MEDICAL SERVICE VOL. 42 No. 6 JULY-1985.pdf

Media

extracted text
introduction : bhopal—a peoples view of death, their right to know and live

• the

challenge

of. bhopal * a Christian

research in bhopal • mental

response to

bhopal > medical

health—introduction S emotional

reaction to

stress • industrialisation : the darker side.

“1

official house journal
of the catholic
hospital association of India

medical
service
"the love of Christ
urges us" 2 cor 5 :14

vol 42

editorial board

no 6

July 1985

contents

dr c m francis
dr ravi narayan
dr pram chandran john
dr daleap mukarji
mr augustin veliyath
fr george lobo sj
profgeorge Joseph

dr paul neelamkavil
fr edwin m j

editor

fr john vattamattom svd

cover, design

1

editorial

2

2

introduction: bhopal a peoples view of death,
their right to know and live

3

3

the challenge of bhopal

7

4

a Christian response to bhopal

9

5

medical research in bhopal

15

6

mental health—introduction

21

7

emotional reaction to stress

25

8

industrialisation: the darker side
anil agarwal and darryl d' monte

29

history of union carbide in india—in bhopal

35

9

p m isaac bangalore

published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001

printed at kalpana printing
house new delhi-110016

,,Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of India**

EDITORIAL
ANSWER ME, MY PEOPLE

What have the people of Bhopal done that on a chilly cold night
they should be treated with 40 tonnes of deadly gas ?
The other parallel to this question resounds in our ears every year on
Good Friday when we are asked "My people what have I done to you? How
have I offended you that you Crucify me? Answer me."

Bhopal is to date the world's worst industrial tragedy, not necessarily
the last one. There is probably a factory near you, or there will be one soon
enough. You have the choice to live in ignorance and die in a holocaust or
seek information and ensure that only appropriate industries come to existence
and that too with adequate safety measures.

Where were you when thousands of people died in their sleep, or woke
up gasping in choking fumes or as they fled with tears streaming from their
burning eyes? Sleeping? Yes it was a cold December night what else could
you have done?
And where are you now?
As the Bhopal gas victims limp back to their precarious
widowed or orphaned, disabled and debilitated,

existence,

as the company continues to bribe heavily, destroy and manipulate
evidence,

as officialdom kowtows to corporate power
as relief workers are being arrested and intimidated,
as the carrot of compensation continues to be dangled so near and
yet so far,

where are you ?

Still sleeping ?

Meanwhile the cry from Bhopal continues to be heard. My people
what have I done to you, How have I offended you, that you have killed me
three thousand times and continue to persecute me? Answer me.

INTRODUCTION: BHOPAL
A Peoples view of death, their right to know & five
They were asleep and unaware of impend­
ing death.. But death did visit the people of
Bhopal that chill winter night of December 2,
1984. A dense mist spread insidiously through
the air turning this city of eight lakh inhabitants
into the biggest gas chamber this world has
ever known. May be, if the lessons of this in­
dustrial catastrophe are well learnt, we will
never witness such a horifying spectre ever
again. But the memory lingers on, haunting,
macabre.

That fateful night, about 40 tonnes of a
deadly gas, methyl isocyanate (MIC), used as
an intermediary in the manufacture of the in­
secticide sevin, escaped from a tank in the
factory of the multinational company. Union
Carbide, spread across many areas of the city
of Bhopal, and killed over 3000 people within
ten days. Some reports put the casualty
figures considerably higher. Many many
thousands more still suffer the consequences
of exposure to this killer gas, which this inci­
dent proves to be among the most deadly
known to man. Deaths still occur and the ling­
ering fear is of the possible long term effects
on humans and the environment of this highly
reactive gas and its reaction and breakdown
products.

A reconstruction of events suggests that the
temperature and pressure of the stainless steel
tank containing the 40 tonnes of MIC began
rising at around 10.30 p.m. that fateful night
of December 2. No one seems to know why,
not even the people of Union Carbide, or so
they say. Possibly some water found its way
to the stored MIC, though how the water
leaked in is not known, or again, presumed
not to be known. MIC, stored in liquid form
under slight pressure, becomes a gas at 39.1 °C.

July 1985

It was a cold winter night when tempera­
tures were around 12.14°C. The exothermic
reaction of MIC with water, however, heated
the 40x8 foot tank to about 100°C (one
report suggests 200°C), turned the liquid
MIC to gas and sent the pressure in the tank
shooting upto 55 psi. That was enough to
burst the safety valve in the pipe leading from
the tank to the 80 foot high chemical scrubber.
The safety valve was rated to burst at 40 psi.
The gas rushed through an 8 inch pipe to an
open vent high above the ground and gushed
as a white cloud into the chilly night air.

The immediate question that arises is: Why
wasn't the gas neutralised by the chemical
scrubber or burnt in the flare tower before be­
ing released ? Answers to why the safety de­
vices in a high technology plant handling dan­
gerous chemicals were inoperative or ineffec­
tive in a moment of crisis need to be sought.
Aparently the rise in temperature and pressure
was not sudden but took some time. Its sig­
nificance doesn't seem to have registered on a
personnel operating the plant. Why was this
so? Is this because of the absence of an in­
dustrial culture, or is it because safety drill
and safety measures were low priority in cor­
porate balance sheets? Or was it merely be­
cause the plant was beginning to show signs
of fatigue, with pipes bursting and valves not
functioning? The plant, which had restarted
production just a week back on November
26, manufacturing Sevin, had been shut down
a day earlier to check out a faulty valve in
the pipe leading from the MIC tank to the che­
mical scrubber. Production of Sevin fluctuates
with fluctuating market demand for this agri­
cultural pesticide formulation. Minor acci­
dents have not been uncommon ever since

3

this plant was installed in 1980. Gas leakages
have led to injury and even death of workers.
In an accident in 1981, one worker, died, in
another in 1982, twenty four were hospita­
lised. It was, thus, only when things began to
get beyond control at around midnight that
senior personnel were informed. The works
supervisor was the first to arrive. The works
manager, informed telephonically by the ADM,
arrived too late, after 1.40 am, a wet towel
wrapped around his face. But by then the tank
had become so hot that no one could go near
it. It is partially underground, reinforced with
concrete. It began to vibrate so violently under
the pressure that it cracked its concrete rein­
forcement.

limits, now bang in the middle of the city
which has since grown and spready out. Be­
fore it dissipated in the early morning winds,
the deadly gas had unfolded a drama of tragic
proportions.

The people were asleep. Innocently asleep.
Many never awoke, dying in their sleep. Their
bodies lay under tattered razais for over a
day before being carted away unceremoni­
ously in trucks to mass cremations and burials.
Those who awoke gasped in choking fumes
of the obnoxious gas which burned their
eyes and seared their lungs. They opened their
doors only to let in toxic fumes of death. Those
living near the factory were used to sudden
gusts of foul air blowing from the plant, but
The time was around 1.30 am. One worker
never before had they experienced something
remembered, rather belatedly, to switch on
like this. Panic gripped them — 'zahreeli gas
the factory siren signalling the catastrophe to
chhooti hai, bhago'. The cry rent the air.
the neighbourhood. Reports suggest that the
And they fled, noses covered with pieces of
siren actually went on only around 2.15 am.
cloth, tears streaming from burning eyes. They
But, by then, the nightmare had already begun.
fled with whatever they could carry. Some­
A light 12 kmph breeze, blowing in a south,
times with nothing, empty handed, only in­
south easterly direction, had already safted tent on escaping the acrid fumes. Unmind­
the dense cloud towards the city. The plant ful of friend or foe, brother or sister, they fled.
workers, trained in the event of such catastro­
On bicycles, bullock carts, buses, cars, auto­
phes to run in the direction opposite the wind, rickshaws, tempos, trucks, mopeds — they
ran to safety. Others were not so lucky. The fled. And the poor fled on foot in a mad rush.
gas, being heavier than air, settled down over No enchanted piper could ever have conjur­
considerable areas of the city as the wind
ed such a macabre stampede. Families were
died down, obscuring even street lamps in a
separated. Many fell along the wayside, es­
foggy glow. The devastation it caused exceed­
pecially the poor on foot who could not out­
ed anything ever attempted or imagined in
run the gas. They fell, eyes burning, retching
the realm of chemical warfare. The seriously out their insides, unable to breathe, weary,
affected area is placed between 5-8 kilometres
waiting for inevitable death.
of the factory, though reports suggest that the
The railway station lay in the path of the gas
gas travelled over 15 kilometres, covering an
cloud, moving more earily than anythng out
area of over 50 square kilometres and affect­
ing over two lakh people constituting one of a science fiction film. It left behind death.
Passengers in waiting rooms, porters and rail­
fourth of the city population. It hung in the
way
staff who stayed on died. Most others fled.
air like a death shroud, creeping into depres­
sions, houses, cupboards, foodstuffs and The station remained cut off from the rest of
clothes. Most of the seriously affected areas the country for over seven hours as trains were
halted outside the city limits. Bodies lay around
comprises slums and shanties of the poor,
haphazardly in the chilling finality of death.
spread across land once outside the city

4

Medical Service

By the time an unmindful sun dawned with
pitiless regularity on a beleaguered city, bet­
ween 300 and 500 lay dead, many on the
roads. Over 2000 lay dying in hospitals and
homes. Over 20,000 victims began their weary
trek to hospitals for treatment that day. It
was December 3, 1984. Black Monday.

The army and the volunteers then began
pouring in. Citizens, concerned about their
fellowmen,eagerly, selflessly helping the dis­
tressed and the dispossessed. It was only
later that the state could gear up its machinery
to face the calamity. Police, medical teams
and administrators were hastily put into
action. But they proved woefully inadequate
in the face of this unprecedented and unparal­
leled disaster. The state took a couple of
days to get to grips with the situation and ar­
range relief and refugee camps. By then the
tragedy had acquired frightening dimensions.
All around lay corpses of the dead, bellies
distended and beginning to rot. The bloated
carcasses of animals were carried in truckloads
outside the city limits, dumped in collective
graves with salt and lime. The city mourned
its dead and lay desolate.
The horror and terror soon sank into apathy
and numbness as the dead came pouring into
the burning ghats and cemeteries. They came
in truckloads from the hospitals and else­
where. There were mass cremations. Orange
flames leapt into the skies without respite.
Crematoriums ran out of firewood and gravey­
ards had to open old graves to bury the newly
dead for want of space. Some say trucks car­
ried their grisly loads as far away as the Nar­
mada in Hoshangabad for burning and dis­
posal. Despite the figures quoted, no one
really knows how many bodies were consign­
ed to oblivion that first day. There was little
dignity left in death. Often nameless, unclaimed,
they died unwept, uncared for, merely a statis­
tic for the world looking on aghast at this
horrendous nightmare.

