WANT TO devise a new form of alternative medicine? No problem. Here's the recipe.

Be warm, sympathetic, reassuring and enthusiastic. Your treatment should involve physical contact, and each session with your patients should last at least half an hour. Encourage your patients to take an active part in their treatment and understand how their disorders relate to the rest of their lives. Tell them that their own bodies possess the true power to heal. Make them pay you out of their own pockets. Describe your treatment in familiar words, but embroidered with a hint of mysticism: energy fields, energy flows, energy blocks, meridians, forces, auras, rhythms and the like. Refer to the knowledge of an earlier age: wisdom carelessly swept aside by the rise and rise of blind, mechanistic science.

Oh, come off it, you're saying. Something invented off the top of your head couldn't possibly work, could it? Well yes, it could—and often well enough to earn you a living. A good living if you are sufficiently convincing or, better still, really believe in your therapy.

Many illnesses get better on their own, so if you are lucky and administer your treatment at just the right time you'll get the credit. But that's only part of it. Some of the improvement really would be down to you. Not necessarily because you'd recommended ginseng rather than camomile tea or used this crystal as opposed to that pressure point. Nothing so specific. Your healing power would be the outcome of a paradoxical force that conventional medicine recognises but remains oddly ambivalent about: the placebo effect.

Placebos are treatments that have no direct effect on the body, yet still work because the patient has faith in their power to heal. Most often the term refers to a dummy pill, but it applies just as much to any device or procedure, from a sticking plaster to a crystal to an operation. The existence of the placebo effect implies that even quackery may confer real benefits, which is why any mention of placebo is a touchy subject for many practitioners of complementary and alternative medicine (CAM), who are likely to regard it as tantamount to a charge of charlatanism. In fact, the placebo effect is a powerful part of all medical care, orthodox or otherwise, though its role is often neglected and misunderstood.

One of the great strengths of CAM may be its practioners' skill in deploying the placebo effect to accomplish real healing.

"Complementary practitioners are miles better at producing non-specific effects and good therapeutic relationships," says Edzard Ernst, professor of CAM at Exeter University. The question is whether CAM could be integrated into conventional medicine, as some would like, without losing much of this power.

At one level, it should come as no surprise that our state of mind can influence our physiology: anger opens the superficial blood vessels of the face; sadness pumps the tear glands. But exactly how placebos work their medical magic is still largely unknown. Most of the scant research to date has focused on the control of pain, because it's one of the commonest complaints and lends itself to experimental study. Here, attention has turned to the endorphins, natural counterparts of morphine that are known to help control pain. "Any of the neurochemicals involved in transmitting pain impulses or modulating them might also be involved in generating the placebo response," says Don Price, an oral surgeon at the University of Florida who studies the placebo effect in dental pain. "But endorphins are still out in front."

That case has been strengthened by the recent work of Fabrizio Benedetti of the University of Turin, who showed that the placebo effect can be abolished by a drug, naloxone, which blocks the effects of endorphins. Benedetti induced pain in human volunteers by inflating a blood-pressure cuff on the forearm. He did this several times a day for several days, using morphine each time to control the pain. On the final day, without saying anything, he replaced the morphine with a saline solution. This still relieved the subjects' pain: a placebo effect. But when he added naloxone to the saline the pain relief disappeared. Here was direct proof that placebo analgesia is mediated, at least in part, by these natural opiates.

Still, no one knows how belief triggers endorphin release, or why most people can't achieve placebo pain relief simply by willing it. Several labs are now thinking of using brain imaging to study the neurobiology of the placebo effect in more detail. "The brain has already been imaged during drug-induced analgesia," says Price. "There's going to be a race between laboratories to do this experiment first for placebo analgesia."

Though scientists don't know exactly how placebos work, they have accumulated a fair bit of knowledge about how to trigger the effect. A London rheumatologist found, for example, that red dummy capsules made more effective painkillers than blue, green or yellow ones. Research on American students revealed that blue pills make better sedatives than pink, a colour more suitable for stimulants. Even branding can make a difference: if Aspro or Tylenol are what you like to take for a headache, their chemically identical generic equivalents may be less effective.

Special delivery

It matters, too, how the treatment is delivered. Decades ago, when the major tranquilliser chlorpromazine was being introduced, a doctor in Kansas categorised his colleagues according to whether they were keen on it, openly sceptical of its benefits, or took a "let's try and see" attitude (American Journal of Psychiatry, vol 113, p 52). His conclusion: the more enthusiastic the doctor, the better the drug performed. And this year Ernst surveyed published studies that compared doctors' bedside manners (The Lancet, vol 357, p 757). The studies turned up one consistent finding: "Physicians who adopt a warm, friendly and reassuring manner," he reported, "are more effective than those whose consultations are formal and do not offer reassurance."

Warm, friendly and reassuring are precisely CAM's strong suits, of course. Many of the ingredients of that opening recipe—the physical contact, the generous swathes of time, the strong hints of supernormal healing power—are just the kind of thing likely to impress patients. It's hardly surprising, then, that complementary practitioners are generally best at mobilising the placebo effect, says Arthur Kleinman, professor of social anthropology at Harvard University.

"This doesn't go down well in these communities because of the denigrating connotations of placebos. It's very threatening to people in those fields," Kleinman says. "The problem is that biomedicine has an extraordinarily negative view of placebos. They're treated as a nuisance rather than being seen as what they really are." And what they are, according to Kleinman, is part of the complex interaction of physiology, psychology and culture which underlies the process of turning a sick person into a healthy one.

This, needless to say, is a world away from the mechanistic approach of most conventional medicine, which has little to say about what people's experience of illness means to them. As Ernst puts it: "The very popularity of complementary medicine is a criticism of mainstream medicine. In the mainstream we have sharper and sharper tools. But in terms of empathy, time, understanding and touch we are losing out."

But even if many CAM therapies do get much of their power from the placebo effect, it's still important to ask whether there's anything more to them than that. To say—as many a CAM practitioner does—that a treatment "works" begs the question of how well it works. If a mantra-induced placebo effect will ease the pain of my bad back, that's good. But might something else do it even better? A handful of aspirin, for example? If doctors had been content to declare that a treatment works and leave it at that, orthodox medicine would not have got far. We want to know not just what works, but what works best. In answering that question, there's no substitute for clinical trials.

