Questioning Prevailing Paradigm in Public Health

Question : I want to have two points to dwell upon to what Dr. Nittin said. Which is you see the point about the whole strategy is almost like a MEDICAL POLICING. Because the mapping up round is basically what they term as house-to-house search. So the implications particularly in the kind of the way the country is going is the cause for concern. Added to it in U.P., Lucknow a plague took place two years ago. It was pre-dominantly in a Muslim Population. Now they are using this to say that they are obstrantist people who will not take without understanding the reasons behind as to why it happened, because there is a study which shows that there is a post injection. An intra-muscular injection in the period and bilatical Polio Millietus in the population. So Dr. Mittal has not gone into the technical unsoundness of the strategy. Nor do we have technical questions about the break. But that would certainly form a major part of our paper.

Question 2 : If you trust as a complete laymen, the medical program has been pushed. Don't you think that there are some pharmaceutical companies behind this certain cooperation which are pushing this a post to other strategies. I would like to have some enlightment on that.

Dr. Nittin : Now that is a very important question which I want to bring on the table here. There are four key partners to this global polio eradication initiative. One is C.D.C. Atlanta, second is W.H.O., another is UNICEF, and one is the Rotary International. Now within that those who are interested and those who want to reach to the conclusion which I have reached is that to see who calls the shots in this. If C.D.C. Atlanta calls the shots then you will reach to different conclusions the kind which I have reached. There are lots of issues there. I can discuss them. Now there are other partners in that content. The Billgates and Bill and Miranda Gates is a partner. The vaccine manufactures are a partner. The private company D.B.S. is a partner. Then there are World Bank Government of Denmark, Itlay, Japan, U.S.A., U.K. and so there are the partners. The key role is being played by the four mentioned. Now one another point for those who want to understand this that also have to see now that in 2004-2008 plan of W.H.O. for Polio eradication strategically. What is emerging clearly is a very close relationship between Global Polio Eradication Initiative and the GABI. Now GABI is a program which is funded by Bill Gates given 500 million dollars to W.H.O. Now he sits on the head of this program. Now this is against the constitution of W.H.O. This program is introducing large number of new expensive Exchange in the developing countries. So this entire initiative is entering into a different phase of introduction of the several new vaccines into the developing countries. So that is another issue. So this is what is happening. Thank you for that Question.

Dr. Dhar : One of the example because of commercialisation. Government of India has taken a decision that this kind of vaccine should be introduced. This is one of the example where we don't need such kind of vaccine to be introduced. One other clarification about her mentioning Muslim population is not at all true. Atlanta Report clearly shows that those who have a comparative study and those who had been paralysed and those who had not been paralysed have taken equal doses. Then they also indicate that they had taken injections one month prior to paralysis. This is what we call in technical terms Polio Billasis. Because if you give an injection a muscle; that muscle is supplied by a nerve through a cell. If the cell becomes suitable to receive the Polio viral. Then in 2000 odd of Polio Mellative and paralysis, then there may be other hundred thousands or few lakhs of Bacteria circulating virus at that time. And only 2000 got injected and hence they suffered. There my wormy is that virus was circulating in large number and that is why we see Polio Virus. The Type-II was not there Type-I was due. Whether the management was fair or not the point is this was not worth. It was a highly costly and operation which requires nearly 3000 crores of rupees. Let us now move to the next topic. The point to note yes !

