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Waves of change in rural health

By Usha Rai

A communications initiative that has spread awareness of healthcare needs and entitlements in hundreds of villages across Gujarat and Rajasthan has had a huge impact

ALERT (Active for Literacy and Environmental Renovation Task)

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Mobile friends for healthy mothers

By Anindita Sengupta

By providing antenatal care information to rural women through voice messages on their mobile phones, mMitra wants to change their beliefs and practices during pregnancy and post-partum

maternal mortality

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Social inequities in cancer ward

Text by Freny Manecksha
Photographs by Chirodeep Chaudhuri

Many poor cancer patients have no recourse but to make their way to the ‘open air ward’ outside Tata Memorial Hospital. An important new study suggests that delay in diagnosis and treatment may be responsible for the rate of cancer deaths in rural India matching urban India, and being twice as high in the least versus most educated segments

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Hooked on disease

By Manipadma Jena

With a Rs 6,750-crore fast food industry growing at 35% annually, non-communicable diseases such as diabetes and cardiovascular disorders are rising sharply. How is this slow-motion health disaster to be tackled?

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Birth pangs in the lost villages of the Sunderbans

By Saadia Azim

Scores of women living in inaccessible island villages across West Bengal’s South 24 Parganas district are finally able to access ante- and postnatal healthcare, and have institutional deliveries at community delivery centres and hospitals

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The Binayak effect

Minnie Vaid travels to Bagrumnala, a Khmar tribal village tucked away in the forests of Chhattisgarh, where Binayak Sen is a legend, and where he set up a remarkable model of rural healthcare, working with the community on everything from healthcare to nutrition and education

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Sound and fury over the 'New Delhi superbug'

By Rahul Goswami

The Indian government has been quick to rubbish the Lancet study on the NDM-1 bacterium, choosing to see this as a commercial problem that will impact our growing medical tourism industry, rather than as a healthcare problem that could seriously impact a country where antibiotics are overused and where scant attention is paid to infection control in hospitals

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Tamil Nadu pioneers easy cervical cancer screening

By B Jayashree

Cervical cancer affects millions in India. It can be effectively treated if diagnosed early. Now, the VIA/VILI kit, which costs only Rs 5 and can be used by any healthcare professional, is being introduced across Tamil Nadu, offering women the possibility of early detection and treatment

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Far from safe with institutional deliveries

By Usha Rai

The government’s Janani Suraksha Yojana is pushing pregnant women towards institutional deliveries, but a study finds that the system is not ready to handle them. Women report terrible experiences at public health centres

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Deadly dust

Text & Photographs by Chitrangada Choudhury

Though many migrant workers from south Madhya Pradesh have died of the incurable workplace disease called silicosis contracted from inhaling quartz dust in stone crushing factories in Gujarat, the public health system has carried out no comprehensive survey to identify the disease, which is often passed off as tuberculosis, many factories have not installed anti-pollution systems, and the NHRC has been sitting on the case since 2006

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Breastfeeding is the key to infant and child survival

By Deepanjali Bhas

Promoting something as simple as breastfeeding can reduce infant mortality by 11.6%. But though India has among the worst infant and child mortality figures in the world, 75% of the nation’s children are not breastfed from birth and over 50% are not exclusively breastfed.

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Jharkhand's fluorosis nightmare

By Moushumi Basu

The fluoride level in water taken from a hand pump in Sidekhurd and other villages of Garwa district is more than twice the permissible level of 1 ppm. Acute dental and skeletal disorders plague these villagers, but they know nothing about fluorosis. Government admits that of the 550 fluoride control mechanisms installed, 100 are defunct

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Swine flu in Pune: A city under siege

By Anosh Malekar

The last time Pune saw a public health crisis like the present swine flu outbreak was the plague epidemic in 1897. As the city virtually shuts down, Pune’s haphazard growth, precarious infrastructure and complete unpreparedness for a crisis are exposed

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The speaking dolls

By Paramita Chaudhuri

India offers just one hospital bed nationally per 15,400 mentally ill patients. The situation in West Bengal is no different. A unique outsider art exhibition of dolls in Kolkata recently helped mentally handicapped individuals from two state-run institutions make dolls that communicate their lives and aspirations to each other and the outside world

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India failing adivasi tribes with sickle cell

By Anosh Malekar

With the spotlight on lifestyle diseases like diabetes and hypertension, traditional illnesses like sickle cell disease, which affects tribals all across India, are not receiving the attention they deserve

