Remember ME - You Me and Dementia

Friday, June 10, 2011

Who will bell the cat? Jan Lok Pal Bill to Stop Corruption

 
Last week’s campaign by Anna Hazare and colleagues raised very important questions about accountability, state, civil society, political means and ends. Critics of the campaign to get the Jan Lok Pal Bill adopted by the Government of India have found fault primarily with the means used by Anna Hazare and by the content of the draft legislation upon which the campaigners were insisting. (1) There has already been extensive commentary on these so this essay will focus on the question of accountability.

Accountability is one of the oldest questions in the study of politics. As social contractualists would tell it, the tale goes that the state was forged by the common need felt by individuals for common laws enforced by a mutually agreed authority. But if we just look at the way the three most prominent thinkers from this school described this authority (ie the state), we can see that the accountability question is rooted in the very nature of the state. Hobbes saw a state that was absolutely powerful, embracing and controlling every aspect of life; the citizen had virtually no rights—except life--vis-à-vis the state. Locke’s state was a carefully drawn up contract in which the state had a regulatory role but could not infringe on life, liberty and property rights. For Rousseau, the expression of society’s “General Will” was sovereign—the most abstract, perhaps most expansive of the three. The three thinkers’ descriptions serve as a quick doodle that highlights the push-pull tension intrinsic to the state-society equation. 

The most commonly told Indian story about the origin of the state bears some resemblance to this. The decline of society necessitates the appointment by a king, who is a manifestation of Vishnu, but at the same time, the king’s powers are not absolute as the story of Vena, arbitrary and corrupt ruler, shows. He was dethroned and beheaded by sages, while the earth, unable to bear his abuse, went into hiding. Kautilya’s Arthasastra gives individuals the right to resist a bad king. And much discussion in the two epics centres on the qualities and practices of good kings. In other words, there is nothing new or exotic about the question of accountability.

State, society, civil society, people
States, through their agents and agencies, perform (or should perform) certain useful functions. Defence, law and order and creating some common rules and instruments for a given population are the core but depending on the history and context of the state, other functions such as development might also be added to this list. There is a point in the performance of each of these functions where the state’s activity and interaction may hurt citizens and communities within. Language policy and redistribution of resources are two examples. 

The relationship between state and society is a symbiotic one. States are born out of society, in a way, and draw their values, agents and histories from society. But they are not co-terminous with society. A single state may be home to many ‘societies’ as people define themselves in multiple ways, intersecting or overlapping, collectively (Bengalis, Sikhs, Dalits, English-speakers) ; and a single society may transcend the borders of a state (Shaivites). 

The extent to which states are embedded in or autonomous of the societies that constitute them is a subject political scientists take an interest in. One of the markers of political modernisation was that the state would be more and more autonomous of society, a function of both the growing power of the state as of changes in society. Such a state was considered better placed to direct social and economic change. In Indian political thought, one of the big questions is the king-priest relationship, but both operate within the common framework of the values of society in a given place and time. The modern Indian state is relatively autonomous of society, given its origin in a constitutional framework. The potential for antagonism between state and society is likely greater when the state enjoys greater autonomy and has an agenda of social change. 

So much for state, society and individuals, but what is civil society? Everyone seems to understand what ‘civil society’ is but it is very hard to arrive at a common definition. The most pedestrian definition might be that the term is a rubric for all collective activities in society other than those organised by the state or part of the economy (market and otherwise). This immediately raises questions about religious organisations, caste panchayats, trade unions and so on: are they civil society? The answer to that question is as varied as the actors that count themselves in and are counted in civil society. The more important question may be: What is the role of civil society in balancing the equation between society and state? This is, after all, one of the questions that the recent campaign has raised by seeking a role for eminent persons from civil society in drafting and enforcing laws that create accountability. 

Meeting the ‘accountability’ challenge
The essence of the accountability challenge is to make sure the state and its agents deliver on all their mandates without infringement of citizen’s rights. Moreover, it is to facilitate communication between state and society so that the actions and policies of the state reflect the changing needs and demands of society. Accountability is seen as a check on the state’s exercise of its powers. But as this is not a new political problem, it is useful to look at some of the instruments devised over centuries to resolve it.

