Indian Tribal Women Rush to a Champion’s Defense #Womenrights


By Swapna Majumdar

WeNews correspondent

Friday, May 31, 2013

Tribal women in India are mobilizing behind a leading maternal-health advocate. Supporters say the case against Madhuri Krishnaswamy was concocted to stop her from flagging rights violations that led to 25 maternal deaths in nine months in one impoverished district.

Tribal women protesting Madhuri Krishnaswamy's arrest.
Tribal women protesting Madhuri Krishnaswamy’s arrest.

Credit: Jagrit Adivasi Dalit Sangathan (JADS).

NEW DELHI, India (WOMENSENEWS)–The May 30 release of Madhuri Krishnaswamy, a relentless campaigner for better maternal health for marginalized tribal women in Barwani, one of the most impoverished districts in the central Indian state of Madhya Pradesh, has brought temporary peace in the district.

Angry protestors who had been gathering in Barwani included about 2,000 tribal women from different parts of India, estimates Jagrit Adivasi Dalit Sangathan, the local advocacy group that Krishnaswamy heads.

Protesters converged on Barwani, ready to face arrest unless police charges against Krishnaswamy, based on the complaint by a Barwani health official, are withdrawn.

The May 16 jailing and arrest of Krishnaswamy on charges of — among things — obstructing a public official, have drawn outcry from rights groups and activists across the country. Demonstrators have been concentrated in Barwani, but some civil society groups have also met with senior health officials at the federal health ministry in Delhi to drum up support for Krishnaswamy.

More demonstrations, public rallies and litigation strategies to hold Madhya Pradesh government officials accountable for violations of women’s rights to life, health and non-discrimination are being pursued to pressure the administration to drop the charges.

The state government turned a blind eye to the health violations that Krishnaswamy was flagging and made up a false case to muzzle her, said Jashodhara Dasgupta of the National Alliance for Maternal Health and Human Rights, a coalition of 17 health advocacies, which has supported Krishnaswamy’s work.

Dasgupta, a member of the alliance, which is headquartered in New Delhi, told Women’s eNews that the arrest was meant to conceal the administration’s failure to implement various government programs for marginalized women.

No Comment from Local Government

The Barwani administration has not commented on the issue. The police filed a closure report in the case for lack of evidence in April. But after testimony by a Barwani health official the court summoned Krishnaswamy and sent her to prison after she refused to seek bail.

The false nature of the case was clear when some of the charges that led to her arrest included “rioting armed with deadly weapons,” said Ajay Lal, a program officer for Support for Advocacy and Training to Health Initiatives, a community health advocacy based in Pune, Maharashtra, that has been working with Krishnaswamy in Barwani.

“Krishnaswamy’s arrest is a blatant act of state reprisal against an activist who has repeatedly drawn attention to the health violations,” Lal said in a phone interview. Lal said poor maternal care in government hospitals was leading to deaths of poor tribal women.

Jagrit Adivasi Dalit Sangathan, the nongovernmental organization headed by Krishnaswamy, has staged persistent protests against the poor health services in the largely tribal area of Barwani for the past 14 years.

Barwani has the second-lowest Human Development Index among the 50 districts in the state, according to the Madhya Pradesh Human Development Report 2007. Using a 2003 government sampling, this report put the maternal mortality rate for the district at 905 deaths per 100,000 live births compared to the state’s already-high figure of 379 per 100,000 live births.

Under Millennium Development Goal No. 5 India has pledged to reduce its maternal mortality ratio by three quarters before 2015 to 109 deaths for every 100,000 live births, far lower than the current figure of 212. By comparison, the United States, a laggard among industrialized countries, has a national average maternal mortality rate of 21 per 100,000 live births.

Tribal Women Denied Care

Supporters say Krishnaswamy’s arrest is linked to the 2008 case of Baniya Bai, a tribal woman living in Barwani district.

When the nine-month pregnant Baniya Bai reached the nearest government health center after travelling about nine miles by bullock cart from her village, a local health officer demanded a $2 bribe before allowing her to be attended. When family members couldn’t pay, she was dismissed from the center and wound up giving birth outside the facility, on the street, according to Krishnaswamy’s advocacy group.

Baniya Bai and her child survived.

Vypari Bai, a resident of another village in the same district, did not. Before dying she went through a terrifying 27 hours of labor pain as she was shunted by health officials from one government health facility to another in search of medical attention.

Krishnaswamy documented both cases in a court petition she filed in 2011 that flagged health-rights violations that led to 25 maternal deaths in Barwani government health facilities during a nine-month period of 2010.

“Tribal women are still dying from pregnancy-related causes because of official neglect and apathy,” saidHarsing Jamre, chief program coordinator of Jagrit Adivasi Dalit Sangathan, in a phone interview. “Are the lives of tribal women less valuable? No action has been taken against such health officials. But our organization head (Krishnaswamy) raises her voice against this injustice, action is taken against her.”

According to the Human Rights Law Network, a Delhi-based collective of lawyers and social activists that investigated the Barwani maternal deaths, 21 of the 25 deaths from April to November 2010 in the district were women from the marginalized caste tribal group known as Scheduled Tribes, which are eligible for special benefits including free healthcare.

Sixty seven percent of people in Barwani belong to Scheduled Tribes.

Fatal Factors for Tribal Women

Krishnaswamy’s supporters say her cause and her own mistreatment show how government corruption, coupled with caste and gender discrimination are fatal for tribal women.

Disturbing correlations between social inequities and access to healthcare were identified in 2011 by health advocacies investigating maternal deaths and denial of health care in Barwani.

The report–by Sama, CommonHealth and Jan Swasthya Abhiyan — found that marginalized groups, in general, had trouble finding justice and tribal women were doubly disadvantaged by gender power hierarchy and caste.

Earlier this year, on Jan. 27, the Indore bench of the Madhya Pradesh High Court directed the state government to improve its healthcare manpower and infrastructure. The order stemmed from a public-interest suit filed by Krishnaswamy’s group and the Human Rights Law Network that documented maternal deaths of tribal women caused by negligence and denial of health care.

Activists working in Barwani say that better infrastructure and more clinicians must also be accompanied by a more humane attitude. Doctors rarely treat marginalized tribal women with empathy, they say, and long wait for service can be fatal for both the pregnant mother and child.

Swapna Majumdar is based in New Delhi and writes on gender, development and politics.

 

#India -Police action traumatised anti-dam tribals in MP #Stateoppression #humanrights


Chaukhand village, Khargone (MP), May 30, 2013

Pheroze L. Vincent

  • Villagers staging indefinite dharna at Kharak Dam at Chaukhand village in Khargone district in Madhya Pradesh on Thursday demanding proper compensation. Photo: A.M. Faruqui
    The Hindu Villagers staging indefinite dharna at Kharak Dam at Chaukhand village in Khargone district in Madhya Pradesh on Thursday demanding proper compensation. Photo: A.M. Faruqui
  • Villagers including children staging indefinite dharna at Kharak Dam at Chaukhand village in Khargone disstrict in Madhya Pradesh on Thursday, demanding proper compensation. Photo: A.M. Faruqui.
    The Hindu Villagers including children staging indefinite dharna at Kharak Dam at Chaukhand village in Khargone disstrict in Madhya Pradesh on Thursday, demanding proper compensation. Photo: A.M. Faruqui.
  • Villagers staging indefinite dharna at Kharak Dam at Chaukhand village in Khargone disstrict in Madhya Pradesh on Thursday, demanding proper compensation. Photo: A.M.Faruqui
    The Hindu Villagers staging indefinite dharna at Kharak Dam at Chaukhand village in Khargone disstrict in Madhya Pradesh on Thursday, demanding proper compensation. Photo: A.M.Faruqui

Sisters Kalibai and Phulbai are in a state of shock after they were caned by the police on May 25. Aged 8 and 6, they rushed towards their father Tudpiabai Gangaram on seeing him being caned by the police during a protest against the Kharak Reservoir being built beside their village.

“I said don’t hit my father. My father asked us to run away. Before we could run the policeman hit us also,” said Kali, struggling to talk with her swollen mouth. Phul asked her to open her mouth. “Her tooth broke as the cane hit her mouth,” she said pointing at a missing tooth.

