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[image, unknown] HEALTH[image, unknown]

Liquid life
Selling oral rehydration

The 1985 State of the World’s Children Report from UNICEF focuses once again on oral rehydration therapy (ORT) as a treatment for diarrhoea in young children. Indeed since UNICEF’s first report in this series in 1983 the world’s press has been flooded with feature articles on this ‘miracle cure’, a simple mixture of salts and sugar which helps the stomach of a dehydrated person absorb water.

Yet there are also articles here in the Indian press about the continuing occurrence of deaths due to diarrhoea, gastroenteritis and cholera. It is not that ORT does not work. The problem is that ORT is not being allowed to work. The dysentery toll in West Bengal in 1984 was eloquent proof of this.

The medical profession itself seems to be one the of the greatest obstacles. One of the doctors involved in treating that epidemic reported that he was repeatedly asked by other unconvinced doctors to give medical proof of the efficacy of ORT. ‘And ignorance among medical professionals,’ he complained, ‘about one of the simplest yet most important medical technologies is inexcusable.’

Health workers in Pune have written to a local medical journal about a similar problem. They have been exposed to a great deal of UNICEF and WHO literature on oral rehydration and have tried to persuade other local people to adopt it. Yet when diarrhoea cases are referred to local doctors they make no mention of ORT. If the health workers’ advice is not supported by the next rung up in the medical hierarchy the credibility of ORT is seriously undermined. Those doctors who do try to promote it however then find a lack of confidence in their patients - who are not very keen on forms of therapy that do not involve drugs. One doctor reports that he has to accompany ORT treatment with a vitamin pill as a placebo. And another notes that patients are much happier with the packaged version of the salts than with suggestions he gives about making up their own solution with a mixture of salts, sugar and water.

While the current media focus on this issue is welcome, one of its side effects is the notion that ORT is linked merely with poverty and childhood - with the implication that adults capable of paying for medicine need not use the salts.

Rich people as a result are clinging to irrational drug therapy when they themselves have diarrhoea. Westerners travelling in the Third World, for example, still carry with them anti-diarrhoea drugs which are actually of little use. They would be much better off carrying packs of the simple oral rehydration salts.

Whether they would be able to get hold of’ such a simple item is another matter. The salts which conform to the formula of’ WHO and UNICEF are mainly distributed through the health care system rather than the shops. And there is disturbing evidence from Sierra Leone, for example, as to what happens when the drug companies set about ‘marketing’ the product. The US company Searle advertises its ‘Rehydrat’ pack as containing a ‘special granule’ to make it more palatable and preserve its lime and lemon flavour. It costs 16 times as much as preparation of the standard WHO formula from basic ingredients. Public sector production of ‘generic’ ORT packs seems to be the only safeguard against this.

There is, however, nothing to stop people making up the mixture themselves - from eight level teaspoons of sugar and one of salt mixed in a litre of water. And there is now evidence that materials even more readily at hand will do the trick just as effectively. According to primary health expert David Werner, Mexican women have for generations been giving children with diarrhoea ‘rice water’ - water in which rice has been boiled.

Vimal Balasubrahmanyam,
CED, Bombay

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[image, unknown] FINANCE[image, unknown]

Secret service
Boom in Cayman Islands

[image, unknown] Talks between the US and Britain have resulted in agreements to co-operate over narcotics traffic and criminal investigations in general. But there is one area that remains sacred - the manipulation of money. This has been highlighted by the case of the Cayman Islands, another of those obscure British territories that the average UK citizen knows little about.

The US government last year wanted to get its hands on some documents lodged in the Bank of Nova Scotia branch in the Cayman Islands. The Canadian bank and the British government refused to comply and as a result the US Court of Appeal imposed a fine of $25,000 a day on the Miami branch of the bank - producing a corresponding flurry of diplomatic protests.

The three Cayman Islands lie 240 km south of Cuba in the Caribbean. The territory is administered by Britain and has a governor appointed by the Queen. In the past the only export of note was turtle meat - a trade which declined when the US imposed a total ban on the import of such products.

Nowadays the Islands’ major industry is banking and the 19,000 lucky local citizens have a per capita income higher than that of the UK. Since its inception in the mid 1960s the banking industry has expanded enormously, primarily because of the territory’s status as a tax haven, its political stability and above all its bank secrecy laws. For such a small place it is well served by banks - around 450 of them. And in addition there are around 19,000 offshore companies registered - one for every one of the local inhabitants.

Andy Crump

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[image, unknown] VIOLENCE[image, unknown]

Peasant vigilantes
Latin American armies divide and rule

Civil patrols are a fairly new concept in the ~ anti-subversion arsenal of the armed forces in Latin America, but these ragged peasants are now commonly found, armed with a bizarre assortment of ancient rifles, machetes and sticks.

Many have been forced to become adjuncts to the repressive state machinery under threat of death. Others have willingly joined for a variety of reasons, not least to be able to exploit their new-found positions of authority for their own ends.

