MEDICAL SERVICE VOL. 41 No. 5 MAY -JUNE-1984.pdf
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COMMUNITY HEALTH CELL
47/1, (First Floor) St. Marks Road,
Bangalore - 560 001,
the change and challenge of the family in the 80's • disability versus
employability • bringing eyecare to villages • people, pills and prescrip
tions-! : the drug dilemma • chai news and notes • legal
vol 41
no 5
education-8
may-june 1984
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Track mounted ceiling suspended model operation theatre
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Track mounted ceiling suspended model operation theatre
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Dual (Twin) Track mounted Operation theatre light having
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Dual (Twin) Track mounted operation theatre light having
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Emergency Lighting Unit for use with above operation
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Vertical high pressure Steriliser size 12“ dia x 20“
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Vertical high pressure Steriliser size 16“ dia x 24“
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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 5
editorial board
may-june 1984
contents
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
1
editorial
2
the change and challenge of the
family in the 80's
3
3
disability versus employability
12
4
bringing eyecare to villages
s kannan
19
people, pills and prescriptions-1 :
the drug dilemma
ravi narayan
23
6
chai news and notes
26
7
legal education—8
p d mathew
32
5
fr john vattamattom svd
cover design
2
p m isaac bangalore
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
“Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india'*
Guest
EDITORIAL
Over 10,000 national and international companies rule the medical
system today. Of these 10,000,110 of them control over 80 per cent of
the world's multibillion drug market. The biggest of them have annual
turn over that exceed that of many developing countries or many Indian
states.
For long the health profession and the health system have been willy,
nilly agents of the colossal pharmaceutical industry. While all of us have
been unconscious and unaware victims of sophisticated marketing prac
tices to such manipulation by accepting free samples, free lunches, mem
entos and in rare cases even costly gifts.
. Of late among the conscientious practitioners of medicine there is this
urge to seek a rational therapeutics or the essential drugs programme
In CH A's search for a more humane and more Christian practice of
medicine, we would naturally always associate ourselves with any such
quest for medicines that are:
* efficient
* safe (with low incidence of side effects)
* low cost and
* easy to administer
To bring our readers uptodate on this aspect of health care we are now
starting a regular column (see page 23)
We hope to use the expertise those in our own institutions as well as
friends outside to make this column possible.
If you have something to say about essential drugs or low cost drugs,
do please write to us. If you have a question on this topic, do let us know.
We shall seek the answers together.
The Change and Challenge of the Family in the 80s
Rev. C.D. Hurley
The socio-cultural revolution of our times
has set us in a state of unrest; the machine
surges far ahead of man's wisdom concern*
ing himself. The pressing circumstances
make it necessary for us to learn the "diffi
cult art of dwelling together is unity, like
brothers".
The form of the family as old as the
human species moulds itself to the conditions
of life which dominate at a given time and
place. There is nothing fixed or immutable
about the family except that it is always with
us. In one sense, we have had thousands of
years on which to grow accustomed to it and
yet in another sense each generation in turn
must learn again how to live with it.
Biologically the family serves to prepetuate the species. The relations of male and
female and sexual mores play a lesser role
than the care of the young. The evolutionary
shift from hunting to agriculture as a way of
life brought with it a shift from the matriar
chal to the patriarchal family and the deve
lopment of property value.
Psychologically the members of the family
are bound by mutual interdependence for the
satisfaction of their respective affective needs.
Economically they are bound by mutual inter
dependency for the provision of their material
needs.
The family is a flexible unit that adapts
itself deliberately to influences acting upon it
both from without and from within. In its
external relation it must adapt to prevalent
customs and mores and must make wide and
workable connections with racial, religious,
social and economic forces. But internally
May-June 1984
the family must also come to terms with the
basic biological bonds of man and woman
and of mother and child.
Concretely, the social purposes served by
the modern family are :
1.
The provision of food, shelter, and
other material necessities to sustain
life and provide protection from ex
ternal danger, a function best fulfilled
under conditions of social unity and
cooperation ;
2.
The provision of social togetherness
which is the matrix for the affection
ate bonds of family relationships ;
3.
The opportunity to evolve a personal
identity, tied to family identity, this
bond of identity providing the psychic
integrity and strength for meeting
new experiences ;
4.
The patterning of sexual roles, which
prepares the way for sexual matura
tion and fulfilment;
5.
The training towards integration into
social roles and acceptance of social
responsibility;
6.
The cultivation of learning and the
support for individual creativity and
initiative.
Clearly the configuration of family deter
mines the forms of behaviour that are required
in the roles of husband and wife, father,
mother and child. Mothering and fathering,
and the role of the child, acquire specific
meaning only within a defined family struc
ture. Thus the family moulds the kinds of
3
persons it needs in order to carry out its
functions, and in the process each member
reconciles his past conditioning with present
role expectations. Clearly this process is a
continuing one, for the psychological identity
of a family changes over a period of time.
And within the framework of this process,
each member at times conforms and, at other
times and within limits, actively alters these
role expectations.
The family may be regarded as a kind of
exchange unit: the values exchanged are
love and material goods. Within the family
sphere there is a flow of these values in all
directions. Usually the parents are the prime
givers. The whole process of distribution of
satisfactions in the family is governed by the
parents. If, the family atmosphere is full of
sudden turns and shifts, deep feelings of
frustration may result, inevitably accompanied
by resentment and hostility. The ^interchange
of feeling between family members revolves
centrally about this oscillation between jlove
and hate.
However, the experiencing of some meas
ure of disappointment the development of
tolerance to frustration, and the acceptance
of less than complete fulfilment are essential
to emotional growth. Without these there
would be an insufficient spur to new experi
ence and new achievement.
The family's task is to socialize the child
and foster the development of his identity.
There are two central processes involved in
this development; first, the movement from a
position of infantile comfort and dependence
towards adult self-direction and its attendant
satisfactions; second, the movement from a
place of infantile, aggrandized, omnipotent
importance to a position of lesser importance,
that is, from dependence to independence,
and from the centre of the family to the peri
phery. Both processes are psychological
functions of the family as a unit. In the
4
interests of the emotional health of the child
it is essential that these processes be imper
ceptibly gradual. The family provides the
specific kind of learning experience that
enable a person to fit himself into a variety
of life situations. The home is the arena in
which a person acquires practice and increas
ing dexterity in filling a wide range of social
roles.
The interrelations of individual and family
behaviour need to be scrutinized in these
dimensions : (1) the group dynamics of the
family, (2) the dynamic processes of emo
tional integration of the individual into his
family role, (3) the internal organization of
individual personality and its historical
development.
Family, Identity, Stability, and
Breakdown
The psycho-social dynamics of family life
may be operationally defined. They are
guiding concepts that attempt to answer for
the dynamics of family functioning : the who
and what of family life, the how, and the
resulting functional patterns of the family.
These concepts are in brief, the following :
(1) psychological identity, which subsumes
strivings, expectations and values, (2) stabi
lity of behaviour, expressed as (a) the con
tinuity of identity in time, (b) the control of
conflict, (c) the capacity to change, learn
and to achieve further development; adapta
bility and complementarity in new role rela
tionships :
Identity
The concept "psychological identity and
values" refers to direction and content of
striving, while stability refers to organisation
and expression of behaviour in action.
Any human entity—possesses a unique
psychic representation. I speak of this as
Medical Service
identity. It is part of the cycle of life that
people strive to express and fulfill the pot
entials of their identity in the context of on
going social relations. Psychological identity
refers to a self-concept expressed in the
strivings, goals, expectations, and values of a
person or a group of persons. It answers the
question : who am I ? or who are we ? in the
context of a given life situation. It qualifies
a particular kind of person or persons, what
they stand for, where they are going, their
purpose and meaning in life.
The psychological identity of an individual
or of a family is its psychic centre of gravity.
It is the "I and Me" or the "We and U s",
the unique configuration of psychic self
representation around which all interpersonal
experience is woven and by which this same
identity is further modified in the passage of
time. At a given point in time the individual
has an image of his personal identity and his
family identity, both continuously being in
fluenced by the images which outside pe rsons hold of these same identities. At each
stage of development, personal identity is
linked to and differentiated from the identity
of parents and family in a special way. This
relationship begins with the symbiosis of the
child—mother pair, it is moulded by a process
of primary identification of the child with the
parents, and it undergoes further change as
the child gradually differentiates his separate
self and expands his identification with other
family members. The organisation of individual identity at any point of time, therefore,
epitomizes a corresponding family identity.
In the context of a family relationship or
group, psychological identity refers to ele
ments of joined psychic identj,ty-the striv
ings, values, expectations, actions, fears and
problems of adaptation, mutually shared in
or complemented by the role behaviours of
members of the family group. In essence
this is a segment of shared identity, reflected
May-June 1984
in layers of joined experience, and enacted in
the receprocal or complementary family role
behaviours of these persons.
It is this feature of family living that gives
form to the standards and deals of the
family—the lines of authority, sexual differ
entiation, division of labour, and childrearing attitudes. The psychological identity
of a family determines the manner in which
elements of sameness and difference among
the personalities of family members are held
in a certain balance. In some families, the
interplay of members in their various family
roles emphasizes the trends toward same
ness over the trends towards difference. In
other families, the opposite pattern may
prevail. In disordered families, differences
may be so intensified as to create a formid
able barrier, which critically impairs the
matrix for joined identity.
Stability
Stability of behaviour is itself the end
product of complex, interdependent proces
ses. The more important of these are: the
continuity of identity in time, the control of
conflict, the capacity to change, learn, fill
new roles, and achieve further development,
and finally, the complementarity of family
role relations.
Stability in its first phase epitomizes the
capacity to maintain the sameness or con
tinuity of a person or a group of persons
through time. It is the maintenance of the
integrity and continuity of identity under the
pressures of changing life conditions. It
assures the intactness and the wholesome
ness of personal behaviour in the face of
dangers in new experiences. This is the con
servative phase of the function of stability.
Its internal aspect is represented in the re
gulation of the balance of intrapsychic
forces.