July 1985

And then began a strange process of disin­
formation and, often, suppression of informa­
tion which manifested itself throughout the
course of the incident, with telling conse­
quences. In fact it began that very night it­
self. 'Nothing is wrong, said a senior factory
personnel when contacted by a frantic police
when things began to go haywire. 'There was
a gas leak, but everything is under control
now', he was to add later, even as the deadly
gas was taking a toll of the hapless people.
'It is not a.dangerous gas,' said the medical
chief at Carbide when contacted by frantic
doctors. 'It is not lethal said another senior
factory personnel, 'Can't you see I am alive?'
The medical chief at the Virginia plant suggest­
ed a wrong medicine and later pleaded he had
got the name wrong over radio. Ironically,
these very senior medical personnel formed
the core of the committee of doctors set up
to decide on a line, of treatment for the victims.
In the morning of the first day, five senior
officials of the factory were arrested under
Section 304(A) — causing death through neg­
ligence, the factory was sealed pending an
enquiry by the CBI and an enquiry by a sitting
judge was announced. Curiously however,
the arrested officials, confined in the plant,
were looking after it in their period of deten­
tion. The sealing by the CBI was more than
symbolic. It effectively sealed most informa­
tion about the factory and what really happen­
ed there that night. It didn't stop people from
asking why the Government had at all per­
mitted a factory dealing with such hazardous
chemicals to be built so close to the city. Or
why the basic safety norms don't seem to
have been insisted upon by its factory ins­
pectors.

The misinformation continued. 'This factory
will never be permitted to produce anything',
fumed the state in righteous anger, only to
later agree to the production of Sevin as the
only 'zero-risk' neutralisation method for the
remaining MIC in the plant. 'The factory offi­

5

cials are guilty of gross negligence, they will
be punished', said the state, only to have
senior Carbide officials as the guiding spirits
of the team of experts set up to decide on a
course to neutralise the remaining gas.
The neutralisation drama only heightened the
level of confused information. Was it actually
meant to encourage people to flee the city
without resorting to the drastic step of an
evacuation? How else does one explain the
volley of confused and contradictory state­
ments coming from medical, scientific and
Government experts regarding the gas and its
effects. 'The water is safe', said the experts
'but boil it before drinking'. 'Vegetables and
fruits are safe', said the experts, 'but wash
them well before eating'. 'The fish is safe',
said the experts and then closed the meat and
fish markets. 'The air is safe', said the experts,
but what were the tests that they conducted ?
'Don't panic', said the administration, yet had
scores of buses brought into the city to carry
people away. The public did not know what
to make of the situation. They did the only

How many Died,

Time marches on inexorably. The city limps
back to a semblance of normalcy. The night­
mare however still continues. It throws up
many questions. About the unchecked use
of science in industry, about the nexus bet­
ween the industry and the state, in a demo­
cratic set up. About the existing dangers from
the hundreds of factories which dot the coun­
try, harbouring their poisons inside or spewing
them out into the wind, water and soil of the
earth. And it raises the fundamental question
about the fundamental rights of a citizen of
this country to know and to live.

Bhopal has already moved into the annals
of history as yet another example of man's
inhumanity to man. An example of callous
mass murder legitimised in the name of
science, industrial progress and the state.
Can we just sit back and let this black act be­
come merely a footnote in a history book ?

How many were Affected ?

The Dead

The official Indian government figures say
that about 1,700 people died.
The press reports that 2,500 people died.

A conservative estimate by Ipcal relief wor­
kers suggests that 5,000 may have died. They
note that 1,000 or more died outside Bhopal
in surrounding villages after they fled.
The truth may never be known. Many of
those who died have no official record; no
ration book, no permanent address. Who
can count the dead who never officially exist­

6

possible thing. They disbelieved what was
said and fled the city.

ed ? And when whole families died together,
there was no one to register their deaths.
The Affected

That night, 200,000 people, a quarter of ther
city's population, were affected by the gas.
Now, some months after the disaster the go­
vernment claims there are no long-lasting
health effects, but doctors estimate that some.
50,000 people have been seriously affected.
Many of these are poor people, with no means
of survival beyond their ability to do daily
manual work. Now they cannot work, and they
have nothing.

Medical Service

The Challenge of Bhopal
"The growing multinational culture must be
destroyed because it leads to economic chaos,
increased social disparities, mass poverty and
filthy affluence in coexistence, environmental
degradation, and ultimately civil strife and
war.
To get a balanced, rational development
and to preserve the environment, a new deve­
lopment process is needed. The biggest in­
tellectual and political challenge of our times
is to articulate and demonstrate this new kind
of development".

—A statement of shared concern Citizens
report on state of India's Environment,
1982.

Its six months since the worst industrial
and environmental disaster in recorded his­
tory. Bhopal has not only been a nightmare for
those who were there on the night of 2/3
December 1984. It is also a portent of events
to come.
World Environment Day (5th June) has.
come and gone. There have been the usual
meetings, seminars and lectures, the usual lipservice to ecological sensitivity, the usual nar­
rations of the health and social hazards of
environmental pollution and the usual pious
recommendations of what can and should be
done.

How many more Bhopals will we need in
this country before we are shaken from our
apathy ?
— from our callousness to our disadvantag­
ed and exploited fellow human beings
who are always the worst hit in such
disasters.
— from our insensitivity to nature, our fo­
rests, our rivers and our land.

July 1985

— from our insensate rush for chemicalising and technologising our lifestyles.
— from our race for profits even at the cost
of the health of our workers, our people.

The medical community in India will be
increasingly called upon to respond to the
medical and health problems caused by more
ecological disasters. What will our response
be?

Will we see every disaster as a change to
refine our clinical skills, satisfy our charity
and welfare urges, exploit the research po­
tential for career development and use the
opportunity to ask for more and more sophisti­
cated gadgetry for our institutions?

Or will we be challenged by these disasters
to raise our voice collectively to oppose the
unhealthy trends in our society to use our
knowledge and social potential to support
the growing awareness for a healthier and
more egalitarian social system; to use our re­
search skills -to strengthen and conscientise
our fellow human beings to an increasing
health and ecological awareness.
The dilemma of a man who enters a room
to find a tap running and a wash basin over­
flowing, faces us today. Will we choose to be
floor moppers or tap turners off?
Overpowered, compromised and hypnoti­
sed by the products and high pressure sales
tactics of the multinational pharmaceutical
industry, our sensitivities have been so dullened that we are quite content to be merely
'floor moppers'. Can we ever be tap-turners
off? The International movement of physi­
cians for prevention of Nuclear war is a thought
provoking example showing that if we want to,
we can.

7

Bhopal too is a challenge? So are many
other more insidious developments in our
country. The growing investment in nuclear—
energy now discredited as an energy resource
in the West, or the gradual take over the cot­
tage industry in food by big business, — each
of this though different from the other has a
growing similarity representing either a sub­

servience to the profit motive or an insensiti­
vity to health hazards or both.
Minimata, Seveso, Long island were too
distant to make any impact. Amlai, Chembur,
Handigodu, Harihar, Zuari, Nagda, Mavoor,
Silent Valley, Thai vaishet hare not stimulated
us either. Will Bhopal do so?

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8

Medical Service

A Christian Response to Bhopal
The entire Catholic Church, the laity, the
religious and the clergy was involved in the
relief and rehabilitation work of Bhopal.
The Archbishop himself took the lead and
called a meeting of teams of sisters and priests
on December 4th morning. The teams set out
to affected areas.

What they saw did not allow them time to
invite for another discussion. They got to work
immediately — medical aid was arranged, eye
drops, injections, cough syrup and tablets,
antacids and antibiotics. Food was arranged
for them in their homes and some had to be
few with persuasion. The evening found
the Archbishop at the site. The team informed
him of the danger of the delay in the dead
animals lying around. The Archbishop was
instrumental .in hastening the clearing of the
animals and also in facilitating the process by
arranging for a few pick-up vans for this work.
Wherever help could be received, attempts were
made to reach help to them. Hospitals were
filled — with patients, doctors, relatives, nur­
ses, volunteers and people. People came to
search — for relative, for news, for something
to satisfy their own curiosity and also to
strengthen their own strong selves. It was
then discovered that some children were left
"alone". Alone, because their parents were
not identifiable, or were no more.
The Government approached the adminis­
tration of Asha Niketan and asked them to
look after these forty odd children till such
time they had taken a more permanent de­
cision about it. The children were put aside in
one of the closed — in corridors of the child­
ren's hospital and the sisters had to give a
twenty four hour service to these. The Adminis­
tration accepted the challenge and did a most

July 1985

Christian Service in washing, feeding, caring
and loving the children.

December 5th to 9th saw the team of vo­
lunteers together with others from college,
schools, associations and families, adminis­
tering medical attention and supplying food
at centres and from house to house.
On December 9th, it was thought necessary
that a team sit together and put their mind to
work to see what should be done immediately
and if necessary, for the future.

It was decided that we should concentrate
our efforts on a fixed locality since the total
area is too vast for us to effectively care for.
It was also agreed that the people of Dharkwar
Nagar, Kainchi Chohola be taken up.. These
two areas besides being affected were by far
most neglected as they are far from the lime­
light.. It was also decided that immediately
'Relief Work' be given in terms of food and
medicines. Till such time the people get com­
paratively better, cooked food will be distri­
buted. After that, for some fixed time raw
food materials will be served to them. Catho­
lic Relief Services, Bombay, agreed to help
in this area. Medical aid was continued to be
given through the nurses at the centres and
at the homes.
With the announcement of the Chief Mi­
nister, that the work on the use of the remain­
ing gas was to begin on Dec. 16, 1984, the
Bhopal City witnessed a mass evacuation of
its inhabitants. People left with their families
either because they were afraid, or because
this was an opportunity to avail of for their
winter vacation, or just one reason to run
away. However, the City of Bhopal was left
desolate and at a standstill.

9

The Government Offices were open but still
not much work could be done as many of the
workers were not present. The shopping
centres were closed, the streets were bare.

