give when
the Fundamental Rights under Article 21 are
violated. It ruled that when the Fundamental
Rights to life and liberty are violated anyone
complaining of such an infringement can ask
for compensation.
The Impact of the Judgement
1.
Illegal detentions and torture in jails
could invite compensation claims
from prisoners.
2.
Since Article 21 (Life and Liberty) is
very wide and includes human dig
nity and decency, any violation of
the person, physical or mental, could
be interpreted in such a* manner that
the State would be liable to pay
compensation.
3.
The State governments may have to
pay for their police officers' violations
of the Fundamental Right to life and
liberty of the people.
Note
In this case the Judges (Justice P. N.
Bhagwati and Justice Sabyasachi Mukherji)
awarded Rs. 15,000 as compensation for
Oraon and Rs. 750 for the legal aid lawyer.
In another case of similar nature. Chief
Justice Y.V. Chandrachud had ordered the
Bihar government to pay Rs. 30,000 to Rudal
Sah, who was kept in a mental asylum for
14 years although he was declared sane.
The mode of filing P1L cases
Much of PIL in the initial period (198182) has arisen out of letters written by social
30
workers, journalists, law teachers, lawyers,
and civil liberty activists to Mr. Justice P.N.
Bhagwati in his capacity as Justice of the
Supreme Court and Chairman of the Commi
ttee for Implementing Legal Aid Schemes.
These letters were accompanied by news
paper clippings or investigation reports.
These letters were converted into writ
petitions and admitted in the Supreme Court.
In all the PIL cases the Court has appointed
public interest lawyers as amicus curiae to
conduct the litigation on behalf of the peti
tioners. When evidence in PIL cases was
not sufficient to prove the allegations narra
ted in the petition, the court has appointed
commissions of experts to investigate the
matter and to submit reports to the Court.
In most cases the Supreme Court accepted
the reports of the Commissions and passed
orders to give interim or permanent relief to
the petitioners.
What is the nature of the PIL cases ?
Most of the petitions admitted in the
Supreme Court as PIL dealt with the repres
sion by government agencies and custodial
authorities (police and prison
admini
strators).
Some of them sought orders
from the Court to compel State agencies to
discharge their responsibilities to the citizens.
The distinctive feature of PIL petitions is
that all of them are filed in the Supreme
Court under Article 32 of the Constitution
i.e., they are writ petitions for the enforce
ment of the Fundamental Rights.
Which are the main Fundamental Rights
that have become the subject matter of
PIL ?
1.
Article 14
(a)
Equality before the law
(b)
Equal protection of the law
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2.
Article 19
(a) Freedom of speech and expres
sion
(b) Freedom of Assembly
Freedom to form Associations or
Unions
(c)
* People are aware that the Court has
constitutional power of intervention,
which can be used to ameliorate their
misery arising from repression, govern
ment lawlessness and administrative
negligence and indifference.
(d)
Freedom to move freely through
out India
(e)
Freedom to reside and settle in
any part of India
(f)
Freedom to practise any profes
sion
* Today undertrials, convicted prisoners,
bonded labourers, unorganised labou
rers, Schedule Castes, Scheduled Tribes,
exploited women, slum dwellers, vic
tims of police torture and other vul
nerable sections of society have access
to the Supreme Court and High Courts
for securing their human rights.
3.
Article 21
Protection
of life and personal
liberty 'No person shall be deprived
on his personal liberty except accor
ding to procedure established by
law.
* PIL has created an awareness among
the judges and lawyers about their res
ponsibility to administer social justice
to the exploited millions and compels
them to take human suffering more
seriously.
4.
Article 22
Protection against arrest and deten
tion in certain cases.
* The Court decisions based on PIL
expose the State to liability for paying
compensation for violations of Funda
mental Rights.
5.
Article 23
Right against exploitation by any
form of forced labour. Prohibition of
employment of children below 14 in
hazardous employment.
Note
In most cases of violation of human
rights, a combination of Fundamental Rights
is infringed; e.g. In the case of eviction of
pavement dwellers.
—Articles 14, 19, 21
Blinding of Bhagalpur prisoners.