5
Stability in interpersonal relations is a
function of the interplay of the orientation to
self and to the group. The inter-action of
family members in their respective family
roles governs the quality of stability of family
relationships. It affects the capacity to cope
with family conflict and restore balance
following an emotional upset. Such stability
may be maintained on the basis of a relatively
static or rigid pattern of family role recipro
city or on the basis of a more flexible capa
city to accommodate to change and achieve
a new and improved level of reciprocity. One
aspect of the function of stability fulfills the
conservative requirement of protecting the
sameness and continuity; another aspect
must make room for new experience, learn
ing, and further development. The recepti
vity to new experience, the capacity to learn
and grow, is the more open, more adventur
ous aspect of life adaptation. It entails risk,
but without risk the power to adapt to
change and to grow is lost. Effective adap
tation requires, therefore, a favourable
balance between the need to protect same
ness and continuity and the need to accom
modate to change. It requires preservation
of the old combined with receptivity to the
new, a mixture of conservatism and an emo
tional readiness to "live dangerously/'
Evaluation of the relations of individual and
family requires assessment of both aspects,
stability in its conservative, relatively stoic
phase, and stability in its more open, flexible,
adventurous phase, which makes possible
adaptation to new experience, learning, and
further growth of personality.
The achievement of stability in these as
pects is, in turn, influenced by the capacity
to cope with conflict. The control of conflict
is a special dimension relevant to the rela
tions of individual and family.
The failure
to find effective solutions leads to adaptive
breakdown and emotional illness.
6
Within the individual, conflict, anxiety,
and symptoms defectively controlled repres
ent vulnerability to adaptive breakdown and
mental illness. Co-existent with these forces
are the potential capacities for finding solu
tions to such conflict or for establishing a
protective equilibrium or compensating for
the effect of conflict. Of special importance
in this connection is the ability to achieve
patterns of family complementary role. The
term "complementarity" refers to specific
patterns of family role relations that provide
satisfactions, avenues of solution of conflict,
support for a needed self-image, and butt
ressing of crucial forms of defenses against
anxiety.
Breakdown
The seeds of mental illness are sown in
the family of childhood; but the growth of
these bad seeds into emotionally twisted
adults becomes meaningful only as we study
the relations of individual and family in ado
lescence and adult life as thoroughly as we
study these relations in the family of
childhood.
Psychiatrists have acquired adaptness in
the retrospective study of mental illness, in
the minute examination of family histories.
But they have not yet cultivated an equival
ent skill in the study of family process, here
and now.
Psychiatric disorders are neither static nor
isolated entities. While the pattern of
vulnerability to illness is laid down in child
hood, the fate of this vulnerability is deter
mined by the interpersonal experiences of
later life adolescence is notoriously a phase
of transitionaj development within which the
vulnerability to breakdown is intensified. The
struggle to entrench personal identity and to
integrate personal drives with the conditions
of social living, and the tension of harmo
nizing the requirements of family roles with
Medical Service
those of extra familial roles play a tremend
ous part indicating the destiny of these pre
dispositions to illness.
When an individual reaches adult age,
marries and creates a family, the pattern of
his adult family may be similar to or differ
from the family of his childhood. In adul
thood the individual may perpetuate an old
and familiar pattern or defensively take flight
to a radically different one. In choosing a
marital partner and raising children, he initi
ates a new set of close relationships which
may either give him added protection again
mental illness or aggravate his inclination
towards it. A circular process is involved.
Conflict internalized at earlier phases of
family integration influences the present
patterns of conflict in family relationships,
and contemporary conflict in family relations
influences the expression and fate of the
older levels of conflicts.
Of special significance in relation to the
contemporary rise of juvenile delinquency is
the investigation of psychopathic tendencies,
as these are influenced by the phenomena of
family life. Johnson and Szurek have illumin
ed some aspects of this problem with special
emphasis on the induction of delinquent be
haviour in a child as a response to the un
conscious expectations of the parents.
The community at large is not yet tuned
to the idea of viewing emotional illness as a
problem of the entire family group. Families
as families do not present themselves to
mental health practitioners as sick units. They
follow rather the traditional habit of referring
one member of the family with emotional
difficulties for study and treatment. But this
first referral calls attention to the psychopathological disturbances of the entire family
group.
Values and Family Structure
Values are personal and yet they are social
too. They do not have a private origin, but
May-June 1984
they become privately treasured. As indi
vidual may defend his values as he defends
his own self. He may even sacrifice his life
to protect these values. Values are born out
of the assimilation of the individual into
group living. They provide orientation to the
relations of individual, family and society.
They give meaning to a person's position in
life. They are the compass which provide a
sense of direction from birth to death.
Values by their very nature tend to be
polarised in sets of opposites. They present
a problem of choice which may be readily
illustrated in a series of pairs :
Creativity.
versus Destructiveness
Freedom
versus Compulsion
Strength
versus Weakness
Independence
versus Dependence
Courage
versus Caution and retreat
Adventure
versus Security
Cooperation
versus Competition
Social
responsibility
versus Self-indulgence
Orderliness
versus Disorderliness
Generosity
versus Parsimony
Inner reality
versus Appearance
Spiritual
enrichment
Equality and
mutual
regard
Respect for the
human
being
versus Material acquisition
Inequality and a
striving
versus for power
versus The human being
as a thing,
a pawn, a tool.
There is a wide range of component value
trends as expressed in the functioning of
contrasting types of families. There are
families where the dominant value orientation
emphasizes the inner spiritual life of the
family, a dedication to the worth, dignity and
personal development of each member. There
7
are others which accentuate the outer facade
of the family, its external image in the eyes
of the surrounding community. Such a family
often pays scant interest to the internal rela
tions among family members. Sometimes its
outward appearance piesents the semblance
of a fine, stable, closely-knit group; it may
earn for itself in the community the reputa
tion of a well-functioning respectable family
group, whereas actually its inner emotional
substance may be rotten to the core.
There are certain families whose com
ponent value trends stress pleasure, the joys
of the moment. By contrast, others live off
the glories of the past; they cherish the re
miniscences of the family attainments of long
ago. Still others concentrate on building for
the future.
The value orientation of some families
reflects a striving for freedom of expression,
spontaneity and creativity. Others emphasize
discipline, duty and self-control. Occasiona
lly such families reveal a profound defensive
antipathy to pleasure. They fear it as a
dangerous contamination.
In some families the dominant value ori
entation is to power, status and money.
Family relations are structured according to
a hierarchy of prestige representations, mainly
moulded by the power position of each
family member, competition is intense. It is
each man for himself and the devil take the
hindmost. The striving is for success, what
ever the cost to the emotional health of
family relations.
In some families where such strivings are
defeated, the family epitomizes social degra
dation and failure. The members of such
families are contagiously invaded by the
atmosphere of family failure. They become
deeply identified with it. A sense of inferi
ority pervades the personal identity of the
8
members; in consequence of this they feel
profoundly ashamed of their families.
To contrast with this, there are families in
which the value * trends accentuate a bond
of family closeness, devotion, cooperation,
and sharing. Here the identity and value
orientation of individual and family are closely
linked. Strong trends towards family unity
may reflect a condition of positive emotional
health, or a negative, suspicious, defensively
toned value pattern which reflects a fear of
life.
In its positive aspect, family cohesion is
expressed in warm, close, cooperative family
relations.' This may lead to a strengthening
of its members and promote free and creative
personal development. In its negative aspect,
a compensatory and excessive barricading of
the family group may intensify the anxieties
of its individual members. It may enormo
usly magnify their perception of the outer
world as harsh and dangerous. Under such
circum stances, individual members of the
family may not derive a sense of protection
from the family closeness. Instead they may
be choked by it. Their excessive dependency
may be linked intensive resentment to
wards their families, which ultimately induces
a sense of alienation and disrupts family
unity.
Family Healing in a Troubled World
The disorders in society, caused by radical
changes include the combined impact of
technology, a state of continuous war, racial
conflicts, violence, the invasion of personal
freedom, the decline of humanistic and
spiritual values, and the loss of human con
nectedness.
Effects of Society's Disorders
From these influences emerge the ''mass
man", the orientation to power, manipulation,
acquisition, and a trend towards deperson
Medical Service
alization and the weakening of moral fibre.
People are being mechanized, dehumanized,
brutalized and rendered numb to the suffer
ings of others. They no longer seem to care.
Whereas fifty years ago the problem was to
much conscience, today it is not enough
conscience.
The malady of the modern family shows
itself in many ways 1. A form of family
anomie, reflected in a lack of consensus on
values, a disturbance in identity relations and
a pervasive sense of powerlessness. 2.
Chronic immaturity, the inability to assume
effective responsibility, and an impaired
potential for viable family growth. 3 Dis
continuity and incongruity in the relations
between family and society.
The pollution of the social environment
magnified the forces of fragmentation and
alienation in family relationships. The yvork
pressures of contemporary society remove
the man from his family. The conflicts of the
community divide husband and wife, parent
and child, parent and grandparent, parent and
teacher, parent and community leader. There
are rising complaints of feelings of emptiness,
meaninglessness, loneliness, despair, and
deadness. In alienated persons, the incid
ence of delinquency, addiction, mental
illness, violence, and suicide are rather high.
Conflict of Social Forces
Charles Peguy states gloomily that
modern society debases the dignity and
values of life. The social patterns of the
modern community are in an acute state of
flux. There are clashes of social forms and
ideals everywhere about us. On the gloomy
side we might consider the statement of Char
les Peguy : "The modern world debases. It
debases the state, it debases man, it debases
love, it debases the family. It even debases a
particular kind of dignity, the dignity of death"
On the more optimistic side, we might point
May-June 1984
to the social participation and protest of our
youth. Disregarding the actions of a minority
we might look with pride at the dignity,
determination, intelligence, and idealism of
the major segment of our nonviolent, protes
ting youth. The youth of our times live out
both sides—the healthy and the pathogenic
elements of our patterns of family, society,
and culture. In short, youth does not want
to adapt to a sick society. It wants to change
it.
Lines of Defense
What is involved here is a progressive
shift from the rational to the irrational, from
the appropriate to the inappropriate, in the
coping with danger. When the equilibrium
of man and society falters and fails, there is
a forced movement towards deeper levels of
irrationality and more destructive patterns. In
our social fabric we are in danger of moving
into the third and fourth lines of defense.
Helping Processes
It may be pertinent here to list some of
the self-healing family trends :
1. A shared search for suitable solutions
to conflicts in family relationships.
2. A strengthening of family unity, inte
grity and functional competence through an
enhancement of the bond of love and loyalty,
and with this a consolidation of sound
family values.
3. Mobilization of external support for
family unity, stability and growth through
community and social service like religious
guidance, psychotherapy, marriage counsel
ling etc.
