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Bhopal Gas-hit survivors still afflicted with birth-related defects and other disease

Wednesday, December 02, 2009 12:18:42 PM, Pervez Bari

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Bhopal: Despair and depression is writ large on the faces of the survivors of Bhopal Gas Tragedy, the world's worst industrial disaster, as they continue to suffer silently with death staring them in their faces. The helplessness of these victims is to be seen to be believed as they watch their progenies afflicted with stunted growth born with a host of birth-related defects. With the upcoming 25th anniversary of the catastrophe a new generation has come up which is handicapped physically, mentally and emotionally.


This scenario and state of affairs is thanks to the fall-out of the poisonous. 40 tonnes of Methyl Iso Cyanate, (MIC), and other lethal gases that spewed out of the Union Carbide Corporation’s pesticide plant in Bhopal, the capital city of central Indian state of Madhya Pradesh, on the intervening night of December 2-3, 1984, exposing over 5,00,000 people to the toxic fumes. While 25,000-35,000 people have died since then and hundreds of thousands of persons have been maimed for life.


Children still being born in Bhopal to badly affected survivors are blind, lame, with limbs twisted or missing, deaf & mute, brain-damaged, with hare-lips, cleft palates, webbed fingers, cerebral palsy, tumours where there should be eyes etc. The still-born often cannot be recognised as human. They were damaged in the womb by chemicals leaking from the same Union Carbide factory that killed thousands in 1984 and to-date still counting.


Bhopal is well known as the site of the world's worst industrial disaster in 1984. What is less well known is that a medical disaster of unmatched proportions continues to re-victimize the gas victims to this day.


Following the gas disaster the Indian Council of Medical Research,(ICMR), a government agency – concluded, on the basis of mortality figures, that over 520,000 exposed persons had poisons circulating in their bloodstream causing different degrees of damage to almost all the systems in the body.


Today, well over 120,000-150,000 chronically ill survivors are in desperate need of medical attention and an estimated 10 to 15 people are dying every month from exposure-related illnesses. Breathlessness, persistent cough, diminished vision, early age cataracts, loss of appetite, menstrual irregularities, recurrent fever, back and body aches, loss of sensation in the limbs, fatigue, weakness, anxiety and depression are the most common symptoms among survivors. The alarming rise in cancers, TB, reproductive health problems and others such as growth retardation among children born after the disaster remain undocumented. The official agency for monitoring deaths has been closed since 1992.


According to Dr. N. Ganesh, an expert from Jawaharlal Nehru Cancer Hospital and Research Centre, the research conducted by him revealed that 53 per cent of the gas victims suffer from chromosomal aberrations as compared to 10 per cent common people. Also the rate of infertility and abortions are four to five per cent higher in gas victims, he added.


A recent survey says that 43 per cent of the gas victims still suffer from respiratory problems, 10 per cent from heart-related problems, nine per cent with eye problems, eight per cent with general depression problems and six per cent with gastro-intestinal problems.


To this day, the treatment of the Bhopal victims is impeded because Dow-Carbide callously refuses to share all its medical information on the toxic effects of the gases released that night, regarding the information as a “trade secret”. As a result, effective long-term medical treatment has been hampered. Even worse, the effects of the gases on future generations remains unclear even as health effects manifest themselves with disturbing regularity among the children of gas-exposed parents. Since the disaster, the city has been plagued with an epidemic of cancers, menstrual disorders and what one doctor described as "monstrous births.”


It may be recalled here that in a show of publicity as the bodies stacked up, Carbide flew a series of “top medical experts” to Bhopal to sing a chorus of reassurance. Dr. Hans Weil - reprimanded for unethical conduct by a US court for fudging medical data on behalf of the Johns-Manville corporation - predicted that ‘most victims would fully recover’. Pulmonary specialist Thomas Petty, also flown to Bhopal by Carbide, said that victims were ‘recovering rapidly’. No report made by Carbide-sponsored doctors was made available to the Indian government.