‘Separation of powers’ and ‘checks and balances’
A beginner in a politics class learns these terms as ways to check the absolute power of rulers. Montesquieu first wrote about separation of the power of the state, advocating that the executive, legislative and judicial powers of a state be reposed in different offices to prevent their concentration in the hands of one. Montesquieu wrote during the reign of Louis XV, when France’s absolute monarchy was still at the zenith of its power and when the excesses of that power were becoming evident. His ideas became very influential outside France, and the new American enshrined his ideas as the system of ‘checks and balances’.

While today, the American President is often described as the “most powerful man on earth”, in reality the genius of the system is that no branch of government is completely autonomous of the other. This was a response to both the autocratic absolute monarchies prevalent in Europe at the time (and heading for revolutionary collapse) and the newly evolving Westminster system in England where the lines between the executive, legislature and judiciary were blurred. When the Indian Constitution was written, while the Westminster model was largely retained, there were two important departures that the Constituent Assembly adopted. The first was to set up a separate Judiciary, with an apex court distinct from Parliament. Over time, the Indian judiciary came to exercise ‘judicial review’—the right to review laws made by the legislature for their constitutional validity—which was an American innovation. The second departure was that India is a federal state, and the second house of Parliament was not made up of knighted and landed peers but members elected by the legislatures of Indian states and union territories. 

A fear that all the powers of a state, all its resources, will be concentrated in the hands of one or a few is an old fear. Most constitutions address that fear in some way and most constitutional debate centres on how power should be distributed and shared—both to benefit the most people and to prevent corruption and abuse. 

When in the 1970s, there was talk about a ‘committed judiciary’ and a ‘committed bureaucracy’, these ideas were met with great resistance. The ability of the judiciary to act independently has been a great bulwark against poor governance, human rights violations and corruption, and has created value for the independence of the Election Commission, Vigilance Commissioners and other statutory bodies. A series of upstanding officials in the top posts has conflated the institution’s independence with integrity. However, the fact remains these are not elected positions and beyond a point, not accountable to the people of India. The concerns that surround the Planning Commission and now, the National Advisory Commission, also apply to these offices—and that of any Lokpal—that policy is being made by appointed rather than elected officials.  

The ombudsman
By now, we’ve all read about how the ombudsman’s office is a Swedish institutional innovation. In 1713, Sweden’s King Charles XII was away from his capital pursuing distant conquests. Unsure of whether his officers were working in accordance with the law, he created the office of the ombudsman to oversee their working. The ombudsman was a representative of the executive. In 1809, Sweden’s new constitution created the office of a parliamentary ombudsman with the power to investigate and prosecute grievances, oversee public servants and identify and advocate good administrative practices. This is the ombudsman model that has been adapted in many parts of the world. 

In India, the suggestion to have an ombudsman-like post was introduced in political discourse by the first Administrative Reforms Commission in 1969. (2) The Lokpal would officiate as a public grievance officer at the central government level and Lok Ayuktas would do the same in the states. Since the 1980s, several states have passed Lok Ayukta legislations and appointed ombudsman officers whose powers vary from state to state. At the central level however, multiple efforts to establish a Lokpal did not bear fruit. Appropriate legislation was introduced 10 times between 1969 and 2011, with no success. 

Apart from the cynical explanation that self-serving legislators would hardly have prepared their own nemesis, what are some of the reasons these drafts did not pass? There are unresolved issues surrounding the structure, jurisdiction and powers of the Lokpal. First of all, should the office of the Lokpal mean a single individual or a multi-member panel? This is more easily resolved than the suggestion that the office of the Central Vigilance Commissioner and the Central Bureau of Investigation should be merged into the Lokpal to create an anti-corruption body. The relationship between the Lokpal and the courts and parliament also remain to be defined. In other words, four decades on, we have not been able to decide what this office should look like. This is partly a function of the challenge of determining jurisdiction. 

