MFCM044: Role of mfc - Notes on the discussion at Patiala.pdf · medico friend circle

MFCM044: Role of mfc - Notes on the discussion at Patiala.pdf

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ROLE OF mfc

Background Paper I

Notes on the discussion at Patiala
July 1985

THE discussion in Patial. was an opportunity to reflect on and
discuss together the papers of ANAn'T PIIADKE and ASHVIN PATEL
which were featured in the special mfc bulletin nos.100-1
in April-May 1984 and to consider the issues raised by AB.HAY
BANG in a recent letter which had been circulated before the
Patiala meeting. A short report of these discussions vas feature
in mfc bulletin 116-7 (Aug-Sept 1985). The following minute is
an attempt to highlight the questions/issues/comments raised
during the discus ion so that a dialogue/discussion initiated
so that a dialogue/discussion initiated in Patiala can continue.
TO help learn from past debates on some of the issues, it was
decided that old timers would support the current debate oy
reporting on earlier debates as and when they became necessary.
PART I:

Why. ,?.r,ej wo dis cuss ing role?

mfc members have viewed mfc as a common forum ’where we can
exchange ideas' and then go back to our own areas of interventio ■
some others feel that we should play a more active common role.
som. e jar obiems

A problem we face is that mfc core group members are too busy
with their local pre-occupations an.- do not respond as actively
as they could/should to common organizational/action issus.
Bhopal has been an exceptional example but even here the quest! x-i
of how much we should get involv d :nd how organised are we
for such interventions come up. Another problem is that we
are geographically too dispersed to effectively take up common
action. A third problem is that we are also members of other
organizations many of which are involved in action.
some.

i)

Should all our expectations and priority interests be met
from mfc?

ii)

We should look at Jha^ other organizations or networks
similar to mfc are doing and identify a more clear and
specific role for ourselves. Is this more realistic?

iii) The pamphlet gives a very broad perspective and it
is expected that e^ch of us are promoting this
perspective through discussion and action in our local
areas. Is this really happening?

iv)

As individuals we may be doing it on our own. But can
we do some of this collectively?

v)

~/e fuel the need for a-near full-time convenor but are
are not willing to give more time organizationally to
support a common endeavour. Is this realistic?

vi)

To ask what we can do as a group or agency...may be
pos-ing a model that creates problems. But should it bo
posed?

vii) If the cor group remains as passjve as it is at present
(except io:>n of Bhopal intervention) then should be seriousl;
decide whfit we c «n/oannot do in the future?
. .2

c 2"

viii) Role identification is not just a convenor’s headache.
It is necesary for all of us to reelect on this and
share these ideas so that common priorities can evolve.
How to do tnis?
ix)

Are we joining mfc because we think it has a :role
’ to pl
in health care today or are we joining it because? wo
are already doing what mfc stands for?

x)

How many of us are really interested or are willing
to give time for collective action? Without such
collectivity how will the organisation grow?

xi)

Should we look at the reality of the health situation
and identify a role in that context? Or should we put
down our limitations and derive a role in that context

xii)

Except for Bhopal mfc has not played a rollective relu
actively . We have not even reacted collectively to
policy issues li^.c drug policy, health for all by 2000
national health policy etc. Why is that?

xiii) Many of our new members,contacts and more recently for./,
organisations have great xplocations from us. The
pamphlet and the bulletin creates this aura. How do re
size up to this expectation?

xiv)

There is a tendency to xw member mfc only at meetings
and forget it after ve go from the meetings. VJhy is - -.h

xv)

There is bound to be a constant conflict between indivi .•
priorities and interests and organizational priorities
and interest . How are we going to face this dichotomy?

<vi)

A key questions is are we just a discussion group, a th’*.
tank or an organization v.ith a perspective beyond
discussion to action also. Ti.is also means can there be
an mfc organizational stand emerging by consensus?
Or is there no mfc s and but individual standsvhich
have some degree of collectivity?

xvii) Those of us who have felt that mfc should react/rcspond
to certain issues why did they not react when they felt
we needed to?
xviii)lf each of us are r spending to issues in health care
in our own ways, writing, lobbying, mobilising etc.,
is this not also a type of collectivity?

xix)

When each of us individually initiates some action arou*
an is.me even if it is local, is it also mfc effort? Hu.do we decide what is and what isnot?

