HARYANA AND HAVOC OF PESTICIDES

gj;k.kk  vkSj dhV uk'kdksa dk dgj

j.kchj flag nfg;k

gj;k.kk Kku foKkua lfefr

dhV uk'kdksa ds vfu;fU=r  bLrseky us gfjr Økafr ds nkSjku gj;k.kk esa  tehu ] i'kqvksa vkSj ekuo tkfr dks yxrk gS dkQh uqdlku igqapk;k gS A foMEcuk ;g gS fd bu dhVuk'kdksa  dh  áweu 'kjhj esa tk¡p djus dh e'khu rd jksgrd  ds eSMhdy esa ugha gSa A

dhVuk'kdksa ds vaèkkèkqaèk ç;ksx ls i;kZoj.k ls ysdj tuthou dks gksus okys uqdlkuksa ls ge lHkh ifjfpr gSaA ij blds ç;ksx dks ysdj tSlh lkoèkkuh dh ljdkj ls vis{kk Fkh oSlh dgha ns[kus esa ugha vk jgh gSA

ifj.kke ;g gS fd tuLokLF; ds çfr lrdZ dbZ fodflr ns'k rks gekjs Qy&lfCt;ksa ds fu;kZr ij ikcanh yxkus tSls dne Hkh mBk jgs gSaA blds ckotwn gekjs ns'k esa oSlh lrdZrk vkSj psruk ns[kus dks ugha fey jgh gS tSlh fd brus laosnu'khy eqís ij visf{kr gSA D;k gS leL;k vkSj dSls gks bl dk gy \ gesa

le; jgrs psruk gksxk A dhVuk'kdksa ds ç;ksx ls euq"; dbZ çdkj dh chekfj;ksa dh pisV esa vk ldrk gSA lcls çeq[k gS &

*rhoz fo"kkärk ¼,D;wV Io‚;tfuax½A blesa dhVuk'kd ç;ksx djus okyk O;fä gh bldh pisV esa vk tkrk gSA gekjs ns'k esa rks ;g leL;k dkQh ns[kus esa vkrh gSA

*dhVuk'kd ds ç;ksx ls gksus okyh nwljh cM+h chekjh gS dSaljA fo'ks"k :i ls [kwu vkSj Ropk ds dSalj bl dkj.k ls dkQh ns[kus esa vkrs gSa A  blds vykok Üokal lacaèkh chekfj;ka vkSj 'kjhj ds vius fMQSal  ra= ds detksj gksus dh leL;k blds dkj.k dkQh ns[kus esa vkrh gSA dbZ ckj ;g uoZl ç.kkyh dks pisV esa ys ysrk gSA

esjs rhl iSarhl lky ds vuqHko eq>s ;g lkspus ij etcwj djrs jgs fd isV nnZ dh yEch chekjh tgk¡ ckdh lHkh VsLV ukeZy vkrs   gSa  mu ejhtksa  esa  isV nnZ dk dkj.k ;s dhVuk'kd gh gksrs gSa  A fjlpZ  ds fy;s  lqfoèkk uk gksus ds dkj.k esjk ;s fe'ku iwjk ugha gks ldk A

        dhVksa vkSj lw{e thoksa dks ekjus esa ç;qä gksus okyk dhVuk'kd ewy :i ls ;g tgj gh gSA vxj dhVuk'kdksa dk nq:i;ksx fd;k tk jgk gS rks blds cgqr xaHkhj ifj.kke gks ldrs gSaA ;g mu lHkh ds fy, gkfudkjd gksrk gS tks fd blds laidZ esa vkrk gSA fdlku] deÊ] miHkksäk] tkuoj lHkh ds fy, ;g uqdlkunsg gks ldrk gSA blfy,] dhVuk'kdksa ds  bLrseky ij lokfy;k fu'kku [kM+s gks x, gSa A mi;ksx rHkh fd;k tkuk pkfg, tcfd mudh t:jr gksA Hkkjr ds dqN {ks=ksa tSls gfj;k.kk ]iatkc] if'peh mÙkjh çns'k] vkaèkzçns'k ls fo'ks"k:i ls dhVuk'kdksa dk vfèkd ç;ksx djus dh [kcjsa vk jgh  gSaA

dhVuk'kdksa ds mi;ksx dk lcls csgrj rjhdk ;g gS fd mudk bLrseky "baVhxzsfVM isLV eSustesaV" ds varxZr fd;k tk,A vFkkZr dhVuk'kdksa dk ç;ksx dhV fu;a=.k ds vU; mik;ksa ds lkFk ,d mik; ds :i esa fd;k tk,A ,d ek= mik; ds :i esa ugha fd;k tk,A Hkkjr esa ;g ns[kus esa vkrk gS fd vfèkdka'k yksx dhV fu;a=.k ds fy, dhVuk'kdksa ij fuHkZj gks x, gSaA çk;: rc Hkh dhVuk'kdksa dk fNM+dko dj fn;k tkrk gS tcfd mudh t:jr gh u gksA tcfd dhVuk'kdksa dks ç;ksx rc gksuk pkfg, tcfd ऎlk yxs fd Qly esa dhV yxuk c<+ ldrk gSA blds lkFk gh xSj jklk;fud tSfod dhVuk'kdksa ds ç;ksx dks Hkh çkFkfedrk nsus dh t:jr gSA

dhVuk'kd ds ç;ksx ds nkSjku] Qy&lfCt;ksa] vukt vkSj ikuh esa igqap pqds dhVuk'kd ds ekè;e ls rFkk dbZ ckj rks nwèk ds ekè;e ls HkhA vk'k; ;g fd ,d ckj dhVuk'kd ds i;kZoj.k esa igqap tkus ds ckn og dbZ ekè;eksa ls euq"; rd igqap ldrk gSA blfy, dhVuk'kdksa ds nq"çHkko ls cpus dk lcls vPNk rjhdk ;gh gS fd bldk mi;ksx fd;k gh uk tk;s ;k de ls de mi;ksx fd;k tk,A blds ç;ksx esa vfèkd ls vfèkd lkoèkkuh cjrh tk,A blesa ljdkj ds —f"k ] LokLF; vkSj [kk| fujh{k.k foHkkx Hkh lVhd  Hkwfedk fuHkk ldrs gSaA

 dqN  lkbal nkuksa dk [;ky gS fd tSfod [ksrh gh vc ,d ek= jkLrk gS A

jklk;fud [kkn vkSj dhVuk'kdksa ls cpko dk flQZ ;gh rjhdk gS fd ge tSfod [ksrh viuk,aA ysfdu lPpkbZ ;g gS fd jlk;fud [ksrh ds fy, ljdkj dh vksj ls rjg&rjg ds çksRlkgu fn, tkrs gSa tcfd tSfod [ksrh ds fy, mrus çksRlkgu ugha gSaA vke vkneh ds LokLF; ds fygkt ls gj gky esa csgrj tSfod [ksrh blh vlarqyu dh otg ls jlk;fud [ksrh ls fiNM+h gqbZ gSA ljdkj fdlkuksa ds fy, jlk;fud [kkn ij djhc 70 gtkj djksM+ :i, dk vuqnku nsrh gSA nwljh vksj] ns'k esa gksus okyh T;knkrj vuqlaèkku jlk;fud [ksrh dks ysdj gh gksrs gSa] tSfod [ksrh dks Hkh vuqlaèkku dh vko';drk gksrh gSA mls bl rjg dk lg;ksx ugha fey jgk gSA