—Articles 14 and 21
What is the impact of PIL ?
* Through PIL cases the Supreme Court
has emerged as the defender and
champion of the have nots.
March 1984
♦ Through interim orders and directions
the Court seeks improvement in the
administration making it more respon
sive than before to Constitutional ethic
and law.
♦ PIL has exposed the failure of the
government to deliver the goods to the
poor and this exposure of injustices and
tyrany began to hurt the national cons
cience.
♦ PIL is a legal device to control govern
ment to as not to leave State agencies
free to violate the law or be casual or
negligent in its enforcement.
* It has awakened the consciousness of
the public regarding the dignity of
human life, the importance of liberty
and the right to equal justice.
31
It is the beginning of a revolution in
our system of delivery of justice and it
'nourishes hope in an otherwise darken
ing landscape of Indian law jurispru
dence/
* In its decisions or orders the Court pro
mises more than it can deliver, e.g., in
some cases the government has not
executed the orders of the Supreme
Court.
* By introducing this new mode of litiga
tion in the judicial system the Supreme
Court has demonstrated a non-violent
means to prevent the exploitation of
the poor and to promote social justice.
♦ While the Court speaks much about
human dignity, equality, social justice,
the actual relief given in many of these
cases is very small, e.g., in the Asiad
workers' case, though the judgement
was a landmark in the history of the
judiciary the actual relief obtained by
the labourers was nil.
* Every individual PIL case is a test case
and its judgement affects a whole class
of people and the principles involved
become precedents for similar cases.
The limitations and problems faced by
PIL in India
* It is in an experimental phase and it has
not been fully appreciated by most
judges and lawyers. It is sustained and
monitored by only few judges and
lawyers.
* The fact that PIL matters are mostly
dealt by Court No. 2 of the Supreme
Court has led to factions among the
judges. Many Judges are not given a
chance to deal with PIL cases. Hence
the learning capacity of the Judges is
constricted.
* Work-load of Court No. 2 of the
Supreme Court with PIL cases causes
problems of priority in processing. If
priority is not given to a PIL case it will
continue to drag on for years like other
cases.
* The entertaining of PIL cases and their
outcome depend very much on a parti
cular Bench of Judges.
* Some Judges have attacked PIL even
before it has taken root.
♦ Facts relied upon by PIL petitioners are
often based on newspaper reports
which are not altogether reliable.
32
* The Court has suddenly raised the
expectation of the poor to get justice
without undue delay, yet the actual
working out takes a long time, e.g.,
the Bhagalpur blinding case filed on
October 10, 1980 is still pending in the
Supreme Court.
* The judiciary is not always able to
enforce its decisions. There is no suffi
cient follow-up with regard to the exe
cution of its orders.
* Very few PIL petitions have resulted in
a final verdict.
* PIL is a sort of renovation within the
existing system, which is very much
elite-clitent oriented and not truth
oriented. The Judges operating the
present system have been bogged
down by the legal technicalities more
than truth and justice.
* PIL is now mostly a Supreme Court
phenomenon. It has not taken roots
at the High Court level.
The evidentiary problem in PIL cases
and the means of solving it
In the past, in most PIL cases, the peti
tioner relied very much on newspaper reports
or letters written by the affected people.
Since there were not enough document and
Medical Service
investigation reports, the State Counsel often
denied all the allegations contained in the
affidavits (the veracity of the newspaper
clippings). The opposite party, especially
the government agencies were unwilling to
produce documents on the plea of privilege.
In most of the PIL cases where there was
a lack of evidence, the Court appointed
Commissions of experts to investigate the
matter and submit their reports to the Court.
In several PIL cases, social scientists,
teachers, researchers, journalists and lawyers,
Court officers, doctors etc. were appointed
as ombudsmen and their reports were accep
ted by the Court without being challenged.
In almost all cases the State was asked to
bear the expenses incurred by the commis
sion.
Examples
* In a case of chamars of Bihar against
the Ziia Parishad regarding the violation
of their rights to trade and profession
in Supreme Court appointed Krishnan
Mahajan (legal correspondent of the
Hindustan Times, Delhi) and Prof.