Civil patrols were conceived by military strategists to act both as civil works units undertaking labour tasks under army control and as irregular militias supplementing regular forces. But the result of what is effectively a divide-and-rule strategy has been either to split the peasants into antagonistic factions where none previously existed or to sharpen existing antagonisms. The end result could be to sow the seeds for future civil wars.

It is not only in military regimes that this is occurring. Since the start of the civil war in El Salvador, it has become widespread. The latest state to adopt the strategy is Peru, where an increasingly desperate civilian government has given its armed forces a free hand in certain regions in an effort to destroy Sendero Luminoso (Shining Path), a burgeoning Maoist revolutionary movement.

In the countryside, locality has been turned against locality, village against village, and neighbour against neighbour in the name of internal security and the fight against subversion.

Father Luis Gurriaran, a Roman Catholic priest who now works clandestinely in Guatemala following attempts on his life, is desperately concerned about the new trend. ‘By setting Indian against Indian, traditional links in the Indian community are broken’, he says. ‘Anthropologists report that the Indians are suffering from shock and total disorientation. The effects on Indian culture are incalculable.’

Mike Rose, Gemini

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[image, unknown] AGRICULTURE[image, unknown]

Dam busters
Ecologists undermine engineers

One billion people will starve to death this century, and huge projects such as big dams will be one of the main causes’. Edward Goldsmith is not given to understatement

‘The international development agencies and the big banks will make Hitler look like a choirboy. Millions will starve because the ‘big project’ people will have taken away their land, desertified it and destroyed the forests.’

Goldsmith has been writing and campaigning on ecology for over a decade. Now he and fellow British environmentalist Nicholas Hildyard have honed in on one topic: dams. And their verdict is clear: ‘Big dams should not be built’.

They have visited dams all over the world and have unveiled their findings in the first of what is to be a three-volume study on The social and environmental effects of large dams.

It is eco-doom writ large: ‘By playing with water, we are in a very real sense playing with fire’, warn the authors. The problem is big in every sense. There will be 113 dams over 150 metres in height by 1990. And they are getting larger - the reservoir for Ghana’s Volta Dam covers an area almost the size of Lebanon.

The electricity output is getting bigger too: China’s Sanxia Dam will provide 25,000 megawatts, the equivalent of 25 large nuclear power stations. And the area they irrigate also grows ever larger. Since food and energy are scarce commodities in the Third World, it is not surprising that dam-building is a boom industry.

Nevertheless, Goldsmith and Hildyard are unequivocal in their condemnations:

‘Large dams are inevitably iniquitous on a number of counts’.

. The resettlement of thousands of people to make way for the dams is almost invariably unsatisfactory. Compensation is usually inadequate and the replacement land poor. Often whole societies are torn apart and self-sufficient ways of life destroyed. Millions are affected: in the Philippines alone, proposals to build 40 new dams in the next 20 years could affect the homes of over 1.5 million people.

. Huge tracts of land are submerged under the reservoirs. Zambia’s Kariba Dam flooded 510,000 hectares; India’s Narmada Valley project will drown 150,000 acres of forest.

. Wildlife is lost. In northern Malaysia, the Temenggor Dam threatens the survival of 100 mammal species and 300 species of birds.

. There are ‘staggering’ water losses from reservoirs and irrigation channels as a result of evaporation. Professor William Ackerman has warned that ‘the reduction of water yield (from evaporation).., surpasses the possibility of increasing low-flow discharges from reservoir storage’.

. The results from water projects can be ‘appalling’ - particularly the spread of malaria (160 million sufferers at any one time) and schistosomiasis (the number of victims has risen from 114 million to over 200 million in the last 40 years).

. Fish yields are reduced in a variety of ways including interference in the habits of migratory fish, reduced river flow downstream and the effects of rotting vegetation in inundated areas. One survey estimates that ‘dams may well cause a net loss in available protein’.

The authors have painstakingly accumulated evidence. But their aim is not simply academic. They want their work to spark a campaign to cut off funds to all large-scale water development schemes.

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[image, unknown] POPULATION[image, unknown]

Rocking Robins
IUD maker sued in US courts

The US drug company A H Robins has begun an advertising campaign in the US urging all users of intra-uterine devices (IUDs) to check with their doctors if the brand they are using is the Dalkon Shield. Robins has offered to pay for all such medical examinations and, in the case of Dalkon Shield users, to pay removal costs. Robins has also written to 185,000 US doctors and clinics and to foreign governments that may wish to get involved.

The Dalkon Shield, introduced by Robins in the early 1970s, sold 2.9 million in the US and 1.7 million overseas. Robins took the Shield off the US market in 1974 and stopped selling it abroad in 1975 after reports of adverse effects, including infertility caused by pelvic inflammatory disease, spontaneous abortions, uterine infections and at least 17 deaths. It did not, however, recall the product and only in 1980 did it contact doctors and family planning clinics, warning of the Shield’s dangers and urging its removal.