Chaukhand has been resisting the construction of the dam, a minor irrigation project in Khargone and Barwani districts, roughly 350 km south west of Bhopal. Inhabited by the Barela tribe, the village grows wheat, jowar, soya, groundnuts and other traditional millets, beside River Kharak. Most residents do not have documents for the land they cultivate. The reservoir will submerge parts of seven villages.

Work on the project, which had started less than a year ago, has stopped for the last two months due to protests by locals. There are daily dharnas under the village peepul tree demanding a comprehensive rehabilitation policy, before the dam comes up.

“We had started work only on the 55 hectares for which claims were settled at roughly Rs. 3 lakhs per acre according to the collector’s guidelines. The problem is with those who don’t have documents. The principal secretary has decided to give them a relief amount of Rs. 4 lakhs per hectare. On Saturday we went to talk with the villagers when the situation deteriorated,” said Executive Engineer SS Raghuvanshi of the Water Resources Department.

Villagers narrated a different story. “At 10.30 a.m. we were on dharna as usual when four police vans came with around 150 male and female officers. The Sub Divisional Magistrate Jitendra Singh Chouhan was in front. They formed a line. We went to the SDM and asked when we will get compensation. He said that everyone with documents will get compensation but first we must clear the area,” said Shivram Kanase an activist of the Jagrit Adivasi Dalit Sangathan (JADS) which works in the area.

The villagers asked them to pay the compensation before starting work. Police then forcibly evicted them from the site. “They chased me and snatched my child from my arms and threw him on the ground. That policeman’s breathe smelt of liquor. He beat me with his cane,” said Samranabai, a local resident.

Collector Navneet Kothari is on leave and Superintendent of Police R. P. Singh refused to answer queries. He said, “You do your job. If I say there was no lathi charge, will you believe me?”

Another lady named Banchibai Ningole, with an infant at her breast, was arrested from her house, said villagers. Totally seven men and twenty women are in judicial custody. They were denied bail on Wednesday. The police have told the court that they are on the look out for others and that if released, the 27 would rejoin the protests.

“I asked the SDM why his men were beating women and children. He said that we were stopping government work and we would be locked up. Inspector T. C. Usre caught my hand and hit me. The women constables didn’t do anything. Maybe they felt bad for us,” said Gyanibai Jadav.

SDM Chouhan denied the occurrence of a lathi charge. “Villagers attacked the workers at the site. I told them that we won’t tolerate violence. We can convey their objections to the government. Police only removed them from the machines. There was no lathi charge,” he told The Hindu.

Many men and women showed the cane scars on their backs and legs. Four children with bruises claimed they had either been hit or had fallen while running from the police. The counsel for the arrested, C. K. Pathak said that he wasn’t pressing charges on the police as he first wants his clients to be released.

Bail was denied on a day when CM Shivraj Chauhan visited the district to conduct a mass marriage. On May 28 the government announced a Rs. 212 crore package for oustees of the Omkareshwar Dam, which will be given on condition that they vacate their homes by July 15. The evictees in neighbouring Khandwa had gained international prominence when they went on jal satyagraha by indefinitely immersing sitting in the River Narmada last year.

Here in Chaukhand, an uneasy peace prevails with villagers unsure of whose lands will be occupied and how much money they will get. Many fields have already been filled with rocks by the construction contractors. They are also under pressure from panchayat leaders not to obstruct the construction. Both the dharna continues and construction work has stopped.

Villager Sakaram accompanied this reporter on the way out of the village, which is connected to Dhulkot Panchayat by a long un-metallled road filled with stones. Ambulances don’t come here, he said, and many women have complicated pregnancies due to the journey on bullock cart to the hospital.

On Thurday a Barwani court granted bail to JADS leader Madhuri Krishnaswamy, who was arrested a fortnight back for a 2008 case of rioting. Ms. Krishnaswamy took up the case of a tribal woman giving birth on the street after being evicted from a primary health centre. The suspended pharmacist had filed the case on her.

“Last time we all voted for BJP as they promised us land pattas. This time we are going to meet (Congress state president) Kantilal Bhuria ji when he visits Khargone of June 4,” Mr. Sakaram added. He goes to public meetings of both the Congress and the BJP. “One day they will listen to us,” he explained.

 

#India – Maternal Health Whistle Blower Arrested #Vaw #Womenrights


madhuri1

Published: Thursday, May 30,2013, , http://www.ibtl.in/
ByDr. Rita Pal

Madhuri Ramakrishnasway, a maternal health activist was arrested on the 16th May 2013 outside the court in Barwani, Madhya Pradesh [MP], India. The police had received a complaint from those in charge of a hospital currently under scrutiny for the alleged mismanagement and neglect of maternal health. The background of this complaint is as follows:- On the night of 11th November 2008, a very poor tribal woman from the village of Sukhpuri came to the Menimata Public Health Centre [PHC] during labour. She was admitted by those in charge who allegedly left her unmonitored all night. The hospital then demanded Rs 100, an amount she could not afford. She was asked to leave and the staff refused to arrange transport. Finally, the patient delivered her baby on the street with the help of the local “Dai” (Traditional Birth Attendant), only covered by a cloth held by her father in law. Having witnessed the event, Madhuri took the patient to another hospital to receive treatment. A protest was launched against the unacceptable incident that appears to have been one of many. This case was also part of the writ petition filed in the High Court of MP, Indore Bench in which the substandard state of maternal health services was raised – e.g. the 26 maternal deaths recorded in Barwani District Hospital in 2010 over 8 months were mentioned. The compounder of the hospital was suspended after repeated demands for action but was soon reinstated. It is notable that no one was subsequently held accountable for the dozens of avoidable maternal deaths that have taken place in Barwani. The picture is similar across the rest of the state. The finer points of the case are discussed in more detailed by an excellent Indian blogger and can be read here . “An investigation of maternal deaths following public protests in a tribal district of Madhya Pradesh” [Reproductive Health Matters] states

“We found an absence of antenatal care despite high levels of anaemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment. We present two case histories as examples. We took our findings to district and state health officials and called for proven means of preventing maternal deaths to be implemented. We question the policy of giving cash to pregnant women to deliver in poor quality facilities without first ensuring quality of care and strengthening the facilities to cope with the increased patient loads. We documented lack of accountability, discrimination against and negligence of poor women, particularly tribal women, and a close link between poverty and maternal death”

This whistleblower’s concerns were not without merit. She was subsequently witch hunted as the hospital in question filed a complaint against her, the patient and the patient’s husband. They received a court notice to appear at Barwani Court regarding this case on the 16th May 2013. Apparently, the police filed a closure report but sadly the court remained unsatisfied with this and the report was refused. Madhuri was arrested from the court and imprisoned in Khargone Women’s Jail. The petition completed by her supporters states

“Although the police had filed a Closure Report, it was refused since “clear reasons for closure had not been stated” and Madhuri did not opt for bail since the charges were clearly false[i]; one Section 148 actually refers to “rioting armed with deadly weapons”! She was sent to judicial custody until May 30th 2013”

It goes onto say

“We find unacceptable that the government targets those who work to protect the rights of the poorest Dalits and Adivasis who are suffering due to poor quality of health services; and we demand accountability from the erring officials who are indirectly responsible for thousands of women dying due to preventable pregnancy related causes”

Madhuri Ramakrishnasway is popularly known amongst the tribals of Barwani as “ Madhuri Ben” .She is a leader of Jagrit Adivasi Dalit Sangathan (JADS), a tribal and Dalit Rights Collective. Various advocacy groups under them often hold peaceful protests with a view to raising awareness of the substandard healthcare during pregnancy and labour. She has been involved in developing a grassroots movement demanding good care for rural maternal and child health in some of the remotest parts of the district. In support of Madhuri Ben’s concerns, it is notable that last year :

“The study, conducted on 819 deaths of a total of 1,065 probably maternal deaths reported in Madhya Pradesh between April 2011 and January 2012, suggests 132 women died on their way home or to a health facility” [Source – The Hindu ].

