HAS THE GOVERNMENT DONE ENOUGH FOR THE FAMILIES OF THE VICTIMS OF 26/11 ?

A nation of 1 billion plus people was in mourning a year back, on the fateful day of 26/11. Kasab, an islamic fanatic along with a group of nine other heavily armed gunmen laid seize of Mumbai, resulting in the death of 166 innocent citizens with grave injuries to another 311. The Mumbai police, the NSG, backed by the sentiments of a whole nation fought back with antique weaponry, endangering their own lives. The battle was won but at a terrible cost.

In a spate of empathy, there were announcements regarding compensations to the family members of the deceased and those who have been injured on that fatal day. Our government promised compensations of upto Rs 3 lakhs for persons who have died or were greviously injured, from the Prime Minister’s Relief Fund. The maharashtra government made announcements of Rs 5 lakhs for death and from Rs 10,000 to Rs 1 lakh for the injured. The Railway Claims Tribunal made announcements of Rs 10 lakhs for the deceased and upto Rs 1 lakh for the injured. The Tata Trust made commitments of Rs 5000 per month for a period of one year for the families of the injured and the deceased. Apart from the compensation packages announced by the maharashtra government and the railway ministry, the victims of Chatrapati Shivaji Terminus were also entitled to compensations from Prime Minister’s Relief Fund, The Ministry of Home Affairs and the Railway Claims Tribunal. All these compensation packages announced by the central and state governments, rail ministry and the Tata Trust, were a ray of hope for the affected families.

Today, after a year have passed, if we try and assess the efficacy of the rehabilitation packages, we will be ashamed to know that as per the version of Maharashtra Relief and Rehabilitation Dept out of the 403 people entitled to compensation from the Prime Minister’s Relief Fund only 118 have received the same with 206 cases still pending with the PMO’s. The cases of the remaining 79 victims are yet to be forwarded by the maharashtra govt. The rule clearly states that a state proposal for compensation is mandatory for disbursal of money. Compensation package to be provided by the ministry of home affairs, also has a backlog of 161 cases, to whom money is yet to be disbursed.

And how have the many families fared who have received compensation from the Prime Minister’s Relief Fund ? Many of them have not received the money even after deposition of the cheque in their accounts and some families have been sent outdated cheques, that have lost its validity !

A FEVER PREFERABLY DIAGNOSED AS MALARIA

HOW THE SLIDE DETECTION CENTER AT 12/1 MEHER ALI LANE BUSTEE FARED !

DATE /SLIDES COLLECTED/P VIVAX/P FALCI

21.11.09/33/02/NIL

22.11.09 SUNDAY - CENTER CLOSED

23.11.09/18/03/NIL

24.11.09/01/01/NIL

25.11.09/05/05/NIL

26.11.09/NIL/NIL/NIL

27.11.09/01/REPORT PENDING

28.11.09 CENTER CLOSED

THE JAPANESE ENCEPHALITIS QUIZ

DAY 3

AN EPIDEMIOLOGICAL AND ENTOMOLOGICAL INVESTIGATION IN PROGRESS

TO ESTABLISH THE CAUSE OF DEATHS IN TWO CASES WHERE SYMPTOMS OF FEVER, HEADACHE, CONVULSIONS AND VOMITING WERE PRESENT

Findings :

a. All animals and birds responsibe for harboring the virus are located in the area

b. culex larvae are found in the circular canal

Actions Taken : NIL

Actions that should have been taken ?

a. JE serological tests of blood from animal and bird sources

b. JE serological tests of blood from suspected as well as nonfebrile human cases

c. Clearing of the waterways of debris, depositions and water hyacynths, thereby ensuring free flow of water

d. providing protective netting along the banks to prevent garbage disposal in the waterways

e. If possible, cementing either banks with steps leading to the water level

f. Anti-larval spray throughout the length of the canal, using a water vehicle at intervals of 14 days

g. Release of guppy/gambusia fish in the waterways

h. For surface drains - desilting, release of larvivorous fish, anti-larval spray at 14 days interval

ACTIONS TAKEN BY THE KMC HEALTH AUTHORITY AT 12/1 MEHER ALI LANE

The actions taken by KMC health authority at 12/1 Meher Ali Lane bustee, till 22.11.09, keeping in mind the public sentiment and rationality of investigating such fever deaths, are detailed below.

