ON the midnight of 24 June 1985, a colleague and I were at the Jana Swasthya Kendra, a clinic that gave sodium thiosulphate injections to people from the communities closest to the Union Carbide factory in Bhopal. The kendra was supported by four local organizations of survivors and workers. Run by volunteer-doctors from Calcutta, Bombay and other parts of the country, the kendra also monitored the effect of this drug on the many symptoms the exposed people suffered. In just 20 days of its running, the kendra had administered more injections than all government hospitals had done in the past six months.

As mangers, we stayed at the clinic at night to get it running by early morning. On this particular night, a dozen armed policemen entered the clinic, forced us into two separate jeeps and took us away to separate police stations where we were locked up till morning and sent to jail the next day. Several of the volunteer-doctors and activist survivors were also arrested and jailed. The charges cooked up against us were those of attempting to murder government officials and committing other serious offences. As we found out a few days later, after sending us away, the rest of the posse took away over 1200 medical folders that contained records of the beneficial effect of sodium thiosulphate injections. These records were never returned.

Sodium thiosulphate injection was literally a life and death issue in the immediate aftermath of the disaster. Dr Max Daunderer from Germany and local forensic specialist Dr Heeresh Chandra both found that the drug when administered intravenously led to excretion of increased levels of thiocyanate in urine. Double blind clinical trials carried out by the Indian Council of Medical Research from 1985 to 1987 confirmed the efficacy of this drug in relieving exposure induced symptoms and causing detoxification of the body.¹

Ten days after the disaster, Union Carbide Corporation’s medical director first supported mass administration of thiosulphate and in another telex message three days later forbade it. Soon after, Union Carbide’s ally in the state bureaucracy, Director of Health Services, Dr M.N. Nagu sent a circular to all doctors in the city warning them that they would be held responsible for any untoward consequences of thiosulphate administration. In the prevailing situation of medical uncertainty this circular effectively stopped any administration of thiosulphate. Interestingly, given that no adverse impact of administration of thiosulphate was reported in literature, the circular had no medical basis.

 

 

In April 1991, my friend T.R. Chouhan, a former MIC plant operator in Union Carbide’s Bhopal factory, and I met with Joseph Geoghen, then Vice President of Union Carbide Corporation, USA in his corporate office in New York city. Earlier, in 1989, the Chairman and CEO of Union Carbide, Robert Kennedy had extended an invitation to the group of three Bhopal survivors whom I had accompanied on a campaign tour. In ’89 Carbide had got all four of us housed in Houston county jail on charges of criminal trespass. In ’91, we decided to talk about Carbide’s toxic trespass into the bodies of the people of Bhopal.

Goeghen met us with two lawyers who vetted each statement he made. They whispered their advice into his ears from either side as we insisted on recording our discussion on tape. I described the deteriorating health condition of the survivors. I told him how doctors were unable to treat people and no medicines seem to be working for the exposure related illnesses. We pointed out that what doctors in Bhopal needed was information about the health effects of the leaked gases. This would help in developing treatment protocols and in identifying specific areas of research, we pleaded. This wouldn’t even cost money, we assured him.

I mentioned the names of the different laboratories where Union Carbide had carried out tests with Methyl Isocyanate, the major component of the leaked gases. Goeghen did not seem to recognize any of them. In particular I mentioned the research carried out at Carnegie Mellon Institute in Pittsburgh where the corporation had documented the effect of MIC on living systems in the 1960s and ’70s. Goeghen refused to get into specifics. He told us we could get Material Safety Data Sheets published by official agencies on MIC and other chemicals. We informed him that we had already looked them up and did not find the information we needed.

Goeghen insisted that all information with Union Carbide had been passed to the Indian government. Chouhan pointed out that at the very least Union Carbide could disclose the medical records of the workers who were subjected to routine examinations in the factory but whose results were withheld from them. Goeghen would not reply to that. He indicated he was pressed for time. One of his lawyers had a flight to catch.