fiNys dqN le; ls iatkc dh [ksrh fQj  ls lqf[k+Z;ksa esa gSA eq[; dkj.k ;g Hkh jgk gS fd [ksrh esa jklk;fud [kknksa vkSj dhVuk'kdksa dh [kir c<+rh xbZA ;gh ugha] fQj ,sls dhVuk'kd Hkh bLrseky gksus yxs tks T;knk ?kkrd FksA iatkc esa ;g lcls vfèkd gqvk gS vkSj blds Hk;kog uqdlku gq, gSaA bu dhVuk'kdksa ds laidZ vkSj Qlyksa esa vk, muds vlj ls dSalj lfgr vusd xaHkhj chekfj;ka iuih gSaA gkyr ;g gks xbZ fd iatkc ds ekyok {ks= ls jktLFkku dh vksj tkus okyh ,d Vªsu dks blfy, ^dSalj Vªsu* ds uke ls tkuk tkus yxk Fkk] D;ksafd lLrs bykt ds fy, gj jkst bl chekjh ds f'kdkj yxHkx lkS yksx chdkusj tkrs FksA xuher gS fd blls lacafèkr [kcjksa esa tc ;g rF; lkeus vkus yxk fd dhVuk'kdksa ds csyxke bLrseky ds dkj.k gh iatkc ds ekyok {ks= esa ;g fLFkfr cuh gS] rks jk"Vªh; ekuokfèkdkj vk;ksx us bl ij Lor: laKku ysdj jkT; ljdkj dks t:jh dkjZokbZ djus ds funZs'k fn,A urhtru iatkc ljdkj us lsgr ds fy, csgn [krjukd lkfcr gks jgs dhVuk'kdksa ds mi;ksx] mRiknu vkSj vk;kr ij ikcanh yxk nh gSA xkSjryc gS fd fiNys dqN lkyksa ls iatkc ds cfBaMk] QjhndksV] eksxk] eqälj] fQjkstiqj] lax:j vkSj ekulk ftyksa esa cM+h rknkn esa xjhc fdlku dSalj ds f'kdkj gks jgs gSaA lÙkj ds n'kd esa iatkc esa ftl gfjr Økafr dh 'kq#vkr gqbZ Fkh] mldh cgqçpkfjr dke;kch dh dher vc cgqr lkjs yksxksa dks pqdkuh iM+ jgh gSA ml nkSjku T;knk iSnkokj nsus okyh Qlyksa dh fdLesa rS;kj djus ds fy, jklk;fud [kknksa vkSj dhVuk'kdksa dk csyxke bLrseky gksus yxkA fdlkuksa dks 'kk;n ;g vanktk u jgk gks fd bldk urhtk D;k gksus okyk gSA ysfdu D;k ljdkj vkSj mldh ç;ksx'kkykvksa esa cSBs fo'ks"kK Hkh bl gdhdr ls vutku Fks fd ;s dhVuk'kd rkRdkfyd :i ls Hkys Qk;nsean lkfcr gksa] ysfdu vkf[kjdkj euq"; dh lsgr ds fy, fdrus [krjukd lkfcr gks ldrs gSa\ foKku ,oa i;kZoj.k dsaæ] paMhx<+ fLFkr ihthvkbZ vkSj iatkc foÜofo|ky; lfgr [kqn ljdkj dh vksj ls djk, x, vè;;uksa esa ;s rF; mtkxj gks pqds gSa fd dhVuk'kdksa ds O;kid bLrseky ds dkj.k dSalj dk QSyko [krjukd Lrj rd igqap pqdk gSA ysfdu fofp= gS fd psrkouh nsus okys ,sls reke vè;;uksa dks ljdkj us fljs ls [kkfjt dj fn;k vkSj fLFkfr fu;a=.k esa gksus dh ckr dghA nsj ls lgh] jkT; ljdkj us bl elys ij ,d ldkjkRed QSlyk fd;k gS rks bldk Lokxr fd;k tkuk pkfg,A dhVuk'kdksa dh ckcr fdlkuksa dks tkx:d djus ds lkFk&lkFk dSalj ds bykt dks xjhcksa ds fy, lqyHk cukus dh fn'kk esa dne mBkuk jkT; ljdkj dh ftEesnkjh gSA ;g è;ku j[kus dh ckr gS fd dhVuk'kd ;k jklk;fud [kkn fNM+dus ds tksf[ke Hkjs dke esa yxs T;knkrj yksx nwljs jkT;ksa ls vk, etnwj gksrs gSa vkSj mUgsa LokLF; chek ;k lkekftd lqj{kk dh fdlh vkSj ;kstuk dk ykHk ugha fey ikrk gSA iatkc ds vuqHko ls lcd ysrs gq, ns'k ds nwljs fgLlksa esa Hkh dhVuk'kdksa ds bLrseky dks fu;af=r djus vkSj [ksrh ds ,sls rkSj&rjhdksa dks c<+kok nsus dh igy gksuh pkfg, tks lsgr vkSj i;kZoj.k ds vuqdwy gksa-lquk  gS fd  vle çns'k dh ljdkj us Hkh tSfod [ksrh dks c<+kok nsus ds fy, dkQh miØe 'kq: fd;s gSa  vkSj lquk rks ;s Hkh gS fd  eksulsaVks daiuh esa vius deZpkfj;ksa ds fy, ogka dh dsUVhu esa Hkh tSfod mRikn gh ç;qä gksrs gSa - ysfdu  yxrk gS fd eksulsaVks vkSj dkjfxy tSlh daifu;k Hkkjr tSls ns'k esa ;s tSfod —f"k ds ç;ksx ugha gksus nsaxs vkSj  ;s rFkkdfFkd fufgr LokFkksZa ds pyrs  usrk vkSj dqN —f"k oSKkfud bls pyus nsaxs\

            Qlyksa esa vaèkkèkqaèk ç;ksx fd;s tk jgs isLVhlkbM ds dkj.k nwf"kr gks jgs [kku&iku rFkk okrkoj.k dks cpkus ds fy, than —f"k foHkkx esa ,Mhvks ds in ij dk;Zjr M‚- lqjsaæ nyky us o"kZ 2008 esa than ftys ls dhV Kku dh Økafr dh 'kq:vkr dh FkhA M‚- lqjsaæ nyky us vkl&ikl ds xkaoksa ds fdlkuksa dks dhV Kku dk çf'k{k.k nsus ds fy, fuMkuk xkao esa fdlku [ksr ikB'kkykvksa dh 'kq:vkr dh FkhA M‚- nyky fdlkuksa dks çsfjr djrs gq, vdlj bl ckr dk ftØ fd;k djrs Fks fd fdlku tkx:drk ds vHkko esa vaèkkèkqaèk dhVuk'kdksa dk ç;ksx dj jgs gSaA tcfd dhVksa dks fu;af=r djus ds fy, dhVuk'kdksa dh t:jr gS gh ugha] D;ksafd Qly esa ekStwn ekalkgkjh dhV [kqn gh dqnjrh dhVuk'kh dk dke djrs gSaA ekalkgkjh dhV 'kkdkgkjh dhVksa dks [kkdj fu;af=r dj ysrs gSaA M‚- nyky us fdlkuksa dks tkx:d djus ds fy, Qly esa ekStwn 'kkdkgkjh rFkk ekalkgkjh dhVksa dh igpku djuk rFkk muds fØ;kdykiksa ls Qly ij iMu+s okys çHkko ds ckjs esa ckjhdh ls tkudkjh nhA iq#"k fdlkuksa ds lkFk&lkFk M‚- nyky us o"kZ 2010 esa efgyk fdlku [ksr ikB'kkyk dh Hkh 'kq:vkr dh vkSj efgykvksa dks Hkh dhV Kku dh rkyhe nhA ;g blh dk ifj.kke gS fd vkt than ftys esa dhVuk'kdksa dh [kir yxHkx 50 çfr'kr de gks pqdh gS vkSj ;gka ds fdlku èkhjs&èkhjs tkx:d gksdj tgjeqä [ksrh dh rjQ vius dne c<+k jgs gSaA vkt ;gka dh efgyk,a Hkh iq#"k fdlkuksa ds lkFk daèks ls daèkk feykdj dhV Kku dh bl eqfge dks vkxs c<+k jgh gSaA nqHkkZX;o'k o"kZ 2013 esa ,d xaHkhj chekjh ds dkj.k M‚- lqjsaæ nyky dk nsgkar gks x;k FkkA blls mudh bl eqfge dks cM+k >Vdk yxk Fkk ysfdu muds nsgkar ds ckn Hkh ;gka ds fdlku mudh bl eqfge dks c[kqch vkxs c<+k jgs gSaA iq#"k rFkk efgyk fdlkuksaa dks tkx:d dj mUgsa vkRefuHkZj cukus rFkk —f"k {ks= esa muds vFkd ;ksxnku dks ns[krs gq, gfj;k.kk fdlku vk;ksx M‚- lqjsaæ nyky ds uke ls jkT; Lrjh; iqjLdkj 'kq: djus tk jgk gSA vk;ksx }kjk gj o"kZ ,d uoacj dks gfj;k.kk fnol ij jkT; Lrjh; dk;ZØe dk vk;kstu dj —f"k {ks= esa mR—"V dk;Z djus okys —f"k foHkkx ds ,d ,Mhvks dks ;g iqjLdkj fn;k tk,xkA vk;ksx }kjk iqjLdkj ds rkSj ij ,d ç'kLrh i= vkSj 50 gtkj #i;s dh jkf'k bZuke Lo:i nh tk,xhA rkfd bl eqfge dks iwjs ns'k esa QSykus ds fy, —f"k foHkkx ds vU; vfèkdkfj;ksa dks Hkh çsfjr fd;k tk ldsA gfj;k.kk fdlku vk;ksx ds ps;jeSu M‚- vkj,l çkSèkk us gky gh esa çdkf'kr gqbZ vk;ksx dh eSxthu esa bl iqjLdkj dh ?kks"k.kk dh gSAMkDVj cythr H;ku us  gj;k.kk foKkua eap  nwljs  —f"k oSKkfudksa vkSj dk;ZdrkZvksa ds lkFk feydj   vius xk¡o esa Hkh dhV ikB'kkykvksa dk vk;kstu fiNys fnuksa  fd;k gS A MkDVj jktsanj pkSèkjh us Hkh fiNys rhu pkj lky ls dqnjrh [ksrh ij mYysf[kr  dke fd;k gS A gj;k.kk Kku foKkua lfefr dk ç;kl jgsxk dh bu lc ç;Ruksa dk laKku ysrs gq, bl {ks= ds dke dks vkxs ys tkus esa viuh Hkwfedk fuHkk,xh A