4. Reintegration of family role relation
ships through the tightening of the family
organisation : rigidification of authority,
sharper division of labour, constriction and
compartmentalisation of roles.
9
Some daye
your patient's life might depend
upon this equipment
• Specifications
• Versatile
Suitable for closed and open circuit anaesthesia
and post-operative recovery and ward
applications. Available with PEEP and fresh gas
inlet valve.
• Main Features
Simple to use—three manual controls
All controls continuously variable
Inflation pressure up to 70 cms H2O
Detachable patient circuit operated by
servo gas, oxygen, and medical air
LOW CONSUMPTION (3 LITERS/MINUTE)
Minute volume 2 to 20 litres/minute
Tidal volume 0 to 1250ml/minute
Inspiratory Pressure 0 to 70 cm H2O
Inspiratory Flow 20 to 120 litres
• Characteristics
Inspiration : Flow Generator volume preset
Cycling to Expiration : Volume with Pressure '
Override
Expiration : Pressure, generation atmoshphere
or positives with PEEP valve
Cycling to Inspiration : Time
• Manufactured by Medishield and marketed by IOL
• Service facilities provided
Freely available from IOL
Medishield1
I*
Oxygen House, P 34 Taratala Road, Calcutta 700 088
A member of The BOC Group
V V898 W 90
Indian Oxygen Limited
Contact your nearest
IOL branch for details.
5. Reintegration of family role relation
ships through a loosening of the family or
ganization : dilution of the family bond,
distancing, alienation, role segregation; thin
ning of the border between family and com
munity and displacement of family functions
from inside to outside.
6. Realignment of family relationships
through splitting of the group and scapegoa
ting of a part of the family.
7. Reduction of conflict and danger
through avoidance, denial and isolation.
8. Reduction of conflict and danger
through compromise, compensation and
escape i.e. sexual escapades, delinquency,
alcohol, drugs and so on.
Family healing encompasses a wide range
of restitutive, regenerative forces in family
life as these occur in nature. In essence,
these forces are spontaneous self-healing
processes. There is a significant healing pot
ential in such events as family gatherings,
religious observances, rituals of confession,
and atonement, feasts, festivals, games
music and dance, initiation ceremonies, wedd
ings, deaths and the rituals of mourning. The
healing potential in these events pertains to
the family within the community and to some
version of the extended family integrated into
the community, but not to the nuclear family
in isolation. Family therapy, on the other
hand, refers to a systematic method of pro
fessional intervention on the multiple, inter
locking emotional disorders of a family group.
As a professional procedure, it tries to cata
lyze an optimal expression of the natural selfhealing processes of family life.
May-June 1984
Conclusion
The family is surely here to stay but must
find a creative rebirth. This change in family
living can happen only within a larger change,
a creative rebirth of the entire social
community.
In the last analysis, the only real test
of a healthy family within a healthy com
munity is its orientation to the problem of
values. The major question is, now to move
away from an orientation to power, acquisi
tion, and a master-slave pattern of exploita
tion to a humanistic set of values : for life
not against life, for peace not for death and
destruction, for respecting the dignity and
worth of all persons, regardless of race, col
our or creed, for sharing and cooperation, not
destructive competition;
for
openness,
honesty and intimacy in human relations, not
isolation and alienation, for recognizing the
creative values of differences not fostering
prejudice and violence, for a meaningful place
and function for youth and for senior citizens
in society; and for a relevant educational
programme that promotes growth and fulfil
nient in the new world. Within the super
human universe, we must try to create human
cells, teams, groups, and neighbourhood
groups, which join people through common
goals and activities. Within such groups we
must nurse a new kind of connectedness
and mutual caring.
Courtesy:The First International
Congress for the Family
of Asia and Australia
11
Disability Versus Employability
P.C. Hurkat
[Society does not go unpunished for its
irrational and prejudiced attitudes towards
the disabled. The economy suffers to the
extent that the skills of a part of humanity
go untapped and unutilised. The relatives,
friends and social welfare institutions
must supplement and supplant the
reduced earnings of the disabled, besides
bearing extra medical and personal care
expenses—ail at a cost to society. What
a different picture would it be if the dis
abled were employed, whether possible,
on their meritsl]
Man is a physical being and therefore
anatomical perfection within the range of
normalcy has been one of the main criteria
for fitness. Outward appearance in terms of
well-developed muscles, complexion, pro
portionate development, etc., are still con
sidered important assets in terms of social
acceptability. Any defect in body perfection,
viz., deformity, loss of limps, loss of vision,
incapacity to hear or to speak, etc., often
lead to certain complexes which produce a
sense of incompleteness and overwhelm the
sufferer from remorse, guilt and rejection.
The disabled, therefore, tend to lose their self
confidence and suffer at physical as well as
mental levels.
Adding insult to injury the employers
equate physical disability with helplessness
and total dependence on others. They do
feel sympathy but hesitate to give them
employment since they consider them unfit.
Employers in private and public sectors
believe that giving employment to physically
handicapped involves higher cost by way of
i ncreased compensation expenses or inflated
12
medical and insurance premiums. They agree
that disabled are more reliable and honest
but they fear involuntary absenteeism, poor
turnover or productivity and lack of flexibility
in job assignments. Studies on job perform
ance in India and abroad have proved that
their views are irrational and discriminatory.
The author admits that disabled do suffer
from lack of flexibility in job assignments
because they have limited openings and capa
city for certain jobs. This deficiency is,
however, more than compensated by their
insensitiveness towards diversifying stimuli
and more concentration on the work in hand.
If they are given the right job after proper
training, they will rarely do mistakes, and
with proper incentives and encouragements,
productivity can be made to increase.
.Loss of manpower: These facts are often
overlooked under the cloud of prejudice—the
attitudes which have become facts of life,
and difficult to change. The employers prefer
able-bodied. These unhealthy attitudes are
the main cause why disabled workers have
lower earnings and lower labour force parti
cipation rare. A study in the USA revealed
that the mean annual earnings of disabled
workers are roughly 7/10 as compared to
those of non-disabled, and a household with
a disabled adult must go with 1/3 less income
than other households. Behind bleak figures
lie untold personal misery, resulting from the
loss of work status and independence. These
data are the facts of life in all countries—
developed or underdeveloped.
The society does not go unpunished for
its irrational and prejudiced attitudes towards
the disabled. The economy suffers to the
Medical Service
extent that useful skills go untapped and
unutilised. Relatives, friends and social wel
fare institutions must supplement
and
supplant the reduced earnings of the disabled
besides bearing extra medical and personal
care expenses—all at a cost to society. For
example, it was found that 2.5 million dis
abled were receiving disability benefits in the
USA. No such figures are available in India,
but the cost in terms of loss of manpower
and relief must only be colossal.
Give them a chance : Activity limitation
survey amongst disabled and nondisabled by
Social Security Administration, U.S. Depart
ment of Health, Education and Welfare con
ducted some time ago revealed that about
4/5 of the disabled suffered from some
physical limitation 2/5 had trouble in walking,
3-5 in lifting more than 10 pounds; half
could not stand for long periods or had diffi
culty stooping and kneeling. The majority of
persons with such physical impairment were
disabled, especially those who had trouble in
walking or reading. The disabled also were
more frequently the victims of multiple limita
tions. It is, therefore, a fact that disabled
cannot function as well as their non-disabled
counterparts. But the fact is that given
proper education, training, encouragement
and, above, all, proper adaptive skills and
implements, most disabled, even with serious
conditions of multiple functional handicaps,
are not only able to work, but work effici
ently. History is full of names of several
handicapped who reached the highest ladder
or proficiency in the fields of cultures, art,
science and politics. The author has written
several articles and a book despite substanti
al loss of function in his lower extremities
and spine (100%). Besides having standing,walking, climbing, sleeping, sitting, stooping
and kneeling difficu Ities, he cannot remain in
chair for more than an hour at a stretch, and
often suffers from tantrums of backache,
shooting in legs and or arms. It has to be
May-June 1 984
duped by bouts of pain killers, shortwave
diathermy and hot foamentations.
The Government of India and the State
Governments have definitely taken steps in
this direction, and special employment ex
changes have been established across the
country for exclusively catering to the
employment needs of disabled. The normal
employment exchanges are also rendering a
helping hand in this task of national impor
tance. However, they have not been able to
do much. It is extremely shocking to note
that most States could not give employment
to not more than two physically handicapped
out of a hundred applicants. This is so,
despite the proclamation that most States
have reserved 2-3% posts in civil services
for them. The employment exchanges cannot
be blamed for this dismal picture of utter
failure. The real guilty are the employers.
They reject them on one pretext or the other,
not once, but several times. The employers
must look for abilities over disabilities and
worthiness over worthlessness in the physi
cally handicapped and give them the jobs
which they can perform without jeopardising
the efficiency. This may need a little resch
eduling, alteration and modification of equip
ment, but it is an absolute truth that they can
do some jobs without loss of efficiency.
What is desired is rightful use of their residual
abilities. It is not the plans and policies but
their speedy implementation which can give
them relief. It is probably with this back
ground that Vocational Rehabilitation Centres
(VRC) were started in the country. These
Centres cater to the needs of clients who are
orthopaedically handicapped with substantial'
loss of function, blind and deaf and or mutes.
While Vocational Rehabilitation is the ultimate
goal of these Centres, they also help them
through a package of services. They evaluate
their physical and mental skills and capacities
in order to find out their suitability for
various types of jobs through psychological
13
and workshop evaluations; make available
expert medical advice to improve their physi
cal handicaps with progressional appliances,
arrange vocational training programmes with
stipend and an all out effort to place them in
suitable jobs or prepare them for self
employment.
Restoring lost productivity: An ideal
vocational rehabilitation seeks to restore lost
or stunted productivity, thereby increasing
earnings, independence and well-being of the
disabled and reducing the need of public
support. To achieve these goals medical,
prosthetic, psychological counselling, voca
tional training, work experience, placement,
etc. are combined. These Centres, therefore,
work on the notion that the efforts will
improve employability and result in long term
benefits to society and individuals.
The data are disappointing and reveal a
dull picture of social scenario of handicapped
in India, The employment profile of blind
and deafmutes is by far the most gloomy.
The lion's share goes to orthopaedically
handicapped. This fact is further attested by
latest revelations of Calcutta VRC which has
so far evaluated 2,370 clients and rehabilitat
ed 500 orthopaedically handicapped, 167
deaf-mutes and 72 blind persons through
training, self-employment and paid jobs.
