MEDICAL SERVICE VOL. 42 No. 7 AUGUST-1985.pdf
Media
- extracted text
-
human
resources development as important as economic development •
nursing : the crisis in
medicine •
patterns
of medical
use of drugs — a
preliminary survey • legal education — worker's rights • book review :
the state of the worlds'children*! 985
medical
service
official house journal
of the catholic
hospital association of India
"the love of Christ
urges us" 2 cor 5 :14
vol 42
no 7
editorial board
august 1985
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
1
editorial
2
2
human resources development as important as
economic development
...............
rajiv gandhi—prime minister of. india
. z .
4
;
3
-4
editor
fr john vattamattom svd
cover design’
*
patterns of medical use of drugs—a preliminary ..
survey
.
. . > 'J. . .
' ;:i
r
perumpanani a j
1
7
12
16
6
readers write
25
7
book review: the state of the world’s children-1985
newton luiz .
29
fr muller's open homoeopathic medical college
s c frank
32
news and notes
34
8
9
printed at kalpana printing
house new delhi-110016
;
5 ‘ legal education—13—workers' rights part—I
p d mathew
p m isaac bangalore
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
nursing the crisis in medicine
dr ravi narayan
’
,,Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"
EDITORIAL
LOOKING BACK —LOOKING AHEAD
Taking stock of things to plan ahead is a prudent step in every day life. The
Catholic Hospital Association of India needs to look far ahead and recognise its all
important role and increasing challenges in the field of health care in this country. It
is all the more important when the governments all over the world and also that of our
own country is recognising the role the voluntary organisations will have to play in
the field of health care. There is an ever growing awareness from all concerned to
come to the service of the poor and the oppressed, the voiceless, the most needy, the
least cared for, the ones in the periphery. It is here the quality of our service lies.
Service to the poor and needy should come, not from a feeling of pity but from
a feeling of duty and dedication. What the poor need is not our pity and charity but
the recognition of their rights and dignity and the type of help that will safeguard this
dignity. Our health services should be directed to the least ones and the last ones and
should not be restricted to matter of convenience and profit. It is here we will have
to examine ourselves and see where we stand.
Already as far back as 1975, the National Advisory Council of the CBCI had said
the following in its meeting held at Bangalore; "Our health apostolate should be plan
ned within the context of the all-round development of the rural people, especially of
the poorer sections, whose needs cannot be effectively answered by our medical insti
tutions with a focus on curative and specialized medical care. Rural -based health
programmes, like cottage hospitals and community health centres in rural areas, should
receive top priority in our planning as also the orientation training and experience of
nurses, medical students and religious towards rural work: Policies of funding agencies
should be directed towards implementing these objectives.
It was generally agreed that in the future our funds should be directed to health
schemes in rural based projects.
— Catholic Hospitals should be committed to giving basic health service
rather than expensive specialised care.
— Every Catholic hospital should endeavour to give at least an additional 10
per cent free medical service to the poor.
— Catholic hospitals should give more care to the training of health nurses for
rural areas.
Training of personnel should be:
—
rural oriented
— committed to the needs of the people rather than the completion of a prog. ramme,
— concerned with the training of health workers.
Efforts should be made to study and use the Indian systems of medicine and
health care. Hitherto this has been negligible. Such attempts will be useful becuase
this system is :
— cheap
— accepted in rural areas
— effective
and can be integrated in health care service.
The Catholic Hospital Association of India during its this year's convention and
workshop to be held at Lucknow from 10-14th November will focus attention on the
future involvement of this mighty and powerful organisation in the field of health care
in the country. Let us be open to the Spirit and His inspirations to know what is ahead
of us in the field of health care ministry in this country.
/
ANNOUNCEMENT
CHAI Annual General Body Meeting 1985.
Credential Committee
Chairman :
Fr. J Antony samy (Ex-officio)
Member:
Sr (Dr) M Fernanda (
Member :
Fr. George Pereira (nominated)
,, ,,
)
Nomination Committee
Sr. Cassia, Fatima Hospital, Lucknow
Sr. Marcellina, Mariampur Hospital, Kanpur
Sr. Tresa, Benziger Hospital, Quilon
Executive Director
Human Resources Development as Important
as Economic Development
—Rajiv Gandhi
Prime Minister of India
Women may be the largest disadvantaged
class in our country today, although much is
said about backward classes and scheduled
castes and tribals but if we put everything to
gether, ultimately, it is women who need help
most. At the same time, this help must come in
a manner that it does not compromise the selfrespect and the dignity of women. Govern
ment can do a lot of things, have tried to do a
lost of things, and have made a lot of laws.
Our Constitution has given equal rights to
women but much of it has not flowed down to
women themselves. And the fact is that a
cial problem cannot be tackled at its own level
and it is really tackled best by Voluntary Agen
cies and by highly motivated people working
in society.
While dealing with social problems, often
we are not really getting down to the root
cause; we are just grappling with the symptoms
only.
Do not compartmentalise
We might ask ourselves: why are we giving
a high priority to women? It doesn't really need
an answer, but let me give a quotation from
Gandhiji. Gandhiji said that 'woman is the
companion of man gifted with equal mental
capacities. She has the right to participate in
the very minutest detail in the activities of man.
And she has an equal right to freedom and
liberty with him'. Unfortunately, Gandhiji had
also related it to man. This is what we have got
to get out of. The idea is absolutely right but
we men tend to really put women in a sepa
rate category. The fact is they are not. We are
4
all human beings, we are all the same. And
everything must be based on that thinking.
Our Constitution gives some fundamental
rights. Discrimination against women is pro
hibited. Women are the key indicators of eco
nomic growth and also a key part of it. Women's
education is again a key indicator of our eco
nomic growth. But, really, why we want to
help women came out and participate more is
that in many ways they are the conscience
keepers of the nation. I feel India's greater
strength is its spirituality, its inner strength
and this comes out much more in Indian wo
men than it does in Indian men. And if in this
race for progress and modernisation, we have
to maintain our sanity and not get carried away
into another stream of civilisation, then we
must give this strength to our women so that
they are able to come out and see that this is
not swept away in what we call or what we
tend to call progress and development today.
How exactly do we view the problem of the
status of women in our society? This is very
difficult to answer because it is not just a
question of how we view it, it is a question
of what we want to achieve, the problems we
face today and finding methods of solving
them. The discrimination against women and
all the problems related to dowry, their basic
rights, are all related to this. And we have to
see that women are able to become truly equal
in every sense.
Family Planning and Women's Education
One of the biggest problems facing us to
day is population, and here the only thing that
Medical Service
is really going to make a dent in family plann
ing is women's education. One of the key
factors is as to how to keep girls in schools.
There are too many dropouts. We have to see
how we can do better in this area. And, of
course, we have to look deeper to see why they
don't stay in school and get to the root of that.
Again it brings us back to our basic social
problems. Vocational training can be very
helpful, for the family, as well for the standing
of the woman herself in the family and for her
independence. Teaching is something that
women are good at and we are very short of
women teachers. Of course, unless they are
educated, we will never get enough teachers.
And this is an area where we must concentrate
on specially for primary schools and middle
schools education. The more women can we
get involved, the better it will be for education.
There are certain occupations or trades
which women can do at home without leaving
their families and, may be, we need to develop
a marketing system which can help women
who don't want to get out of their homes to
be productive and selfreliant.
Dowry is one of our most serious social
problems and it is an area where voluntary
agencies can come in a big way. We have
made laws and set up family courts. If there are
certain flaws, we are willing to change the
provisions. But ultimately it is what the people
living in an area actually feel, believe or react
that matters. And there is no law which can
cut across that. It is an awareness which so
cial workers have to build into our society. We
are willing to help voluntary workers in what
ever way we can, but this requires a lot of leg
work and really only voluntary agencies can
do this.
I feel that women must be more active in
politics and at all levels and more especially
at the very grass root, i.e., Panchayat level.
In my own constituency I find that they are
very active and they do very good work. Again
August 1985
it is only social awareness which will allow
this to happen and voluntary agencies must
play a big role in this.
Human Resources Development
We have got a very large number of de
partments dealing with helping women. And
here we do need some coordination. We
are forming a Cabinet Committee for human
resources development and this could be a
point from which we could start working. We
have been working furiously at economic
development. Unfortunately, we have not paid
enough attention to human development and
I feel this is very much an important part.
Another area where I think we have not
been active enough but I think it is time that
we really got involved is the drug scene. And
this is the time when it is not very big in India
and we can try and do something from the
Government. We are taking action to see that
proper steps are taken, but they will be more
sort of hard steps — legal identify it, but what
is must systems to stop it, catch it, more im
portant is to see that the need for drug does
not arise amongst the youngsters and that can
happen only with the proper environment in
the family, with proper advice and instruction
and training. Again the voluntary agencies really
are the key in bringing this about. They
should see how they can be more involved in
trying to stop the drug business before it
really gets down to our system.
A problem which women really face and
which is very serious is old age. And again it
is less of a problem as long as our old family
system continues, but more and more in the
urban areas we find that this is not happening
and women are finding it a tremendous prob
lem. We have to see what schemes we can
devise and how we can help these women in
their predicament.
5
Child labour is another very serious area
for us to consider and it is not something that
we can just pretend it doesn't exist or legis
late away. We should see what we can do
to make it easier for children to see that they
get education and proper care and they are
not exploited, not used in areas which spoils
their eye sight, limbs or make them handicapp
ed in any way.
All these are not problems that the Govern
ment on its own can tackle. These will only
be tackled if Government action is helped by
the voluntary agencies and by social change.
And this is where women social workers and
voluntary agencies can work in concert with
Government agencies to get to grips with
most of the problems.
— Courtesy : Social Welfare
H pioneers of Ayurvedic research in * Medical • Dental • Veterinary fields
from&
etktcot pnxTctucts
for • GUM • DENTAL • ORAL Hygiene
as Gum massage, Dentifrice, Rinse & Gargle
MARSH
Relief in 2-3 applications
Remarkable improvement in 2*3 days.
in easily crushable tablet form
GUMS Gingivitis : Bleeding, swollen, spongy, painful Gums
TEETH : Painful, Aching, shaky & Hypersensitive;
prevents plaque formation.
ORAL hygiene : in disease ordrug induced conditions,
where oral hygiene has to be improved & corrected.