While recent news reports ran headlines about the sudden miraculous “improvement” in mortality rate in the state [ Times of India ], these reports conflicts with a presentation in the previous year on maternal death reviews in MP. Apurva Chaturvedi, State Consultant, National Rural Health Mission, and Archana Mishra, Deputy Director (NRHM), explained that 32 per cent of the reviewed deaths had occurred in district hospitals, 25 per cent in maternity centres, 13 per cent in sub-centres and 6 per cent in private facilities.

“Only 17.7 per cent of the expected maternal deaths are being reported and analysed while the remaining go unreported. Worse, in 37 per cent of the cases the cause of maternal deaths is registered as ‘other’,” they said.

The questionable statistics and the reasons for this was argued well by Sachin Jain. The government’s position isn’t convincing given the reports on the ground. It is therefore time for a legitimate investigation into the serious risk posed to vulnerable mothers in this state. The first task for the government is to cease harassing its whistleblowers who point out their spectacular failings. Then they should apply their minds more constructively to improving healthcare for patients at risk of neglect and death. They may also wish to improve their ability to collect statistics to avoid being embarrassed further. Click here to Sign the Petition

Author : Dr Rita Pal, Follow her twitter.com/dr_rita39

 

PRESS RELEASE- The illegal order remanding Madhuri to Prison


                                                                        25 May, 2013

 

PUCL Takes Serious Exception to Illegal Order Directing Imprisonment of Social Activist Madhuri of Jagrit Adivasi Dalit Sanghatan and

PUCL Coordinator for Madhya Pradesh

PUCL is extremely shocked and takes exception to the arbitrary, illegal, and capricious manner by which the Chief Judicial Magistrate (CJM), Barwani on 16th May, 2013 directed the imprisonment in Central Prison, Barwani of Madhuri Krishnaswamy, a well respected tribal rights activist of the Jagrit Adivasi Dalit Sanghatan (JADS) and PUCL co-ordinator for MP. PUCL also takes exception to the rejection by the CJM, Barwani of the `Closure Report’ filed by the prosecution in a 2008 case as illegal, violative of established principles, abuse of the process of law and resulting in harassment of accused.

 

Facts of the Case:     The case in which Madhuri was imprisoned on 16th May, 2013 relates to incidents that took place in November, 2008. On 11.11.2008, 21-year old Baniya Bai, wife of Iddiya, of Sukhpuri village, full term pregnant, was brought for her first delivery to Primary Health Centre (PHC), Medimata, after a 15 km journey over bullock cart. The next day, 12.11.2008, the PHC Compounder, VK Chauhan, and nurse Ms. Nirmala, allegedly demanded a bribe of Rs.100/-.  As Baniya Bai and her parents-in-law were unable to pay the bribe, she was thrown out of the PHC. Baniya Bai delivered her child, in public, on the road opposite the PHC gate. A local tribal traditional mid-wife, Jambai Nana, assisted the delivery. Madhuri, who happened to be in the town heard about the incident and contacted the Silawad Child Health Centre, the Silawad Police Station.  Senior health officials at the District HQs at Barwani arranged for a vehicle to transport Baniya Bai and the newly delivered child to Silawad Hospital for further treatment. In the meantime local people gathered and protested about the callous and inhuman treatment meted to Baniya Bai, which was routine in the area.

 

In a bizarre manner, the Silawad police instead of taking action against the PHC compounder, Chauhan and other staff for criminal negligence endangering the life of Baniya Bai, corruption and abuse of office, registered an FIR, Crime No. 93 of 2008 dated 12.11.2008 u/s 353, 332, 147 and 427 IPC and sec. 3 and 4 of the Madhya Pradesh Chikitsak Tatha Chikitsa Seva Se Sambadh Vyaktiyon Ki Suraksha Vidheyak, 2008 at the Silawad Police Station showing PHC Compounder Chauhan as the complainant and naming Bachiya Borla, Bhurelal Borla, Basant Kumar, Kamal, Iddiya (husband of Baniya Bai) and Madhuri as accused. Iddiya was not even in Medimata on the incident day!

 

The offences charged included voluntarily causing hurt to deter public servant from his duty (sec. 332), assault or criminal force to deter public servant from discharge of duty (sec. 353), mischief causing damage to the amount of Rs. 50/- (sec. 427), and punishment for rioting (sec. 147).  All the offences carried a maximum sentence of 2 to 3 years imprisonment.  Sections 3 and 4 of the Madhya Pradesh Chikitsak Tatha Chikitsa Seva Se Sambadh Vyaktiyon Ki Suraksha Vidheyak, 2008 provides for imprisonment for a period of 3 months or fine of Rs. 10,000/- or both for act of violence or threat to medical personnel, which is deemed to be a cognisable and non-bailable offence.

 

In December 2010, Bachiya and Bhurelal Borla were arrested and released on bail by the local court. Madhuri, for the first time in over 4 years, was summoned to appear before court of CJM, Barwani on 16th May, 2013.

 

The Closure Report filed by Prosecution and its Rejection

 

A full 4 years after the FIR registration, on 18.12.2012 the prosecution filed a Closure Report u/s 173 Criminal Procedure Code (Cr.PC for short) stating that at the end of investigation they did not find enough evidence to prosecute Madhuri and others and seeking the `closure’ of the criminal case. Importantly, the prosecution reported that investigation revealed and established that the incident of 12.11.2008 by which Baniya Bai, was forced to deliver her child on the road outside the PHC had indeed taken place, and that local people had got agitated over the incident but that there was no pre-meditation or plan and it was a spontaneous gathering. Further, the police, on record, concluded that there was not sufficient evidence to establish the allegations of the PHC compounder.

 

In the meantime the case was transferred to the CJM Court, Barwani. On receiving notice, a sworn statement was recorded from the de-facto complainant, VK Chauhan. Chauhan on 5.3.2013, to the effect that the incident as narrated in the FIR did take place. On 20.4.2013, the CJM confirmed the statements of 5 witnesses. Noting that there is corroboration in the statements of all the witnesses regarding the names of the accused, the CJM held that there is no merit in closing the case and closure report cannot be accepted. The prayer for closure was therefore  dismissed and cognisance  taken for offences u/s 332, 353, 147, 427 and 3 & 4 of the Madhya Pradesh Chikitsak Tatha Chikitsa Seva Se Sambadh Vyaktiyon Ki Suraksha Vidheyak, 2008.

 

Importantly, the 2 accused who had obtained bail, Bhachiya and Bhurelal,  were not informed about the Closure Report or the objection of the de-facto complainant and not informed that they had a right to place before the CJM’s court their arguments in favour of the closure report or the de facto complainant’s objections.

 

Why is the Rejection of Closure Report Illegal?

 

The Supreme Court has in numerous cases including `Dhasmana v. CBI’ (2001(7) SCC 536), `Bhagwant Singh v. Commissioner of Police’, (1985(2) SCC 537), `M/s India Carat (P) Ltd v. Karnataka’, (1989(2) SCC 132) held that the Magistrate has the powers to reject the `closure report’ filed by the prosecution and to decide to continue with the criminal case. However the court has to strictly comply with the procedures enumerated in law and clarified by the SC.

 

There are three critical steps: (a) De-facto complainant should be informed to file his detailed objection rebutting  the prosecution decision to close the case. (b) Similarly the accused should also be given an opportunity to oppose the de-facto complainant as their interests will also be prejudiced by the order of the court; and (c) the Magistrate, after study of all relevant facts and materials before the court, should give a detailed reasoned order recording the reasons and explaining why the closure report is being rejected.

(i)                In the present case, the judicial order of the CJM, Barwani rejecting the `closure report’ is mechanical. It would not be out of place to highlight that in the eventuality of rejection of the closure report, the CJM ought to have directed for further investigation u/s 173 (8) or 156 (3) of the CrPC directing the police to examine Baniya Bai w/o Iddiya and her in-laws, who are referred  by the complainant in the FIR, the 161 Cr PC statements, to find out the truth of what happened on 11th and 12th November, 2008. By not doing so it shows a prejudiced mind  of the CJM and also violates their duty under law to do       ” full justice”. CJM also failed to take note of the remark of the closure report in which the incident of denying the PHC facilities to Baniya Bai which forced her to deliver on the roadside opposite the PHC which caused a public outcry. This selective and pick and choose method adopted by the CJM to decide on continuing with the prosecution is seriously objectionable, causes prejudice to the accused and is illegal.