The working of rehabilitation programme
is no better in developed countries either. An
analysis in the working of vocational rehabili
tation centres in U.S.A, had revealed that 3/4
of the disabled who had received rehabilita
tion services felt that the services had helped
in some way as improving mobility, self-care
capacity, self-confidence and employability
but it is only 11% of the clients who could
actually get the jobs because of their training
and assistance. Most of them felt that much
time was spent in arranging services and
processing paper work rather than providing
help and guidance. The public funds spent
14
by way of salaries and other benefits on the
staff of special employment exchanges, social
welfare departments and national vocational
rehabilitation centres is, therefore, far more
in amount than the actual relief rendered in
the form of training of job placements. They
have thus become self-care and self-welfare
centres for the ablebodied themselves.
How can this malady be set right ? The
author suggests that 50% of the staff of
spe cial mployment exchanges, social welfare
departments and vocational rehabilitation
centres be recruited from amongst the phy
sically handicapped so that they can under
stand the problems of the disabled better,
besides generating employment for them.
These centres, must be run on the basis of
industry rather than an office and that they
must have less holidays and strict eight hours
working. They must develop a chain of
services in counselling, physical restoration,
education, maintenance, work adjustment,
placement, help in establishing a small busi
ness, social services and other aids. No one
should mistake that the importance of voca
tional rehabilitation does not He in combating
the consequences of disability but in restoring
tha residua! abilities. It aims at inducing
self-confidence and self care activities and
above all in creating self-awareness about
their abilities, worthiness and usefulness—
may be in a limited sense of term.
At the end of the queue : The disabled
population is however, at the end of the
labour queue in all lands and at all times
including that of India. In the circumstances
competitive employment is a distant unattain
able goal. Most severe mentally and physi
cally handicapped, therefore, need special
arrangements for preparing them for entry
into labour market. Advanced countries have
solved the problem by establishing a network
of sheltered workshops. They are truly the
last resort for giving employment to physi
Medical Service
cally handicapped with serious loss of
functions. They focus on unskilled, labourintensive work after proper training such as
packaging, bench assembly, wood working,
metal working, inspection, custodial work,
manufacturing jobs, reclamation, salvage
operation etc. India has not yet experienced
in this field. Sheltered workshops are indeed
indispensable and will go a long way in
ameliorating the difficulties of handicapped
for these are the final major component of
the rehabilitation system and provide employ
ment for those who have few options in the
competitive labour market. Sheltered work
shops are thus not only the employers of last
resort but also a source of service for those
most in need—welfare for workfare in its true
sense. The magnitude of services rendered
by sheltered workshops will be obvious by
the fact that they employed nearly 1 million
separate clients during the last decade in
U.S.A. While the manpower and veteran's
programme together reached about 500,000
handicapped in the same duration.
The government must, however, be cau
tious from the very beginning to see that the
employment programme designed for the
disabled may not become employment pro
gramme for the able bodied workers. It is
suggested that the ratio of the staff in shel
tered workshops must be 50:50 between
disabled and able bodied workers, and that,
they must work on the principle of industry
and commercial establishments. The products
and services created by these workshops
subsidised by the Government of India to
make them competitive and be sold on the
pattern of Khadi Gramodhyog. These work
shops must also provide non-vocational
services to the clients like developing skills
of independent living—such as personal
hygiene, speech therapy, homemaker training,
training in mobility, adult education, psych
otherapy, transportation, housing and home
bound employment. Such services by
May-June 1984
sheltered workshops will go a long way in
inculcating a sense of workfare and will wean
them away from public relief and charity. The
private sector employers can do a wonderful
job by providing suitable placements to the
physically handicapped in their industrial and
business establishments. Such an endeavour
will crack down on the age old prejudices
towards handicapped to conserve their profits
because the then Finance Minister had intro
duced a new clause ii (a) in Subsection (1)
of Section 36 of LT. Act during the budget
proposals for the year 1980-81. As a result
of this amendment, an assessee carrying on a
business or profession will be entitled to a
weighted deduction in respect of any salary
upto Rs. 20,000 per annum paid by him to
an employee who as at the end of the rele
vant previous year was totally blind or who is
subjected to or suffers from a permanent
physical disability, other than blindness which
has the effect of reducing substantially his
capacity to engage in a gainful employment
or occupation. The weighted education would
be allowed only if the employer produces
before the I.T. Office in respect of the first
assessment year for which the deduction is
claimed under this clause, in the case of an
employee who is totally blind, a certificate as
to his blindness from a registered medical
practitioner being an oculist and in the case
of an employee suffering from any permanent
physical disability a certificate from a regis
tered medical practitioner. The then Finance
Minister deserves a warm pat for a correct
step in right direction.
Right man for right job : Based on the
principle "RIGHT MAN FOR RIGHT JOB"
following jobs are listed for placement of
different categories of physically handicapped
by private, public and government sector
employees:—
1. Loss of Function in Lower Extremities;
These persons must be able to move about
15
with some sort of walking aids (a) Teaching
jobs in schools, colleges and technical institu
tions, (b) Research, data compilation and
processing, statistical evaluation, jobs requir
ing use of complicated machines and instru
ments, jobs in laboratories, etc. (c) Clerical,
executive and administrative jobs including
accounts, sales, etc. but they should entail no
or less moving about, (d) All skilled, semi
skilled and manual jobs requiring use of
upper extremities, but less or no moving
about such as liftman, compositer, proof
reader, relephone operator, salesman, water
man, typist, stenotypist, peon, clerk, account
ant, receptionist, electrician, plumber, cashier,
technician, tailor, painter, artist, moulder etc.
(e) Technocrats such as doctors, enginers
and other professional executives, judges etc.
temporary or permanent basis, (a) Fixing
stamps, putting seals, mail sorting etc., in
post office, (b) Writing addresses, counting
currency notes, checking of accounts, com
parison of statements, sorting and destruction
currency notes, typing etc. (They are thus
very useful for employment in banks and
reserve bank branches), (c) Liftman, photo
graphers, artists, tailors, gardeners, factory
workers, copying and composing jobs. (They
are most suitable for composing and printing
of confidential material) and all precision and
manual jobs, (d) Teachers in deaf and dumb
schools, (e) Factory jobs requiring collating,
stuffing, packaging, mechanical assembly,
inspection, salvage and reclamation opera
tions. (f) Custodial, wood and metal works,
weaving, knitting, hosiery, and skilled and
unskilled jobs are some of the other areas
where they can be suitably employed.
2. Loss of Function in Upper Extremities'.
These persons must have one useful hand.
There may be partial or complete loss of
4. Blind : Employment of blind persons
function in another hand or arm. (a) Teaching
is
a
real problem firstly because vision has a
jobs in schools, colleges and technical institu
very
vital role in man's life and his activities
tions. (b) Research data compilation, statisti
and
secondly,
because the capacity of one
cal evaluation in various categories of
blind varies considerably from that of another.
research institutions, laboratories, offices etc.
Music (vocational and instrumental), law,
but requiring little or no use of instruments
teaching,
journalism, general and business
or complicated machines or tools, (c) Clerical
administration,
physiotherapy, computer pro
and senior administrative executive jobs
gramming, stenography, telephone operators
requiring no or little use of instruments but
(using digital telephones) and public address
moving about, (d) Public prosecutors and
systems
are some of the professions where
government advocates, (e) Semi-skilled and
blind persons can be found very suitable.
unskilled jobs which can be handled with one
useful hand along with prosthesis in the other
No record and statistics are available to
hand such as liftman, waterman, proof reader,
reveal the quantum of disabled work-force
peon, clerk, accountant, receiptionist, artist,
currently under employment in India vis-a-vis
chowkidar (Ex-service man most suitable for
productivity, efficiency and lapses by way of
this job). Jobs requiring visual attention
absenteeism, accidents, poor.turnover, bloated
with one hand such as in factories where
medical bills, increased insurance compen
quality is to be checked at regular intervals,
sation, etc. excepting that one from Vijay
traffic control by observation and electric
Merchant, the ace cricket player, who employs
signals and delivery of instruction through
in total about 113 disabled workers (19 blind,
public address system.
20 deaf, 38 orthopaedically handicapped—
including 2 paraplegics, 10 mentally retarded,
3. Deaf Mutes : They may be very
suitably employed in the following jobs on
29 leprosy arrested and 3 cancer cured). His
16
Medical Service
experience is that disabled give equal pro
duction, good quality work and fewer
accidents.
Example from U.S.A. : Similar encourag
ing reports have come from U.S.A. General
Motor Company alone employs 25,000 dis
abled workers out of its total work force of
580,000. They most systematic and enco
uraging report is from Du Pont Company
which goes on to read. "Du Pont employs
more than one lakh workers in the United
States, roughly 15,000 of them are physically
handicapped. Their job titles range up and
down the corporate ladder from labourers to
managers.
So far as safety is concerned, 50% of the
disabled workers proved to be above average,
just 4% were below average. In attendance
79% were average or above. In job perfor
mance, rated by their supervisors, 37% came
out above average and just 9 were below
average," The study concluded that nature
of the handicaps did not prevent workers
from doing good job. Some of the best per
formers had the most severe handicaps. It is,
therefore, hoped that above cited authentic
reports, both from India itself and abroad,
are forceful enough to convince that if dis
abled persons are suitably employed in the
jobs which they can perform the productivity
and efficiency will remain optimum. It is
time that public and private sector enterpreneurs must shed their age old prejudice and
false beliefs so that they make forceful efforts
for providing more and better employment
to the physically handicapped. By doing so,
they will not only be serving Gandhiji's last
man in line, but also be involving in mam
moth cause of social reconstruction. This
will help them to save income tax on their
earnings on one hand, and will make them
the heroes—the torch-bearers for the future.
The light so lit will disperse the cloud of pre
judice and will illuminate the path for those
rejected by the society into a secure and
bright future.
Courtesy : Social Welfare
A House for Everything in Medicine & Surgery
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Scientific Appliances, Microscope
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Princes Street, Bombay-400 002
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May-June 1984
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Bringing Eyecare to Villages
S.
[Studies show that lakhs of people are
functionally blind in rural India on account
of cataract—a condition that is reversible
through surgical techniques perfected
over years, yet bulk of the people do not
get the benefit of surgery just because
they live in rural areas from where access
to these surgeons is difficult or they are
too poor to afford the treatment and
associated transport cost, food and the
like and, also due to a certain extent, fear
complex connected with the operation
and aftercare.]