The Government Authorities had arranged
a few Camps to accommodate the people from
the certain specified 'affectable' areas. Ar­
chbishop Eugene D'Souza was one of the
members on the high level committee to look
into the arrangements of these camps. The
first few days the Committee members went
around the camps to look into its working and
meet with the campers. The arrangements
were elaborate and every detail was taken
care of. However, the expected number of
campers did not turn up. Arrangements were
made for buses to transport the people, camps
were equipped with tents, food for the people,
medical aid, toilets and what not. People
however, in the majority, found their own hide­
outs and fled away from the site.

members of our Institutions in Bhopal offered
personnel. This led the Archbishop to can for
a meeting of the heads of the different Insti­
tutions here at Bhopal. On December 26th,
1984, it was explained to the members at the
meeting that there was an urgent need to help.
Financial help was coming in. It was necessary
to find the people to reach out this help to the
Heads of Institutions were asked to take cour­
age and offer their help. They were asked to
choose any sector that they thought they
could take care of. They were asked to make a
commitment to render this help for a period
of a month. This help would be in the form
of meeting with the people of the area, under­
stand their needs, administer food, medical
care and at the end of the month suggest a
plan of future action if any has to be taken up.
The response to this request was more than
encouraging.

Dwarka Nagar continued to remain in the
care of the Core group. Kainchy Chola being a
big area was divided into two compartments,
St. Joseph's Convent School taking up one
and the S.V.D. Fathers with their Seminarians
the other. Chola Mandir was in the care of
the Seva Sadan Parish with the S.D.B. Fathers
leading the group. Neech Chola Mandir was
taken up by the Asha Niketan Parish assisted
by the Asha Niketan Rehabilitation Centre
and Krist Premalaya Seminary. Garib Nagar
was to be looked after by the Jehangirabad
Parish together with the Missionary Sisters
of Charity and the Craft Training Centre at
With the return of the inhabitants of the Jehangirabad. Chola Road was to be looked
affected area to their own places of residence after by the St. Francis School with Gabriel
in bits and pieces, the city shops opening for
Brothers leading. The Orissa Colony came
the daily business and life going on as usual,
under the patronage of the C.M.I. Fathers of
the voluntary help offered from other agencies
Poornodaya. The B.H.E.L. Parish promised to
was reduced. The Archbishop grew concerned
help the Core group, the Clarists Sisters
about the fact that there were so many people
helped the Poo nodaya Fathers and the Holy
in the affected area that were still not cared
Family Convent Sisters helped the S.V.D.
for. Help was being offered from all sides —
Fathers. All in all, every Institution had some
Financial aid care from concerned friends, and
responsibility.

More than just administering food and me­
dicines to the people, the need is to be with
them, to give them the support and encourage­
ment, is a need. There are a number of fami­
lies
that are not merely shocked but very
much afraid. The mass media too were no
help. There is plenty of ambiguity in what is
happening, what is said from mouth to mouth.
As a result, they were asking themselves if they
would want to continue to live in the vicinity
of the factory. Our presence gave them some
assurance and support.

10

Medical Service

The groups set out in all earnest from the
very go. Families were identified, ration cards
were handed out and the distribution of food
was done. The ailing members were attended
to and it was found that a new life had entered
into the lives of the people.

Come January 3rd, 1985, the people of the
effected area were aroused to voice their
grievances to the Government by a long pro­
cession to the residence of the Chief Minis­
ter. Whatever may have been the result of the
procession, an announcement was made by
the Government that food would be made
available to the people through the Govern­
ment Ration Cards. By January 7th, 1985
it was found that the Government was sincere
to its word and long queues were made be­
fore the ration shops. With this, we on our
side held back our rations -and persuaded the
people to make use of the Government pro­
visions. People were then helped by our
volunteers to receive their ration cards. Medi­
cines however continued to be given as
there was no reliable source of medical atten­
tion being given. Care was taken to make sure
that no family remained hungry or uncared
for because of any lapses.
The Morcha :

It is a fact that on January 1st, 1985, a
number of aggrieved people of the affected
area got together and blocked the main Com­
mercial road—Hamidia Road. Buses from out­
side the city were not allowed to enter, and
vice versa, none were allowed to go out.

It is also a fact that on January 3rd, 1985,
a long procession of about seven thousand
men, women and children marched from the
Union Carbide Main Gate through the city to
the residence of the Chief Minister. The Chief
Minister not being present, the people stayed
on the night to await his arrival. On his arrival,
the Chief Minister met with the people, tried
to tell them that the Government is trying to
July 1985

do its best. But, the members did not relent*
They stayed on for ten days. Their demands:

1.

The Union Carbide should be removed
from the present site with immediate
effect; v

2.

Relief and Welfare Centres should be
set up for each sector of the affected
area to look into the socio, economic
and health needs of the people.

3.

Every family in the affected area should
be given an ex-gratia payment of Rs.
2,000.00.

4.

The widows be given pension, the
incapacitated members be given social
Security and the orphaned children be
taken care of.

This was the time for us to get down and
help the people to do some constructive work.
They must get themselves to do something
for themselves. They must learn to fend for
themselves. They must develop a sense of
self respect and depend on themselves.
For the children, we opened a small school,
where they were kept busy during the day.
They receive their mid-day meal cooked and
served to them. On registration, we gave them
some suitable clothes to wear. Cleanliness,
discipline, development of values and res­
pect for themselves and others, besides teach­
ing then the reading, writing and arithemetic
will be given them.
For women, a craft training programme is
conducted where they are kept busy doing
some craft work for which they will receive
some remuneration. Here again an attempt was
made to give them some adult education and a
sense of values.

For the men, small jobs in the colony was
given them to do for a few hours without
expecting too much from their weak bodies.
.11

For this they will be paid a daily wage and thus
give them a sense of satisfaction of earning
their living and doing something for their own
community.

In all these works, attempts were made to
take care of their health problems. Besides
the food that they earn or receive, the medicines
or multi vitamins were given to them to
strengthen their bodies to physically fight
against any kind of hazard that comes their
way. With this it is also hoped that they will
improve their psychological selves and deve­
lop a sense of independence and stop hoping
or fighting for hopes that they hear people
give them.
Towards this, we occupied two rooms where
the core group is presently in residence. Addi­
tional rooms in temporary style were construct­
ed to house a small clinic, a Balwadi and a
Craft Training Centre. Children are being iden­
tified for whom we could offer a sponsor­
ship programme through the Christian Child­
ren's Fund at New Delhi. This programme will
help us focus on the child no doubt, but in
keeping with the philosophy of the CCF
we will help develop the family and through
the families to the community development.
Medical equipments were procured for better
attention to the patients. A doctor has been
employed to give professional service.

With the passing out of the month of
January 1985, things began to take shape.
Thanks to the many members of the different
institutions who gave of themselves to share
their feelings, their selves and all that they had.
With their presence during those days, Christ
and the Church were made present. The people
saw the interest, the devotion and the love of
Christ made manifest through the Christian.

Till this time it had been my cry of 'uncertinity', 'change of events., 'unrealistic de­
mands'. Today, as I look back to see it all,
it seems HIS PLAN to have things happening
in the way they did. You and I should be proud
12

to know that here was here you and I are in
the fulfillment of this great plan. Let us pray
that the decisions that we take may be in the
better fulfillment of the plan.

The Happiness
At the end of January 1985, the two sister
nurses who had generously been given us
during the relief work, were called back. The
sisters of Holy Family stepped in to con­
tinue their services and promised to help till
the end of March 1985.

The activities in the different sectors grew
less as members got back to busy themselves
with their own home work. Except for the
Asha Niketan Parish who looked after a part
of Chola Mandir, the C.M.I. Father, who
looked after the Orissa Colony. The sisters
of St. Joseph's Convent continued to look
after a part of Kainchy Chola.

Beginning February 1985, a full fledged
medical clinic was arranged for with the neces­
sary equipment. An X'ray machine was pro­
cured, installed and used. A fulltime doctor
was employed. A specialist visits the clinic a
couple hours a day and a Gynaecologist visit
the clinic to take special care of the women.
The pregnant women are under instructions
to regularly visit the Gynaecologist and re­
ceive her instructions. The children are be­
ing thoroughly examined in turn. About 250
to 300 patients are attended to daily.
The Balwadi, with one hundred and sixty
odd children, continues in the same style.
On January 26th, the children were given a
white dress and practised to a solemn parade
to host the National Flag for Republic Day
and sing the National Anthem. The Archbishop
was rejuvinated in the midst of these children
when he hoisted the flag and sang with them
the National Anthem as brothers and sisters
of one Indian Nation. The children perform­
ed for their parents and teachers a few exer­
cise and sang action songs. The Archbishop

Medical Service

shared his joy with the children by sharing
distributing sweets and eats to the children
and all the people of the colony.

The parents took advantage of the occasion
and surrounded the Archbishop to plead with
him to ask his team to stay with them and not
leave them alone. In an empathetic and parently
manner, the Archbishop gave them the as­
surance and promised to continue to help
them.
The women continue to gather together to
learn a few stitches. During the period, it is
taken off.the give them a few Morals Classes
and also tfrje proper care of their home and
children. These too are benefited with a mid­
day meal. It may be mentioned here that one
of the objectives in starting the Balwadi and
Craft Centre was to give them some nutritious
food. Having done so, we find that, that was
a good decision. In a weeks time their colour
changed and the faces grew brighter. They do
have their regular meals at home. But we were
not sure that the food that they eat is nut­
ritious.
For the men folk it was discovered that
many of the men were left jobless. Others did
not have jobs. We advanced them some
money to purchase a hand cart to help them go
out to. earn their living. Others were advanced
money to help them improve their business.
It was also discovered that some of them had
not had the money to pay the rent for their
houses. We helped them and made them secure
in their own rented houses. Some were given
small jobs in the colony to clean up some of
the areas and also to build up the tempo­
rary sheds for the dispensary, the craft centre
and the workshop. With the help of some of

July 1985

our friends, a small unit of chalk making was
started where the adoloscent were given some
responsibility. We hope that our educational
institutions will help us by purchasing the
chalks from us for use in their institutions.
During this period of three months our team
has been here. Relief has been reached out to
the peoples around the area. The people have
been touched by the services and our pre­
sence. Their response to us has been an
INVITATION TO STAY. Having worked with
them, lived with them and shared their fee­
lings, we have become of their need and so....
...................
HAVE DECIDED TO STAY.

Negotiations were being made to purchase
a house to live in, when we were suddenly
told to vacate the two rooms from where we
were offering our services. We tried to make
further attempts to talk them into a more
generous yet reasonable agreement. It did
not make sense. We had to leave.

