#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- Clinical Trials offer no security to clinical trial participants


 


Trial and error

Author(s):
Kundan Pandey
Issue Date:
2013-4-15

Recent notifications offer no security to clinical trial participants

Trial and errorVICTORIn the past eight years, 2,868 deaths have occurred during clinical drug trials across India. But only 89 have been attributed to such trials and compensation has been paid in 45 cases, said the Union health minister on March 5 in Parliament. Considering the Supreme Court’s recent observation that uncontrolled clinical trials “are causing havoc to human life”, Ghulam Nabi Azad’s speech only highlights the poor state of regulations for clinical drug trials.

To tighten guidelines for conducting these trials, the health minstry had amended the Drugs and Cosmetics Rules by passing three not ifications between January and Febr uary. The notifications specify procedures for compensation and functioning of the ethics committee, which is constituted by an institution conducting the trial.

Health activists say the notifications are rife with loopholes. The first one deals with compensation in case of injury or death during clinical trial but the onus of deciding the injury continues to be with those carrying out the trial. S Srinivasan of All India Drug Action Network says, “The notification does not define injury. How does one  prove that an injury is related to the trial? Who is the appellate body in case the compensation is not satisfactory?” Amar Jesani, editor of Indian Journal of Medical Ethics, says it is important that arbitration boards are created at local and regional levels to arbitrate on the quantum of compensation a provision that was present in the draft but is missing in the notification.

Claiming compensation continues to be difficult. As per the first notification, the Drugs Controller Gen eral of India (DCGI) will be the final authority to determine cause of injury and compensation amo unt. There is a provision that the victim, if not satisfied with the compensation decision, can approach the Centre. How ever, it is not clear which Central body should be approached. In the abs ence of an appellate body, the final auth ority should have been a neutral body, say activists.

The first notification ensures that compensation is received within six months. But what if the pharma company does not agree with DCGI’s decision? If it approaches a lower court, the decision could get prolonged indefinitely.

sordid  
taleActivists say since the majority of the participants in clinical trials are poor, there should be provision that the aggrieved party can promptly approach the resp ective high court. This will fast track the case.

In view of the complications in obtaining compensation, activists have long been demanding that in case a participant starts showing signs of an adverse effect he or she be immediately paid half of the compensation. Although the draft had met this demand, the final version makes no such mention. Srinivasan says the compensation model needs clarity (see http://www.downtoearth.org.in/content/clinical-trialsillogical-compensat… [1]).

Another sphere where government efforts have fallen short is in defining the role of ethics and expert committees in the third notification. Jesani, who has participated in many ethics committees, informs, “The notification on ethics committees is in response to the criticism that they are not registered with public authorities and there is no supervision over them.” The notification, however, does not satisfy on two counts. First, there is no information on how the Central Drugs Standard Control Organisation, which oversees pharma companies and clinical trials, will manage since it is short of staff and low on funds, says Jesani. Secondly, he says, unless all ethics committees adopt a uniform procedure for monitoring trials, their decisions would become arbitrary. “They also need to be independent of their institution’s interests.” Similarly, the third notification does not define the constitution of the expert committee, which is tasked to recommend quantum of compensation to DCGI in case of death. “On what basis will the expert committee recommend has also not been defined,” says Jesani.

 


Source URL: http://www.downtoearth.org.in/content/trial-and-error

 

#India – Ethics of immunisation services in Kerala and Tamil Nadu #healthcare


This  article is published  in BMJ  in the context of increasing immunisation resistance in Kerala and Tamil Nadu. The article trace part of the reason to special campaign approaches in vaccination. We wanted to convey the importance of understanding and recognising ‘agency’ of individuals, families and communities. Unfortunately, this is an often neglected aspect in the authoritarian public health world.
The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study

The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study

  1. Joe Varghese1,2,
  2. V Raman Kutty2,
  3. Mala Ramanathan2

+Author Affiliations


  1. 1Centre for Chronic Disease Control, New Delhi, India

  2. 2Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India
  1. Correspondence toDr Joe Varghese; vakkan2000@yahoo.com
  • Published 1 March 2013

Abstract

Objectives This study examines the existing norms regarding immunisation within the communities and the ethical notions that govern the actions of different health professionals and their collective synergistic or conflicting effects on the governance of the programme.

Design We used descriptive and analytical qualitative methods as it suited the research question.

Setting The data were collected from areas under 16 primary health centres in Kerala and Tamil Nadu identified through a three-step sampling process.

Participants This involved in-depth interviews with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mothers of under-five children and participant and non-participant observations of vaccination-related activities.

Results Unlike most other ethical analyses that look at the ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust.

Conclusions Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or herd immunity. Understanding the interactions of normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.

Article summary

Article focus

  • Ethical analysis includes not only ethical rationale but also the exploration of interactions of ethical and moral notions.

  • The article examines the interactions of ethical notions of the health professionals and moral values governing parental actions and their collective effect on governance of childhood immunisation programmes.

  • The study hypothesises that the vaccination policies and programmes that do not take into consideration the need for equilibrium of normative notions that motivate the actions of immediate stakeholders can be detrimental to its implementation.

Key messages

  • Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or public safety.

  • The interactions at the normative level play a significant role in sustaining the acceptability and compliance to vaccinations at the community level. The moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved in immunisation.

  • Overly aggressive vaccination programmes based on utilitarian notions can conflict with other dominant normative notions that motivate the actions of healthcare providers and parents.

Strength and limitations of this study

  • An analysis of interactions at the normative level of the providers and the users of vaccination gives new insights for developing sustainable vaccination programmes.

  • Generalisability of findings to other contexts where the immunisation programme faces challenges, including resistance, should be verified through further studies.

Background

Normative principles, explicit and implicit, operate within a social system and guide the delivery of public health interventions such as vaccination. They influence not just policy decisions and programme implementation, but they also shape the decision making of medical practitioners and community behaviours.1 ,2 For an intervention like immunisation, it is important to understand how the ethical principles that influence policies or behaviours of health professionals interact with the moral values that operate at the level of parents whose decisions ultimately facilitate paediatric vaccinations. This understanding is expected to provide valuable information for designing policies and programmes related to immunisation.

Most ethical deliberations on public health revolve around providing a framework for capturing the appropriateness of measures used in interventions and policies.3–6 The ethical deliberations in vaccination have highlighted the utilitarian orientation of public health professionals against the healthcare worker’s value of client beneficence.7–9 This paper examines the interactions of the ethical notions of the health professionals and the moral values governing parental actions and their collective effect on governance of the paediatric immunisation programmes. This analysis is part of a larger study to understand relatively recent decreasing immunisation coverage in two states of India, Kerala and Tamil Nadu, which have otherwise reached a fairly high level of coverage compared to most of the states in the past (figure 1).10

Figure 1

Immunisation coverage in Kerala and Tamil Nadu.