One important hurdle is to decide which government offices should fall under the purview of the Lokpal—all public servants, political functionaries, parliamentarians, ministers, prime minister—there has been no consensus on any of this. Moreover, in a hierarchy-conscious society and secrecy-conscious state, it is suggested that inquiries against some functionaries should require prior sanction. Should the Lokpal merely look to corruption charges and complaints about non-delivery of services or should the Lokpal also hear commercial and contractual matters? An anti-corruption office might receive allegations that a particular official acted in their self-interest (by asking for a bribe, allocating resources a certain way) or a complaint that a citizen was inconvenienced or hurt as a result of poor administrative responses. The question of jurisdiction also extends to defining which of these (or both) a Lokpal should hear.
The question of power is as contentious as the question of jurisdiction. The Lokpal could be set up as an advisory office, which receives grievances and advises the government to act on them. It could also have the power to investigate and prosecute. If investigative and vigilance agencies were merged with the Lokpal, it would presumably be a far more powerful body. In that case, the question also arises as to whether the Lokpal should be limited to acting on written complaints or whether the office may initiate its own actions independently. 

These are not small matters and they are not contentious merely because they open up turf-battles between ministries. There is also the broader question of checks and balances in government and fitting a new, independent statutory body into that framework. 

Civil rights
Rights are the ‘thus far and no further’ line between state and citizens. While there are other mechanisms that create a relationship where state agents are responsible and accountable to citizens (representative institutions and voting, for instance), rights define the relationship between state and society, state and individuals. The constitutions of most states now include a Bill of Rights, and states are charged with protecting their citizens from the violation of those rights by other citizens. Individuals and communities also enjoy rights vis-à-vis the state—political rights, civil rights, cultural rights and increasingly, economic rights. 

The Indian Constitution guarantees fundamental rights (to life, to equality, against exploitation, to freedom, cultural and educational rights) and also the right to constitutional remedies.(3) These constitutional remedies include the writ jurisdiction of the high courts and Supreme Court which can be invoked to ensure that the state protects the fundamental rights of an Indian citizen. There are five such writs: Habeas corpus (which is used to challenge unlawful detention); mandamus (whereby a public official can be instructed to carry out official duties and protect rights); quo warranto (which questions a public official’s authority to decide or act in a certain way); prohibition (which results in a higher court issuing a ‘stay order’ to stop implemention of a decision under challenge); and certiorari (which allows a higher court to transfer a case or a particular process to a better-suited office if need be). Four of the five writs relate as much to the question of accountability as they do to violation of individuals’ rights. 

Civil society has used both the language and the instrument of rights to create more participatory processes in development and social change arenas. It has also highlighted the close relationship between accountability, rights and welfare. The Right to Information, enacted as law in 2005, is a result of grassroots movements making and articulating this connection, rather than city-based think-tanks holding seminars about it. From the villages of Rajasthan and the villagers’ outraged insistence on knowing what was happening to public resources, came the national campaign for the Right to Information. Transparency and insisting on transparency are vital instruments for enforcing accountability. Since the passage of the RTI Act, RTI petitions—which are very easy to file—have been used across policy sectors and levels of governance. Vinta Kamte used an RTI petition to access the phone and mobile records of key actors on the night of 26/11/2008, when her husband was killed in the terrorist attack in Mumbai.

The media
Press freedom is one of the pillars of democracy, and in India, for more than four decades, investigative journalism has left tabloid columns behind to become a marker of serious purpose in the mainstream. The Indian media work in an atmosphere of relative freedom compared to many other settings, and their work exposing corruption or violence has often been important, but their credibility has also been dented in recent years.

Most recently, the Radia tapes showed how closely knit India’s elite is—their phone calls, their references to each other, their sharing of inside information, their confidence in their influence. The disclosures adversely affected many reputations but journalists were possibly worst-affected. Even before the Radia tapes though, the Press Council of India’s report on ‘paid news’ described different ways in which journalism was compromised by the close association of editors, owners and business. The practice consists in the purchase through roundabout or indirect means of column space on the news and editorial pages of newspapers. This practice tricks the reader into believing that what is really an advertisement is factual newsreporting, and it also constitutes financial malpractice by both the purchaser and the media company. Election candidates and business houses are both known to engage in this practice. The real damage is to the ability of the news media to be independent and vigilant observers who bear witness. The now-common practice of investigative and ‘sting’ reporting is now also an instrument for the same vested interests. 

