Title

An extract from - Bhopal: The Imagination of a Disaster

Creator

Shiv Visvanathan

Rajini Kothari

Date

1986

extracted text

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An extract Froms

BHOPALs THE IMAGINATION OF A
DISASTER

Shiv Visvanathan
with
Raj ini Kothari
V
Between the muteness of the victim'and the propogadistic
erasure of the State stands the voluntary organization.
Voluntarism attempts to create an ethical space, an eco­
logical niohe where the victim as survivor marked by the stigma
of the disaster can grieve, mourn, remember and recover.
But the voluntarist is more than a mourner. He realizes that
the victim becomes in the aftermath of a catastrophe, the
focus of a grid, the huge apparatus of health and social wel­
fare seeking to diagnose, survey and map him out. He seeks
humanize and even alter the structure of such an expertise.
One example of such an attempt is the effort to alter the re­
lation between doctor and victim in Bhopal. The voluntarist
realizes that much of the formal language of medical expertise
is. caught in the mechanics of cause and effect. He seeks to
transform the idea. of a clinical gaze* where the patients is
spread out like a _table of symptoms, into speech with its
more encompassing concern for signs, symbols and symptoms.
Through this he hopes to articulate the victim's conception
of his own pain. One strategy adopted in Bhopal was to move
the site of the analysis from a formal, organization like’ a h
hospital into the bastee itself. In the hospital, the patient
is an isolated unit. Now he is a part of the community. Rather
than being, based ona. formal reading of symptoms, cure and relief
now become part of the socio-drama of a. community. The doctor
listens while the patient enacts out his pain amidst a. chorus
of familiar actors, rTypical
"v x
of sucha strategy is the work of a
the Medico Friends Circle. (MFC)
Its report completed in May
1985 is probably the most sane, compassionate piece of scholar­
ship on the problems of relief'in Bhopal.

The MFC describes itself as a circle of health interested
professionals united by the belief that the medical system is
skewed in preference for the rich, It seeks to demystify
medic al expertise, decommercialize medicine, emphasising community orientation of health care . Its basic survey was under-t
taken betweenJL9-25 March,y 1985.1 ts aim was three fold. It
sought to uphold~'the idea of an e xpert as trustee, of science
as publicly available knowledge. It articulated the pain of the
victim and his/her idea, of relief into a more integrated plan
for.medical rehabilitation. Thirdly, with true anthropological
reflectiveness, it shows how conceptions of the patient, ideas
of cause and effect, diagnoses and cure form an integrated
consciousness, a gestalt as it were.

The survey began by studying the impact of the gas and in
pursuing this they faced two sets of problems. Firstly, little
was known about the properties of MIC and secondly, what little
was known, was kept secret, It obtained with difficulty,
Carbide's manuals which showed MIC to bd a toxic gas under­
going runwaway reactions when contaiminated. The voluntary
groups publicized data•available in such manuals. The MFC also
launched a survey of the literature available. The doctors
realized that the information available, in them was incomplete
and flawed. They referred to lung fibrosis and corneal damage
as the only two long range problems of survivors. The voluntary
groups also realized that government research, despite the
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- 2 fanfare, was sketchy and unsystematic, The ICMR's research
appeared as ’’twenty or so vortical programmes, without inte­
gration into a wider conception of epidimoological community based
endeavour” What was missing was a systematic rationale fordetoxification by Sodium Thiosulphate.

It was in this context that MFC with the aid of other
groups planned a community survey. It included a people's
perception of medical services, Tho doctors also decided that
a summary of findings and technical recommendations would bo
handed over to each person in the sample. The surveys of tho MFC
and those of the Delhi Science Forum and the Morcha showed the
enormity of the crisis as a social situation. The studies of ’
Jai Prakash Nagar showed that income levels had fallen drastically,
that rates of interest were high. They proved that compensation .
was inadequate, even though at the high point of --tho crisis,
it was the only source of income for many disabled, people. Tho
report argued that doles were not enough. Tho mechanical
hydraulics of the dole could not return the community to it ori­
ginal condition. What was required was an imaginative scheme of
occupational rehabilitation. Such a: scheme could not be
based on the wage that was earned before tho exposure as indcator. It had to take into account long range physical disa­
bility, the
tho mental traumas, the persisting sense of -insecurity.