G32 is an excellent supportive & follow up treatment:
to consolidate the gains of Surgical & Systemic management
of Gum & Teeth conditions and ORAL Hygiene.
Oral Herbal Haemostatic tr Coagulant
in all Bleeding Conditions of Gums, where
the patient needs systemic heamostatic
Pre-operative: as prophylaxis to minimise
bleeding.
Dosage can be adjusted according to the
severity of bleeding (up to 6-12 tabs a day
in divided doses)
for immediate & lasting results in
• HYPER ACIDITY • ORAL ACIDITY
relief within 5-15 minutes even in severe
eases with 3-6 tabs at a time
Masticating trouble leads to: Indigestion.
Flatulence, Constipation, Hyper-acidity
syndrome (nausea, vomiting ptyalism)
SOOKTYN helps assimilation, degestion.
morning evacuation
DOSE : 2 tabs tds between or after principal
meals.
for Rx all available in 50 & 100 tabs PACKS at Chamists
as Anti-inflammatory, Analgesic & Antibacterial
Quicker relief without side effects Complete relief within 5-7 days
in all Inflammatory & Painful conditions of Oral cavity:
after teeth extraction. Trismus, Odontitis, Dental Pulpitis,
Cellulitis. Periapical abscess, T. M. Jt. problems.
DOSE: 2 tablets tds for 7 days.
6
for Hospitals & Clinics: Supply from factory only.
1000 tabs PACKS except G32.
'/rid'e'^ricejiist
'piease write fjfc. sE&lffiALARSIN MARKETING P. LTD.
11 K. Dohath Marg. Fart. Bombay -400 021
Medical service
Nursing the Crisis in Medicine
—Dr. Ravi Narayan
Background
their competence in growing up, caring
for each other, and aging----- -
The World Health Organisation has defined
—Ivan HHch in 'Medical Nemesis'
health as "a state of complete physical, men
tal and social well-being and not merely the
absence of disease or infirmity." In the four
♦ I believe that more than ninety percent
decades since this definition, there has been
of modern medicine could disappear
a rapid expansion of efforts which have aimed
from the face of the earth -r doctors, hos
at the improvement of health of people. In
pitals, drugs and equipment — and the
keeping with the historical evolution of medi
effect on our health would be immediate
cine, these health efforts have been primarily
and beneficial.
associated with the increase in numbers of
—Robert Mendelsohn, MD in "Confessions
hospitals and dispensaries, medical colleges,
of a Medical Heretic"
nursing colleges, other professional training
institutions, pharmacies and a massive growth
in the drug and equipment industry. This has
* Eternal vigilance is required to ensure
resulted in an increase in the technological
that the health care system does not get
quality of care, in the specialization of profes
medicalised, that the doctor-drug pro
sional training and in the costs of medical
ducer axis does not exploit the people,
care. However, the most disturbing trend in
and that the 'abundance of drugs' does
the last decade is the increasing accumula
not become a vested interest in ill-health.
tion of evidence that this growth of the medi
—ICMR/ICSSR Reports on "Health for
cal institutions, technology and industry, sup
posedly in the quest of health, may actually
AH—an alternative strategy (India)".
be proving to be anti-HEALTH. The following
quotations taken from the better known sour
If medicine, doctors and hospitals who
ces, including a recent National Health Re were thought to be necessary pre-requisites
port, echo this growing truth:
for health and health care are increasingly be
coming the causes of ill-health, then surely
Medicine today is in deep crisis.
* Increasing and irreparable damage ac
companies present industrial expansion
in all sectors. In medicine, the damage
Dimensions of crisis
appears as "iatrogenesis", Iatrogenesis is
Any sensitive person today visiting one of
clinical, when pain, sickness and death
our hospitals, both government or private,
result from medical care; it is social when
would very clearly pick up evidence of this
health policies reinforce industrial orga
crisis. A special of hospitalization would put
nizations which generate ill-health; it is
the stamp of personal experience on this situa
structural, when medically sponsored be
tion. The crisis in our hospitals has at least six
haviour and delusions restrict the vital
dimensions if not more.
autonomy of people by undermining
August
7
(a)
Technical crisis
Overdrugging or irrational prescribing, un
necessary hospitalization and surgery, unre
liable investigations, incompetent use of
poorly maintained equipment, the use of treat
ments designed for critical conditions in every
day situations, and the decreasing quality of
care, are well-known every day experiences.
They contribute greatly to hospital infections,
drug allergies, iatrogenesis of all sorts, and
increasing diagnosis of 'non-diseases\
(b)
Attitudinal crisis
Within professional circles — both medi
cal and nursing — treatment is becoming more
important than care, drug-pushing more im
portant than healing, technological interven
tion more important than patient examination.
The patient is no longer seen as a whole per
son suffering but as a dehumanised machine
in need of repair and his needs are becoming
subservient to the needs of the medical in
dustry.
(c)
Cultural crisis
The hospital culture is becoming more anti
family, anti-death and anti-faith. It is insensi
tive to feelings of people and to local culture
and traditions. Births and deaths which in the
past were meaningful family events are today
alienated hospital events cut off from their
family roots.
(d)
Social crisis
Doctors, nurses and hospitals are increa
singly cut off from the masses of people. The
private hospitals including mission hospitals
are catering mainly to the rich and privileged
few. Free service, if given at all, in these hos
pitals, is given grudgingly, and with lack of
sensitivity. The government hospitals which
are forced to cater to the poor, treat them like
animals, fully exploiting their pain and needs.
Doctors and nurses continue to migrate west
August 1985
wards in large numbers to places where the
money is.
(e)
Economic crisis
Medicines and the hospital system are fast
pricing themselves out of the market. Hos
pitalization or even a visit to a doctor is often
the cause of an economic crisis for the family,
further contributing to ill-health.
(f)
Transcendental crisis
Both medicine and nursing had in their
past, roots in a service-based spirituality and a
missionary sense of vocation. Today, as
froritliners of the drug and technology indus
try, these professions are losing their transcen
dental roots ond are becoming mere business
ventures. Capitation fees, life-styles of pro
fessionals, and the growing 5-star hospital
culture testify to this trend.
Challenge to the Nursing Profession
The nursing profession has evolved from
its early roots, in service and care to a highly
scientific and professionalised service aiming
at quality care based on latest technology.
More than the doctors, nurses have today
become a very important and essential part
of the hospital system, and for a very long
time to come, will identify strongly with it in
their work. Hence, as hospital medicine grows
in technical,' attitudinal, cultural, social, eco
nomic and transcendental crisis, the nursing
profession will be called increasingly in the
years to come to respond and tackle this crisis.
What can the Nurses do to Alleviate the
Crisis ?
The nursing profession will be increasingly
challenged in the years to come to move from
its medically biased, task-oriented, technology
dependent approach in nursing to a healthbiased, care-oriented and human relationshiporiented approach in nursing. Some aspects
of this approach will be :
9
(a)
Care of the Total Patient
Nurses are best suited to begin this pro
cess of humanising our hospitals because of
their own historical traditions. They can help
a great deal in the practice of 'medicine of the
whole person' i.e., responding not only to the
physical needs of the patient but also to his
mental, social, spiritual, cultural and economic
needs.
(b)
Unbiased Quality of Service
By personal commitment, nurses could
ensure that the quality of service which they
provide will not be related to the paying ability
of the patient but to his actual need. In fact,
this would mean that rather than pampering
the rich or private ward patient (the hall-mark
of the present system I) they will have to be
more sensitive to the poor non-paying general
ward patient whose needs are often greater
because of his social circumstances.
(c)
Supportive of Family Culture
The respect for family and local culture must
be re-emphasised in our hospital practice.
These include a family approach in ante-natal
care;an enhancing of mother-child relationships
in post-natal and paediatric wards; involving
family in matters of care; informing and allay
ing tension of relatives; respecting family
roles and cultural traditions, and re-orienting
hospital practice and communication to local
culture, language and situation.
(d)
Health Education
An increasing educational effort in all situa
tions of the hospital, involving all members
of the hospital team including the nurses,
should become an important part of hospital
service. Apart from improving patient comp
liance and hospital experience, this aware
ness-building process aimed at both patients
and their relatives will be a good investment in
the future health of the family.
10
(e)
Team Work
Hospital practice is increasingly requiring
good team work in patient care. If relation
ships between team members are healthy and
mutually supportive, then there will not only
be a raising of ward morale but definite effects
on patient care and well-being. Only a healthy
team built up on the principles of participative
management, group decision making, sup
portive supervision, and sensitivity to staff
welfare, will be able to make hospital practice
more healthy. Staff Nurse and Ward Sisters
being leaders of a team of nurses, aids, helpers
and auxiliaries, will be challenged to play
this role in the future.
(f)
Cost-consciousness
The constant search for low cost regimes,
therapies and techniques should be an impor
tant preoccupation for nurses. In addition, a
great concern for reduction and increased
caution in the use of medicines: and decreas
ing unnecessary investigations and proce
dures will go a long way in reducing hospital
costs. This will need a greater commitment at
the individual, group and administrative levels,
since It is the most neglected dimension of
the crisis.
(g)
Community Extension
Finally, realising that hospital practice
tackles or intervenes in less than 25 % of exist
ing ill-health in the community, hospital ad
ministrations need to reach out more and more
to specific communities, especially villages
and slums, through extension of hospital ser
vices. These could include mobile clinics, ex
tension clinics, leprosy, tuberculosis, and
maternal and child health programmes, spe
cialist camps (diagnostic and surgical), health
education programmes, and home visiting
programmes. This community care process will
expose hospital staff to the hard realities of
Medical Service
our socio-political and economic environ
ment, and the inadequacies updirrelevancies
of our hospital system. It will sensitise them to
reorient hospital practice towards people's
health needs, and will stimulate them to orga
nize health programmes in and outside the
hospital, to tackle the mental, social, cultural,
environmental and economic aspects of health
in the community. The nurses of the hospital
and the nursing profession at large have an
important role to play in this reorientation.
Are the nurses trained in our nursing schools
and colleges, today being prepared for these
challenges of tomorrow?
—Courtesy: Golden Jubilee Souvenir 19331983 St. Martha’s Schoo! of Nursing, Banga
lore.