1. A vector team was immediately deployed in the area to carry out anti-larval spraying on 20.11.09, 21.11.09 and 22.11.09. Plenty of breeding spots were located in domestic containers and peri-domestic water collections. We involved the local population in our efforts to do anti-larval work in the locality and showed them the containers, receptacles and masonry tanks containing breeding. The local representatives agreed to take immediate remedial measures on their own initiative, but their point of contention remained the acute shortage of water, thereby forcing them to store water in containers that become future breeding places. We have also been successful in discussing with them the issue of resistance met by our field workers in trying to empty such containers, during the course of their regular work.

2. Deployment of a team of fourteen hon health workers for a house to house survey of fever cases for the consequetive two days of 20.11.09 and 21.11.09. A total of 723 households have been surveyed covering approximately 3000 population of the affected area. The number fever cases recorded till 21.11.09 being only 27 (twenty seven) and not in the range of hundreds as stated by the visual media, which is a very rational occurence and does not indicate any grave concern of epidemic proportions.

3. A fever slide collection center has also been opened at Pragati Sangha, a local club at 12/1 Meher Ali Lane, for the benefit of the local populace. The center that has started functioning on 21.11.09 will also function on 23.11.09 and 24.11.09. The fever blood slides collected at this center will be examined at the Ward Health Unit 57 and appropriate medications will be provided to the febrile cases as required.

4. A team of doctors from ID Hospital have visited the affected area on 21.11.09 around 3 pm and have collected 10 (ten) specimens of blood for serological testing from febrile patients of the bustee. The results of these tests will be made available to us by 24.11.09.

5. Though the area has already been visited by the vector control officer of KMC on 21.11.09, an entomologist will visit the area on 23.11.09 as a follow up action, to conduct his relevant investigations to rule out the incidence of japanese encephalitis as a probable cause of the deaths. The presence of the relevant vector culex vishui needs to be proved, to corroborate deaths due to the disease, japanese encephalitis.

6. Lastly the absence of serological test reports of the two death cases, questions the rationale of putting encephalitis/meningoencephalitis as the cause of deaths in the two cases under scrutiny.

LESSON OF THE DAY : Are we on the right track ? If we are talking of a fever with headache, convulsions and vomiting, then probably we are not talking of malaria even dengue or chikengunia.......thus we are more concerned about the occurence of a zoonotic disease, also viral in origin, japanese encephalitis. If that is so, we should concentrate our efforts exclusively in locating the carriers and amplifiers of this virus and the mosquitoes in its larval stages that are responsible for the spread of the disease. Anti-larval spraying as done above may only be a complimentary action and not the sole vector control activity. The real vector control activity lies elsewhere, in the breeding places of culex vishnui or culex tritaeniorhynchus. So we should search for larvae of the culex mosquito in the two canals that runs on either sides of this bustee and also the surface drains of the locality, even open septic tanks instead of the domestic and peri-domestic water collections. Thus we have not addressed the real cause even on the second day !

TWO DEATHS AT 12/1 MEHER ALI LANE BUSTEE, WARD 57

Two young people have died very recently at 12/1 Meher Ali Lane bustee in ward 57.

Mustari Khatoon, daughter of Mhd Rashid, aged about 15 years, was taken to the ID Hospital with fever on the morning of 18.11.09. Mustari was refused admission by the hospital authorities then, but was eventually admitted there at 3.25 pm, in the late afternoon hours with the symptoms of fever, headache, convulsions and vomiting. Mustari expired on the same date at 9.30 pm and the cause of death was recorded in the death certificate as meningoencephalitis.

Sarique Mohammad, son of Shah Mohammad, also a promising young boy of 16 years of age, was admitted to ID Hospital on 5.11.09 at 10.10 am with similar symptoms but he expired on 6.1109 at 10.20 am. The cause of death mentioned in his death certficate was cardiorespiratory failure in a case of encephalitis.

A state hospital of repute has given the cause of deaths as encephalitis/meningoencephalitis in these two cases. This no doubt has to be a clinical diagnosis as Mustari was admitted to the hospital for only 6 hours and Sarique for about 24 hours. I have spoken with representative doctors from ID Hospital about corroborative investigations regarding such claims and have been informed about the absence of crucial investigations of CT / MRI scan of brain or lumbar puncture, required to diagnose such cases. Still talks about a brain fever affecting a sizable section of the local populace has been circulated, leading to an atmosphere of fear, apprehension and anger among them!

Again as the most common cause of encephalitis is viral in origin, there may be the natural inquisitiveness, whether these deaths are at all linked to the dreaded Japanese Encephalitis. We also have information that besides being an area of great uncleanliness, a good proportion of the population are involved in rearing pigs and culling cows and buffaloes. So the rumour may try and attribute these two deaths as caused by the japanese encephalitis virus. As far as my knowledge of public health goes, JE is a zoonotic disease, infecting mainly animals and only incidental in man who is a dead-end host, the disease being primarily limited to the cycle of pigs, cattle, buffaloes - mosquito - pigs, cattle, buffaloes or certain birds/poultry - mosquito - birds/poultry of which pigs are the most important amplifiers, and the culex vishnui complex of mosquitoes responsible for the propagation of the disease is absent in the city of kolkata ( as informed by Dr Debasish Biswas, vector control officer KMC).