Ramaswamy, working as a clerk-cumsalesman in a village cloth shop in Madurai
District for the past quarter century, had
been feeling that his eyes were letting him
down
gradually. One fateful morning,
feeling pretty depressed, he stopped going
to work. He had been the sole bread
winner of the family and the stoppage in
income was a severe jolt to his family. His
four children were still in the school stage
and to keep his family going he had to
pledge whatever he had, even his wife's
meagre jewellery.
Things went on like this for almost a
year and when his economic ruin was almost
complete, one fine morning he heard of a
free eyecamp, conducted by the Arvind . Eye
Hospital, Madurai, being held in the nearby
village school premises. He wasted no time
and went there.
the doctor who examined him said that
his vision has been impaired by cataract and
could be restored with an easy operation.
Ramaswamy did not anticipate such a thing.
Being financially broke, he hesitated and was
May-June 1984
Kannan
wondering what to do to meet the expenses
for the suggested surgery. Sensing his
predicament, the doctor assured him not to
worry and that he would be taken care of
fully. It was a blessing in disguise for
Ramaswamy. He gave his consent for under
going the operation and the hospital did the
rest. After another operation on the other
eye, he is no back at work and efficient as
before. The whole family is jubilant. He is
only sorry that he wasted so much time just
doing nothing to get back his sight. He
wished somebody had told him much earlier
so that his ailment could have been got over,
thereby preventing the associate hardships.
Well, this is not a stray case. It has been
the case with thousands of people in rural
India. There have not been much of concer
ted efforts to motivate the villagers, who
are often ignorant, skeptical apathetic to
seek the real remedy, which is actually with
in their reach. With a good chance to
restore the vision, in most cases, should they
be allowed to be depressed and remain
blind throughout the rest to their life, as a
burden to their relatives and society, certai
nly not. Our villagers have taken to modern
farming methods and are capable of taking
good care of their work animals and even
their bicycles, sprayers and pump-sets. They
should not be allowed to neglect their per
sonal faculties as well.
Recent estimates show that about 90
lakhs of people are functionally blind in Rural
India due to cataract—a condition that is
reversible through surgical techniques that
have been perfected over the years, yet bulk
of the people do not get the benefit of sur
19
gery because they live in. rural areas from
where access to an eye doctor is difficult oi;
they are too poor to afford the treatment and
associated costs of transport, food, etc. and
also due to a certain extent, fear complexes
connected with the operation and aftercare.
Fortunately the concept of eyecare has
changed over the years and today the eye
hospital is no longer an isolated ivory tower,
confined to the urban elite. It is today very
much an integral part of community pro
gramme, according to Padmasri Dr. G. Venkataswamy. Founder-Director of the Arvind
Eye Hospital. Necessary help is rendered
at the rural doorstep, where the problem is
acute
To alleviate the problem, the Government
and several private organisations have been
organising free eye-examination and opera
tion camps in villages. The Tamil Nadu
Government had fixed a target of one lakh .
cataract operation during 1983-84 in the
state.
The eye camps, organised by the Arvind
Eye Hospital, ever since 1977-78, have been
unique in many ways. In all their camps
there is an active community participation.
Service organisations like the Lions club.
Rotary club, Bhagwan Sri Sathya Sai Seva
Organisations arrange for these camps and
enlist patients through propaganda. The
hospital proposes to do 15,000 free cataract
operations this year. The hospital bears the
entire expenses towards surgery, medicines
and period of stay for the operation, while
the service organisations provide the patient
with spectacles and a food allowances amouuting to Rs. 25 per head, besides meeting
the transport cost for travel to Madurai and
back. The average length of stay at the
hospital for the cataract patient is seven
days.
A beehive of activity, the hospital is run
by the Govel Trust, a non-profit charitable
20
organisation founded in March 1976 by the
former professor of Ophthalmology, Madurai
Medical College, Dr. Venkataswamy. The
object of the Trust is to establish and run
hospitals to end need less blindness. Star
ted with a 20 bed facility it is today a
modern building with 300 beds, totally
costing Rs. 60 lakhs.
The hospital has the infrastructure for all
types of sugery including surgery to set right
retinal detachment, catract and glaucoma,
vitrious surgery, corneal grafting, physical
and surgical correction of squint and opthalmic plastic surgery. It had modern imported
equipment so that the ophthalmic care given
to every patient will be the best.
As an adjunct to the main building
another five-storey 300-bed free hospital is
nearing completion. The new unit will be a
three - in - one institution, viz., hospital,
research centre and training wing. Research
projects are proposed to find out how best
they can improve the delivery of, eyecare to
the rural people, how to plan and provide
eyecare facilities; and above all how to moti
vate the patients to come forward to utilise
the facilities—
It will also train rural people as health
educators who will ultimately organise the
rural eyecamps and motivate their suffer
ing bretheren to get rid of their malady in
time.
The hospital has bus and three vans for
the medical team to visit the village and also
transport patients to and from the hospital.
Free rural eye screening camps are almost
a daily routine and the people who need
operations are brought to the main hospital
for surgery. Surgery camps are also condu
cted where there are great number of cases.
During 1982, they conducted 214 eyecamps,
treated over 40,000 patients. Several service
organisations give a helping hand in the
restoration of sight to the poor.
Medical Service
The Royal Commonwealth Society for the
Blind, U.K., supported 132 camps where
30,608 patients are treated and 5,348 oper
ations performed.
Diwaliben Mohanlal
Mehta Charitable Trust supported 82 camps
where 19,423 patients were treated and
3,399 cases operated. In addition to these,
several industrialists, rural organisations,
colleges and schools helped the hospital in
arranging these camps and providing shelter
to the patients.
In one of the most ambitious programmes
in December 1982, the hospital conducted
a free eyecamp in the Maidive Islands. The
camp was organised under the auspices of
the World Health Organisation. The Medical
team camped at Kulhudufusshi, a long boat
journey from Male for the team of three
doctors, four surgical scrub nurses, one
refractionist and one theatre assistant.
The team led by Dr. (Mrs) G. Natchiar.
Senior Medical Officer, examined about
1,800 patients and performed about 250
operations during its stay. The camp was
conducted to serve the 62 northern—most
islands, covering a population of 33,619.
The entire exercise took an enorous amount
of organisation and care of minute detail
both in Madurai and in the Maldives. The
hospital has plans for two more such camps
and it has also a proposal to bring Maldi
vians to the main hospital to be trained as
ophthalmic nurse or assistant who can work
in the islands in community—oriented pre
vention of blindness programme. <
Opening of satellite clinics is also an
important programme the hospital is contem
plating to reach out to the masses. After all
the eyecamps, temporary in nature with a
limited service facility, cannot go on for
ever. Already the hospital bestows its tech
nical service to Seethalakshmi Hospital at
Gobichettipalayam (Coimbatore District) and
the Blisy Hospital at Udhagamandalam (in
May-June 1984
the Nilgiris). A branch hospital and a peri
pheral clinic are functioning at Theni (Madu
rai district) and Sankarankoil (Tirunelveli
district).* The hospital is to set up 30 more
satellite clinics spread all over Tamil Nadu.
Each will have an operation theatre, a cent
ral fertilisation room, an out-patient clinic,
30 beds for paying patients and 30 beds
for free patients.
These satellite clinics will serve as a base
for conducting camps in remote villages for
screening eye patients and bringing them to
the clinic if surgery is needed. They will also
facilitate regular and better follow-up care
and also cut transport cost for the patient
and medical team.
The hospital is diffusing ophthalmic
knowledge far and near. It is affiliated to
the Madurai Kamaraj University to conduct
two-year diploma courses in ophthalmo
logy. It is also recognised by the National
Medical Board to train candidates to become
members of the Academy of Medical Scien
ces in ophthalmology. The Indian Medical
Council has recognised it to train senior
house surgeons. It is also a centre for
research leading to Ph. D. of the Madurai
Kamaraj University.
The W.H.O. chose the hospital to offer
training for a batch of 10 Nepalese last year
to become ophthalmic assistants. After
training ‘they have returned home and this
year another batch of 10 Nepalese have
come for a similar purpose.
In .fine, the Arvind Eye Hospital has
earned a name in a short span of less than a
decade since its inception and it has become
a force to recon with in the field of rural
ophthalmology, thanks to the foresight,
visionary and missionary zeal exhibited by
the nearly two dozen doctors and over 100
para medical staff. It is waging a silent but
determined war on blindness. It is certainly
the cynosure of all eyes.
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PEOPLE, PILLS AND PRESCRIPTIONS-1
The Drug Dilemma
—Ravi Narayan
The CHAI's goal has been and will always
•be a 'Healthy Community'. In our new
vision, we seek 'to promote social justice in
the provision and distribution of health care'.
With the increasing emphasis on "Primary
Health Care" we are all in an increasingly
important quest for PRIORITIES. We have
to seek "clean water before antibiotics, food
before vitamin pills, vaccination before kidney
machines, mother's milk before powdered
baby foods mixed with dirty water, and health
for villages and slums before more hospitals
for the affluent suburbs of capital cities".
The dilemma before many of our members is
how to shift priorities from our historical
commitment to hospital systems to our new
vision of community health care.
One of the big problems we are facing in
our hospitals is the INCREASING COST OF
DRUG BILLS. Drugs are becoming the main
stay and main cause of expenditure in our
hospital system. Any shift of priority can
only result from a concerted action on our
part to look at drug policy and drug costs.
We have to see whether we can as a group
of voluntary health workers, do anything to
reduce the drug bills as a first step towards
shifting priorities. Can we change our
prescribing policies ? Can we stock low
cost drugs ? Can we produce lowcost
drugs ?
The ICMR/ICSSR study on "Health for
all—an alternative Strategy" warns us that
'"eternal vigilance is required to ensure that
the health care system does not get medicalised, that the doctor-drug-producer axis does
May-June 1984
not exploit the people and th at the abundance
of drugs does not become a vested interest
in Hi health".
Can CHAI Members do anything
about this individually and collectively?
To find an answer to this growing pro
blem, we are starting a column on drug issues
in the Medical Service, to discuss some of
the following matters :
* The pattern of drug production should
be oriented to the disease pattern in
India, with an emphasis on the produc
tion of essential and basic drugs. If we
agree, what can we do about it ?