42nd Annual Convention of
The Catholic Hospital Association of India and workshop on
"Towards a People Oriented Drug Policy"
Dates :
November 10-11, 1985
November 11-14, 1985
Venue :
St. Fidelis School/Ashram
Aliganj Extension P O
Near Vishnupuri Colony
Lucknow 225 020 (UP)
Fees :
Workshop and Convention
Convention alone
Drug Workshop /
Convention Proper
Rs.
Rs.
350.00
250.00
(Payable by crossed cheque/draft or M O in favour of The Catholic
Hospital Association of India)
Last date to receive
Registration form & fees
20th October 1985
For Registration form and further details please write to :
K
August 1985
Executive Director
The Catholic Hospital Association of India
C.B.C.I. Centre, Goldakkhana
New Delhi 110001
Tel : 310694, 344470
11
Patterns of Medical Use of Drugs—A Preliminary Survey
—Perumpanani A.J.
Introduction
-The prescribers and dispensers of drugs have
a professional obligation to consider more
efficient systems that will enhance the quality
of care when prescriptions are indicated.
Nevertheless the data regarding this area is
scanty in our country.
offender in accidental ingestions because it is
mistaken for over-the-counter products and
is also accidently ingested by toddlers. Lastly,
the committee has suggested that pediatri
cians warn parents of the danger of camphor
containing products as long as they are mar
keted.
It this paper, we present the preliminary re
This history of camphor can be cited as an
port of a student project, which analyses the
example to highlight these developments (1). cost differences between therapeutically use
Traditional use of camphor dates back to ful and useless drugs prescribed by profes
^Chinese medicine. It has been used as an sionals to patients attending the hospital with
abortifacient, contraceptive, cold remedy,
psychiatric illnesses.
aphrodasiac, anti-aphrodasiac,
suppresser
of lactation and antiseptic. Albeit no longer Materials and Method
used for these ends, camphor continue to be
The study was conducted on 10 patients
an ingredient of a number of over-the-counter
remedies. It has been estimated that 1,00,000 who attended the psychiatric out-patient ser
gallons of camphorated oil and 137,000 gal vice of St. John's Medical College, Bangalore,
lons of spirits of camphor were produced in during the months of September, October and
November, 1984. Only those patients who
the United States in 1975 and marketed "in
packages without safety caps. It is now largely could furnish the previous prescriptions of
marketed in multi-ingredient
liniments for ■ treatment for the present illness were included
symptomatic relief of 'chest congestion' and in the study. It was also ascertained that these
'muscle aches' which contain about 1-20%* patients were treated .for the same presenting
complaints for a period of 3 months prior to
camphor.
the present consultation and that they had no
The committed on accidents and poison
non-psychiatric disorder.
Both male and fe
prevention in the United States has endorsed
male patients between the ages of 20 and 50
the following conclusions on the use of cam
were studied.
phor. Firstly, it has no established therapeutic
role in scientific medicine. Secondly, it has
All prescriptions were collected from the
potent toxicologic actions. The ingestion of patient after the final diagnosis was made by
relatively small amounts has been proved to the consultant psychiatrist and their use by
be fatal. Although accidental oral ingestion the patient for his present complaints were
is the most common routs of intoxication, ascertained. Those prescriptions not relating
significant quantities can be absorbed per- to his present complaints were discarded. The
cutaneously and via inhalation. The transplace
remaining prescriptions were divided into two
ntal transfer may be toxic to be foetus. Thirdly, groups based on the present knowledge of the
camphorated oil in particular is the worst pathology of the illness in question. The first
12
Medical Service
RESULTS
TABLE 1
Analysis of Drugs Used
(N = 10)
SI. Total No. of
No.
drugs
Cost/Patient/Day
Total Cost
Group I*
Group II*
163.30
0.63
0.14
114.30
0.06
0.22
0.01
0.02
0.00
2.00
0.00
0.14
494.80
107.25
2.60
0.18
13.70
1.95
22.70
7.20
135.90
363.30
0.43
0.04
2.61
2.06
94.55
314.14
0.397
1.202
23.3
76.7
24.9
75.1
Group 1 *
Group II*
1.
16
2.
25
3.
4.
19
17
28.40
19.35 •
608.85
214.85
5.
16
00.00
6.
7.
25
36
8.
14
00.00
96.60
10.10
470.40
458.40
9.
8
10.
18
Total/N 19.4
0/
Zo
731.50
29.70
0.20
1.00
•Group I — Possibly and/or definitely effective drugs.
•Group II — Definitely not effective drugs.
group consisted of 'Drugs that are possibly
and/or definitely effective for the present
illness' and the second group was 'Drugs that
are definitely non-effective other than through
placebo response'. Following this the total
number of different drugs per patient, total
price of drugs per patient and the average price
of drugs per patient per day of his treatment
were computed.
Discussion
Surveys of drug consumption in United
States during the decade ending in 1973
showed a doubling effect. The total economic
August 1985
value of all ordered pharmaceutical services in
1973 amounted to about 11 billion dollars,
after being adjusted for an increase in popula
tion by 10% and an increase in wholesale
drug prices by 3% (2). There is some basis
for believing that the population using medi
cation has not changed significantly during
this interval. Surveys of Spitzer et al (3) con
firmed that 60% of the people in the commu
nity take at least one medicine at any given
time and that 30% are taking at least one drug
prescribed or suggested by a doctor. Approxi
mately 90% of these figures were represent
ed by the private sector of the health care
13
system and 70% of these prescriptions reflected
drugs used by ambulant patients. It appears
that there is a more or less static quantum of
population which consumes prescribed drugs
in increasing quantities for minor ailmeqts
as more drugs are being produced. This sec
tion seems to be serviced by the private sector
of the health care system.
The annual drug production in terms of
cost in India has increased from Rs. 380
crores in 1973-74 to Rs. 2,450 crores in 1984
with an increase of annual per capita consump
tion of drugs from Rs. 6.56 to Rs. 32.97 in
the same period. According to a survey done
in a North Indian district, 16.6% of the po
pulation sought the services of the allopathic
system of medical care (4).
Vitamins and tonics are the most commonly
used drugs in the North American population
(3). They are used by 25 to 28% of the po
pulation, 40% of whom use them as a result
of physicians' prescriptions.
Various esti
mates of pattern of drug use show that females
and the white population receive 50 to 60%
more prescriptions than counterparts. Varia
tions in per capita drug use is also associated
with difference in factors like income, educa
tion and geographic location (2). A survey
conducted on the South Indian urban popu
lation showed that the maximum number of
prescriptions were for nutritional products
and that 16% of these prescriptions had more
than one product having the same ingredient
in various dosage forms. It was also found that
though iron deficiency, anaemia and BJt
deficiency were the more common deficiencies
in the population, sales of B-complex pre
parations and other vitamins were the highest
(5).
Use of multi-drug prescriptions by a large
proportion of the population has turned istrogenic morbidity and mortality into a signi
ficant public health issues. The annual direct
and indirect cost to the population from com
14
bined effects of morbidity and mortality attri
butable to predictable, hence preventable,
reactions to drugs has been estimated at nearly
4 billion dollars out of the 11 billion doller
drug production in the United States, in 1973
(2). In a 3 year survey of medical services, 2.9 %
of the admissions were found to be due to
drug induced illnesses excluding suicide
attempts and drug abuse. More than 6— of
these patients died. In 82— of the cases no
over-the-counter drugs were implicated.
Studies from our country show that 27%
of the doctors' prescriptions were for 3 to 4
drugs and 4.3% were for more than 4 drugs
at a time (5).
The findings of this preliminary report of
10 cases show that on an average the patients
had taken 19.4 different kinds of drugs for the.
present complaint before they came for psy
chiatric consultation. Similarly, the average
expenditure on noneffective drugs was 76.7 %
of the total, as compared to 23.3% of expen
diture of the possibly effective drugs. The
average cost of non-effective drugs per day
per patient was Rs. 1.20 and of possibly effec
tive drugs was Rs. 0.40. These results indicate
the possibility of an excessive use of drugs of
questionable value in the cases studied, and
may reflect the magnitude of wastage in our
health care system.
However, the trends shown in this study
cannot be generalised to the whole of medical
care, primarily because the cases selection for
this study were of chronic psychiatric illness
secondly due to the limitation of the sample
size and thirdly because the consultant psy
chiatrist's diagnosis could have been erro
neous. The selection of the chronically psychiatrically ill has been specifically incorpora
ted into this study because it has been report
ed that the prevalance rates of these cases are
as high as 20% among the masses attending
general hospital services; and that as primary
health services are developed, an increasing
number of these patients are expected to seek
Medical Service
help (6). In this study an attempt has been
made to reduce the errors due to diagnosis by
a brief follow up after the first visit to the out
patient services, though this stage had not been
included in the primary methodology.
3.
Spitzer, W.O., Roberts, R.S., Delmore, T.
(1976) Patterns of Medical drug use - a
community focus Canad. Med. Ass. J.
114, 33 - 37.
4.
Melrose, D. (1982) Better Pills Pub :
Oxfam, Oxford, 125.
5.
Drug utilisation survey report (1984).
The drug actions,
network : News letter, January.
6.
Thomas M.J. (1981). On planning a gene
ral hospital psychiatric unit.
Ind. J. Med. Ed., 20, 1 - 6.
References
1.
Committee on drugs (1978), Camptor:
who needs it? Paediatrics, 62, 404-406.
2.
Rucket, T.D. (1974). Drug use - Data,
sources and limitations.
JAMA, 230,
888 - 890.
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15
LEGAL EDUCATION — 13
Workers’ Rights
(Part I)
— P.D. Mathew
Labour Laws
A Majority of the Labour force in India lives
in rural areas. Members of the weaker sections
of society, especially women, children, land
less labourers, tribals and Scheduled Castes,
constitute the bulk of this labour force. They
are not adequately organised to demand their
rights. Their poverty, illiteracy, ignorance and
lack of employment opportunities are exploit
ed by landlords, big porjects recruit workmen
from rural areas through their agents and
employ them in construction works in cities
and towns. Being unskilled and unorganised
they are forced to work for long hours in
unhygienic conditions for less than minimum
wages.
There are many labour laws enacted for the
protection and the welfare of workers. But this
progressive legislation is not adequately imple
mented due to the lack of political will, effec
tive Government machinery and lack of aware
ness of their rights among the workers. Many
of the provisions of labour and minimum
wages are scrupulously violated by contrac
tors. Today, most of the legal rights of workmen
in the unorganised sector exist only on paper
and not in reality.
