#India – Whistleblower Dr K V Babu’s 5-yr battle for #medicalethics drags on #Publichealth #IMA


WHISTLEBLOWER Dr KV Babu has risked his medical career to expose a gross violation of law by India’s largest body of medical practitioners (Photo: MADHURAJ)

Rema Nagarajan
30 May 2013, TNN

May 30, 2013: It is exactly five years since Dr K V Babu took up the issue of the Indian Medical Association (IMA) endorsing the products of various companies in violation of the medical code of ethics. The case continues to drag on as the Medical Council of India (MCI) gave one more chance for Dr Rajagopalan Nair, Kerala state secretary of the IMA to appear before it after he failed to do so on two previous dates given to him.

On May 30, 2008, Dr Babu complained to the IMA national president about IMAs endorsement of products of various companies like Pepsico and Dabur. Instead of being lauded for having prevented the association from violating the code of ethics, Dr Babu has been harassed by the IMA, which had to forego crores of rupees that it used to earn from endorsement of products.

Even the MCI which is supposed to regulate the medical profession has been dragging its feet in helping an individual doctor’s efforts to ensure compliance of the ethics code. The battle goes on  relentlessly as IMA continues to harass Dr Babu for standing up against the system, while Dr Babu persists in fighting his lone battle against the largest and most powerful association of doctors in the country.

The saga of endorsement and harassment: 

April 2008- IMA Central Working Committee met and decided to endorse Pepsico products -Tropicana and Quaker

May 2008- Dr Babu K V complained to IMA national president that endorsement was unethical according to the Medical Council of India’s (MCI) code of ethics for doctors

June 2008- Complaint was filed against IMA endorsement to MCI.

August 2008-MCI sent show-cause notice to IMA on endorsement issue

November 2008- IMA ratified minutes of the meeting regarding endorsement

May, June 2009- MCI sent several notices to IMA

July 2009- Ethics committee of MCI took up the issue and decided that IMA was not under the jurisdiction of MCI

July 2009- Dr Babu approached the health ministry to take action against MCI for not upholding the code of ethics.

-Health ministry asked MCI to take up the issue again

August/September 2009- MCI sought legal opinion on whether endorsement by IMA was unethical and whether IMA was within the jurisdiction of MCI

November 2009-Dr Babu approached Chief Information Commissioner (CIC) as no reply was coming from MCI on RTI application on whether endorsement by medical associations was unethical or not. CIC directed MCI to reply by December 31, 2009.

November 30,2009- IMA decided to stop all endorsements in future but would continue already signed MoUs for endorsement

December 2009- MCI clarified that IMA was within the jurisdiction of the code of ethics and that code of ethics was applicable not only to individual doctors but also to professional associations of doctors

March 2010- MCI ethics committee again decided IMA not within jurisdiction on basis of legal opinion of an outdated legal opinion prior to the clarification

April 2010- Dr Babu complained again to the ethics committee of the MCI

May 2010- Dr Babu wrote to MCI seeking information on why no action was taken against office bearers of IMA for violating the code of ethics or MCI regulations 2002 which prohibits endorsement of any commercial product by a physician or group of physicians.

June 2010- NHRC in response to Babu’s complaint directed Health Ministry to take appropriate action on complaint against IMA

July 2010- MCI claimed that IMA was not under its jurisdiction and that action could only be taken on complaints against individual doctors

August 2010- Dr Babu sent a complaint to MCI again, naming individual doctors, 187 members of the Central Working Committee of IMA who decided on the endorsement

MCI declared that IMA was under its jurisdiction and sent show cause notice to IMA

November 2010- Board of governors of the MCI declared IMA endorsement unethical and asked for it to be stopped immediately. Penal action, if any, was to be decided on November 9, 2010

Health minister informed Parliament that MCI had decided to remove the names of the national president of IMA Dr G. Samaram and secretary Dr Dharam Praksh, for 6 months and censure 61 members of the IMA executive.