XX )

When wo work in coordination with other groups or notuv
networks, there is often a degree of urgency in.arrivin'
at an mfc common stand. How does one go about getting t
in a specific situation?

PART II:

Keeping Abhay’s list in mind components of role wer-_
identified as:

a)

Evolving/evaluating alternative health care strategic
field level.

b)

Critical evaluation and analysis of national health
programmes and health care approaches.

c) Acting as a forum for raising health issues and organizing
campaigns.

d) Monitoring health policies and playing a ,atch dog role.

e) Influencing health policy by lobbying and legal action.
f) Medical activism which would include organizing people around
health issues.
g) Investigative research with a critical social perspective,
h) Documentation

collection, rc.-vic' and dissemination.

i) Participating/linking with other groups in a health action
network.
j) Consultancy/support work for community health projects
k) Organising field orientation for medicos and others to
sensitise them to broader social issues in health.

1) Building stronger links with members through sharing
of experiences and evolving common perspectives.

r) What do we mean by alternative strategies'/ or experiments?
Do we mean those strategies or attempts that help us in our
overall goal a more people oriented thealth system which
we set ourselves?
We need to identify problems and gaps in these strategies,
formulate research programmes to get over these problems,
look t how such ideas con be practiced on a wider level;
communicate our critique to sensitive sections primarily medicos
and decision maker in health care and thus try to influence
health c.re policy.
A critical study is not enough. We must communicate our
findings to sensitive sections for it to have real meaning.

Medical education is a good example, './hat has concretely emerged a
from the discussions? Do we have an alternative- medical oducatior
policy worked out if only in outline? If so, how can we
communicate it?
b) How do wo critically evaluate. existing policies or programs?
Review of literature, case studios and our own small field
studies? ;Is it possible to anticipate changasin policy
.and lobby against it before it is finalised/formulated?
DROM (a) and (b) th-_ important issues which arise are:
What can the role of th. bulletin be? Could we'write about
our critical findings? Should it be the only forum through whi ^h
wo communi cits our reflections?
Who are the key groups to which communication should be
directed, apart from members and subscribers? Should wo
send it to key decision makers? Should we k-ep health activist
groups informed/updated?

iii) This basically means that whenever we take up an issue
we should identify the important target groups and
evolve a specific COMMUNICATION STRATEGY. Wo have never

4

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done- this specifically in the past.
(Recently, ho /ever, the Bong lore team has done it with
Bhopal reports, Bhopal issues of mfeb etc. In Norm .-da
problem influecing bur aucrats did help. Some lobbying with
Inj. contraceptives and TB issues of mfeb has also been
done. In oral contraceptive issue senior politicians wore
useful, in the nuclear fuel complex is. ue letter to the
Prime Minister was useful. From our own experiences, th e r foi .,
communic.tion/lobbying is import nt/useful)

iv)Writing reports is not enough. We need to write different
types of report; for different groups so that our arguments
are demystified and available in the form to stimul te action,

v)

Another important policy issue willbe the need for action/
intervention meetings- not just discu.sions. Just sen ing out
information is not enough. Bringing groups together to discu :
finding- so that actions by different groups can emerge is al c
an import nt task.

vi) Should there be a greater result orientation in our efforts?
eg. Should we ask ourselves what critical information have
we added to he 1th activist groups in a year?
vii)Another important question is res the Tcritical analysis’
word that we use often.* For whom is this analysis? Is it
just intellectual stimulation or luxury? Do we sug est social .y
relevant alternatives? Should critical analysis be an end
by itself?

FROM all the discussions five roles emerged as of greater priori y

1. Critical analysis of policies and programmes

2. Evolving alternative str tegies of health care
3. Lobbying/communic. ting with intention of changing
policies etc.
4. Support/sharin., ideas/consultancy for community health
interventions .