Question : I want to share with this group some experience. I was a Polio Medical Officer for two years in Bihar. My concern is not with the technical part of it which is also true also other issues which are covered. like Dr. Sachdeva pointed out the Muslim issue. What I am trying to put here is from the prospective of the service provider to the Polio officer, as I have seen. In the Indian context 1992, which is very strong anti-muslim bias at the National level. I have seen as a Medical Officer in reaction to that among my colleagues who work as a Polio Medical Officer. I want to share one small incidence. I was at Bhagalpur District sitting in the city of Bhagalpur during Gujrat Genocide last year in 2002. We were a group of people trying to help Bhagalpur district for a special immunisation round. And during the round there was one figure recorded for UNICEF so it was official in official publications. So one particular area of Bhagalpur town they were refusing the vaccines. It was the Muslim town. It was the Muslim community who had refused it till the end of the round. At the end of it animators from the UNICEF. They have their own animators. Their own people they call block officers. Now these men and we went there and we found that community was refusing because they were insecure with any kind of interaction with the state. Because they were so angered and disturbed by the chain of violence which culminated in the Gujarat Genocide they refused the vaccines. There were lots of discussion finally for the acceptance of the vaccines. It was not a question of religion itself per se. But the perception of the community they receive from the state can never be good. Similarly experiences quoted unofficially. I cannot say somewhere in U.P. where the community leader said at the point blank range that U.K. you may go to the houses and the women will either tell if the children have received the vaccines or they don't have children below five years. But the point of the issue is, "Doctor Sahib () these are the places, these are the areas where voilent Nasbandi during Indira Gandhi regime had taken place and our community had suffered most. If you see the real reality of a particular community and factors like poverty, ignorance if they are taken care of then I am assured that all communities are allowed. The question is the ignorant community and communities which fall in this line. About globalisation we started by saying this is a globalisation issue. Question is if somebody ask me to buy this bottle for Rs.10/-. Then you need not buy but I may give you a loan may return it after 50 years. I may tell him that even if you give it to me free of cost, I may not buy. First of all it is open and I don't need water at all. Therefore here half people have accepted the program. If Dr. Dev Dhar was in the ministry this program would have never been the event of the day. It is the fault of ours and why we already venture it is the weakness of our system.

Question/Explanation : Last point raised by Dr. Dev Dhar. May be he does not know people who can afford to join this program have to leave the ministry. I have been working on this issue of globalisation and global public work partnership from past two years. I was in U.K. sitting in the international department. Now these paper here on the global social policy for those who are interested I will appeal to them. There is a comprehensive paper; a very important paper for everybody to understand this global game which is going on. So it is my personal to all those to read these papers. Now I just because some key issues have not been brought to the information of public; there is a phenomenon which is called Vaccine Association Polio Paralysis. Now there are about one thousand children on record who have been paralysed because of Polio Vaccine and that has not been publicised at all and these children have a right to compensation and that should be taken up. Next thing which is going to happen as their strategy and as our strategy intra-high B.P., intra-muscular vaccine instead of oral polio vaccine in our country. There are large number issue including that. At least one person I know in U.P., a very respectable person who has been arrested on the charge of seduction. He had to take bail. He had published one article against pulse polio vaccination. My last point is as U.N. is now saying. WHO in saying. Even a single case of polio is a global health emergency. So where a large number of things are happening around that phenomenon, we all know what emergency means in our country they continue to say that a single case of polio anywhere is a Global Health Emergency. Thank you very much.

Dr. Dev Dhar : Please be loud........ After the tea break. One important point which is equally important is Tuberculosis. And next presentation is lessons from (?). Dr. Atul Sharma.