The solution to the problem of the exploita
tion of contract and migrant labourers lies
first and foremost in organising them as a
consequence of their social awareness. This
is possible only through a continuous process
of critical reflection on their exploitative situa
tion and through greater awareness of their
legal rights.
16
This brochure is prepared to educate the
labouring classes regarding their legal rights
under the Contract Labour (Regulation and
Abolitions) Act, 1970, the Employment of
Children Act, 1938, the Equal Remuneration
Act, 1976 and the Inter — State Migrant
Workmen (Regulation of Employment and
conditions of Service) Act, 1979. In what fol
lows the salient features of the Acts are ex
plained as also the Constitutional remedies
available to workers for the enforcement of their
rights.
The Contract Labour (Regulation and
Abolition) Act, 1970 with Central Rules
1971
What is the purpose of this Act?
This labour law was enacted to regulate the
employment of contract labourers in certain
types of establtement and to prohibit its prac
tice under certain circumstances.
To which establishment does this Act
apply?
It applies:
(a) to every establishment in which twenty
or more workmen are employed or
were employed on any day of the pre
ceding twelve months as contract
labour.
(b) to every contractor who employs or who
employed on any day of the preceding
Medical Service
twelve months twenty or more work
men.
(ii) in relation to a factory, it is the owner
or occupier (one who has ultimate
control over the affairs of the factory)
or the manager appointed.
Note
* The Act is not applicable to those estab
lishments which carry on work of a casual
nature occasionally.
(iii)
in a mine it is the owner or agent or
the appointed manager.
(iv)
in any other establishment, any per
son responsible for the supervision
and control of the establishment
(Section 2 (1) (g).
* Dispute whether work performed in an
establishment is continuous or of casual
nature will be decided by the Govern
ment after consultation with the Board.
Its decision will be final.
Explanation for terms used in the Act
Authorities
(I) Central Advisory Board
* "Workmen" means a contract labourer
who is hired to work in an establishment
or in connection with the work of the
establishment by or through the contrac
tor with or without the knowledge of the
principal employer (Section 2 (1) (b).
The Central Government has established a
Board called the Central Advisory Contract
Labour Board to advise it on matters related
to the provisions of this Act (Section 3.3).
* "Contractor" means a person who under
takes to produce a given result for the
establishment through contract labour or
who supplies contract labour for any
work of the establishment (Section 2
(1) (c).
— a Chairman appointed by the Central
Government;
Contractor includes a sub-contractor.
The above definition also covers contractors
engaged in construction of buildings.
♦ "Establishment" means :
(i)
It. consists of:
— the Chief Labour Comissioner (Cent
ral), ex-officio;
— 11 to 17 members nominated by the
Central Government to represent Go
vernment, Railways, Coal Industry,
Mining industry, contractors and work
men.
Note
any office or department of the Go
vernment or a local authority, or
On the above pattern. State Governments
are authorised to constitute the State Ad
(ii) any place where any industry, trade, visory Contract Labour Boards. In both the
Boards the number of members nominated to
business, manufacture or occupation
represent
workmen should not be less than
is carried on (Section 2(1) (c).
the number of members nominated to represent
* "Principal Employer" means:
the principal employers and the contractors.
(i) in relation to any office or depart
ment of the Government or a local
authority, the head of that office or
department or the officer specified.
August 1985
(2) Committees
The Central and State Boards are given
power to constitute Committees to supervise
17
the effective execution of the provision of the
Act (Section 5).
revoked by the registering authority is not en
titled to employ any contract labour in that
establishment.
(3) Registering and Licensing officers
The appropriate Governments may appoint
gazetted officers of the Government to be
registering and licensing officers and define
the limits within which they can exercise their
powers.
(4) Inspecting staff
The appropriate Governments may appoint
inspectors and define local limits within which
they can exercise their powers (Section 28).
The Inspector has the power:
* to enter at reasonable hours any place
where contract labour is employed for
the purpose of examining any register,
record or notices or documents related to
contract labour.
* to examine any contract labourer.
* to seek information from persons super
vising the work regarding the address of
employer and the rate of wage paid, etc.
* to seize copies and registers, records of
wages and other relevant, documents in
respect of an offence committed by the
principal employer or the Contractor
(Section 28).
Are Contractors bound to get licences?
The contractors are not allowed to under
take or execute any work through contract
labour without obtaining a valid licence from
the licensing officer. The licence may contain
conditions imposed by the Government re
regarding the hours of work, fixation of wages
and other amenities in respect of contact
labour (Section 7).
Note
For a contractor to undertake or execute
any work through contract labour without a
licence is a continuous offence and he is liable
to be punished until he obtains a licence.
Can a licence given, to a contractor be
revoked, suspended or amended?
If the licence has been obtained by mis
representation of facts or if the contractor
fails to comply with the conditions on which
the licence has been granted, his licence may
be revoked, suspended or amended or the
money deposited as security may be forfeited
(Section 14).
REGISTRATION AND LICENCE
Is there any obligation on the part of the
principal employer to register his estab
lishment ?
Every principal employer of an establish
ment is "bound to register his establishment
within a period fixed by the Government
(Section 7).
WELFARE AND HEALTH OF CONTRACT
LABOURERS
Every contractor is expected to provide for
contract labourers employed by him the fol
lowing facilities in accordance with the rules
made by the Government (Sections 16-19).
1.
What is the effect of non-registration of
the establishment ?
A principal employer who does not regis
ter his establishment or whose registration is
18
Canteens
* In every establishment, where work re
garding the employment of contract la
bour is likely to continue for six months
and where one hundred or more contract
Medical Service
— The food stuff served must be accord
ing to the normal customs of the la
bourers.
labourers are ordinarily employed, one or
more canteens are to be provided by the
contractor for the use of the contract
labourers employed by him. A canteen
must be provided within 60 days of the
date of coming into force of the rules in
the case of existing establishments and
within 60 days from the date of com
mencement of employment of contract
labour in case of a new establishment
(Rule 42).
— The charges for food served should be
on a 'no profit no loss' basis and it
must be displayed in the canteen.
— The books of accounts pertaining to
the canteen must be produced on de
mand to an Inspector (Rules 45-49).
II.
* If the contractor fails to provide the can
teen within the prescribed 60 days then
the same shall be provided by the prin
cipal employer.
* The Canteen must be maintained by the
contractor or the principal employer in
an efficient manner.
* The canteen should have:
— a dining hall, kitchen, store-room,
pantry and washing places for wor
kers
Within 15 days of the commencement of
the employment of the contract labourer.,
contractors are obliged to provide rest rooms
or other suitable alternate accommodation at
every place, where contract labour is required
to halt at night in connection with the work of
an establishment and in which employment
of contract labour is likely to continue for 3
months or more (Section 17).
Note
* Separate rooms must be provided for
women employees.
—' sufficient light
— smooth and clean floors and limewashed kitchen walls
* Rest rooms must have a adequate venti
lation and light, adequate protection
against heat, wind, rain and smooth,
hard and impervious floor surface and
have adequate supply of clean drinking
water.
— provision for removing waste water
and collection and disposal of gar
bage (Rule 43).
Dining Hall
—
•'
It must accommodate
labourers at a time.
♦ If these facilities are not provided by the
contractor within 15 days of the com
mencement of the employment of the
labourers, they are supposed to be pro
vided by principal employer.
30% of the.
— A portion of the dining hall must be
partitioned off and reserved for women
workers.
— It must have sufficient tables, chairs or
benches, furniture, utensils and cro
ckery.
—
Furniture, utensils and the floor must
be kept clean.
August 1985
Rest rooms
* The expenses incurred by principal emp
loyer in providing the amenity may be
recovered from the contractor concerned.
111.
Drinking water facilities
The contractor must provide sufficient
supply of clean drinking water at convenient
19
places and must maintain separately clean
washing places for men and women workers
at accessible places (Section 18).
Latrines and urinals
IV.
—
one bottle of potasium permanga
nate crystals;
—
one pair of scissors;
—
one bottle containing 100 tablets of
aspirin;
* Where females are employed, there must
be at least one latrine for every 25 fe
males ;
—
* Where males are employed, there must
be at least one latrine for every 25 males.
— sterilized cotton wool (Rule 59).
* Every latrine must have proper door and
fastenings to provide privacy.
* Latrines and urinals provided for men and
women workers must have sign boards
with the figure of a man or a woman and
must have a notice in the language of
the majority of the workers indicating
"for men only" or "for women only".
* There should be at least one urinal for
every 50 workers.
* The latrines and urinals should be situat
ed at convenient places and must be
kept clean at all times. Their type and
maintenance must meet the requirements
of public health authorities.
* Water shall be provided by means of tap
or otherwise near the latrines and uri
nals (Rules 51-56).
V.
First - Aid facilities
* There should be First - Aid Boxes plac
ed at easily accessible places at the rate
of not less than one box for 150 contract
labourers (Section 19).
* It must contain:
— small, medium and large size sterilis
ed dressings;
— one bottle of iodine;
— one bottle of salvolatile;
— one snake-bite lancet;
20
— ointment for burns;
a bottle of suitable surgical antisep
tic solution; and
* The First-Aid Box must be kept in the
care of a trained person, who is readily
available during the working hours of
the establishment (Rules 61-62).
VI. Creches
In an establisment, where 20 or more
women are ordinarily employed as contract
labourers, their children below 6 years must
be provided with 2 rooms for sleeping and
playing (Rule 25(iv)(a).
The contractor must supply them with an
adequate number of toys and cots and bed
dings (Rules 25(iv)(b).
Rules issued in 1972 by the Chief Labour
Commissioner (Central) regarding the cons
truction and maintenance of a creche:
* It must be located within 50 metres of
every establishment.
* It must be constructed of heat resistant
materials and should be rain-proof.
* It must have necessary doors and win
dows and adequate light and ventila
tion.
* Accommodation in the creche per child
should be at least 20 sq. ft. of floor area.
* It must have a shady playground suitably
fenced for elder children.
Medical Service
* It must provide clean drinking water for
the children and the staff, milk for child
ren below 2 and refreshments for child
ren above 2.
second working day from the day on
which his employment is terminated.
3.
Wages must be paid to the workers on
working days at the work site on a fixed
date.and time. If the work is completed
before the expiry of the wage period final
payment shall be made within 48 hours
of the last working day.
4.
Wages must be given directly to the wor
ker or to a person authorized by him.
