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Culture and systems of knowledge, cultivation and food, population and consumption

Posts Tagged ‘medicine

Wind and soil, culture and change

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With soils and humus, with grasses wild or cultivated, with water whose form may be a hill tarn or a great tropical river, has intangible cultural heritage found expression and renewal. Whether in the Himalayan hill districts of northern India, the central province of Sri Lanka with its hydraulic wonders, the great basin of the Tonle Sap in Cambodia whose bidirectional water flow is the basis of both ritual and an aquacultural livelihood, or the highland ‘aldeias’ of central Timor-Leste, in which an age-old institution that bans exploitation of the forest continues to be respected, the bio-physical foundation on which so much intangible cultural heritage depends has remained plentiful and as reliable as the seasons.

RG_WHR_77_coverBut no longer, for new disturbances have shaken this relationship and they are depleting these fundamental materials just as much as altering their very nature. The new uncertainty is undermining the intimate knowledge held by communities of natural processes in their specific locations, such as inter-annual variations in weather or the cycles of certain plant and animal species. Protecting such knowledge is of critical importance – not only for its role of being cultural heritage, and for respecting the wealth of accumulated and transmitted knowledge – but because it possesses the keys to living with change, and especially living with the effects and impacts of climate change.

In domains such as traditional medicine, forestry, the conservation of biodiversity, the protection of wetlands, it is ICH practitioners and the communities they belong to who observe and interpret phenomena at scales much finer than formal scientists are familiar with, besides possessing the ability to draw upon considerable temporal depth in their observation. For the scientific world, such observations are invaluable contributions that advance our knowledge about climate change. For the local world, indigenous knowledge and cultural practices are the means with which the effects of climate change are negotiated so that livelihoods are maintained, ritual and cultivation continue, and survival remains meaningful.

[This short extract is taken from ‘How intangible cultural heritage adapts to a changing world’, my article in the current issue of the UNESCO World Heritage Review. The entire article can be read here (pdf 558kb).]

Washington shakes an IPR fist at India

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As we had expected in 2013 December, the mutual back-slapping over the WTO ‘deal’ between Indian and the USA evaporated very quickly indeed in the face of American business aggressiveness. For the US industry, business and trade associations and lobbies, ‘partner’ means vassal, ‘deal’ means binding obligation, ‘priority’ and ‘sanction’ become weapons (which hurt the poor and vulnerable the most), and ‘trade’ itself means subservience.

And this is why this week, the last of 2014 February, the National Association of Manufacturers in the USA – which represents some 50 American business groups – asked the US Trade Representative to designate India a Priority Foreign Country in its 2014 report. “This designation appropriately would rank India among the very worst violators of intellectual property rights and establish a process leading to concrete solutions,” NAM said in a letter to US Trade Representative Michael Froman.

In its official foreign policy and business pronouncements on India, the government of the USA, its representatives and its agents adopt a tone reminiscent of the 1950s, when American foreign policy and its agricultural scientists joined forces to bulldoze a green revolution in India. Here and now too, the USA likes to hear itself make statements such as “the promise of the 21st Century depends squarely on a robust US-India commercial and strategic partnership” and “central to this partnership will be the co-development and sharing of our best technologies, as well as free-movement between our economies of our best minds and thinkers”.

But the US doesn’t do diplomacy. America’s manner and approach has always been, my way … or else. And that is why one of the most powerful factors influencing Indo-American business and trade connections, the US India Business Council, through its seniormost officer (Ron Somers, who had worked for the energy company Cogentrix in Karnataka), called “attention to India’s need to calibrate regulations to protect data, or inspire India’s future legislature to adjust its Patent Act to align more wholly with international norms particularly regarding incremental innovation”. The USIBC also bluntly said: “Everyone agrees that India needs to spend more on its healthcare system” and that “evolving ecosystems that reward and protect Intellectual Property will be crucial”.

These disagreements between India and the USA have surfaced anew because the USTR is holding public hearings for its annual report, scheduled to be issued in April. This report will be on countries that the US government thinks are “denying protection of IP rights or fair market access to US firms”. The USTR has said that “India is widely perceived in Washington as a serial trade offender, with US firms unhappy about imports of everything from shrimp to steel pipes they say threaten jobs, as well as a lack of fair access to the Indian market for its goods”.

This is among the most signal, and deliberate, failures of the two UPA terms of government – that its reckless and dangerous chasing of foreign direct investment and its reckless and dangerous opening of domains previously in the public sector to private interests have left Bharat and India in such a crippled state that we as a country tolerate such an insult. There is not the slightest hint of fairness in America’s bullying ways, for it wants nothing less than the capitulation of India’s pharmaceuticals industry, and it wants the handing over of insurance – from life insurance to automotive to weather – to its own freebooting companies whose practices have assisted the plunge of a sixth of America’s population into poverty over the last decade.