* We cry for drugs needed by poor and
underprivileged groups which should be
produced in adequate quantities and
sold at cheapest possible prices. How
may we bring about this ? What has
been the experience of the Central Pur
chasing Service 1
* One of the most distressing aspects of
the health service today is the habit of
doctors to overprescribe or to prescribe
glamorous and costly drugs will limited
medical potential. Can the medical
profession in our hospitals be made
more discriminating in prescribing
habits ? Can we commit ourselves to
rational therapeutics ?
* The small scale drug industry needs to
be encouraged and expanded subject
to strict quality control. Can we pro
duce low cost alternative in our hos23
mittee on Drugs and Pharmaceutical
Industry (1975) believes that health
needs can be met by only 116 drugs.
Can we agree to a simple standardised
low cost pharmacopia for the Voluntary
Health Sector ?
* A Government Committee looking at
drug costs has recommended accep
tance of
— A basic drug list
— Generic Prescribing practice
— Bulk purchasing
— Local formulations
— Use of indigenous drugs
AMD
Taken separately; each policy is a power
ful weapon for change; taken together, they
build into an integrated strategy. Can we
consider these and accept them to change
the drug scene in our hospitals ?
SEND
DRUG COLUMN
MEDICAL SERVICE
C.H.A.I., C.B.C.I. CENTRE
NEAR GOLDAKKHANA
NEW DELHI-110001
pitals, health
projects
and
village
communities ?
* Thirty thousand branded drugs are on
sale in India. But a Government Com
May-June 1984
* Do you know that drugs banned all
over the world are still prescribed in our
hospitals ? The Government has already
banned 34 combinations. We need to
join movements to ban many more for
the sake of our people.
All these issues will be discussed in this
column.
25
CHAI
NOTES
NEWS
Community Health Development of CHAI
Review its Plan of Action
After nearly an year, the Community
Health Department of CHAI again met
together at St. John's Medical College,
Bangalore, from 19th - 27th May, 1984 to
review the plan of action based on the philo
sophy and vision of Community health which
was formulated last year. The following
persons were facilitators during the Session.:
Prof. George Joseph, Fr. Stan Lourduswamy,
Fr. Claude D'Souza, Mr. Rudy Lobo, Drs.
Ravi and Thelma Narayan, Mr. Augustin
Veliyeth and Mr. R.T. Rajan. The main thrust
of the discussion was the role of CHAI's
CHD as a national organisation. It was the
common consensus that CHAI's CHD should
strive to make Community Health a national
movement rather than limittihg its scope to
train some groups. Hence it was felt that
CHAI (CHD), being a national organisation
has to share the CHD vision with the nation
to make Community Health a movement,
instead of concentrating on activities which
could be carried out by other individuals and
organization at various levels who could be
the future partners of CHAI (CHD).
The sharing of the vision consists in
exchanging discovering, appreciating and
promoting the same vision in the health and
development activities and movements going
on in various parts of India. It also means
learning from each other as friends and
equals assuring solidarity for one another.
This kind of sharing can be achieved only by
working with (and through as many indivi
duals, groups and organizations as possible.
Only through this way CHAI (CHD) can
facilitate a national health movement.
With this understanding, we envisaged
the following objectives and strategies
26
General objective : Sharing the vision to
make 'Community Health' a national move
ment.
Specific objectives
(i) To get the vision across national
bodies as Catholic Bishop's Conference of
India (CBCI), Conference of Religious of
India (CRI), Caritas India, Catholic Relief
Services (CRS), Indo German Social Service
Society (IGSSS), Indian Social Institute (IS!)
Voluntary Health Association of India
(VHAI), Central Health Education Bureau
(CHEB), Indian Medical Council, Ministry of
Health (Govt, of India), Central Social Wel
fare Board (CSWB), Indian Federation of
Medical Guilds, Catholic Nurse's Guild of
India (CNGI), Medico‘Friends Circle (MFC),
Participatory Research in Asia (PRIA),
People's Institute for Development and
Training (PIDT) etc.; media like AIR & TV,
News agencies like PTI, UNI, etc,, CHAI
member institutions, State Ministries of
Health and education, health directorates.
Diocesan Directors, Heads of religious for
mation houses, various action groups. In
short all those who are interested in People's
development.
(ii) Identify partners who share similar
vision—individuals, voluntary agencies and
action groups.
Strategies : The following strategies are
to be worked out by the Central (CHD) team
or with the partners or through the partners.
(a)
By the Central (CHD) team :
(i)
Identifying partners either thro
ugh correspondence or personal
contacts.
Medical Service
(ii) Research, Documentation, Dis
semination through publications
and other media.
(b)
5. Getting across the
regional languages:
— Translation of the vision, important
Church documents the National
Health Policy, etc. into at least 6
languages as Hindi, Oria, Telugu,
Kannada, Tamil and Malayalam.
With partners :
(i) Seminars, Workshops
(ii) Consultation, Evaluation, Plan
ning
(c)
— Visual presentation of the vision
through mobile exhibition and
through printed materials that can
be sent by post.
Through partners :
(i) T raining Programmes
(ii) Demonstration — etc., bringing
on a common platform organi
sations, groups and individuals
sharing a similar vision on health
and development and promoting
joint action in selected areas.
These are proposed to be carried out
through a time bound three year plan.
Specific Plan for 1984-85
1. Identifying member institutions with
Community Health Programmes. This will
be done through sending communication to
individual institutions by means of a ques
tionnaire.
2. Identifying groups and individuals who
could be the partner of CHAI (CHD) from
already existing informations collected by
agencies as Caritas India, ISI, IGSSS, CRS,
Solay, NFC, etc. Besides these concentrate
on at least two regions in the coming year
for collecting detailed and comprehensive
informations.
vision through
— Audio-visual exhibition on drug
issues.
6.
Staff Development Programme :
— The existing annual evaluation and
study session, which normally falls
around the month of May.
— Three other meetings at the team
level for sharing, study, evaluation
and planning.
Tentatively they
were fixed to be in the months
August, October/November, and
February.
— Weekly meeting of the team for
half day at least, during which each
one can share their work and - the
information received Jrom books,
journals and different persons or
groups. This session could also
form as part of an ongoing study,
evaluation and planning pro
gramme.
— Attending useful short term courses
seminars etc. depending on the
3. Organise regional workshops, atleast
interest and needs of each team
four, for member institutions and possible
member.
partners, where they can meet, exchange
views and develop links for effective colla
7. Existing programmes : Though in the
boration in future.
light of the present understanding and in
4. Organise two Zonal Workshops for tune with the general long term action plan,
diocesan health co-ordinators who were ap
the type of involvement of the team will be
pointed at the request of CHAI.
different, the existing programmes will have
May-June 1984
27
to be continued. Even afterwards, the pos
sibility of taking up similar Training Pro
grammes in the future is not completely
ruled out.
As we are aware that any movement can
be only at the people's level we plan to
join hands with any one who is interested
in people's growth and development.
Fr. John Vattamattom, SVD
Executive Director, CHAI &
Secretary, Health Section of
the CBC1 Commission for
Justice Development and
Peace.
President of World Health
Assembly Stresses Importance
of Political will
Speaking of the goal of Health for All by
the Year 2000 Professor Guillermo Soberon
Acevedo, President of the 37th World Health
Assembly, declared that "there has never
been in the history of humanity a concerted
effort on such a scale to achieve higher levels
of well-being. It may be added nevertheless
that the importance of this initiative by the
World Health Organisation has been paralleled
by the effort made in the field to achieve
this goal." In this year of 1984 we are
coming ever closer to the year 2000 which
the countries of the world, joined together in
the World Health Organization, have chosen
to make a substantial step forward for the
benefit of all peoples of the world : namely,
to ensure that they enjoy a state of health
compatible with an
agreeable life and
adequate social and economic development.
This goal, although possible, is not one that
will be easy to achieve. Nevertheless, the
difficulties which are being encountered can
only spur on the determination of those who
are participating in this task."
‘"Political will on the part of governments
is indispensable." Professor Soberon Acevedo
added. "They must realize, "he said, '’that
in order to meet popular demand in regard to
28
health, must be conceived as a social
objective of deep significance and political
importance."
WHO Director-General Calls for
Imaginative Management
Introducing his biennial report of the work
of WHO in 1982-83, the Director-General,
Dr. Halfdan Mahler, called for imaginative
management : "In reality, what is required is
imaginative management to orchestrate the
never ending arduous tasks that have to be
performed—by Ministries of Health and
related social and economic sectors; by social
security organizations; by Universities and
research and development institutes; by
people in all walks of life as facilities, health
centres, hospitals and laboratories; and by
storehouses, factories and the like. In this
gigantic human beehive each and every indi
vidual and institution has a specific role to
play—planning and identifying priorities in
such a way as to bring epidemiological needs
and social preferences into line with each
other; in allocating resources; in deciding on
the most appropriate technology; in taking
preventive action; in providing care. Yes,
even keeping health centres and hospitals
clean and shining; without that nobody will
have any faith in them."
"Permeating all that is the information
and education of people and the everlasting
training, training and training again of health
workers for the specific jobs they have to
perform; and ensuring that they are provided
with conditions that will be sufficiently attra
ctive to recruit them to the service and keep
them there and yet be commensurate with
the social and economic realities of the
country and the community in which they live
and, hopefully, serve. I realize fully well that
all of this is easier to preach from this plat
form than to practice in real life. But that
practice is the real challenge : more repeti
tions of the sermon in countries and in WHO
will get us absolutely nowhere."
Medical Service
Editorial Board of our Journal
Medical Service meets at
Bangalore
was commissioned to do the needful in this
regards.
Doctors Commit to Rural Work
The meeting of the Editorial Board of our
journal met at St. John's Medical College,
Bangalore, on May 18, 1984. The meeting
reviewed the situation and it was felt that
our journal should be made still more attrac
tive and informative. It was decided to start a
new column on drug issues moving towards
a rational drug policy.
Another point discussed was the popula
1
tion issue. This being the population year,
where, under the auspices of our journal the
various moral and ethical issues of popula
tion problem could be studied for the benefit
of all. Fr. John Vattamattom SVD, the Editor
_
=~_»V(.dl4/?SW
Under the auspices of CHAI and St.
