Bhopal: At 8:30 clock one morning, during the monsoon season of 2023, Aqeel Ahmed (43) with the support of a walking stick arrived on the premises of the Bhopal Memorial Hospital Research Centre (BMHRC), Bhopal, India. Even though he used a walking stick, Aqeel limited his walk. He watched his steps to evade any accident. He was not doing this, particularly on Monday, but he follows the same alertness and routine thrice a week (Monday, Thursday and Saturday) during his visit to the BMHRC. And that’s the routine he has been following for the last two decades to undergo dialysis.
There is a connection between his disorder and his situation. His family were like the many other families who on the intervening night of December 2 and 3, 1984, came in grip of approximately 40 tonnes of methyl isocyanate, one of the most toxic gasses leaked from the factory in Bhopal owned by the US chemical giant Union Carbide Corporation (Union Carbide India was taken over by Dow Chemical, which recently merged with Dupont to create DowDupont).
The exposure to lethal gas left a lethal impact on his family members. He lost his elder brother within six months after the Bhopal disaster, he unknowingly began surviving on one kidney and his parents struggled to fix the weaknesses and breathing problems.
The direness of the situation hit him when he arrived at a healthcare facility for a consultation that ended with some tests in 2006. His primary care doctor detected the formation of stones in his urinary tract and noticed a dead kidney and improper functioning of one other kidney.
“I had no symptoms. I felt nothing.” To address his situation, the doctors advised him to undergo dialysis which he is continuing to this date. “Earlier I had to undergo dialysis twice a week (between 2006-2012). Now, with the progress of kidney disease (muscle twitches, muscle weakness and cramps) my nerves are becoming weaker,” says Aqeel who now undergoes dialysis thrice a week.
Now his life is a connection between home and the Bhopal Memorial Hospital Research Centre (BMHRC). He is one among the estimated 170,000 gas victims who have regularly sought treatment at the BMHRC ever since it was founded in the year 2000.
For Aqeel and hundreds and hundreds of gas victims, BMHRC is considered to be the ‘temple of hope’ that emphasises the constitutional mandate of extending benefits for gas victims and creating other benefits with more advancement.
As per the Hon’ble Supreme Court’s directions, a “specialised medical and research establishment with the best of expertise” and “with the best equipment and facilities” in the form of BMHRC was set up in Bhopal in July 2000.
The Supreme Court directive was to the US multinational to establish a full-fledged hospital with a bed strength of at least 500 beds with the best of equipment for free treatment of the victims of the Bhopal gas tragedy. The present strength of the hospital has been confined to 260 beds, in defiance of the Supreme Court ruling.
BMHRC has always been surrounded by controversy soon after it was set up as a super speciality hospital in 2001.
In the year 2006, the hospital faced its worst time, when 17 people lost their lives when hospital staff went on a strike in support of their various demands.
One another shocking and disgraceful episode at the hospital came to light in 2008 when secret drug trials were illegally conducted on gas victims at the BMHRC between 2004-2008. All efforts were taken to shield the culprits after the matter came into the public domain.
Moreover, in the last eight years (2006-2014), nearly 300 employees (including specialists) out of a total staff of 650 of the Bhopal Memorial Hospital and Research Centre (BMHRC) have resigned in protest against the arrogant and careless attitude of the management maintains representatives of organisations working among the gas victims.
Since BMHRC was the best hospital in Central India in the year 2000, pressure was mounted on BMHT to render treatment at BMHRC to private patients (non-gas-victims) on a payment basis – a proposal that BMHT had accepted.
Slowly but surely, priority for specialized treatment at BMHRC was effectively given to privately paying patients. Soon, needy gas victims found it extremely difficult to obtain specialized treatment.
Meanwhile, the BMHRC undoubtedly set the tone for the future of the basic structure doctrine for private players. Attractive packages managed to lure several consultants, super specialists, and other doctors resulting crippling of services in the BMHRC. Even the country’s apex court highlighted the vacant posts.
In its order dated 09.08.2012 in W.P.(C) No.50 of 1998, the Hon’ble Supreme Court in para 35(10) directed as follows:
“We are informed that there are a large number of vacancies of doctors and supporting staff in the hospitals and allied departments. In the BGTRRD, 80 per cent of specialists and 30 per cent of doctors are lying vacant. Some posts are also lying vacant in the Fourth Grade staff. Thus, we direct the concerned authorities to take appropriate steps in all respects not only to fill up these vacancies but also to provide such infrastructure and facilities that the doctors are not compelled to or prefer to resign from BMHRC employment and its various departments, due to inadequate facilities.”
By the year 2010, several private super-speciality hospitals had come up in Bhopal and since they offered higher emoluments, several super-specialists and consultants quit BMHRC to join such private establishments. This hurts the quality of treatment for the large number of patients visiting the said hospital.