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Miracle care

Rashme Sehgal visits a state-of-the-art sick and newborn care unit in the Guna district hospital in Madhya Pradesh. When set up across 50 districts in MP, this model is expected to reduce the infant mortality rate from 74 to 40 per 1,000

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The benefits of sex education and counselling

By Usha Rai

A drop-in sexual-health centre in New Delhi and an adolescence sex education programme for class 10 students in rural and urban Haryana clearly demonstrate the benefits of sexuality education and counseling for youth

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Kerala spearheads community-care health revolution

By M Suchitra

A unique home-based palliative and chronic care movement is sweeping through Kerala. Thousands of trained citizens are volunteering two hours a week to take care of the chronically ill in villages and cities. Funding for this community-based scheme that has won WHO recognition comes in cash and kind from citizens, including schoolchildren, bus drivers, labourers and others

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Why is the women's movement silent on abortion?

By Anjali Deshpande

The Union Ministry of Health is examining the Medical Termination of Pregnancy (MTP) Act with a view to raising the time limit for abortion from 20 weeks to 24 weeks. What would the moral and ethical implications of this move be? And why has the women’s movement in India been strangely silent on these important developments?

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Smoking out India

With smoking in offices and private establishments banned from October 2, India is finally recognising that tobacco consumption is a major public health problem. But the ban by itself will not work. We need to reduce accessibility to all tobacco products, including gutkha, by taxing them out of reach and banning their sale in public places, says Deepanjali Bhas

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Sexuality education, minus the sex

By Rashme Sehgal

After the furore over the direct nature of India's Adolescence Education Programme last year, NACO has come up with a sexuality education module that dare not mention 'intercourse' or 'safe sex' or even 'condoms'. Over 30 groups working with sexuality have rejected the material

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Discrimination is built into our legislation

By Alok Prakash Putul

India passed the Leprosy Act in 1898 to ensure that leprosy patients did not face discrimination. A hundred years on, Indian laws and regulations do just that. Legislation in several states prevents leprosy patients from obtaining a driving licence, travelling in trains, and contesting panchayat elections. And many marriage laws make "contracting leprosy" grounds for divorce

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The pain of Roshanara

By Benita Sen

Cancer patient Roshanara's morphine tablets keep her relatively pain-free. Morphine is part of palliative care, which allows terminally ill patients to live a life of dignity, free of pain. Why, then, is it so scarce in India?

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Village of hope

By Aditi Rao

Over 4,000 people live in the Delhi leprosy complex. Though leprosy has been eliminated -- not eradicated -- in India, the stigma and discrimination that leprosy patients and their children face is far from eliminated, and it is only in colonies like this one that they can find companionship and a home

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Storm over sexuality education in UP

By Sushmita Malaviya

Recent data from NFHS-III reveals that an overwhelming majority of Indians feel their children should be taught about sexual behaviour and HIV/AIDS in school. Nevertheless, Uttar Pradesh, with the country's highest infant mortality rate and high maternal mortality and fertility rates, has chosen to ban its very successful Adolescent Education Programme in schools across the state

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Failure of Kerala's famed public healthcare system

By N P Chekkutty

Two reasons are attributed to the return of many epidemics to Kerala, a state that had achieved developed-country status in all the major human development indices: erosion of the grassroots-level public healthcare system that once thrived on government support, and dysfunctional municipal systems that do not deal effectively with waste-disposal

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20 years on, a reality check on HIV messaging

By Bharathi Ghanashyam

Why is AIDS awareness so limited, despite 20 years of national and international efforts? Is it time to devise more creative and innovative measures, such as having one health worker in each primary health centre dedicated to spreading awareness on HIV/AIDS?

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Putting mental health within the primary health system

By Rupa Chinai

In the first such major experiment of its kind in the country, the Manas project trains local people in Goa to deal with common mental health disorders, including depression, within the primary health setting

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Healthy debate: Lessons from Brazil

By Andrea Cornwall

Brazil's innovative institutions offer inspiring lessons for engaging citizens in improving health for all

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TB in Assam: Why vertical health programmes don't work

By Rupa Chinai

Hafeeza Begum of Sipajhar is one of thousands of patients in Assam who are desperate to find a cure for tuberculosis but for whom the divide between availability of services and access to them is impossible to bridge

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A bottom-up approach to sanitation

By Darryl D'Monte

South Asia has 900 million people without sanitation. The problem, as the success of recent total-sanitation community projects have demonstrated, is not a lack of funds but a lack of conviction amongst people that they need sanitation, and that they can meet those needs themselves

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The dark side of the Kerala model of development

By N P Chekkutty

It is not by accident that the most violent clashes in Kerala in recent times have been the Muthanga adivasi struggle in Wayanad and the communal flare-ups in coastal Maradu. Kerala's famed model of development left the tribal-dominated hills and the coastal fisher communities socially, politically and economically marginalised, leaving the coast clear for communal forces to enter

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'What services can a doctor provide without basic resources?'