January 2011- Dr Babu filed a complaint filed to Delhi Medical Council pointing out that the endorsement had not been stopped despite MCI directions

February 2011- PepsiCo stopped using logo and health message of IMA on Quaker oats and Tropicana

IMA Kerala branch decided to expel Dr Babu from IMA for bringing disrepute to the association by complaining to MCI and going to the media

Dr Babu complained to MCI, DMC and Kerala state medical council regarding threat of expulsion and harassment

March 2011-Pepsico officially withdrew IMA endorsement nine months before MoU was supposed to run out.

April 2011- IMA CWC rejects request of MA Kerala to expel Dr Babu since it was not as per IMA bye laws. Request for expulsion was sent back to IMA Kerala

May 2011- MCI and DMC refuse to intervene saying it is a dispute between a member and an association

August 2012- Notice issued from IMA Kerala to Dr Babu appear in person for being instrumental in the publication of an article on the endorsement issue in the press.

Dr Babu complained to the MCI to intervene in the matter

October 2012-Dr Babu appealed to the Health Ministry as MCI was not taking any action on his complaint of IMA’s harassment

November 22, 2012- Health Ministry sought comments from MCI on Dr Babu’s appeal

Jan 22, 2013: MCI ethics committee examined the complaint and discussed the issue

March 22, 2013: Summoned Dr Babu and Dr Rajagopalan Nair, former IMA state secretary. Both parties could not attend

April 26, 2013: Dr Babu and Dr Rajagopalan summoned again. Dr Babu appeared before the MCI ethics committee and presented his case and submitted relevant documents. Dr Rajagopalan failed to appear

May 24, 2013- Dr Rajagopalan was summoned again. He did not appear and the ethics committee has decided to give him one more chance to appear next month.

And so the quest for justice drags on beyond five years.

 

#India – When Doctors are also perpetrators of Crime #Vaw


Study shows sex selection practices in doctors’ families

, TNN | May 28, 2013, 06.42 AM IST

NAGPUR: A study by a Nagpur-based institute has found the sex ratio skewed in doctors’ families, too. The child sex ratio in these families was 907 girls per 1,000 boys, lower than the national average of 914. It was indicative of a deep-rooted social malady that could pose a critical challenge in correcting the sex ratio in India, the study stated.

The skewed ratio in the doctors’ families was strongly indicative of underlying sex-selection practices even though the ratios offer only circumstantial evidence, rather than proof, the study stated. The study was published recently in the American Journal ‘Demography’ and titled ‘Skewed Sex Ratios in India: Physician Heal Thyself’.

The researchers investigated the sex ratio in 946 nuclear families with 1,624 children where either one or both parents were doctors who had studied at the Government Medical College and Hospital in Nagpur between 1980 and 1985. The medical college is a large tertiary care teaching hospital in Vidarbha region, admitting 200 students for the Bachelor of Medicine and Bachelor of SurgeryMBBS) .

Other than being more skewed than the national average, the researchers observed that the conditional sex ratios consistently decreased with increasing number of previous female births. Third, the birth of a daughter in the family was associated with a 38 % reduced likelihood of a subsequent female birth.

“Our investigation has revealed startling concerns about the potential sex selection practices among doctors of Vidarbha region. We are aware of the limitations of this study as the sample size is not very big and hence may not faithfully represent the entire physician community in India. But it definitely warrants a closer look. It will also be interesting to see whether such practices pervade others in the medical profession, such as nurses and paramedical workers,” said principal investigator Archana Patel.

Patel also works as a professor and head of the department of paediatrics. She is a director of epidemiology unit at Indira Gandhi Government Medical College, Nagpur. The others who conducted the study with Patel are Neetu Badhoniya, Manju Mamtani and Hemant Kulkarni.

“The study was conducted for three reasons. The medical profession enjoys high esteem in India, and physicians are regarded as role models in society. Second, physicians have a crucial role in the implementation of the Pre Conception and Pre-Natal and Diagnostic Techniques (prevention of sex selection) Act to prevent the misuse of ultrasound and other techniques for prenatal sex determination, which has been implicated for selective abortion of girls. Third, little is known whether this preference for boys also exists among the families of Indian physicians. Hence, we investigated the pattern of sex ratios in the immediate families of physicians,” Patel said.