At the end of 2019, BMHRC once again landed in controversy and received global attention. Charges were levelled against the BMHRC for not treating Abdul Jabbar, a leading activist for survivors of the Bhopal gas tragedy victims and convenor of Bhopal Gas Peedit Mahila Udyog Sangathan well. Jabbar, a gas victim himself was shifted from the BMHRC to the Kamla Nehru Hospital meant for the gas victims.
According to a news report written by senior journalist Ashutosh Shukla in the Times of India two days before Jabbar’s death, the two hospitals could not provide the required treatment to Jabbar. Chief Medical and Health Officer (CMHO) of Gas Relief, Ravi Verma admitted to a shortage e of expert doctors in the various Gas Relief hospitals and added that Jabbar had been admitted to a private nursing home and the total expenditure on his treatment would be borne by the Gas Relief Department, the news report said. Gas victims warmly remember his relentless fight, his first victory in the Supreme Court and talk about almost all the judicial interventions and mass agitations that have resulted in the gas victims getting compensation, houses, hospitals, stitching and zardozi works.
Barely three months after Jabbar’s death, BMHRC once again came into the national limelight after the Union Government announced a complete nationwide lockdown in March 2020. The Madhya Pradesh government decided to turn the Bhopal Memorial Hospital and Research Centre into a state-level COVID-19 treatment facility forcing patients to shift to other hospitals.
And once again, the government order made gas victims feel cheated, betrayed and panicked.
However, during this period patients like Aqeel, the late Tulsi Yadav and several others like them received wholehearted support from members of civil society, NGOs like Bhopal Gas Peedith Mahila Udyog Sanghathan (BGPMUS), Bhopal Gas Peedith Sangharsh Sahayog Samiti, Bhopal Group for Information and Action (BGIA), Bhopal Gas Peedit Mahila Stationery Karmchari Sang, Bhopal Gas Peedit Nirashrit Pensionbhogi Sangharsh Morcha, Bharat Gyan Vigyan Samiti, Madhya Pradesh Vigyan Sabha, Eka Bhopal and from several other organisations (though, all of them work differently covering vast areas under different capacities however, their sole aim is to provide better life to every living being). This was the time when the very idea of our common humanity was expressed across the globe by many individuals, groups, and organisations.
An attempt has been made to develop BMHRC as a teaching institution by obtaining the consent of affiliation for a few PG courses offered at BMHRC from the Madhya Pradesh Medical Sciences University (MPMSU), Jabalpur.
In a letter written in October 2022, Member of Parliament Digvijaya Singh addressing Dr Mansukh Mandaviya, Union Minister for Health and Family Welfare, and Chemical Fertilizers requested to convene an early meeting of all concerned parties to upgrade the status of BMHRC to that of an autonomous, premiere institution as par with AIIMS by elevating the stature of BMHRC.
However, such a meeting is yet to take place.
The process is too slow and it may take decades before BMHRC is turned into a full-fledged teaching institution with the requisite faculty. Even then, there is little chance that BMHRC would ever be recognized as a premier national institution that would attract the best talent in the country.
Already about 39 years have elapsed since the Bhopal disaster took place and the gas victims are in no position to wait any longer to receive proper treatment. The government can ensure fruitful cooperation if not merger between BMHRC and AIIMS, Bhopal, to provide the best possible treatment to the gas victims – a step that they have failed to take.
Another concern is about more than 4.5 lakh registered gas victims seeking medical care at BMHRC. Broadly, many of the second and third generation of the survivors are battling a spectrum of disabilities. Many of them need an attendant as they are immobile, and cannot sit, wash, eat and even defecate. Another alarming fact is that even after over two decades medical records of nearly 17% of the total number of 4.5 lakh registered gas victims have been computerized.
One of the major objectives that the computerisation and digitisation of the gas victims would be that it will create a national and state-level database of registered victims that would help in updating other databases resulting in efficient delivery of not only medical care but also public services and social benefits. The database would provide information that could be updated in the National Population Register, linked to Aadhaar Numbers, ration cards, passport, electoral rolls and other databases at the national level.
So, if the authorities maintaining other databases require information on a victim, it is possible to design a system wherein the data flows to their databases daily or even on a real-time basis from the BMHRC–level database.
The main issue from a public health perspective is that a ‘patient’ has not been defined anywhere under Indian Law. However, the term covers those people who receive healthcare services from doctors or medical professionals. The center as well as state governments must provide healthcare services and improve public health. Moreover, the Ministry of Health and Family Welfare and the National Human Rights Commission released the Charter of Patient Rights. It enumerates 17 rights that all patients in India are entitled to. Understandably, Bhopal gas victims too come under the ambit of the NHRC Charter of Patient Rights.
The Bhopal disaster has highlighted the significance of tailoring health care to the specific needs of victims exposed to a tragedy. It is a remarkable opportunity for the BMHRC to tell their stories in their vocabulary, using a framework of their choice to forefront their work on a global platform. And happily, no one is going to stop them.
Anup Dutta is a fellow of Vikas Samvad Constitution Fellowship 2022.