On the other hand however, while in the
process of planning our stay, some generous
soul offered us a' room to locate our office.
With no further delay, the furniture was brought,
laid out and work began. Today it is a common
office for AGAPE and the local community
members to come together and discuss their
problems.
Come mid February, the Archbhishop raised
the Centre to one more of the Archdiocesian
Welfare Centres. A resident priest with a
group of sisters would be appointed. Not to
delay further, it was informed that the Salesan
sisters of Mary Immaculate from Nagpur had
agreed to come and begin the house from
March 1985.

13

Medical Research in Bhopal
—Are we forgetting the people?

Concern for man himself and his safety must always form the chief interest of all
technical endeavours. Never forget this in the midst of your diagrams and equations.
—Albert

Einstein

Preamble

The Plan

In a tribute to the medical relief workers
involved in service to the Bhopal disaster
victims the ICMR has noted (I) that a disas­
ter of such magnitude, of such suddenness
and caused by the release of a highly toxic
chemical methyl . isocyanate (MIC) into a
densely populated habitat is unparallelled in
human history. The doctors, medical students,
civil servants, governmental, public sector and
voluntary bodies and the people themselves
rose to the occasion in a human gesture equally
unparallelled'.........

A report on the first nine days of the Bhopal
disaster identified (1) three objectives for the
ICMR's research programme:

In the absence of authoritative information
on the released gas; the unwillingness of the
company to part with authentic information;
the unpreparedness of the local bodies and
the government health authorities to under­
stand the consequences of the disaster; and
the absence of technical or toxicological ex­
pertise on MIC among our scientific commu­
nity, it was imperative that a national body like
the Indian Council of Medical Research
through its own initiative would have to har­
ness the scientific medical expertise in the
country including the local medical college
community to meet this challenge. Consi­
dering that the affected population was over 2
lakhs and that the dead were over 6000
(though official estimates are 2000!) this re­
search initiative had to be equally unparallell­
ed in meeting the phenomenal challenges of
the world's worst recorded ecological disas­
ter. Do the records of events in the past four
months since the disaster bear this out?

July 1985

1.

To establish a clinical and patho-physiological profile of the hazard which would
also provide clues for improved patient
management and clinical outcome.

2.

To study the long term sequelae of toxin
exposure to lung, tissues, foetus, genes
and cancer induction.

3.

To obtain a basic understanding of the
biological alterations associated with
MIC exposure.

Strangely enough there is no mention in
this report of a strategy by which conclusive
research data as and when available would be
transmitted to the relief and rehabilitation
effort in Bhopal, i.e. to the treating doctors
and through a health education effort to the
affected public.

A report of projectization of ICMR support­
ed research effort (2) lists out 17 study pro­
jects which covers acute and long term health
effects, lung functions, follow up of children
aged 5-15 years, ocular changes, pulmonary
and neurological changes, growth and deve­
lopment of new boarns, clinical and forensic
toxicological studies, pathological and micro­
biological investigations, radiological studies,
biochemical and immunological studies, car­
cinogenicity, mutagenicity, teratogenicity and
chromosomal changes, data management in­

15

formation system, hospital based cancer re­
gister, cytofluoio metric studies and blood gas
analysis. The studies ranging from a time span
of 6 months to 5 years would incur a total
financial outlay of 1.07 crore rupees.
Some surprising omissions in the list were
the assessment of psychological stress and its
manifestations in the affected families, studies
on health of women (not obstetrical outcome
but gynaecological effects) and the assess­
ment of medico social effects like reduced
earning capacity and functional disability
which would affect rehabilitation efforts.
Though there were references to an epidemio­
logical and community based outlook the re­
search endeavour atleast as on paper did not
seem to be a coordinated holistic effort in
understanding the total problem but basically
a series of vertical research programmes ini­
tiated and funded according to the interests
of the professors involved in the exercise.
Results

It is four months since the tragedy and about
three months since many of the research prog­
rammes got underway.
As far as a communication strategy goes
three press releases and two lectures by the
director generals and a minutes of the meeting
on the thiosulphate controversy are the only
freely available literature on the research (3-8)
efforts. From these all that any member of the
sicientific community or the general public
can gather are :-

iv.

that a double blind clinical study under­
taken using sodium thiosulphate and a
placebo has established that sodium
thiosulphate administration
results in
symptomatic improvement and in in­
creased excretion of thiocyanates in
the urine. On the basis of clear cut re­
sults, the State government has been
advised to administer sodium thiosul­
phate to the exposed population and de­
tailed guidelines have ’been drawn up
and circulated;

v.

that two visiting psychiatrists have found
that 10-20% of the affected individuals
attending the medical clinics in Bhopal
are presenting with psychiatric mani­
festations — symptoms of anxiety and
depression are foremost.

Why this secrecy ? or is it administrative over
caution ?
A more updated report prepared in mid
March collating all data as of that date has
again become a casualty in the commitment
to secrecy (caution) and no press release has
followed.
Issues of concern

i.

that there is no evidence of irreversible
eye damage or blindness

ii.

that the autopsy findings are indicative
of severe respiratory damage caused by
pulmonary odema and asphyxia;

An mfc fact finding team which visited
Bhopal in mid February at the request of va­
rious non governmental agencies and action
groups published a report on the realities of
medical research and relief which has been
widely circulated and is now well know (9).
In mid March an mfc team of 16 members
camped in Bhopal and undertook an epide­
miological survey which included detailed
history taking, physical examination, lung func­
tion tests, haemoglobin estimation of a 10
percent sample of a severely affected area and
a control area (10).

iii.

that studies of exposed persons with
lung symptoms/signs have shown obsstructive and or restrictive abnormalities;

The team also met decision makers, relief
and service providers, medical teams of vo­
luntary agencies and others, apart from under-

16

Medical Service

taking a survey of the people's perceptions of
relief services and an overview of the services
itself. The findings of the team are being ana­
lysed and will be reported shortly (a press
release is published in this issue) but the ex­
perience of the third week of March in Bhopal
strengthened the findings of the earlier fact
finding team and identified a whole series of
issues of concern in the ways in which re­
search efforts were becoming exploitation of
peoples' suffering rather than expressions of
support to programmes of human welfare.

1. Lack of dissemination of technical
gudelines
The medical relief service continue to be
starved of authentic and authoritative scienti­
fic medical information to support clinical
judgement and patient management. In the
absence of clear cut guidelines from the seniors
in the profession treatment continues to be
adhoc, symptomatic and unstandardised. Fin­
dings of autopsies, lab investigations and
x-rays and other tests are not available to the
treating doctors. Doctors have not been alert­
ed to the fact that a wide range of symptoma­
tology like fatigability, weakness, memory
problems are all part of the MIC syndrome. In
the' absence of such information peoples'
sufferings have often been passed off as
malingering or compensation neurosis.

2.

Pills distribution

The treatment basically consists of a whole
series of pills which are efficiently and actively
prescribed to the people in a sort of condi­
tioned reflex. In the absence of proper record
linkages each patient is collecting large
amounts of pills and not feeling the better
for it, apart from the dangers of over drugging.
Other forms of care, counselling and non-drug
therapies have not been though of.

3.

The Thiosulphate controversy :
Even after the ICMR studies establishing

July 1985

the validity of thiosulphate administration and
the preparation of clear cut guidelines for its
administration, (6,8) this specific antidote is
not being used as effectively as it should be.
It has become a causalty in a medical con­
troversy between cyanogen and carbon mo­
noxide lobbies and the victims rather than
being informed and helped are being con­
fused and neglected.

4.

Women's health :

. The mfc fact finding team had highlighted
the problems of women who have suffered
abortions, still births, diminished foetal move­
ments, suppression of lactation, abnormal vagi­
nal discharges and menstrual disturbances.
The studies undertaken by two doctors of mfc
reported in this bulletin (11) establish the
magnitude and severity of the problem. It,
however, continues to be neglected by the
concerned authorities.

5.

Absence of Health Education efforts :

Whatever the other validity of the research
efforts, in the ultimate analysis it should get
translated into a strategy of health education
and awareness building of the affected people.
As of date there are no official guidelines or
efforts in this direction. The range of areas is
phenomenal advice to mothers of the risk to
the foetus and preparation for consequences
including options for MTP, advice to couples
on contraception till detoxification is over,
breathing exercises and antismoking advice to
those with fibrosis of lungs, avoidance of over­
drugging of.pregnant mothers, advice to mo­
thers regarding feeding of infants/children as
lactation suppression has taken place, avail­
ability of thiosulphate and other medical re­
lief measures. None of this has even been re­
cognised as being necessary.

6. Poor epidemiological and medico so­
cial orientation of problem assessment.
The general impression is that research and

17

* Need to evolve a creative, relevant health
education and awareness building public
education strategy to meet to expecta­
tions of the disaster victims and to help
and reassure them through the crisis and
prepare them for the eventualities.

relief efforts are suffering from an acute clini­
cal and institution based orientation rather
than a community based epidemiological orien­
tation.

Only if all data is field based and is related to
known available morbidity patterns (or com­
parison with controls) can early problems and
special trends be identified and urgently acted
upon. The danger of getting into the pursuit
of a very neat and fool proof epidemiological
planning exercise can be equally counter pro­
ductive.

* Need to ensure that research efforts are
geared to supporting relief and rehabili­
tation efforts and not become esoteric
exercises for institutional development and
career advancement.

* Need to make the commitment to patient
cafe and human welfare primary and to
ensure that it does not get bogged down
by professional rivalries, inter depart­
mental incoordination, procedural cons­
traints and administrative protocols.

7. Lack of informed consent

The people are not being informed about
the tests being done. Nor is consent being
taken for being included in the studies or for
procedures to which many of them are being
subjected to. This is a minimum medical ethic.

* Need for closer coordination between ►
voluntary agencies, action groups, citizen
committees, medical and health workers
and the people oriented and socially
sensitive sections of the medical pro­
fession and government authorities to
ensure that the peoples' suffering are not
exploited and made pawns in the games
palyed by politicians, multinational com­
panies, and misinformed professionals —
all symptomatic of an exploitative social
system.

8. Lack of coordination

This is a universal problem and the ultimate
sufferer's are the disaster victims themselves.
This incoordination is occuring between go­
vernment services and research efforts in the
medical college, between the different re­
search workers themselves, between govern­
ment and nongovernment relief efforts, bet­
ween voluntary agencies involved in action,
relief, rehabilitation and of all these groups
with the disaster victims themselves.

While a more detailed report is awaited we
in the mfc appeal to government decision
makers in Bhopal, medical college professors,
ICMR scientists, IMA, voluntary agencies,
action groups that there are urgent needs to
be actively met:
* Need to evolve a bold, imaginative and
open communication strategy to all the
doctors and health workers (treating the
disaster victims) who are presently starv­
ed of authentic technical/medical in­
formation hampering clinical judgement.