General surgeon Maya Tulpule, president of the city chapter of Indian Medical Association said, “I will discuss the matter with IMA managing committee members to see whether we can take up such a survey here in Pune.”

It was an important study which reflected the mindset of the society of which doctors are a part, said senior psychiatrist Devendra Shirole, former national vice president of IMA. “However, a multi-centric study with a larger sample size is needed. We will discuss this at IMA’s national meeting soon,” he added.

Previous studies have also claimed that this son preference varies little with education or income and that selective abortion of girls is common in educated and affluent households, presumably because they can afford ultrasound and abortion services more than uneducated or poorer households.

 

#Chhattisgarh #Andhra – Setback to health insurance


Published on Down To Earth (http://www.downtoearth.org.in)

Setback to health insurance

Author(s):

Kundan Pandey

0 Comments
Author(s): Kundan Pandey
Issue Date: Apr 30, 2013

Private hospitals in Chhattisgarh, Andhra refuse to treat under government insurance scheme

Strengthening primary healthcare facilities would cost one-third of what governments spend on health insuranceStrengthening primary healthcare facilities would cost one-third of what governments spend on health insurance (Courtesy: swasthindia.in)

LAST year when the Chhattisgarh government announced health insurance scheme for people above the poverty line (APL), it was touted as an initiative to improve healthcare delivery in the state. But within a few months of introducing it, Mukhyamantri Swasthya Bima Yojana (MSBY) has turned out to be a political gimmick to capure the vote bank as the government faces elections in October-November.

The state launched MSBY on the lines of the Centre’s Rastriya Swasthya Bima Yojana (RSBY), which caters to people below the poverty line (BPL). It provides cover for hospitalisation cost up to Rs 30,000 for a family of five on floater basis. The state has roped in the 350 private hospitals under RSBY for its MSBY scheme. But the hospitals are not willing to admit APL patients under the scheme, saying the insurance amount is too less.

Like RSBY, MSBY sets down the amount a hospital can charge for the treatment of a particular disease. For example, hospitals under the scheme can charge Rs 3,500 for treating pneumonia or malaria and Rs 9,500 for jaundice. The private hospital authorities say they treat BPL patients at such low rates as a welfare scheme. It would be difficult to provide the care to all at such low fees.

Ajay Sahay, president of the Chhattisgarh chapter of Indian Medical Association (IMA), says, “We have informed the government about our demands to increase the insurance amount to somewhere between Rs 1.5 lakh and Rs 2 lakh.” On April 4, a group of private hospital authorities held a meeting with the state’s health minister, principal secretary and other government officials to discuss their grievance. “Instead of proper solution, they proposed increasing the cost of one treatment and reduce that of the other. They also said that we would have to treat MSBY beneficiaries, if we want to treat people under RSBY,” says Sahay. “We are now left with no option except refusing BPL patients as well.” Sahay alleges that the government did not consult the private health sector while planning MSBY, but now it wants the sector to implement the scheme before the elections.

Can private players help?

In December last year, the Chhattisgarh government had tried to outsource diagnostic facilities for government hospitals to strengthen its public healthcare system. But no private party showed interest to provide diagnostic facilities in remote areas of the state.

“It is not strange or unexpected,” says T Sundararaman, executive director of National Health Systems Resource Centre, a technical support institution with the National Rural Health Mission. Private sector works for the maximum margin and is demanding just that, he adds. But increasing the insurance amount is not the solution, Sundararaman says, citing the example of Andhra Pradesh, where the private health sector is demanding an increase in the insurance amount from the existing Rs 1.5 lakh.

Private hospitals in Andhra Pradesh have threatened to discontinue providing treatment under Rajiv Arogyasri scheme for BPL category from May 3 if their demands are not met. Every year about 200,000 patients undergo surgery under the scheme for 938 listed diseases.

