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Issue 123

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[image, unknown] HEALTH[image, unknown]

The pointless needle
India’s mania for injections

AFTER selling a load of cotton, a 30 year old farmer, well built and healthy, stops his bullock cart before a doctor’s dispensary. Why? To get a tonic injection.

A woman, scantily clothed in worn-out garments, brings her ill child into a doctor’s dispensary. After examining the child the doctor prescribes some tablets and a syrup. But the mother is not satisfied. ‘Doctor,’ she asks, ‘will you not give an injection?’

Patients have come to regard injections as a vital part of medication and the costlier they are the more faith they have in them: the total prescription bill, with injection, is usually around $I.00. Patients may not be able to make two ends meet, have scarcely any clothes or even a roof above their head but somehow manage to find the money for the medication.

Injections of the vitamin B-complex are one of the most common. Normally these should only be given to patients with a very severe deficiency but the mildest cases are now getting megadoses, sometimes even a thousand times above the recommended daily allowances. These include well-known brands like Neurobion from the Merck pharmaceutical company and Bevidox which is marketed by Abbot.

When they buy such doses patients are sometimes paying a hundred times more than they would have done for a tablet which would have been perfectly adequate. All the extra vitamins simply go out in the urine. The products are mostly imported or produced by foreign drug companies so it’s literally a case of foreign exchange going down the drain. The only ones to benefit are the doctors and the drug companies.

Another common injection is calcium gluconate, a drug which is designed among other things for calcium deficiency and allergic reactions in leprosy. Its use otherwise is deplorable. But patients feel a hot flushed sensation immediately after the injection and that makes them feel that it is a very potent drug.

As a result of all the treatment they have received, patients are now developing strong opinions on what injections should be like. As an alternative to penicillin doctors may prefer to give tetracyclin which produces less severe reactions. But an adult dose of this consists of 250mg in a five cc oil-based injection which is quite painful As painful injections bring discredit to the doctor— patients may say that his hand is heavy and that he doesn’t know how to give injections the doctor is often tempted to inject only one or two ccs. An inadequate dose tends to produce resistant bacterial infections.

Oral medication — capsules, tablets or syrup should generally meet the needs of the majority of patients. Those few who need injections usually require them frequently and require hospitalisation. So if you are not in hospital in India you do not usually require an injection.

Doctors say that patients demand injections and seem to get relief— if only through a placebo effect. But can patients be expected to know the full effects of drugs? Doctors are the ones entrusted by society to be experts in medicines. The whole regulatory system falls apart when they do not behave responsibly.

Dr Ulhas N. Jajoo CSE

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[image, unknown] EDUCATION[image, unknown]

Book bind
Third World publishing dominated by foreign languages

THE world’s presses churned out about billion books in 1982 about 700,000 different titles — according to Professor Robert Escarpit, who has analysed international book production for UNESCO.

Most of the books, of course, are published in the rich world Thirty-four countries with less than 26 per cent of the world’s people publish more than 80 per cent of the titles each year. Of these. most are available only in English (25 per cent). Russian (15 per cent), German (11.5 per cent), French (7 per cent) and Spanish (6 per cent).

There are very few books available in local languages in the Third World. In Ghana in 1978, for example, of the 251 books published, only 29 were in African languages. And in Kenya in 1976 there were only 46 books published in the national language, Swahili, compared with 121 in English.

There are some notable exceptions such as Madagascar which published 219 books in 1978, 164 of which were in Malagassy.

The high cost of paper and printing and the frequent diversity of culture and language within countries have served to make things difficult. Even India which has 22 widely-spoken languages and in the past has encouraged low-cost vernacular book production now sees its industry stagnating.

With so much of their book production in foreign languages there is little for the vast majority of people in poor countries to read once they leave school. Some of their governments might have assumed that billboards, pamphlets and newspapers, when available, would be sufficient to sustain the reading habit. But such optimism would be out of place. According to Professor Escarpit only one-third of the 150 million people who learn to read every year are likely to remain literate.

‘One-third are doomed to relapse into functional literacy;’ he says, ‘another third are likely to become poor readers, and only one third have any chance of becoming habitual readers.’ The main problem he sees to be the lack of reading material.

IDRC/Depthnews

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[image, unknown] MIGRATION[image, unknown]

Mobile maids
Arabs attract Sri Lankan girls

THE sexual composition of the immigrant workforce in the Middle East is changing. The semiskilled or unskilled group, once almost totally male, now has an influx of hundreds of women each month from Sri Lanka alone. According to the Asian women’s monthly. Female, most of them go there to work as housemaids, braving warnings of possible ill-treatment by Arab employers. Indeed Sri Lankan newspapers have been full of stories alleging rape, sexual harrassment and other forms of cruelty.