Both these deaths have been greatly highlighted by the media as "AJANA JAR" that has affected about 100-150 people and is also on the rise on a daily basis. It has also been reported that the civic services particularly of solid waste disposal being almost absent in the area, is an important responsible factor in such untimely deaths of two young people. True the whole bustee at 12/1 Meher Ali Lane has not been serviced by the solid waste disposal department for a considerable span of time, thereby leading to the accumulation of garbage and plastic materials and containers in huge quantities, leading to a situation hazardous to health. There is truly an urgent necessity to remove these at the earliest, but the question remains whether someone is listening !

Regarding the concept of "ajana jar", all I would like to say, that at any point of time, there may be about 10% of the population who will be suffering from fever and that may be viral in origin or malaria or related to other obvious bacterial causes. Our findings after a house to house survey has corroborated this concept and is not supportive of either the rising trend of fever in a large section of the local populace nor the diagnosis of "encephalitis" or "ajana jar" as tagged by ID health authorities or the visual media.

LESSON OF THE DAY : Though we trust the clinical eye of physicians, hospital authority should have given the cause of death as cardiorespiratory failure in a patient suffering from pyrexia of unknown origin or cardiorespiratory failure in a patient suffering from suspected viral fever. Specific cause should only be given if there are supportive investigations.

A NOTE OF APPRECIATION

I record my happiness and appreciation for my friends who have believed in me and have come forward voluntarily to join the cause and the group, "DOCTORS WHO TREAT THE UNDERPRIVILEDGED".

I also want to highlight the singular instance of a lady who had joined the group with the ulterior motive of projecting her profession of a call girl, in search of would be clients from among the group members and ultimately leading to the revoking of her membership for all times. This incident has been a bitter learning for all of us and I would like to caution my friends to view their friends profiles in details, before inviting them to join the group.

Thanks once again for all the support, leading us from strength to strength. We are now 361 members strong !

A CAUSE AND GROUP NAMED "DOCTORS WHO TREAT THE UNDERPRIVILEDGED"

I have started a cause and a group in the name of "DOCTORS WHO TREAT THE UNDERPRIVILEDGED". The cause is the brains and has a following of 247 members till date. The group is the hands to implement the cause and there are 347 supportive members who have empowered me with their unconditional friendship during the stressful period, when our very first event, the inauguration of a subsidised clinic at Tapuriaghata, got cancelled due to political interference.

I feel the group which is growing very fast indeed, needs to be registered as a non-profit , non-government organisation as early as possible and should have it's own account, 80G affiliation, FCRA, e-mail and website. In view of this thought, I have already circulated a format among the existing members of the group, regarding member qualification and experience and the options of members in involving themselves in the future activities of the group. I have also specifically clarified that the group's activities will not be limited to the health sector alone and will encompass areas like education, formation of self help groups, vocational trainings, sponsorship programs for people living below the poverty line and such activities that will improve the quality of life of the underpriviledged section of the society. I have also raised the issue of forming city chapters of the group, as many of the members are located outside Kolkata and there should be equal scope for them to work for the group in their own communities. I hope that when members submit the filled in formats by 30.11.09, I will be better informed about their wishes and expectations from this group.

I am already in the preparatory phase of applying for registration for the group and hope that this long time consuming process will be not be a frustrating experience for me. Till then let's keep our fingers crossed and hope for the best.

FEELS GREAT TO HAVE SO MANY SUPPORTIVE FRIENDS !

The opening of the subsidised clinic at Tapuriaghata on 21.11.09 was cancelled. I guess the real cause was political interference, as kolkata municipal elections are due within approximately six months and politicians are busy making promises of a rosy future, to these underpriviledged section of the society. The club office bearers were more interested in acquiring a free supply of medicines, which we could not principally agree to and thus we backed out of this venture. We indeed lost some money in this effort, but our learning from this development is more important to guide us in our future initiatives. I always believe that there should be some community ownership of a program, as little as it may be, or that program is destined to flounder.