Upendra Baxi
(Vice-Chancellor of
South Gujarat University) as a Commi
ssion of experts to study the problem
and to submit a report to the Supreme
Court.
* In the case of pavement dwellers, the
Supreme Court appointed a Court offi
cial of Bombay High Court to supervise
the execution of its interim orders.
* In the Kanpur undertrial rape case, the
Court has asked the district Judge to
investigate the case.
* In the Asiad Workers
*
Case the Supreme
Court appointed three social scientists
March 1984
(Dr. Alfred de Souza, and Dr. Walter
Fernandes of the Indian Social Institute
and Prof. Das Gupta of People's insti
tute for Development and Training,
Delhi) as ombudsmen. The landmark
judgement of the Supreme Court was
based on the reports submitted by these
ombudsmen.
* In the case of 'Bhagalpur blindings' the
Court appointed the Registrar of the
Supreme Court to interview the victims
and to submit a report.
What is to be done to put PIL on a
sound footing
* It must become the common policy of
the Supreme Court and High Courts to
accept and entertain PIL cases on a
priority basis.
* The Courts must use their own officials
not only to assertain facts, but also to
monitor the implementation of the
various directions given by the Court.
It must create a fact finding machinery
as part of its structure.
* Contempt of Court provisions must be
strengthened, so that those who lie in
the Court can be punished.
* Court orders must be issued to the
concerned persons as soon as possible.
Certified copies of orders must be made
available immediately to those who
have to go and make an enquiry.
* With the growing volume of public
interest litigation, procedures needed to
be streamlined and ground rules estab
lished.
33
* The Committee for implementing Legal
Aid Schemes must create a cadre of
committed lawyers to conduct PIL cases
in the Supreme Court and High Courts
and create PIL lawyers
*
chambers
funded by legal aid societies or the
public.
* There should be periodic meetings of
PIL lawyers to share their experience.
* Cooperation among the lawyers, pro
fessors, journalists, social activities and
academics must be strengthened so
that there can be better inter-discipli
nary approach and support to complex
PIL cases.
* There is a need of a PIL journal to
report all relevant PIL cases and to pro
vide a forum for sharing information
and ideas among those who are invol
ved in this field.
* The legal aid programmes at the
Supreme Court and High Courts levels
must be expanded to meet the expen
ses of PIL petitions.
♦ Voluntary agencies must be encouraged
to take up PIL to enforce the rights of
the poor.
* The occasion of PIL must be used to
educate a group or a community and
help them to see it as part of its com
munity action for justice.
34
* The affected people must be helped to
participate in PIL so that it can awaken
their consciousness.
* Every PIL petition filed in the Court
must be the result of Community or
group involvement, reflection and deci
sion.
The role of Voluntary
promoting PiL
Agencies
in
PIL is a new phenomenon in India. It has
originated from the new awakening of a few
judges and lawyers. Its whole-hearted
acceptance and promotion cannot be expec
ted from government agencies, 'adjournment
*
lawyers
and elite groups. This is a boon to
the voluntary organisations working at
the grass-roots level. This new legal tool
can be a great t help in their non-violent
struggle with the masses to obtain legal
justice. Several voluntary agencies and social
activists are making use of it as a support
in their social action to fight against exploi
tation of the poor.
For further information in Legal matters
contact :
Director, Legal Aid
Indian Social Institute
Lodi Road, New Delhi 110 003.
Tel : 622379, 624760
Gram INSOCIN
Medical Service
Understanding Diphtheria
Diphtheria is caused by a bacteria. The
disease affects the tonsils, the pharynx, the
larynx, the nose, and occasionally the skin.
The source of the infectiori can be either a
patient or a healthy person who is a carrier
of the disease.
The bacteria which causes diphtheria is
found in the mucus from the nose or throat.
The bacteria can also spread by direct con
tact, or indirectly through personal articles
which are contaminated by the nose and
throat secretions of the patient.
Symptoms
A few days after contact with an infected
person, the following symptoms appear:
— a greyish or yellowish membrane
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cases, there is a marked swelling of
the tonsils, and oedema of the neck.