B Bhaskar Rao, president of Andhra Pradesh Specialty Hospitals Association (ASHA) says the government launched the scheme six years ago. But there has been no hike in the amount despite requests by the private doctors’ association. “We demand that the government raise the insurance amount by 30 per cent and thereafter increase it by 5 per cent every year,” says Rao.

To achieve universal healthcare, senior public health specialist Sakthivel Selvaraj, says governments should focus on strengthening primary healthcare facilities. After all, this would cost one-third of what they spend on insurance, he says, adding, “We have never invested sufficiently in public health system which can solve the problem.”

 

#India- 70 year old Doctor sent to prison for doing his duty , by Jayalalitha’s cop #WTFnews


TNN | Mar 30, 2013, 12.49 AM IST

Jaya’s cop sends doctor,70, to jail for doing his job
 CHENNAI: Doctors’ associations in Tamil Naduare up in arms after a 70-year-old physician in Chennai had to spend a night in prison for stopping a police sub-inspector accompanying chief minister J Jayalalithaa from entering the intensive care unit of Apollo Speciality Hospitals in Nandanam with his shoes on. Doctors have threatened to hold a protest on Thursday, if the charges are not withdrawn.
Dr Karunanidhi, a retired government doctor, is the personal physician of B Sivanthi Adityan, owner of Tamil dailyDinathanthi, who is admitted in Apollo Hospitals. On Wednesday, Dr Karunanidhi was arrested after sub-inspector Asaithambi complained that the doctor abused and pushed him when he went to the hospital to check on the security arrangements for the chief minister’s visit.Police charged Dr Karunanidhi under sections 332 (voluntarily causing hurt to a government servant while he/she is on duty), 353 (assaulting or using criminal force on public servant), 341 (wrongful restraint) and 506 (criminal intimidation) of the Indian Penal Code.The doctor was produced before the 18th Metropolitan magistrate Anandavelu. Dr Karunanidhi was remanded to judicial custody and sent to Puzhal prison. Almost immediately, the doctor’s lawyer moved bail application. Bail was granted at 8.30pm on Thursday. The doctor, however, had to spend the night in jail as the bail order reached the authorities after office hours. He was released on Friday.

Advocates, too, have taken exception to the speed with which Dr Karunanidhi was remanded by the magistrate. The Madras High Court has said on several occasions that magisterial courts should not behave “like a rubber stamp” and remand people “in a mechanical manner”. S Prabakaran, president of Tamil Nadu Advocates Association, said, “Assuming that an unarmed senior citizen intimidated an officer, a prima facie case is not made out for remand. The magistrate could have exercised discretion, recorded his reasons and let him out from the court itself.”

Doctors associations say ICUs are sterile zones and could be contaminated if visitors walk in without protective gear. Further, there is risk of infection to the visitors, which is why certain protocol is followed the world over. Tamil Government Doctors’ Association secretary Dr P Balakrishnan said Dr Karunanidhi had done what was best for his patient. “It is important for the hospital administration to ensure that certain zones are sterile. If they fail to do so, the doctor should do it,” he said.

Doctors also questioned the need to imprison a senior citizen. “He is a retired government doctor, who has been practicing medicine for several decades. He has been a great teacher. He will be available any time for an inquiry. What was the need to arrest or jail him?” said Dr T N Ravishankar, former honorary secretary, Indian Medical Association.

Invitation- Know Whats wrong with Clinical Establishment Act in context of Maharashtra


Consultation on the proposed Clinical Establishment Act in context of Maharashtra on 12th of March, 2013 at 3 pm at College of Social Work, Nirmala Niketan, New Marine Lines

 

 

Jan Swasthya Abhiyan (JSA) is the Indian circle of the People’s Health Movement, a worldwide movement to establish health and equitable development as top priorities through comprehensive primary health care and action on the social determinants of health. The Jan Swasthya Abhiyan coalition consists of several hundred organisations as well as a large number of individuals that have endorsed the Indian People’s Health Charter adopted in the year 2000.