Yet it's not easy to design those trials in a way that both CAM advocates and conventional scientists will agree is fair. To give the clearest possible test of the treatments in question, experimentalists want to randomly assign patients to receive, say, aspirin or mantra therapy while rigorously holding all other conditions constant. But CAM practitioners charge that this cookie-cutter regularity is unfair to CAM therapies because it removes the individualised care that is such a central feature of most of them. "Because I apply orthodox research methods to complementary medicine, I've been accused of stripping it of what makes it work," says Ernst. "They say I'm throwing out the baby with the bath water. I accept that this could be a danger. If a therapy works only as a placebo then maybe one should keep science out of it. On the other hand this is how science advances."

This problem of context extends far beyond the realm of research. It also casts a shadow over attempts to integrate alternative therapies, with their powerful placebo-invoking techniques, into mainstream medicine. In practice this integration would mean, among other things, offering alternative medicine on state systems like Britain's National Health Service. To a limited but growing extent this already happens: the NHS runs a couple of homeopathic hospitals, and increasing numbers of family doctors invite aromatherapists, acupuncturists, herbalists and others into their surgeries. Some doctors even administer these treatments themselves.

But for much of CAM—especially techniques in which the placebo effect accounts for most or perhaps all the benefit—integration might well be counterproductive. After all, the value of CAM depends partly on its unorthodoxy. Price talks of a "clash of cultures". Would your free, state-registered crystal therapist, pressed for time and perhaps wearing a uniform just like other paramedical staff, still be able to mobilise as good a placebo response? Ernst, for one, doubts it, and sees this as a powerful argument against integration. "Although there is little evidence to support the view, one intuitively feels that something exotic has a stronger placebo effect than something bog standard. And some complementary therapies are very exotic," he says.

Integration faces other obstacles, too. Doctors would face serious ethical problems in recommending what they know to be placebo treatments to their patients (see "An ethical dilemma"). And complementary practitioners would likely be disparaged by their conventional counterparts, as they often are today. With the growing emphasis on evidence-based medicine, installing a roomful of radionics boxes or setting aside a clinic for dispensing Bach flower remedies would be hard to justify, however much it might please the customers. Integrated medicine "would have about as much validity as a hybrid of astronomy and astrology", Neville Goodman, an anaesthetist in Bristol, wrote in the April newsletter of HealthWatch.

Healthcare managers, too, may view such moves with some alarm. The addition of a whole raft of new and time-consuming treatments could play havoc with already overstretched budgets. In the long term, though, a few CAM techniques might achieve integration. A study of low back pain by Britain's Medical Research Council, for instance, revealed that chiropractic compares favourably with conventional hospital treatment in terms of cost and effectiveness (British Medical Journal, vol 300, p 1431). It's likely that chiropractic treatment provides specific benefits over and above the placebo effect.

Even CAM techniques that do largely depend on their placebo value could achieve the same cost-effectiveness. Indeed, for most of medicine's history, compassion, attention and tender loving care—all big contributors to the placebo effect—were all that doctors had to offer. The advent of science changed that, but in adopting their new role of body technician, doctors have to a great extent dropped the traditional one of healer: the non-specific but still valuable business of caring. Most doctors would now be faintly embarrassed by the suggestion that "healing" might be part of their job description. It sounds a bit pre-scientific. But that's what most CAM practitioners still offer, and they are certainly not embarrassed by the idea.

A professor of surgery with a confident manner, an expensive suit and an international reputation who sees you privately and guarantees to solve your problem with a costly operation may still be unrivalled as a source of placebo power. But most doctors are beaten hands down by countless alternative practitioners who might not know a lymphocyte from a lump of cheese. What they do know is how to make you feel better. And that's a big part of the battle.
Geoff Watts is a medical and science journalist, and author of Pleasing the Patient, a book on the placebo effect. He is also vice-chairman of the group HealthWatch, which argues the case for reliable information about medicine

From issue 2292 of New Scientist magazine, 26 May 2001, page 34

When we used to hold events at different temples, garba, dandiya/ poojas or social gatherings in US cities, I used to wonder why a significant part of the Indian community couldn't identify with or support our petitions. But the reason was a similar lack of awareness and proper knowledge of facts/events that occurred in 1984 and the way things have evolved for the communities since. I have encountered two polarized views so far about the Bhopal disaster. One was while helping man a booth in San Diego for AID last year. An American lady came to us inquiring why we were raising the issue after two decades when everything was resolved – hadn't the company compensated the affected people? We weren't surprised to be asked this question and after sharing the facts and telling her about the present condition of the survivors and the reason for our display of posters, she willingly signed the petition and said she hoped those people would get proper compensation. I was glad that she at least signed, unlike some of our own Indian folks who, even after hearing the details and facts, refused to sign because they strongly believed that Bhopal was a lost cause.

The other incident occurred in Bhopal. I was on my way to the Sambhavna Clinic in a rickshaw and casually asked the driver what he thought of the gas-peedith (victims) people and if anything needed to be done for their benefit. First of all, he didn't want to discuss the issue, stating that it was an old story and there was no point going back to the past. He was more interested in describing different tourist destinations in and around Bhopal and the town's new shopping areas and markets – which is understandable given the evident globalization in most cities/towns of India. He seemed aloof from the Bhopal issue although born and living in that same town. I asked myself, what makes me one of those who are supporting that same cause? I am sure he has his reasons for his opinions and I will find mine.

Reaching the Clinic was not much of a problem except the rickshaw driver was surprised to know that such a hospital existed in the interior of the community as opposed to being on a major road or street. I would say the clinic is a 'state of art' piece of architecture, blends very well with the surrounding locality, smartly chosen colors, beautifully landscaped and cross ventilated structure gives it an airy feel in each and every room and hall of the clinic. The structure details of the clinic can be found at: http://www.bhopal.org/sambhavnaclinic.html

I had never been to Bhopal before and hence never visited the Clinic. So this was my first visit to the city as well as to the Clinic. I had planned to be there from Tuesday through Saturday and return back to Mumbai on Sunday. After being accommodated at the volunteers' residence and discussing with Rachna the possible roles I could play during my stay as part of 'shramdaan', I agreed to attend the clinic with Dr Kaisar, who is the sole allopathic physician and offered to provide my services to the clinic patients. Since I enjoyed spending most time in the clinic, my observations below pertain to the allopathic services provided in the clinic.