5. Investigative field research.

TO continue these discussions, it was felt that small groups/c .1 s
could be formed who would go into each oi these in greater
depth and evolve more clarity in action.
1. Mira Shiva, Padma Prakash, Abhay Bang, An nt Phadke
Ravi Duggal.

2&4

Abhay Bang, Narencer Gupta, Anil Patel

3. Dhruv Mankad, Mira Shiva, Mahtb Bamji

5. Satyamala, Padma Prakash, Kamalabahen.
MANY core group members were undecided in making a choice
immediately. So it w: s decided that they could join colls as
and when they evolved their own priorities.

....5

:5:
Meetings

DURING the discussions it was often raided that common
perspectives/consensus can emerge only through more common
meetings at the regional level.
Can core group members organise such meetings? Previously
in the past they were done™regional meetings, camps etc.
Even values like not taking drug samples etc*, are hardly known
among newer members. These could be discussed along with common
reflection/action

Non-medicos are intimidated by medical jargon and professionalise
that commonly creeps in. Medicos are intimidated by socio
political analysis or jargon. Frequent local meetings could
get over this problem. Some of this Tintimidation’ is often
due to the aggressive ways in which we debate on issues. Can
recognise each other as thinking/evolving human beings and bring
more spirit of dialogue and listening to the other rather than
proving a point’.type of mentality?

Reporting
A nagging question that came up often in the discussion was 2
why do core group members not send reports of their activities
their reiiections
rneir
reflections and impressions/responses to issues? Why are
we hesitant to share our views? Does it in any way reflect on
the ethos of our discussions/our group?

Role of MFC

Background - III Paper
Requests to the MFC convenor 1984-85
The role of MFC can be discussed in abstract. It can also be
seen in the context of the sorts of requests that come to the
MFC Convenor from different people, groups? organisations. The
following is a list of requests that came to the mfc office in
1984 and 1985. It gives some idea of the expectations of people
who contact mfc for support, advice, action and solidarity.
(Can we respond to all these requests?
Should we respond
to all these? Do we have the collective technical know how,
organisational base or shared perspectives to respond to these?)
Note The classification is adhoc and does not represent any
prioritieso The list is also not complete.

1.

Support to Research (mainly information preferences etc)
Govt, of India’s policy towards Drug'industry
(research student)
Study of occupational injury among orthopaedic patients in
an ESI Hospital
(medico social worker) .
Ayurveda and occidental medicine (French postgraduate)
Health Education in India (German Research Students)
Medical-Education in Bombay presidency (Medical College
Professor, Bombay)
Appropriate technology in wather supply and sanitation in
India (Geography postgraduate, UK)
Drugs availability/marketing in the third world
(Oxfatm researchers)
Occupational hazards of radiation in a factory
(researcher from Kerala)
Drugs, pesticides, Dams and Deforestation
(Oxfam campaign researchers

2.

Participation in Seminars/Workshops
Popularisation of science (KSSP Trivandrum)
Science Teaching & Education Policy (Eklavya, Bhopal)
Protecting the child consumer, (Indian Academy of
Paediatrics and QG S t, Gorv.khpur;
Ten' years after Hath! Commission (KSSP, Trivandrum)
Bhopal Hover Again ( K Consumer protection Board & 10CU
New Delhi)
The Drugging of Asia-Pharmaceuticals & the poor (10CU, VHAI,
ACHAN* Madras)
Peoples Science, Environmental protection and Democratic
rights groups convention (ZGKSM, Bhopal)
^People for Drugs or Drugs for people (Welfare organisation
Jalpaiguri)
Health Workshop (TN Theological seminary, Madurai)
+ Many meetings related to Bhopal and issues arising
our. of disaster (various city networks)
Community Health interventions
Planning- Health Education programme in urban slums
(Chetan, Delhi)
Support to trainers of community health workers
(Volag, Madras)
....2.

3.