5.
No deduction in the wages of a worker
is permissible except that which is speci
fied by the order of the Government.
6.
The principal employer must ensure the
presence of his authorised representative
to supervise the payment of wages by
the contractor to the workmen and it is
the duty of the contractor to ensure the
payment of wages in the presence of the
authorised representative.
7.
The authorised representative of the prin
cipal employer must certify at the end
of the entries in the Register of wages
in the following form: "Certified that the
amount shown in column No... has
been paid to the workmen concerned in
my presence on................. at........... "
8.
In case the contractor fails to pay the
wages to the workmen within the pres
cribed period, or makes short payment,
then it is the responsibility of the princi
pal employer to give the unpaid amount
of wages to the worker. The amount paid
by the principal employer can be recover
ed from the contractor.
* A kitchen with utensils for boiling milk
and preparing refreshments must be
attached to the creche.
* Children and the staff must be provided
with suitable uniforms.
* A bathroom adjoining the creche must
contain washing facilities, soap and clean
towels.
* Every child in the creche must be provid
ed with a cot,
mattress, bedsheets
blankets, and pillow with a cover.
* The person in charge of a creche should
be a woman with midwifery qualification.
She must be assisted by female Ayas.
* Working hours of the creche should cor
respond to the working hours of the
mothers.
* It must have first-aid equipment kept in
good condition.
* Every child must be medically examined
before admission. The weight of each
child must be recorded after the monthly
medical check-up.
* Creche may be inspected at any time by
any of the authorities mentioned in the
Act.
Wages
What are the rules to be followed
regaridng the payment of wages?
1.
The Contractor must pay wages to the
Workers every month on a fixed date.
2.
When the employment of any worker is
terminated by a contractor, his wages
must be paid before the expiry of the
August 1985
Note
Rule 25(ix) prohibits employment of fe
male contract labourer before 6.00 a.m. or
after 7.00 p.m. This rule does not apply to
women employed in pithead baths, creches,
canteens and nurses and midwives in hospitals
and dispensaries.
21
OFFENCES
AND
PENALTIES
Cognizance of offences by tht Court
1; Obstructing the Inspector
Those who obstruct an Inspector in the
discharge of his duties, or those who refuse
to give reasonable facility for making any ins
pection, examination, inquiiy or investigation
in relation to an establishment are liable to be
punished with imprisonment for a term up to
3 months or with fine up to Rs. 500, or with
both (Section 22).
2. Wilfully
ments
refusing
to
produce
docu
Those who wilfully refuse to produce on
the demand of an Inspector any register or any
other documents, or prevent any person from
appearing before an inspector, shall be punish
able with imprisonment for a term up to 3
months, or with fine up to Rs 500, or with
both (Section "22").
3. Contravention of the provisions of the
Act and the Rules
Those who act against any of the pro
visions of the Act or the Rules, or the condi
tions of licence granted are liable to be punish
ed with imprisonment for a term up to 3 months
or fine up to Rs 1000, or with both and if the
offence is continued an additional amount up
to Rs. 100 per day will be fined, during the
period of the contravention (Section 23).
Offences by companies
If the person who commits an offence is a
company, the company and every person in
charge of the conduct of its business at the
time of committing the offence or any other
responsible person of the company whose
negligence or consent or connivance has
caused the offence will be considered guilty
of the offence and liable to the punished
(Section 25).
August 1985
No Court inferior to a Presidency Magis
trate or a Magistrate of the first class can try
cases arising out of the offences committed
under this Act.
The Court can take cognizance of any
offence only when a complaint is made by the
Inspector or with his previous sanction in
writing only (Section 26).
What is the time limit for initiating prossecution ?
The Court cannot take cognizance of an
offence under this Act, unless the complaint
is made within 3 months from the date on
which the alleged commission of the offence
came to the knowledge of an Inspector.
If the offence consists of disobeying a
written order of an Inspector, complaint may
be made within 6 pionths of the date on which
the offence is alleged to have been committed
(Section 27).
Power of the Government to exempt in
special cases
The Government in the case of an emer
gency, may exempt an establishment or a
class of contractors from the perview of the
Act and the Rules:
Protection of action taken under the Act
No one has a legal right to file a suit or
initiate a prosecution against the Govern
ment or any of the officers appointed under
this Act for anything done in good faith in
pursuance of the Act or the Rules (Section
32).
23
Duty of the principal employers and the
contractors to maintain Registers
♦ Every principal employer is expected to
maintain a register of contractors of his
establishment in a specified form (Form
XII).
* Every contractor must maintain a register
of contract labourers employed by him in
form No XIII.
* Every contractor must issue an employ
ment card in Form XIV to each worker
within 3 days of the employment and the
same must be maintained up-to-date.
Duty to maintain Muster Roll, Wages
Register, Deduction Register and Over
time Register
Every contractor who employs contract
labourers in connection with the work of an
establishment must maintain:
— a Muster Roll in Form XVII
— a Register of Wages, in Form XVII
— a Register of Deduction for damages or
loss in form XX
— a Register of Fines in Form XXI
— a Register of Advance in Form XXII
— a Register of Overtime in Form XXIII
Duty of the contractor to obtain the sig
nature of the workmen against his en
tries in the Registers
The contractors must obtain the signature
or thumb — impression of worker against the
entries relating to him in the Registers. These
entries must be authenticated by the initials
of the contractors or his representative. It
must be duly certified by the authorised rep
resentative of the principal employer as speci
fied by Rule No. 73.
Duty to exhibit notices
The principal employer or the contractor is
expected to display notices, in English, Hindi,
and in the local language understood by the
24
majority of the workers at a suitable place in
the establishment and in the worksite
regarding rates of wages, hours of work,
wages periods, dates of payment of wages,
names and addresses of the Inspectors etc.
A copy of the notice must be sent to the
Inspector and he must be informed of the
changes as and when made.
Within 15 days of the commencement or
the completion of each contract work under
each contractor, the principal employer must
inform the Inspector regarding the actual date
of the commencement or completion of such
contract work in Form Xl-B (Rule 81).
Duty of the Contractor to issue Service
Certificate
When the work of a contract labourer is
terminated for any reason, the contractor must
issue him a Service Certificate in Form XV.
Power of authorities to call for informa
tion
The members of the Board, Committee,
The Chief Labour Commissioner (Central)
and the Inspector have the powers to call for
any* information or account in relation to
contract labour from any contractor or prin
cipal employer at any time by an order in writ
ing and a person called upon to furnish the
information is legally bound to do so (Rule
83).
Note
The provisions of the Act and the Rules
explained above are based on the Central Act
and Rules. The State Governments are given
power to make rules for carrying out the pur
poses of the Act. Persons working for the
welfare of contract labourers must also be
aware of the State rules so that their legal rights
can be enforced effectively and the violations
of their rights can be prevented in time.
Medical Service
READERS WRITE :
William A.M. Cutting, FRCP, DCH
Senior Lecturer in Child Health
Department of Child Life and Health
University of Edinburgh
6 May, 1985
To,
The Editor
Medical Service
Catholic Hospital Association of India
C.B.C.I. Centre
Goldakkhana
New Delhi 110 001.
Dear Sir,
Recently a friend of mine who knows my
interest in both India and therapeutics sent
me a copy of "Medical Service" 42,1, January
1985. This issue appears to contain a number
of contradictions which could confuse your
readers who are genuinely wanting to provide
a better service. On the one hand you seek to
promote a "rational drug therapy" (pages 3-7),
and on the other, recommend the "role of
traditional medicine in primary health care"
(pages 22-24). Of course these are not mu
tually exclusive, and used correctly, should
complement each other. However, there is
some discrepancy when your authors urge the
adoption of the limited drug list proposed by
the World Health Organisation, but at the
same time recommend the use of indigenous
medicines and point out "Ayurvedic Pharmacopieas contain 8000 recipes". On one side
polypharmacy is condemned, and it is pointed
out that only 7 out of 250 essential drugs re
commended by WHO are combinations of more
than one compound, while most ayurvedic
medicines are mixtures, for example a "combi
nation of Thulasi leaves juice, pepper powder
and honey".
Quality control of pharmaceuticals is an
important matterfor all countries concerned to
August 1985
provide effective and economic drug treat
ment for its citizens. I was interested to note
that every state in India has "its own drug
standardisation centre which supervises and
maintains standards of Ayurvedic drugs". How
can it be possible to undertake such a task is
beyond my comprehension, because despite
the giant ayurvedic pharmaceutical companies,
most products are produced on a small scale
or even at a domestic level.
All scientific health workers are agreed that
authenticating existing and new remedies,
and developing new ones, requires careful and
objective* research. The only pharmaceutical
advertisement in your magazine is from• a
company which claims to be "pioneers of
ayurvedic research". I have written to this
company and look forward to receiving their
promised set of "latest research data". Re
garding the three ayurvedic preparations which
they promote, there is no information about
the pharmalogical constituents of the pro
ducts, but the claims of effectivenss are quite
dramatic. One product is claimed to be effec
tive for conditions from "masticating trouble"
. . to... "constipation", producing "relief
within 5-15 minutes even in severe cases".
Confidence in their products is not increased
by nothing that the allopathic medicine they
25
advertise, "R. compound", is a combination
of oxyphenbutazone and aspirin which is
claimed will bring "Quicker relief without side
effects. Complete relief within 5-7 days".
In Britain paracetamol has largely replaced
aspirin because of the latters irritative effect
on the stomach, and oxyphenbutazdne has
been withdrawn from the market on account
of unacceptable side effects. The author of
your article on traditional medicine recom
mends as "effective remedies,.... pomegrannate skin dry powder.. . in dysentry,... and
papaya seeds for intestinal worms". While
these things may be effective, I would prefer
to treat my patients with drugs whose efficacy
has been proven for these conditions by cont
rolled studies. On the one hand your journal
is appealing to "socially conscious medicos
CONTINUING MEDICAL
EDUCATION
Ref : 12/06/1897/85
Fr. John Vattamattom
Executive Director
CHAI, CBCI Building
Near Goldakkhana
Ashok Place
New Delhi 110 001.
Dear Fr. John,
I was happy to receive the comments of
Dr. William A.M. Cutting, conveyed in his
letter dated May 6, 1985. These comments
are very valuable.