In this paper, we use this concept of ‘ethical notions’ instead of ethical principles as we refer to values that are acquired collectively from an understanding of what is right and wrong based on the healthcare and public health practitioner’s professional training and the professional code of ethics that is adopted for practice by health professionals. Moral values are the norms defined and accepted by a larger section of the society. Both ethical notions and moral values are normative principles that guide the decision making of immediate stakeholders.

In India, vaccines have been widely used since the early 1900s and several collective vaccination programmes were periodically introduced nationally and regionally as part of various disease control programmes. The Expanded Programme of Immunisation was started in 1978, though it was limited mainly to urban areas. The Universal Immunisation Programme (UIP) against basic vaccine preventable diseases was introduced in the year 1985 with a mandate to progressively cover the entire country. The programme is implemented through the government’s three-tier health institutions with the active support of a vast network of field workers. The private healthcare providers also complement the immunisation programme. Even after two decades of implementation, the progress of the UIP has not been very encouraging in most parts of the country. Although UIP has contributed to improvement in ensuring the availability of vaccines and maintenance of cold chain requirement, the system is considered to be failing to deliver in many states in terms of coverage.

The states of Kerala and Tamil Nadu have a tradition of state intervention in health which ensures an adequate basic administrative system for implementing immunisation programmes. The state of Kerala is known for its remarkable health achievements in the public health discourse. Public investment in health has been traditionally high compared to many other states.11–12 Similarly, the improvement in population health status of Tamil Nadu in recent decades has been attributed to increased public expenditure in health and a relatively well-functioning public health administrative system.13–15 The increased presence of private sector in healthcare is indicative of the acceptability of private providers in both the states.14 ,16

Another important factor to be considered in the context of immunisation is the influence of reduction in fertility rates in both states. With the decreasing family size, children have assumed a special place in these societies and the child-centredness of these societies has been noted.17 ,18 Immunisation programmes in these two states have recently faced new challenges. Media reports of sporadic and organised forms of resistance against immunisation exist. Special vaccination programmes for polio eradication and targeted campaign against Japanese encephalitis have been the special focus of widespread resistance against immunisation in Kerala.19 ,20 Polio eradication campaigns included additional doses of oral polio vaccines given to all children under 5 years of age on at least two occasions every year. The vaccination campaign against Japanese encephalitis in the previous year had targeted schoolchildren in Alappuzha district. These programmes are organised by the government public health machinery with significant political commitment and resources. There are extensive planning and preparations for the execution of the programme, which involve a number of government departments other than the health department. The dates of the programme are announced well in advance in the review meetings and special instructions are issued to all peripheral institutions. Local-level health department staff hold several rounds of planning meetings with other government departments, local self-government officials, local non-governmental organisations and schools well ahead of the programme in order to identify and access potential non-compliers with regard to the special immunisation drive.

The state of Kerala has seen organised forms of resistance spearheaded by some practitioners of alternate systems of medicine including homoeopaths and naturopaths especially in the northern districts. In the state of Tamil Nadu, a false propaganda of death of a child aired through a news channel in the previous year’s special vaccination drive against polio had caused widespread anguish among parents and resulted in violence in some locations. Deaths related to immunisation have been reported in both states in the recent past with an associated negative image, sometimes leading to a temporary stoppage of the programme.21

Methods

The study employed a descriptive and analytical qualitative method for data collection as it suited the research question. This included a review of the relevant literature and documents as well as a field-based study of implementation of the immunisation programme. The field study employed a range of qualitative methods and specific comments on each of the methods are detailed in table 1. These included multisite participant and non-participant observations, focus group discussions (FGDs) and interviews.

Table 1

Methods of data collection used in Kerala and Tamil Nadu, 2009–2010

Sampling of study areas

A three-step sampling process was used to select 16 primary health centre (PHC) areas as study sites for maximum variability of regions with successful implementation of immunisation programmes in terms of coverage. Each PHC covers a population of about 30 000. On the basis of immunisation coverage, the districts in each state were categorised into three groups and two districts in each state were selected randomly, one from a better performing category (Alappuzha in Kerala and Dindigul in Tamil Nadu with an immunisation coverage of 90.2% and 87.5%, respectively) and another from a poorly performing category (Kozhikode in Kerala with 65% and Theni in Tamil Nadu with 72.1%). The immunisation coverage was assessed based on a percentage of fully immunised children in the 12–23 month age group as per the District Level Health Service survey.22 Average population in a district in Kerala and Tamil Nadu was 2 384 834 and 2 254 342, respectively. In each of these four districts, one better performing block and one poorly performing block (one block consists of 100 000 people) in terms of immunisation service coverage were identified with the help of district-level managers. In each block, two PHCs were identified for detailed study. One PHC in the block was selected based on an assessment of difficult geographic terrain and significant presence of poor and marginalised communities, and the second one randomly. One private facility used for immunisation services within each of the eight study blocks was selected randomly for observation of the immunisation services and interviewing the practitioners.

Data collection

Non-participant observations focused on immunisation sessions at health facilities, outreach immunisation sessions and review meetings of field staff in charge of the immunisation programme. All participant observations were made at the time when the researcher made house visits along with the health field staff or community health worker for mobilising beneficiaries for the upcoming immunisation session. During each of the visits, the researcher was introduced to households as a public health researcher and was involved in motivating and educating the families on childhood vaccinations. In most of the households visited, the initial communication related to vaccination was provided by the field staff or community health worker and the researcher was asked to clarify it further. In this process, the researcher had to shift between the role of an expert and researcher. All observations were made by JV. At the time of the observation rough notes were made, and at the end of the day, a full record was prepared by appropriately commenting on each of these activities as per the observation.

The respondents of in-depth interviews were immunisation service providers from the public and private sectors, those who facilitate vaccination like community health workers and those who opposed vaccination, all from the study areas. They were identified using the snowball method whereby, at the end of an interview, the respondent’s suggestion was asked about other important stakeholders for identifying the next respondent. Key informants were identified based on their expertise of immunisation service as a past or present state or district-level immunisation programme implementer or researcher in either or both of the states. Two of them were primarily researchers of immunisation services with expertise on the functioning of immunisation services in these two states.