In May 2001, about three months after Union Carbide merged with Dow, as part of our negotiations I presented a brief note titled ‘Two humanitarian things the Dow Chemical Company, USA can immediately do to help survivors of Bhopal, India’ to the Managing Director of Dow India in Bombay. The first was to release the unpublished medical information. In November 2001, the Managing Director wrote that they were sending us an inventory of published medical research and that not only had they not found any unpublished research, they were unable to locate anyone in the ‘UCC organization’ who knew of such research.

 

 

In November 1991 about a dozen of us carried out a survey in three gas affected communities to find how the health damages suffered by people had been assessed by the medico-legal authorities.² We found that the procedure of injury evaluation formulated by the state government’s Directorate of Claims grossly underestimated the range and degree of injuries caused by toxic exposure. We found that only 10% of the claimants in the most severely affected community had been given the Pulmonary Function Test. Only 18% had their eyes tested. While ICMR studies were reporting gas-exposed women having an abortion rate five times that of unexposed women, even five years after the disaster,³ only 11% of women claimants had been examined by a gynaecologist.

 

 

Leaving room for procedural errors in an exercise of such large magnitude, the number of claimants from the 36 municipal wards matched well with the number of residents. Yet the results of categorization of claimants were completely at variance with the epidemiological research on the exposed population. While ICMR found that immediately after the disaster 99% of the population had breathlessness, 86% had eye problems and 92% had loss of appetite,⁴ the Directorate’s medical evaluation reported that 42% of the claimants had suffered no injury at all.

52% of the claimants, the Directorate declared, had only temporary injury. This while ICMR researchers were finding that ‘one to three months post-exposure, a majority of the already affected population continued to suffer from breathlessness, cough, chest pain etc....’ According to the Directorate only two persons from the two most severely affected municipal wards had suffered injury in the most severe category. In fact, the results were so scandalous that the authorities in charge of fixing compensation decided that those categorized as having not suffered any injury at all would be considered at par with those who were considered to have suffered temporary injury.

In September-October 2002, I was part of another survey in Jai Prakash Nagar, a settlement right opposite the Union Carbide factory.⁵ In this house-to-house survey we found that 91% claimants in this area that bore the worst brunt of the toxic attack had received only Rs 25000 as compensation and most received their compensation eight to ten years after they registered their complaint.

What role did medical professionals play in sustaining an irrational and unscientific system designed to downplay the damages caused to a majority of the people?

 

 

On 16 July 1988, Dr N.R. Bhandari, a Professor of Paediatrics, presented the findings of his team’s study on children born to exposed mothers after the disaster before the Scientific Advisory Committee.⁶ As compared to children of unexposed mothers, these children were found to have delayed physical and mental development and lower values for anthropometric parameters such as height and mid-arm circumference. According to the minutes of the meeting, Dr. Bhandari and his team’s work was appreciated by senior scientists and he was asked to continue the study till the children were 14. The 16 May 1989 meeting of the Project Advisory Committee recommended the continuation of the study and further recommended that the children’s sexual development and immunological functions be also studied. The same committee in September 1990 reiterated that the children must be studied till they attain puberty.⁷ Despite the positive and significant findings regarding teratogenic effect of the toxic exposure, and in the face of opposition by the Principal Investigator of the study, it was wound up in June 1991 following directions from the Indian Council of Medical Research headquarters.

Ten years later in May 2001, I was part of a team that carried out anthropometric measurements of teenagers born to exposed mothers. We found that compared to age-matched teenagers whose mothers were unexposed, male children born to exposed mothers were shorter, thinner, lighter and had smaller cranial and mid-arm circumference. The study was published in an international medical journal.⁸

Why was the study that showed injuries in the next generation of survivors prematurely terminated?