The press campaign does not seem to have deterred women. Perhaps that is not surprising. A Sri Lankan housemaid earns locally a maximum of $20 monthly; the lowest pay offered in the Middle East is at least $200, But they do not go there purely for the hard cash. Living conditions in Arab homes are obviously better than in their humble villages— despite the 16-hour workday. And there is that remote possibility of romance which may lead to a new and more comfortable life.

According to the official employment agencies there are 7.000 women from Sri Lanka working in the Middle East as domestic help. Many of these have gone knowing little of what to expect when they get there so the Sri Lankan authorities now run crash courses in an attempt to lessen the cultural shock The girls get pep talks on sex and marriage as well as advice on how to use modern household equipment

There is a major problem now, however, with unregistered and unscrupulous employment agencies. People who know little about the complex procedures of travel and immigration may mortgage property and sell all their jewellery to raise the cash for the fare — and get nothing for their money. The Colombo Fraud squad has been inundated with complaints and says that 50 per cent of the con men flee the country with their illegal takings.

Lim Siang/IOCU

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[image, unknown] TOURISM[image, unknown]

Fellow-travelling
Socialist holidays in Grenada

HIGH-RISE hotels and neon-lit casinos throughout the Caribbean flash out their welcome to tourists: ‘Come and spend your dollars here!’

The island of Grenada needs foreign exchange too. But it refuses to sacrifice its traditional way of life to get it. Gambling is illegal in Grenada and no hotel may be built higher than a palm tree.

While other Caribbean capitals are overcrowded and polluted Grenada’s capital, St George’s, with its jumble of red-roofed buildings is like a Cornish town dropped carelessly into tropical foliage. The atmosphere is of an English village from a generation past — with ‘Cynthia’s Stores’ and ‘Dorothy’s Snackette’ — and everyone greets passers-by, locals and tourists alike. Yet despite the island’s charms, tourism has declined in recent years. This is partly due to the recession — which is affecting even such favourite haunts of American travellers as the Bahamas and the US Virgin Islands.

But on top of this there has been political pressure. The Reagan administration’s condemnation of Grenada’s socialist government has been supported by a campaign to ward off would-be tourists. Grenada has been portrayed as an unstable country, patrolled by Soviet and Cuban troops, to which visitors from the West venture at their peril.

Not abashed by all this the government of Grenada is determined to build up its tourist industry ‘in a phased and orderly way’. A new international airport is being built with financial help from the EEC and Arab countries and technical assistance from Cuba. Despite US attempts to hold back the project the airport should be open later this year.

In addition to traditional tourist pursuits such as swimming. sunbathing and sailing there are some special tours designed to introduce the traveller to Grenada’s ‘participatory democracy’ and which will include visits to Zonal and Parish Council meetings, the popular forums where ordinary Grenadians present their ideas and complaints to the government.

Lindsey Hilsum

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[image, unknown] BABY FOODS AND THE INTERNATIONAL CODE OF PRACTICE[image, unknown]

Nestlé leaves a trail of broken promises

The New Internationalist in March 1982 supported the call for an international boycott of all Nestlé products in response to that company’s continued promotion of infant food in countries where its use was dangerous. We believe that this boycott should stand. Despite Nestle’s public declarations of intent it is clear that the company still continues to abuse the trust of poor consumers.

The International Baby Food Action Network has drawn up the table below as a graphic demonstration of the problem. It compares the international code drawn up by WHO and UNICEF and Nestlé’s latest policy statement of October 1982 with examples of what the company is actually doing in the Third World.

Boycott pressure has caused Nestlé to change some of its policies on the marketing of baby foods. But, as is clear from the table below, there is still a long way to go.

WHO / UNICEF Code What Nestlé says What Nestlé does

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No formula promotion to the general public

Article 5.1

Information relating to infant formula must not be communicated directly to the public In Bolivia, Nestlé formulas are publicly promoted through a large advertisement on the front of Nestlé distribution centre.

October ‘82

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No promotion through health facilities. No product brand names or pictures on materials for mothers

Articles 4.2, 4.3, 6.2

Product names and photos of Nestlé formula tins are allowed on prescription pads and product leaflets. Nestlé’s generic information’ on formula allowed to be given to mothers. In India, Nestlé gives pads of prescription sheets advertising Lactogen – using doctors as advertisers when they hand the written prescription to mothers.

