Not being a vote bank, endosulfan victims fail to get their due

The government has declined to write off the loans for endosulfan victims though it is offering debt relief to farmers and fishermen.  The government says it did not have the money to write off the loans of the families of the victims amounting to about Rs. 50 crores while it is willing to find bigger sums for farmers and fishermen.

BLINDED FOR LIFE: Devikiran and Jeevanraj, identified as vicitms of endosulfan by government, with their mother

The loans were taken mostly taken for the treatment of the victims and many families are not in a position to repay them.  The government plans to pay the victims compensation of Rs. 5 lakhs / Rs. 3 lakhs recommended by the National Human Rights Commission. These are to be paid in installments and through the banks.  For many, this would only suffice to repay their loans. Some may not even get the amounts as the banks would adjust them against their loans.

Compensation for victims can be considered adequate only if that covers the treatment costs and ensure a decent living. Farmers and fishermen could get their demands conceded because they are better organised and the politicians have stake in terms of their votes. The endosulfan victims are no a vote bank. However, the situation is changing with the victims and their families themselves getting organised and coming forward to fight their cause. (Till, now the fight for justice to the victims were being fought by outsiders or those marginally affected by the spraying of the pesticide by the State-owned Plantation Corporation of Kerala). The government will heed them when get organised and stand together forgetting any communal or other considerations.

Endosufan controversy: truth is not easy to decipher

Whether there is any substance in the controversy over the letter written by Principal Secretary (Health) to the Community Medicine Department of Kozhikode Medical College asking, essentially, whether they are willing to make any amends to the report of their studies on endosulfan is not easy to determine.

Chief Minister Oommen Chandy has denied any wrong-doing by officials of the Health Department in their response to legal notice on endosulfan and that no minister had seen the file or the correspondence.  Even if a Minister has given a directive, the Health Secretary has seen to it that the letter is carefully worded after obtaining the advice of the Law Department.  The letter written by the Health Secretary is reproduced below.

The wordings like the use of ‘impediment’ may suggest a bias in favour of endosulfan manufacturers.  However, the net result of final decision communicated to Mr. Ganesan strengthens the legal case in favour of ban on endosulfan.  From the letter (reproduced below) read with earlier communication to the Department, it would appear that the government is upholding the results of the studies after due process and had shown no bias towards the Department.  It could be that the Principal Secretary Rajiv Sadanandan acted intelligently.

The only problem with the letter is that the date appears to have been over-written. Was it sent before the controversy broke out or after that?

Such doubts arise because the history of the UDF government headed by Oommen Chandy was not one of unblemished support to the victims of endosulfan. As pointed out in an earlier post, the Agriculture Secretary of the Government had signed the report of the Mayee Committee (conclusions are reproduced below) hardly a fortnight before  Mr. Chandy set out to tour the affected villages of Kasaragod district promise solace to the victims in 1984.

Recommendations of Mayee Committee

Endosulfan: the denouement

The Supreme Court has finally said it: no more studies are needed (to establish the link between the broad spectrum pesticide endosulfan and the health effects on people).  This is apparently the results of work done by Dr. Mohammed Aisheel and others in compiling a large bibliography of studies on endosulfan besides recent studies by Kerala government and various research establishments.

The studies showed   that the endosulfan could cause large number of diseases reported from Kasaragod district of Kerala and Dakshina Kannada district of Karnataka and the mechanism of action of the pesticide in human body. Studies may still be needed to conclusively establish that some of the diseases manifesting in the district is indeed caused by endosulfan.

endosulfan

A severely handicapped child who is getting assistance as an endosulfan victim

That is, while endosulfan as cause of many diseases is established, it may be more difficult to establish that the very diseases in a person or group are caused by endosulfan. The disease can be caused by other factors and these needed to be eliminated to prove the latter. However, the Supreme Court is satisfied with the evidence at hand and ordered continuing of the nation-wide ban on endosulfan on the basis of the precautionary principle.

It is notable that the Union Agriculture Commissioner maintained in his report prepared for the committee appointed by the Supreme Court that said that the problems were confined to Kerala and Karnataka and recommended ban only in these two States.  They had even taken the line of the endosulfan manufacturers that endosulfan is safe to pollinators which goes against the findings of the Kerala Agriculture University.

It is also notable that much of the data and studies linking endosulfan to various diseases were available when the O.P. Dubey and C. D. Mayee committees appointed by the Central government declared that no link had been established between the use of endosulfan in the estates of Plantation Corporation of Kerala and the health problems reported from the Padre village. The Director of Agriculture of Kerala Government, who was a member of the Mayee committee, signed the committee report. This was despite the findings of the expert committee (headed by Dr. P. K. Sivaraman), appointed by the Kerala government, which was before him.  The report was submitted in August 2003 and the Director signed the report in December 2004, hardly ten days before then Chief Minister Oommen Chandy visited Kasaragod promising succor to the endosulfan victims.

The victims are yet to get the package promised to them except for sanction given for a project funded by National Bank for Agriculture and Rural Development (NABARD). Though it has been shown that the aerial spraying of endosulfan was done disregarding the rules and without valid requirement for pest management, no action had been taken against any of the officials culpable of poisoning entire villages.