- 2 Opinion on Health Records & under five core
(Coordinating & funding agency, Bangalore)
Course for school teachers and mothers
(MFC members, Calcutta)
Training of village Health Workers (Volag, Dharwar)
Survey of Tuberculosis in slums (MFC members Calcutta)

4

Support to medical/ Non medical student initiatives
6 month special elective in Community Health
(Final year Medico, ,.CMC Vellore)
Community Health Project tour in Karnataka, Tamilnadu &
Kerala (Medical students group from AllMS, New Delhi)
•Community Health & Development Project tour in South India
(postgraduate & Friend, Karnataka)
Elective, with MFC to get broader understanding of medicine
■ (US student before joining medical school)
Public Health Committee of All India Medical’ Students
Association requesting for ideas for action by Medicos
Exhibition on Alternatives - Jamkhed and Astra (Medical
studdnt group, Calicut) .
’
Medical Students Debate on Health issues (student group,
MIMS, New Ddlhi)
Permissipn to print mfc articles in student unions magazines
(several Medical Colleges in Keraha
Voluntary placement in MFC related hospital or rural
projects (Psychology Student, US)
Elective in Mental Health (Psychology postgraduate,
Chandigarh)
Study tour of volags in Health Education in South India
(French Students)
Lecture discussion by MFC members for Medical student
of group, New Delhi. --

5e

Miscellaneous/Unusal.
Discussion on social movements at rural level, Drugs &
(
environmental issues ( representative of french India
Solidarity group)
Education Foundation•in Gujerat requests for MFC members to
give lectures at Community Science centre in Saurashtra
Technical support requested from medical group working
with refugees/from Sri Leuika
Information for All India Science and Technology Directory.
Requests for initiating National dialogue on building
rural health delivery systems' and comprehensive assistance
for low income rural mother & Children (Preluminary
reports from a Volag in Gujerat)
Charitable Trusts requesting for contacts with groups in.
Rural Health Education (a UK registered charity and afamily
trust■in Bombay)
Members in state govt. Health Service requesting for
ideas to tackle the system1
A doctor couple (both Ophthalmologists) interested’ in
• voluntary.social work - request for ideas.
Support to peoples Health Forum in Madurai formed as a
result of inspiration from MFC
Paediatrician asking for thought provoking articles on
Community Health for his Department staff (Medical Collegd
■ Aurangabad)
Material on Tuberculosis for continuing education of

. .3.

- 3 Church related Medical Coordinating agency.
Solidarity with Third World Action network for information
dissemination.
Request from consumer group to study baby food sale practices.?
(Consumer guidance Society, Bombay)
Request from German, Drug action group in drug campaign
against German multination.
6.

MFC-Linked action/campaign/initiatives
Writ petition against import of injectable contraceptives
Epidemiological and Socio Medical study .of Bhopal gas victims
Rationality study on Antidiarrhoeals K .
Study of pregnancy outcome in Bhopal
Rationality study of Analgesics and antipyretics
Circulation of a note on communication strategy on health
issues in Bhopal
.participation in the evolution of a comprehensive medical
care strategy in Bhopal
Technical support to volags and action groups in Bhopal
Circulation of note on Health Services in tribal regions
to get collective response
Circulation of WHO document on government and
Voluntary agency participation to get collective feedback
Technical handout on Sodium Thiosulfate treatment for
doctors and volags in Bhopal .
Health Education pamphlet and porler for gas disaster
victims in Bhopal.
Anthology of articles related to medical education
generated by MFC- sources
Fact finding report on medical relief and research
in Bhopal

Role of MFC
Background paper

IV

From letters to MFC
I am getting more and more convinced that progress in this
country in community medicine is likely to come from the work o?
devoted individuals rather than employees of the system.

Ramachandran, Professor Biostatistics, AHUS,
At the outset let me congratulate the MFC team for their singul-r.
■ ,ique contribution, you have once again proved whet the voluntary
sector can contribute and that too, in a crucial area where the
public sector has not come upto the expectation.

The way the whole problem has been handled by those responsible
including the administrators and the leaders of the medical
profession does not leave the impression that their actions
were guided by the true gravity of the situation and a real
concern for the lives of those affected. The MFC report owes
credit, morethan anything else, for bringing this out. Yours
is not an armchair critique bur based on a serious, indepth
on the spot community enquiry •

It behoves the scientific community at large and the medical
profession in particular in their role as custodians of the healt •
and wholeness of the community to exercise greater prudence
of their stewardship.
Thanks once again to the MFC Team and its leadership.