August 1982

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No free formula samples for mothers, directly or indirectly.

Articles 5.2, 7.4

Samples are allowed for ‘professional evaluation’. (This term is undefined in their statement) In Singapore, hospitals get large quantities of samples marked ‘for professional evaluation’ on the understanding that these will be routinely distributed to mothers.

October 1982

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All information for health professionals should be strictly scientific and factual, including clear information on the superiority of breast feeding and the hazards of formula use

Article 7.2

Materials should include the ‘required information’ but they can include promotional material as well. In Malaysia, Nan is advertised to doctors as ‘Better than ever’ without the required information.

October 1982

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Labels must include ‘required information’ and cannot have pictures of infants Label modifications are ‘currently underway’ and will be implemented ‘as soon as possible’. In most countries, Nestlé tables remain unmodified. And even where, as in India, label changes have been made there is still required information missing.

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Long-term supplies should only be for infants who must use formula for medical, economic or social reasons. Supplies are allowed to meet ‘social needs’. (Nestlé gives its staff no guidelines to define such needs.) In the Philippines, Nestlé provides large supplies of formula to hospitals which use them for routine bottle feeding of all infants

September 1982

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[image, unknown] TAKING ISSUE

Ashok Mitra

Ashok Mitra’s monthly column looks at a novel Indian approach to the creation of wealth.

Redefining poverty

Great things are on the anvil. Sadhuram Mondal, his wife and their children have not yet heard about it. Maybe nobody will bother to tell them even. But it does not matter. For it has been decided by the government that with immediate effect Sadhuram Mondal, landless labourer, — and several others like him — will cease to be poor. They are being lifted from below the ‘line of poverty’; henceforth they are going to be rich, Is not that wonderful?

Thereby hangs a tale. In the fiscal year 1960-61, twenty Indian rupees were equivalent to a little more than four US dollars. But never mind, the experts said; those who could buy each month goods worth what twenty rupees or more, fetched in 1960-61 would be described as rich: only those unable to spend this sum would be regarded as poor. Expenditure equivalent to Rs.20 at 1960-61 prices thus became the ‘line of poverty; if you are above the magic threshold, you are rich.

The experts were not aware what complications they were creating for the government India has now been independent for more than thirty five years; some sort of economic planning has existed for more than thirty years. Yet in both town and country according to estimates which the statisticians keep producing, nearly one-half of the population have continued to live below this line of poverty. That is to say, out of a total population of 700 million, as many as 350 million do not have the means to spend on goods and services what the equivalent of four American dollars at 1 960-61 prices was worth. Sadhuram Mondal, the landless peasant in the village of Bariska, about fifteen miles Out of Calcutta, belongs with his family to this huge mass of the poor. They continue to live, nonetheless, in squalor and hunger, if you want to call that living. They are patient people, or perhaps they are too enfeebled— and too disorganised— to protest against this kind of sub-human existence.

But the government is sensitive, it is embarrassed, it is full of the milk of human kindness Is it not a matter of shame that so many people, after so many years since independence, remain below the line of poverty, almost one-half of the population, did the statisticians say? The government is earnest enough is enough, something has to be done about it Something is being done about it

The government has decided to shift the line of poverty. This is a State matter, it is still confidential, but according to the grapevine, the authorities are considering two alternative proposals One is that only those unable to spend the equivalent of not twenty rupees, but ten rupees, at 1960-61 prices will be declared as poor. In the other formulation, poverty will still be defined in terms of the lack of resources to spend twenty rupees each, counted not at 1960-61 prices, but at 1970-71 prices: since considerable inflation took place between the ten years, the real content of twenty rupees at 1970-71 prices is much less than what it is at 1960-61 prices. Whichever suggestion is finally accepted, the picture, from the point of view of the government will now look much better; once the line of poverty is pushed down, both the number and the proportion of the rich are bound to go up.

Sadhuram Mondal and his family have no lanet he is hired by the landlord for only four months in the year; the landlord cheats on wages and keeps back a part as interest charges for grain which Sadhuram borrowed last year; the family have a morsel of food only once during the day there are days in the lean season when they have to starve. But never mind, now that the authorities have decided to shift the line of poverty, Sadhuram and his family will begin to belong to the hegemony of the rich. This is a new genre of revolution previously unheard of revolution by redefinition.

Ashok Mitra has been Chief Economic Adviser to the Government of India — and lately Finance Minister in West Bengal. From now on he will be writing a monthly column for us.


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