The MFC and othergroups wore thus challenging the restrictive
notion of health articulated by the government. The latter seemed
to read the disaster in mere physical terms. What it refused to
see was the psycho-social dimension of the disaster. ’’Thousand s
of people have experienced mass death, mass morbidity, mass
migrations, disruption of family and social life, escalations
into an acute socio-economic financial crisis and literally a
loss of moorings in society. Such an experience is bound to
manifest itself in psychological, somatic and psychosocial mor­
bidity whoso long term management will probably be’ more crucial
than treatmeat of physical ill health and disability”.
The doctors of the MFC wore true listeners, sensitive to
the word and tho sheer detail with which patients outlined these
problems. The importance of this is brought out in tho report
’’The words and examples used by the patients while describing
their sysmptoms clearly showed the gravity of the symptom as well
as its effect on the person's day-today work. The different
manner in which the symptom was described also showed that the
person was informing us of a problem based on his/her own experi­
ence and not just vague hearsay expressions. This is particu­
larly important since in the absence of signs in tho same pro­
portion as symptoms, doctors attending on these people in busy
government hospitals were often passing of those symptoms reported
as ’compensation malignoring' or no too ^clinical significance.'
We have every reason tobolieve that those symptoms were real ex­
pressions of physical and mental ill health and many should
bo accorded the same significance as tho use of patterns of
cough with or without expectoration on tho diagnoses of Chronic
brouchities or the use of Anginal history in the diagnosis of
Ischaemic Heart Disease”.
Tho conception of disease as a problem of tho community,
of tho patient as diagnostician in his.own right, contrasts
with tho conventional notion of the doctor as the sole interpet or
of signs and symptoms, to which must bo added tho attitude of
many doctors who perceived tho behaviour of patients as malignoring or compensation neurosis. Those doctors proscribed ’’whole
plates full of colorful capsules in a routine manner”. The
MFC survey eventurally shows how such contrasting perceptions
quietly link up to two separate views of diagnoses and cure..
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The two basic theories were the Pulmonary theory and the
Cyanogen pool theory. The Pulmonary theory is based on the
current literature availabe on MIC, which indicated that fibroses
of the lungs and corneal damage are the only long term effects
to be expected. The impact on an any other system is, it holds,
due to secondary effects. The Cyanogen pool theory contends that
the impact is not one of Pulmonary fibrosis alone but a deeper
cellular one, not merely confined to lungs. What is important
for the analysis is the style of research underlying the two V..
theories. The first operates in terms of the direct mechanics
of cause and effect, the second in terms of deeper relations.
The mechanistic theory of pulmonary impact is advocated by the
establishment and government hospitals. The cyanogen pool theory
finds its advocates among voluntary health specialists and dis­
sident doctors.
But what is most fascinating is the manner in which text
and context are related. Voluntary health specialists have
repeatedly advocated that the focus of study should be suffering
in the community, rather than the patient as an isolate in the
hospital. The first they argue, leads to a holistic view of di-^..
sease while the latter propagates a reductionist view of illness
and an atomistic view of the patient. The latter-view which
underwrote the pulmonary model, is based on numerous vertical
studios rather than an integrated search for interconnections.
In a telling paragraph the MFC report suggests, ’’The approach of
examining say 200 eyes or 200lungs and so on independent of one
another lacks this integration. Strange it may sound, but it
seems to derive the rationale-unconsciously-from the pulmonary
model, wherin toxic gas directly hits the target organ (lungs,
eyes, etc.) to produce damage without any intrinsic connectionswhich is at the heart of the’Cyanogen Pool’ model”.

It is this anthropology of gestalts that is fascinating
about the report. What it offered were two clusters which
deserve further exploration.
1. Patient as an analytical
. grid

Patient as Person

2. Clinical gaze of the
doctors

Victim’s speech aids
diagnosis

Focus of diagnosis is
the hospital

Focus of diagnosis is the
Community.