(ii)              The de-facto complainant did not file a `protest petition’ or in any case, in his sworn statement recorded on 5.3.2013 did not explain the grounds as to why the prosecution’s `closure report’ was bad in law and fact. Not specifying the grounds of protest has robbed the prosecution and accused an important opportunity to counter the de facto complainant’s case and thus legally affects the rejection by CJM of the `closure report’.

(iii)            No opportunity was given to the accused in the case, particularly the 2 accused persons released on bail, to oppose the de-facto complainant. This constitutes a serious violation of the `Principle of fair hearing and opportunity’ to be given to the accused and thus invalidates the rejection by the CJM of the `Closure Report’.

(iv)             The SC in `Vasanti Dubey vs State of MP’ (2012) has clearly pointed that the functions of the magistrate are different from the police and reiterated the view that “we cannot impinge upon the jurisdiction of the police by compelling them to change their opinion so as to accord with his view” and that the Magistrate “cannot direct the police to straightaway file charge sheet”.

 

As the SC pointed out, unless the procedures were followed, the orders of the Magistrate to continue with the criminal prosecution would become illegal, and would result in an abuse of process of law resulting in vexatious proceedingand harassment of the accused.

 

Bar to taking Cognisance u/s 468(c) Criminal Procedure Code

We would like to point out that the CJM seems to have ignored the bar imposed by section 468 of the Criminal Procedure Code that no court shall take cognisance of an offence beyond a period of three years if the offence is punishable with imprisonment for a term exceeding one year but not exceeding 3 years. It is to be noted that all the offences charged in the present case impose a maximum sentence of three years. Hence the order of the CJM, Barwani dated 20.4.2013 taking cognisance itself is illegal as it hit by the limitation for taking cognisance imposed by section 468(c) of the Cr.PC.

It also needs to be pointed out that sec. 473 Cr.PC provides for extension of limitation in certain situations; however for invoking this provision the CJM ought to have clearly explained and spelt out in the order dated 20.4.2013, the reasons why the CJM was satisfied that the cause of delay has been properly and satisfactorily explained or that it is necessary to condone the delay in the interests of justice. To our knowledge, the order of the CJM neither explains the reason for the delay in filing the closure report (in effect the police final report u/s 173 CrPC) nor explains the reasons for condoning the delay thereby directing taking of cognisance in the `interests of justice’.

The provisions of sections 468 and 473 are mandatory and non-compliance with them vitiates the order of the CJM dated 20.4.2013 taking cognisance. In effect the order of the CJM taking cognisance of the case in FIR, Cr. No. 93/2008  becomes illegal. It follows that the consequent legal proceedings initiated in the case, including remanding Madhuri thereby imprisoning her, are also illegal.

 

Order of CJM Remanding Madhuri to Prison is Illegal

 

It needs to be pointed out that on 16.5.2013, Madhuri appeared voluntarily before the CJM, Barwani’s court on receiving summons. This clearly establishes her to be a law abiding citizen. It is in this light that PUCL takes exception to the action of the CJM, Barwani remanding and imprisoning Madhuri as being violative of criminal laws and procedures established by the Supreme Court, as being an infringement  of her fundamental right to freedoms to life and liberty under Articles 20 and 21 of the Constitution and being an egregious abuse of power by the Judicial Magistrate.

 

  1. The Supreme Court has repeatedly stressed that imprisonment should be resorted to only as a last resort and only in the circumstance when the court feels that the accused will abscond or evade justice or threaten witnesses or tamper with evidence and this fact should be recorded. In all other circumstances, if the accused person will appear on summons, then imprisonment should be avoided.

The material on record indicates that Madhuri is a law abiding person who appeared voluntarily, on being summoned to appear before the CJM, Barwani. Hence the order directing Madhuri’s imprisonment is bad in law, abuse of power of court and an act of judicial excess violative of fundamental rights of Madhuri.

 

  1. The key point to be noted is that there is a difference between the preliminary investigation stage when a FIR is registered to when a person has been summoned to appear and appears in compliance, at the end of investigation. The Supreme Court has said in `Joginder Kumar v State of UP’ (1994), that even at the stage of start of investigation the power to arrest is one thing, but the justification of the arrest is another matter altogether and can be judicially reviewed. Such being the legal dictum at the start of investigation, at the stage of end of investigation, the court will necessarily have to provide sound reasons justifying the need for imprisonment. Not doing so taints the remand order with illegality and unjustness.

 

  1. The SC has in M/s India Carat (P) Ltd v State of Karnataka (1989(2) SCC 132) and  in `Vasanthi Dubey vs State of MP’ (2012) said that in the event of a rejection by Magistrate of `Closure Report’, the CJM could only have proceeded to continue prosecution case by way of taking cognisance u/s 190(1)(c) or 200 CrPC and order issue of process to accused. In such a case where the accused appears on summons the accused is automatically entitled to bail on personal bond.

 

  1. There was no need for the CJM to have ordered remanding Madhuri to judicial custody as there is no need for `custodial interrogation’, as the case had reached the concluding stage. There are provisions like sec. 88 of the Cr.P.C. for `binding over’ accused to appear in further hearings. Hence it was unjust on the part of the CJM to have remanded Madhuri on 16.5.2013 and the remand order is illegal.

 

We reiterate, `Any order which is passed without adhering to the “procedure established by law” is illegal Further the `procedure’ must be “fair procedure”.

 

In the face of such illegalities committed by the CJM, Barwani in unjustly remanding Madhuri Krishnaswamy to judicial custody and imprisonment and the violation of procedural compliance while rejecting the `closure report’ of the prosecution, PUCL would like to place the following demands before the Madhya Pradesh Chief Minister Shri Shiv Raj Singh Chauhan:

 

1.      The immediate release of Madhuri Krishnaswamy: The State through the Director of Prosecutions must approach the appropriate judicial forum and defend the closure report and challenge the cognizance taken by the JMFC Court of the charge sheet by placing all relevant documents before the judicial forum so that an informed and judicious decision can be taken for closing the criminal case against Madhuri and other tribal people.

 

2.      Appropriate Criminal and Departmental Proceedings against errant PHC Staff: Appropriate criminal and departmental Proceedings must be initiated against the compounder, VK Chauhan, the nurse, Nirmala, and other staff of the PHC who denied the basic medical services to the pregnant woman, Baniya Bai on 11th November, 2008, endangering her life. The issue of limitation in initiating prosecution must be properly explained so that legally, criminal action can be launched against Chauhan and Nirmala and others responsible for endangering the life and health of Baniya Bai, even now.

 

3.      Just and adequate compensation: The State must pay just and adequate compensation to Baniya Bai for the severe physical harassment and mental agony she was forced to undergo in November, 2008, owing to the omissions and commissions of the Staff of PHC, Medimata.

 

4.      Proper Pre-&-Post Medical care for Expecting Mothers and Implementation of NRHM and JSY: The Government of MP must ensure that no woman, in the future, will be subjected to what Baniya Bai and others like her were subjected to, and medical services in maternal cases inter alia must not be denied and must be provided promptly and effectively. Barwani District Administration should ensure proper implementation of the Janani Suraskha Yojana as also the National Rural Health Mission.

 

5.      Protection and Care of Human Rights Defenders: The State government must ensure the protection and care of Human Rights Defenders in the State of Madhya Pradesh from any kind of retaliation, violence, discrimination or any adverse action whatsoever from private or State actors.

 

We would like to point out to the State Government that there has been consistent attempts by the state administration to silence and intimidate Madhuri by `externing’ her from the district and by threatening to arrest her by dubbing her a Maoist. Such intimidatory tactics are a shame and should be immediately stopped. We are also constrained to point out that there are similar attempts to specifically target other social activists like Medha Patkar, Dr. Sunilam and others by falsely implicating them in foisted cases. We call upon the Government of Madhya Pradesh to desist from such anti-democratic and anti-human rights and anti-constitutional practices and remind the government that voicing dissent and opposition are not part of democratic and human rights but in the end, help strengthen democracy.