FGDs with mothers were held in anganwadi centres (government-run free preschool and nutrition centre) belonging to the study areas. The number of participants in the FGDs varied from 7 to 10. The mothers included in the FGDs had children below 5 years of age who attended the anganwadi centre. They were identified and invited to participate by the teacher of an anganwadi centre. FGDs involving female field staff of the study PHCs were held in the PHC building after the weekly immunisation session. Leading questions were asked of the respondents of the interviews and participants of FGDs and they were encouraged to narrate their responses in detail. Clarifications were sought on specific points emerging from their narratives. All the interviews and FGDs were conducted in the local languages and recorded with the permission of the respondents.

Data collection was undertaken over 6 months during late 2009 and 2010 by JV who has oral communication skills in both languages. The additional help of a person familiar with the FGD process was taken in organising FGDs and for note-taking in Tamil Nadu. Only five FGDs with the female field staff of PHC could be organised as the staff found it inconvenient to sit in groups after the immunisation session. The recordings were simultaneously transcribed and translated into English by the JV within a few days of the interview. JV and VRK decided on the required number of in-depth interviews and FGDs by periodically assessing the saturation of the information by reviewing the transcripts.

Data management and analysis

The template approach, which is described as one of the four approaches to qualitative analysis by Crabtree and Miller,23 was used for data analysis. This method uses a template or analytical guide that derives from a theory or research tradition. As the analysis had to reconcile varying perceptions of different stakeholders across the same set of issues, the template approach, otherwise called deductive coding, was used. Sufficient attention was paid to negative case analysis during data collection and analysis for validation. Weft QDA, a software for qualitative data analysis, was used for arranging the text according to codes and managing the codes in the interpretive phase. The quotes of the study are included in the results as illustrations of themes emerging from the analysis of the data.

The study protocol was reviewed for ethical and technical clearance by the Institutional Review Board, where the JV was affiliated as a research student. Many parents approached JV during data collection for his opinion on the need for vaccination of their children. As suggested by the Institutional Review Board, the researcher had taken the initiative to clarify the vaccination-related doubts of parents who were interacted with and also reassured the need for vaccination. Official permission for data collection was taken from state-level health officials as well as from district-level officials, and participation in the study was made voluntary by ensuring informed consent from all participants.

Results

The ethical analysis using the qualitative data shows that there are implicit ethical notions and moral values involved in the delivery of immunisation services. Identifying them makes it possible for use to understand the varying rationales involved in decision making regarding immunisation of children.

Utilitarian ‘notions’ of public health authorities

Strong utilitarian notions prevail among the government public health authorities at the state and district levels and guide the vaccination programmes. This considers the best ultimate outcome for the society. It supports mandating vaccinations for all.Vaccination should be mandatory. What is wrong with it? After all it is for the benefit of the society. If some do not agree, all of us will be affectedA district official (male), Theni

The utilitarian focus runs through all levels of the government’s health department and shapes the way the institutional mechanisms are structured for functioning. Its explicit outcome is the ‘thrust on coverage’ which is translated as targets for staff. The staff of the government public health service department placed at different levels of the hierarchy are expected to ensure coverage. This is evaluated against the targets fixed in the beginning of the programme. The transactions at the departmental monthly review meetings at various levels reveal how targets and their assessments form key activities in such programme reviews.There are very strict (annual) targets … By September if we did not reach 50 to 60%, we will be made to stand in the review meetings and explain. Excuses will not be of any helpFieldworker (female), Alappuzha district, Kerala

The overwhelming emphasis on coverage results in the use of coercive means to achieve targets. It restricts the options for refusal to undergo immunisation or for postponement of immunisation available to beneficiaries. This is especially so with the special vaccination campaigns introduced for the control or elimination of diseases such as Japanese encephalitis or polio. In Alappuzha district which had a targeted immunisation campaign against Japanese encephalitis, focusing school students in the previous year had openly debated the issue of consent of parents.We were told (by the district authorities) that the consent of parents was not required. Truly speaking there is no need for consent of parents. But schools were objecting. Teachers were not willing. They said “if we give, parents will question us. But, if we wait for the consent of parents, nothing would happen”. Taking parents’ consent is a wrong strategyA fieldworker (female), Alappuzha

Similar feelings have been expressed by a district-level officer (male) who was in charge of the special immunisation campaign against Japanese encephalitis in Alappuzha district.This is a state programme, no need to take consent of parents, if we take consent of parents, nothing is going to happen, programme will be a failureA district-level official (male), Alappuzha

Most of the public health workers who participated in FGDs believed that parental consent was a wrong strategy especially for special vaccination programmes. Even those who supported parental consent for vaccination wanted it for avoiding conflict and for the smooth running of the programme.

For many health department officials of the immunisation programme, targets are imperative to state-led governance of a public function. The emphasis on coverage is also applied to various levels of hierarchy in the department. If district coverage is less, DMO (district-level health authority) will be questioned at the state meeting and he will in turn raise it in the district meeting, then it goes down to each level—observed a district-level officer (male) from Kozhikode district.

In the FGDs, field staff described how any delay in vaccination among children is attributed to ‘lack in strictness’ in implementation. The utilitarian orientation is visible in the extensive planning and preparations for the execution of the special vaccination programme, such as vaccination programmes against Japanese encephalitis and polio, which involves coordination across various government departments. The dates of the programme are announced well in advance in the review meetings and special instructions are issued to institutions at all levels. Public health department staff hold several rounds of planning meetings with other government departments, local self-government officials, local non-governmental organisations and schools well ahead of the programme in order to estimate and identify beneficiaries and access potential non-compliers with regard to the special immunisation drive.

The special immunisation day is followed up with mop-up rounds where volunteers and vaccinators make house-to-house visits to vaccinate dropouts. These preparations contribute to creating a sense of urgency. An expert on immunisation policy and implementation described it using the following words:Polio campaign is like a war. Logistics and tactics are adapted like in a war. The word strategy, the word logistics or tactics are all taken from war. Logistics are about how armaments and supplies are reached the battlefield, tactics is about how you fight in a locality, it is more about how you design your war tactics

The utilitarian approach of the public health authorities results in making the vaccination programmes coercive and such efforts throw up conflicts with the caregivers of children. For example, a targeted campaign against Japanese encephalitis in Alappuzha district, Kerala was resisted by the school authorities as the public health workers sought to abrogate the need for parental consent. Some schools called a meeting of office bearers of the parent teachers association (PTA) and the PTA decision was taken as consent. Some other schools sent a note to parents through children asking for their approval.People saw this as a test dose. They thought government is experimenting on their children. JE vaccination was used for the first time; they had doubts … Many had raised a lot of questions to us; why this vaccine; why only on us?Medical officer (male), Alappuzha district

Even when special campaigns receive a high priority from the public health department, resistance from beneficiaries is found to be widespread in Kerala. ‘my child was given all vaccine injections when she was small. Even my 15-year-old daughter was given all injections. We did not understand why they were giving it again in the school. My husband said no when she told us about this. My daughter did not go to school on that day.’, explained a parent who refused a school-based vaccination programme against Japanese encephalitis. In resistant areas, attempts to reach out to unvaccinated children through house-to-house vaccination drives occasionally result in heated arguments between health workers and family members. Most field workers from Kerala who participated in the study shared their experiences of similar incidents.