On the other hand, the media have found a new, hitherto unlikely ally, in ‘ordinary’ citizens, who armed with mobile phones and social networks, are extending the reach of the press in three different ways. They are reporting from where they are with text and video events that unfold around them as well as exposes of inefficiency and malfeasance. They are offering opinion on blogs and through text messages, extending the community of the disappearing op-ed page far beyond its historical reach. They are voting in spot polls, allowing media agencies to take dipstick readings of public opinion. The combination of media advocacy and citizen activist-journalism has resulted in instant mobilisation, especially around urban events and interests. The protests that followed the 26/11 attacks and the current support for the Jan Lok Pal Bill are both examples of how powerful this combination has become.

When you overlay the evidence of corruption and cronyism in mainstream media organisations and the power of this combination, the result must raise red flags for any thoughtful observer of politics and society. Used wisely and cautiously, this is a democracy’s biggest asset. Thoughtless and emotional responses however, can create pressure for outcomes that are sub-optimal in the long run. 

The power of protest
Morchas. Rallies. Candlelight vigils. Silent marches. Padayatras. Sit-ins. Dharnas. Relay hunger strikes. Hunger strikes. Fasts unto death. Gheraos. Walk-outs. Go-slows. Work-to-rule. Strike. Flash strike. General strike. Bandh. All-India bandh. The vocabulary of non-violent protest is especially rich and innovative in India. The crown jewel of this treasury is surely, satyagraha—non-violent resistence or soul-force are common translations.(4)

The idea of satyagraha draws more from ideas in spiritual traditions that connect inner transformation to social transformation, than from theories of resistance and revolution. The character of the satyagrahi is thus central to satyagraha; readiness for satyagraha is an objective in itself. Some of the qualities that Gandhi sought in satyagrahis were honesty, self-discipline, faith in democracy, belief in the law so that disobedience is really a conscious departure, patience and forbearance, courage, especially the courage to trust the adversary, and self-effacement. Satyagraha was never to be coercive, but to seek a transformation in the other’s attitude. There was no place for anger (nor outrage?) in satyagraha. Satyagraha was also to be undertaken by those directly affected by a situation, not another on their behalf. For any satyagrahi, the inner quest for truth and the outer struggle for it were of a piece. 

Gandhi is sure of the power of this approach to political action, as now are most Indians. Of the different ways to undertake satyagraha, fasting—which directs the action at the self—is the most powerful. Gandhi wrote in Young India, in 1927: “Since satyagraha is one of the most powerful methods of direct action, a satyagrahi exhausts all other means before he resorts to satyagraha. He will, therefore, constantly and continually approach the constituted authority, he will appeal to public opinion, educate public opinion, state his case calmly and coolly before everybody who wants to listen to him, and only after he has exhausted all these avenues will he resort to satyagraha. But when he has found the impelling call of the inner voice within him and launches out upon satyagraha, he has burnt his boats and there is no receding.”

In other words, street action—satyagraha or otherwise—must follow the unsuccessful use of all other methods. 


But who will bell the cat?
The task of enforcing accountability rests ultimately with citizens. The terms and conditions of citizenship in a democracy include an implicit undertaking by citizens to remain informed—of rights, of laws, of policies and of current affairs—and exercise their rights, including the right to vote. In India, as in other democracies, they also have the right to file for constitutional remedies through a variety of writ petitions. 

Civil society brings to this the advantage of acting collectively, as it reflects the diversity of interest and temperament of the citizenry at large. Drawn from this same body of citizens, neither civil society nor government can claim a monopoly on virtue and integrity. Acting collectively in civil society organisations empowers citizens, but the collective energy of the group also reinforces special interests and entrenches positions. This is one reason that no group in civil society or no coalition of groups can claim legitimately to represent all citizens the way elected representatives of a legislature can, even with all the limitations of representative electoral democracy. 

There are three very important functions that civil society can perform better than the individual citizen. First, it is easier for a group to marshal the technical, material and financial resources for certain courses of action, whether it is an RTI or writ petition. Second, an organisation is better placed to undertake a sustained and systematic programme of research and public information on specific issues than most individuals. This includes gathering the learnings of grassroots organisations and the documentation of social movements, informing in turn research that is oriented towards policymaking. Finally, civil society organisations are sometimes in a position to create and facilitate interactions between government and different groups of citizens on particular issues. All are essentially long-haul functions. Insofar as civil society organisations show the patience to undertake these functions, one measure of the responsiveness of a democratic government is their openness to inputs and initiatives from civil society. 