 

State government is moving to adopt the National Clinical Establishments Act in its existing form in Maharashtra.  While the National Act in its existing form has certain positive provisions, its implementation is likely to remain quite inadequate, since it does not specify any dedicated regulatory framework to ensure implementation of provisions, the manner of regulation is not participatory or accountable (opening the likelihood of totally bureaucratic regulation without much scope for civil society organizations to promote interests of patients), and there is no mention of patients rights.

 

The Mumbai Chapter of Jan Swasthya Abhiyan is organizing a consultation on the proposed Clinical Establishment Act in context of Maharashtra. The Consultation will be held on the 12th of March, 2013 between 3 pm and 6 pm at College of Social Work, Nirmala Niketan, New Marine Lines.

 

There is significant interest among civil society organisations regarding this act, since there is an urgent need to regulate the current private medical sector. There is need to build awareness in society about the significance of this act, especially  given certain amount of resistance and misinformation from sections of the private medical profession regarding the act. 

 

This consultation is aimed at developing a clear understanding about the proposed Act and its implications on people’s 

access to quality health care.

 

A panel comprising of an advocate, a representative from JSA and the President of Indian Medical Association, Mumbai  will be addressing the participants at the consultation.

 

You are requested to kindly attend the consultation.

 

for more information contact- Leni Chaudhuri-9820639762, Kamayani Bali Mahabal – 9820749204

 

 

 

Doctor, Heal Thyself ! # Satyamevjayate #Aamir khan


 

Doctors asks Aamir Khan to apologise for his recent show on Satyamev Jayate

 

Rediff.com, Last updated on: June 06, 2012

The latest episode of Aamir Khan‘s [ Images ] television showSatyamev Jayate probed into malpractices that some doctors follow, looking at the way they dole out wrong treatments for monetary gains. It has understandably not gone down too well with the medical fraternity.

Dr Sanjay Nagral — a consultant surgeon, department of surgical gastroenterology , Jaslok Hospital and Research Centre, Mumbai [Images ] — explains what exactly has hurt the doctors. 

Satyameva Jayate‘s recent episode on healthcare in IndiaImages ] has created quite a stir within my fraternity. What began as benign posts on social media and closed door conversations has snowballed into a movement against what is being described as a ‘diatribe’ by Aamir Khan against the medical profession.

In an additional bizarre twist, the Indian Medical Association, the apex body of medical professionals in the country, is asking Aamir to ‘apologise’ and, in what can only be termed as an acute case of silliness, has called for ‘boycotting’ him.

The issues raised in the show, and the profession’s response to them, have important lessons. Lest they get lost in the din and drama, here is a contrarian view for the record.

What is it exactly in that episode that has hurt my colleagues?

From my reading of the various statements, it seems there are some common themes that many are upset about.

First, the show ‘exaggerated’ the extent of unethical practice in the profession. Second, it showed only the ‘bad’ side of the profession, not the ‘good’. Third, it was factually incorrect at times.

There were those who wanted to know why doctors are being targeted when the entire society is corrupt.

Finally, the one below the belt: Who is Aamir Khan to pontificate about service to the poor when he charges crores of rupees for the show?

The last one, though probably the most superfluous, is the most emotive of all.

Is it really a revelation that ‘stars’ like Aamir charge such amounts for television serials? If Aamir declares he has not charged for the show, will it in any way alter the response to the show?

Post your comments on Satyamev Jayate here.

Now, we come to the more substantive issues.

What was one of the unethical practices that the show highlighted and ‘exaggerated’? The episode talked about the practice of ‘cuts’ and ‘commissions’ that are offered by doctors, labs and hospitals for referral of patients. These are cash transactions; they are not revealed in official documents and are arbitrary in amount.

Although there is no documentation of the extent of this practice (Not surprising! How many would admit to it?), having had a ringside view in a large metropolis for many years, I would suggest it involves a large majority of referrals.

We can quibble over the precise extent, but that would just serve to obfuscate the issue at hand.

Hasn’t such ‘fee splitting’ become so commonplace and institutionalised that, as a young doctor, if you don’t participate in it, you are effectively ostracised? Isn’t this activity non-transparent and doesn’t it increase the cost of health care and affect quality? Has any medical association ever tried to build internal resistance or opposition to such a patently corrupt practice?