July 1985

An authoritative Lancet editorial (12) had
mentioned that 'In a year's times we will have
learned a lot more about methyl isocyanate at
an appalling price'. With the prevalent medical
anarchy in Bhopal in relief and research, this
price may be immeasurable.
—mfc team. Bangalore

References
1.

ICMR, The Bhopal disaster-current status
(the first nine days) and programme of
research.
19

2.

ICMR, Projectization of ICMR support­
ed Research

3.

ICMR,
Medical Research problems in
Bhopal (V Ramalingaswami)

14 Feb 1985
9.

mfc, Medical Relief and Research in
Bhopal—the realities and recommenda­
tions.

ICMR, Pathology and clinical toxicology 10. mfc, Approach document of a project to
of the Bhopal disaster (S Sriramachari)
evolve a strategy of medical relief and re­
habilitation which best meets the peoples'
5. ICMR, Medical research on Bhopal Gas
medical social needs and expectations.
Tragedy-Press release 31st Jan 1985.
11. Rani Bang, Effects of the Bhopal disas­
6. ICMR, ibid, press release, 12 Feb 1985
ter on the women's health — an epidemic
7. ICMR, ibid press release, 27th Feb 1985
of gynaecological disease: reports I & II

4.

8.

ICMR, Thiosulphate threapy in MIC 12. Lancet editorial, Calamity at Bhopal, 15
exposed — minutes of meeting at ICMR,
Dec 1984.

SITUATION VACANT
A parish owned L shaped building with 8 rooms, latrines and kitchen is
laying unused in the vicinity of the beautiful church here. The parish will
place the said building at the disposal of a family of Doctors who can live
rent-free in the staff quarters nearby for serving the rural sick. From Tellicherry or from Cannanore this village is 62 kilometres east and south-east
respectively. The recently tared road from Edoor helps 6 service buses to ply
their trips past IRITTI which is 10 kilometres away, having private hospitals.
For further particulars, contact:
Rev. Administrator
Lourdeumatha Dispensary
Kottugappara, Koomanthode P 0
Cannanore Dist, Kerala 670 704
20

Medical Service

Mental Health—Introduction
On the night of December 2/3, 1984, 40
tons of methyl-i'so cynate (MIC) from tank
610 of the Union Carbide India Limited fac­
tory at Bhopal leaked into the surrounding
environment. This leak of an 'extremely hazar­
dous chemical' which occurred in a short
span of few hours, covering the city of Bhopal
in a cloud of poisonous gas, left behind a
large number of dead (1400 to 2500), thou­
sands affected by acute and chronic effects of
MIC. The estimated population has been ex­
posed to MIC is 2,00,000 of the 7 lakh popu­
lation of Bhopal city.

HANS, Bangalore and K.G. Medical College,
Lucknow, the present training for the medical
officers has been planned. The focus of the
one week training was to provide mental
health skills needed for the care of the short­
term needs,, especially among those attending
the medical clinics. t
Before considering the larger aspects of the
mental health care let us consider the ques­
tion of 'are there special mental health needs
of the affected population?'

VENUS CIRCUS TRAGEDY
The Fourth Advisory meeting on Mental
Health (ICMR) (December 12-14, 1984)
viewed the mental health needs of the affect­
ed population as follows:
"The recent developments at Bhopal in­
volves exposure of 'normal' human beings to
substances toxic to all the exposed and fatal
to many raises a number of mental health needs.
The service needs and research can be both
viewed in the short-term and long-term pers­
pectives.

The acute needs are the understanding and
provision of care for confusional states, reac­
tive psychoses, anxiety depression reactions
and grief reactions.

/

At this point, we would like to share the ex­
perience of colleagures from
NIMH ANS,
Bangalore (Dr. H.S. Narayan and team) who
actively provided help in a crisis situation.
This was as follows :

On the 7th Feb. 1981, fire accident occured
in the city of Bangalore taking a heavy toll of
lives. The investigating team followed up by
home visits, 58 families with 70 family deaths.
The team visited each family many times and
provided emotional support by listening to
their feelings and offering emotional support.

Long-term needs arise from the following
areas, namely, (i) psychological reactions to
acute and chronic disabilities, (ii) psychologi­
cal problems of the exposed subjects currently
not affected, to uqpertainities of the future,
(iii) effects of the broken social units on child­
ren and adults, and (iv) psychological prob­
lems related to rehabilitation".

The observation of the emotional reactions
of the 58 families are as follows Chronic
grief (75%), excessive guilt (52%), excessive
anger (37%), change in the attitude towards
God (31 %), sleep disturbance (67%) eating
problems (57%),
preoccupation
with
thoughts, vivid memories and perceptual
anomalies (90%) death wish (18%), change
in pattern of social and recreational activities
(45%) were noted in the family members.

It is against this background of awareness
of the mental health needs of the affected
population of Bhopal and the observations of
the visiting mental health teams from NIM-

In addition, 46% reported deterioration in
health since the time of relatives death of
these 12.5% consulted a general practitioner
or specialist for their health problems.

July 1985

COMMUNITY HEALTH C-.LL
47/1. (First Floor) St. Marks Read,

Bangalore - 560 001.

Of the affected family members, 74% gave
evidence of depressed feelings. Some of the
males were consuming more alcohol. The team
noted that 36% of the members need psy­
chiatric intervention.

The team developed a method of providing
help to the affected families which resulted in
positive adjustment.
Emotional Reactions to a Disaster

The above experience of understanding the
needs of the disaster victims is relevant to
the current needs of the Bhopal population.
The magnitude of the disaster at Bhopal is
much larger compared to the Venus circus
tragedy not only in numbers but in its de­
vastating physical and social effects.
At this point let us look some of the obser­
vations of the psychiatric team visiting Bho­
pal. Some of the reactions noted were :

Mr. A. is 40 years, mechanic, with a family
of 6 children (2 male and 4 female). On the
night of the disaster, he lost 2 of the male
children and he himself sustained injuries.
When seen at home he was. slow in talking,
crying, had attempted to end life the previous
night, feel that life was not worth living. He
says 'I keep thinking to my two sons, if I stay
at home memories of the children comes to
mind, I find it difficult to forget them, I some­
times feel I should free them, who will care
for us, our life has become destroyed. I will
continue to stay here so that if.the gas leaks
again the whole family can die". Since
Dec. 2/3 he has not returned to work. (Feb.
1985).

Ms. B. 36 years is 7 months pregnant. Her
past pregnancies have been normal. She
complained when we met her at home of
anxiety GABARAHAT, poor appetite and fear
of going mad by eating of medicines. Her
sleep is markedly disturbed and cannot sleep

22

in a closed room. She is also noted to be irri­
table and can not tolerate criticism leading to
frequent quarrels. She worries about the child
and does not want to go to the hospital for
the delivery. She feel the child in her womb
is not as active as before (Feb. 1985).

Mr. C., 35 years, a blacksmith, with wife
and 2 children was constructing his house
with bricks when we met him in Feb. 1985.
He told us that he feels that he destroyed the
earlier kutcha wood house he felt that the wood
still contained the gas. He cannot cover his
face with razai and sleep. He has many bodily
complaints and on enquiry says he has lost
his sexual desire. At nights, he gets in the
middle once or twice with anxiety (gabarahat) and has to go to open spaces to feel
better. He has not been taking any treatment
(Feb. 1985).
Ms. D., 40 years, housewife, when seen in
her house-complained of headache, sleep
disturbance feelings of anxiety. On enquiry
she says these days 'I do not want children
to leave me. I keep looking for children till
they return from school, I want my children
to be with me all the time. At night I wake up
once or twice and check whether children
are weir. She also feels that everything is lost
and has lost the confidence in future. She
has a son (13 years) who has disability in one
leg due to polio (Feb. 1985).

Mr. E., is -14 years, complains of pain in the .
eyes, throat and swelling of abdomen. He
has abdominal pain most of the time and at
times wakes up in the night with pain. His
sleep is disturbed. He has dreams of running
away from home and thejavents of that night.
These days he is finding school less interest­
ing. He cannot concentrate on studies and
cannot remember. On enquiry mother report­
ed that he has wet his bed 2 or 3 times in the
last one month. While talking to us he start­
ed crying and said 'so many people have died
and it can happen to me also' (Feb. 1985).

Medical Service

Ms. F., 13 years, seen in the 30 bedded
hospital where she was admitted for breath­
ing difficulty. Since December she is confined
to bed and can hardly move for his basic needs.
She also has cough and feelings of anxiety.
There definite evidence of huge damage on
X-ray chest. She cried and expressed that it
is better to die than live. Her future life will
be miserable (April 1985).
Ms. G„ 35 years, married woman with
continuous cough and extreme degree of
dypsnoea has been in the hospital since De­
cember 2/3. She cannot sleep due to cough.
In her family, she lost two of her four children
and her mother and father-in-law. Currently
her husband is looking after the children. He
was working in an another city and this is not
affected. She cried during most of the inter­
view. She was angry about what had happen­
ed to her and felt that life is going to be mise­
rable (April, 1985).
Ms. H., 50 years old, helper in one of the
medical centres was a very good worker.
Since December, she has become irritable
and quarrellsome. She reacts with violence
to requests by patients and recently she ran
after a patient and him. She is also known to
• be forgetful and cryings without reason. All
the staff of the centre wonder what has
happened to her. 'She is now a completely
• changed person' (April 1985).

The above eight descriptions are represen­
tative of the type of reactions seen in the gas
affected population.
Types of Emotional Reactions

The reactions are of three types.

1. Emotional reactions to the disaster,
though the individual himself or herself is
not having any physical problems due to
direct effects of the gas inhalation. These

July 1985

are the reactions to the happening of the
unexpected and the destruction of the sense
of confidence and security.
This type of reactions are seen in the form
of subjective feeling of therapy, feelings of
anxiety and depression and disturbance of
biological functions like sleep, appetite and
sexual interest.

2. Emotional Reactions to the loss of family
members : These are referred to as grief
reactions. The reaction is very similar to
that seen in the family member of a decreas­
ed person. However, the difference here in
the members affected, the unexpectedness
of the deaths and the lack of supports from
other relatives as they themselves are going
through the same experience. The expression
is mainly in the form of.depressive features.

3. Emotional Reactions to Physical Prob­
lems : Physical problems affecting the lungs
is the most significant. In addition there are
complaints relating to the eyes, the genito­
urinary systems in women. These are a
mixture of both physical and emotional
complaints.
At Bhopal, in comparison to the total emo­
tional needs of the affected population there
is very limited specialists help. This is the chief
reason for organising this training for all the
Medical Officers involved in medical care of
the affected population.