· The clinic draws a huge patient population that includes not only disaster survivors but also patients from nearby neighborhoods and distant localities. I encountered an elderly women suffering from malnourishment and asthma, who had come to the clinic riding a bus for an hour one way! Around 150-200 patients are seen everyday who come seeking allopathic, ayurvedic, yoga/ massage therapy, diet, pediatric or gynecological services. A warm and friendly person, Dr Kaisar, the sole allopathic (modern medicine) doctor, sees around 60-80 patients regularly in the span of 5 hours.
· The majority of patients suffer from breathing disorders (asthma, bronchitis, lung tuberculosis, restrictive lung disorders), malnourishment, diabetes, heart disease, hypertension, obesity, alcohol and drug abuse related ailments.
· Cancer is also prevalent, mostly lung, esophagus, uterine and cervical cancers. I was astonished to see an operated case of transverse colon cancer, that's more widely found in Western countries where reduced fibre intake is a common cause unlike in India and that too in an interior community of Bhopal.
· Diabetes is a huge problem and it is clubbed with obesity at Sambhavana Clinic. On a regular day, we saw at least 40-45% of the patients who were diabetic, either on multiple oral medicines or on insulin injections.
· The Clinic opens at 8 in the morning and functions till 3 in the afternoon with one-hour lunch break around noon. There is an evident smooth coordination between the staff workers, clinicians, health workers, interns and patients, which is a striking feature of its work.
· The in-house blood work lab and medicine-dispensing facility reflect the farsighted vision of the Clinic and are an added advantage not only to the patients but also for the treating physicians.
· The majority of the patients are Muslim and the staff members and physicians are well versed with their cultural and traditional mores, which helps the Clinic create good rapport and trust with patients.
· An in house kitchen provides food and breakfast at an economic price both to the Clinic staff and patient, thus saving time in seeking afternoon meals from venturing outside the complex.
· The Clinic provides ample space for patient waiting/ registration in the corridors and lawn.
· Housing alternative therapies like ayurveda, yoga, massage and dietician services provides a 'one step destination' for patients who need to seek multiple referrals to cure their ailments.
· The services are offered at a nominal service based fee structure, which is less than any hospital/clinic around Sambhavna.

I have tried to analyze each disorder as a single entity. My recommendations are based on my observations as stated below:

· Lung Disorders: As there is a huge patient population with lung ailments, most of them requiring steam/steroid inhalation with nebuliser, the Clinic needs an additional two nebulisers to meet the need. One should be solely reserved for pediatric patients. The clinic should also stock ample quantities of breathing masks. Pediatric masks should not be used for adults. Best practice would be to identify those patients who seek nebuliser every week and either ask/ provide them with an individual mask to reduce cross infection with other patients.
· Pulmonary function test/ Lung function tests should be done at affordable intervals to assess the improvement of treatment. Since it's a costly test, some sort of collaboration should be made with nearby investigative labs to get the test done at a discounted rate for Sambhavna patients.
· An in house TB-Tuberculosis Center supported by the Central Health Govt. can be proposed to help subjects with tuberculosis. This can reduce the traveling distance for the patients and also would increase the compliance for treatment. Another suggestion would be to collaborate with the nearby Public Health Centers and make sure the patients referred are followed up for complete duration of therapy.
· Patients suffering from lung ailments seemed to be malnourished, more so protein deficient. Dietician should study the local food and commonly obtained food items and formulate a diet intake focusing on increasing protein intake, keeping the cost and culture in mind.
· Obesity: Obesity is a huge problem nationwide and seems more prevalent in Bhopal. As in India obesity is often seen as a sign of economic prosperity, this link needs to be broken by creating awareness of the diseases related to obesity – namely diabetes, high blood pressure, high cholesterol, breathing problems, knee and joint pains and few organ cancers. Physicians and dieticians should stress the importance of ideal weight, weight loss for obese patients and keeping a strict chart of weight, height and waist measurement at each visit for such obese people. Awareness camps/ lectures at the clinic, building educational materials for dissemination and healthy diet marketing should be stressed upon.
· Alcohol/ Drug Abuse: I was shocked to see a 12 year old male child with end stage liver failure due to alcohol intake and another 8 years old male child consuming some sort of whitener for snorting and his elder brother consuming some "white" powders. Dr Kaisar informed me that drug use was an important yet challenging health problem in kids in some localities. Both alcohol and drug use needs a multi pronged effort and cannot be treated in the Clinics unless the community is made aware and the parents are made responsible and aware to the ill effects of these drugs. Here Sambhavna should take a lead in raising community awareness, making local government take severe steps against those who peddle/supply such drugs to children and youngsters. Alcoholics Anonymous group meetings should be promoted in the Clinic campus to help such alcoholic patients.
· Cancer: I was informed that cancer was equally widely seen among the patient population. Incurable cancer patients or terminally ill patients due to cancer should be provided appropriate palliative care more so focusing on reducing pain at such late stages. The clinic staff and members should be educated to be empathetic and various ways to reduce pain in terminally ill cancer subjects. In house cancer registry should be maintained to help provide details of type, trend and history of various cancer for educational and research purpose.
· Diabetes: The clinic draws a huge diabetic population and I think it's the case with any primary health care in India today, as we are heading to be the world's Diabetes Capital in the next 20 years. In Bhopal, diabetes is more seen in the adult group and its mostly type 2 diabetes, which can be controlled with weight loss, diet and oral medicines. But I saw a large number of diabetics who were poorly controlled and overweight and most of them were post prandial (after intake of food) glucose raised. Some had severe form of vascular and foot disorders related to diabetes. The picture was even more complicated in those with high blood pressure and heart disorders with obesity. I suggest that the Clinic should strictly follow "ABC". A: Hba1c should be done every 2 months or at least 4/5 months to see how tightly the glucose is maintained as it's the most important and valid indicator for blood glucose treatment. Tighter and radical steps should be followed to achieve ideal glucose levels and the same should be stressed to the patients during education or dietary class and more so should come from the treating physician. B: A good measure of blood pressure and treating even mild hypertension in diabetics is good. C: Cholesterol check and medicines to reduce raised cholesterol should be promoted in addition to dietary changes. These three steps should be followed in each and every diabetic. Preventive steps to reduce the risk of complications due to diabetes like yearly eye examinations by fundoscope or eye doctor, annual kidney tests and monthly feet examinations to detect changes in sensation or color of feet should be widely promoted.
· Six monthly or annual diabetic special camps should be conducted by inviting a local eye doctor, kidney specialist and cardiologist as a team to assist the in house physicians. One or two days of the week should be named as "diabetes clinic' so that doctor can give better care and attention to diabetic patients.
· A chart recording details about the onset of diabetes, regular weight and waist measurements, blood sugar levels done on various days, and eye examinations should be carried by the patient during each visit – it could be called "My Sugar Book".
· Diabetes education classes should be held either by the health educator or dietician, in the communities and clinic premises to promote education and awareness of complications due to diabetes. Each diabetic patient should be well informed of his disease and should be equally prepared to handle any emergency state due to low/high blood glucose levels.
· Insulin intake/ injection behavior seems to be widely misunderstood. One lady was delighted to have insulin injections after being educated and taught how to take the injection. She had been flatly refusing to get started on insulin as she thought it was going to be painful and cause her more discomfort and she preferred to continue with oral medicines. But her diabetes was not under control, hence she needed to start on insulin. Friendly and proper training about insulin injections should be given at awareness lectures or meetings.
· Support Groups: I think starting support groups among alcoholics, diabetics, asthmatics and cancer patients should be encouraged to infuse a friendly and healthy behavior among such groups.
· The clinic needs a minor surgical room to attend to cuts, bruises, boils or suturing/ dressings, to carry out the physicians' wishes.
· The Clinic is well designed to handle and accommodate volunteers. Volunteers should document interesting cases, form patient charts, and maintain blood sugar/ pressure measurements, height and weight charts and data collection and data input. Attention should be given to take pictures of such interesting cases and archive them in the library for future reference including the therapy.
· I would recommend that the Clinic should try to present their case series, patient data on prevalence of diabetes, problems of residing closer to the Union Carbide factory and similar health outcomes at national/ international meets and medical conferences, write articles and scientific papers to similar journals. This would propel the Clinic and the cause behind it to a wider and different group.