राष्ट्रीय चिकित्सकीय संस्थान अधिनियम 2010

राष्ट्रीय  चिकित्सकीय संस्थान अधिनियम 2010
Clinical Establishment Act 2010. (CEA)
केंद्र सरकार द्वारा पारित अधिनियम निसःसंदेह स्वास्थ्य सेवा के व्यय और गुणवता मानकीकरण की तरफ एक कदम है।
केंद्रीय कानून के कुछ महतवपूर्ण तत्व-
अ. इलाज के लिए मानक दिषानिर्देष का प्रावधान
ब. दरों के मानकीकरण के तरफ प्रयास
क. संस्थानों द्वारा दरों का प्रदर्षन
ड. यह कानून लगभग सभी चिकित्सीय संस्थानों / सभी मेडीसन षाखाओं को पंजीकृत करता है, न कि सिर्फ ण्लोपैथी को ।
वर्तमान राष्ट्रीय   कानून में कमियां व समस्याएं
1. चिकित्सकीय संस्थान कानून ;ब्म्।द्ध के क्रियान्वयन के लिए अलग से स्वायत ढांचा , अतिरिक्त स्टाफ ;सम्बन्धित बजट, की कोई बात नहीं की गई है। निजी स्वास्थ्य सेवा में , आज शासकीय सेवाओं की तुलना में 5-6 गुणा ज्यादा डाक्टर हैं । इतने व्यापक निजी क्षेत्र की प्रभावी रुप से निगरानी करना बहुत कठिन काम है। इस कानून के मुताबिक राज्य स्तर पर पहले से ही बोझिल हो चुके स्वास्थ्य सेवा संचालनालय और जिला पंजीयन प्रधिकरण , जो जिला कलेक्टर व जिला स्वास्थ्य अधिकारी से मिल कर बना है, को दी गई है। अतिरिक्त स्टाफ के अभाव में यह खतरा है कि कानून सिर्फ कागजों में सिमिट कर रह जाएगा।
2. जिले पर कोई साझेदार( Multi-stakeholder)  समीक्षा समिति नहीं है, जिसमें मरीजों /ग्राहकों के प्रतिनिधि, स्वास्थ्य के क्षेत्र में कार्यरत स्वंसेवी संस्था और डाक्टर शामिल हों। जिला पंजीयन प्राधिकरण के सभी सदस्य या तो डाक्टर हैं या अधिकारी। स्वास्थ्य अधिकार संघटनों के प्रतिनिधि सहित अन्य साझेदारों के लिए इसमें कोई औपचारिक जगह नहीं है।
3. मरीजों के अधिकारों की रक्षा का कोई प्रावधान /जिक्र नहीं।
4. म्रीजों के लिए कोई षिकायत निवारण प्रणाली नहीं, शिकायत करने की व्यवस्था नहीं है।
5. जिस  तरह यह कानून सार्वजनिक स्वास्थ्य सेवा को देखता है, वह समस्यामूलक है। मानकों को पूरा न करने पर संस्थान को बंद करने या दंड भरने का प्रावधान , सार्वजनिक स्वास्थ्य सुविधाओं की दृष्टि  से गैर वाजिब है। विशेषकर जहां सार्वजनिक सेवाओं का विस्तृत जन सरोकार होता है, और जहां निजी सुविधाओं से अलग ढंग से जवाब देही करने की जरुरत होती है। इसके साथ , नियमन के लिए अलग से सार्वजनिक अधिकारी रखने का प्रावधान , जो वर्तमान सरकारी स्वास्थ्य अधिकारियों से स्वायत हो ज्यादा अच्छा होगा।
6. नियमन ढांचे में क्लीनिकल संस्थानों के लिए पुलिस अधिकारी को रखना अवांछित है, और डाक्टरों का इस बारे में संषय वाजिब है।
7. यदि संस्थाओं  को स्थायी पंजीकृत कर दिया गया, तो किसी नागरिक /मरीज की उस संस्थान के प्रति शिकायत कि वह न्यूनतम मानकों का पालन नहीं कर रहा, के लिए कोई जगह नहीं बचेगी।
8. कनून में कुछ प्रावधान अव्ययवहारिक और अप्रासांगिक हैं-
क. मिशाल के तौर पर चिकित्सीय संस्थान में लाए गये किसी व्यक्ति की आपात मेडिकल स्थिति को स्थिर करने की बाध्यता समस्याग्रस्त है। मान लिजिए किसी हर्ट अटैक के मरीज को सिर्फ विशेषज्ञता प्राप्त यूनिट में ही स्थिर किया जा सकता है, न कि किसी आंख वाले अस्पताल में।
ख. व्यक्तिगत डॉक्टर के द्वारा चलाये जाने वाले बाह्यरोगी क्लिनिक के लिए भौतिक   आवश्यकताओं , जैसे क्लिनिक के लिए वर्ग फुट क्षेत्र  द्ध  को कानूनी तौर पर निष्चित करने का खास मायना नहीं है।

9. क्लीनिकल संस्थानों के लिए मानक तय करने की प्रक्रिया बेहद केंद्रीकृत है। इस कानून में यह राश्ट्रीय स्तर पर ही की जा सकती है। हाल की स्थिति से यह डर पनपा है कि कानून में ऐसे केंद्रीकृत फैंसलों को बड़े व्यावसायिक अस्पताल आसानी से अपने पक्ष में करके गैर जरुरी उंचे पैमाने तय करने के नियमों में अपना प्रभाव जमा सकते हैं। इन मानकों को छोटे अस्पताल पूरा नहीं कर पायेंगे।
रणबीर सिंह दहिया --जन स्वास्थ्य अभियान
हरयाणा ज्ञान विज्ञानं समिति
9812139001

