Ethics in Public Health Practice in India by Arima Mishra & Kalyani Subbiah

Author:Arima Mishra & Kalyani Subbiah
Language: eng
Format: epub
ISBN: 9789811324505
Publisher: Springer Singapore

Nonoccupational

Mother to child

Established health effects of endosulfan based on over 140 peer-reviewed papers on the health effects of endosulfan. This included impacts on:Nervous system

Endocrine system

Reproductive health

Genotoxic and mutagenic impacts

Carcinogenicity

Immune system

Others

Benefit of the doubt for inclusion in the list was given to the patient.

Despite perceptions among political leaders and others that almost all deaths in the area were being inappropriately attributed to endosulfan, it was still felt that erring on the side of the people was the better thing to do, as they felt that the victims should not be missed, and in addition, the affected people were “so poor” (Venugopal 2008). As in the case of most environmental tragedies (for instance, Bhopal gas tragedy and climatic disasters), the bulk of the impact is faced by the poor.

It may sound mundane, but it never gets old: prevention is better than cure. As the tragedy was not prevented, the costs of including even those who may not have been victims will have to be borne, as it would be unethical to miss even a single victim. The costs of relief and rehabilitation were probably a lot more than the savings of the aerial spraying programme. Minimising negative externalities are critical for distributive justice.

A total of 3435 persons were initially identified as probable victims of endosulfan exposure. For patients who were unable to make it to the camps, but had been identified in previous surveys and camps, additional follow-up visits were conducted by medical officers, and using the same criteria, 838 more persons were identified. Support and benefits were being received by these 4273 persons as of February 2011 (Department of Health and Family Welfare 2011). For those persons who were neither identified in previous surveys nor had attended the camps, a system was set up as follows: applications can be submitted at any time by patients to the Endosulfan Victims Relief and Remediation Cell (which was now called Sneha Santhwanam Cell), which will then be forwarded to the District Medical Officer. This officer in turn instructs the local PHC medical officer to examine the patient and provide a report (or alternatively directly visit a nearby government health institution, according to a key informant). Based on that, a second level of screening and allotment to different departments is done by a district team (according to a key informant), and then the DMO then refers the case papers to a committee of experts which will review submissions in periodic intervals to make a decision about the case. Of the 1097 applications received until February 2011, 738 were examined by the committee, and 257 were included as probable victims of endosulfan. This list of patients was further sent to the District Collector for address approval, so that support can be initiated (Department of Health and Family Welfare 2011). In 2013, two additional detailed guidelines on temporality and biological plausibility were added to assess cases, and based on this, an additional 337 probable victims were added to the list (according to a key informant). This robust system was essential to ensure the best possible screening for potential victims.

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