The above recommendations might not seem essential to the Clinic organizers, hence it's totally up to their discretion. I also understand that to implement some of the above recommendations, funds and hiring additional manpower has to be met. But once the above steps are implemented, Sambhavna Clinic would proudly emerge as an 'Ideal Primary health Care Clinic' giving excellent standard of care treatment for chronic disorders like diabetes, hypertension and lung disorders.

I couldn't have completed this visit report without describing my time spent in the company of AID JeevanSaathi, Rachna Dhingra.


Rachna Dhingra:

An individual with immense energy to fight for the rights of the marginalized sections of the community, that includes the Bhopal disaster survivors. She is a dedicated, hard working and never compromising female who is not only supporting the cause but living among the survivors communities. AIDers who have been supporting the Bhopal campaign are very well aware that she was working for Dow Chemicals in US after graduating from Univ. of Michigan and now she is currently self-employed whole heartedly towards the cause. She has definitely set a fine example of sacrifice and selfless service towards a cause that she feels her contribution is worth and without which, she would might not be happy. The few days that I was at Sambhavna, I failed to see a single day where she wasn't actively involved at any second of the time. She was either busy making sure the clinic was running as per the protocol, supervising & cooking for breakfast and lunch in the kitchen, responding to her emails, drafting letters, writing press releases or coordinating with local supporters and guiding the next possible step. I don't feel we would have accomplished to find any other person who would have been so honest and dedicated in supporting Bhopal campaign as Rachna. She has been instrumental in conducting AID wide awareness for Bhopal campaign, coordinating with 'Students for Bhopal' to polarize students from various universities globally, going on indefinite hunger strikes since last two years, walking on feet from Bhopal to Delhi and has also been jailed for her never failing conviction. I would agree with Ravi, co-founder of AID, who has rightly described her as "beacon of AID", in one of his email communications. We, the AID family, are proud having Rachna Dingra as one of our JeevanSaathis and it is apt to honor her as the 'keynote speaker' at the upcoming AID-US conference.

I was inundated with incidents and stories of Mr. Sathyu Sarangi, the force behind the development of Sambhavna, who was traveling overseas during my visit, but plan to meet up with him during my upcoming future visit to Bhopal.

Biswanath Gouda MD, MPH. Born in India, educated in Nair Hospital (Mumbai), graduated majoring in Clinical Epidemiology from Tulane University ( New Orleans, US) and recently completed fellowship in advanced laparoscopic surgery from Scripps Clinic ( San Diego, US). He has been an active AID volunteer since 2004 and was instrumental in starting AID-New Orleans Chapter. He also serves on the Executive Board and is the current Co-Chair on South Asian Public Health Association (SAPHA), a South Asian health advocacy group based in US.

Visitors to the exhibition are greeted by a painting done by students.

Specimins of viscera brought by Dr Sathpathy, who performed the greatest number of autopsies on those who perished in the 1984 disaster.

Dr Sathpathy explains to an attentive crowd what they are looking at, specimins which show how Union Carbide's methyl-isocyanate and other toxic gases affected people.

Dr Sathpathy delivers his powerpoint presentation.

A foetus with meningocele. Impaired infants, often born dead, were known in the months after the disaster as "gas births".

Foetus with head abnormality. 50% of the women who were pregnant on "that night" spontaneously aborted, but in the months that followed the city saw an epidemic of "horrific births".

His talk done, Dr Sathpathy views the other items in the exhibition.

Sambhavna's Aziza Sultan talks about her work to a visitor.

People crowding in to see the exhibits.