Private Sector

निजी स्वास्थ्य सेवा क्षेत्र की सामाजिक  जवाबदेही  व उसका नियंत्रण होना जरूरी  है
दुनिया का सबसे बड़ा निजी स्वास्थ्य सेवा क्षेत्र भारत में है । परन्तु पूरी  तरह से गैर जवाबदेह और अनियंत्रित रहा है । मरीजों से मिले उनके अपने अनुभवों से पता चलता है कि  किस प्रकार निजी अस्पताल व नर्सिंग होम में मरीजों का बार बार आर्थिक शोषण होता है  । साथ ही उन्हें अक्सर निम्न स्तर की बेतुकी दवाएं दी जाती हैं । निजी स्वास्थ्य सेवाओं के दाम बेहताशा बढे हैं । सन 1980 और 1990 के मध्य वे दोगुने से भी ज्यादा हो गए हैं । अनुमान लगाया जाता है कि आधे से अधिक भारतीय परिवार , स्वास्थ्य सेवा सम्बन्धी खर्चे के कारण ही गरीब हो रहे हैं , जिनमें करीब 4 करोड़ भारतीय प्रति वर्ष इस खर्च के चलते गरीबी में धकेले जा रहे हैं । ऐसी प्रतिकूल परिस्थिति से सभी परेशान हैं ।  एक तरफ आम मरीज बाजारीकरण व निजीकरण की मार से त्रस्त है और दूसरी तरफ संवेदनशील डाक्टर व जनहित के लिए काम करने वाली गिनी चुनी स्वास्थ्य सेवाएं बहुत दबाव महसूस  हैं और उनके लिए नैतिक रूप से काम करना बहुत मुश्किल  है ।
1990 के बाद से भारत में निजी स्वास्थ्य सेवा  क्षेत्र का बढ़ता वर्चश्व : कुछ आंकड़े
निजी स्वास्थ्य सेवाओं का आज देश की स्वास्थ्य सेवा व्यवस्था में खासा दबदबा  है । भारत में  सेवा के विभिन्न हिस्सों में निजी सेवा प्रदाता का अंश नीचे देखा जा सकता है ।
1 . ग्रेजुएट डॉक्टर ( M.B.B.S.)---90 %
2 . पोस्ट ग्रेजुएट डॉक्टर ---95 %
3 . ओ पी डी सेवा ( बाह्य सेवा ) --- 80 %
4 . इनडोर ( अंत: रोगी ) सेवा ---60 %
5 . मैडीकल कालेज --- 30 %
6 . दवा उद्योग ---99 %
7 . चिकित्सा यंत्र उद्योग ---100 %
1990 के बाद से सरकार की नव उदार नीतियों के प्रभाव से वैश्वीकरण , निजीकरण और बाजारीकरण को बढ़ावा मिला है , जिसके फल स्वरूप निजी स्वास्थ्य सेवा क्षेत्र दिन दूना रात चौगुना बढ़ रहा है । डॉक्टर , मंत्री और स्वास्थ्य अधिकारी इन तीनों के लिए ही " स्वास्थ्य सेवा" एक व्यापार बन गया है । जबकि यह एक ऐसा पेशा है , जिसे मानवता की सेवा के लिए समर्पित होना चाहिए था ।  अब यह बहुत हद तक मुनाफा कमाने वाला उद्योग हो  गया है , जो एक ओर दवा कंपनियों एवं दूसरी ओर मंहगी डाक्टरी शिक्षा के चंगुल  में पूरी तरह फंसा
हुआ है ।
कैसे बदल सकते हैं यह हालत  ?
आज सार्वजनिक स्वास्थ्य सेवाओं को मजबूत करना और निजीकरण की नीतियों को रद्द करना जनहित में आवश्यक है । इन व्यापक उपायों के संदर्भ में , हम निजी स्वास्थ्य सेवा के बारे में अपने सुझाव रखना चाहते हैं । निजी स्वास्थ्य सेवा क्षेत्र पर विस्तृत सामाजिक नियंत्रण की आज सख्त जरूरत है । इस नजरिये से पेश किये गए अपने पॉलिसी ब्रीफ में हम निजी स्वास्थ्य क्षेत्र की स्तिथि पर विस्तार से गौर करने की जरूरत है ताकि उससे प्रभावशाली ढंग से निपटने के लिए जरूरी ठोस तरीके सुझाये जा सकें ।
भारत में निजी स्वास्थ्य सेवा क्षेत्र के कुछ प्रमुख पहलू :
1 . भारत में निजी स्वास्थ्य सेवा क्षेत्र के बारे कुछ गंभीर मुद्दे :
* यह क्षेत्र आज तक पूरी तरह अनियंत्रित है । इसमें गुणवत्ता के कोई भी स्टैण्डर्ड नहीं हैं साथ ही तर्कहीनता भी व्यापक है । निजी क्षेत्र का अधिपत्य आज स्वास्थ्य सेवा क्षेत्र में है । अत: इसने सार्वजनिक स्वास्थ्य सेवा व्यवस्था को भी कमजोर कर दिया है ।
* इसके बावजूद कुछ गुणवत्ता पूर्ण स्वास्थ्य सेवा सुविधाएँ और कुछ विश्वसनीय गैर लाभकारी अस्पताल  गरीब , आदिवासी और कमजोर वर्गों की सेवा में लगे हुए हैं । लेकिन यह निजी प्रदाताओं का एक  हिस्सा है , जबकि बहुत बड़ा हिस्सा ऐसा है जहाँ बड़े कार्पोरेशन , बड़े प्राइवेट अस्पताल , फर्जी धर्मार्थ अस्पताल , छोटे नर्सिंग होम व अशिक्षत झोला छाप डॉक्टर ही छाये हुए हैं , जिनमें नियंत्रण का पूरा आभाव है ।
* वैश्वीकरण , निजीकरण और उदारीकरण के दौर में प्राइवेट मैडीकल कालेज और कॉर्पोरेट अस्पतालों की संख्या लगातार तेजी से बढ़ रही है ।
2 . वर्तमान निजी स्वास्थ्य सेवा क्षेत्र की मुख्य समस्याएं
* अस्पतालों में  दर्जे से कम भौतिक सुविधाएँ -- यद्यपि कुछ निजी सेवा प्रदाताओं ने भारत में अपनी सुविधाआओं का भौतिक और व्यावसायिक स्टैण्डर्ड बनाये रखा है , लेकिन सेवाओं की गुणवत्ता एक जैसी नहीं है । आम तौर पर यह स्टैण्डर्ड से कम है ।  खासतौर पर मरीजों को जरूरी न्यूनतम भौतिक सुविधाएँ नहीं मिलती हैं जैसे --पर्याप्त जगह , प्राइवेसी , सफाई और प्रशिक्षित पैरामैडिकल स्टाफ इन सभी की कमी रहती ही  है ।
* अनावश्यक दवाईयों से बेहद बर्बादी -- एंटीबायोटिक , विटामिन का अनावश्यक इस्तेमाल और दवाओं की गलत खुराक , तथा संदेहात्मक दवाएं देकर मरीजों से बेहिसाब पैसा लूटा जाता है ।
* गई जरूरी ऑपरेशन का बढ़ता सिलसिला -- इसका उदाहरण है गर्भाशयों  को निकलने के अनावश्यक ऑपरेशन , जो देश भर में कई जगहों पर हुए अध्ययन से ज्ञात हुआ है  ।
* सर्जनों द्वारा ली जाने वाली बहुत ज्यादा फीस -- भारत में एक सिजेरियन प्रसव  खर्च प्रति व्यक्ति की मासिक आय  ज्यादा है
* अनावश्यक जाँचें -- स्वास्थ्य सेवाओं में कार्पोरेट हितों के प्रवेश के साथ ही अत्यधिक पैथोलॉजिकल जाँच करने की प्रवृति बढ़ी है ।  पिछले एक दशक में एक भाव मुनाफे  काम करने वाली कुछ पैथोलॉजी लैब और डायग्नोस्टिक  केन्द्रों ने बेहिसाब प्रचार  किया है व मार्केटिंग रणनीतियां तैयार की हैं , और ये केंद्र जनरल प्रक्टिसनर्स को कमीशन देकर मरीजों की गैजरूरी जाँच करवाते हैं ।
* डॉक्टरी नैतिकता का आभाव -- मरीजों की स्वाभाविक कमजोरी और असहायता के चलते चिकित्सा  आचार
नीति अपेक्षा रखती है कि डॉक्टर का नैतिक कर्तव्य हो कि वह मरीज के हितों को सदैव सर्वोपरि रखे । लेकिन  नैतिक सिद्धांत की  अमूमन  अवहेलना की जाती है ।  भारत में डॉक्टर द्वारा पिछले  दशकों में सोनोग्राफी का दुरूपयोग  कर के लाखों कन्या भ्रूण का गर्भपात किया गया है  । व्यावसायिक सरोगेसी या स्थानापन्न मातृत्व , इस नयी प्रजनन मेडिकल तकनीक का दुरूपयोग हो रहा है ।  नयी दवाओं का ट्रायल करने के लिए मेडिकल नैतिकता को ताक पर रख कर मरीजों को ही गिनी पिग की तरह  रहा है ।
* मरीजों के अधिकारों का हनन -- उदाहरण  के तौर पर आपात सेवा अधिकार , सूचना का अधिकार , जानकारी  सहमति का अधिकार , दूसरा विकल्प /राय लेने का अधिकार , विशेष उपचार के चयन का अधिकार आदि का लगातार उल्ल्ंघन   होता है ।
* भारत सरकार द्वारा कराये गए अध्ययन से पता चलता है कि ऐसे अस्पताल जिन्हें राज्य द्वारा सब्सिडी दी जाती है और गरीब मरीजों का निशुल्क इलाज करना उनकी जिम्मेदारी है , वे ऐसा करने में असफल रहे हैं ।
* लाईसेंसी  डाक्टरों द्वारा मेडिकल पेशे का दुरूपयोग और उनके विशेषाधिकारों  दुरूपयोग आम बात है ।
आज का असफल नियंत्रण ,और निजी स्वास्थ्य सेवा क्षेत्र के बारे में प्रभावहीन कानून :
1 . डॉक्टर खुद पर नियंत्रण रखने में असफल --मानक निश्चित  हेतु तथा स्व नियंत्रण करने  में मेडिकल असोसिएशन व काउंसिलें असफल रही हैं । दुनिया के सबसे बड़े निजी स्वास्थ्य सेवा क्षेत्रों  होने के बावजूद , जो कि भारत में 80 % स्वास्थ्य सेवा सुविधा उपलब्ध कराता है , लगभग नियंत्रण विहीन ही है , यह एक चिंता का विषय है ।
2 . कानूनी व्यवस्था की असफलता -
भारत में तीन करोड़ से ज्यादा मुकदमें ढेर  सारे न्यायालयों में लम्बित  पड़े हैं । विश्लेषकों का मानना है कि  इस पूरे  मामलों को निपटाने में 350 से 400 वर्षों  का समय लग जायेगा । हमारी कानूनी व्यवस्था का यह हाल देखकर हमें कतई उम्मीद नहीं है कि मेडिकल लापरवाही के विरुद्ध शिकायत लेकर जाने से मरीजों को न्याय मिल पायेगा । साथ ही यह भी दिक्कत है कि  डॉक्टर  किसी दुसरे डाक्टर के खिलाफ ब्यान नहीं देना चाहता है।   इसी प्रवृर्ति के कारण  उपभोगता संरक्षण कोर्ट से भी मेडिकल लापरवाही के मामले साबित करना कठिन होता है । इसमें कोई आश्चर्य नहीं कि न्यायपालिका या उपभोगता कोर्ट निजी मेडिकल सैक्टर का नियंत्रण करने में आज कोई भूमिका नहीं निभा  है ।
 3. क्लीनिक व अस्पतालों  रजिस्ट्रेशन से संबंधित कमजोर कानून --
महाराष्ट्र जैसे  राज्यों में पंजीयन  के लिए आज तक बॉम्बे नर्सिंग होम पंजीयन अधिनियम (BNHRA) ,1949 ही लागू है ।  यह कानून सिर्फ नर्सिंग होम के पंजीयन के लिए ही है । इसमें ऐसा कोई प्रावधान नहीं है , जो निजी मेडिकल क्षेत्र को प्रभावी ढंग से विवेकपूर्ण व मानकीकृत करने में सक्षम हो ।  उसी तरह , कर्नाटक और आन्ध्र प्रदेश जैसे राज्यों  विभिन्न  कानूनों की वही  स्तिथि है ।  राष्ट्रीय चिकित्सकीय  संस्थान अधिनियम 2010 को बहुत  से राज्यों द्वारा  अभी तक लागू नहीं किया गया है ।
निजी स्वास्थ्य सेवा क्षेत्र का नियमन करने के लिए लोकाभिमुख ढांचे के कुछ महत्वपूर्ण तत्व -