In the next six days, efforts will be made
to provide an orientation to understanding
human behaviour, the different types of
mental disorders, the emotional reactions to
disaster in children and adults. Final section
of the training will be directed to enhance the
management skills. The overall effort is to
increase the availability of mental health care
to the affected population on a continuous
basis to alleviate their suffering and improve
their quality of life.

23

Emotional Reaction to Stress
In life, one faces different types of stresses
of varying severity. It is well known that life
stresses play a significant role on the health
of individuals. Different people have different
abilities and resources to cope with stress.
Reactions to stress vary not only with the in­
dividual but also with the nature and severity
of the stress itself. In general it is true that the
more severe and chronic the stress situation,
the greater would be the degree of disturbance
to the individual.

The individual variations are largely depen­
dent on the 'Personality' of the individual.
The individuals personality in turn is deter­
mined by a series of factors which start ope­
rating quite early in life. The genetic or here­
ditary endowments constitute the substrate
on which various environmental factors inter­
act. Early childhood experiences, the in­
fluence of parents and significant others the
home and school atmospheres and several
socio-cultural factors contribute to the deve­
lopment of personality. The ability of an in­
dividual to cope with and adjust to life stress
is also dependent on the social support system
available to him. When conditions of over­
whelming stress occurs, even normal well
adjusted individuals with stable personalities
can get emotionally disturbed.
This section deals with the psychological
and behavioural disturbances which can
affect large number of persons exposed to
sudden severe stress. There are several ac­
counts of the psychological sequale of over­
whelming and terrifying catastrophes, which
have occured in different parts of the world
and in different socio-cultural settings during
the past several decades. They have been va­
riously turned as follows: Disaster, syndrome,
Traumatic neurosis, War neurosis, KZ syn­
drome, (from the German word for concen­
July 1985

tration camps) and Post-Traumatic stress Dis­
order. The disaster reported include natural
catastrophes like earth quakes, fires, floods,
accident like explosions, shipwrecks, plane
crashes and man made disaster like wars bomb
explosion, racial and communal violation.
Many of these situations produce continuing
chronic stress for the affected population and
long term consequences. In addition, there are
also reports of situations of prisoners of war,
soldiers in combat and the large number of
people who survived the Nazi concentration
camps.- You are perhaps familiar with the most
disastrous of them all namely the second world
war with all its consequences which ulti­
mately culminated in the atom bomb explo­
sion in Hiroshima; There are many other lesser
known disasters the consequences of which
have also been systematically studied. The
Cocoanut grove Nightclub Fire which occured
in Boston in 1942, the Buffalo creek dam
breach which occured in 1972, the Spkopije
earth quake which killed over 1000 persons
and injured over 3,300 the Beverly Hill supper
club fire in 1977 are few of these disasters
whose” psychiatric camp lications were syste­
matically studied. In India, at Bangalore, the
sequelae of the Venus circus fire of 1981 has
been studied~and followed up for four years;

A review of many of these accounts show
that there is a great similarity in the emotional
reactions of people to these disasters in spite
of their being very different in nature, severity,
sociocultural and geographical setting. The
extent of emotional disturbance following a
disaster appear to be widespread. For example,
over half the survivors of the Boston Cocoanut
grove Night club fire required treatment for
severe psychological shock. The emotional
responses of the people of the disaster area
have been described in stages turned variously
25

by different authors. In sudden severe disas­
ter, initially there is the stage of shock which
affects most of the people. The victim is
'stunned' 'dazed' and 'apathetic'. He becomes
inactive, non-responsive, docile and indecisive
at times becoming intensely fearful. He is
unable to function in an integrated manner.
Some persons may develop bizzare, inappro­
priate behaviour or hysterical reactions. In
certain extreme cases individuals may become
disoriented and confused or stuporous.

Certain circumstances which present close
encounter with death, can overwhelm the
individuals basic sense of safety and security
leading to panic reaction with 'flight be­
haviour' to escape the imminent death. The
suddenness and severity with which the dis­
aster strikes, often take the people by surprise
who have no pre-arranged plan for dealing
with it. The panic behaviour can become
highly contagious leading to irrational be­
haviour and a 'struggle for existence'. It is
reported that in a theatre fire in the United
States (Chicago 1903) five hundrad people
were killed in’less than eight minutes due to
trampling and asphyxiation rather than to
burns. In the Boston Cocoanut grove fire too,
the number of people killed would have been
much less if they exited in an. orderly way
without jamming the doors.

like looting, heavy drinking and rape, and other
irrational behaviour.
The recovery stage lasts for weeks, months
or even years. There is a general feeling of
fear and apprehension lasting for varying
periods of time but most people gradually
regain their emotional equilibrium. During this
stage, commonly there are widespread fears
about recurrence of the disaster or new dis­
aster occuring. This is particularly a period
when all sorts of rumours spread like wild
fire adding to the existing fear.

Many individuals who survive the. disaster
present with a typical constellation of symp­
toms which is often referred to as the 'post
traumatic neurosis'. The basic feature of this
syndrome, is anxiety. Anxiety may be genera­
lized and mild, present most of the time. In
addition, there may be several episodes of
intense acute anxiety (panic attacks) during
the day and night. These episodes are charac­
terized by recall of the disastrous event ex­
treme degree of fear feeling of insecurity,
fear that the event could occur again, restless­
ness, bodily complaints like beating in the
chest, breathing difficulty, tremulousness and
abdominal discomfort. In addition, the in­
dividuals who suffer from this syndrome would
have a series of other complaints as follows :-

Following the immediate response of
Generalized weakness and tiredness, easy
'shock' is a stage where individuals become
fatigability and inability to work, impaired
passive and dependent on others. They be­
concentration, forgetfulness, preoccupa­
come suggestible and are willing to listen to
tion, disinterest in allround activities, sleep
others. Their inability to deal with the situa­
disturbances of varying severity, recurrent
tion continue and some authors have des­
dreams and nightmaras which closely re­
cribed their behavious to be 'childlike' during
late to the event, disturbances in appitite
this period. People are pre-occupied with the
and eating pattern,various somatic comp­
implications of the disaster to themselves,
laints involving different systems of the
their family members and their community.
body — aches and pains, respiratory and
The search for safety continues and people
. gastrointistinal
distress,
weakness etc.
co-operate with rescue and relief operations.
disinterest in sex, change of pattern in so­
During this phase while many people return
cial and recreational activities. Many suffe­
to normal functioning, it has been reported
rers have an urge to repeatedly talk about
and relieve the catastrophic event although
that some may show psychopathic behaviour'
26

Medical Service

it can be very painful. During these repeat­
ed discussions, they could be quite criti­
cal of the relief measures undertaken by
Government and other agencies. They could
be critical of their own actions before, dur­
ing and after the event. While this is try
of some people, others try to avoid any
thoughts, talk or reminders of the event and
may even deny the reality of the experiences
and the consequences of the event.
In individuals who suffered various types of
bodily and physical injuries and illnesses dur­
ing the disaster, the symptomatology can be
complicated by the presence of emotional
symptoms described above. Often, there can
be problems in establishing the correlation
between the symptoms which the individual
reports and his actual physical illness. The
symptoms are likely to be more numorous and
severe than can be explained and understood
by the injury or disease (Refer to section on
'Emotional reactions to physical illness'.)

often with addition of severe
symptoms.
Studies carried out on persons who under­
went severe emotional stress during various
civilian disasters as well as during II world
war, Vietnam and Korean Wars, and Nazi
concentration camps have shown that symp­
toms like fetigue, lack of initiative, sleep dis­
turbances, feelings of anxiety and depression,
irritability, inability to concentrate, impair­
ment of memory, feelings of inadequacy and
various bodily complaints persist for a very
long period. Damage suits and possibilities
of monetary compensation may not have any
major role in the precipitation and perpetua­
tion of the post-disaster syndrome in the large
majority of cases.

Management : Concepts of mental health
and mental health professionals have a role
to play in all phases of a 'disaster'. It may not,
often be possible to organize immediate care
for large number of persons affected in the
acute phase but the later complications of
grief or depressive reaction, post traumatic
neuroses, emotional problems of those physi­
cally affected and emotional disturbances in
children should always be adequately cared for.
The fundamental approach to relief for the
disaster victims should be an integrated one
of physical, psychological and social.

The most severe emotional consequences
of the disaster occurs in people who are faced
with death of loved ones. In these cases, in
addition to many of the above mentioned
symptoms, intense feelings of depression and
grief are present. Vivid memories of the per­
son and the disaster feelings of guilt, death
wish and suicidal ideas and an extremely
pessimistic vision of future are also present.
While the percentage of persons requiring
The sleep disturbance is more marked. These specialist psychiatric help for long duration
symptoms disable the individual to a great may not be very high, large percentage of the
extent. In many persons, these are other population will be in need of simple suppor­
changes too. Their attitude towards life and tive psychotherapeutic
help. Establishing
god changes. The strong feelings of guilt, effective rapport with those who are disturb­
when present, are centred around a sense of ed and listening empathetically to them will
having failed to protect near and loved ones be the first step. Helping them to narrate
who died or were seriously injured in the dis­
and relieve their experiences several times may
aster (refer to section on Grief Reaction).
be valuable. Aprat from helping individuals,
Many persons who develop any of the above efforts must be taken to assist the community
described symptoms of post traumatic syn­ as a whole to cope with the large scale death,
drome, are likely to become chronic sufferers, disablement and material loss.

July 1985

27

Industrialisation: The Darker Side
Anil Agarwal and Darryl D'Monte

The process of industrialisation as a whole is
an extremely hazardous one and what
happened in Bhopal is only the tip of the
proverbial iceberg. In fact, say the authors,
the basic premise that the current model of
of industrialisation
denotes progress and
modernisation needs to be re-examined.