Exhibition organisers, from l, Biju, Masarrat, Sabah, Amita and Ritesh, all of the Sambhavna Trust Clinic.

The Sambhavna Trust Clinic that provides free medical care to the people poisoned by Union Carbide in Bhopal will be holding a 4-day exhibition at the Swaraj Bhavan on the occasion of the 22nd anniversary of the worst industrial disaster in the world.

The exhibition will be inaugurated by Dr D K Satpathy, Director, Medico Legal Institute at 5 PM tomorrow and will continue till December 3rd the day of the anniversary. Specially aimed at children and those born after the disaster the exhibition presents photographs, documents and other artifacts in simple language. An on the spot painting competition will be held for school students in three categories on all days.

Dr Satpathy who carried out the largest number of autopsies following the disaster on December 3, 1984 will be speaking on the contributions of forensic science in apprehending those responsible for the disaster. Journalist Mr Rajkumar Keshwani who had forewarned about and campaigned against the hazards of the Union Carbide factory will be speaking at the exhibition venue on December 2. Former operator of MIC plant in the factory and author of a book on the technical causes of the disaster Mr T R Chouhan will answer questions on the evening of December 1.

The Sambhavna Trust Clinic completed 10 years of its work this year. Nearly 18000 (17, 980) people are registered for long term care at the clinic through Allopathic, Ayurveda, Panchakarma and Yoga systems of healing. This year till November 6608 people poisoned by Union Carbide [4524 female, 2084 male] visited the clinic.

The members of the Sambhavna Trust Clinic said that this year they have started several new works in the face of adversity and loss due to the floods in the city in mid August. Facilities for eye care, large scale production of herbal medicines, microbiological tests in the pathology laboratory have been added to the clinic this year despite heavy financial losses due to damage to the walls and the herbal garden in the clinic. In addition several medicinal plant gardens were created in the affected communities.

The members stated that proper medical care that includes healing through Ayurvedic, Unani and Yoga systems of medicine, Clinics in every affected community, Gainful employment, Pensions, Safe drinking water, Clean up of contaminated soil and ground water, Medical research, Health education and Health surveillance are critically needed for the improvement of health of the people poisoned by Union Carbide.

Satinath Sarangi
Amita Gupta
Masarrat Jehan
Ritesh Kumar Pal

UPDATE DECEMBER 1, 2006

Sambhavna Trust exhibition on the Bhopal gas disaster draws the crowds

Sambhavna Trust Clinic
Bafna Colony, Berasia Road, Bhopal
Tel : 2730914 / 2743157,
Email : sambavna@sancharnet.in, Web : www.bhopal.org

Date : December 1, 2006

FOR IMMEDIATE RELEASE

Students from DAV School, Seven Hills School, Elite Higher Secondary School and Oriya Basti non-formal school today visited the exhibition organized on the 22nd Anniversary of the Union Carbide disaster in Bhopal by Sambhavna Trust was visited by school children from.

Mr T R Chouhan, former plant operator in the Union Carbide factory in Bhopal made a power point presentation on the technical and managerial aspects of the disaster and the contamination of soil and ground water in and around the now abandoned factory. Mr Chouhan is also the author of the popular book “Bhopal: The inside story” on the scientific causes of the disaster.

Mr Chouhan held the American senior management of the multinational he once worked for, guilty of deliberate neglect. He pointed out the design differences between the corporation’s MIC plant in West Virginia and the Bhopal MIC plant and said that unsafe conditions were created in Bhopal due to the top management’s policies that led to reduction in number and training period of staff.

He said that one of the big reasons for the poor operational safety and maintenance of the plant in the months preceding the disaster was that the top management had decided to dismantle the plant and sell it off to buyers in Indonesia or Brazil.

Mr Chouhan informed the listeners that the formulation of Sevin carbaryl, the product of the Union Carbide Bhopal’s factory, is continuing in India including in Bhopal.

He said that he has informed various government agencies about the poisoning of the ground water and soil due to the dumping of thousands of tons of toxic waste in and around the factory but no effective steps have been taken so far.

On 2nd December, members of Sambhavna Trust Clinic will hold a candle light vigil and a slideshow at Top–n-town, New Market at 6:00 pm


Satinath Sarangi
Managing Trustee

Meanwhile a group run by Muslims has been distributing biryani [rice cooked with meat] which Hindus won't eat. This state of affairs began on the first day.

On the afternoon of the 14th residents of Rajgarh [a mixed community of Muslims and Hindus] organised a chakka jaam [blocking traffic] demanding medical care and monetary relief from the government.

A van carrying people from Seva Bharati attempted to cross the blockade and there was an altercation with the leader of the protesters who is himself a low caste Hindu.

The Seva Bharati people went back and roused their followers. About 1,000 of them came to Rajgarh Colony threatening violence. More than 100 were carrying swords. A large police force was present but they did nothing to stop those who were brandishing swords.

The tension diffused by early evening after the RSS followers were assured that police would take action against those who had stopped the Seva Bharati van. Since then about 15 residents of Rajgarh Colony, most of them Muslims, and their Hindu leader, have been arrested. Their families allege that some have been tortured in police custody. There is little doubt among the ordinary people that the arrests and torture have been ordered by higher-ups in the government that is run by the BJP hindu fundamentalist party.

Our teams came back around 4 pm and reported talking to about a hundred families who hadn't eaten for two days. Many of their houses were completely submerged and all were among the very poorest residents.

At 5 pm we decided to pool our resouces. The first donation of 500 rupees came from Faisal, the local BBC correspondent. Sathyu put in another 500 and Shahid said he would raise the rest from people in his neighbourhood.

Shahid's neighbours, who are all people with limited means, gave whatever they could. Mehra who runs a small store gave 25 kilos of wheat flour [aattaa]. Raju Bhai who runs a provision store gave another 25 kilos. Kaka who has a small store gave 5 kilos of oil. Maliram who runs the store next to Kaka's gave 10 kilos of aataa.

Saleem Bhai, Ram Singh and Sharad each donated 50 rupees. Shahid's aunt Akhtar Bee went out and bought 400 rupees worth of vegetables.