(1) Some examples: Economic and Political Weekly, What ‘Movement’ is this anyway? April 16, 2011, http://epw.in/epw/uploads/articles/15939.pdf; Pratap Bhanu Mehta, Of the few, by the few, Indian Express, April 7, 2011, http://www.indianexpress.com/new; Pratap Bhanu Mehta, What’s in a solution? Indian Express, April 14, 2011, http://www.indianexpress.com/; Prashant Bhushan, Jan Lok Pal Bill: Addressing concerns, The Hindu, April 15, 2011, http://www.thehindu.com/opinion/lead/article1696970.ece; Manoj Mitta, Lok Pal Bill: United in opposition, civil society a divided lot, Times of India, April 7, 2011, http://articles.timesofindia.indiatimes.com/; Shuddhabrata Sengupta, At the risk of heresy: Why I am not celebrating with Anna Hazare, Kafila.org, April 9, 2011, http://kafila.org/2011/04/09/; Harini Calamur, My issues with the Proposed Jan Lok Pal Bill, April 6, 2011, http://calamur.org/gargi/2011/04/06/; The Acorn, Against Jan Lok Pal and the Politics of Hunger Strikes, National Interest, April 8, 2011, http://acorn.nationalinterest.in/2011/04/08/against-jan-lok-pal-and-the-politics-of-hunger-strikes/.
(2) The best resource on the Lok Pal Bill is the webpage maintained by PRS India: All about the Lok Pal Bill, http://www.prsindia.org/index.php
(3) The Constitution of India is available online at http://indiacode.nic.in/coiweb/coifiles/part.htm.
(4) Resources for the section on satyagraha are drawn from the websites run by the Bombay Sarvodaya Mandal and Gandhi Book Centre (http://www.mkgandhi) and Gandhi Smriti and Darshan Smriti (http://gandhismriti.nic.in).

(Swarna Rajagopalan is a Chennai-based political scientist. She is the founder of Prajnya Initiatives for Peace, Justice and Security, a Chennai-based non-profit.) 


 

Forget yourself for others, and others will never forget you.

Why poor rural tribals will remain poor for generations


A new survey by the Chronic Poverty Research Centre identified 15 regions spread over six states where poverty is getting concentrated and chronic, and found that tribal and forested areas are likely to remain poor, with the decline in poverty among the rural tribal population going from 51.9% to just 47.3% .

  Poverty is becoming hereditary in India, at least for a sizeable population. That is the conclusion derived from a three-decade tracking of poor households in rural India.
A survey by the Chronic Poverty Research Centre (CPRC), an international association of researchers and academicians, claims that those who are chronically poor may pass on poverty to their next generation. What’s more, people residing in tribal and forested areas are likely to remain poor forever, fomenting violent conflicts in future. Most of India’s forested districts are already dens of Naxalites.

The survey, India Chronic Poverty Report, comes at a time when the country is awaiting its latest National Sample Survey for estimation of poverty. On April 21, while unveiling the approach paper to the 12th Five Year Plan for 2012-17, the Planning Commission disclosed that poverty has reduced from 37.2% in 2004-05 to 32% in 2009-10. The estimate is critical for the next Plan and the eagerly awaited and much debated National Food Security Law.

A controversy erupted the day the commission made the disclosure. The Supreme Court ordered the commission to explain how it fixed percentage of people below-poverty-line (BPL) at 36%. The percentage helps the commission decide the direction of development programmes and distribution of foodgrains under the public distribution system.

The apex court’s observation came in the wake of a petition filed by nonprofit People’s Union for Civil Liberties. The petitioner contends that adequate foodgrains are not being given to people living below the poverty line. This case is known as the Right to Food. The court also challenged the commission’s estimates of BPL families. “There cannot be two Indias,” said the apex court while describing the country’s high economic growth and consistent poverty. “The poverty level is reducing but at a slow pace,” says Biraj Patnaik, principal adviser to the court’s commissioners for the case.

Two Indias
The survey by CPRC explains the “two Indias”. “Why do some people remain poor for a longer period of time? Why do poor areas remain poor forever? These are the questions answered by the survey,” says Aasha Kapur Mehta, professor of economics at the Indian Institute of Public Administration in Delhi, who leads CPRC in India.