नियमन  करने वाली संरचना में यह पहलू होने जरूरी  हैं --
* मरीजों के अधिकारों की रक्षा , पारदर्शिता , सूचित निर्णय  चयन , पसंद और मना  करने की मरीजों की आजादी ।
* प्रत्येक  के लिए बेहतर गुणवत्ता सेवा , विवेकपूर्ण , साक्ष्य आधारित उपचार जो निजी स्वास्थ्य सेवा क्षेत्र द्वारा उचित दरों पर  उपलब्ध कराये जाएँ ।
* नैतिक निजी  प्रदाताओं , छोटे    नर्सिंग होम,   विश्वसनीय धर्मार्थ अस्पतालों और आदिवासी व  कमजोर इलाकों में   काम करने वाली स्वास्थ्य सुविधाओं  के मुद्दों का ख्याल रखना  ।
* मानक और इलाज संबंधी दिशानिर्देशों के नाम पर  कार्पोरेट अस्पतालों को अपने हित थोपने से रोकना ।
 छोटे अस्पतालों और जनार्थ काम करने वाली  स्वास्थ्य  संस्थाओं के  मुद्दों  ध्यान में रखना ।
* बाबू राज लाने से बचाव : नागरिक , मरीजों के प्रतिनिधि , स्वयंसेवी संस्थाएं और डॉक्टर - इन  सभी को मिलाकर बनी साझेदार संस्था के प्रति अधिकारीयों की जवाबदेही ।
* डाक्टर और मरीजों के लिए प्रभावी और जनोपयोगी शिकायत निवारण निवारण प्रणाली ।

Contaminating The Nation's Food: GM Food On The Shelves of UK S upermarkets

Contaminating The Nation's Food: GM Food On The Shelves of  UK S upermarkets

By Colin Todhunter

11 November, 2014
Countercurrents.org

From the US to India, the GMO biotech industry appears to have a ‘contaminate first then push for regulatory authorisation later' policy. The contamination of our food seems to be a deliberate strategy of the industry [1].

In the UK, there is a multi-pronged approach to try to get GM food onto the nation's plates.  The majority of the British public who express a view on GM food do not want it [2]. However, we are experiencing a consistent drive to distort the debate over the GM issue, hijack institutions, co-opt so-called ‘public servants' and pass off vest commercial interests as the ‘public good' [3].

The GMO industry is mounting a full-fledged assault on Britain via the Environment, Food and Rural Affairs department, the Business, Innovations and Skills department, the Agricultural Biotechnology Council, the Science Media Centre, All-Party Parliamentary Group on Science and Technology in Agriculture, strategically placed scientists with their ‘independent' reports and the industry-backed Science Media Centre [4,5,6].

Monsanto and other agritech companies are also lobbying hard for the Transatlantic Trade and Investment Partnership (TTIP) [7], which aims to throw Europe's door wide open to GM food imports from the US with unchecked, uncheckable and unlabelled GM food [8]. The same companies are also behind the drive to weaken the pan-European regulatory framework currently in place by attempting to push through legislation that will allow them to pick off each state one by one and force their GMOs onto people [9,10].

The industry, its mouthpieces and proxies are moreover pushing to do away with European process-based regulation [11], which would effectively side-step any effective process for assessing and regulating GMOs.

As if these tactics aren't enough, the contamination of our food with GMOs is occurring right now via imported GM food from the US, which is finding its way onto the shelves of supermarkets, sometimes unlabelled. Even when it is labeled, it may be buried in the small print.

GM food in  UK  supermarkets

Sean Poulter writing in the Daily Mail (7 th  November) notes that Marks & Spencer does not use GM in own-label products [12]. However, it now sells products from other brands which contain GM soya or corn. Marks & Spencer had a policy of selling only GM-free food, but the chain is now selling six products containing GM soya or corn despite having long presented itself as being opposed to such engineered products. The six are teriyaki, ginger, and hibachi sauces from the American TonTon brand and three flavours of Moravian Cookie – sugar, chocolate, and cranberry and orange.

Other stores are also selling an increasing number of imported US foods from brands including Reese, Hershey and Oreo that contain GM ingredients.

Last year, M&S, Tesco, Sainsbury's and the Co-op abandoned pledges to ensure animals supplying milk, eggs, chicken, pork, and beef were not fed a GM diet.

While some food on UK supermarket shelves comes from animals fed on GM crops, without this fact needing to be declared on the label, (the  EU imports about 30 million tons a year of GM crops for animal consumption),  what we now have are GMOs appearing in various food products.

There was a row last year when it emerged Tesco was stocking American Lucky Charms cereal, which is made from GM corn (declared in small print on the package). The cereal also contains artificial colours that the Food Standards Agency has linked to hyperactivity in young children.

Dr Helen Wallace of GeneWatch says:

"By importing this product, M&S is contributing to the devastating crash in Monarch butterfly populations. Weedkiller on GM soya and maize has destroyed vast swathes of the habitat. Customers are likely to be shocked by this cavalier disregard for the environment."

Liz O'Neill of GM Freeze states:

"People expect to be able to trust their favourite retailers, who wouldn't put these ingredients in their own brand products."

The regulations concerning the import and sale of GMOs for human and animal consumption grown outside the EU supposedly involve providing freedom of choice to farmers and consumers. All food (including  processed food ) or  feed which contains greater than 0.9% of approved GMOs must be labelled.

Therefore, in the  UK , foods made with GM ingredients need to say so on the label. This is a legal requirement and is one of the main reasons why there is very little GM on the  shelves: the GMO biotech sector knows the public would not to buy it.

But what about food production that involved GM enzymes that helped to make the product on the shelf? What about flavourings? What about GM micro-organisms that aided a fermentation process? While the product itself may appear to be non-GMO, genetic engineering may have been involved somewhere along the line.