A Mr Gupta, who owns a roadside restaurant, donated his stove for the evening. Pappu Verma who has a "tent house" [he rents out marquees, chairs and utensils for weddings and parties] gave his cooking vessels for free.

Cooking began in front of the offices of the survivors organisations at around 8 pm and before midnight there was potato curry and puris [deep fried bread] for 600 people.

The cooking was done by two professional cooks who gladly donated their time and skills.

Firdaus, Aftab Bee, Guddu Bhai, Afsar, Verma, Chetan, Mehfuz, Raja, Satish, David, Parvati, Narayan Sarathe – Hindus, Muslims and a Christian - all helped together in chopping and washing and packing the food into individual packets.

The food was carried on a three wheeler "loading auto" free of charge by Kailash. Leaders of survivors organizations Hazra Bee, Syed M Irfan, Mira, Shahid Noor and supporter Vikas worked hard and with the help of local young men and women distributed the packets of puris and aloo curry to the hungry people.

Lalita Bai told her story to Aziza:

At around 4 early morning water came over the boundary wall of the factory gushing towards our houses. In no time there was five feet water inside our home. One of my neighbours carried me on his shoulder up onto his roof. Others in my family were also helped by neighbours.

65 year old Biniya Bai, Raj Bai and Pradip Singh Tomar [42] risked their lives helping people out of the water. My three-month-old granddaughter Poonam fell in to the water and was saved by our neighbours. They wrapped her in a blanket and put her in a dry place.

All our food grain is wet and wasted.

Laxmi told her story to Ritesh:

I had made daal and roti [bread] for dinner like every other day. We went to bed at around 10 PM. We did not know that some thing like
this could happen. My husband was the first to get up early next morning at around 4 AM. By then water had already risen to 3 feet inside the house. He woke all of us up.

We saw that water was flowing over the boundary wall of Union Carbide factory and coming towards our houses. we went up on the roof
of our neighbour. we saw large snakes coming out of cracks in the wall.

The water kept rising in the house. All our bedding and what ever grains we had - about two quintals - were submerged and wasted for ever. We have lost about ten thousand rupees.

We have not stopped itching all over our bodies ever since we
waded through the water. We also have eye infections, fever and colds. Many people in the basti have similar complaints and everyone has eye problems.

Grain drying in Shakti Nagar. The grain had been inundated with water flowing from the flooded Union Carbide factory. Unable to afford to lose their small stores, desperate people washed the grain with water from taps to try to save it.

Three teams from the Sambhavna Trust Clinic today went out to deliver medical relief to different areas. Each team took with them water purifying tablets, medicines and health education pamphlets.

Observations from Shakti Nagar and Atal-Ayub Nagar

Aziza, Masarrat, Ritesh and Biju went to Shakti Nagar and Atal-Ayub Nagar.

They found people suffering from loose motions, vomiting, fever, body ache, and skin rashes and eruptions. The skin problems affect the parts of people's bodies that were under water. Most adults have skin eruptions on the lower half of their bodies, below the waist, for many children they reached to their necks.

In Shakti Nagar 35 houses next to the boundary wall of the Union Carbide factory were submerged and damaged. In Atal-Ayub Nagar there were 100 such houses. Government officials have distributed water puriying tablets here. Everyone had a story to tell about people helping each other and saving lives. Krishna Tomar [55], Pushpa Rathore [35] and Radha Bai [45] helped the team in distributing medicines and other stuff.

Observations from Shaaheen Colony and Sundar Nagar

Tasneem, Anand, Jyoti and Brian went to Sundar Nagar and Shaaheen Colony.

The team placed themselves in 5 different spots in these bastis and, with active help from local teenage boys, distributed medicines, pamphlets, water purifying tablets and medical advice. Officials had done a cursory survey but left out quite a few houses. No medicines had been distributed by government officials. People complain of itching, cold, hoarseness of voice, chest pain and body ache.

Observations from Oriya Basti and Shankar Nagar

Mukesh, Shehanaz, Tabassum, S M Nasir and Adriane went to Oriya Basti and Shankar Nagar.

Here our team found three people from Jawaharlal Nehru Hospital distributing medicines. They were handing out, quite inappropriately, strong antibiotics for children in the form of amoxycillin and metronidazole suspensions, and potentially harmful pain killers such as sodium diclofenac. The main complaints being reported are itching and skin eruptions, fever, loose motions and abdominal pain. Whatever foodgrain people had in their homes is now wasted. People want food here and clothes becaue all they had is wet.

Donations of medicine

Mr Lalit Jain donated a box of medicines, Dr Goswani donated 5000 water purifying tablets each tablet good for 20 litres of water. Tomorrow our teams will visit the bastis that are most in need of medical care and other assistance.

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.

MORE PICTURES AND STORIES BELOW.

Sambhavna health workers distribute Ayurvedic medicines in Shakti Nagar.

Laxmi talking to Ritesh.

Grain drying in Shakti Nagar. The grain had been inundated with water flowing from the flooded Union Carbide factory. Unable to afford to lose their small stores, desperate people washed the grain with water from taps to try to save it.

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.

Ritesh distributing oral rehydration salts

Aziza distributing medicine

Masarrat handing out health advisory pamphlets written and printed by Sambhavna the day before

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.

Today, I saw where all of that water and flotsam ended up – in the ironically-named neighborhood of Sunder Nagar. The name roughly means "beautiful place." There is nothing beautiful about the pools of stagnant water and mud throughout the neighborhood today. Sambhavna staff and volunteers took action today after conducting a survey of flood-affected neighborhoods this week. The water washed away the homes, food supplies, and household belongings of people already suffering the after-effects of exposure to Union Carbide's methylisocyanate gas in 1984 and decades of neglect in the communities they have built themselves with the scarce resources and materials available to them. In the meantime, the flood delivered water-borne and mosquito-borne diseases to the doorsteps of the residents of Sunder Nagar.

I was privileged to accompany the Sambhavna staff on their visit to Sunder Nagar today to distribute free medications to the residents there suffering from those diseases. As soon as we arrived, word spread of the arrival of help and residents flocked to the distribution point. The staff members, Tasneem and Jyoti, carefully recorded the names and symptoms of each person they spoke with as well as the medications distributed. Meanwhile, Anand went door-to-door to distribute a 4-day supply of water purifyng tablets to the householders.