The show talked about the shocking state of the Medical Council of India and how its president, Dr Ketan Desai, was arrested by the CBI in 2010 on charges of corruption. He was thereafter removed from the post of MCI president by the government and is now cooling his heels in Tihar jail.

Desai amassed crores (one estimate pegs the amount of money recovered from the raid on his home at Rs 1800 crore (Rs 18,000 million)) from the lucrative business of recognition of medical colleges.

The episode also showed how Desai, who had been indicted by the courts and temporarily sacked in 2002, staged a return. What the episode did not mention is that the same individual was also the national president of the Indian Medical Association.

Thus, a convicted individual not just survived but actually thrived for an entire decade at the highest levels in the Indian medical establishment both as the president of the Medical Council as well as the IMA. Isn’t this a reflection of the permissiveness and ambivalence medical professionals have developed towards corruption in their own representative bodies?

The current president Dr K K Talwar, who appeared on the show, had no credible answer when asked why not a single doctor in India has had his licence cancelled when the General Medical Council of the UK figures showed substantive numbers every year.

One of the ‘errors’ repeatedly pointed out by those outraged by the show is the numbers that were quoted about private and public medical colleges in India. One wonders, though, what is more important — the precise number or the fact that India can be counted among the countries that have the highest number of private medical colleges in the world? Isn’t the crass commerce of medical education in these colleges, where seats are sold at high prices, the real issue?

Isn’t it true that private medical college empires have grown because they have managed to hire and retain medical teachers, set up arrangements with hospitals to provide ‘clinical material’ in the form of patients and get recognition for postgraduate courses from inspection teams consisting largely of doctors?

Of course, there is a large industry supported by politicians at work here but the collusion of the profession is substantial.

Did the episode show examples of ‘good’ doctors and the positive side of things?

To be fair, the show did profile alternative models quite extensively. The issue of generic drugs and the work of Dr Samit Sharma in Rajasthan [ Images ] were highlighted in some detail.

That they predictably chose media favourite Dr Devi Shetty, when they could have profiled any of the hundreds of brave, committed doctors who have chosen to work under harsh  conditions in rural India to come up with alternative models of people-centric health care, is a pity. But some of this is inherent to the medium and its compulsions.

And, finally, a very old complaint — why should doctors be ‘targeted’ when the entire society is commercial and corrupt?

It is obvious that, unlike other professions, health care has a huge social dimension and hence will inevitably be scrutinised more intensely. But it is exactly this aspect that also gives doctors more visibility (don’t many of our colleagues enjoy a lot of media publicity on a regular basis?).

Historically medicine has a social contract which allows it a unique form of self-regulation in the form of medical councils, a front on which we have failed miserably. So whether it is the killing of the female foetus or the sale of kidneys, the state has had to step in with new laws because self-regulation failed.

The principle of market economics have been rejected by most societies, including western nations, as inappropriate to health care. In a strange paradox, India has one of the most privatised of health care systems.

Now, before my colleagues say that this is a result of state policy, which it essentially is, we have to admit India’s medical profession is a willing and enthusiastic participant in this process. Witness in the current boom of market medicine a new entrepreneurial spirit that is sweeping the profession. But the same market medicine, which uses media and television to sell its wares, is disturbed when the medium turns around and asks disturbing questions.

Was the show free of blemishes? Of course not.

There were occasional moments, like when the rather improbable allegation of a ‘liver transplant’ being advised for gastroenteritis was made by a member of the audience. Or when a family alleged that they did not know that a pancreas would be transplanted with the kidney in a large private hospital in Bengaluru [ Images ]. But these aberrations should not distract from the big issues that the show managed to raise.

Rampant commercialisation of the practice and of medical education, hard selling by pharmaceuticals, the high cost of drugs and the shocking price differences for the same drug from different brands are all highly disturbing parts of our healthcare policy.

That a popular film star with a huge audience articulated on prime time television what health activists have been saying for years is perhaps what has disturbed some in my fraternity.