Endosulfan: spray of death
Endosulfan: brochure published by Kerala Government
Endosulfan: a Kerala story

 

Administering drugs, instead of controlling mosquitoes

The government and local bodies, which could not control mosquitoes or supply mosquito nets to the poor, will again embark on mass administration of drugs for filariasis later this month, assuming that an unknown percentage of the population is infected.  (Official documents claims that the prevalence of microfilaria towards the end of last century was about 15 per cent.  Current figures are not known.)

This is somewhat like administering paracetamol to the entire population during monsoon assuming that many people have contacted fever. No one knows whether repeated administration of drugs (diethyl carbamazene citrate-DEC and albendazole) year after year would reduce its effectiveness. Filaria may develop resistance over a long period, going by the evolutionary principle. WHO had conducted a study in 2008 to find out whether the effectiveness of albendazole had decreased following mass administration among children in Nepal. (Though the study has been reported on the WHO Website, the results could not be found.)

However, the main concern is regarding the ethics and use of funds.  It is against medical ethics to administer potent drugs to people with no disease for which the drug is a cure. Moreover, principles like that a doctor should see the patient and administer drugs as per body weight is dispensed with. This also means that advisable precautions are not taken. (See http://www.icm.tn.gov.in/drug%20formulary/ANTIINFECTIVE%20DRUGS.htm)

Mayor swallows pills

Thiruvanathauram Mayor K. Chandrika takes the pills at inaugural of Mass Drug Administration

Drugs for entire families are delivered together by volunteers even to children if the parents are not at home. There is the risk of children consuming the drug indiscriminately, resulting in overdose. Warning against use of the drug by infants, pregnant women and the elderly may not always reach them. Both DEC and albendazole are prescription drugs which are to be administered by doctors and supplied through pharmacists.

The mechanism of action of the diethylcarbamazene citrate against microfilaria (the causative parasitic organism of filariasis) is not known.  Latest studies show that the unusual and novel therapeutic effect on the cell walls of the parasite which is yet to be fully studied. The drug has effect on human neutrophil and eosinophil. (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC185347/pdf/aac00198-0157.pdf)

Doctors are not even sure of the dosage (The earlier recommendation was for administration of diethyl carbamazene citrate for 12 days. Now the prescription is just one dose of the drug combination). Still, it is being administrated to the entire population (excluding three districts in Kerala) though none can be sure of long term effects of taking the drug year after year.   Albendazole can cause birth defects in newborns, if taken during pregnancy, according to authoritative sources. (See http://www.nlm.nih.gov/medlineplus/druginfo/meds/a610019.html)

Reaction to diethyl carbamazene citrate can range from dizziness, nausea and vomiting to skin rashes, fever and even anaphylaxis (which can be fatal). The latter reactions caused by dead microfilaria rather than the drug occur only if microfilaria is present in the body in large numbers and anaphylaxis will occur only in people allergic to dead microfilaria. ( A case of such reaction was reported from Trivandrum Medical College years ago.) Few reports of such incidents in Kerala indicate the prevalence of microfilaria is actually lower than projected.

The practice of mass drug administration against filariasis had been started about a decade ago. The claim was that the disease could be eliminated in five years with 65 per cent coverage of the endemic areas. This did not happen and the project is now being extended with new target of 2015 for elimination. If the money spent on mass drug administration was spent on improving primary health care, it could have helped in the treatment of many diseases.

Fogging

Fogging for mosquito control

The prevalence of filariasis, it may be noted, is actually the results of lack primary health care. Diseases like elephantiasis, the advanced form of filariasis, occur in society because of absence of proper health care. For filariasis could be cured, if detected at its early stages, and progression into elephantiasis could surely be prevented. Doctors can easily advice tests to confirm filariasis at early stage when swelling of testis or breasts is noticed.

Elephantiasis is absent among upper strata of society because they get early treatment. Incidence of filarisis is also lower among them because of use of mosquito nets and other measures to prevent mosquito bites. If the government provided mosquito nets to the poor, instead of drugs for cure, not only filariasis but also other vector borne diseases such malaria, Dengue fever, chikungunya could have be prevented to a great extent.

Poisoned food

Every man has a right to food as implicit in the right to employment. However, this right is being denied not only to the poor but also to others also these days.

Almost all the food items sold in public markets are poisoned. The situation usually goes beyond mere adulteration. High levels of red and yellow category pesticides including organo-chlorine and organo phosphorous pesticides found in vegetables and fruits. There are reports from Tamil Nadu that some farmers cultivate vegetables differently for own use and sale.Mangoes

Pesticide is applied at every stage on vegetables for sale. Coconut too has become unsafe with the use of aluminium phosphide.  Some of these applications are quite unnecessary or by way of extreme action to prevent pest attack. The consumption of vegetables treated thus has resulted in high incidence of various diseases, including impotency and kidney failure.

Pesticide is being applied even on fish to keep away flies. Fomalin is being used to prevent rotting.  Milk also comes with pesticides and formalin besides a number of chemicals used for preservation including antibiotics. These can cause serious health problems. Very few dairies supply milk that is not dangerous.

Similar is the case with meat. Quality checks are only in paper while producers and traders use all sorts of methods to increase yield.  The government had been failing to act the new food adulteration law, citing various excuses including absence of laboratories for routine checks.  The real reason for lack of enforcement is, however, the nexus among traders, politicians and officials.