The survey followed about 3,000 households for almost 30 years across the country. It adopted a three-pronged approach to poverty: what drives poverty, what retains poverty and what causes exit from poverty.

CPRC has published 32 research papers in the past five years explaining various aspects of poverty in India. It defines the chronic poor as people who remain poor through their lifetime. Analysis of the papers shows that at least 50% of India’s poor are chronic poor. The survey identified 15 regions spread over six states where poverty is getting concentrated and chronic (see map). “Persistent backwardness and inequality have led to concentration of poverty in certain parts of India. So there is a geographical dimension to poverty,” says the CPRC report.

The count of very poor (with a consumption expenditure of Rs 9 per day per person) is an indicator of chronic poverty. Though the number of very poor is decreasing, the percentage is quite substantial. Their number was 115 million in 2004-05—37% of the total poor. The percentage of the very poor in the total population has declined in all states except Orissa, between 1983-94 and 2004-05. The percentage in Bihar, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu and Uttar Pradesh is higher than the all- India figure.

The share of Bihar, Madhya Pradesh, Maharashtra, Orissa and Uttar Pradesh in the total of very poor people rose from 57.5% in 1983 to 66.8% in 1993-94 and to 70.6% in 2004-05. “This is alarming because the next generation of these people will also be poor. Thus a vicious cycle is created,” says Mehta.

According to the survey, people in tribal and forested or degraded forest regions are more likely to remain poor forever. Nine of the 15 identified regions are forested; they have been targeted for poverty alleviation programmes since the early-1950s.

The report says, “In forest regions, the issues are not so much agronomic or natural conditions as poor people’s access to the resources that are there, their human capital endowment and the way they are incorporated into labour market.” The survey points out the poverty reduction among tribals is slow. Estimates for 1993-94 and 2004-05 indicate that against a decline in poverty for the entire population from about 37% to 27%, the decline among the rural tribal population was from 51.9% to 47.3%.

Amita Shah, director of Gujarat Institute of Development Research, says, “Poverty reduction programmes must include issues of economic growth, employment generation, socio-spatial equity, environmental sustainability and political stability within a holistic framework.”

Why poverty becomes chronic
According to the survey, there is inequality in the efforts made to prevent people from poverty and get them out of it. The numerous poverty alleviation programmes are inadequate and insufficient. Of the 29 such programmes studied in the survey, only nine could prevent people from falling into the poverty trap. Thirteen could enable escape from poverty and 16 could alleviate chronic poverty. Consequently, says Shashanka Bhide, a senior fellow of the National Council of Applied Economic Research, a significant proportion of non-poor households may fall into poverty while a large proportion of poor may not manage to escape it.

The report is a wake-up call. “Social conflict may find easy recruits among the chronically poor, who have less to lose by engaging in conflict and might be mobilised by the politics of grievance,” says the report. Anand Kumar, professor of sociology at Jawaharlal Nehru University in Delhi, says, “The report points to four major deficits the country is facing—development, legitimacy, governance and democracy. This created another crisis, time deficit.” He adds, “People are no longer willing to wait; there is a sense of urgency, suggesting the need for continued mass mobilisation and protests.” 

The full report is available http://www.chronicpoverty.org/publications/details/india-chronic-poverty-report
 
This article first appeared in Down to Earth, May 31, 2011. Richard Mahapatra is a senior environmental journalist presently with Down to Earth, and a former Infochange Media Fellow.

 

Forget yourself for others, and others will never forget you.

Monday, May 23, 2011

Medical Student's Experience of Geriatrics in India: Summer 2011


India is big, crowded, and changing faster economically and socially than it can seem to keep up with.  The largest democracy in the world with over one billion people, it is completely overwhelming and exhilarating, but there is also a prevalent warmth and hospitality within the people wherever you go.  India’s history is as rich and colorful as you can get, with hundreds of different conquerors and border changes, the famous story of independence led by Mahatma Gandhi, and evidence of it all remaining in the temples, statues, and preservations of countless historical sites.  The culture is heavily influenced by religion and their daily rituals influence almost every part of the lives of the Hindu people I interacted with.  Muslims and Christians, along with Sikhs, Buddhists, Jains, Jews, and Zorastrians also are seen openly practicing their religions, and all living in relative peace and sybiosis with each other. 