Taking such matters into account, European legislation requires labelling for certain products and not for others, depending on what was involved during the food manufacturing process – see here:  https://www.food.gov.uk/science/novel/gm/gm-labelling

As it currently stands, a GMO must be approved by the EU for import as food and feed before it can be sold in the  UK  or any other European country. The European Food Safety Authority (EFSA) does a risk assessment and decides if the GMO is safe. The member countries then vote whether to accept it in food and feed. If no qualified majority is achieved, the Commission makes a final decision.

The EU bureaucracies do not inspire much confidence, however: the conflict-of-interest-ridden EFSA's track record on glyphosate leaves much to be desired [13]; similar  conflicts of interests within the European Commission's Scientific Committees [14] seriously compromise consumer safety; the

previous  European Commission  willingly  pursued a corporate agenda  [15]; and the biotech lobby's massive presence in Brussels is worrying to say the least [16].  

So, given the scenario outlined above, how can people in the UK avoid GMOs on an everyday basis? Here are just a few pointers.

Grow your own food if you have the space.

Do not shop at stores that stock GM products or sell animal products that involved GM feed. 

Pressurise

stores  to stop selling GM items.

Lobby your MPs, MEPs to stop the TTIP and to strengthen European legislation pertaining to GMOs. 

The GM Freeze website has a wealth of information concerning who to write to in the UK, how to have an influence, which stores are doing what in terms of GMOs, etc.

Be informed and take action:

http://www.gmfreeze.org/

Colin Todhunter : Originally from the northwest of England, Colin Todhunter has spent many years in India. He has written extensively for the Deccan Herald (the Bangalore-based broadsheet), New Indian Express and Morning Star (Britain). His articles have also appeared in various other newspapers, journals and books. His East by Northwest website is at:http://colintodhunter.blogspot.com

Notes

1]  http://www.globalresearch.ca/genetically-engineered-poison-first-regulate-later-the-criminality-of-the-gmo-biotech-industry/5412810

2]  https://yougov.co.uk/news/2014/02/21/many-britain-remain-sceptical-gm-foods/

3]  http://www.globalresearch.ca/monsanto-syngenta-and-bayer-cropscience-the-gmo-biotech-sector-cant-win-the-scientific-debate-the-options-are-co-option-deception-and-collusion/5381725

4]  http://www.genewatch.org/article.shtml?als%5Bcid%5D=492860&als%5Bitemid%5D=571543

5]  http://www.dailymail.co.uk/news/article-2581387/Scientists-hidden-links-GM-food-giants-Disturbing-truth-official-report-said-UK-forge-Frankenfoods.html

6]  http://www.deccanherald.com/content/405309/scientists-sale-way-multinationals-039buy039.html

7]  http://corporateeurope.org/pressreleases/2014/07/agribusiness-biggest-lobbyist-eu-us-trade-deal-new-research-reveals

8]  http://corporateeurope.org/trade/2013/05/open-door-gmos-take-action-eu-us-free-trade-agreement

9]  http://www.gmfreeze.org/actions/42/

10]  http://corporateeurope.org/food-and-agriculture/2014/05/biotech-lobbys-fingerprints-over-new-eu-proposal-allow-national-gmo

11]  http://www.gmwatch.org/index.php/news/archive/2014/15722-uk-gmo-lobby-wants-genome-edited-products-to-escape-gmo-regulation-and-labelling

12]  http://www.dailymail.co.uk/news/article-2826108/Frankenstein-foods-slip-M-S-Anger-store-puts-GM-food-shelves-despite-opposed-engineered-products.html

13]  http://corporateeurope.org/efsa/2013/10/unhappy-meal-european-food-safety-authoritys-independence-problem

14]  http://corporateeurope.org/sites/default/files/attachments/ceo_-_sanco_sc_conflicts_of_interest.pdf

15]  http://corporateeurope.org/sites/default/files/record_captive_commission.pdf

16]  http://corporateeurope.org/international-trade/2014/07/who-lobbies-most-ttip

`Health indicators improving' - The Hindu

`Health indicators improving' - The Hindu

The Gender Inequality --A Perceptive Threat to Health

The Gender Inequality --A Perceptive Threat to Health

Impressive achievements and intolerable shortcomings characterise India's Health Programme and Haryana as well over the last 65 years. Not only has there been a decline in mortality rates ,but life expectancy and infant survival conditions have also improved. But, it is still very high when we copmare with other countries .The world bank notes that public health financing in India is characterised by an emphasis on hospital rather than primary care; urban rather than rural population;medical offices rather than paramedics;services that have larger private rather than social returns;and family planning and child health exclusion of wider aspects of female health. In fact ,gender diffrences in health and mortality have not  perpetuated but also accentuated. 

saptrang

 सप्तरंग संस्था में आज अपने जीवन के अनुभव साँझा करने जा रहा हूँ  । एक  अजीब सी घबराहट महसूस कर  रहा हूँ । क्यूँ ? शायद इसलिए कि चुनाव करना  मुश्किल काम है शेयर करना तो आसान है । क्या  व्यक्तिगत है और क्या सामाजिक है यह एक बड़ी कम्प्लेक्स चुनौती है ।

ग्रेड 4 कुपोषण

एक बात सामने आई बात चीत में कि सरकारी ढांचों की रिपोर्टिंग में बच्चों में ग्रेड 4 का कुपोषण नहीं पाया जाता है ।  या यूं कहें कि रिपोर्ट नहीं किया जाता क्यूंकि यदि कोई बच्चा ग्रेड 4 कुपोषण से पीड़ित है तो उसकी वॉर फुटिंग पर इलाज करने की हिदायतें हैं जिनसे बचने के लिए रिपोर्टिंग न करने का मौखिक फरमान उप्पर से दिया जाता है । इसमें कितनी वास्तविकता है इसका पता तो कुपोषण पर निस्पक्ष सर्वे करके बताया जा सकता है या फिर जन पक्षीय बच्चों के विशेषज्ञ हमें समझा सकते हैं ।
रणबीर सिंह दहिया
हरयाणा ज्ञान विज्ञानं समिति 

Contamination from depleted uranium (DU) munitions

Contamination from depleted uranium (DU) munitions

Tuesday, 14 October 2014 09:42 By Dahr Jamail, Truthout | Report

(Photo: Patty Mooney / Flickr)Contamination from depleted uranium (DU) munitions is causing sharp rises in congenital birth defects, cancer cases and other illnesses throughout much of Iraq, according to numerous Iraqi doctors.Iraqi doctors and prominent scientists believe that DU contamination is also connected to the emergence of diseases that were not previously seen in Iraq, such as new illnesses in the kidney, lungs and liver, as well as total immune system collapse. DU contamination may also be connected to the steep rise in leukaemia, renal and anaemia cases, especially among children, being reported throughout many Iraqi governorates.

There has also been a dramatic jump in miscarriages and premature births among Iraqi women, particularly in areas where heavy US military operations occurred, such as Fallujah during 2004, and Basra during the 1991 US war on Iraq.

It is estimated that the United States used 350 tons of DU munitions in Iraq during the 1991 war, and 1,200 tons during its 2003 invasion and subsequent occupation.

Official Iraqi government statistics show that, prior to the outbreak of the first Gulf War in 1991, the country’s rate of cancer cases was 40 out of 100,000 people. By 1995, it had increased to 800 out of 100,000 people, and, by 2005, it had doubled to at least 1,600 out of 100,000 people. Current estimates show the trend continuing.

The actual rate of cancer and other diseases is likely to be much higher than even these figures suggest, due to a lack of adequate documentation, research and reporting of cases.

“Cancer statistics are hard to come by, since only 50 percent of the health care in Iraq is public,” Dr. Salah Haddad of the Iraqi Society for Health Administration and Promotion told Truthout. “The other half of our health care is provided by the private sector, and that sector is deficient in their reporting of statistics. Hence, all of our statistics in Iraq must be multiplied by two. Any official numbers are likely only half of the real number.”

“Genocide”

“The world should know that Iraqi people were the victims of the aggression inflicted by the use of DU munitions by the American and British troops during these wars, and this is genocide,” Dr. Jawad al-Ali, a consultant physician and oncologist, told Truthout.

Al-Ali, an expert oncologist at the Basra Cancer Treatment Center, member of the Iraqi Cancer Board and a member of the Basra Cancer Research Group, estimates that there are 300 sites throughout Iraq that are contaminated with radiation from the DU munitions.

He attributes the extreme rates of birth defects in Fallujah to the US use of DU there during its two sieges of the city in 2004.