 

 

In June 1990, with help from a group of young doctors we interviewed 500 gas-affected patients in two government hospitals and collated information from their medical prescriptions.⁹ We found that 53% of the patients had been prescribed medicines that were banned in several countries and were considered fit for banning by the Indian government. 40% of the medicines prescribed were irrational and hazardous. In 1994, Drs Rajiv Bhatia and Gianni Tognoni of the International Medical Commission on Bhopal, a 15 member international team of voluntary medical professionals, found irresponsible and indiscriminate use of antibiotics and corticosteroids among the gas exposed population.¹⁰

 

 

In October 1996, we collected data on most sold medicines from 50 drug stores in the gas-affected area. We also recorded the medicines listed on prescriptions brought by 200 customers to 25 of these shops. We found that among the most sold 391 medicines, 46% were harmful, hazardous or useless and that 52% of the drug market was controlled by multinational pharmaceutical corporations. One out of every three prescriptions by a qualified medical practitioner was found to be irrational.¹¹

From June to November 1998, we collected information on the treatment given at one of the community clinics run by the Bhopal Memorial Hospital Trust from 474 gas affected patients and their health books. Analysis of the data showed that drugs prescribed were not targeted to the organ system damage but towards short-term symptomatic relief. Data also showed the use of high potency systemic corticosteroids that may increase susceptibility to tuberculosis.

In 1997, we began documenting the beneficial effects of simple yoga postures and a few pranayama breathing exercises on people with respiratory disorders caused by their exposure to Union Carbide’s gases.

The participants were initially trained in the exercises for 15 days by two yoga therapists at the clinic who also monitored the condition of their lungs through spirometry and physical examination for six months. The study reported significant and sustained improvement in lung function parameters for all participants. Half of the people in the study could do away with the bronchodilators they had been so dependent upon ever since the disaster.

After the study was published, in 1998,¹² the two yoga therapists sent reprints of the paper to senior officials of the state government’s Bhopal gas tragedy relief and rehabilitation department and the Bhopal Memorial Hospital Trust. In the covering note, the Sambhavna therapists sought their opinion on the paper and on introducing yoga and pranayama in the hospitals and clinics run by them. When they did not receive any reply for one month, they sent reminders. The government official sent appreciation for the paper and regretted that yoga could not be introduced in government hospitals because it was not possible to find so many instructors. At a stretch, this could have been accepted in any other city but Bhopal has a surfeit of yoga instructors, thanks to the efforts of Dr K.M. Ganguly who has helped train thousands of instructors.

 

 

In February 1985, a team of four doctors observed that women who had been pregnant at the time of the disaster had reported spontaneous abortions, stillbirths and menstrual disturbances.¹³ Clinic-based information generated by independent physicians in February-March 1985 indicated large number of menstrual and gynaecological disorders.¹⁴ Another study initiated by a survivors’ organization showed that 50% of the women who were clinically examined had persistent gynaecological symptoms with excessive vaginal secretion [leucorrhoea] being the commonest symptom.¹⁵ In the same month, a study carried out by an independent team showed that among women in the age group of 15-45 years there was a significant alteration in the menstrual cycle, excessive bleeding during menstruation, and dysmenorrhoea.¹⁶

 

 

From March 1985, when data indicated the presence of exposure induced gynaecological diseases, persistent attempts were made by survivors’ organizations and their supporters to include the gynaecological impact of toxic exposure in the proposed research to be carried out by the Indian Council of Medical Research. However, these attempts were unsuccessful and none among the 24 research projects identified by the ICMR concerned themselves with documenting the gynaecological impact of the disaster unless it was related to fertility.

In the June 1999 issue of Meri Saheli, a Hindi monthly magazine, a copywriter trying to raise funds for the Sambhavna Clinic published an advertisement on the health situation in Bhopal. The ad focused on the continuing gynaecological impact five years after the disaster. Earlier in February the same year, the copywriter had visited gas affected communities and interviewed teenage women. The publication of the advertisement in a local newspaper was followed by threats of police action and worse. The Chief Medical Officer announced to the media that he would lodge a criminal complaint against me for spreading alarm.¹⁷ The Principal Secretary of the Department of Bhopal Gas Tragedy Relief and Rehabilitation of the state government told another newspaper that he had asked officials to explore legal possibilities.