What may happen now? There are press reports that India may take the USA to face the WTO’s dispute settlement mechanism if included by the USTR in the ‘Priority Foreign Country’ list for intellectual property rights. American industry and trade lobbies are putting pressure on their government to include India under this list. Thus far, the position held within the central government is that the demand (from the US companies) is “completely wrong” as India’s intellectual property rights are compliant with global laws, including that of the World Trade Organisation (WTO).

It is concerning pharma that the American MNCs are most vociferous. US pharma companies had objected to India’s move to issue a compulsory license in 2012 to Hyderabad-based Natco Pharma to manufacture and sell cancer-treatment drug ‘Nexavar’ at a price over 30 times lower than charged by patent-holder Bayer Corporation.

A delegation from the US International Trade Commission (USITC), described as a quasi-judicial agency, has arrived intending to probe the impact India’s policies on trade and investment have on the American economy (the intention is to supply the USTR with ammunition and to prepare for a WTO dispute confrontation; the Americans involved perhaps cannot see or appreciate the irony of the USIBC also praising India for investing in the USA and creating jobs there).

The USITC has raised the Natco matter, and has also raised the rejection of patent to Bristol-Myers Squibb’s Sprycel and Novartis’ Gleevec. It has stated that Indian IPR laws are not Trade Related Aspects of Intellectual Property Rights (TRIPS) compliant under the WTO. The response of the government of India has been to ask all its officials to stay away from any interaction with the USITC delegation.

But we have stood firm till here. Swiss pharmaceuticals manufacturer Novartis AG had lost a legal battle for getting its blood cancer drug Gleevec patented in India and to restrain Indian companies from manufacturing generic drugs. The Supreme Court had rejected the multinational company’s plea last year in a judgement that was loudly and widely hailed in all countries of the South. This came as a blow to the US-EU pharma MNCs who see the very much larger populations of the South as new markets. Hence the threatening fist-waving by the US government.

The complaint by American companies that India refuses to implement laws to provide data protection and to provide patents for bio-pharmaceutical companies is framed in terms of being against the interest of Americans in terms of jobs and ‘fair’ competition in the global marketplace. To support such nonsense, the US Chamber of Commerce’s Global IP Centers issues what it calls an International Intellectual Property Index, which compares the IP laws and implementation of those laws of 25 countries. In the 2014 Index, India received the lowest overall score, with a score of 0 for ‘Membership and Ratification of International Treaties’ and 0.25 for ‘Trade Secrets and Market Access’.

India’s policy on generic drugs has so far refused to accept ‘evergreening’, a scheme used by pharmaceutical companies to continue having a patent over a drug – even after its patent has expired – by modifying it slightly. India’s decision to grant compulsory licenses (within Indian and WTO rules) to anti-cancer drugs by Novartis and Bayer has infuriated Big Pharma in the US. To retaliate, the USA banned Ranbaxy selling medicines from its fourth plant in the USA – so much for being ‘fair’ at home in America; why does Ranbaxy continue to want to do business there?

India’s generic drug policy is guided by the need to provide cheap medicines to a large population that cannot afford even a fraction of the international patent-protected prices of these medicines, as several authoritative civil society responses to the matter have competently pointed out. This is the practice the judiciary has supported and this is the practice that must not change under any circumstance and regardless of the threats and blandishments by Froman and his shylockian collaborators.

Women and health in a rural community in India

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'Putting Women First: Women and Health in a Rural Community', published by Stree Samya Books

'Putting Women First: Women and Health in a Rural Community', published by Stree Samya Books

This book is as much about the lives and times of ordinary people as it is about social medicine. It is a doctor’s story about her practice, which lets her extrapolate about the realities of rural India for all Indians. Set in Gadchiroli, a district in central India, known for being an underdeveloped and backward area.

The introduction to ‘Putting Women First: Women and Health in a Rural Community’, tells us that this district is where Dr Rani Bang and her husband, Dr Abhay Bang, set up the clinic for the Society for Education, Action and Research in Community Health (SEARCH) and practised medicine that explicitly catered to the Raj Gond, Madiya Gond, Pardhan and Halibi, the dominant tribal groups, along with non-tribal poor people who live in the area.

This settlement goes back to prehistory and is a part of the ancient Dandakaranya forest mentioned in the Mahabharata and the Ramayana. Rani Bang’s research found that 92 percent of women in this region had no access to treatment for gynaecological disorders in the absence of women doctors. Such neglect was exacerbated by ‘development’ since rural families were, and remain, unprepared for the rapid changes wrought in the spheres of education, information, material enhancement and changes in lifestyle, which impact on relationships and health.