Beneficence to patients

The ethical principle of beneficence that marks the immunisation function is also part of the professional relationship of healthcare delivery. Within the professional relationship, the expectation is that the caregiver will act in the best interests of the patients. This notion is visible in the thrust received for vaccination against mumps, measles and rubella (MMR vaccine). This vaccine does not form part of the UIP in the study states, but doctors, both in the public and private sectors, recommend it to children. Many older children in Alappuzha district in Kerala and both the study districts in Tamil Nadu had been prescribed MMR vaccines by doctors in the public and private sectors. While many practitioners prescribe MMR vaccine in the interest of their clients, the state public health authorities delayed its introduction in the routine schedule mainly due to cost considerations.

Beneficiaries’ expectations from caregivers are also rooted in the belief that health workers act in the interest of their patients. This has been an accepted notion in society which submits itself to the decision of the caregiver to a large extent. Most mothers who were part of the FGDs agreed that the doctors would act in the best interests of their children, even though some have raised doubts about the potential conflict of interest arising out of financial incentives to doctors.

Parents even accept the paternalistic behaviour by medical caregivers as they see this as an exercise of beneficence. This is reflected in their tolerance of rebukes from medical care providers for not holding the infant the right way or for delays in approaching the system for vaccinating their wards.If a mother comes late for vaccination by two or three months and if we question her, I am sure she would definitely cry. This happens in my clinic.A paediatrician (male), Theni

Here, paternalism takes the form of a belief among the caregivers that clients should accept decisions made in their best interests by caregivers. Therefore, negotiations and discussions with parents on the choice of vaccines and vaccination decisions are perceived as unnecessary in clinical settings. Often, the only verbal exchanges are a set of prevaccination inquiries and postvaccination instructions.

Several private medical practitioners across Kerala opposed the repeated rounds of polio campaign and advised their clients against vaccination as they thought it unnecessary for children in Kerala. For them, repeated doses of oral polio vaccines can only enhance herd immunity and not individual immunity, which was already covered under the UIP. Most of the private practitioners interviewed as part of the study in Kerala raised doubts about the rationale of repeated doses of oral polio vaccine to children.We are often approached by parents whenever a vaccine campaign is announced. Patients always ask their own doctors. If they are not sure of vaccination, they will advice against it.A paediatrician (male) working in a private hospital in Kozhikode

The state public authorities have failed to engage or convince them. Many parents who did not vaccinate their children during special campaigns, but had taken the routine vaccination, trace their decision to a doctor who advised against it. However, it should be noted that all the private medical practitioners from Tamil Nadu who were interviewed supported the special campaign for polio. Many of them referred to the decision taken in a meeting of the professional association of paediatricians in the state which supported the polio vaccination campaign.

Moral value of parental obligation

Parents’ moral obligation towards their children plays another major role in guiding the immunisation programme and contributes to its sustainability. This value comes out of the parent’s feeling that immunisation is their duty towards children.With small family norm people are ready to take vaccinations against even lesser known diseases. Yes vaccination is seen as norm; just like the need for good nutrition a ‘good’ is also attached to vaccinationAn expert (male), Tamil Nadu

It is widespread in societies which have a good coverage of immunisation. In such areas, vaccines have become a societal norm making it difficult for parents to avoid it. The FGDs with mothers held in areas of high vaccination coverage reiterated that in an environment where all parents vaccinated their children, it was difficult to be a deviant. Healthcare workers use this factor to ensure compliance to vaccination schedules and tend to chide parents saying that parents would be held responsible for their lapses (by their children when they grow older).People are not seeing disease as they were seeing before. Their fear has now gone. They are still taking it because everybody else is taking itA district-level supervisor (male), TheniThey have no fear of diseases. Most people think it is their duty towards their children. Many mothers are in their 20s. As a child, many of them had not received these vaccines. Some of them are daily wage workers, but want to bring up their children in the best possible way. Whatever they missed in their childhood they want to give to their children. They think vaccines are important. They have already made up their mind that vaccination is a mustAn expert (male), Tamil Nadu

Vaccination is one of the fist things that people do as parents for the well-being of their children. Some parents were apologetic that they used government facilities for vaccinations as these are seen as inferior to those offered in private facilities. Acceptance of vaccination as a social norm has been an important driving factor for sustaining the immunisation coverage when the incidence of diseases gradually declines. This also partially explains the high acceptability of optional vaccines.For some people, if they take the child to a private hospital for immunisation, they have a feeling that they have done something great for their child. Even poor are taking injections costing Rs. 500 and more. They have no problem in spendingCommunity health worker (female), Alappuzha

It is important to consider the perception of parents who did not vaccinate their children in the context of widespread propaganda against vaccination programmes in Kozhikode district. Contradictory information on vaccines and the vaccination programme left many parents in a dilemma. The efforts by the field workers to convince the mothers of unvaccinated children only led them into more confusion. One of the mothers interviewed who did not fully vaccinate her child as per the schedule explainsBut the problem is that nobody here is too keen about injections. It is difficult for me to take initiative; I have lot of difficulty which you should understand. I am an educated lady; I have studied up to degree. I am in favour of this. But if I decide alone and take the child for vaccination and after that if the child develops even a cold, all blame will be on me. They will say this was because of the vaccines and I did not listen to them. Last time, after I had taken the child for vaccination, child had developed fever in the night. Then my husband’s family members started scolding me saying I had caused this to the child who was otherwise healthy. After that I did not take the child (for vaccination).

Discussion

Explicit and implicit values and norms are critical to the implementation of paediatric immunisation programmes as they influence the institutionalisation of programmes. The interactions of values and norms play a significant role in sustaining the acceptability and compliance to vaccinations at the community level.