An epidemiological study titled “Cancer, Infant Mortality and Birth Sex-Ratio in Fallujah, Iraq 2005-2009″ involved a door-to-door survey of more than 700 Fallujah households. The research team interviewed Fallujans about abnormally high rates of cancer and birth defects.

One of the authors of the study, chemist Chris Busby, said that the Fallujah health crisis represented “the highest rate of genetic damage in any population ever studied.”

The crisis in Iraq is bad enough that the country recently called for a global treaty ban on all DU weapons. At this time, it is unknown whether DU munitions are still being used in Iraq, but it seems unlikely they are as US attacks are presently limited to airstrikes, while most DU in the past was used in rifle rounds and tank shells.

In a report submitted to the UN Secretary General in August, Iraq “expresses its deep concern over the harmful effects of the use in wars and armed struggles of armaments and ammunitions containing depleted uranium, which constitute a danger to human beings and the environment (the air and the soil).”

In September, the Center for Constitutional Rights in New York submitted a Freedom of Information Act (FOIA) request to the US Department of Defense (DOD) and the State Department on behalf of itself and Iraq Veterans Against the War (IVAW), seeking the firing coordinates of weapons used in Iraq that contained depleted uranium.

According to a 2013 report by the Netherlands-based organization Pax Christi, Iraq has been subject to the largest use of DU munitions of all areas of conflict and test sites, conservatively estimated to be at least 440 metric tons – though the UN Environment Program has estimated an amount up to five times that based on satellite imagery.

Meanwhile, doctors in Fallujah continue to witness the aforementioned steep rise in severe congenital birth defects, including children being born with two heads, children born with only one eye, multiple tumors, disfiguring facial and body deformities, and complex nervous system problems.

Residents there have told Truthout that many families are too scared to have children, as an alarming number of women are experiencing consecutive miscarriages and infant deaths with critically deformed and ill newborns.

Dr. Samira Alani, a pediatric specialist at Fallujah General Hospital, has taken a personal interest in investigating an explosion of congenital abnormalities that have mushroomed in the wake of the US sieges since 2005.

“We have all kinds of defects now, ranging from congenital heart disease to severe physical abnormalities, both in numbers you cannot imagine,” Alani told Truthout at her office in the hospital last year, while sharing countless photos of shocking birth defects.

Alani also co-authored a study in 2010 that showed the rate of heart defects in Fallujah to be 13 times the rate found in Europe. And, for birth defects involving the nervous system, the rate was calculated to be 33 times that found in Europe for the same number of births.

In pursuit of answers, Alani visited Japan, where she met with Japanese doctors who study birth defect rates they believe are related to radiation from the US nuclear bombings of Hiroshima and Nagasaki. Alani was told birth defect incidence rates in Hiroshima and Nagasaki are currently between 1 and 2 percent. Alani’s log of cases of birth defects amounts to a rate of 14.7 percent of all babies born in Fallujah, more than 14 times the rate in the effected areas of Japan.

In March 2013, Alani informed Truthout that the incident rates of congenital malformations remained around 14 percent. Alani has had to flee the city due to bombardments from the Iraqi government, including shellings that targeted clinics and hospitals, as Truthout previously reported.

Basra

Iraq’s southern city of Basra was heavily bombarded with DU munitions by US warplanes during the 1991 war.

Al-Ali was heavily involved in working on two birth defect studies carried out in the wake of that war.

“The types of birth defects were hydrocephaly [an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain], anencephaly [the absence of a large part of the brain and the skull], cleft lip and phacomelia [loss of limbs],” al-Ali told Truthout. “Other consequences are the cancers which increased three-fold during the last two decades.”

He said that clusters of cancers occurring at higher incidence within the same family were another new phenomenon seen in Iraq only after the 1991 and 2003 wars.

“Other diseases related to effects of DU were the kidney failure of unknown cause and stone formation,” he added. “Respiratory problems like asthma and also myopathy and neuropathy are now very common as well.”

In Babil Province in southern Iraq, cancer rates have been escalating at alarming rates since 2003. Dr. Sharif al-Alwachi, the head of the Babil Cancer Center, blames the use of depleted uranium weapons by US forces during and following the 2003 invasion.

“The environment could be contaminated by chemical weapons and depleted uranium from the aftermath of the war on Iraq,” Alwachi told Truthout. “The air, soil and water are all polluted by these weapons, and as they come into contact with human beings they become poisonous. This is new to our region, and people are suffering here.”

According to a study published in the Bulletin of Environmental Contamination and Toxicology, there was a sevenfold increase in the number of birth defects in Basra between 1994 and 2003.

In addition, never before has such a high rate of neural tube defects (“open back”) been recorded in babies as in Basra, and the rate continues to rise. According to the study, the number of hydrocephalus (“water on the brain”) cases among newborns is six times as high in Basra as it is in the United States.

Childhood cancer also appears to be unusually prevalent in Basra.

“We have noticed bouts of malignant tumors affecting children’s limbs,” an Iraqi doctor who has worked in various parts of the country for 20 years told Truthout. He requested anonymity for security reasons. “These malignancies are usually of very aggressive types and in the view of the shortage of facilities we are running in our hospitals they usually have a fatal outcome.”

His prognosis was grim.

“The only help we can provide to those children is amputation, which sometimes does nothing but prolonging their suffering, in addition to the great psychological impact on both the child and the parents,” he said. “We know that it is possible to save most of these children in specialized oncology centers by advanced salvage surgery, with the attendant chemotherapy and radiotherapy. Unfortunately, this seems to be a kind fantasy for our government and health administrations, which are currently busy with the large amount of trauma overwhelming our hospitals’ resources.”

Other Struggles

Al-Ali, Alani and the anonymous doctor all agreed that the two biggest challenges they face today are security and the lack of adequate supplies and equipment.

“Since 2003 and just [a] few months after the American occupation of the country, we witnessed the emergence of gangs and mafias specialized in threatening and kidnapping for ransoms and assassinations,” the anonymous doctor told Truthout. “Most of these groups work under Islamic logos, yet their affiliations are ambiguous. Amongst the target victims were doctors and their families.”

He himself had to hide in hospitals and the homes of relatives for more than half a year after he and his family was threatened.

Al-Ali said the major challenge in the south of Iraq now is the difficulty in obtaining new medicines – things like equipment for PET scans – “and also the advanced centers for bone marrow transplantation.”

The anonymous doctor explained that the security situation has degraded from bad to worse.

He explained that when Mosul was under control of the Iraqi military, military personnel regularly threatened doctors.

Now, of course, doctors across the country are under a new security threat, with militants affiliated with the Islamic State now in control of many areas of Iraq.

“The greatest concern now is the future,” al-Ali said. “After the many blind airstrikes that destroyed civilian housing and sacrificed innocent lives, we believe that the war against ISIS is going to be a process of retaliation against Sunni people in an indiscriminate way. This is how things go on in Iraq, terrorism against terrorism, blood for blood, destruction for destruction, and the vicious circle goes on.”

Ultimately, he, like many Iraqis today, blames the United States and Iran for triggering and maintaining the chaos that is engulfing Iraq.

The violence contributes to an exodus of doctors from the country, as more than half of all medical personnel in Iraq have fled the country since 2003.

“Doctors are trying to escape outside the country to save themselves and their families,” al-Ali added. “Doctors that have remained in the cities are still there for humanitarian reasons.”

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Dahr Jamail

Dahr Jamail, a Truthout staff reporter, is the author of The Will to Resist: Soldiers Who Refuse to Fight in Iraq and Afghanistan, (Haymarket Books, 2009), and Beyond the Green Zone: Dispatches From an Unembedded Journalist in Occupied Iraq, (Haymarket Books, 2007). Jamail reported from Iraq for more than a year, as well as from Lebanon, Syria, Jordan and Turkey over the last ten years, and has won the Martha Gellhorn Award for Investigative Journalism, among other awards.

His fourth book, The Mass Destruction of Iraq: Why It Is Happening, and Who Is Responsible, co-written with William Rivers Pitt, is available now on Amazon. He lives and works in Washington State.