 

 

In July 2001, the state government proposed the setting up of an Institute of Life Sciences at Bhopal at an estimated cost of Rs 200 crore. The proposal sent to the Ministry of Chemicals and Petrochemicals, the nodal ministry for issues concerning the disaster in Bhopal, stated that the institute was ‘mainly to study the deleterious effects of MIC which were seen in humans, plants and animals (following the gas tragedy of December 1984) with a view to finding genetic solutions.’¹⁸ ‘The proposed Institute of Life Sciences,’ the proposal went on to say, ‘would be an excellent Centre to provide the infrastructure and manpower to find the genetic solution to reduce the sufferings using the various modern day molecular biology and biodiversity techniques such as RFLP, RAPD, PCR, DNA fingerprinting and gene therapy.’

Commenting on the state government’s proposal, Dr P.M. Bhargava founder Director of the Centre for Cellular and Molecular Biology, Hyderabad, wrote, ‘It is clear that whosoever has written the note has virtually no understanding of modern molecular biology, including genetics. Scientific jargon has been used in the note without understanding what the terms mean and merely to lend some credibility to the idea of setting up a Institute of Life Sciences amongst those who have no idea of modern biology or even the problems of the Bhopal gas tragedy victims. To try to set up such an institute with the money that was meant to be a compensation to the gas tragedy victims for all the pain, suffering and loss inflicted on them is nothing short of an arrogant and dishonest attempt to hoodwink and divert the funds that were not meant for the purpose for which they are being attempted to be diverted. Indeed, no genetic solutions are required to take care of the present problems of the gas tragedy victims.’

 

 

In April 1990, after several people living in the vicinity of the abandoned factory had complained about the foul smell and taste of the water in their hand pumps, we sent samples of ground water and soil from the vicinity of the Union Carbide factory to the Citizen’s Environmental Laboratory in Boston, USA. The test reports showed the presence of chemicals that damage the lungs, kidneys, liver and produce cancer. These reports were presented at Union Carbide’s annual general meeting the same month.

Reports of tests carried out by the state government’s Public Health Engineering Department in 1991 and 1996 confirmed severe contamination of ground water in several communities adjacent to the factory. In 1999, Greenpeace scientists tested 22 samples of groundwater from in and around the factory site. They found heavy concentrations of chlorinated benzenes, carbon tetrachloride, trichloroethene and other chemicals that cause various cancers and damage the liver, kidneys, brain, immune system and other organs. In 2003/2004 samples from 13 locations tested by the Madhya Pradesh Pollution Control Board showed the presence of lindane, benzene hexachloride and other hazardous chemicals.

Despite the alarming test reports from government agencies from 1990 to 2003, the government continued to deny the contamination of ground water. The minister of Bhopal Gas Tragedy Relief and Rehabilitation, who ironically was a medical professional himself, announced to the media that the ground water was safe to drink. Another minister drank a glass of the hand pump water before media persons, a la Norman Borlaug, in a bid to make the denial stronger.

Meanwhile, studies by Sambhavna showed high prevalence of severe anaemia, known to be caused by ingestion of trichlorobenzene, that is known to be present in ample amounts in the community hand pump, among the resident population. That every second person in the community was suffering from symptoms such as abdominal pain, skin disorders, giddiness, chest pain, headache and fever. That among the teenage females in the age group of 13 to 15, 43% had not begun their periods.

 

 

Most of October 2004, I was down with a stomach infection. A stool examination showed plenty of bacteria, so I took a five-day course of an antibacterial that did me no good and left me weaker. I took a seven-day course of another antibiotic but my condition further deteriorated. A culture sensitivity test reported that the strain of bacteria I was infected with was resistant to 18 out of 20 antibiotics it was tested against. Included among the 18 were what are known in doctor’s parlance as second and third generation antibiotics and the two that were effective had rather unpleasant side-effects. So I switched over to Ayurveda, and it worked wonders. My next test reported no bacteria and I regained my strength within a week of drinking half a cup of foul tasting decoction twice a day.