I recorded the scene of terrible adversity that the already-afflicted people of Sunder Nagar face in the wake of the flood. Several people I spoke with said that no local officials had yet surveyed their houses for damages, let alone distribute assistance. When I asked one man who has helped them, he responded, "Only Allah." The flood deposited a thick layer of mud and garbage throughout the neighborhood, including the interior of the houses. Those homes nearest the small creek that runs alongside the neighborhood suffered the most damage. Many of these homes consist of one solid room of brick and concrete and adjoining rooms built of whatever material is available.

In this neighborhood, the available building material appeared to be two-foot square metal vents, wooden poles, and blue plastic sheeting. Those makeshift rooms were mostly washed away.

The man in one photograph wearing a turban told me how his chickens literally flew the coop to escape the floodwaters.

The chickens were his livelihood as he planned to sell them in the market. Other people lost goats. In many houses, I saw grains drying on the ground that had been spoiled by the waters.

As I stood surveying the muck that the residents must wade through just to reach their front doors, I realized that there were indeed some things about Sunder Nagar that remain beautiful. The rains did not wash away Bhopali hospitality. One man whose meager existence was made worse by the flood invited me repeatedly inside for some tea. In many houses where I was invited to take pictures, people offered me water to drink. In many of the pictures that I took, I found people smiling amid the devastation in the photographs, as happy as ever to greet a foreign visitor.

Most compelling, however, were the young men who quickly came over to us when we arrived. At first, like many idle young men, they engaged in typical male joking and posturing for the attention of my camera. After a short while, though, they had assumed responsibilities for helping Anand on his door-to-door delivery of water purifying tablets and one-page sheets of health information. Soon, they were also helping to carry the bags of medications for us and leading us safely through nearly impassable alleys filled with muck and sludge. After having joked with me at the start, one young man told me a few times that he hoped he wasn't being a bother to me. At the end of the afternoon, they came back to Sambhavna Clinic where they joined our meeting in order to learn more about volunteering for the Clinic in their own neighborhood.

Treated with dignity and realizing the opportunity to do something meaningful for their community, they were rapidly transformed into health education volunteers under Anand's guidance.

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.

Health Education

We have produced 5000 pamphlets on simple preventive measures [drink boiled or disinfected water, wash hands with soap before eating, put small amounts of kerosene or burnt engine oil on stagnant pools in your neighbourhood].

Symptoms and first contact treatments [including herbal, we are recommending 'bhuiamla for treating hepatitis and turmeric and oil for skin diseases and home remedies such as lime water for loose motions] for malaria, hepatitis, typhoid, loose motions, vomiting and skin diseases. This will be distributed by about 10 people from sambhavna. More will be printed tomorrow.

Medicines

We have made a list of medicines that will be immediately required including quantities in which we need:

1. Paracetamol 500 mg 20, 000 Tabs for fever and aches
2. Chlorpheniramine Maleate 4 mg 10, 000 Tabs for cold, itching, cough and other symptoms of allergy
3. Oral Rehydration Salts 20, 000 packets for loose motion, vomiting, causing dehydration.
4. Marichadi Taila 10 litres for Ayurvedic prepared in the clinic skin diseases
5. Khadiradi Vati 10 Ayurvedic purchased kilogram for cough and cold
6. Sarjaras ointment 500 tins Ayurvedic prepared in the clinic for wounds and ulcers

We have purchased these medicines [except #4 and #6 which we produce ourselves] and have thankfully received 3,000 tablets of paracetamol, 3,000 tablets chlorphniramine maleate and 300 packets of Oral rehydration salts from Mr Atul Patel a long term supporter of Sambhavna. We have not been able to get a supply of water purifying tablets and are expecting a large supply of them from Mr Patel's contacts tomorrow morning.

Saturday plans

Tomorrow at noon 4 or 5 groups of Sambhavna staff with other volunteers will move with the pamphlets, medicines, water purifier tablets, cameras, and note books and pencils.

In several of the bastis they visited today they have already formed peoples' health committees. in these places the administration of medicines will be done by health committees.

In the others it will be done along with people in the bastis who haven't formed a committee yet but are known to the health workers well and who are personally interested in helping others. Information [extent of damage done, spread of toxic water, illnesses, peoples' needs, other initiatives to help those in distress etc] will also be gathered by the Sambhavna members and volunteers as well as photo documentation.

Local Support

The Private Medical Practitioners Association of Bhopal [PMPA] has offered to provide free consultation to individuals who are referred by us. Individuals needing urgent medical attention can be identified by people in the local health committee and be referred to doctors who are members of the PMPA.

We expect to include a small group of volunteer lab technicians who will visit the bastis and prepare blood slides for testing malaria and collect stool specimens for stomach infections and assess the pathology test requirements of the population.

Media Work

We will distribute an account of our findings and work to the media tomorrow and make an appeal for support from individuals and organisations.

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.

Flood water entered thousands of houses. Everything people had is wet and because the sun hasn’t come out since then except very briefly nothing is dry.

1. Well over 1500 families were submerged by contaminated water from the Union Carbide factory and the Solar Evaporation ponds/landfill.

2. Thousands of children are suffering from fever, loose motions and cough and cold.

3. Government officials have left out large populations affected by the flood during their survey.

4. Everywhere people have requested medicines and medicare.

5. Purification of water is one of the most important relief activities.

1. Shakti Nagar

Location: Right next to Union Carbide factory to the east.

Water came in from Union Carbide factory entered up to 4 feet [and some places more than that] in approx 125 houses. Because of bursting of water pipes they have been getting dirty drinking water. People have not received any help from the government officials. After intervention by Sambhavna community health workers, chlorine tablets [for water purification] were distributed today.

Main medical complaints: Cold, cough, fever, eye infections, abdominal pain, loose motions.

2. Atal-Ayub Nagar

Location: Adjacent to Union Carbide factory to the east and north.

Water came in from Union Carbide factory. Up to 250 houses had up to 5 feet water inside. People have received chlorine tablets and food packets. Some water was supplied through water tankers.