In regions with good immunisation coverage, the programme has been sustained because of the confluence of several ethical notions involved. This has been possible because the values that influence the actions of parents and the ethical notions of professionals involved in immunisation find a common ground in immunisation-related decisions. Parents’ motivation is driven by the fact that vaccination is seen as a routine and parental obligation towards their children. This consideration is important as it ensures the public health department’s utilitarian goal of adequate protection against vaccine preventable diseases. The other studies which analysed the prevalent values that motivate parents to comply with paediatric vaccination have also highlighted this fact.2 Steefland et al have noted how vital it is for parents to retain a positive perception of the vaccination process if the immunisation programmes need to succeed.24

The role played by general acceptance of the small family norm in Tamil Nadu and Kerala has an influence over the values of parental obligation towards their children.17 ,18 This has facilitated the state’s entry into the domain of family decision making. The state’s goal of universal immunisation has benefited in contexts where state interventions are accepted by parents.

Another important notion that plays a role in sustaining immunisation in regions with good immunisation coverage is beneficence, which is attributed to the healthcare providers. An explicit recognition of beneficence by healthcare workers can have a synergetic effect with values of parental obligation. The government sector in both the study states has acted differently to tap into the importance of parents’ expectation of beneficence from caregivers. Tamil Nadu had made it mandatory for doctors to see each child before vaccination. The decision was taken as a confidence-building measure immediately following an incident of deaths of children after immunisation, which created widespread anguish and derailed the programme.

Ethical notions and moral values can also run into conflict with each other. The ethical principles operate differently in the policy-making process and in service delivery or at the household level. Interventions with a strong utilitarian focus have the potential to undermine parental obligation. In other words, state-led interventions in immunisations are accepted as long as they do not overshadow parental values of welfare for their children. The state’s utilitarian intentions are accepted only when the voluntary nature of the universal programme is ensured. A paternalistic state and public health driven compulsion for vaccinations have the potential to undermine the value of parental obligations, which is one of the driving forces behind paediatric vaccination. ‘…may be because when it is forced, they may think it is for the others benefit not for their benefit’—commented one of the experts on the widespread resistance against special campaign in Kerala.

Many medical practitioners also advised their beneficiaries against repeated intake of oral polio vaccine as the global polio eradication goal did not appeal to them beyond the benefits of their clients. This perspective is important in understanding their support for routine immunisation and general indifference to special campaigns. Such an attitude of medical professionals to the immunisation programme has also been noted by other authors.25 ,26

As the incidence of vaccine preventable diseases declines, it is difficult for the state to motivate individual parents to attain a utilitarian public health goal. This is evident in the way beneficiaries are motivated by the field health workers for special campaigns where the health message is invariably directed at personal benefit. They avoid discussing the objective of global polio eradication with beneficiaries. The public health officials try to tackle the widespread resistance against immunisation by raising the issue of possible return of vaccine preventable diseases. As the fear of diseases no longer explains the acceptability of vaccinations in these societies, it proves to be a weak strategy.

Conclusion

The arguments in this paper are different from the other criticisms of the campaign approach in immunisation for its single-disease focus or its contribution to weakening health systems in the developing world.27 ,28 We emphasise on the need for public health actions to take into consideration the manner in which societies organise themselves to manage public affairs. Ethical analysis is one such aspect that enables us to understand the decision-making process surrounding public health interventions. This analysis should include an exploration of the ethical rationale and the interplay with multiple moral notions.

Immunisation policy decisions need to go beyond the simple rationales of life saved or monetary benefits due to vaccinations29 to enhance vaccine acceptability in societies where resistance to the programmes is developing. We also advocate analysis that transcends mere ‘risk perception’ to assess household behaviour related to paediatric vaccination.30–33 Our analysis identified that the role of the norm ‘vaccination as a parental obligation’ cannot be ignored especially in societies with high coverage and low incidents of vaccine preventable diseases.

Exploration of the operation of the ethical notions and moral values involved enables us to understand the decision-making process surrounding a public health intervention such as immunisation. However, this analysis does not claim that confluence or conflicts of ethical notions and moral values alone explain the resistance or acceptance against collective vaccination programmes. The study also does not explain why most parents accepted vaccination even when some of the parents opposed. We argue that the ethical notions which are professionally created and sustained often result in judgements about how others should conduct themselves and contribute to the complexity of vaccination programmes. The moral values and ethical notions operate not only in the decisions of the governors of the public health interventions but also in that of those who are governed. The study emphasises on the need for public health governance to take into consideration the nature of all the interactions, including those at the normative level at which societies organise themselves. Recognising these values and notions and their interactions with each other should be a key strategy of public health programme planners and implementers. The role played by informal interactions at the level of households or at the clinical settings cannot be ignored. This offers considerable challenges to state-led governance of public health functions.

 

Conversation flows, ideas don’t


T. M. KRISHNA, The Hindu

  • FORGETTABLE QUOTES: Economics finally decides even the basic format of discourse. Such events are thus no different from anything else that we consume.
    PTIFORGETTABLE QUOTES: Economics finally decides even the basic format of discourse. Such events are thus no different from anything else that we consume.
  • FORGETTABLE QUOTES: Economics finally decides even the basic format of discourse. Such events are thus no different from anything else that we consume. Photo: Rajeev Bhatt
    FORGETTABLE QUOTES: Economics finally decides even the basic format of discourse. Such events are thus no different from anything else that we consume. Photo: Rajeev Bhatt

Conclaves, all the fashion now, are no brainstorming sessions as they consciously exclude the very people they discuss — the aam aadmi

Almost every leading newspaper and magazine in India these days seems to think it is necessary to organise an “intellectual” event. They call these events summits, conclaves or conferences. The organisers project these events so as to appear on the side of “thought” or “ideas,” as if seeking credibility and justification for their existence. But these gatherings are nowhere close to the brainstorming sessions they are cracked up to be. Basically, they are huge “talking” extravaganzas in which every participant is a performer before an audience, and like any other performer, craves its approval. To hand it to them, the performances are quite extraordinary, and those who anchor them are equally skilled in the art.

Speakers are drawn from politics, cricket, Bollywood and a variety of other arenas, not to forget the smattering of international personalities, without which no conclave is considered worth its salt. Of course the activist who is the flavour of the season has to be included and given a prime spot, so that the social-political-cultural spectrum is covered. We also need to bring in the gossip and romance, which is provided by at least one well-known Bollywood star. If his or her film is being released at the same time, it is only a coincidence. The audience consists of the usual suspects from politics, bureaucracy and media, with some socialites in tow; among them will be those who can ask intelligent questions, playing to the script, to bring out the best performance from the lead characters. Everyone looks serious. The clothes are appropriate. Nobody is overdressed such that the event is misconstrued as a social gathering. But everyone is still distinctive enough to be noticed. So what we have is a well-scripted film with abundant funding, which also exudes a sense of social responsibility.