HARYANA HEALTH MANIFESTO

HARYANA HEALTH MANIFESTO
September 16, 2014 at 3:46pm
Manifesto to promote health and healthcare in Haryana:
The right to health is a fundamental and universal right of all citizens and this will need to be respected and realized within a time frame. The Right to Health needs also to be located in the underlying determinants of health such as access to safe water and sanitation, adequate food and nutrition, housing, and secure livelihoods. Above all social inequities -- based on disparities along gender, caste, class and other lines – have a profound impact on the health of the poorest and the most marginalized.
The following concrete proposals are designed to reverse the present -- entirely unacceptable -- situation in the health sector, and to secure conditions of living and health care services that promote health in all its dimensions..
1. Act on the Social Determinants of Health: In Haryana this aspect is not taken seriously .This would include promotion of food security by universalization and expansion of the Public Distribution System (to also provide local cereals, pulses and oil)in an effective way; a national policy on Child Health and nutrition and universalization of ICDS with expansion of staff and services to effectively cover under-3 children; ensure universal availability of safe water in each village and habitation of Haryana ; and universal access to safe hygienic toilets in all habitations.
2. Address the Gender dimensions of Health: In Haryana gender bias is very predominant. This is reflected in sex ratio .Guarantee comprehensive, accessible, quality health services for all women and transgender persons for all their health needs which includes but is not limited to maternal care. Abolish all coercive laws, policies and practices that violate the reproductive, sexual and democratic rights of women; and regulate use of invasive reproductive technologies. Recognize gender based violence as a public health issue and ensure access to comprehensive health care (physical as well as psychosocial), screening, documentation, referrals, as well as coordinated, ethical medico-legal processes for survivors. Guarantee comprehensive, quality, accessible, adolescent-friendly health care, including for their reproductive and sexual health needs. Health Education in schools should be undertaken with pro gender orientation.
3. Immediately reverse Caste Based Discrimination: Haryana is having caste domination in our social life. Take immediate and effective steps to entirely reverse all forms of caste based discrimination, which is one of the most important social determinants of ill health. Immediate ban on manual scavenging. In the health care sector, special measures to promote priority access to discriminated sections of society.
4. Enact a Right to Health Act in Haryana which assures universal access to good quality and comprehensive health care for all the entire range of primary, secondary and tertiary services, and that makes denial or non-availability for reasons of access, affordability or quality a justiciable offence.
5. Increase Public Expenditure on Health to 3.6% of GDP annually (Rs 3000/- per capita at current rates) with the central government’s contribution being at least 1% of GDP (Rs 1000/- per capita). All public health expenditure to be tax financed. Public health spending to be increased to 5% of GDP in medium term.
6. Ensure quality and assured availability of health care: A lot can be said about the present infrastructure and staff in Haryana Health Sector. It should be updated as per laid down norms. Quality of care to be ensured in all health facilities, which would mean health care that is effective, safe and non-exploitative, provided with due dignity and respect to patient rights, and which aims at patients’ comfort and satisfaction. Quality norms and standards shall not mean conforming to infrastructure or other standards, which favor large corporate hospitals, or worse medical tourism, and make it impossible to provide low cost, rational and effective care. Every public health care facility would be required to provide guaranteed health services appropriate to their level in assured manner. Public health facilities to be entirely free of user fees and the entire range of services to be provided directly by government run facilities and not through Public Private Partnerships (PPPs).
7. Stop both Active and Passive Privatization of health care services in Haryana: Necessary measures to stop active privatization in the form of transfer of public resources or assets to private entities that provide services on a commercial basis. Measures to stop passive privatization by increasing investment in public health facilities, increasing number of beds and facilities in the public sector, and by expanding range of services available in public facilities. Public facilities to provide comprehensive health care services, not limited only to reproductive health care, immunization and a care for a few diseases of national importance.
8. Training of Health workforce in Haryana on war footing : Increase public investment in education and training of the entire range of health personnel. Ensure that government run colleges to train a range of health workers, nurses and doctors are located in areas where they are needed most. Training to be reoriented to impart skills that address the health needs of local communities. The trend of commercialization of higher education in medical and allied health sciences to be reversed, along with stringent mechanisms for regulation of existing private institutions in a transparent manner. The functioning of the Medical Council of India and the Nursing Council of India to be thoroughly scrutinized and revamped to weed out rampant corrupt and unethical practices in these institutions.
9. Well Governed, Adequate Public Health Work force in Haryana :Create adequate posts for the entire range of health personnel in the public health system. Regularize contractual employees and provide ASHAs, ANMs and all levels of public health system staff with adequate skills, salaries, and decent working conditions .The health and safety of workers, particularly of women to be assured. Act on available evidence from many states which show that the problem of the lack of doctors in rural areas is more a result of administrative incompetence and political failure than a matter of professional culture. Creation of a cadre of doctors, nurses and other paramedical workers who have training in primary health care, public health and in working as a team.
10. Secure access to quality assured essential medicines and diagnostic services in all public health facilities, free of charge in Haryana . This would be achieved by developing autonomous and transparent procurement and demand driven distribution mechanism (on the lines of Tamil Nadu, Kerala and Rajasthan). For chronic illness it would mean ensuring such access throughout the year from a distribution point most accessible to patients. Generic prescriptions to be made compulsory in all health facilities. The various schemes for benefit of patients should be implemented earnestly. Monitoring system should be there from top to bottom.
11. Participatory Planning, Community Participation and Community Based Monitoring of health services in Haryana to ensure accountability and responsiveness of services. Community Based Monitoring and Planning will be generalized and made a core component of all public health programs and health care services, to help effective delivery of services and ensure accountability and transparency.
12. Eliminate Corruption in the Public Health System. Deep rooted problem in Haryana . Can be contained through transparent policies for appointments, promotions, transfers, procurement of goods and services and infrastructure development – all of which are legislated through a Transparency Act (as in Tamil Nadu for procurement and Karnataka for transfers). Institution of robust grievance redressal systems, which are adequately financed and managed with some degree of autonomy from the management.
13. Reverse Exploitation by private hospitals and protect ethical private non commercial private providers in Haryana : The national Clinical Establishment Act would have provisions for: observance of patient's rights in all clinical establishments; regulation of the rates of various services; elimination of kickbacks for prescriptions, diagnostics and referrals;and establishment of government supervised independent grievance redressal mechanisms for patients. Standards would be designed in a manner that would prevent corporatization of health care. This would promote genuine not-for-profit and ethical health care providers and would contain costs of care in the private sector.
14. Absorb, over a period, existing publicly funded health insurance schemes (RSBY and different state health insurance schemes) into an expanded public health system publicly financed through general taxation .All entitlements available under these schemes would be made available through the public health system, suitably expanded and adequately resourced. This should include a comprehensive system for health care protection of unorganized and organized sector workers (providing primary, secondary and tertiary health care), linked with expansion and rejuvenation of the ESI.
15. Eliminate the role of multi-lateral and bilateral financing agencies from all areas of technical assistance or health policy formulation. Eliminate the influence of agencies -- such as the World Bank, USAID and Gates Foundation, as well as consultancy organizations such as Deloitte and McKinsey – in formulation of national priorities and approaches to health care provisioning and financing. Build international collaboration for generation and sharing of knowledge resources, especially with other developing countries. Exert pressure at the governmental level to free WHO, UNICEF and other UN agencies from dependence on corporate financing and influence. Critically examine the offer of advise and expertise from such agencies till such time as they continue to be influenced by corporations and private foundations.
16. Build National and State level capacity for Health research and development: The government would invest at least 5% of its public health budget on health research including health systems research. The government, for the purpose of promoting health systems research and research for domestic priorities, would develop institutions and strengthen existing institutions that are financed through public funds.
17. Ensure access to essential and safe Drugs & Devices :Cost-based price-control of all medicines, measures to ensure drug and device safety ,banning of irrational medicines and irrational combinations, opening of generic medicine outlets in adequate numbers, mandatory provision for doctors to write generic names of medicines ,use of the public health safeguards in the Indian Patent Act to promote access to medicines, and active promotion of indigenous manufacture of most drugs and devices.
18. Regulation of clinical trials and ethics in biomedical research: Develop a clear framework for the ethical conduct of clinical trials in India, combined with the regulation of all those that are involved -- sponsors of trials, CROs, ethics committees etc. Ensured that the CDSCO and the ICMR monitor the conduct of clinical trials at the trial sites and only permit trials at sites which are equipped to handle emergencies and adverse events. Fair compensation norms for trial participants who suffer from adverse events to be expeditiously developed and implemented. A charter of rights of clinical trial participantsto be developed and made justiciable.
19. Ensure access to treatment and care of persons with mental illness (PWMI) through integration of the revised District Mental Health Program with the National Health Mission. The rights of PWMI need to be protected by adoption of the Mental Health Act and action on the draft mental health policy.
20. Ensure facilities for estimation of residual effect of pesticides in human beings. Stop irrational and unethical use of Oxytocin in buffaloes and cows,
21. Stop Nuclear Plant in Gorakhpur . It will have many health hazards. Be more vpertinent about environmental issues related in development of Industry