In 1972 Robins began dumping the Shield on the Third World through the population office of the US Agency for International Development (AID). Robins sold bulk packs of unsterilized Shields to AID at 48 per cent discount. Only one set of instructions accompanied each pack of 1,000 Shields and these were printed in English, French and Spanish - though the Shield was distributed in 42 countries. Robins provided only one inserter per ten Shields, thus adding to the danger of infection, a danger already present since the Shields themselves were unsterilized.

Following the halting of sales in the US in 1974, AID recalled its stocks of the Shield. It had already been inserted in approximately 440,000 women throughout the Third World, however, and despite the AID recall it was still being offered to women in Kenya in early 1979. Robins has also admitted that it continued selling Shields overseas in the first quarter of 1975, even though they were being recalled and destroyed by AID at that time.

Robins’ four million dollar publicity campaign in the US is a response to the growing tide of damages being awarded against it in Shield cases.

Punitive damages awards have been helped by the revelation in August of this year that documents relating to the Shield had disappeared despite a court order protecting them. Robins claims their destruction was accidental and they were thrown out when a lawyer’s wife was doing her spring cleaning. Earlier in August, Robert L Turtle, a former Robins lawyer, testified that he was ordered to destroy hundreds of Shield documents in a spring-cleaning operation soon after the company lost a test case in 1975

T. Jones

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[image, unknown] TAKING ISSUE

Ashok Mitra

Ashok Mitra reviews the world’s worst industrial accident.

The Bhopal disaster

Multinational corporations - or, not to offend their sensitivity, transnational corporations - are for ever. So history will absolve Bhopal. Be reasonable, capitalism reaches its fullest fruition with the transgression of barriers of lands and seas. If labour is dirt cheap in a poor country such as India, capital will move towards the direction of such cheap labour - that is how economies of costs are effected. The difference in labour cost can be as much as 100:1; to wit, one can get away with paying a worker in a poor country one-hundredth of the going wage in the United States or Europe. The overriding consideration in deciding to locate plants in under-developed countries is however elsewhere. The environmentalists are making a nuisance of themselves in western countries. With them on the prowl, the total capital cost needed to eliminate environmental risks can be of a staggering magnitude.

Therefore go abroad, transnational corporations. Pick your favourite poor country, and wangle an operational licence from an overly solicitous government. Prestige still attaches to multinational companies. Who knows, if one of them came, a bee line could be made by several others, and soon the poor land would turn rich. The government is therefore only too willing to turn a Nelson eye even when minimal measures for eliminating pollution hazards are ignored. The risk of environmental pollution is a small price to pay. With a little greasing of assorted government palms, the corporations manage to effect an enormous saving in costs. Pollution control is only a marginal concept in the poor countries.

Three thousand lives ‘were lost in Bhopal in one grey winter morning when methyl isocyanate and phosgene leaked from the storage tanks in a pesticide plant started by a transnational unit. It was pollution in its extreme form. None of the supervisors and technicians who could detoxify the leaked supply were available during the couple of hours over which the leakage occurred. The leaked phosgene damaged the lung tissues, leading to pulmonary edema. The leaked methyl isocyanate caused bacterial and oesinophilic pneumonia, tumour, laryngeal edema and massive cardiac arrests. Nearly a hundred thousand persons have lost their sight whether the affliction is permanent or for a temporary period only time will tell. For several thousand others, it is an uncertain future: they could survive in precarious health, or they could die because of the spread of malignant cancer.

But the memory of the tragedy will pass. The transnational corporations know that governments of poor lands cannot afford to pick too intense a quarrel with them. Offer some money to the government’s relief fund, offer some compensation to the relatives of the dead and the afflicted, donate a couple of hundred thousand dollars for starting a cancer hospital, and you should be able to live for another day. After all people do die at regular intervals in poor countries because of hunger, malnutrition, epidemics because water is contaminated, accidents, because suddenly thunder strikes them under the naked sky. So how does it matter if yet another factor attributable for death and terror is added to the list?

There is a variant of black humour which is being unfolded in the aftermath of the disaster. The parent unit of the transnational corporation is transferring the entire blame for what has happened on to the local managers. Along with transfer pricing, a new dimension has apparently been added to transnational corporations; the phenomenon of transfer blaming.

The phase of mutual recriminations will hopefully die down soon. Some of the comprador elements, if they persist in their refusal to own up will be forcibly retired. In no time, their place will be tilled by other native eager beavers who would not mind taking the rap for similar disasters in future if the monetary compensation is of the right order. It is little use to urge the compradors of the under-developed world to unite since they have nothing to lose but their transnational chains. It is these chains which are their life belts, even if the belts are choking with phosgene and methyl isocyanate.

Ashok Mitre is Finance Minister in the State government of West Bengal, India.

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