I am definitely not disheartened and will try to establish this chain of subsidised clinics throughout Kolkata and its vicinity, that will solely cater to the health needs of the underpriviledged section of the society. Though our very first initiative has run into troubled waters, I am greatly overwhelmed by the love and support of the members of my group, "DOCTORS WHO TREAT THE UNDERPRIVILEDGED", who have stood by me in my decision to withdraw. I want to categorically mention the names of Onkar, Paramita Prajna, Kanta, Protip, Sudhir, Partha Sarathi, Sandeep Rathod and of course my dear friend Rajibul Islam who have expressed their support, in this time of stress.

All I can say thanks friends, the group will definitely overcome this initial set back and fulfil its mission in the days to come.

CANCELLATION OF THE INAUGURAL PROGRAM OF TAPURIAGHATA CLINIC ON 21.11.09

Dear Members of DOCTORS WHO TREAT THE UNDERPRIVILEDGED,

I bring a piece of bad news on this auspicious CHILDRENS’ DAY. There has been an unexpected and unusual setback for our group. The inauguration of the first " SUBSIDISED HEALTH CLINIC" at Tapuriaghata has been cancelled due to possible intervention by some outsiders ( political ?), who do not want the program to succeed. Today Dr Rajibul Islam, a child specialist and a member of this group, a representative of a pharmaceutical house and myself went to the club to finalise arrangements for the inaugural program on 21.11.09. We were greatly disappointed in finding the club representatives more interested in pressing their demand for uninterrupted supply of free medicines, as a pre-condition for the establishment of the clinic. It is my firm belief, a belief acquired by serving at the grassroot level for more than 22 years, that a free service without community ownership always flounders and thus we had talked about doing relevant investigations at cost price or providing 50% subsidy on medicines from the very beginning. As we could never agree to this unjust clause of theirs, we thought it right to withdraw from the venture, with immediate effect. I request my friends to be patient and supportive, as we are already in talks with other area representatives and our honest intent of setting up a chain of such clinics for the underpriviledged section of the society will definitely materialize. Please accept my sincere apology for the inconvenience I must have caused, unknowingly, but you know there is a Robert Bruce in me…. Till then, be with me my friends

Regards

Subrata

THE DRAINAGE AREA OF THE CLINIC

On one side we have ward 23 of bidhannagar municipality that borders our clinic, seperated by a waterbody. the picture shows the rear portion of the residential quarters of the low scio-economic group of people who will avail the facilities of the clinic. Though this place is about 12 mins walk from the E M bye-pass, the houses do not have any sanitary facilities and the people have constructed these bamboo makeshift latrines for themselves. One may relevantly question the usefulness of a municipality in the heart of greater Kolkata, that fails to provide the minimum civic facilities to its people

The other drainage area of the clinic lies as far as the village of Makhaltala, that starts at the base of "Dhapar Dhipi", the dumping ground of the city of Kolkata. The place is extremely unhygenic, but people have built shanties at the base of this artificial mountain of garbage and have started living a life, an unequal fight of survival with the dogs and pigs that abound the place. The village of Makhaltala has no electricity, no conveyance facility nor is there any govt health infrastructure !

This lone goddess stands on guard on the way (aler pathe) in between the waterbodies that abound the region, between the two villages of Makhaltala and Tapuriaghata. Will she help the people, the poor people of this locality in dire health emergencies ?

One may easily guess the answer and so when I first visited the twin villages on 19.10.09, I made up my mind to set up a health facility, as a part of our group's activity at Tapuriaghata, that may be equally accessed by the people of Makhaltala, Tapuriaghata and ward 23 of bidhannagar municipality.

SETTING UP A FREE WEEKLY CLINIC AT TAPURIAGHATA

This is Tapurighata Boys' Sporting Club at Tapuriaghata, just 2 mins walk from Chingrighata on the E M Byepass. It is my intention to start a free weekly clinic, probably every saturday, for the poor people of the locality.

This clinic will be the first of a series of such clinics throughout Kolkata, meant for the poor and underpriviledged section of the society. The group "DOCTORS WHO TREAT THE UNDERPRIVILEDGED", created by me in sept 2009, will be the driving force behind this unique venture. Kolkata Municipal Corporation does have a chain of primary health care facilities in this city and provide for free consultation by in-service doctors, malaria detection, TB and leprosy treatment and free medicines, but this chain of clinics will differ in the respect that the doctors attending these clinics will provide voluntary service, all relevant investigations will be available to the poor people at cost price and there will be provision of supply of prescribed medicines at 50% discount. I have plans in the future to introduce package treatment facilities related to general surgery, orthopedics, eye, ent and gen medicine cases, requiring hospital admission, for the poor section of the society.

The group will be instrumental in running these clinics as a non-profit venture. In the mean time we are seriously thinking of registering the group as a NGO as early as possible and applying for 80G affiliation.