Why are such events needed? This basic question must be answered to assess their efficacy. Presumably, the concept is to provide a platform where thoughts are expressed, initiated, exchanged and discussed, leading to some kind of ideation. If so, such events must leave us with perspectives that are incisive and important.

Question of integrity

But what are the speakers saying? Nothing new, nothing thought-provoking, nothing that changes your life, or even makes you think about life. It’s nothing. It’s just talk — yes, loaded with wit, drama, controversy and intrigue, but beyond that, nothing. Content, if it is present, is often lost; if there is one speaker who brings out an important issue and deals with it seriously, it is but an accident.

Let’s not forget that a lot of money is involved in these events. Why should we care so long as it is private money? But we should, as these are the same institutions that question the way public money is being spent. When such questions are being raised, every citizen has a right to question private practice too. Huge corporate houses back many such events and some speakers are chosen due to the financial support available for them, bringing into question even the basic integrity of such events. Are thoughts being manipulated? Are speakers succumbing to corporate pressure? These are serious ethical issues that need to be addressed.

I wonder why there cannot be a televised conclave with the same aam aadmi that the politicians, bureaucrats and media houses love to talk about. Perhaps they are not intelligent enough to add to or receive the wisdom that is being purveyed at these events. The aam aadmi seems to have only two roles: to make a noise about the issues that hurt him most and provide a foundation for a discourse at a summit by the chosen people; and, to cast a vote that gives the same people an opportunity to continue to be a part of the discourse.

This way we can conveniently forget the person on whom most of these discourses are based. But if anyone needs to speak and talk about real issues, it is this aam aadmi. I haven’t seen a single event — excluding award ceremonies or political events — organised by the power houses where the speakers as well as the audience consist of this section of society. Such a summit would not sell. Economics finally decides even the basic format of discourse. We need television to partner such events, but it won’t unless we have the same people who say the same things in the same way, and we consume exactly as we have, always.

Such events are thus no different from anything else that we consume. Those who expect something different from such platforms are bound to be disappointed. We need serious dialogue with serious people who will change the way we think. Conclaves must trigger change but that will not happen unless the intentions change. This will in turn influence the curation and quality of the engaged audience. At the same time we need to provide the farmer, carpenter, household help, clerk, craftsman — and everyone else we refer to as the aam aadmi — a national platform to speak. They should be speaking not just to the politician, bureaucrat and media but also to people like themselves, other aam aadmi. Only this can integrate society in the search for answers to our problems.

(T.M. Krishna is a Carnatic vocalist.)

 

“You Can’t Be Neutral on a Moving Train.” #change.org #mustread


Director, SignOn.org, the MoveOn.org petition site

Posted: 10/23/2012 6:42 pm

 

That classic quote from Howard Zinn came to mind this morning as I was thinking about the recent news about Change.org. It’s a line Zinn started using in the 1960s to challenge his students to get involved in the civil rights movement.

History, he said, is like a moving train. You can’t ride the train and then say you have no idea how you arrived at your destination. You’re either on board or not — you can’t be neutral.

Yesterday, The Huffington Post’s Ryan Grim reported that Change.org would begin selling advertising space to any customer, including promoting right-wing petitions paid for by corporate clients. From now on, they say, they’ll be neutral.

This has led to a lot of soul-searching in the movement — and a lot of questions about SignOn.org, the online petition site that I help run and that was created by MoveOn.org. So I wanted to take this chance not to criticize others, but to explain our choices, our vision.

First, like Change.org, we at SignOn.org see the enormous, game-changing potential of giving regular folks the tools they need to run their own online campaigns.

Over the years, MoveOn has listened to our members and run incredible campaigns giving our members smart, timely ways to get involved.

But there were so many fights MoveOn couldn’t take on. Just in my own community in Maine we have a growing homeless population, schools that need money, sewage runoff polluting the beaches, and so much more.

And after the 2010 election, the rise of the tea party, and Citizens United, we realized that what we were doing wasn’t enough. So we set out to re-invent people-powered politics by tapping into the passion and leadership of our seven million members to run hundreds more campaigns than we could ever take on before.

MoveOn launched SignOn.org about 18 months ago, and already tens of thousands of people have started petitions and many of them have scored amazing victories.

Robert Applebaum, an attorney in New York, started a SignOn.org petition calling for student loan forgiveness and it spread quickly, gathering more than a million signatures. Then, something amazing happened. President Obama responded — not with a form letter, but with an actual change in policy that will lower student loan payments for more than 1.6 million people.

When religious conservatives in Utah tried to pass a bill banning sex education in public schools, over 40,000 Utahns signed a petition urging the governor to veto the bill — and he did. The petition was started by Paul Krueger, a school bus driver and retired firefighter, who was quoted in the news coverage as saying, “I’ve never done anything like this, and it’s kind of amazing how fast this took off.”

And when Delaware Governor Jack Markell was considering supporting weak rules for fracking in the region, John Kowalko started a petition on SignOn.org urging the governor to vote no. After more than 1,000 signatures and a wave of media coverage, Gov. Markell came out against the rules, protecting drinking water for more than 15 million people.

That’s just the tip of the iceberg, and the movement is growing every day.

So how is this different from Change.org? First, SignOn.org is non-profit and proudly progressive. Our goal is to make America live up to our best progressive ideals as a nation. We don’t answer to shareholders; we answer to our members — seven million Americans who share a commitment to making our country better through collective action. We will never, ever, ever give right-wing front groups a channel for co-opting our members’ organizing.

Second, we never, ever let anyone pay us to promote their campaign. If MoveOn asks you to sign a petition, you don’t have to wonder if it’s because someone paid us to. We trust our members to decide which campaigns to promote, and their judgment has been impeccable.

Third, we built SignOn.org to empower long-term organizing. Petitions are great, but most of the time it takes an ongoing campaign to win real change. So we want SignOn.org petition creators to send regular email updates to the MoveOn members who sign their petitions, and our toolset provides unlimited, free access to do so.

In short, we take sides, and we’re proud of it. We’re for economic justice, equality for women and LGBT individuals, ending poverty, racial justice, quality education for all, a clean environment, and peace. Because like Howard Zinn said, you can’t be neutral on a moving train.