I agree wholeheartedly with the observa
tion that in promoting "rational drug therapy",
we must employ acceptable standards (same?
similar?), whatever be the system of medi
cine. It is essential to ensure that the drugs are*
efficient (effective and economical), safe and
of good quality.
August 1985
to ask for the withdrawal of all preparations"
which contain combinations of drugs of un
proven efficacy (page 33), but on the other
you seem to be encouraging the use of ayur
vedic polypharmacy with preparations, many
of which have not been standardised nor sub
jected to clinical trials. I continue to believe
that some ayurvedic medicines are effective
for some diseases against which there are no
satisfactory allopathic drugs. However, "ra
tional drug therapy" must apply the same
standards to all the medicines which it pro
motes ?
Yours sincerely,
.
Willam
A.M. Cutting,
Sd/FRCP,
DCH
Senior Lecturer in Child Health
Christian Medical College
Vellore — 2
6-7-85
It is true that there is an apparent contradic
tion between the stand against polypharmacy
and advocating the use of ayurvedic prepara
tions, which contain a large number of active
(?) ingredients. One of the main differences is
that the ayurvedic preparations are mainly in
the crude form of the herbs and their extracts
and cannot be compared directly to the pure
chemicals or formulations. When the alkaloids
and other active principles are extracted and
used, it is a different story altogether.
I agree fully that quality control is very
important, while there are some attempts at
standardization, these are as yet, far from be
ing satisfactory. We expect improvements with
the greater awareness of the need for quality
at every stage.
Clinical trials (in their own way) are being
carried out in a number of places (e.g., the
W.H.O. supported trials in Coimbatore), us
27
ing the traditional ayurvedic preparations in
the traditional way and also through certain
institutes of modern medicine. While many
of the tall claims may not stand scrutiny (and
such preparations ought to be removed from
the drug lists), it is hoped that out of these
research studies and clinical trials, a few use
ful and cost-effective drugs will emerge.
The failure to carry out studies in the usual
form acceptable to practitioners of modern
medicine is practically due to our own fault be
cause ayurvedic physicians are not knowledge
able about our methodology; they follow their
own methods, we will have to synthesize
them.
It has been the policy of Medical Service
to remove or at least reduce the drug adver
tisements. 'Alarsin' is the only one remaining.
There seems to be a misunderstanding. Ac
cording to the advertisement, the 'R. com
pound' is not a combination of oxyphenbu
tazone and aspirin. The firm seems to have
compared their 'R. compound' with oxyphen
butazone and aspirin in its effectiveness' in all
inflammatory and painful conditions of oral
cavity." We do not have data regarding the
effectivenss, safety and other parameters of
this drug.
As elsewhere in the world, paracetamol
has been replacing more and more the use of
aspirin, though in India, aspirin continues to
be used (in spite of the side-effects) in a big
way. Ciba Gigy has withdrawn oxyphenbu
tazone but restricted use (for conditions like
ankylosing spondylitis) is allowed by the Go
vernment of India. There are moves to make
the Government ban the use of oxyphenbu
tazone and especially its combination with
analgin.
Some of the substances like papaya seeds
for worms have been used traditionally as
home remedies. We will have to study them
under controlled conditions, though not al
ways necessarily under the usual "double
blind studies".
With regards.
Yours sincerely
Sd/Dr. C.M. Francis
Co-Ordinator, CME
[The above correspondence shows the need
to be careful about the choice of drugs. What
ever be the system of medicine (ayurveda,
unani, siddha or other) or home remedies, we
have to be careful to use only drugs which
are effective, safe, economical and of good
quality. The practitioner must use only drugs
of which they are knowledgeable, bringing the
same critical thinking with respect to their
indications, contra-indications, side effects,
cost and other criteria. We must not swing in
our opinion from one end of being against all
other remedies to accepting blindly any drug
(home remedies, traditional medicine or other
systems of medicine), but take a balanced, in
formed view, using drugs only where essential.
—Editor]
EMPLOYMENT
A young and energetic doctor seeks suitable employment preferably
in a Kerala hospital. Interested Institutions may contact directly :
Dr. Vijayan Nair
3OA3, Juhu Tara Road
Juhu, Bombay 400 049
28
Medical Service
Book Review
“The State of the World’s Children-1985”
UNICEF
— Newton Luiz
The situation is ripe for a revolution in.child
health. Poverty need no longer be so severe a
hindrance to health — four low cost techni
ques are now available to the poorest peoples
of Asia and Africa, four techniques that can
dramatically reduce Infant Mortality Rates
(IMR) by upto 50% within just 5-10 years.
This is the sum and substance of the booklet,
"State of the World's Children, 1985". It is an
astounding claim, considering that IMR has
decreased by only 25% in the last 20 years,
in these least-developed and developing count
ries.
And what are these four magical methods ?
GOBI is the answer — Growth monitoring.
Oral Rehydration Therapy, Breastfeeding and
Immunization. Four simple techniques that
will place the responsibility for a child's health
in the hands of its mother, largely displacing
the modern doctor as casually and as contemptously as he has displaced the magician, the
witchdoctor and the traditional healer.
And even as one turns away in intention
and disbelief — what utter nonsense, GOBI
indeed :- the evidence is mobilized:
In Matlab, Bangladesh, the IMR of a study
population of 90,000 was brought down by
11 % in just 3 years.
Less than 15% of the world's families are
now using ORT, yet it has already saved half
a million children in the last one year.
But how does it work? Author James
Grant, Executive Director of UNICEF, realily
explains: Growth monitoring will show the
mother that her child is malnourished and un
healthy. "Most malnutrition is invisible and
most parents of malnourished children do
not know that there is anything wrong".
"Most malnourished children live in houses
where there is no absolute shortage of suffi
cient food to provide an adequate diet for a
small child".
"Most malnutrition is caused not so much
by lack of food as by repeated infections which
burn up calories, depress the appetite, drain
away nutrients in vomiting or diarrhoea, and
often induce mothers to stop feeding while
the illness lasts."
In Cheraga district, Algeria, IMR has been
reduced from 103 to 43 between 1976-81,
by these techniques alone.
If mild malnutrition is detected early and
treated at once, it permits the child to resist
infections.
In India a study of 200 Integrated Child
Development Services (ICDS) Blocks shows
that the IMR has fallen to 89 within 10 years,
at the start, the IMR in these areas must have
been very much above the national average
of 124, considering that in some of them the
prevalance of Severe malnutrition was as high
as 21.9%.
Ora! Rehydration Therapy (ORT) can cure
most episodes of diarrhoea, and mitigate its
ravages in all but the most severe cases, there
by causing a dramatic reduction in morbidity
and mortality of the poor man's No. 1 killer
disease. The duration of diarrhoea is decreas
ed, and malnutrition is less severe. In 1971,
faced with a deficiency of IV fluids while cho
August 1985
29
lera raged among refugees from E. Pakistan in
Calcutta, a medical team treated 3700 patients
with ORT alone; only 3.6% died.
Breast feeding
. takes the infant out of
poverty for these first few vital months in
order to give the child a fairer start in life and
compensates for the injustice of the world
into which he was born". This is because
there is no difference in the quality of breast
milk of rich or poor, healthy or unhealthy
mothers, except in women with extremely
poor nutrition. Bottle feeding, on the other
hand, means diluted milk and hence malnutri
tion, unclean water and unsterile bottles lead
ing to diarrhoea, and a loss of the immunologi
cal protection afforded by breast milk.
Immunization against TB, Diptheria, Polio,
Pertussis, Tetanus and Measles would pre
vent 50 lakh deaths and save another 50
lakhs from disability annually; it would also
prevent the malnutrition that follows mealses
and TB, and leaves them prone to infection.
Further, a bottled fed child is pushed onto
the infection — malnutrition—infection cycle
of illness very early in life, and this vicious and
often spiralling cycle can kill him easily. But
breast feeding would probably protect him for
6 months or so; immunization would reduce
the possibility of dangerous illness; ORT
would mitigate the diarrhoeas that strike so
frequently; malnutrition would be handled
promptly. The result would be a child who falls
ill less often and less seriously, and thus have
time to regain his health in between illnesses.
The longterm damage to his health will then
be minimal.... In this context, the Gambian
study may be quoted 5% of children who
developed measles died of it, within 9 months,
another 10% of them died of other illness;
only 1 % of those who did not get measles died
in the same period.
And finally, a bonus. In the afore mention
ed Matlab area of Bangladesh as the IMR
30
fell there Was a fall in the birth rate too, for the
average mother had decided spontaneously
to have 2 children less than usual. Thus
GOBI would probably help to stabilize world
population at a lower level than previously
estimated.
The book goes on to discuss how these
techniques can be made known and put into
practice. Innovative ideas will be necessary,
no doubt, but there is no logical reason why
ORT salts cannot be as cheaply and as freely
available in every small shop as condoms, and
be used freely and confidently by families in
the treatment of diarrhoea. With the wide avail
ability of radio and TV, it will be much easier
to communicate with the people. What is now
needed is professional and powerful adver
tising backed by indepth study of the target
groups.
The claims made by the author — a 50"
reduction in IMR within years — are very
impressive. Too impressive, in fact, they sound'
like an elaborate fairy tale, an intoxicated re
verie, an optimist building airy castles. Yet,
the nature of the claimants is such that they
must needs be taken seriously.
The socialist would say, this is highly un
reasonable. Little or nothing can be achieved
by such simple and direct attacks on illhealth,
which is but one facet of a very complex so
cial, economic and political tragedy. You must
fight the problem at its root; you can't destroy
a tree by snapping a few twigs, nor can you
plug a volcano.... And grant coolly answers,
you can — to some extent. 60% of Bhutanese
suffer from goitre, and more than 5% are
born with retarded mental development. The
use of iodated salt on a national scale, and a
ban on the use of plain salt, has meant that
this disease will be cured within a few years,
by a minimum of effort. A lot can be done
within the system.
Medical Service
The author is not unaware of the deeper
aspects of the problem. He states categorically
that, "The cause of diarrhoea is poverty —
poor water supply, poor sanitation, poor health
education, poor housing, ORT will not change
that poverty." And now he expresses his view
point. "The front line in the long war or po
verty and underdevelopment is and remains
the struggle for economic justice and growth.