Organisations like the IMA should actually seize the moment and ask Aamir to commit to a sustained public campaign on universal health coverage and the right to health. That would also test Aamir on a charge that has been made about him; that he raises social concerns transiently to stimulate interest in an ongoing release.

As for the boycott call, I would suggest that Aamir doesn’t really need to worry on that count. He has to just sneeze or cough and there will be a bevy of doctors running to attend on him.

After all, being a film star’s physician counts a lot in a doctor’s professional trajectory in India.

Nurses vs Doctors: How the backbone of Kerala is fighting for their due


G Pramod Kumar Feb 7, 2012

The fast-spreading strike by nurses in Kerala has laid bare the inherent contradiction in India’s burgeoning healthcare sector: it is a highly exploitative industry dominated by money-minded corporates and doctors.

While the doctors and surgeons earn by the hour, sometimes running into millions of rupees a month, the nurses who form the backbone of patient care are thrown the crumbs. At best, on an average, Rs 4000-8000 a month.

While managements are trying every trick in the book to rein in the striking nurses, including court injunctions and new recruitments, the doctors asked for invoking ESSMA, the essential services maintenance act, the bogey that oppressive governments use against labour unrest. The state unit of the Indian Medical Association (IMA) and the Qualified Private Medical Practitioners Association (QPMPA), an association of private medical practitioners and hospital managements were united in this demand.

The QPMA even went a step ahead and asked the political parties and the government not to encourage the strike.

Does it matter that for every doctor, you need many nurses and without them, hospitals will crumble? The contrarian stand of the doctors clearly demonstrates the power and class inequality in the healthcare sector.

The nurses are now clear that even the doctors they serve 24/7, much less the management, will not support them. Their agitation is spreading to every part of the state threatening to cripple its private healthcare sector. It’s a “white-revolution” that is as spontaneous as the Arab Spring.

The demands of the nurses are very simple. They want decent salaries and better working conditions. Nothing more. In 2009, the state government has fixed a minimum salary of Rs 9,000. A majority of the hospitals do not pay this, although the nurses say that even this salary is inadequate and should be revised.

According to United Nurses Association, the newly formed organisation that galvanised the feeble voices of protest into a snowballing movement, only five per cent of the hospitals in the state pay the minimum wages. In a Kochi hospital where the nurses are on strike, a nurse with 16 years of experience is given only Rs 7,000. Most of the nurses are paid Rs. 4,000-6,000.

The worst off are the “trainees” or the straight-out-of-college nurses. They are usually paid Rs 1,000 or so and work under bonded conditions. This is widely prevalent in hospitals outside the state, where the managements even confiscate their certificates. The state of their bonded condition was brought to light, when a nurse committed suicide in Mumbai last year. The trainees suffer in silence in the hope of a few years experience so that they can shift to a bigger hospital or go abroad.

The flicker of protests first appeared at the end of last year with Keralite nurses going on strike in Mumbai, Delhi and Calcutta. Early this year, about 800 nurses from a “multi-speciality” hospital in Kochi and another 600 in a private medical college hospital in a southern district went on strike, followed by several other hospitals.

The organisational capacity of the nurses has strengthened considerably since they agitated in Mumbai and Delhi. They were so busy with enslaving work that they didn’t even know how to organise a protest without inviting criticism. The main charge against them has been that they didn’t give sufficient notice to managements and the patients suffered.

The labour minister of Kerala, Shibu Baby John, while supporting nurses advised them to follow fair labour practices, such as sufficient advance notice, so that they are on good legal footing. Now they serve notice and go on strike. The Association says that more hospitals have been served notice, including the one where they had reached an agreement last year. Apparently this hospital reneged on their commitment.

The doctor-management nexus that the strike has brought to light was not unexpected given their mutually beneficial stakes. “IMA seeking ESMA against striking nurses is only a ploy to protect hospitals, some of which are owned by its members.” according to Jasmin Shah, State President of the United Nurses Association. The doctors also came in for severe criticism from civil society because they went on strike several times in the recent past. “If the IMA can call for state-wide strike when doctors face a problem, why can’t we agitate for minimum wages,” is Shah’s counter.