 

#Mangalore Mob attack- TV reporter’s version #VAW #Moralpolicing


The shameful news of Mangalore is very well known to you all. It is a good sign that eight assailants have been arrested in relation to this case. Along with the eight of the assailants the reporter Naveen Soorinje who reported the incident first has also been booked under section unlawful activities prevention act along with the eight assailants.  A friend in mail sent the account of the shameful event and him being framed in the case.
Here is what Naveen Soorinje has to say, A TRANSLATION….
At 6.45 in the evening on July 28, one of my news sources from Padil (in Mangalore) called me. This was all he told me: “Naveen, around 30 men have gathered near the Timber Yard in Padil Junction and I overheard them talking to someone trying to coax them to gather some more people. They were instructing someone to be prepared with their motorbikes. It looks like they are planning to attack the guest house in Padil. I overheard them saying something like Muslim boys and Hindu girls.”
I asked him to find out which organization the men belonged to. All he could gather was that they were from some Hindutva organization, though he could not find out the name of the exact organization they belonged to.
The immediate thought that crossed my mind was this: “Should I inform the police right away or should I not?” The dilemma was because there was no accurate information as to who belonging to which organization was to attack whom and where. I just had very rudimentary information on hand. If the members of the organization had called me themselves, I could have indeed informed the police instantly. As the news came from a my source, I thought I should inform the police only after confirming the news. Having come to this decision, I set out on my bike to Padil along with my cameraman.
In a while, my cameraman and I were outside the guest house/ home stay named Morning Mist located on the hill in Padil. None of the attackers who eventually turned up were present at the spot then.We stood there for five minutes unable to understand why anyone would plan to attack that particular home stay which is located half a kilometer away from the highway cutting through Padil. The home stay is surrounded by a tall compound wall on all four sides. There is only one gate and 60 meters from the gate is the home stay. I stood near the gate and watched. There was nothing happening inside that could conceivably provoke an attack. A girl was sitting outside on a chair and two boys in another corner of the bungalow were absorbed in their mobile games. They were not indulging in any activity which can be considered illegal. That is the reason why I did not inform the police at that point of time. If my information turned out to be wrong, it would be an unnecessary anxiety for the entire police department.
While I was making all these calculations in my mind, I saw a group of over 30 people marching towards the home stay. Out of curiosity I asked them in Tulu: “Do you know what the matter is? What is happening here?” Some boys in the group pointed to the girl sitting outside saying: “Look, there is the girl and there are the guys…” They ran towards them, all set for attack. The girl, who realized that the group was there to attack, ran inside the bungalow and tried to close the door unsuccessfully. The group of 30 managed to run to the door and open it before the girl could close it completely.
Only at that point was I completely aware of what was happening and my conscience was also awakened. I immediately called Ravish Nayak, Inspector, Mangalore (Rural) (+91-948085330) from my official number (+91-9972570044). That must have been around 7.15 p.m. Ravish Nayaka did not receive my call. On the other hand, the assault had just begun. The girls started running helterskelter failing to understand what was happening. The police personnel were not receiving the calls being made. I asked my friend Rajesh Rao of TV-9 to call the police and Ravish Nayak did not receive the call made by Rajesh Rao either.
While I was trying to get in touch with the police inspector, the cameraman ran behind the attackers and got started on his duty of recording the action. Till then only my cameraman and I were present at the spot but were soon joined by the cameraman of Sahaya TV, Sharan, and a photographer, Vinay Krishna. I was a mute witness to all that was happening there, with the guilt of not being able to do anything. More than half the attackers had consumed alcohol and were not in a position to listen to anything. I have been witness to violent incidents in my life, but never before violence of this scale and nature. Our cameraman was running wherever the group was attacking individuals. I was watching it and screaming and requesting, “Don’t hit the girls.” My request reached the camera sound recorder but did not reach the attackers.The boys who were attacked were pleading, “Please leave us. We are having a birthday party here. Please…” and were falling at the feet of the attackers. But nothing moved the attackers. If it were to be just this, probably I could have forgotten the incident. But I saw something much more terrible and shocking.
The girls who saw the boys being trashed were shocked at the sight and ran in all directions only to be followed by the attackers. Believe it or not, one of the girls jumped down from the first floor but was caught by nearly 20 attackers who began to pull out her clothes. They slapped her and pushed her to the wall. By then the girl in pink clothes managed to run away. When the attackers caught her, she was literally stripped naked. Leaving her with only one piece of cloth the assailants molested her. This sight sent a chill down my spine. Never in my life had I seen something as horrific as this, though I had heard of such things. These were the scenes which could not become visuals for the news. Only a portion of the incident was shot. Later on, all the boys and girls partying there were locked inside a room. All this happened in a matter of 15 minutes.
When the attackers were done with one round of their planned action, Inspector Ravish along with Police S.I. Manikantha Neelaswamy and others arrived at the spot. It appeared as though the police had a tie-up with the attackers. For over half an hour the police were in conversation with the attackers. I was utterly shocked by the scene of police conversing with the them. While they were conversing, one boy who was in the partying group tried to escape, but was caught by the police. When in the custody of the police, the attackers trashed him.
By then many media persons had arrived at the spot. My cameraman and I returned to the office and uplinked all the visuals to the Bangalore office. At 8:45 p.m. the news was aired. Within no time the visuals of our channel was used by national channels and thus the incident became national news. This angered city police Commissioner Seemanth Kumar who called my friend Rajesh Rao of TV-9 who then was with me. Rajesh put the call on loud speaker while Seemanth Kumar was saying: “Why should Naveen have reported the incident? I will teach him a lesson. He not only compared this incident to the Assam incident, but also said that Mangalore is being Talibanized. This time he will be taught a lesson. We will fix him in this case and none of his contacts at any level will be of any help.” It is crystal clear from the words of Seemanth Kumar that his concern was not the attack itself, but the fact of the attack being reported.
This morning I received yet another shock. The attacked boys and girls had given statements against me at the Mangalore Rural Police Station. I was sure that those statements were given under pressure. I guess the boys and girls had heard me requesting the assailants not to trash them. By evening my doubt was cleared. Speaking to the media the attacked boys and girls said: “We haven’t complained against the media. They have stood in our support.”
Mangalore (Rural) police have filed a case against me under the Indian Penal Code and Unlawful Activities Prevention Act. The police have arrested eight of the assailants with the help of our visuals. The incident we have reported is shameful, not the visuals we have shown. The 28 July incident at Mangalore is neither a stray incident nor are such attacks in Mangalore a new phenomenon. Every week such incidents take place. Fundamentalists not only attack boys and girls mixing with the boys and girls of another religions but also take them to the police station. This incident would have taken place even if I had not shot it. Our recording has revealed the inhuman face of the fascists and has led to the arrest of eight attackers. No matter what is said and what cases are booked against me, I believe I have done my duty as a reporter and that is the only satisfaction to my hurt self.
It doesn’t matter to me that there are complaints filed against me and an FIR has been lodged. I will be happy if the attackers are punished because of the FIR lodged against me. If I am to be freed of these charges because of some pressure and if that is going to benefit the the attackers in any way, then I do not need such freedom. No matter what punishment is given to the attackers, it will never do justice to those girls who were assaulted right in front of my eyes. Yet they need to be punished.
There is more to write, but time does not permit. If any individual or association needs more information to fight the cause or if any investigation team needs more information, I can be contacted at any time of the day.
My address:
Naveen Soorinje
Reporter
Kasturi News 24
Mangalore
Mobile: +91-9972570044. +91-8971987904