It may be recalled that in March 1985, a column of frightened mothers-to-be wound towards a government hospital with bottles containing urine samples. The women asked for the samples to be tested to check whether their babies could be born damaged, and to ask for sodium thiosulphate injections to rid their bodies of toxins inhaled on ‘that night’.


Instead of injections, tests, medical advice and kindness they were driven away by police with sticks. Ironically, even as these scared women were being chased away, the Indian Council of Medical Research, (ICMR), was carrying out a double-blind clinical trial to test the efficacy of sodium thiosulphate injections as a detoxifycant for the gas-exposed.


Other ‘expertise’ included Carbide’s Dr. Bipin Awasia, who sent a telex to Bhopal recommending treatment with sodium thiosulphate. When in Bhopal, flanked by lawyers, he said he’d been mistaken. As a result, tens of thousands of ailing victims were denied a treatment that double blind clinical trials had shown to be effective. Success of the treatment would have proven that the gases had crossed into the bloodstream, thus generating more expensive damages against Carbide.


And while the fears of mothers-to-be were all too soon realized in what one Swedish doctor described as ‘a spate of horrific births’, the ICMR results took 22 years to be published, when they revealed – a whole generation too late – that the injections could indeed have saved tens of thousands of lives. The disaster has faded in the world's memory, but in Bhopal the damaged births continue.


Union Carbide (now Dow Chemical, following the February 2001 merger) continues to claim over 60 years of research (including research on human 'volunteers') on MIC (the gas that leaked from the Bhopal pesticide plant) as “trade secrets”. There is more than enough research to suggest that by withholding information, propagating misinformation and the withdrawal of funds meant for medical care, Union Carbide has impeded the health care efforts of the victims to help themselves. The ICMR in turn stopped all research into the health effects of the gas in 1994 and is yet to publish the findings of the 24 research studies it had carried out up to that point involving over 80,000 survivors.


From the start, the medical response ranged from inadequate to catastrophic. On that night, hospital officials frantically called Union Carbide, seeking a treatment protocol. When they finally got through, they were blithely assured that the gas which was killing thousands was “nothing more than a potent tear gas” and that victims merely had to “wash their eyes with water.”


In the absence of medical information, no treatment protocols specific to exposure-induced multi-systemic problems exist and symptomatic treatment remains the mainstay of medical response. Of the two official publications resembling treatment protocols, the most recent by the ICMR is 11 years old and covers little except the management of respiratory problems, and the vast majority of the medical community in Bhopal is not even aware of its existence. As a result, drugs for temporary symptomatic relief have been the mainstay of medical care ever since the morning of the disaster. This indiscriminate prescription of steroids, antibiotics and psychotropic drugs continues to compound the damage caused by gas exposure.


In the prevailing situation of despair, the Sambhavna Trust, which is a charitable trust run by a group of eminent doctors, scientists, writers and social workers who have been involved with various aspects of the Union Carbide disaster ever since its occurrence in December 1984, believes in creating possibilities by generating compassion. At Sambhavna, survivors are offered free medical care through Allopathy, Ayurveda (an indigenous system of medicine based on herbs) and Yoga. The 21 staff members of the Sambhavna clinic (among whom 9 are survivors themselves) include five physicians, two yoga and two Panchakarma therapists and five community health workers who carry out health surveys, health education and community programs for better health. Satinath Sarangi, the metallurgical engineer-turned-activist, who arrived in Bhopal a day after the disaster and has stayed on to help the survivors in every way. Better known as Sathyu, he is a founding trustee of the charitable Sambhavna Clinic for the gas victims.


The work carried out by the Sambhavna Trust since 1996 has shown that it is possible to evolve simple, safe, effective, ethical and participatory ways of treatment monitoring and research for the survivors of Bhopal. However, Sambhavna is small compared to the magnitude and complexity of the disaster. While an estimated 120,000-150,000 survivors of the disaster are today chronically ill, the clinic run by this trust has provided direct treatment to little over 16,000 people and provided support to about the same number through its health initiatives in 10 communities close to the Union Carbide factory.