Main medical complaints: Fever, fever with chills, body ache.

3. Shivshakti Nagar & Preet Nagar

Location: Next to the Solar Evaporation landfill to the north.

Water came in from the Solar Evaporation pond. Water entered 4 houses. Have received no help. Water tanker came yesterday after a gap of 3 days.

Main medical complaints: No complaints related to flood.

4. Shiv Nagar

Location: 3 kilometer north of Union Carbide factory.

350 houses had more than 5 feet water that came in from the Solar Evaporation pond and landfill. Water has not receded 3 days after the flood.

Main medical complaints: Cold, cough, skin problems, fever, fever with chills.

5. Rajgarh Colony

Location: 1 kilometer south east of Union Carbide factory next to railway track.

500 families affected. Water entered houses 3 to 5 feet. People have lost food grains. People have received chlorine tablets. Government officials have carried out survey for damages due to floods.

Main medical complaints: Fever, loose motions, vomiting, cough and cold, skin diseases.

6. Dwarka Nagar

Location: East of Rajgarh Colony on the other side of railway track.

600 to 700 houses had 4 to 10 feet water. 30 houses were completely submerged. People have lost food grains. Cattle have died. Government officials have carried out survey but the most badly affected remain to be surveyed.

Main medical complaints: Cold, cough, fever, loose motions, skin diseases, vomiting.

7. Congress Nagar

Location: 1.5 kilometer south west of Union Carbide factory

1000 to 1100 houses had 5 to 8 feet water. 30 houses were completely submerged. Government officials have carried out survey but the most badly affected remain to be surveyed.

Main medical complaints: Fever, loose motions, vomiting, skin diseases, pain in limbs.

8. Teela Jamalpura

Location: 2 kilometers south west of Union Carbide factory

800 to 900 houses have been affected. About 25 houses next to the nullah completely submerged. Several houses have got cracks. People are getting very dirty water through their taps. Chlorine tablets have not been distributed. Survey has been carried out.

Main medical complaints: Cold, cough, fever, loose motions, skin diseases, vomiting.

9. PGBT College area

1200 houses affected by water flooding in from nullah. Houses had 5 to 8.5 feet water. People have not received any help from government. Lot of garbage piled up.

Main medical complaints: Cold, cough, fever.

10. Shankar Nagar

Location: 1 kilometer north east of the Union Carbide factory

170 of 300 houses had 4 to 5 feet water. Water has not receded even now. People lost food grains. Many walls have collapsed. One woman delivered her child in the autorickshaw that was taking her to the hospital. The child died. 25 mud houses collapsed. Non government organizations distributed food on two days.

Main medical complaints: Cold, cough, fever, fever with chills, loose motions, skin diseases, chest pain.

11. Oriya Basti

Location: 1.5 kilometers north east of Union Carbide factory.

25 of the 136 houses have collapsed. Water had entered many houses and receded only after people broke the wall of the office of the Department of Telecommunications. Baby died after delivery. People have got chlorine tablets. Garbage piled every where. Non government organisations distributed food on two days.

Main medical complaints: Cold, cough, fever, fever with chills, loose motions, pain in limbs.

12. Kalyan Nagar

Location: 2 kilometers north of Union Carbide factory

600 houses affected. Houses had up to 4 feet water. 20 cement and 8 mud houses have collapsed. 8 buffaloes were carried away. Many people lost their belongings. People are drinking water from tube wells that is contaminated. No government help has reached here. People complain of severe infestation of mosquitoes.

Main medical complaints: Cold, cough, fever, fever with chills, skin diseases.

13. Shaaheen Colony

Location: East of Sambhavna Trust Clinic

All 72 houses submerged completely. Several houses still have water. People have received chlorine tablets. many children are sick.

Main medical complaints: Cold, cough, fever, loose motions, skin diseases, abdominal pain.

14. Sundar Nagar

Location: East of Sambhavna Trust Clinic

70 houses submerged. People have nowhere to stay. Walls of houses are cracked. Government officials have surveyed for flood related damage and distributed food packets.

Main medical complaints: Cold, cough, fever, fever with chills, loose motions, skin diseases.

Survey carried out by : Masarrat Jehan, Aziza Sultan, Ritesh Kumar Pal, Biju Kumar, Tabassum Ara, Shehanaz Khan, S M Nasir, Tasneem Zaidi, Anand Verma

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.

1. Appeal to doctor's bodies (Private Medical Practitioners Association, Junior Doctors Association, BMHRC doctors) for medical volunteers to go to the clinic and work in health camps

2. Appeal to paramedical college students to volunteer to take samples of blood and prepare slides.

3. Common illnesses expected: malaria (complicated by many cases of chloroquine resistant malaria), diarrhoea/vomiting, jaundice, skin diseases, typhoid. also expected leptospirosis which is spreading in surat and other places that have recently been flooded.

4. Causes for the flood : unusually heavy rain, unregulated construction choking drainage channels, use of polythene carrier bags caused drains to clog, global warming/climate change.

5. Sambhavna's community health workers will complete a survey of more than 20 bastis by tomorrow, recording:
- approximate numbers affected in each basti
- the impact of the flood
- facilities, if any, provided by the government
- common symptoms among people
- main needs.

6. Explore possibilities of donating water purifying tablets and medicines.

7. Provide health education (a pamphlet is already being written) on common illnesses caused by flooding.

8. Bastis on which we will focus:
Shiv Nagar, Shivshakti Nagar, Preet Nagar, Oriya Basti, Kalyan Nagar, Shankar Nagar, Atal-Ayub Nagar, Gareeb Nagar, Teela Jamalpura, Dwarka Nagar, Kainchi Chhola, Congress Nagar, PGBT College, Sundar Nagar, Shaheen Colony, Rajgarh Colony, Ibrahimganj, Labour Colony.

Making a donation to help the flood relief work

Donations can be made online to the Bhopal Medical Appeal, which funds the work of the Sambhavna Trust Clinic, by clicking here now.

Please note, the Bhopal Medical Appeal is a project of the Pesticide Action Network, UK, and so the receipt on your credit card statement will say PESTICIDE ACTION NETWORK.