In all poor countries, the process of industri­
alisation is seen as benign and beneficient,
the path to progress and modernisation. It is
only a tragedy on the scale of what happened in
Bhopal that exposes the ugly face of industri­
alisation. Even though the Bhopal disaster
has been followed up by dozens of editorials
and articles in Indian and foreign newspapers
calling for the more efficient control of hazar­
dous industries and hazardous products like
pesticides — some even calling for their ban—
the point that the industrialisation process as
a whole is an extremely hazardous one, has
neither been adequately made nor understood.
What happened in Bhopal is simply the
proverbial tip of the iceberg that has penetrat­
ed into a highly biased public view, which
seldom focusses on the problems of the poor
and of the workers who work in mines, in
factories and in agricultural fields. For these
people, industrialisation has meant steadily
increasingly hazards and increased destruc­
tion of natural resources like rivers and forests
which sustain tens of millions of people. And,
as far as these trends are concerned, it matters
little whether the industry is in the private sec­
tor or in the public sector or controlled by
Indian or multinational interests. Each of these
groups has its own vested interests and manner
of operation^
Industrialisation poses hazards in several
ways. The first hazard it poses is through the

July 1985

highly dangerous work places it demands and
creates. Probably the most callous sector is
the mining sector — a major source of fuel
and raw materials for industry — and most of
it is in public hands. Accidents occur with
frightening regularity in mines. No one knows
till today precisely how many miners died in
the Chasnala disaster in Bihar. Equally, there
are hazards to those workers who produce
power — another major input to industry —
from both coal and nuclear stations.
If the plant had been in the public sector.
Chief Minister Arjun Singh would probably
have dismissed the now famous journalist
Rajkumar Keswani (who warned about the
dangers of the plant) for his then sensational
articles as "anti-national". Industries them­
selves pose enormous hazards to their workers
— form accidents,
explosions and fire
hazards to gassing and exposure to dange­
rous
chemicals. The
Indian
Chemical
industry — the most hazardous
of
all
industries — has had a phenomenal growth in
India since Independence. There are today an
estimated 4,000 chemical factories with an in­
vestment of over Rs. 3,000 crores and employ­
ment of 3.8 million. The chemical industry
accounts for 20 per cent of fixed assets in in­
dustry and produces more than Rs. 6,000
crores worth of goods every year.

The alkali industry has grown ten-fold since
1947. With a total licensed capacity of 78,000
tones, India is the largest manufacturer of
pesticides in the whole area comprising South
Asia and Africa. The total dye stuffs produc­
tion in India during 1975 was around 18,500
tonnes and is expected to increase 2.5 times
to 46,000 tonnes by 1980. As many as 139
organic chemicals, heavy metals like zinc,
lead, chromium, copper, mercury and moly­

29

bdenum and their compounds, and various
acids and alkalis are used in manufacturing
dues. Indian industry uses toxic substances
that can cause allergies, damage the repro­
ductive system, produce malformations in
unborn children, damage the brain, liver and
kidneys, produce eye, lung and skin diseases,
and can cause or promote cancer. Statistics on
injuries and deaths in industries are highly
inadequate but those that exist show that the
chemical industry kills more workers every
year than any other Industry — 100 workers
were killed and about 11,000 injured in chemi­
cals and chemical products industries in 1980.
The biggest cause of death was explosions.

nobody has yet looked for this disease. In­
dian scientists are well aware that the mercury
load in estuaries and water sources near
chloralkali, paper and rayon firms in India has
been increasing. The dyes and pigments in­
dustry also releases substantial quantities of
toxic waste into the1 environment. Some of
the organics and intermediates used in this
industry are known to be highly toxic and the
incidence of bladder cancer has been found in
workers of the dyestuffs industry in India.

Incidence of Minamata disease has not been
reported in India but this may only be because

expected to register significant growth rates
in the next few decades.

Toxic waste disposal methods in India are
still very primitive. Generally, the dyes and
pigments industry neutralise the toxic wastes
with lime and the neutralised effluent, which is
still highly toxic, is discharged with little or
Toxic Wastes :
no treatment. The sludge and other solid and
The second hazard that the process of in­ semi-solid wastes are disposed off on fallow
dustrialisation poses to society is through the public land. "No data on the effects of such
toxic wastes that it generates and regularly disposal are available," says a report from the
releases into the environment. With industriali­ National Environmental
Engineering Re­
sation, this danger will steadily grow. The search Institute (NEERI).
dumping of industrial toxic wastes is today the
The chances of these toxic chemicals rea­
biggest environmental issue in the U.S. There
ching ponds, rivers and ground-water, and
are today 22,000 hazardous and toxic wastes
contaminating drinking water sources, are
sites in the U.S. and, in August 1984, the U.S.
high. The sludge from the waste treatment
congress voted to increase the "super fund"
plants to DDT manufacturing units contrains
to £ 10 billion to clear up these sites over the
an estimated 14 tonnes of DDT annually. These
next five years.
wastes, too, are dumped in low-lying areas
The disposal of toxic wastes into the Indian from where they leach out to pollute both
environment is also growing rapidly. Paper ground and surface waters. Wastes from or­
and rayon industries use large quantities of ganic chemical units are also dumpted on
caustic soda and soda ash. A Japanese team fallow land.
of environmentalists working with the Mina­
Danger-ridden scenario
mata Bay victims, which recently visited India,
was shocked to find that many chloralkali
From a toxic hazards point of view, petro­
plants in India are still based on the old pro­ chemical, coal and ethanol based organic
cess using mercury. This process was discard­
chemical complexes are the most potent
ed in Japan after the horrific Minamata dis­ sources of established mutagenic and carci­
ease was discovered in 1960s. The country nogenic chemicals. Plastics, polymers, arti­
imports around 200 tonnes of mercury, of ficial fibres, synthetic dyes, drugs and phar­
which 180 tonnes are used by the chloral­
maceuticals and pesticides are industries which
kali industry alone.
use these chemicals. All these industries are

30

Medical Service

A massive and uncontrolled explosion of the
type that occurred in Bhopal releasing toxic
gases and fumes is rare only in terms of its
scale. Several explosive accidents have oc­
curred during the storage and transport of
chemicals. Except for newspaper reports,
there is no proper documentation of such
accidents, A major accident occurred in Delhi
only in September 1984, but it failed to attract
continuing press attention presumably be­
cause nobody died. Toxic gas and fumes
spread over an area of one Sq. Km. following
an explosion in a godown. Two school child­
ren fainted and two labourers engaged in the
godowns received burn injuries.
Since the Bhopal incident India newspapers
have reported several other incidents of acci­
dents in which people have been killed. First,
three people died and three others were taken
critically ill when a liquid ammonia tanker
collided with an empty oil tanker near Chandi­
garh. A week later, a one year old girl died and
three others sustained injuries when a tanker
carrying sulphuric acid turned turtle near
Baroda. About a fortnight later, 47 people
were seriously affected when two chemicals
got accidently mixed in a factory near Cochin
releasing large quantities of chlorine. Reports
of similar incidents have poured in from all
over the world.

Add to this danger-ridden scenario, the
transport of radioactive wastes from nuclear
power stations in Rajasthan to spent fuel
reprocessing units in Maharashtra and the
transport of recovered plutonium from there
to a fast breeder reactor in Tamil Nadu—all
of which should start coming true within a
few years.
The third hazard that industrialisation poses
to society is through the use of chemicals
that it promotes in daily life. Chemicals are
now readily added to our daily food, especially
industrially processed and packaged foods
from milk to tomato sauce. Detergents, cos­
July 1985

metics, paints and many other of our consumer
products are based on chemicals, so are our
medicines. Use of chemicals in the modern
human's life is so extensive and pervasive
that some environmentalists have even des­
cribed this as "the chemicalisation of our en­
tire lifestyle".
Industrialised agriculture, more popularly
known as the green revolution agriculture, has
promoted an extraordinary use of dangerous*
chemicals in the form of pesticides and ferti­
lisers. Pesticide residues now appear in all
varieties of foods like fish, fruit, vegetables
and milk and often expose human popula­
tions to acutely dangerous chemicals. The
first report of poisoning with pesticides came
from Kerala in which some 100 people died
after eating wheat flour contaminated with
parathion. Since then, more than 25 incidents
have occurred due to insecticide poisoning
affecting anywhere from a few individuals to
large groups. Many hundreds of smaller inci­
dents could have gone unrecorded.

In Andhra Pradesh, a large number of vil­
lagers contracted the now well-known "handigody syndrome" after eating pesticide-con­
taminated crab meat. Extensive use of syn­
thetic fertilisers can also cause serious en­
vironmental pollution. Levels of fluorine and
cadmium tend to build up in soils treated by
phosphatic fertilisers for instance, and these
toxic elements can be accumulated in dange­
rous quantities by food crops. "With an ex­
pected consumption of 1.3 million tonnes of
phosphate fertilisers by 1983-84, there is
need to compute the load of cadmium pollu­
tion from this source," says C.R. Krishna
Murti, a former director of the Industrial
Toxicological Research Centre in Lucknow.

What is amazing is that we know so little
about all the chemicals we use. The world to­
day uses some 50,000 to 70,000 chemicals.
A recent U.S. study indicated that no toxico­
logical information whatsoever is available for
31

about 80 per cent of all chemicals and not
surprisingly, these chemicals keep shocking us
with their fatal properties.
The fatal effects of methyl isocyanate (MIC),
the gas that killed over 2,500 people in Bho­
pal, were little known to scientists until the
disastrous event. No fatality was recorded
until then. And even today, MIC would be,
relatively, a far safer chemical than many others
used in industry. In fact, the closely-related
compound, toluene discyanate (TDI), which
is used far more extensively in the plastic in­
dustry for making foams, has a permitted ex­
posure level that is four times more strict than
that of MIC, that is five parts per billion, equi­
valent to a few drops in an Olympic size swimm­
ing pool.
Safety measures :

If these be the danger, what do we do ? The
first response, of course, would be to institute
greater controls—through rules, regulations
and legislation — and undertake safety mea­
sures with greater stringency. But there will be
enormous political, social and technical prob­
lems in doing this. Safety is not something in
which anyone necessarily wants to invest.
Regulatory authorities must insist that safety
measures be undertaken. But this will require,
as one commentator has pointed out, a cer­
tain culture of political discipline. Otherwise,
however many laws and rules there may be,
safety measures will never be taken. A former
member of the Monopolies Commission has
even said that the Bhopal plant should teach
a lesson to all those who preach economic
liberalisation and carefully scrutinised licens­
ing^ of industry must continue.

It is not that the government is unaware
of the problem. Speaking at the first meeting
of the National Environmental Advisory Com­
mittee in mid-1984. Dr. T.N. Khoshoo, Sec­
retary to the Department of Environment, had
clearly pointed out the growing problem of
toxic substances. "If we don't get’ a national

32

policy on toxic hazards, we will soon have
situations worse than Love Canal in the U.S.
Dr. Khoshoo had said (Love Canal is a hazar­
dous waste dump near the Niagara Falls on
which houses were built and where people be­
gan to falll acutely ill 20 years later). With
Bhopal — the world's worst industrial disaster-coming only a few months after, these
were prophetic words indeed.
The department had already submitted to
the licensing authorities a list of hazardous
industries and siting guidelines which stipu­
lated that hazardous industries must not come
up near populated areas. The Ministry of In­
dustry, however, not only allowed the Bhopal
factory to continue but also permitted its ex­
pansion in 1984.