By Rupa Chinai

At the Rowmari state health dispensary in Bodoland, which caters to villages within an 8 km radius, there is no electricity, no anti-malarial drugs, no paper and pens even for birth and death certificates. The health facilities here are indicative of the state of all Bodo areas, which show shockingly high maternal and infant mortality rates

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Karnataka's community health insurance scheme makes a difference

By Bharathi Ghanashyam

Three years after a community health insurance scheme was implemented by the government of Karnataka and Karuna Trust, around 200,000 poor people have benefited, paying annual premiums of just Rs 30 per year for insurance cover of Rs 50 per day of hospitalisation

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Rogue research in the guise of stem cell therapy

By Sandhya Srinivasan

The stem cell therapy industry is booming in India, without regulation of any kind. Unorganised, unscientific 'research' is being passed off as therapy. Some of those offering stem cell therapy in India today may be preying on the desperation of seriously ill patients likely to agree to unknown risks

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'India is being projected as a global hub for clinical trials'

By Sandhya Srinivasan

Dr Vasantha Muthuswamy, who helped draw up the guidelines for biomedical research in India, discusses the difficulties of ensuring that the trials being conducted in the country do not risk the lives of Indians

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Some questionable drug trials

By Sandhya Srinivasan

In the '70s and '80s, over 1,000 women with precancerous lesions of the cervix were left untreated, without their knowledge, to see how many developed cancer. In 1999, 25 patients of oral cancer were given an experimental drug without their knowledge or consent. How ethical are clinical trials in India?

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Open house on drug trials in India

By Sandhya Srinivasan

Contract research organisations are aggressively marketing India's potential for cheap clinical trials to meet foreign drug regulatory needs. The government is actively promoting India as a site for clinical trials. This new fortnightly series points out why we should be concerned about this

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The importance of health research

By Rupa Chinai

The Global Forum for Health Research held in Mumbai in September emphasised how health research that is linked to community response can help bridge the gap between policy and delivery of services

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Semi-literate, and saving lives

By Freny Manecksha

Nine months ago, in one of India's least-developed districts, Malika was born, premature and underweight, with pneumonia, umbilical sepsis and hypothermia. This is the story of how she survived, thanks to the efforts of village health worker Gandhara Bhagde

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Healthcare in the north-east: Education and sanitation is the key

By Rahul Goswami

With only 407 doctors, inadequate sanitation and poor development indicators, Nagaland's people have limited access to quality healthcare. A report from the north-east

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The rot in Orissa's reproductive health services

Manipadma Jena

At a recent public hearing in Orissa's Jagatsinghpur district, both men and women told harrowing tales of negligence, bungling and lack of facilities in the state's public healthcare system

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On the road with village health workers

By Freny Manecksha

Ankur, a home-based neo-natal care programme based on the acclaimed SEARCH model, is operative in 11 villages of Osmanabad district in Maharashtra. The programme is making a tangible difference to the health of infants and mothers. Freny Manecksha goes on night calls through the twisting lanes of Chauhanwadi with two village health workers

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Marooned by caste...and rising floodwaters

By Naren Karunakaran

In caste-ridden Bihar, in the village of Math-chilaven, it is the Brahmins who are discriminated against by the powerful Yadavs. The Brahmins of Math-chilaven, a village that is entirely cut off during the monsoon months, do not even have a voice in the elections

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Yet another committee, as government drags its feet over soft drinks standards

By Dr Sudhirendar Sharma

The issue of contaminated soft drinks seems to have been pushed on to the backburner with the Pesticide Residues Sub-Committee deciding to set up yet another committee to monitor soft drinks for a year before any attempts are made to decide standards for pesticide contamination

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Why 40,000 pregnant women die in UP every year

By Rashme Sehgal

Uttar Pradesh has a maternal mortality rate of 707 per 100,000. Activists believe that the poor quality of reproductive health services offered by state primary health centres, and the continuing target-based approach to family planning are responsible for this. Our correspondent discovered a trail of botched sterilisations, unsafe abortions, antiquated surgical techniques and hasty cover-ups