Corporate Social Responsibility and Satyamev Jayate #Aamir Khan


 

 Guest Post, Ipshita Samanta, writes for Kracktivism

 ‘“There must be some way out of here” said the joker to the thief

“There’s too much confusion”, I can’t get no relief
Businessmen, they drink my wine, plowmen dig my earth
None of them along the line know what any of it is worth. ‘  —-All along the watch tower, Bob Dylan

We are watching from watch tower. We are traipsing along the tricky road. Yet we are enjoying our smug delirious delusions. We belong to the army of workers, supporters of corporate. No, we are not here to talk in tropes. Rather there is severe need to redress the issue of corporate social responsibility. Our ‘’responsibility’’.

We can say corporate social responsibility (CSR) is a form of corporate self-regulation incorporated into a business environment. It works within realm of ethics, morality and international law. The goal of CSR is to accept responsibility for the company’s actions and encourage a positive impact through its activities on the environment, consumers, employees, communities, shareholders and all other members of the community who may also be considered as stakeholders.’’

So in a more layman’s language CSR (corporate social responsibility; from here on CSR) is giving back some of the profits that corporate makes by lactating society’s resource to the people, to the nature in a word to the society itself. But this juxtaposition seems to be highly ironical, vacuously true. That is, if a profiteering organization strives by profit making why should they part their so dear sizeable portion? And if they do, why in the first place the free trade (this coinage is very much capitalistic; without which corporate presumably cannot do business) comes from barrel of gun, why they resort to the coercive methods? Why is there fierce competition to suck the cows dry? Why occlusion of peoples’ freedom of speech, democratic rights in most of the third world developing countries, where CSR is a comparatively newer concept.

Yes, we are talking about Vedanta, Posco and other expropriator corporate companies. In accordance to the rule book CSR is all about self policing, moral guide liners. But in real paradigm there is a shift between the definitions of commitment to the deed. We need not give the data. Data of exploitations, evidences of corruptions, instances of gross misappropriation are splashed in every nook and corner. State machinery is in cohort. Grapphiti is in the wall.

The face of Soni Suri is fading. Instead faking of happiness is in the wind.

So called messiah against corruption Mr. Anna Hazare is smiling.

Jago Bharat campaign of  Tata is buzzing.

Flocks of youth are in trance of corporate responsibility.

Ours own Oprah has came in to fore. He is the actor turned social reformer. Amir khan.

While he argues against sexs selection  he talks, discusses for the sake of destined to be unmarried 2 crore single men. He cries with the female guest who has been aborted against her wish for bearing female fetus. Yet his own child has been born out of surrogacy, one of the crudest forms of women slavery, lending your womb for money.

But he starts his program with jai hind. He remains politically correct. And also does not try to insinuate the patriarchal core. Commercial, eh? Oh it also has a greater production value. Every paisa will go the NGO run by Ambanis. The speculative money maker. The gambler whose speculations have drained surpluses of manufacturing sector in to the share markets, price fixings, speculative trade. Implicit assassinator of millions of farmers. Puppeteer of government. And he is protecting the girl child! Ironies do not stop here. Every corporate company has been tied to one or more NGO where they wash their bloody hands down. A laying off machine of black money. A devil in saint’s hood. Every slum in metropolises boasts of a NGO which is invariably linked to one or more corporate companies.

The network of capital and NGO is like infinite loop. To fix the poverty turn the lenders in to beggars. In return of education, health, infrastructural changes suck the country till death. And NGO becomes agent of death. Some will argue with trickledown effect. But is it not the one of most important reasons that in third world countries there is so higher political and bureaucratic corruption. To begin with let us look back in to the origin.

The term CSR came in to vogue in 60’s. The motivation was to make a social impact so that there could be long term profit. It involves with business ethics in a business environment. Cynics argued that it was merely a hoodwinking maneuver to the government to sideline the improper practices of big MNCs.

Also one of the aspects of the CSR was to treat human resources as capital or human capital, to potentiate them for future labor pool. So CSR is merely Keynesian approach to the corporate core value. A window dressing. CSR works as a lackey of business sustainability. A caudal approach to hide business agenda from the consumers. Also in the epoch of imperialism CSR has made up the ugly feature of neo classical economy in to a sacrosanct virtue. To facilitate the change of mode of production in the upcoming new economy from semi feudal to more aggressive oligarchy  CSR has played a big role. It has gained trust through its beleaguering methods. By building brand values it has cleared the path of monopolistic hegemony. And a way to survive in troubled water. A malignant growth which cannot be uprooted only by reformist attitude.

In Indian context in 2009 ministry of corporate affairs had published a guideline for inclusive growth and responsible business. We should note here everything is voluntary, i.e it is not a law to be abided. There come lots of good words. Ethical practice, respect for workers’ right, respect for human rights, environment keeping, social development activities and so on. But still everything remains fuzzy. Everything depends on the corporate will. And every single day every basic right is flouted. In our city the poor are driven into corner, they are being brushed under carpet. We are making our cities beautiful. Those who can buy have their amenities, we, the middle class commuter of vacillating bridge are in fear. And the poor have nothing to lose.

Here in the second episode of ‘Satyameva Jayate ‘Amir Khan tells of child abuse. 53% of the children are abused silently. Most of the incidents occur in their safeness of home. And we should not forget about the hapless child laborers. For whom there is no Amir Khan to shed tear on who are being molested, raped, sodomised in their work places. In the dark corners, in the alleys of corporate profit making factories they are sacrificed daily.

And still Amir Rocks!!!!

Ipshita  Samanta  is doing my phd in statistics from ISI, in kolkata

 

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