The membrane sometimes blocks the
air passage at the back of the throat
and can kill the child by suffocation.
Treatment
Take the child immediately to a doctor.
Diphtheria antitoxin is the specific treatment
for the disease and must be started as soon
as possible.
Prevention
— moderate fever
Give three doses of DPT between the age
of six to nine months, at an interval of four
to six weeks each. In order to sustain the
immunity, an additional booster dose should
be given when the child is one and a half to
two years old.
— loss of appetite
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— sore throat
— headache
— weakness
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Protection from
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CHAI
NEWS
NOTES
World Leprosy Day and Anti-Leprosy Weeks Celebrations at
St. Joseph’s Leprosy Hospital, Tuticorin
Gandhiji's Martyrdom day is observed as
the World Leprosy Day in India. This year
as we had planned to have it celebrated in
more leprosy endemic areas of our sub
centres the actual celebrations were on
different dates. But the 30th January was
not ignored. Prior to the public meetings
elocution competitions for the high school
students
of project area and essay
competition for primary school teachers were
conducted. In all 27 students and 37
teachers participated in the competitions
from the control area. On the 30th it was
kept in Tuticorin Harbour High School for
the schools of Tuticorin, Spic Nagar and
Harbour Termal project. The meeting began
at 11.00 a.m. by observing 2 minutes silence.
The headmaster of that school spoke a few
words about Gandhiji and his compassionate
care for the Leprosy patients followed by an
introduction by Dr. M.G. Mohandas our
medical officer. We are grateful to the
local people who gave a small contribution
for purchasing prizes for the winners of the
competitions.
Other areas selected for the public meet
ings were Ottapidaram, Eral where there are
556 known cases, Keelamudimen and Keel
vaipur. The former three places are the
oldest areas of our control work with the
duration of nearly twenty five years and the
later nearly thirteen years. The dates of the
meetings were 8th February at Ottapidaram
presid ed over by Mr. Koilpillai, Manager and
March 1984
Headmaster of TMBM school Ottapidaram.
One the 10th it was kept at Eral presided
over by Rev. Fr. Francis Devasagayam,
Correspondent of St. Teresa's school on the
12th at Keelamudimen presided over by Rev.
Joseph S. Leon, Correspondent of St.
Joseph's school Keelamudimen and on the
14th at Keela Vaipur presided over by Rev.
Fr. Karunakaran, Correspondent of St. Louis
school.
In all there was a good response although
in one place it rained throughout the day and
by evening we had to shift the meeting into
the school hall. At all 4 meetings Dr. M.G.
Mohandas gave an introduction as to the
purpose of our going there about the actual
work. Besides the presidents speech there
were felicitations by the well wishers. On the
last day of the celebration Dr. Santhammal,
District Leprosy Officer of Government Head
Quarters Hospital, Tuticorin gave felicita
tions. Dance programmes were given by the
convent schools of the respective area. We
are grateful to the sisters of the Immaculate
Conception, Sisters of Louis Gonsala and
the Servites sisters. A drama was staged by
our staff "Let us live and show". A person
having early signs of leprosy getting married
with a girl after getting cured. It was a
challenge. The boy and the girl along with
the doctor, who was treating him challenged
the girl's father and relatives. It was done
very effectively. Congratulations to our
staff.! I
37
Medical Ethics Forum-33
—Fr. George Lobo sj
Mercy and Justice in Health Care
Traditional health care was largely based
on 'mercy' or 'charity'. Some noble souls
felt compassion for the suffering sick and
provided various forms of relief. However,
health care gradually became organised and
the State entered the field in a massive way.
Now medical treatment has become genera
lized and more and more the element of
justice is gaining prominence. The enormous
development of medical science and techno
logy gives the impression that man has
absolute dominion over nature, including his
bio-physical organism. Mercy seems to have
no place in this context. Besides, recipients
of mercy often feel demeaned by the bene
volence of others. Are we then, to discard
the motive of mercy altogether and rely only
on justice?
First of all, it is true that every citizen has
a basic right to minimum health care and
society has the corresponding duty to provide
it. Isolated acts of benevolence will not meet
the demands of the present time. There is
need for a system in which the basic health
needs of all are met.