John's 2 days sharing session by the doctors
who have done or still doing the rural place
ment, after their studies in St. John's Medical
College, was done on 19th and 20th May
1984. Twenty doctors coming from various
parts of the country and some of the alumni
staff of St. John's participated in the dis
cussion. Dr. Ravi and Thelma Narayan and
Fr. Claude D'Souza were the facilitators. The
discussions ended on a very positive note
and with number of very valuable sugges
tions. A more detailed report on this will be
published later on.
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29
been haphazard and the impact
has been little. We need sys
tematic CME, within the reach
of all health professionals.
Continuing Medical Education
What is it ?
Why CME ?
Has there
been CME ?
30
—Medical Education is contin
uous and life-long; CME is that
part of medical
education
which follows formal under
graduate and postgraduate
medical education. Unfortun
ately, there has been a tend
ency to divide life into an area
of "Iearning"—the first 20-25
years, and "doing"—the follo
wing 30-35 years. This compartmentalisation is wrong.
Learning has to be "by doing"
and "while doing".
—CME is a must for all those
who want to be practising good
medicine. So, whether you are
a general practitioner, out in
the village or in a posh locality
in the city, or a specialist in
small hospital or Faculty mem
ber in a prestigious institution
(clinical or non-clinical) all
need CME. CME prevents our
slipping down, re-inforcing
what we had learnt and learn
ing what is new, updating our
knowledge, skills and attitude.
The need is so great that CME
has been made mandatory in
may States in U.S.A.
Yes; bits and pieces of CME
have been taking place all the
time. When you attend con
ferences or the programmes
prefixed or suffixed to them.
You do have some CME. Re
cently there have been pro
grammes arranged in posh
hotels in New Delhi, Bombay
and Srinagar. But these have
Present
Plans now :
There are two areas which
C.M.C., Vellore will be taking
up now :
(i) General Practice
<
(ii) Specialties
These programmes will
be aimed priority wise
at
(i) Alumni of CMC
(ii) Mission Hospitals
(iii)
Others
The urgent area is that of general practice.
The practitioner finds it almost impossible to
get away from his practice. Yet, the need
for updating knowledge, skills and attitude is
greatest here.
Correspondence Course
—The answer to the problem
is correspondence course (Dis
tance Learning). The material,
prepared by the Faculty of
C.M.C., Vellore is brought to
you by post, in 12 instalments.
They will give 'What is New
'and' What is Relevant' to the
Practictioner. The first book
let will be sent in the first
week of August, 1984.
How to join
—Write to the Co-ordinator,
CME, CMC Vellore-632 002
for details, enclosing a long,
self-addressed and stamped
envelope.
Medical Service
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LEGAL EDUCATION—8
On Your Rights if Arrested
P.D. Mathew
Your Rights if Arrested
The Constitution of India guarantees the
citizens' fundamental rights to participate in
the political life of the country and to express
themselves as political beings. But the free
dom is hedged in by many legal restrictions
by the police, bureaucrats and politicians.
Even legitimate activities of citizens may be
considered as infringement of the law. The
general ignorance of our legal rights is being
exploited by law enforcing agents of the
State and consequently violation of human
rights is increasing day by day at an alarm
ing proportion. The objective of this note on
Arrest and Bait is to raise the legal con
sciousness of the citizens with regard to
their rights when confronted by the.police
and agents of the judiciary.
Arrest of a Person
A person is arrested when a police officer
or a citizen takes him into custody or other
wise substantially deprives him of his free
dom of action so that he may be held to
answer for a crime or an offence. The police
in India do not have any power to detain
anybody for questioning unless he is arrested
with or without warrant.
demands, shall show him the warrant. He is
expected to bring the required person before
the Court without unnecessary delay.
Valid Warrant
A warrant of airest should be(i) in writing
(ii) signed by the presiding officer of the
Court and (iii) should bear the seal of the
Court. It should also contain the name of
the accused, his address and indicate the off
ence with which he is charged. If any of
these factors is absent, the warrant is not in
order and an arrest made in execution of such
a warrant is illegal. Warrants are of two
kinds:
i.
Bailable
ii.
Non-Bailable
A Bailable Warrant is a Court's order
which contains a direction that if the person
arrested executes a bail with sufficient sure
ties for his attendance before the Court, he
may be released from custody. In that case it
shall further state the number of sureties, the
amount of the bond, and time for attending
the Court. (Section 71 Cr. P.C.)
In ease of a non-bailable warrant the
direction for bail will not be endorsed on the
warrant.
Warrant of Arrest
Arrest without Warrant
It is a written order issued by a Court to
a police officer to arrest and produce an off
ender or to search his premises for a parti
cular thing. A police officer who exe
cutes the warrant shall notify the substance
■thereof to the person to be arrested and if he
A police officer has power to arrest a
person without warrant if he is suspected of
having committed a cognizable offence. Nor
mally* in non-cognizable offences a police
officer cannot arrest a person without a
warrant from a Magistrate.
32
Medical Service
In the first Schedule of the Criminal Pro
cedure Code (Cr. P.C.) offences have been
classified and enumerated as cognizable and
non-cognizable. The more serious offences
such as murder, rape, robbery, theft, wagin
war against the State etc. are cognizable.
When can a person be arrested without
a warrant ?
A person can be
warrant
1.
arrested
without
a
If he is concerned in a cognizable
offence or if there is a reasonable
suspicion, complaint or information
that he has committed a cognizable
offence;
2.
If he possesses implements of house
breaking;
3.
If he possesses stolen property;
4.
If he is a proclaimed offender;
5.
If he obstructs a police officer on
duty;
6.
If he escapes from legal custody;
7.
If he is a deserter from the army,
navy or air force;
8.
When he is out of India, commits an
offence punishable under any extra
dition law or under the Fugitive Off
enders Act;
9.
If he is a released convict who breaks
the restrictions imposed by the Court
on his movements;
10.
If he is suspected of preparing to
commit a cognizable offence;
11.
If he is a habitual criminal;
12.
If he, after commiting a non-cogni
zable offence in the presence of a
police officer, refuses to give the
police officer his name and address
May-June 1984
or has given him a false name and
address;
13.
If he is required by a police officer
of another police station who suspects
that he has committed a cognizable
offence;
How is Arrest made ?
Arrest is complete when there is submis
sion to custody by word of action and in such
a case touching or confining of the body of
the person arrested is not necessary, but
mere surrounding of a person by the police
does not amount to arrest (Sec. 46).
What happens if you resist arrest?
If you forcibly resist arrest, the police
officer can use all means necessary to effect
the arrest (Sec. 46). He can even cause your
death provided you are charged with an of
fence punishable with death or life imprison
ment. However, he is not justified in using
force more than necessary to obtain the arrest
[Sec. 46). Therefore, unnecessary restraint
or causing physical inconvenience; tying of
hands and feet are not permissible if there is
no necessity for doing so.
What are your rights when you are
arrested?
If you are arrested :
1.
You must be informed of the reasons
for your arrest (Fundamental Rights :
Article 22 and Sec. 50 Cr P.C.);
2.
You have a right to see the warrant
if you are arrested under warrant (See
75 Cr. P.C.);
3.
You have a right to consult a lawyer
of your choice. (Fundamental Rights :
Article 22 of the Constitution);
4.
You must be produced before the
nearest Magistrate within 23 hours
33
(Fundamental Rights : Article 22 of
the Constitution);
5.
You must be told whether you are
entitled to be released on bail, (Se.
50 Cr. P.C.),
Can you be handcuffed ?
According to the latest ruling of the
Supreme Court, normally an arrested person
should not be handcuffed unless he is violent
or he is a desperate character or he is likely
to attempt to escape or to commit suicide.
Arrest is not a punishment. Hence unnece
ssary restraints are not permissible, if there is
no necessity for doing so.
Search of a place entered by a person
sought to be arrested
Sec. 47 of Cr. P.C. Compels all persons
to afford to the police facilities for search in
a place for a person sought to be arrested.
Police officers have power to break open any
door or window to carry out a search and to
liberate himself or any person who is detain
ed inside a premises.
Search of an arrested person
A police officer has the right to search a
person only after he is arrested. After the
search the police officer must keep in safe
custody all the articles taken from the person
and give him a receipt for the same.
A search of an arrested female should be
done with strict regard to decency. A woman
can be searched only by another woman.
(Sec. 51).
•
Examination of arrested
medical practioner
person
by
A police officer not below the rank of a
Sub-Inspector may require an arrested person
to be medically examined if he feels that this
may provide evidence to prove the offence
(Sec. 53).
34
* He may use reasonably necessary force
to have the medical examination per
formed;
* The accused person can make a request
to the Magistrate that he had not com
mitted the offence (Sec. 54);
* A woman has a right to demand that
she be examined by a woman doctor
(Sec. 53 (2), 54);
♦ In cases of torture in police custody,
this provision of law must be taken
advantage of and the victim should
demand in the Court that he be medi
cally examined to prove torture by the
police.
Detention of an arrested person
Article 22 (2) of the Constitution lays
down that every person who is arrested and
detained in custody should be produced be
fore the nearest Magistrate within a period of
24 hours of such arrest exclusive of the time
necessary for the journey from the place of
arrest to the Magistrate's Court. However,
Sec. 167 of the Cr. P.C. vests the power in
the Magistrate to authorise the detention of
the arrested person for more than 24 hours,
if the investigation cannot be completed
within that period. In no circumstances can *
the accused be detained in custody for a
moment more than twenty four hours with
out a special order of a Magistrate who can
order his detention for a term not exceeding
16 days on the whole. At the end of 15
days he must be produced before the Magis
trate. If there are adequate grounds for fur
ther detention in judicial custody (jail) he
can pass an order to that effect, for a period
not exceeding 15 days. But the total period
of detention cannot exceed 60 days, whether
the investigation of offence against him has
been completed or not. The order of a
Magistrate sanctioning the detention for an
indefinite period is illegal. If the accused is
Medical Service
not able to furnish bail during the stage of
investigation he may be detained in judicial
custody beyond 60 days. In case of a nonbailable offence the arrested person may be
kept in jail until the trial is over.
Search Warrant
Search Warrant is issued by the Magis
trate for the following purposes :
.
* For the recovery of a document or thing
which may not be produced in the
court otherwise;
* For search of a house suspected to con
tain stolen property, forged documents,
etc;
* Seizing any publication banned by the
government;
♦ For discovery of a person wrongfully
confined.