George Joseph, Ex Professor Community Medicine, AIIMS
.1 too am deeply concerned why even the concerned community
physicians have not succeeded in developing the sort of thin king which could be developed for NTP. I am hoping that people
in MFC will be able to ponder over this issue and as a result
of the deliberations wo will have creative thinking from MFC
which will influence health s ervice development concepts and
hopefully practices in India and abroad
(Jan 85)

My complaint with the s tudy is thatwhile giving so much of
importance to the controversy on the cyanogen theory the MFC
group has unwittingly drawn attention.away from much more
important aspects of the tragedy, even in conventional public health terms. Besides of course there are very critical poli
tical economic and social dimensions.
(June 85)
—D. Banerji, Professor Comm.Health & Social Modicne,
JNU.
This letter comes after repeated readings published in different
papers and EPW about your activities.....! believe that you
are also helping to strenghten the organisations which at
present are putting upredistant struggles against the savage
oppression of the state, machinery. I express my solidarity
with you in your fight against these oppressions and social
evils prevailing in the present Indian Society....! am a health
worker residing in one of the remotest villages of U.ttar Pradesh
and while writing to you, hesitate a bit to ask you, whether
you keep yourself confined to only MBBS degree holdert* or not?
'I hope you will bo friendly enough to make this'communication
two-way. rt? ' -•
— Amite v-i Choudhry, UP
This is just to inform you that I would like to stop receiving
the MFC bulletin and to explain why.

2.

2

There are so many reasons actually. But it boils down to this
that very few people can gothrough books like Health Care in
India and MFC
still persist in having faith in radical soc .alism of any type. What penetrates throughout in the .hatred of
the human race, so ...cleverly disguised as the love of suffering
humanity. . .It was Russel who applied the test to those who wou.-l
destroy the present system--to find out if they are creative o '
destructive--find out whether they have a practical alternativ j,
or merely mouth slogans.
The World is divided into angels and devils, good men and bad.
Everything is blackand white,- the rainbow is a mirage Human .
beings are tools towards a(marxist) heaven, ruled by a (marxisu)
intellectual criche, governed by the pcwerr of fear, hatred and
propoganda.

Forgive my trite statement but I do not believe that good
p^s'S’i’irfism and hatred can be creative*
can come out of evil, that
''
There is plenty that needs to be done.. . .So like so many before
me, I too an. leaving the negative atmosphere.
—Newton Luis, Muvattupuaha, Kerala

I recently read j| handbook, entitled fHealth Care which way
to Go published by MFC. I found several of the articles quite
engrossing.
‘ ~ » The appendix related to the genesis of the
group was to me~specially significant. Being a superintendent
of a 30 bedded rural hospita
■’line backward district. ......., - ■

-- I am becoming increasingly aware of the limits of the thera
peutic approach to health care.Additionally a constant entangle
ment with administrative problems and a growing alienation with
actual clinical work (and thus the challenge of Diagnosis) is
rapidly leading to a pre-senile fossilisation of my thought
processes.1 Naturally I would like to avoid such a state of
af fairs-r... therefore would request you to let me know something
about your organisation and just how I could participate in it’
atleast passively if not actively.

Arab ar Kumar Gupta, Islampur, West Bengal

Reactionary ideas and wretched trends are becoming powerful^
in the medical profession. A sense of inevitability and helplessness as regards the corruption is growing. Organisations
like the MFC can a ctively be in the forefront of a struggle by
the progressive sections amongst medicos to resist these trends.
And this can only be done by actively taking part in struggles
both inside and outside the profession for a more just and
rational medical system.
We are trying our best to mould MARD into one such organi
sation. With. -I-- help of friends like
■> ., you all
— and- magazines
nrrn
SQ#
like MFCB and SHR
we hope > to
do

San jay Nagral, SHO, Bombay.
Ours is neither a formal organisation ncr even a group.
It . is just a gathering of some 10-20 students
— ”" -T~ moulded
vm.v«.>^<xl uncon
sciously to a common awareness just by living together in a
hostel for 2-3 years.
*>

■

*

Some six months ago an idea came into our common talk to th' IK
of some practical forms of activity which we can adopf in our
future medical practice
practice. And we decided without breaking the
informality of our gathering to reprint relevant articles regard,
ing health*'issues
it ^inside
health issues and to distribute
distribute!!
inside Vthe whole campus.
It was at this time that we got the MFC manifesto which we
published in Nov 1983.
• ••3.