However, justice alone is not sufficient. A
person's objective needs may be satisfied.
But this may happen in an impersonal way.
38
in a beaurocratic setting in which the patient
becomes only a 'case'. Further, in a system
organised only on the basis of strict justice,
a person may be entitled to medical attention
in proportion to his utility to society.
Patients then would be reduced to instru
ments or cogs in a vast machine which would
lead to massive depersonalization.
That is way, Pope John Paul II has declar
ed that justice needs to be complemented by
mercy : "The equality brought by justice is
limited to the realm of objetive and extrinsic
goods, while love and mercy bring it about
that people meet one another in that value
which is man himself, with the dignity that is
proper to him." [Dives in Misericordia, N. 14).
Hence while justice should not be ignored
in favour of mercy, it should neither be over
stressed to the neglect of mercy. Rather in
the words of the Pope "true mercy..... is the
most profound source of justice", [ibid).
Rendering justice to others in an adequate
way implies an ever present effort to assess
the actual condition of people and to remedy
evils to the best of one's ability, it is the
basic attitude of compassion that gives justice
its full meaning. For a Christian, this implies
a religious attitude that respects human
values and the eternal destiny of man.
Medical Service
A 30 BEDED HOSPITAL in Darjeeling requires a residential doctor for
immediate appointment. Doctors who are interested may contact directly to :
Sister In-charge
Bhogibita Hospital
Gayaganga PO
Kamala Bagan Via
Darjeeling Dist
West Bengal 734 426
Applications are invited urgently for the following posts at Evangelical
Mission Hospital, Tilda, M.P. which is a 110 beded General Hospital running
"A" Grade School of Nursing, situated in a semi-urban region.
'
1.
One Laboratory Technician—CMAI Diploma or equivalent. Salary
Scale—Rs. 310-10-340-15-460-20-6604-D. A. 30% of basic salary
and Uniform.
2.
Staff Nurses Midwives—"A” Grade General Nursing and Midwifery.
Salary Scale—Rs. 350-10-390-15-540-20-8404-D.A. 30% of basic
salary and Uniform.
3.
A.N. M.s—Salary Scale—Rs. 250-7.50-280-10-360-15-5104- D.A.
30% of basic salary and Uniform.
4.
Community Health Worker—Matric Nurse—Midwife with one year
post-graduate course in Community Health Nursing and experience.
Salary—Negotiable.
5.
Hostel Matron—An elderly lady ex-matric pass or a retired General
Nurse without any incuberance. To look after the Nurses' Hostels
training "A" grade nurses, both male and female students having a
total of 50 students. Salary negotiable.
Aplly with complete bio-data to the
Director
Evangelical Mission Hospital
Tilda, Neora PO 493 114
Raipur Dist, M.P.
F 0 R M IV
(See Rule 8)
Statement of ownership and other particulars about
MEDICAL SERVICE
1.
Place of Publication
2.
Periodicity of its publication
: Monthly (10 issues a year)
3.
Printer's Name
Nationality
Address
: Fr. John Vattamattom SVD
: Indian
: Catholic Hospital Association of India
C.B.C.I. Centre, Ashok Place
New Delhi—110 001
4.
Publisher's Name
Nationality
Address
: Fr. John Vattamattom SVD
: Indian
: Catholic Hospital Association of India
C.B.C.I. Centre, Ashok Place
New Delhi—110 001
5.
Editor's Name
Nationality
Address
: Fr. John Vattamattom SVD
: Indian
: Catholic Hospital Association of India
C.B.C.I. Centre, Ashok Place
New Delhi—1.10 001
6.
Name and address of the indi
viduals who own the Newspaper
and partners or shareholders
holding more than one per
cent of the total capital
:
:
:
:
:
New Delhi
Catholic Hospital Association of
India
C.B C.l. Centre,
Ashok Place,
New Delhi—110 001
L Fr. John Vattamattom SVD, hereby declare that the particulars given above are
true to the best of my knowledge and belief.
Dated March, 1984
Fr. John Vattamattom SVD
Signature of the Publisher
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