The Ministry of Industry's callous disregard
for safety apart, it can still be asked, can siting
regulations function in a country like India?
Cities in the third world are far more rapidly
growing and dynamic entities than cities in
the West, where zoning regulations originated.
Zoning requires an affluent population with
access to efficient transport facilities. Even in
an affluent city like Delhi, a sizeable fraction
of the urban population cannot afford the
subsidised public transport system. Human
settlements experts have repeatedly found that
slums come up where work opportunities are,
and usually at a great speed. Urban planners
can only declare them illegal but find them ex­
tremely difficult to control. People and hazar­
dous plants will continue to, in all probability,
live together. In the name of siting regulations
for hazardous industries. It is more likely that
poor people will be removed than the factories
themselves. An industrialist has already made
a public plea to this effect.
Indian regulators only have two choices in
front of them. If they must allow the building
of hazaroud factories, then the installation of
safety systems must be given top priority,
overriding all economic considerations. Or

Medical Service

they should not allow the building of such
factories at all.
The right to know

If the first option is chosen, human and en­
vironmental safety is clearly too important a
subject to be left to safety regulators alone.
Together with this, people must acquire the
full right to know what factories are being
sited and where, why and what dangers they
pose to people, including the precautions to
be taken if any. Only when people know, will
there be a public pressure for safety and a
regular response from regulators to give a high
priority to it. Otherwise, in the overriding de­
sire for industrialisation, and in the desire to
make profits through short cuts, safety will
be repeatedly overlooked.
The right of the people to know’ is parti­
cularly important in a society like India's
where most producers of scientific knowledge
are under the control of the government, which
can turn off all flow of infdrmation needed by
the public, especially in adverse circums­
tances. Scientific institutions in the develop­
ing world have largely grown under the aus­
pices of the government. Investment in science
has a long gestation and private industries,
looking for short-term profits, have generally
not shown much interest in scientific research.
For this reason, the government's investing
in science has been seen as a progressive and
forwardlooking move.

But excessive government control creates
the danger of political and bureaucratic cont­
rol over information. There is a definite need
today to democratise access to information so
that people can become full partners in . de­
cisionmaking. Any sensible democratic go­
vernment shoud welcome and support such
a trend. If, indeed more points of hazards
have to be created in society, they must be
based on informed consent and informed
choice. Otherwise every interest group will
try to exploit a society's ignorance for its own
July 1985

ends. Multinational companies, for instance,
have repeatedly exported banned drugs and
pesticides and even entire factories to the third
world. A few years ago, an American company
had even bribed the Government of Sierra
Leone to allow it to set up a dump for Ameri­
can industrial toxic wastes. Only when the
information reached the public, was the pro­
ject stopped.
At least a beginning in public interest
"poison research" could be made even by the
resource-starved voluntary sector. A subs­
tantial amount of safety information is already
available publicly in western countries which
can be readily collected and compared with
Indian regulations and danger points thus
identified.
Much of the research on unethical market­
ing of drugs has simply consisted of compar­
ing drug labels collected from different count­
ries in the world, and these exercises have
been able to'show up clearly how a drug like
ancoloxin (usually prescribed for nausea),
which is not permitted to be sold to any wo­
man who is pregnant or likely to become preg­
nant in the U.S. was actually being sold in
India as good for morning sickness during
pregnancy. Even a dozen people's "poison
experts" who need not be little more than good
science journalists, could help increase the
information flow about dangerous plants and
products enormously. Trade unions could even
take the lead by helping to form such groups.
A new approach to development

A boarder question can also be raised at this
stage. Do we really need this pattern of indus­
trialisation which generates such a massive
demand for toxic substances? Is control of
poisons, while their use continues to grow
the only option we have? Can't we get rid of
many of these poisons completely?

It is interesting that few editorials or articles
have demanded a ban on hazardous products

33

and factories. As one poetess put it: "There
In agriculture, too, there is really no need to
was no anger in any of the newspapers."
rely so heavily on a highly input, intensive
Indeed there can't be, because the chosen x crop production strategy. On the contrary,
development model demands more of these through land reforms, caring for the land
poisons. At most, there can be some anger through soil conservation measures, building
against a foreign company which brought the
small water harvesting systems like tanks and
hazardous industry to our shores and against
ponds, planting multipurpose food, fuel and
a government that was not careful. But must fodder tree species, setting up integrated sys­
of this anger will be false because all of us tems of animal husbandy, aquaculture, crops
share the ruling development paradigm among
and orchards, our rural .villages can be turned
western newspapers. The liberal Guardian
into highly productive ecosystems of food­
has even tried to teach us the arithmetic of
fuel-fish-fertiliser-fodder biomass. The need
life and death after Bhopal: If pesticides have
for chemical fertilisers and pesticides could
killed a few thousands in Bhopal, have they
thus be considerably reduced and, if possible
not saved millions from starvation, the paper eliminated.
has asked.
Therefore, our options are not limited to all
powerful bulldozing chemicals. But change
will definitely require a wholistic approach to
To ban these substances will require a new
people's problems and people's participation
approach to development in this country.
in both management of resources and genera­
Theoretically, it is indeed possible. It will re­
tion of technology to meet their needs.
quire carefully thought-out lifestyle and tech­
This will also require, as Hindi poet Raghubir
Sahay puts it, a culture of anusandhan (re­
nology choices. A number of poisons can then
be easily discarded. There is no reason why search and discovery) and not of anukaran
(blind imitation). The Bhopal factory, he rightly
there should be such a demand for plastic or
detergents, for instance, which demand dozens claims, is a symbol of that imitative culture,
of poisonous chemicals for their manufacture which is not only highly destructive of our
ecology but also of our society. Controls on
which then pollute the environment and en­
this culture can help only to a limited extent.
danger human health.
Previous Accidents in Bhopal Plant

The history of Union Carbide's Bhopal plant
is chequered with accidents:
—The alpha-napthol storage area had a
huge fire on November 24, 1978 which could
only be controlled after ten hours; it resulted in
a loss of about Rs 6 crores ($5 million).

—Plant operator Mohammed Ashraf was
killed by a phosgene gas leak on December
26, 1981.
—Another phosgene leak in January 1982
caused 28 persons to struggle between life
and death for several months.

34

—Three electrical operators were severely
burned while working on a control system
panel on April 22, 1982.
—On the night of October 5, 1982. methyl
isocyanate escaped from a broken valve and
seriously affected four workers. Several people
living in nearby colonies also experienced
burning in the eyes and breathing trouble
due to the exposure.
—Plant operator Shabbu Khan's hand got
caught in a conveyor belt on October 14,
1982.
—Two similar incidents were also reported
in 1983.

Medical Service

HISTORY OF UNION CARBIDE
In India

In Bhopal

Union Carbide has a long history in India:

A pesticide plant was begun by Union
Carbide at Bhopal in 1969. In December 1984,
there were about 600 regular and 300 cont­
ract workers in the Bhopal plant.

—Assembly of dry cell batteries prepared in
England started in Calcutta in 1924.

—Production of dry cell batteries started in
Calcutta in 1940.

—Another dry cell factory was set up in
Madras in 1942.
—A flashlight manufacturing plant was set
up in Lucknow in 1958.
—An arc carbon plant was set up in Cal­
cutta in 1965:
—Another dry cell plant established in Hy­
derabad in 1917.

—Setting up of pesticide plant in Bhopal
started in 1969.
Electroiite manganese dioxide factory put
up in Bombay in 1971. During 1983, Union
Carbide India Ltd (UCIL) had sales of Rs 210
crores ($ 180 million), half from dry cells.
Chemicals (including pesticides) accounted
for one twentieth of this total . After taxes,
the company made a profit of about Rs 15
crores ($13 million) in 1983.

—The first batch of methyl isocyanate (MIC)
was imported from America in 1973 for ex­
perimental purposes.
—The first production of 321 tons of pesti­
cide Sevin took place in 1977.
—With an investment of Rs 30 crores ($17
million), a modern research and development
center was.started by Union Carbide in Bho­
pal in 1976. The entire research work is kept
highly secret. The center is tax-exempt.

—After spending Rs 10 crore ($19 million)
in foreign currency, an alpha-naphthol plant
was set up in 1970. However, it has done no
production so far, and alpha-naphthol is still
imported from the USA for pesticide pro­
duction.
—A unit to manufacture MIC was set up
in 1980. The production of pesticides based on
MIC was 4704 tons in 1981, dropping to 2308
and 1657 tons during 1982 and 1983 respec­
tively.

ANNOUNCEMENT
Workshop on "Managerial skills for Development Managers"

Venue : RUHS A Department of CMC(H), Vellore, RUHSA Campus P O,
North Arcot Dist, Tamil Nadu 632 209
Date 8- Duration :

23.9.85 to 27.9.85 (5 days)

No. pf participants :
Course Fees :

15

Rs. 350/- includes food, accommodation, course materials
and tuition fees.

For further details please contact:

Head, Department of RUHSA
RUHSA Campus P O, N.A. Dist
Tamil Nadu 632 209

Wanted A Medical Officer for health programme of village
development project (registered Charitable Society) in rural Tamil
Nadu. To be responsible for day to day management of establi­
shed village health care centre and to supervise TB, leprosy, MCH
and ANC and school health programmes, plus village outreach
work.
A full-time and challenging position requiring a definite commit­
ment to justice in health for the poor. Salary negotiable.
Euquiries to:

The Director
Reaching the Unreached of Village India
Genguvarpatti P.O., Madurai Dist 624 203 T.N.
'n

*

*

*

*

*

’ r.

t

Wanted A qualified and experienced Nurse/ANM for health
programme of village development project (regd. Charitable
Society) in rural Tamil Nadu. Duties include clinic work, mother
and child care and ante natal care with home visiting.- Mature
person preferred. Salary negotiable.
Enquiries to :

The Director
Reaching the Unreached of Village India
Genguvarpatti P.O., Madurai Dist 624 203 T.N.

*****

Wanted A Field Officer for community health and development
programme of village development programme (regd. Charitable
Society) in rural Tamil Nadu. Prefer INSA/RUHSA Deenabandu
trained applicants for responsible and demanding work. Salary
negotiable. .
Enquiries to:

The Director
Reaching the Unreached of Village India
Genguvarpatti P.O., Madurai Dist 624 203 T.N.
Director
Reaching the Unreached

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