 

We reiterate that it is a fundamental right of the citizens to be provided corruption-free, good governance, especially in the area of health services; people also have a fundamental democratic right to protest if the government and its functionaries fail to provide inclusive, equitable dignified health and other public services. The MP State Government in particular and all governments in general, also ought to recognise the democratic rights of citizens to seek accountability from state functionaries and to demand transparency, responsibility and open administration. The government ought to understand that a vigilant citizenry demanding good governance is reflective of a vibrant, strong democracy and should not treat them as `foes or adversaries’ who should be silenced and suppressed.

 

 (Dr. V. Suresh)                                   (Kavita Srivastava

National General Secretary                 National Secretary

 

#India – 5000 people on the road to Protest Arrest of Women Health Activist


Massive rally by JADS in Badwani, MP to protest against unjust arrest of Madhuri

madhuriprotest1
As is now widely known, the leading organizer of Jagrit Adivasi Dalit Sangathan, Madhuri was arrested
on 16th May 2013 at Barwani district court. This arrest was made in connection with the protest done by
the Sangathan related to the case of an adivasi woman Baniya bai, who was forced to deliver on the
roadside near Menimata PHC, because she was denied care in the PHC.
In response to this unjust arrest, nearly 5000 people mobilized by JADS, including large numbers of
women, demonstrated on 21st May 2013 in front of the District collector’s office at Barwani. Key
demands of the protesters were release of Madhuriben along with dismissal of all false cases against
various activists, major improvement in public health services, and eliminating large scale corruption in
implementation of the NREGA programme in the district. Major slogans included “Amu akkha kon chhe
– Madhuri chhe, Madhuri chhe” (‘Who are all of us – all of us are Madhuri’), “Aspatal mein loot band
karo” (Stop exploiting patients in Hospitals) and Nyay nahi to jail do” (‘Either give us justice or give us
jail’). The demonstrators from various far-flung areas of the district had gathered from 1 pm to 9.30 pm
in front of Collector’s office, but the collector refused to address the demonstrators or to meet their
representatives.
In this situation of total non-responsiveness of the District administration, JADS activists finally pasted a
notice on the police barricade, addressed to the Chief Minister, giving the warning that if the government
does not release Madhuriben by 30th of May, the Sangathan would mobilise an even larger rally at the
Collector’s office.

madhuriprotest

protest2

 

Woman Activist lands in jail for protesting lack of health facilities in tribal district five years ago


Author(s): Kundan Pandey
Date: May 18, 2013

People picket police stations; fellow activist claims case is baseless

Madhuri Krishnaswami had protested the treatment meted out by a health centre to a poor woman in labour. She has also exposed corruption under MGNREGAMadhuri Krishnaswami had protested the treatment meted out by a health centre to a poor woman in labour. She has also exposed corruption under MGNREGAMadhuri Krishnaswami, a health activist working with tribal communities in Barwani district of Madhya Pradesh, was sent to jail on May 16 after she turned down the court’s suggestion to take bail. The court ordered her arrest in connection with a five-year-old case  registered in 2008 against Krishnaswami and others for their protests against the deficiencies in public healthcare facilities in the state.

People protesting against Krishnaswami's arrest People protesting against Krishnaswami’s arrest

Residents of the area have been on sit-in protest in front of six police stations in the district since Friday, demanding the activist’s immediate release.

Krishnaswami is the head of Jagrit Adivasi Dalit Sangathan (JADS), a non-profit that works on various matters, including healthcare for tribal people and marginalised communities. She has been sent to Khargone women’s jail on 14 days’ judicial remand.

Harassed for exposing corruption

Social activist Chinmay Mishra, who is closely associated with the case, in an interview over the phone, said Krishnaswami has played a significant role in exposing corruption worth several hundred crore in development schemes under Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) in the district. The local administration is quite annoyed by her activities and had earlier ordered her externment. However, after protests by locals, the administration cancelled the order. This step (of arresting Krishnaswami) has been also taken for the same reason, adds Mishra.

The 2008 case was registered against Krishnaswami for protesting the treatment meted out to a pregnant woman in labour. Baniya Bai was refused admission by the compounder at the Menimata public health centre, Vijay Klumar. The woman delivered her baby on the road. Krishnaswami, who was in the area, intervened and sent the mother to hospital, and protested her ill-treatment.

Kumar later lodged a complaint against Krishnaswami, Baniya Bai’s husband Basant and other protesters. A case of rioting and assaulting a public servant under sections 353, 332, 147, 148 and 342 of the Indian Penal Code was registered against Krishnaswami and other protesters in 2008. Five years later, police filed a closure report (April 30, this year).

But the court refused to close the case and ordered notices to be served on the parties on May 2, says Mishra. The notice was not served on Krishnaswami, he adds. The activist appeared in court voluntarily to justify her actions. She was informed that the police had filed a closure report but had not stated clear reasons for the closure and so the report was rejected, adds Mishra.

The court suggested that Krishnaswami take bail, but she refused, quoting Mamatma Gandhi, “Jail is rightful place for independent persons of slave country.”  She demanded that the case be revoked and the doctor and compounder responsible for Baniya Bai’s ordeal be punished. Krishnaswami was subsequently placed under arrest on court’s order.

Mishra says that the case is baseless, and was filed with malafide intention.

Baniya Bai is also a party to the writ petition filed in the Indore bench of the Madhya Pradesh High Court, in which the status of maternal health services in the state was questioned. Twenty-nine maternal deaths have been recorded in a span of nine months at Barwani district hospital.
 

 

Press Release- Is organising for proper health services for a poor a `criminal activity’ ? #Vaw #Stateoppression


Release Madhuri immediately

 

New Delhi, May 20th , New Delhi

National Alliance for Maternal Health and Human Rights (NAMHHR), a group of civil society organisations from across the country have come together as a broad alliance, that strongly condemn the use of court proceedings against maternal health activist, Ms Madhuri working in Jagrit Adivasi Dalit Sangathan(JADS1) who has been arrested on 16th of May 2013. She has been arrested for forcing a pregnant woman i.e. Baniya Bai who was in a critical condition and was in labour to deliver in full public view just outside the Menimata PHC. The case was filed against Madhuri, Baniya Bai’s Husband, Basant and others by the compounder and was registered as FIR No 93 of 2008. This case of Baniya Bai is also part of the writ petition filed in the High Court of MP, Indore Bench in which the status of maternal health services was raised in light of 29 maternal deaths recorded in a span of 9 months in Barwani DH.

Madhuri appeared in the court on 16th May at Shri D.P. Singh Sewach, JMFC and informed, that the police had filed a closure report (khatma) but had not stated clear reasons for the closure and therefore the report was refused. Madhuri was arrested from the court complex and has been remanded in JC till 30th May 2013 and will be placed in Khargone women’s Jail.

As social health activists, many of us are witness to the fact that the area has a history of organised action and peaceful protests for improvement of rural health services, specifically for maternal health services. The details of the case clearly show that Madhuri informed the police officials and helped the pregnant women and newborn to get emergency obstetric care after delivery. However, instead the administration who should have taken a stringent action against the hospital staff (the compounder and the nurse) who forced Baniya to leave the hospital and asked for informal fees from the family members have arrested Madhuri.

We, the civil society groups are extremely disturbed by it and need an answer from the administration as why helping and organising for proper health services for a poor vulnerable family can be construed as a `criminal activity’.

Details of the case are as follows:

A ST resident of of village Sukhpuri, Barwani. Baniya Bai was taken to the Menimata PHC for delivery by her father-in-law, Dalsingh, on the night of 11 November 2008.  They made the 15 km journey on a bullock cart because no other transport was available.  After admitting and taking a cursory look at her, the compounder, V.K. Chauhan, and nurse, Nirmala, left the PHC and went home.

The next morning, Baniya was forced by the compounder and the nurse to leave the hospital.  Her family was asked for Rs. 100, which they did not have and so Dalsing immediately went to get money from their village.  Despite attempts to re-admit Baniya Bai to the PHC, the compounder flatly refused saying that they could not manage the delivery so she would have to go to Barwani DH or Silawad Hospital.