The changes that the country is experiencing are palpable.  A brand new office building next to a rusty corrugated metal capped slum in Mumbai, a polished SUV on the road next too a cow, and of course the technology boom bringing western modernity into the developing world that is trying to keep up, are some of the obvious sites showcasing the new vs. the old.  Health issues are changing too- there is improvement in some public health measures, but there is still a long way to go; you’d be very adventurous to drink the tap water.  And with the large amount of people moving into the cities and greater availability of unhealthy foods, rates of diabetes and hypertension are on a dangerous incline.  But when talking to the locals about what is changing, especially from the elderly generation, you hear about the huge social changes taking place.  The breakdown of the Indian family model, which used to be comprised of a large household with all generations, is now becoming nuclear and leaving many from the silver generation without a home. 

My rotation focused on the health and social issues of the elderly population in India.  I worked with a multi-faceted medical NGO in Bangalore, the Nightingale Trust, whose realm includes home medical care, an inpatient dementia care unit, adult day care, and rural medical visits amongst other things.  I also worked with a newer NGO in Mumbai known as Silver Inning Foundation which uses social networking and media to help address multiple human rights issues and needs of the elderly.  My goals in this rotation were to learn about the health and human rights issues involving the elderly in India and compare them to the USA’s, share my knowledge and ideas with the Indian people I work with, and use my connections and what I learned in the future in some way to help address these and similar problems.

Before leaving, I had some grasp on the issues affecting the elderly.  I had heard that there were rising amounts of elderly people due to increasing life expectancy, and little infrastructure to support them.  Also I knew rates of diabetes were on the rise.  I wanted to explore the issues from a medical and human rights perspective, as are my interests.  When arriving, I found that these things were true, and more.  Again and again I heard the stories of children abandoning their parents, or moving away to the US.  There was no government support to help them finance their daily life.  Rates of depression have increased in the elderly as an outcome of the changing family structure too. 

The NGOs I worked with were helping to address these issues.  Nightingale Trust was providing home care to people in the cities and the rural areas that once had no access.  They also help underfunded people with adult daycare, abuse help lines, and sliding scale payments.  Silver Inning foundation was using social networking and media to connect elderly people with each other and with the help they needed.  They put poor people in touch with affordable old age homes, provided an elder abuse hotline, visited men’s and women’s group and provided them with information and ideas, and were constantly promoting awareness with innovative networking.  I was a part of these NGOs as an observer and short-term worker.  I think my presence benefitted the people I interacted with by sharing my knowledge of how the elderly are treated in America and by showing my support of the activities and the people in need.

I think the greatest benefit of students’ involvement in global health is the impact is has on the student herself.  I would not be the person or doctor that I am if it wasn’t for my community service and global health experiences.  My experience in India humbled me and took my breath away several times.  The family that I stayed with told me that instead of selling their printing company, they just gave it to their employers as a sign of gratitude for years of hard work.  Both NGOs I worked with were started by individuals who used all self-funding for years to keep them alive.  The fact that everything seems to work out so well in the face of so much constant chaos in India, I can only attribute to the amazing way everyone is constantly helping their fellow man.  As my rotation had a large focus on human rights, I think this observation of hospitality, selflessness, and charity made the largest impression on me. 

In terms of my professional career, experiences like this rotation benefit me greatly.  I am entering into a residency in Internal Medicine that focuses on helping a diverse and underserved population, and the more experience I get with other cultures and pathologies, the better I can treat each individual.  It also shapes my goals and reiterates my desires to help all people, regardless of class, race, and borders.  I will be more of an advocate for the elderly after interviewing and assisting so many in India.  And I will be much more mindful of human rights issues with the elderly such as abuse, lack of support and a home, depression and loneliness.  Also, I made a lot of connections with doctors and activists in India, and I have no doubts that we can continue to work together in the future.