3

Regarding fran ideas and suggestions—we hope that at
least for few coming years we would be having nothing to suggest
to MFC but to adopt from you and transform our awareness.
B rahmaputhran

Calicut Medical College Kerala.

I am writing for several reasons (after the annual meet
1985). One to express my happiness over the frank and honest
discussions. Two because of the opinions expressed by all those
who are themselves field workers. Three because of lack of
hypocracy among participants. Four a very keen sense of urgency,
militancy and so one
I am happy for having got acquainted with so many people
who have shown an inspiring disregard for greed, for money
affluence and power etc*, I know these things to be not as
absolutely rare as thoughtgenerally but meeting them was a
pleasure if not something very astonishing.

I want to also convey my wish that I will be willing to
undertake some sort of specific task for MFC. My own subjects
of interest, work and some elementary research I am doing and
some experiences (othersthan with the Tibetian settlements)
i will be willing to share when they become sufficiently
worthy of being shared.
-- S.K

Kolkar5 CMC of a Pvt. Hospital, Maditeri
Karnataka.
*
***
$

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Role of rnfc

■* ■■

- 9 ■ » wirw. * — «-•

Blck ground Paper J

ON the ethos of mfc discussions....

rnfc is a progressive, broad-front between socially conscious
medicos of all kinds—from Gandians to Marxists. We come
together with a certain minimum common understanding and
stick to the common perspectives during our discussions. Each
one has to keep his/her own ideology/jargon a bit more to
one self and operate, discuss within the parameters of the
common framework of medico friend circle. It is through this
tradition of restricting oneself to the common perspective and 1
language during discussion that rnfc has been able to hold
together politically diverse elements on a common platform.
Admittedly this does reduce the sharpness of analysis to a cor :
extent. But bringing together medicos fund mentally critical
about the medical system in India is to<.ay a very import .nt tv ;1that some organisation must take up. rnfc has evolved as such <?
kind or organisation.

IN view of this background, we
wo feel that persons from differerr:
different
(but basically pro-people) backgrounds can come together for a
meaningful discussion if all of us observe certain norms.
If everybody completely sticks to his/her framework and
political language, then different people would talk in differ/,
languages end a meaningful discussion would become almost
impossible.
SECONDLY, though almost all members of rnfc are socio-politicai
oriented, we have kep directly political issues out of our
discussion and confine it to the politics of medical caro only.
As we go nearer to the directly political question, difference ;
emerge- sharply and a common consensus can ot emerge. It would
therefore bo better to refer to general political issues only t.
they are directly related to the point b^-ing discussed. Within
a broad pro-people consensus there are bound to be difference? c
opinion end they arc indirectly linked to politics. But if
different groups/individuals coming together start ’exposing’
each others politics then the purpose of me meeting would be
defeated; there would be political polemics and not a discussion
on the topic.

As an organisers of such discussions, we ar. concerned to sou
that these discussions are fruitful and the above lines may
please be re.^d in that context.
—from a let I:er written to all socially conscious
medico in West Bengal
Anant Phadke Oct 1983
On study and campaigns
I would like to pose a general question. Given that the old tim.
in rnfc are /aware of the relationship between health and socio
economic issues should they or should they not concern thumss.lv.
with study and investigation of actual issues that come up and
start mobilising around issues? I think the answer is :Thoy
should”.

SHOULD not old-timers concentrate on alternatives and campaigns'
What does c.mpaign really m .an unless it means study and invest:’
gs.tion of relevant issues and mobilising and helping to mobilise
around them?
... .Lalit Khanra July 1932

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