Baniya’s relatives tried to get the Menimata hospital compounder, nurse and staff to call for the Janani Express, but were unsuccessful. The family was told to make its own arrangements to refer to a higher hospital.  When forced to leave the PHC Baniya Bai crawled out of the labour room, on to the road outside the PHC, where she lay down in severe pain.

Eventually, Baniya’s mother-in-law, Suvali Bai, went looking for a Dai in the marketplace and found Jambai Nana, who had come to market collect her wages. After hearing about Baniya Bai’s situation, Jambai agreed to assist her, and at around 12PM, conducted a normal delivery on the road outside the hospital. The father-in-law gave his dhoti (loin cloth) to provide cover for Baniya Bai during delivery. Following this incident, a crowd gathered outside the health centre.

Madhuri was passing by, inquired about what was happening. She then called up the Silawad CHC, the Silawad Police Station as well as health officials from Barwani. Upon being informed, senior officials from the health department ordered for a vehicle to be sent immediately to the Menimata PHC. After being denied emergency obstetric care and being forced to deliver in public view, Baniya Bai’s and her child were taken to the Silawad Hospital for admission. The compounder was suspended after repeated demands for action from JADS, but was soon reinstated.

1 JADS is a membership- based mass organisation of several thousand families, has been campaigning for over 14 years for the realisation of the constitutional and legal rights of adivasis in Barwani, Madhya Pradesh, one of the most backward districts of the country.

contact us —http://namhhr.blogspot.in/

SIGN PETITION FOR MADHURI HERE —http://petitions.halabol.com/2013/05/17/release-maternal-health-activist-madhuri-immediately

 

Tribals protest over Madhuri being sent to Jail for speaking for the ‘right of pregnant women #Vaw


PLEASE SIGN PETITION FOR HER RELEASE HERE

http://petitions.halabol.com/2013/05/17/release-maternal-health-activist-madhuri-immediately

May 18, 2013, 03.55AM IST TNN

INDORE: Tribals from different villages of Barwani are on an indefinite dharna in front of police stations in the district protesting judicial remand of Jagrit Adivasi Dalit Sangathan (JADS) leader Madhuri. Different social organizations from the state have come under the banner of Jan Sangharsh Morcha to protest against the development.

Alok Agrawal of Jan Sangarsh Morcha said the incident of sending Madhuri to judicial custody has exposed the ‘Janani Suraksha Scheme’ of Madhya Pradesh government. He said an activist is sent to jail for speaking for the ‘right of pregnant women.’

Har Singh of JADS said, tribals are sitting in front of different police stations of the district including Pati, Silawad, Pansemal and Niwali. He said the protests will continue till fake cases against Madhuri were not revoked and guilty are punished.

Madhuri had refused bail in a five-year-old case registered against her and four other persons at Menimata under Silawad police stations. She was sent to Khargone jail on judicial custody on Thursday.

Social organizations claimed that the incident has once again highlighted the apathetic condition of health services and schemes like rural health mission in tribal areas. A case under sections of 353, 332, 147, 148 and 342 of IPC was registered against Madhuri in 2008 for raising question mark on health service and system.

On November 12, 2008 a pregnant tribal women Baniya Bai of Shukpuri village was forced out of Public Health Service (PHC) of Menimata. Despite repeated request she was not taken in and Baniya Bai delivered her child on the road in front of PHC. Madhuri of JADS was passing by and immediately summoned an ambulance and took the tribal woman to the hospital. Thereafter, she launched a protest against the PHC.

Irked over a compounder of PHC Menimata Vijay Kumar filed a complain under a non- bailable offence against the social activist Madhuri.

 

Gandhian activist arrested in MP, adivasis up in arms


Bhopal, May 17, 2013

 

Staff Reporter

 
A file picture of Gandhian activist Madhuri Krishnaswami who was arrested for fighting against the injustice meted out to adviasis in Madhya Pradesh.

The Hindu A file picture of Gandhian activist Madhuri Krishnaswami who was arrested for fighting against the injustice meted out to adviasis in Madhya Pradesh.
 
 

Madhuri Krishnaswamy, a leader of the Jagrit Adivasi Dalit Sangathan (JADS) – which works for health and labour rights in the south-western Madhya Pradesh – was sent to judicial custody for a fortnight, on Thursday. Ms. Krishnaswamy, popularly called Madhuri Ben, and four others were summoned by Judicial Magistrate First Class D. P. Singh Sewach in Barwani on Thursday for a 2008 case of rioting and assaulting a public servant.

The police, in fact, had filed a closure report for lack of evidence, but the court took cognizance of the testimony of plaintiff Vijay Chouhan and summoned the respondents. Only Madhuri Ben appeared and was sent to Khargone Women’s Prison after she refused to seek bail. Two of the four others are already on bail. The others are expected to be arrested soon.

In 2008, Madhuri had alerted health and police officials after a tribal woman was forced to deliver her child on the road, after been evicted from a primary health centre by the compounder Mr. Chouhan. He also filed the case against the JADS, was suspended only to be reinstated later.

JADS activists picketed at six police stations in Barwani district on Friday. Union rural development minister was also in the district for the Congress’ Parivartan Yatra. “We told him that arresting the person who exposed the government is injustice. He said he spoke to the chief secretary. We also told him that we are only getting Rs. 22 to 26 as MNREGA wages (instead of the stipulated Rs. 100). He did not say anything,” Harsing Jamre of the JADS told The Hindu.

District superintendent of police R. C. Burra told this reporter, “We had to arrest her as the court ordered it… He (Mr. Jairam Ramesh) asked about her and we gave him all the details of the case.”

Ms. Krishnaswamy is scheduled to appear before the Chief Judicial Magistrate on May 30.

She was served a show-cause notice of externment from the district administration, last year, which accused her of preventing officials from doing their duties. This came after she protested against the death of a tribal woman after 27 hours of labour without medical help. Mr. Ramesh had then too written to chief secretary R. Parasuram to intervene.

Maternal Health Activist Madhuri of JADS arrested #Vaw #Tribalrights


 

English: National Rural Health Mission of India

English: National Rural Health Mission of India (Photo credit: Wikipedia)

 