And the fundamental issues of women's
rights, land reform, disarmament, income dis
tribution, job creation, fairer aid and trade
policies, and a more equitable international
order remain fundamental determinants of
children's survival, health and well being. But
while that struggle is being waged, an ex
traordinary opportunity has now arisen to
strengthen the 'second front'. Most parents
in poor communities could now be given the
knowledge and the support to enable them to
protect their children from the worst effects
of that poverty in their children from the worst
effects of that poverty in their most valuable,
vital years of growth. And in so doing, a long
awaited blow could be struck against deve
lopment's 'enemy within' — the self-per
petuating cycle of ill-health, poor growth, and
lowered potential by which the poverty of one
generation casts its shadow on the next."
Grant is a humanist — "Many times it has
been agreed and demonstrated that it is a na
tion's human resources which are the key to
its social and economic, progress and that
investment in people makes economic sense.
In its 1980 World Development Report for
example, the World Bank concluded that the
right kind of social investment in such things
as primary education and health care can yield
an average economic,return of up to 25%
a year — far higher than can be expected from
most ‘investments in physical goods. "An
attitude which probably would make some
Marxists see Red. They might also consider
as empty rhetoric his repeated suggestion that
the child's health would now be in the hands
of its mother (rather than the doctor), which is
needed since only she can take an integrated
and long term approach to it.
Finally, Grant points out that a change in
health priorities is very much needed. We
must spend less money producing doctors
and supporting specialist institutions — the
money is needed to train dais, to supply our
PHCs. We must not imitate Tanzania and give
14% of an health budget to the main hos
pital in the country, and 15% to all the village
dispensaries together. A change in attitudes is
due: we must stop thinking that it is accep
table if children continue to be blinded by
xeropthalmic and deformed by rickets. We
must stop thinking that it is "normal" for wo
men to be anaemic, tired and chronically ill —
so common an attitude even among doctors I
We must stop overworking, underfeeding and
exploiting our women.
This, then, is the author's thesis. The main
criticism of his theme would be that, in order
to emphasize GOBI, he has deliberately de
emphasized the importance of an integrated
approach to development, and treated child
health as an isolated event. However, if the
claims made are in future proved to be valid,
then it would be very difficult to overemphasize
GOBI. The author has unequivocally asserted
that these techniques, all by themselves, can
produce magnificient results. Such "isolated"
attacks have been quite successful in the past.
Smallpox was eradicated. The NMEP may
have failed to eradicate malaria, but it reduced
malarial mortality from 8 lakhs in 1953 to a
few hundreds annually since 1964; it helped
to suppress kala-azar and plague; it permitted
development work like roads and railways to
be carried out in what had previously been
highly malarious areas. It is a sensible approach,
after all: if the cellar is infested with rats, one
must employ a few cats at once, and need not
starve till the new raproof cellar is made.
The book makes challenging reading, since
such a bold approach needs to be studied, if
only to repudiate its thesis. It has an efective
and lucid presentation, and makes for easy
and interesting reading. (It is supplied as a
free booklet, on request from UNICEF, 73
LODI ESTATE, NEW DELHI :- 110 003).
Fr. Muller’s Opens Homoeopathic Medical College
/
—S.C. Frank
The Management of Fr. Muller's Chari
table Institutions has decided to start an Ins
titution of Homoeopathic Medical Education,
Training and Research from the academic year
commencing June 1985. The Institution is
named "Fr. Muller's Homoeopathic Medical
College" after the late Fr. Augustus Muller,
sj, the founder of the Institutions.
The College has already been affiliated to
Mangalore
University and offers a 5|
year comprehensive graduate course leading
to the Degree of Bachelor of Homoeopathic
Medicine and Surgery (BHMS) as recognised
by the Central Council of Homoeopathy, New
Delhi.
intensive study and training extending over
5| years, with the necessary clinical ex
perience has been clearly outlined for the as
pirants. At end of the 5| years of BHMS
Course, a postgraduate course of 3 years is
on the cards.
Fr. Augustus Muller brought homoeopathy
to India, and set up a Homoeopathic Dis
pensary at Kankahady, Mangalore, 105 years
ago (1880), and by rendering commendable
service to the poor and the rich alike, made the
homoeopathic system of medicine popuar
not only in Dakshina Kannada but all over
India and outside.
With the existing facilities at their disposal
in the way of buildings, laboratories and staff,
preparations are being made for admitting a
batch of fifty students from all over India for
the 1985 term. The College is open to all ir
respective of religion, casts or community.
The people of Karnataka and elsewhere
have all along evinced the keenest interest in
homoeopathy and developed great faith in
the system. The demand for homoeopathic
medicines and specifics is on the increase.
But the Governing Board of Fr. Muller's,
with the Bishop of Mangalore as its President,
took up the challenge and spared no pains to
give Fr. Muller's a College of Homoeopathy.
Today Fr. Muller's has its own manufac
tory and pharmacy for the preparation of many
of these drugs and specifics. The remarkable
curative effect of Homoeotherapy on many
chronic complaints is very well appreciated.
From its inception in 1880 Fr. Muller's
In 1980, when Fr. Muller's celebrated its
Homoeopathic Dispensary has been manu
centenary, a bold plan was outlined for the facturing and importing from Germany and
establishment of a College of Homoeopathy.
other foreign countries homoeopathic mediTo many it looked over-ambitious—a mere . cines and specifics.
dream.
The team of experts entrusted with the
study of the need, relevance, feasibility and
viability of a Homoeopathic Medical College
in Mangalore have been more than satisfied
with their findings.
Realising that no haphazard, slap-dash
methods can yield results, a Degree Course of
32
The promotion of education in the field of
health care envisaged in the Memorandum of
the Association (1960) of Fr. Muller's Chari
table Institutions is the aim of the College and
its existing School of Nursing started 25 years
ago.
Medical Service
Fr. Muller's has all along held firmly to the
highest principles of service to suffering hu
manity in the spirit of Christ.
Fr. Augustus Muller, himself a great Ho
moeopath, was a staunch advocate of Homoeo
pathy. He pursued the science and made a
deeper study of the system for the purpose of
serving the poor through homoeopathic re
medies.
Following in the footsteps of the founder,
Fr. Muller's through its college of Homoeo
pathy, will devote itself to the progress of this
science by getting dedicated young men and
women genuinely interested in the system
and training them for service in the villages as
well as in numerous hospitals and dispensaries
all over India.
Moreover, with well-trained Homoepaths,
Fr. Muller’s can depend more and more on
itself for the bulk of the homoeopathic medi
cines it has been importing all these 105 years
of its existence.
The assets on the human side are an ex
cellent team of doctors — both allopathic
and homoeopathic — dedicated nurses train
ed for the last 25 years in its own School of
Nursing, para-medical and service personnel
of proven loyalty and integrity and trained,
efficient pharmacists.
On the facilities and equipment side, Fr.
Muller's has provision for 750 beds (250 of
them are free), an outpatient department, an
Emergency ward, a leprosy hospital with a re
habilitation unit attached to it, a maternity
hospital, a psychiatric hospital, well-equipped
modern operation theatres, a physio-theraphy
centre, a chest clinic, a pharmacy (both allo
pathic and homoeopathic), quarters for se
nior doctors and land for the future expansion
of the college and hostels. The hospital has
its own ambulances and other transport.
The Institutions are professionally designed
to assure all who seek them, of the utmost lov
ing and sensitive care to the relief of suffering
and preservation of life.
Planning of New Hospital ?
Expanding Existing Nursing Home ?
Modernising facilities ?
Consider "JANAK" for fine Patient Care Beds such as Intens
ive Care Bed, Recovery Bed, Hi-Low Bed, Modified Fowler's
Bed, Bed with backrest, Emergency & Recovery Trolley, Obste
tric Labour Table 2 Section, Medical Tables, Trollies Wheel Ch
air and other Ward furniture
METALBEDS INDIA (in association with Janak Mfg. Works)
Janak House, Opp. Indian oil Corpn Depot,
Sheikh Misry Road, Wadala (East)
Bombay-400037
Tel : 8820171/8820769
Cable : JANAKBED (MT)
Telex : 011-71584 JKMG IN
August 1985
33
CHAI
NEWS
NOTES
Sr. Elizabeth Edattukaran Receives National Award
SR. ELIZABETH
EDATTUKARAN
CEIVES NATIONAL AWARD
RE
The North-East in general and the Rapsbun
School of Nursing of the Nazareth Hospital
in particular have all the'reason to be proud of
when on August 8th, 1985, Sr. Elizabeth
Edattukaran of the Salesian Sisters (Daughters
of May Help of Christians) and the Principal
of Rapsbun School of Nursing received the
National Award for Nursing personnel for the
Year 1984. In the following lines, this unassu
ming little sister explains about her life and
life ambitions. We also join with Sr. Elizabeth
to share her joy and extend our hearty congra
tulations. — Executive Director
“I have left my home town in Kerala in
1956 as a young girl to give my life long ser
vice among the poor and needy. Under the
direction of Salesian Missionary Sisters, I
completed my General Nursing Course from
Ganesh Das Hospital, Shillong from 1956 —
1959. The Midwifery Course later in 1963
from the same hospital, passed in honours in
both General Nursing and Midwifery.
After General Nursing Course, I took up
2 years of formation course for Salasian Re
ligious life and took religious profession in
1961. In 1961 - 1963, I worked in School
Health Programme in Shillong and Tangla,
Assam, in Voluntary Institutions for 1| years.
From 1963,1 took up the call of Assam Govt.
to work as Staff Nurse in Ganesh Das Hos
pital, Shillong. From 1963 —1976, I worked
in the above hospital, as Staff Nurse, Ward
Sister, Sister Tutor, Home Sister's substitute.
34
Sr. Elizabeth Edattukaran
and filled the gap whenever needed. I worked
with enthusiasm in Surgical, Medical, Paediat
ric, Nursery, obstetrical as well as teaching and^J
gained a lot of experience. From 1969 on
ward I was appointed as full time Tutor for
both G.N.M. and A.N.M. Course. My alround
practical experience now contributes to a suc
cessful service as a Principal of this Prog
ramme Rapsbun School of Nursing with an
independent Administration.
During the Pakistan trouble as well as
Assam fight I had gone out of my way, along
with my Staff and Students to meet the needs
of Refugees in their Camps and I consider it
as the best services I had ever given to hu
manity.
Nursing Education is my first choice in the
Nursing field, and I am grateful to God and
all who co-operated with me till today to
enable me to contribute my mite in this field.