 

 

The story had a happy ending but I couldn’t help contemplating (and one of the joys of a stomach infection is the time and quiet it provides for contemplation) on whether what I had wasn’t the tip of a serious public health problem of resistant bacteria. I thought of the thousands of people in the city who were taking a range of antibiotics, most for insufficient number of days (in the government hospitals prescribing antibiotics for two days is routine). Given the realities of civic facilities, drainage systems and public water supply in Bhopal, it is likely that different resistant strains of bacteria find their way into the water people drink. This opens up a whole can of worms regarding the end of cycle consequences of the consumption of vast quantities of medicines by a large population.

So there you go. I have told a few of my favourite stories (and even managed to sneak in my excuse for the awful delay in sending them in). I guess, I am now expected to make my point, elaborate on the meaning of the stories, draw upon their interconnectedness and present a framework that holds them together. That would however, be straying away from why I really wanted to tell these stories.

Why I really began telling these stories was to move you, dear reader, to action. Twenty years is much too long and we have had a lot of words. No more interpretations, no more words – the point is to stop the medical disaster in Bhopal.

 

Footnotes:

1. S. Sriramachari, ‘The Bhopal Gas Tragedy: An Environmental Disaster’, Current Science 86(7), 10 April 2004.

2. Compensation Disbursement: problems and possibilities. Bhopal Group for Information and Action, Bhopal, January 1992.

3. Health Effects of the Toxic Gas Leak from the Union Carbide Methyl Isocyanate Plant in Bhopal. Indian Council of Medical Research, Ansari Nagar, New Delhi, May 2004, p. 50.

4. Ibid.

5. Minutes of the meeting of the Scientific Advisory Committee for Bhopal Gas Disaster Research Centre held on 16.8.88 at Bhopal.

6. Letter to the Director General, Indian Council of Medical Research from Professor N.R. Bhandari, Chief Investigator, ICMR Project, 1 December 1990.

7. Nishant Ranjan, Satinath Sarangi, V.T. Padmanabhan, Steve Holleran, Rajasekhar Ramakrishnan, Daya R. Varma, ‘Methyl Isocyanate Exposure and Growth Patterns of Adolescents in Bhopal’, Journal of American Medical Association 290(14), 8 October 2003.

8. Evaluation of Some Aspects of Medical Treatment of Bhopal Gas Victims. Bhopal Group for Information and Action and Socially Active Medicos, Indore, August 1990.

9. Rajiv Bhatia and Gianni Tognoni, ‘Pharmaceutical Use in the Victims of the Carbide Gas Exposure’, International Perspectives in Public Health, Volumes 11 & 12, 1996.

10. The Bhopal Gas Tragedy: 1984 – ? A report from the Sambhavna Trust, Bhopal, November 1998.

11. A. Gupta, S. Durgavanshi and I Eckerman, Effects of yoga practices for respiratory disorders related to the Union Carbide gas disaster in 1984. XVI World Congress of Asthma, Buenos Aires, Argentina, 17-20 October 1999, pp. 83-87.

12. Medical Relief and Research in Bhopal: the realities and recommendations. Medico Friend Circle, February 1985.

13. Rani Bang, Effects of the Bhopal Disaster on Women’s Health: an epidemic of gynaecological diseases. Mimeograph, 1985.

14. Medical Survey on Bhopal Gas Victims Between 104 and 109 Days After Exposure to MIC Gas. Nagarik Rahat aur Punarvas Committee, March 1985.

15. The Bhopal Disaster Aftermath: an epidemiological and socio-medical survey. Medico Friend Circle, October 1985.

16. Storm in Bhopal Over Ad on Gas-hit Girls, The Times of India, 1 June 1999.

17. Letter from Alka Sirohi, Principal Secretary, Government of Madhya Pradesh, Department of Bhopal Gas Tragedy Relief and Rehabilitation, to N.C. Gupta, Joint Secretary (Bhopal), Ministry of Chemicals and Petrochemicals, 9 July 2001.

18. Personal communication from Dr P.M. Bhargava, 28 October 2003.

19. The Bhopal Legacy. Greenpeace Research Laboratories, University of Exeter, November 1999.