Five Years of NRHM-JSY and more than a decade of RCH: continuing maternal deaths in Barwani and MP
Background
Janani Suraksha Yojana (JSY) was launched under the National Rural Health Mission (NRHM) in
April 2005 as a safe motherhood intervention, with the specific objective of reducing maternal and
neo-natal mortality by relying on institutional delivery as the primary strategy for making available
medical care during pregnancy, delivery and post delivery period, and thus promoting safe
motherhood. All women are encouraged to avail institutional care during pregnancy and delivery,
and through ASHAs recruited specifically for this purpose institutional delivery is being promoted
among poor pregnant women. JSY is a 100 % centrally sponsored scheme, and it links cash
incentives to pregnant women with hospital delivery and post-delivery care. Reproductive and
Child Health (RCH-I) has been operational since 1997 as a project to provide a variety of
reproductive and child health services in rural areas to bring down maternal and infant mortality, in
order to reduce fertility rates and achieve population control. The second phase of the program
(RCH-II) also commenced in 2005. NRHM itself was launched with the promise to improve
availability and accessibility to health care services to the rural population, especially the
disadvantaged groups including women and children, by strengthening public health systems for
efficient service delivery, improving access, enabling community ownership and demand for
services, enhancing accountability and promoting decentralization.
It is against this context of programmes and interventions and associated fund flows from
the central government and several international agencies that one needs to view the status of
public health services, of maternal and child health in the country in general and specifically in the
high-focus states like MP, and the developments in Badwani that is the focus of this report.
Mass protest against maternal deaths in District Hospital, Barwani
On 28th December 2010 a rally was held in Barwani town, the headquarters of a predominantly
adivasi district in south-western MP. Nearly a thousand people gathered under the banner of
Jagrit Adivasi Dalit Sangathan (JADS), a mass organisation, to protest against extremely
negligent treatment of women in pregnancy and labour, particularly the death on 29th November
2010 of Vypari bai, an 8-months’ pregnant woman admitted in the District Hospital.
The people had come for this rally
from far-flung adivasi villages of the
district, and sought to draw attention to and
to protest against extreme callousness and
ill-treatment regularly meted out to women
in pregnancy and labour by the public
health system, particularly the District
Hospital (DH). A quick perusal of the DH
records indicated that between April-
November 2010 there had been 25 maternal
deaths, and 9 maternal deaths had been
recorded in this hospital in the month of
November 2010 alone. In addition, deaths
of 21 neonates (within 24 hours of birth) had been recorded, related to 511 deliveries conducted
in the hospital during November 2010. People complained that women with problems during
pregnancy and labour were frequently referred to Indore Medical College Hospital, located 150
kms away, despite the DH being supposed to deal with such cases.
The tragic story of Vypari bai – ‘institutional death’ instead of ‘institutional delivery’
Vypari bai, a 22 year old woman had travelled over 55 kms from her village Ban since the
morning of 27th November 2010 to reach the District Hospital, having been referred from the
PHC at Bokrata, and then from the CHC at Pati. She had been carried in a `jhuli’ (cloth sling)
over the first 10 kms from her village to Bokrata, from where the family managed to get the
Janani Express ambulance. She had experienced a convulsion that morning, and had high blood
pressure (BP) and eclampsia at the time of admission in the DH around 1.30 pm on 27th
November.
Following her examination by a gynaecologist at the time of admission in the DH on 27th
Nov., she was visited only once by another doctor during the entire day on 28th Nov. She had been
prescribed medicines after admission to control her BP, but her treatment sheets show only two
measurements of BP during the entire stay from 27th to 29th Nov. No attempt seems to have been
made to deliver the baby, by either induction or cesarean, as is the standard procedure in such
cases. An ultrasound scan on 28th November (for which the woman was taken by auto-rickshaw to
a private centre even though the hospital has this facility) showed the presence of live foetus.
Both the mother and mother-in-law of Vyparibai are trained health workers, presently
working as ASHAs in the NRHM. The mother-in-law Dunabai in desperation attempted to contact
the gynaecologist, who never turned up to see the patient in spite of repeated pleas from the
patient’s family. Moreover the doctor on duty, after checking the patient only once on 28th, was
also absent from the hospital premises. After repeated efforts to contact her, at late night at around
11 pm on 28th November, she instructed the nurse on duty that the relatives could take the patient to
Indore, but did not bother to examine the patient or modify the treatment. When the family went to
the doctor’s residence (which is within the hospital premise at a stone’s throw from the ward) on
28th night to ask her to attend to the woman as she was in great pain, the doctor refused to go,
saying she would phone the instructions to the nurse. The young woman finally breathed her last at
5 am on 29th November 2010, without medical attention despite being admitted in the District
Hospital.
Both the block CHC and Barwani DH are CEMONC (Comprehensive Emergency Obstetric
Neonatal Care) centres, and the DH is equipped with a Blood Bank. Such centres are supposed
to provide emergency services related to pregnancy/ delivery round the clock and 365 days a year.
In any case, a hospital at the level of district hospital is supposed to provide emergency services at
all times, whether or not it is a CEMONC. Further, there is provision that in case of complications,
CEMONC centers can contract-in services of private medical practitioners. So she could have been
referred under the ‘Janani Sahayogi Yojana’ to one of the two local private hospitals. The DH has
four gynaecologists and two anaesthetists, who could have ensured Vypari bai’s delivery. However,
the case paper shows that nearly 35 hours after admission, the patient had been referred to the
medical college hospital in Indore at around 11 PM on 28th. Further, the family was asked to sign
an undertaking, stating that they were refusing to take her to Indore and they took responsibility for
the consequences. It has been repeatedly experienced that, rather than using the institutional
provisions, patients are generally referred to Indore. And are also made to sign such undertakings.
Several other cases of denial of services leading to complications and ill-treatment at all
levels of health services have been documented by JADS. Few illustrative ones are described
below.
District Hospital, Barwani – Baltabai, 20 years, Village- Ubadagad, Pati Block,
On 6th June 2010, 9-months’ pregnant Baltabai was taken to Pati CHC with labour pains, by bus at around 12
o’clock in the afternoon. There was no doctor in the CHC. When the family contacted the BMO and
requested him to see Baltabai, the BMO did not do so, but simply arranged for the Janani Express
Ambulance and referred the patient to the District Hospital. Around 3 PM Baltabai was admitted in the
female ward of the DH. Not a single doctor was present in the female ward, ostensibly because `it was
Sunday’. The nurse on duty informed the doctor who was supposed to be on duty, but was not physically
present in the hospital premises, about the serious condition of Baltabai. She was advised some blood test,
and after the blood report was available, referred by the doctor to M.Y. Hospital, Indore. During this period
the relatives were not adequately informed about the condition of the patient and need for referral. What is
more serious is that the family was not informed about intrauterine foetal death. Following the nurse’s
advice to go to the local hospital instead of Indore, the family took Baltabai to the private trust hospital in
the Barwani town, where the doctor examined Baltabai and informed them that the foetus was dead. She
recommended an emergency operation to remove the dead foetus and save the mother. The family had no
option but to go ahead with this surgery. They incurred a cost of around Rs 10,000/- and an additional Rs.
7000/- were spent on medicine. The family, dependent on daily-wages, had to borrow money from local
money lenders at very high interest rate.
On 14th June Baltabai was discharged from the trust hospital. However, her agony was not
over yet. On reaching home that evening she complained of abdominal distension and pain. On 15th
June, at 4 am she was taken to a private practitioner, where she was cathetarised, and again referred
to the DH, where she was treated till 21st June. On 21st June Baltabai was referred to M. Y. Hospital
Indore for treatment of paraplegia. What exactly happened to Baltabai from15th – 21st June is not
very clear, largely because there are no trustworthy clinical records. Why and how Baltabai
developed paraplegia was never explained to the family members and other concerned people.
Fortunately Baltabai’s condition improved in the M.Y. Hospital and she was subsequently
discharged on 1st July. The ordeal of Baltabai lasted for 24 days (6th June to 30th June), and has left
the family severely indebted.
In September 2008 a woman in labour at the District Hospital was referred by the attending
doctor to Indore as a case of obstructed labour. The family took her to the local Trust hospital,
where a caesarean operation was performed and the child delivered safely. However, due to the
delay the child developed complications and had to be admitted in the neo-natal intensive care unit
(NICU) in the DH.
CHC-Pati block – Meera, Patel phaliya , Pati
Meera had symptoms of threatened abortion since the second month of pregnancy; and was treated
at CHC, Pati. However, the doctor advised her that she should not rely on the medicines available
in the hospital, and made the family purchase injections and medicines from outside the hospital,
worth about Rs 1000-1200. Meera followed all the instructions given by the doctor, as she was told
that she would have a difficult labour. Despite this treatment Meera had intrauterine bleeding one
morning. When she called up the CHC for the Janani Express ambulance she was told that since
she was from Pati itself, she should go to the hospital by herself, and would not be provided the
ambulance. The lady walked over 5-8 km, for almost 2 hours, bleeding and in terrible pain, to reach
the CHC. At the CHC, she was informed that the baby had died in the womb. The family was
forced to purchase few special medicines from outside for the operation to remove the dead foetus.
PHC Menimata – Baniya Bai