Meanwhile, support is pouring in from all quarters. The CPM, the CPI, the women’s wing of the Congress and INTUC have openly supported the cause of the nurses. The labour minister remained categorical that he wouldn’t allow anybody to pay the nurses below the minimum wages and violate labour rules. The State Women’s Commission member T Devi said that the commission will intervene if the nurses asked for help.

Even the courts are on their side. While responding to a plea on the issue, the Kerala High Court said last week that nurses were being exploited. They were forced to work for low salaries and that is why they were on strike, the court said. Some private hospitals haven’t revised the salaries even in the past ten years.

It’s worthwhile to note that when the nurses from Kerala went on strike in Mumbai and Delhi last year, the politicians in Kerala hardly paid any attention since they were busy with a politically expedient Mullaperiyar.

However, the nurses didn’t wait for any patronage. Their working conditions were so exploitative, that they abandoned their fear of job-(in)security and anxieties about hefty loan-paybacks. The sincerity of purpose paid off. Now that their movement is gaining momentum, all political parties want a share of the success.

The doctor-management voice against them continue to demonstrate the class struggle in the healthcare sector.

Ever heard of sari cancer?


Doctors at Grant Medical College have stated in Indian Medical Association journal that  something called sari cancer’ is on the rise.

CHENNAI Jan 30: The next time you drape a sari, you might want to re-tie that petticoat knot. According to an article in the November issue of the Journal of the Indian Medical Association, doctors at Grant Medical College in Mumbai have reported cases of what they are referring to as sari cancer.

“We have treated three women for waist or sari cancer in the last couple of years,” says author of the article Dr G D Bakhshi, who is an associate professor of surgery at Grant. He authored the piece with colleagues Dr Ashok D Borisa and Dr Mukund B Tayade. While two of the patients diagnosed a couple of years ago are mentioned in the article, the third was detected just three months ago. All the women were above the age of 40.

“The sari petticoat, if tied in the same place day after day, can cause chronic irritation along the waistline,” says the report. “The constant irritation can result in scaling or pigmentation. But most sari-wearers don’t notice it until it gets chronic,” says Dr Bakhshi.

He adds that women need to be cautious because waist dermatoses can turn malignant as it did in the case of the three women treated at GMC.

Dr Bakhshi advises sariwearers to tie their petticoats looser or switch from the usual rope-like belt to broader ones that reduce pressure on the area. He also suggests that they keep changing the level at which they tie saris. “This kind of cancer does not really affect those wearing pants or belts because the pressure is spread over a larger area, unlike in the case of a petticoat nada or string,” he says.

Treatment depends on the stage at which the cancer has been diagnosed. “If detected early, it can be treated with reconstructive surgery. But if the cancer has spread to the lymph nodes then we need to remove the malignancy,” says Dr Bakhshi. He adds that if detected early the cancer is curable.

Chennai-based dermatologist Dr Maya Vedamurthy says that around 3% of sari-wearers who come to her have waist dermatoses but she has not seen any cases where it has turned malignant. “The moment I notice it, I tell the patient to start wearing the nada a little looser or switch to a broader string,” she says.

Like sari cancer, there are several lifestyle-related cancers that are increasingly being seen in India, such as breast, ovarian and tobacco-related cancers. “There are many types of tobacco-related cancers from lung and stomach to bladder and pancreatic. The cancer is also lifestyle-related, caused by smoking as well as increased levels of pollution in the environment,” says Dr T Rajkumar, professor and head of molecular oncology, Cancer Institute, Adyar.

He says breast and ovarian cancer have similar lifestylerelated causes such as late childbirth, lack of exercise, and breastfeeding on the decline. “Working women tend to postpone the age at which they have their first child and going beyond 30 is risky. With ovarian cancer, risk factors include early menarche and late menopause,” he says. Dr Rajkumar adds that colonic cancer, which is related to a low-fibre diet, is also on the rise world over.