Atul Sharma : My talk is made easy by Dr. Onkar Mittal. Because Tuberculosis is also a part of this Global Program. So the issues he already raised, I am not going to deal with that also before that people have made issues on sanitation and nutrition. So T.B. becomes the disease of the poor. So I will go very briefly because there is no time. In case there is time, let Dr. Mittal clarify his issue which is more important. So now we have told the Drug Programme which is called the Renew National Drug Control Program. So what is new in it is a question ? It is the old thing. In 1953 we had a revolutionary program to control the tuberculosis, much away from the conventional type of regime where we have absolutely thought of providing the treatment. Not just isolating the patients. And it was a very well thought about strategy in Public Field. It says for the reason we do not have a political will. We do not have a positive bureaucracy. We do not have a Primary Good Health System or may be a later primary system. We do not have today a good primary system but we have now as a part of Global Disease concern program this new program in India which begins in 1908 AD. So we had a study in Delhi 1990 or 2000 AD in Delhi's slum under Dot Program Conducted as a Pilot Project. So but before going further I will just confirm one of my friend from National Institute of Tuberculosis. This is Atalji this is very good. Now we have firm support at any level, so we can cure as many people as we can. But you were also disturbed that with this new regime a large number of poor people were denied treatment on the ground that they do not have total residence or they do not have a proof of residence. With this the system wants to show its efficacy and how receptive the system is with its claim with 80% cure rate is psydo. They are not telling they are explaining people. They are already exploding a large number of people into the system. So whatever they are taking they are talking about that. This is a hectic process. Now we go to the other thing. This our system do not believe in people. They do not trust us. They trust their own mechanism. So this new dot has more stress from health workers administrating medicine in front of him. Putting the drug himself into the mouth of the patient. But this is not seen in India. People do not have medicine. And now or taking medicine he has to visit everyday to the center. It has all social and financial constraints. Like not many women particular unmarried girls are not coming to the centres. For one simple reason. Now they may be visiting this faculty almost every ultimate day they may be ? The other point there are fewer people who are affected by this disease. They do not have enough finance to survive. So first fifteen days or two months they take medicine. They have a feel good factor and start going to the work. Forget about medicine if now we are doing O.K. then I am fine. Because he will continue to take medicine without working he will not survive. And the health worker tell him everyday before taking medicine please have something in your stomach. So it is a very complex kind of thing. So if we are excluding so many people out of the system how can we say that we are going to say that we are going to control tuberculosis by 2010 or may be 50% of it. Unless we do not provide food, medication and other support things we are not going to achieve it. The other thing which is very disturbing is Multi Drug System Cases in on rise. Not only in India but globally. That is also the worry of these people who are sponsoring this kind of technology. So Multi Drug System cases come as a challenge or as a threat because we are already exploring a large number of population and we are using a second line of trust. And this health worker they just consider this as their duty to hand over this medicine to these people. So for their own social reasons and for their own economic reasons if they are not continue to take this facility they drop it again in between. So if they decide to continue to again they are already out control. So we have to seriously look into it. That is why this is my little submission. Because I wanted Dr. Mittal to take some more time and still there is some time we can adjust.

Intervention : Time cannot be transferred. I think it is a very important time for discussion and I will initiate by supplementing what he has already said. Now in this country of ours such programs are already here since last fifty and since last fifty years nothing has happened. Instead of ......... not audible .............. Now if you compare India with U.S.A. Tuberculosis infection can be detected by a skin test. What we call as Tuberculosis infection test. And tuberculosis positivity is one in one million. And Tuberculosis positive rate in India is above 85% infection and this is above one to one and half percentage. And therefore as we say rightly this can be controlled by economic power. If you see the history of England you will see that tuberculosis has declined rapidly in last hundred years by social economic development long before anti-immunisation drug were invented. And then slow continuing without outburst. And the point is that control of Tuberculosis of you really need to achieve, I think you achieve. I think the impact will be much more if you see and be with it if you see how we can transfer tuberculosis trends to other suspectables. Therefore we see how the initial program failed. Because the recommendations were too ideal could not get followed ........ not audible ....... no recording ....... No other country in the world where communicable diseases for that matter have been treated whatever be the disease the chance of tuberculosis is low. So if we are not willing to do anything we cannot control in another century. As our social-economical logistics conditions are different. Whatever happened in England cannot happen here........... no recording.............. And therefore question of evaluation is not only on population. Studies in Delhi, Rajasthan and M.P. have completely showed 30% drop............ This is the fact of life. So income generation is also important. With this I think the subject is open for discussion.

Interruption : Legal clarification ............. Recently I have not given vaccine to my own children. Because I thought I will do better by keeping ? by known instructions in my country. So when I was talking of 80% people, I was talking about people into the program. Large number of people remain outside the programme and they have no way to come and enter the Program. And then we talk of holistic method and WHO, why there is no IFO education and information program is 30% because each minute a person is dying of it in India. We have lots of campaign and exposure on HIV AIDS but there is no campaign in totally as to how you can treat yourself from Tuberculosis. Because they told us a very low center rate. But we have very different rates of recipients and we do not have enough resources.

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