4. Diagnoses as mechanics
of cause and effect

Diagnosis as an analysis of
inter-relations

5. Pulmonary Model

Cyanogen Pool Model

6. Anti Thiosulphate

Use of Sodium Thiosul­
phate as a critical tool

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VI
The experiences of the MFC', the Morcha and other groups
demand that this has to be located within a wider political
context. The problem of voluntarism has acquired a dramatic
focus within a span of two months. The November riots and
the December gas leak created a new objective situation which
has to bo understood within the theory of the State. The ’riots’
in Delhi saw the formal emergence of the State as terrorist.
The Bhopal gas leak revealed the complicity of the State in an
act of industrial genocide. Tn both cities, the traditional
corporate groups-the trade unions, the political parties, the
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the universities-failed to act as a cushioning medium between
state and the people. In Delhi, it was the civil rights groups,
along with a network of feminists, journalists, university teach­
ers and Jesuit priests which brought analytical clarity to the T
violence of the State and even provided relief to the victims.
The situation in Bhonal was similar.
Caught in the grid of modernity , which sees industrialism
as good and inevitable, the traditional corporate groups saw
the victim as an embrassment. Wo must add.however that political
parties like the CPI did gincrly conduct a few demonstrations.
Some student wings of leftist groups responded by conducting sur­
veys and providing some medical relief. But one felt a whiff
of self-congratulation here, as if a few dozen injections had
transformed them to the status of a Kotnis. Most pathetic werethe trade unions. So startling was the disaster, and yet so usd
were they to negotiations with the management, that they refused
to see that the normalcy of coll ctive bargaining was inadequate
to this situation. Eventually Carbide declared closure of the
factory, offering the workers1 a nominal compensation. To add to
this the railway unions had failed to claim .even workmen's
^compensation for the railwaymen who died on duty on December 3.
The Railways passed the buck to the factory and vice versa. But
the Workmen’s Compensation Act is clear on this s the victims are
entitled to relief irrespective of the source of damage. Such
lethargy was typical of almost all the corporate groups as organi­
sations, even if some of the individual ’members discarded these
routine scripts.

The voluntary organizations had to substitute.for these
groups though one must add that few.were self consciously
equipped for such a task. Voluntarism'in this contxt required
a double responsiblity. It had to.redeem not only the traditional
idiom of power but also the repressive nature of modern knowledge.
This point is crucial. As mediators between State and the people
they are not only refractors of power but proponents of an
alternative ecology of knowledge. It is not only the victims as
politically defeated people that they had to protect but also
their vdice, their memory, their right to their own vernacular,
pain and distress.
highlighting
One fact needs highlighting.
There is a distinctive
quality about voluntarism in these new contexts. The voluntarism
of the old Sarvodaya-social service kind no longer occupies a
central place. In Bhopal, certain church groups , the RamaKrishna Mission and the SEWA did perform important service but .
stuck grimly to traditional styles. They accepted the official
procedures of medication, basically symptomatic treatment,
including use of steroids and antibiotics and looked to the
leadership of the government in all these activities. The
Health Secretary's question ’’why can’t the Morcha be like the
SEWA ?” sums up this traditional and dedicated style. These
organizations work as extensions of government relief and
avoided confrontationist stances. The litmus tost for such an
attitude in Bhopal was the Sodium Thiosulphate controversy.
All the above mentioned groups refused to administer those injec­
tions. The point we wish to make is that the new voluntarists
were not content with relief. What they also sought seek was i
justice for the victims. In this, the importance of socially c
conscious professionals became obvious. In the Delhi riots,
university social scientists, researchers and journalists
provided an enormous data base which the State has found diffi­
cult to refute. In Bhopal too, the role of the professional as
'counter expert' has b-en crucial. These include health groups
environmentalists, lawyers’ collectives and peoples science
movements.

REPRINTED FROM LOKAYAN BULLETIN, Volo 3, No.4/5
13 Alipur Road Exchange Building Delhi 110054.
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