Medical Service
1971 - 1972. Section of P.C. Course for
General Tutor in College of Nursing, New
Delhi, I have been deputed by the Assam Govt.
and took the course under the leadership of
Mrs. Chaboak one of our well-known leader
of Nursing profession and came out success
fully standing in 2nd position. On my return,
I was posted as Sister Tutor in G.D.H. till 1976.
1976 - 78, I did the post certificate B.Sc.
Nursing at Christian Medical College Hos
pital, Vellore came out successfully with 2nd
position in Madras University Examination.
1979, I worked whole heartily for starting
New School of Nursing "RAPSBUN" and my
Superiors appointed me as the Principal of
this Voluntary and independent School of
Nursing.
Rapsbun Nursing School was one of my
dream since 1963 onward. It came to a reality
in an improvised hostel with improvised school
facilities in 1979 Sept and now I am in my
6th year as Principal.
On 4th June, the
hostel and school facilities areshiftedtoa new
and one of the beautiful building in this area.
I am happily spending my life with 44 enthausiastic G.N.M. Nursing Students.
First Fruits of Rapsbun School of Nursing
(The following is a short description by
Sr. Elizabeth herself about the School of Nur
sing she started. It is encouraging to see how
the nurses passed out from this school are
doing commendable services in the remote
rural areas. This institution deserves help and
encpuragement from all.
— Executive Director)
From 1979 we have taken up a project of
Nursing training programme to prepare Nur
sing Personnel for the North East zone mainly
for the Rural areas where other prepared catego
August 1985
ries of nurses are unable to reach. I have been
appointed as Principal of this particular school
which is Voluntary and independent in re
gards to administration. It is attached to Naza
reth Hospital Shillong for its practical ex
perience. Bishops and Religious congrega
tions and hospital
and other benefactors
sponsor the candidates for training and the
Salesian Sisters give Voluntary Service to
teach and form these candidates to dedicated
nurses. We have already sent out 3 batches of
nurses total 31 of them. Among these 31
nurses, 15 of them are working in different
parts of North East zone in the Rural areas
giving voluntary services in their own dis
pensaries and villages visiting programme do
ing much good to bring about health for all
by 2000 A.D. Hope we will be able to conti
nually prepare nurses for the rural areas. The
sent 16 nurses are young girls to nursing
profession. I am still looking forward for help
to furnish the new building and to get a full
time staff from outside as I don't have enough
prepared people from our own.
Later on, we are also planning to begin
with the Female Health Workers Course which
will be much needed in rural areas to work
along with the senior nurses. May the Lord
inspire good people to help us so that we will
be able to continue the good work we have
started.
— Sr. Elizabeth Edattukaran
PARTICULARS OF THE INSTITUTION
FOR
PREPARATION
OF
CITATION
The SACRED HEART LEPROSY CENTRE
is a voluntary organisation started during the
year 1916 with five patients as an asylum.
In those days the patients who had been
abandoned by their families were taken care
of by this institution. Gradually the number
of patients increased with the discovery
35
Government
Development
Sr. And!Ia receiving the Award*
of modem drugs. The institution could trans
form itself into a modern hospital from 1969
onwards.
The institution has all the required facili
ties for the treatment of' Hansen's Disease.
There are about 700 inpatients in the hospital
and the out-patients clinic is attended by
around 100 patients daily. Various services
provided by the institution are in-patients and
out-patients services, fully equipped modern
laboratory, reconstructive
surgery, physio
therapy and occupational therapy, shoe and
splint workshop, special school upto 8th
standard for the children affected by Hansen's
Disease, social welfare and rehabilitation.
There are 91 employees in the institution.
The institution started the rehabilitation de
partment during the year 1972 and since then
special efforts have been taken for the wel
fare of the leprosy cured persons. The number
of persons rehabilitated rose gradually every
year, with the implementation of many new
schemes. The institution provides financial
assistance for self-employment of cured lep
rosy persons. Vocational training programmes
are arranged for leprosy cured persons inside
the institution as well as in other training
centres. During the year 1983, the institution
punched rehabilitation programmes under the
Schemes — Integrated
Programme (IRDP).
Rural
In collaboration with the local panchayat
union, we could undertake 8 training prog
rammes under the IRDP scheme for persons
cured from Hansen's Disease. It was for the
first time a voluntary organisation engaged in
the treatment of Hasen's disease was select
ed to take training programmes under the
IRDP scheme in this district. We consider this
as a recognition and appreciation by the Go
vernment. Impressed by our training prog
rammes we could secure more training prog
rammes from the Government during the year
1984. The training programmes were one of
the best way for the rehabilitation of leprosy
cured persons. We could also secure bank
loans for the rehabilitation of the cured lep
rosy patients.
During the year 1984, in addition to the
medical assistance provided for 10,902 cases
vocational training for 108 disabled persons
were given. Two persons have been emp
loyed for the regular salary, 212 patients have
been assisted for self-employment under our
rehabilitation scheme. The institution has
necessary infrastructure to undertake training
and other rehabilitation programmes for the
leprosy cured persons.
(Sr. Ancilla)
WHO WORKSHOP ON CONTROL OF
TOBACCO-RELATED DISEASES
New Delhi; 22 July : With growing evi
dence of the direct relationship between smo
king and lung cancer, many countries are
considering measures to curb the habit, parti
cularly among the young. Similarly, it is re
cognized that the use of tobacco also has
adverse effects on health and that tobacco
smoke is carcinogenic to humans. Yet, the
* Sr. Ancilla, Superintendent, on behalf of- the Sacred Heart Leprosy Centre, Sakkottai,
Kumbakonam (T.N.) received the National Award from the Vice President of India on 13th
May 1985. The award consists of a certificate and cash of Rs. 50,000./-
manufacture of cigarettes and other tobacco
products and their consumption are increasing
in the South-East Asia Region. .
proportion of the adult population has been
smoking, the higher the incidence and morta
lity from lung cancer in that population.
To review ongoing national activities, po
licies and strategies in relation to smoking and
health in the WHO South-East Asia Region,
a five-day regional workshop on control of
tobacco-related diseases opened at World
Health House today. The workshop is expect
ed to formulate national plans of action with
specific reference to enhancing inter-minis
terial cooperation and coordination for effec
tive implementation of the programme.
The habit of chewing tobacco which is
associated with an increased risk of oral and
oropharyngeal cancers is also an area of con
cern in the South-East Asia Region. These
risks are enhanced by the intake of large quan
tities of alcohol. The other cardiovascular and
respiratory diseases related to tobacco con
sumption are also of a chronic nature, leading
to absenteeism from work, reduced industrial
production and huge costs incurred on the
hospitalization of these patients.
Addressing the participants, which include
senior health administrators and officials from
related Ministries, the WHO Regional Direc
tor for South-East Asia, Dr. U Ko Ko, caution
ed that there was evidence of an increase ,in
the number of cases of cancer of the lung,
chronic pulmonary diseases including emphy
sema and ischaemic heart diseases. "The
global figures for the mortality from lung can
cer alone have already risen to 1 million an
nually. It has been estimated that this figure
will increase to 2 million by the year 2000
and continue to rise unless effective action is
taken now to halt the smoking epidemic",
he added.
Besides, lung cancer, smoking and chewing
of tobacco are responsible for the vast majority
of cases of oropharyngeal and laryngeal can
cers. Other cancers related to smoking are
those of the pancreas, urinary bladder and
oesophagus. The cure rates of lung cancer
are extremely low, even when treatment is
early. The only effective method presently
available for the control of lung cancer is
prevention of smoking.
The risk of lung cancer is particularly de
pendent on the duration of smoking; the ear
lier the age of onset of the habit, the greater is
the risk to the individual. Furthermore, the
longer the duration during which a major
August 1985
There is yet another disturbing dimension
to smoking — ecological. The curing of to
bacco requires large amounts of firewood.
Naturally, this has contributed to deforesta
tion bringing in its wake soil erosion and de
sertification.
The Regional Director pointed out that seve
ral countries in the Region had initiated acti
vities to control tobacco consumption. Na
tional advisory committees had been set up
in some countries to define the most feasible
strategies, approaches and action plans. Some
countries had already introduced anti-smoking
legislation. "Obviously, a multi-disciplinary
approach is required and activities which are
in conformity with the socio-cultural milieu
are called for", the Regional Director said.
In the final analysis, the success of any
tobacco control programme has to be measur
ed by the level of reduction in the prevalence
of tobacco-related diseases, such as lung
cancer, cardiovascular diseases, chronic bron
chitis and emphysema. In countries where
such control programmes have been initiat
ed, the results have been encouraging. Ob
servations made in the USA by the American
Heart Association showed that mortality rates
from heart diseases had decreased signifi
cantly with a reduction in the smoking habit.
37
In North Karelia in Finland, measures taken
over a 10 year period to prevent smoking led
to a decrease in the levels of hypertension and
deaths from cardiovascular diseases. A re
duction in the rate of smoking amongst male
doctors in Great Britain from 43 per cent in
1954 to 20 per cent in 1971 was associated
with a lowering by 25 per cent in deaths from
lung cancer during this period.
The outcome and recommendations of the
workshop are expected to provide an impetus
and added momentum to the activities for the
control of tobacco-related diseases in the
Region.
Courtesy : WHO
ANNOUNCEMENT
Dear Doctor........ I
Of the drugs that are being marketed in our country, approximately
60% are either unscientific, harmful, substandard or banned. Doctors have
to- depend mainly on the drug companies for information about drugs.
Tall claims (often false) are made by drug companies about these drugs
while all the harmful side effects and contraindications are not placed be
fore the doctors.
Drugs Action Forum, West Bengal is going to publish a quarterly jour
nal on Drugs and Rational Therapy which will also contain‘information on
harmful, banned and unscientific drugs. The journal will function under
the guidance of an advisory body comprising of some members of All
India Drug Action Network (AIDAN) and other noted doctors of the coun
try. Doctors and health personnel are likely to be benefited.
Annual Subscription Rs.
12.00 (Four issues).
Bank drafts in favour of Drug Action Forum, West Bengal or Money
Orders for subscription may kindly be send to the following address: (Ple
ase do not forget to mention your name and address in the M.O. coupon).
Dr. P.K. Sarkar, Editor
Journal Of Drug Action Forum, W. B.
254, Block-B
Lake Town, Calcutta: 700089
August 1985
39
Position: 2634 (5 views)