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UP's women die in childbirth for want of a four-rupee dai kit

By Rashme Sehgal

Forty thousand women die every year of childbirth and related complications in Uttar Pradesh, which has the highest maternal mortality rate in the world. Now, a tussle over where to buy dai kits has stalled their distribution to village midwives, putting more lives at risk

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The sinister targets of Indian health camps

By Sreelatha Menon

At Usayini in Uttar Pradesh, some 'health camps' funded by USAIDS are really places where local midwives are pushed to bring women in for sterilisation. There is absolutely no attempt to provide all-round reproductive health care. This approach flies in the face of India's official policy of target-free family planning

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NIMHANS recommends the Banyan model for mental healthcare

By Lalitha Sridhar

The Banyan model of care for the mentally ill incorporates support, vocational training, rehabilitation and permanent care. NIMHANS, the nodal institution for mental health in India, recommends that the 10-year-old and very successful Banyan model be replicated in other parts of the state

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Orissa's IMR Mission

By Elisa Patnaik

Orissa has the highest infant mortality rate in the country at 97 per 1,000 live births. Approximately 86,000 infants die in the state each year. Poor healthcare facilities for mother and child, malnutrition, malaria and lack of awareness are major contributing factors. Can the state reduce IMR to the targeted 60/1,000 by 2005?

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HIV: The numbers controversy

By Sandhya Srinivasan

Do we have 2 million or 20 million HIV-positive in India? Or is there a plateuing of the epidemic? Speculative and alarmist figures about the number of Indians affected by HIV/AIDS have added to public confusion and affected the programme's credibility. This is the first in a series of articles on the issues and controversies surrounding HIV in India

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DEBATE: Is Electroconvulsive therapy still relevant in psychiatric treatment?

By Chittaranjan Andrade

Presenting two sides of an ongoing public health debate

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Fractured minds, fragmented lives

Exploring the lives of the mentally ill in India

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Food security, not vitamin supplements, is vital for public health

By Sena Desai

A year ago, Unicef's vitamin A campaign in Assam caused the death of 30 children and sent over 1,000 to hospital with vitamin A toxicity. The larger question is whether such mass campaigns to combat malnutrition-related deficiencies in India are still required. Or do we need a more sustainable approach?

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The Handwashing Initiative: selling soap or saving lives?

The World Bank's Handwashing Initiative is based on the conviction that the simple practice of washing hands with soap could reduce deaths from diarrhoea by half. But its intentions are being questioned in Kerala, where people say they need safe drinking water, not multinational soap

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Friends of Melghat

By Huned Contractor

An estimated 5,000 tribal children died of malnutrition in Melghat, Maharashtra, between 1992-97. Since 1997, a group of volunteers has been working with the Korkus in this remote forest region, helping educate them about nutrition, sanitation and preventive health care

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The barber's wife: Sex advisor to child brides

By Pamela Bhagat

In the Terai region of Uttar Pradesh, where no family planning campaign has ever penetrated, it is the Naun or barber's wife who accompanies child brides to their husbands' homes at puberty and advises them on family planning and family welfare. This traditional practice does not seem likely to change in the foreseeable future

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Building a new world at Parinche

By Jaya Jose

In 1995, the Foundation for Research in Community Health began training semi-literate village women to diagnose and treat common health disorders. Today, Parinche's tais are not just barefoot healthworkers. They're also scripting an ecological, cultural and educational revolution in their villages

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The economics of TB

By Sandhya Srinivasan

Tuberculosis in developing countries is not just a disease requiring effective medical treatment. It is a disease complicated by complex socio-economic problems such as unemployment, poverty and malnourishment. The story of tuberculosis in India is the story of people with no right to food, employment, shelter or healthcare. No wonder the figures for TB haven't changed all that much in the last few years

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Inequality and poverty cause mental illness

By Keya Acharya

Health experts warn that mental health problems are increasing sharply worldwide. According to the World Health Organisation, depression is set to become the main cause of disability and the second leading health problem by the year 2020. In developing countries, inequality, poverty and gender are significant factors contributing to mental illness

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Women in white: India's widows

Following the recent announcement that the National Human Rights Commission will now coordinate governmental and non-governmental measures to help the widows of Vrindavan and the rest of the country, this article discusses the situation and problems of widows in India, past and present

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