A search warrant gives the power to the
police officer to search the required place
and to seize the objectionable article known
as 'Mudammar. Police may use force to
effect a legal entry provided that they an
nounce who they are, and why they have
come, demand entry and are unreasonably
refused.
* The Police officer executing the warrant
may search any person in or about such
place if that person is reasonably sus
pected of concealing on his person any
article for which search is made. If the
person to be searched is a female then
the search shall be made by another
woman with the strictest possible
decency.
Procedure to be followed
The officer making a search shall:
* Call upon two or more respectable resi
dents of the locality (called ‘panches')
May-June 1984
to attend and witness the search. Fai
lure to attend is an offence under Sec.
187 I.P.C.
* Make the search in their presence. So,
the search would be illegal if the
'panches are kept outside while the
search takes place inside the building;
* Make a list of all things seized and of
all places in which they were found.
(The list is called the 'panchnama';)
* Get the list signed by the witnesses—
.Ranches';
♦ Permit the occupant of the place to
attend the search and give him a copy
of the list of things signed at his
request;
* 'Panches' are not required to attend the
court as witnesses unless specially
summoned by the Court.
Rights of the occupant of the premises
searched
* The accused himself cannot be compel
led to produced any document or pro
perty which is likely to involve him in
any criminal charge. Hance police have
to get a warrant issued by a Court of
Law;
* The police have no general power to
enter or search your premises without
your consent;
♦ The court may specify in the warrant a
particular place only to which the search
will extend;
* It is important that the warrant is read
and the directions are taken note of be
fore the police are allowed to make
inspection;
* If the police have no legal authority to
enter your premises you can refuse the
entry;
35
♦ If they have no legal authority to remain
you have a right to insist on them lea
ving;
* If they refuse you have the legal right
to use reosonable force to remove them
(Sec. 97, of I.P.C.).
BAIL
Bail means releasing an arrested person
from legal custody until his trial. Bail gives
the freedom to seek advice from friends, con
sult a lawyer, to trace witnesses and to col
lect evidence for one's defence and to
continue his job.
When bail is not granted, the arrested
person will be on remand and will be kept
in custody to facilitate the investigation and
to obtain evidence.
Provisions regarding bail can be classified
into 2 categories : i.e. (1) Bailable cases; and
(2) Non-Bailable cases.
Bailable Cases
In the case of bailable offences, granting
of bail is a matter of legal right. This means
that bail cannot be refused and shall be
granted by a police officer in charge of a
police station having the accused in his
custody. The release may be ordered on the
accused executing a bond, even without
sureties.
Non-Bailable Cases
grounds, to be guilty of an offence punisha
ble with death or imprisonment for life. But
women, children under 16, and sick people
can be released on bail by a Magistrate even
if charged with offences punishable with
death or life-impnsonment.
An accused person is entitled to be
released on bail as soon as reasonable
grounds for guilt cease to appear, between
the close of the case and delivery of judge
ment. A person released on bail may be
taken into custody by an order of the Court,
if his conduct subsequent to release is found
to be prejudical to a fair trial (Sec. 48 Cr.
P.C.)or if he does not observe the conditions
of the bail.
Power of the Court to grant bail
The discretionary power of the Court to
grant bail is a judicial power and is given by
established principles. Before granting bail
the Court must consider the seriousness of
the charge, the nature of the evidence, the
severity of the punishment prescribed for the
offences and in some cases the charactrer,
means and the status of the accused.
If you are arrested, how to get released
immediately from police custody ?
In warrant cases, find out the directions
endorsed in the warrant and execute a bond
with sureties (Sec. 71) :
* If the offence charged is bailable and
the arrest is made without warrant, ask
the police officer in charge of the police
station to grant you bail after executing
a bond;
In non-bailable cases, only the Court can
order release of the accused person on
bail. However, if the police officer or the
Magistrate is of the opinion that there is no
sufficient material against the accused and
that the complaint needs further investigation
he may also release the accused on bail
(Sec. 437 (2) Cr. P.C.).
* The police officer has the discretion to
to release a person on his executing a
bond without sureties (Sec. 436 of
Cr. P-C.);
Normally bail is not granted when the
accused person appears, on reasonable
* If you are not granted bail immediately
you have the right to telephone your
36
Medical Service
advocate, a friend or a relative. Give
your advocate the names and addresses
of the possible sureties. If you don't
have an advocate inform your friend or
relative;
* The name of the Magistrate Court
where you will appear;
* The time the Court starts;
* To take to the Court anyone else who
is prepared to stand surety;
* To contact an advocate if possible.
If you can deal with these matters before
you go to the Court you may be saved an
unnecessary remand in custody.
Granting of Bail by the Magistrate
If a person is arrested for a non-bailable
offence, and there exists a reasonable
ground to believe the guilt of the person, he
may not be granted bail by the police officer.
In such cases the accused person must give
a written application to the court to grant
bail. The court must grant bail unless he is
charged with a crime punishable with death
or life-imprisonment. In such cases only
the sessions or the High Court can grant
bail.
Common police objections to bail
* The accused will not appear at his
trial;,...
* The co-accused are absconding;
* The weapon with which the crime was
committed has not been recovered.
Normally the police makes an application
for the remand of the accused. In such an
application they give their reasons for further
detention of the accused in custody. The
reasons given by the police must be refuted
to the extent possible.
Application for Bail
* If the accused can afford an advocate
he can make an application and repre
sent the accused before the judge;
* If the accused cannot afford an advo
cate he may make a written application
to the judge. For this he must get an
application form from the prison staff
and complete it as fully as possible
giving sufficient reasons to convince
the judge of the need of granting bail.
The following special grounds for release
must be mentioned in the application :
* Condition and state of accommodation;
whether there is a possibility of evic
tion in case bail is not granted;
* Whether he is likely to loose his job;
* How refusal of bail would create hard
ship to the dependent members of the
family;
* How keeping in custody would affect
the poor state of health and treatment.
* He will interfere with witnesses or
material evidence;
Refusal of Bail by the Magistrate
* He will commit further offences while
on bail;
If bail is refused, the Magistrate must
record the reasons for the same. Such a
record is necessary to make a proper appeal
for bail in higher Courts.
* Police enquiries are not complete;
* Further charges might follow;
* Stolen properties have not been reco
vered;
May-June 1984
Appeal
If application for bail is rejected by the
Magistrate the accused person can appeal to
a Sessions Court or High Court.
37
Disagreement with the objections raised
by the police in granting bail or the fact of
no objection raised in the Court must be
incorporated in the application for bail. If
one's application is rejected one may try
again in one's next Court appearance.
Conditions for Bail
The Magistrate may grant a bail:
* Without any condition;
* Subject to special conditions;
* Subject to bond with or without sure
ties.
Special conditions usually state that the
accused person must report to the police
station at specified times or surrender his
passport. One can challenge in a Court any
unreasonable condition
imposed by the
Magistrate. If the Court refuses to change
the conditions, the accused person can reject
them. But in that case he will not be relea
sed until his appeal is heard and disposed
of in his favour.
Bond and Sureties
* An accused person may be released
on personal bond with or without
sureties;
* Sureties are people who guarantee a
sum of money for appearance of the
accused in the Court on the appointed
day and time.
* Those who stand as sureties must be
present in the Court and if asked must
guarantee the Court under oath that
they are prepared to act and have
sufficient funds;
* They can file affidavits before the Court
stating the fact to show that they have
sufficient funds to pay the surety and
that they are even otherwise fit to be
sureties;
38
* The Magistrate has the power to reject
the surety without giving any reason.
If the sureties are not in the Court, the
arrested person will be kept in custody
until the police have interviewed them
and found them to be satisfactory;
* Sureties must be over 18, have a per
manent address and have sufficient
money to cover the amount of surety
after payment of all their debts. The
sureties may carry to the Court docu
ments such as ration cards, rent
receipts, provident fund slips, salary
slips and income tax challans;
* The police and the Magistrate have no
right to reject sureties on grounds of
their personal character, political opini
ons, criminal records or sex, unless
they are professional sureties.
Bail after Conviction
If an accused person is found guilty, the
Magistrate will pass the sentence after
considering his past record. If the convicted
person wants to appeal against his sentence
in a higher court, the Court which passed
the sentence must release him on bail.
* When the sentence is for imprisonment
for a term not exceeding 3 years, or;
* When the offence for which the person
is convicted is a bailable one and the
person is already on bail.
The release will be for a period that will
enable the convict to present the appeal and
get the orders of the appellate Cou rt.
Once a person files an appeal against his
conviction, the appellate Court may suspend
the sentence and release him on bail or on
personal bond.
Anticipatory Bail
When a person has reason to believe that
he may be arrested for a non-bailable offence
Medical Service
he may apply to the High Court or to the
Court of Session for a direction that in the
event of such an arrest he may be released
on bail.
If such a person is arrested without a
warrant by a police officer and if he is prepa
red to give bail, he must be released on bail.
In case a warrant is issued against the accu
sed by a Magistrate, it must be a bailable
warrant in conformity with the direction of
the High Court or the Court of Session.
The purpose of the provision is to releive
a person from disgrace by being detained
in jail for some days before he can apply for
bail when he is implicated in a false case by
a rival.
Recent Observations and Recommen
dations of the Supreme Court on Bail
* The Bail system prevalent in our
country is oppressive and discriminatory
against the poor, since the poor would
not be able to furnish bail on account
of their poverty. The court, by ignoring
the differential capacity of the rich and
the poor to furnish bail and treating
them equally, producesinequality be
tween the rich and the poor.
* The bail system should be thoroughly
reformed so that it should be possible
May-June 1984
for the poor to obtain pre-trial release
as easily as the rich without jeopardis
ing the interests of justice.
* The Court and the police must abandon
the antiquated practice of release only
against bond with sureties, and if the
accused has ties in the community and
there is no substantial risk of nonappearance, he may be released on his
personal bond without monetary oblig
ation, subject to penalty in case of
breach.
* The amount of bond the Court fixes to
release the accused on personal bond
should not be based merely on the
nature of the charge but on the finan
cial capacity of the accused and the
probability of his absconding.
* When the accused is released on per
sonal bond, the Court or the police
should not insist upon inquiring into his
solvency as a condition of acceptance
of his personal bond.
For further information in Legal matters
contact:
Director, Legal Aid
Indian Social Institute
Lodi Road, New Delhi 110 003
Tel : 622379, 624760
Gram : Insocin
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