Women's Health: Given the official neglect towards monitoring and care of gynaecological complications caused by the disaster, special attention is paid by Sambhavna in this area. While officials continue to deny any exposure-related gynaecological health consequence, data collected at Sambhavna shows that of 190 females, aged between 13 and 19, who came to the clinic between 1st June 1999 and 31st March 2000, 113 reported menstrual problems, including painful and irregular menses, heavy bleeding and excessive vaginal secretions.


The secretions, locally as ‘safed pani’ (literally white water), are not often openly discussed because of social taboos. Community health worker Aziza explains, "Women do talk about it more now but are often confined to their houses and can’t talk to their husbands about their problems or get education." Worryingly, Sambhavna’s pathologist has found a high proportion of abnormal PAP smears among women survivors, increasing fears for a connection between cervical cancer and gas exposure. Already in India, cervical cancer is the highest occurring cancer for women, but there is no provision for routine cervical screening in Bhopal. Women who are referred to local hospitals after producing abnormal smears have been reluctant to attend, given that the most common medical procedure for cervical abnormalities is an immediate hysterectomy. This is referred to as a "blind hysterectomy" because no one including the doctor knows how far or how little the malignancy is.


Meanwhile, the Indian Supreme court directed Carbide to build a 500 bed hospital from its own money. Instead, Carbide put £1000 into a trust in London and tried to transfer into this its shares in UCIL that had been seized by the Bhopal court due to Carbide’s non-appearance to face manslaughter charges. In 1994 it succeeded, thus evading the Bhopal court where the judge declared the transfer ‘malafide’. The 350-bed hospital took nearly ten years to build and within a year of opening was found to be profiteering with private patients, despite being bound to treat gas victims for eight years ‘in the first instance’.


So many government hospitals have been built in Bhopal since the 1984 disaster, that, as the International Medical Commission on Bhopal, (IMCB), has observed, there are more hospital beds per 1000 population here than in the USA or Europe. The Comptroller and Auditor General's annual reports suggest that excessive commissions, and not concern for victims' welfare, is the real motive for building these huge hospitals that house seldom-used expensive equipment.

Government initiatives towards identification of survivors have resulted in confusion, corruption and utter discrimination.

Consequently there are no credible official figures of the number of victims and the degree and extent of injury. Similarly lacking are systems to document the health status and treatment given to hundreds of thousands of survivors under long-term medical care.

Given the nature of chronic exposure-induced illnesses and the need for continuous medication, systematic efforts towards finding non-toxic drug alternatives or drug-free therapies is long overdue. Such initiatives are even more imperative in the context of the rich possibilities offered by long-established indigenous systems.

However, systems of health care such as Ayurveda, Unani and Yoga that are known to provide sustained relief – without contributing to the toxic load – have been given only token recognition within the official system of medical care in Bhopal. The government budgetary allocation to “alternative” medical care is under 1 per cent.

Despite repeated advice from medical professionals, including the IMCB, a community health perspective has failed to inform health care delivery among the gas-affected population. Budgetary allocations to community health services have remained under 2 per cent. As a consequence, such vital areas as health education and community involvement in medical management remain neglected.

While the corporation continues to evade liability for contamination of community water sources, the government has done little to protect over 5000 people from additional exposure and injury. Both Union Carbide [now Dow] and the Indian government are in possession of information on the hazardous and persistent nature of these pollutants, yet no effort is being made to assess the damage, or plan for remediation.


The failure of Madhya Pradesh Government agencies(despite spending over US $43 million of public money) to offer sustained relief has meant big business for private doctors and nursing homes. In the severely affected areas, most of the meagre compensation has been spent on private doctors, nearly 70 per cent of whom are not even professionally qualified, yet they constitute the majority of the medical care providers.


The BMHT (originally set up by Union Carbide) has also been found to be prescribing drugs that do more harm than good. Dr. Rajiv Bhatia, Medical Director of the Department of Public Health in San Francisco, has audited over 400 prescriptions given to chronically ill patients in the Trust's community clinics with alarming conclusions.


It is indeed a shocking situation – people surviving against the most gruesome odds – a company carrying on with “business as usual" – a government that is about to close its files on the "expendable people" of Bhopal – and the prevalent system of health care most probably doing more harm than good.








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