On the night of 11th November 2008 Baniya bai went to the PHC Menimata for delivery. The
compounder and nurse asked her family for Rs 100, which the family did not give. The next
morning she was forced to leave the hospital on grounds of being anaemic. Baniya Bai, in
labour pain, managed to crawl out to the road outside the PHC, where she delivered with the help
on the local dai. She was then sent by members of JADS to CHC Silawad by the Janani
ambulance.
These are not isolated cases; there are reports of similar incidents of maternal deaths and
denial of treatment at the health centres, including the DH in Barwani.
Demanding Accountability for Negligence
We were visiting Barwani to get a firsthand
account of the situation there
concerning health services, particularly
in the District hospital. On the morning
of 28th December when we tried to meet
the CMHO and the concerned lady duty
doctor (who happens to be the CMHO’s
daughter) we were told that they were
out of town. The gynaecologist who had
admitted Vypari bai on 27th November
said she had anemia and eclampsia and
was not in a condition to be operated
upon; and that they did not have a
ventilator in the hospital. This
gynaecologist was not around the day
after admission (28th November) to monitor the progress; she is usually out of the hospital four
days of the week performing sterilization operations in family planning camps.
We observed the rally taking place outside the DH on 28th December. About 500 people
(nearly half of them women) had gathered at the entrance of the DH at around 12 noon, by which
time the OPD was almost over. The 2-3 doctors present there left when they heard the rally
approaching. The police tried to snatch away from the rallyists their microphone and the cart on
which it was placed; however the rallyists managed to convince them that they would leave very
soon. About fifteen minutes later the people moved away from the hospital premises and
continued their dharna on the road in front of the Collectorate office, well away from the DH.
Several activists and ordinary village women, including the mother-in-law of the deceased
Vyaparibai spoke of their travails at the DH. A set of 22 issues concerning the District hospital,
which were mentioned in the memorandum of demands, were read out to the assembled people.
The Civil Surgeon was asked for, but he refused to come out to receive the petition; finally the
ADM came and just gave a brief assurance that the issues would be responded to in writing in 15
days time. By around 4 PM the rally had dispersed.
Response by the administration – ‘the message is secondary, crack down on the messenger’
We met the Collector on 28th December evening after the rally and apprised him of the state of
affairs in the DH. It emerged that the process of carrying out maternal death reviews had not
been carried out in case of any of the 25 maternal deaths. During our meeting with the Collector,
the CMHO and CS came when they were summoned. According to the CMHO such maternal
deaths keep occurring, that women here were very anaemic, and it was ‘not possible to bring
them down to zero’. When pointed out that the DH was a CEMONC centre, that there were 4
serving gynaecologists and 2 anaesthetists, and it was enquired why such institutional deaths
were still taking place, there was no satisfactory response. The Collector appreciated our
bringing things to his notice, and said he would initiate
the task of Maternal Death Reviews. At the same time,
he also hinted at linkages of the mass organisation with
‘Bastar’ and ‘Andhra Pradesh’, thereby seeking to
discredit the people’s organisation as being associated
with the ‘Naxalites’, who have been outlawed by the
central government.
We are now extremely shocked and dismayed
that two days after this rally (on 30th Dec.) as per local
press reports, the police has foisted several charges on
the leaders of JADS and 200 people who participated
in the protest. They have been charged with Sec 146 of
IPC (unlawful assembly, rioting, armed with deadly weapon which when used is likely to cause
death), Sec 186 IPC (obstructing public servant in discharge of public functions), and Sec 16(3)
of MP Kolahal Rules. On 31st December one of the activists of the organisation, Bachhiya bhai,
was arrested and sent to jail on charges that were slapped on him and others in 2008, when they
had protested against the denial of services in PHC Menimata (described above).
It needs to be mentioned that the pilot phase of community-based monitoring of rural
health services in MP under NRHM had been implemented in Barwani during 2007-08. Even
prior to this the mass organisation JADS had been actively addressing the health problems in the
area in several ways. In May 2008 a three-day programme of monitoring of services at the CHC
Pati and dialogue with health officials (with the intention to improve them), was followed up
with a rally at Barwani town on the dismal state of health services in the DH. So the area has a
history of peaceful rallying for improvement of rural health services. However, there seems to
have been hardly any concerted response from the administration to address the genuine
problems faced by and raised by the people.
Is the situation restricted to Badwani?
The situation regarding maternal deaths seems to be similar in many other districts of MP. The
audit report of NRHM in MP by the CAG gives an idea of the serious situation in the state.
According to the CAG audit report for the period 2005-06 to 2008-09 incidences of maternal and
infant deaths in MP remained high. In the 12 districts surveyed for the audit there had been 1377
maternal deaths in all in the four-year period – Betul recorded 152, Bhopal 269, Indore 162,
Shahdol recorded 393, Dhar recorded 125, Ujjain 124, and so on. Shahdol district reported 55
maternal deaths in 2008-09. The audit report also points out that despite increase in number of
institutional deliveries, post-delivery mortality remained alarmingly high. The Maternal Mortality
Rate remained high at 379 per lakh live births. Interestingly, the state government has fixed a
lower target than that of the central government for reduction of MMR and IMR. While NRHM
envisages MMR of less than 100 per lakh live births and IMR of 30 per 1000 live births by 2012,
the MP government has set these at less than 220 and 60 respectively. It has said that due to
shortage of manpower it was not possible to achieve the NRHM targets! The audit also found that
Maternal Death Review Committees were to be constituted at each district, but had not been done.
A large number of neo-natal deaths also seem to be occuring: according to figures (collected by
RCH – NRHM for monitoring and evaluation) between April-November 2010, there were 154 neonatal
deaths in the entire district of Badwani, of which 133 have been recorded at the District
Hospital (3879 deliveries recorded at the DH in the same period).
Some other findings of the CAG audit indicate that even after four years of NRHM the
state government was not taking adequate measures to address the long-standing problems of
lack of basic medical facilities, lack of physical infrastructure, and of doctors and other staff.
For instance: the number of health centres fell short of the prescribed norms; several centres,
particularly sub-centres were functioning without buildings; none of the institutions had been
upgraded to Indian Public Health Standards (IPHS); of the 82 CHCs designated as first referral
units (FRUs) 80 percent were non-functional and the rest were only partially functional. The
state government itself acknowledged that the health centres are non-functional due to shortage
of man-power. 101 out of 297 PHCs in the 12 districts studied were running without doctors,
despite the provision for hiring contractual staff under NRHM. Monitoring Committees too at
state and at lower levels to review the activities under NRHM had not been formed till 2009.
One also finds that several hundreds of crores of rupees have been spent over the past few
years under RCH-JSY. Government reports show that the allocations for RCH-JSY had increased
since 2005, and expenditure too had increased from Rs 26.29 crores in 2005-06 to Rs 344.87
crores in 2008-09. By 2009-10 Rs 797.65 crores from NRHM funds had been spent on activities
to improve maternal and child health.
Issues and Concerns
We wish to draw attention to the grave situation that seems to be building up in places like
Barwani. It is now more than a decade of RCH and five years since NRHM, RCH-II, JSY etc,
were launched as flagship programmes. On one hand, the government is spending several
hundreds of crores of rupees annually, is vigorously promoting institutional deliveries as a
panacea for high maternal and infant mortality, and talks of safe and guaranteed health services;
through processes such as community monitoring it is promoting the idea of demanding
accountability from the public health machinery. On the other hand, the ground reality in places
like Barwani shows little change. And when people get organized to demand accountability
through peaceful actions, attempts are made to discredit and ‘brand’ their leaders, to intimidate
and repress them, and to shield the responsible officials who seem to be to completely indifferent
to the plight of the patients.
One finds that in spite of several interventions and expenses of crores of rupees, women
continue to die in large numbers. Majority of these deaths are avoidable and completely
unacceptable. It is precisely these preventable deaths that JSY claims to address, right from
ante-natal care (ANC) to post-delivery care of mother and new-born, by getting the pregnant
women to register soon after pregnancy and `motivating’ them to go to a hospital for delivery.
However, the ground reality indicates that the government is not improving the `health’ of the
health facilities in order that they treat satisfactorily women in labour, especially those with
complications. This is corroborated by the findings of the audit of the performance of NRHM in
MP. The experiences of ill-treatment narrated by the rural women also point to the apathy of the
doctors and the poor quality of care they receive when they come in pain and suffering.
How many more such `institutional deaths’, complications and denial of services, are to
occur before the hospital doctors become responsible and accountable; before the state health
department, the health ministry, the rogi kalyan samitis, the district health societies, the
numerous managers, planners, consultants, and international agencies look beyond their
ritualistic exercises of working on technical assistance, planning, evaluating, re-evaluating, replanning,
merely recording numbers of pregnant women registered, of institutional deliveries and
of beneficiaries etc., in the name of safe motherhood and child health, and seriously take note of
the reality of the deaths of women and infants?
Dr Abhay Shukla – National Joint Convenor, Jan Swasthya Abhiyan
Dr Indira Chakravarthi – Public Health Researcher, Delhi
Rinchin – Bhopal
8.1.2011

 

 

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