The book plays many roles: a commentary on the ‘chronic myopia’ of a planning process that refuses to see millions of Indians or to think of the ways in which their lives could be bettered;   careful observations on the enormous social changes that impact on tribal society where  traditional kinship and ecological systems being sorely stressed; and a logbook of case medicine.

In their own way, the Bangs have set in motion a type of revolution that equips people, communities and administrators with the tools to ‘build an indigenous expression of development, one in which the fundamentals of healthcare, interdependence and sustainable economics are paramount’. The last chapter of the book summarises the author’s views on recommendations for policy makers.

I was associated in a small way with the early work that went into ‘Putting Women First: Women and Health in a Rural Community’, and was then asked to write the foreword, a signal honour. I have extracted a few paragraphs of the foreword below, and you can read the full foreword [pdf] here. You can order the book directly from the publisher, Stree Samya, here.

Adivasi 'dais' (traditional birth attendants). A picture from 'Putting Women First'.

Adivasi 'dais' (traditional birth attendants). A picture from 'Putting Women First'.

From the foreword:

In shifting to another section of the Gadhiroli (and indeed of the rural Indian) canvas, ‘Putting Women First’ speaks sagely of the manifold aspects of the care our population needs: of regional disparities and critical gaps in the health care delivery system, of infant mortality, obstetric care, maternal and child health, of ‘dais’ and anganwadis, medical termination of pregnancy, and the desperate need for better-staffed primary health centres. “Meeting health needs of women through a system that is sensitive to the differential needs of men and women and their differential access to health care also needs to be taken into account,” recommended the National Commission on Population. Bang-bai’s clinic practices that sensitivity, day in and day out.

The differentials that Search grapples with routinely are daunting. The very premise of girls’ education, especially education of poor girls, is based on an understanding that education is critical to social development, that it leads to lower fertility rates and better child-rearing practices for example. On the one hand, the benefits of women’s education are compelling yet all too often, the struggle for the right of girls and women to education gets reduced to issues of access alone. In general, it has been easier for women’s groups and voluntary groups to work with girls outside the system of formal education, especially the government system of education which is notoriously inflexible.

If one was to describe a large circle around the Search campus, of say 50 kilometres, one would see in the nearby settlements of Aheri, Brahmapuri and on the Raipur road the assembly-line blocks that in rural India purport to be schools. What does it mean to be ‘schooled’ in one of these miserable containers? Conditions in these schools are hardly conducive to meaningful learning – none possesses the very basic set of facilities such as adequate classrooms, toilets and drinking water, teaching-learning materials and libraries. As is the case elsewhere in India, physical inaccessibility, irrelevance of curricula, repeated ‘failure’ and harsh treatment in schools contribute to children dropping out or never enrolling. According to a National Sample Survey Organisation survey (1998), about 26 per cent of those who had dropped out of government schools cited reasons other than poverty – unfriendly school environment, doubts about the usefulness of schooling and an inability to cope with studies. Among girls in rural areas these factors accounted for over 75 per cent of dropouts.

Pakistan Indus flood relief: Himal Southasian

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The excellent Himal Southasian magazine is maintaining a packed page full of information about relief, ways to contribute money and services, maps and data, contact emails and phone numbers of people coordinating relief work in Pakistan, names and contact data of agencies doing relief work.

Himal Southasian magazineThe Indus Flood Relief – Fund Collection Drive is being organised by Himal Southasian, South Asia Alliance for Poverty Eradication (SAAPE) and NGO Federation of Nepal. This is a fund opened in Kathmandu for those all over Southasia and elsewhere seeking to support the immediate, ongoing relief efforts in Pakistan. Himal asks you to please use this facility to send money to the victims of flood along the Indus. The recipient organisation is The Institute for Social Movements-Pakistan (ISM PAK) in Hyderabad (Sindh), working with the Orangi Pilot Project (OPP) on emergency response and support. ISM PAK and OPP urgently need funds for rations, medicine, shelters, drinking water, infant diet support, livestock fodder and vaccination, hygiene kits, makeshift toilets and schooling camps.

The Himal page provides detail such as: “”The Sindh government has decided to move displaced people from Jacobabad to Karachi, Hyderabad and Jamshoro. The City District Government Karachi (local government) has identified four locations in Karachi where the displaced families will be brought in: Gaddap, Bin Qasim Town, Keamari, Toll Plaza. Kashmore and Dadu are the worst effected districts. In Kashmore, 50000 people are either on Bunds or in camps. Around 150000 people have been moved to Sukkur, Khairpur, Karachi, Hyderabad and Sibi (Balochistan).”

There are also daily updated lists of what’s needed where – clothing, utensils, toiletries, food, medicines – and who’s doing what – the Provincial Disaster Management Authority (Pakistan government), the Orangi Pilot Project (OPP) and The institute for Social Movements, Pakistan (ISM-Pak).