In my time in India I worked in two large cities, visited rural sites surrounding them both, and traveled to 5 cities total.  I aimed to get as much possible out of my short time there and I think I succeeded.  The NGOs I worked with showed me a comprehensive view of the health and human rights issues affecting the elderly in India.  Most of the medical problems were similar to what we see here.  Diabetes is on the rise, mostly due to the influx of people into urban areas, and the availability of food, unhealthy food, in the cities.  Also with urbanization come many sedentary jobs leading to lack of exercise and obesity.  Other common things are common, such as hypertension, asthma, COPD, dementia, depression, and cancer.  Dementia is receiving growing attention, and the prevalence is increasing due to the increase in life expectancy and increase in awareness. 

When I explored the Indian people’s perception of health care in their country I was surprised at how little people complained, which was much less than I feel we do here in America.  I found myself looking for problems, asking leading questions to get to the bottom of it.  What I found is that most people say they get medical care when they need it, and at not too high of a cost.  Very few people have insurance, and there is no Medicaid or Medicare equivalent for the destitute and elderly.  However with the lower cost of health care due partly to the lack of insurance companies, most people get what they need.  I asked, “What if you get cancer?  What if you have diabetes?  What if you’re the poorest poor?”  Most of the responses were basically that if you have chronic diseases there are schemes available to help, and that there are good government hospitals that are free to the poor.  But when I got to the bottom of it I noticed that people were not getting the primary care they needed.  Indians would rather treat themselves at home, with naturopathic or Aruvedic medicine or an antibiotic they picked up at a pharmacy without a prescription, than go to a doctor.  With this pattern comes many late presentations of disease.  This problem is sure to get worse with the increasing levels of diabetes, and this does not seem to be being addressed as of now.

Having soaked in the sites, sounds, smells, and tastes of a country as large and busy as India gives me a great perspective on the rest of the world.  Almost 1/6th of the world’s people are on the subcontinent, and I have gained confidence after living how that huge chunk of the world lives.  Like any time I leave the USA, I am reminded of the incredible luxuries that we have here.  Potable water, roads that aren’t littered with garbage, potholes, cows, and unbelievably bad traffic, and decent access to health care.  Also my freedom as a woman and as an American are something I take for granted.  I was disappointed to see women not usually being treated as equals, and I constantly heard about the corruption of the government with attitudes of hopelessness to change.  But I will never forget the kindness I and incredible selflessness I witnessed by my mentors, my hosts, and even strangers in India.  Also there is great beauty in everything in India, from the temples, the delicious food, and the smells of jasmine and incense burning.  This global health experience has enriched my education in medicine and human rights, and also personally enriched my life.  


By Robin Reister
Medical Student
MEDI 7003 Reflective Essay
UTHSCSA


Forget yourself for others, and others will never forget you.

Friday, May 20, 2011

4th Annual National Essay Competition 2011 : World Elder Abuse Awareness Day (WEAAD)


On occasion of 6th Annual World Elder Abuse Awareness Day (WEAAD) 15th June 2011 Silver Inning Foundation a NGO working with senior citizens and their family members in association with INPEA (International Network for Prevention of Elder Abuse) Indian Chapter through Development, Welfare and Research Foundation (DWARF) and 'Little Things Matter Initiatives' (LTMI); SSS Global; FESCOM (Mumbai) ; 1298 Senior Citizens Helpline, Mumbai; AISCCON  & Harmony for Silvers Foundation will be commemorating Elder Abuse Awareness Day from on May 20th to June 20th 2011 . It has taken the initiative to create awareness among civil society and Government to eliminate elder abuse at both micro and macro level.

SILVER INNING FOUNDATION invites an Essay of maximum 2000 words in following category and topics:

1)    For all age group:
Can Elder abuse be prevented, if not eliminated? If yes how? If no why not?

2)    For School Students - Class 5th to class 10th:
Grandparents are the best Friends


3)    For Students - 1st year College to Post graduation :
Youth are important link towards Elderly friendly society       


What is Elder Abuse?
Elder abuse is an under-recognized problem with devastating and even life-threatening consequences. Elder abuse is often defined as a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an ‘expectation of trust’ which causes harm or distress to an older person.

Types of Elder Abuse:
  1. Physical abuse
  2. Sexual abuse
  3. Emotional or psychological abuse
  4. Financial or material exploitation
  5. Neglect
  6. Abandonment
  7. Self-neglect

All of us know that we will be elders one day and join the ever increasing percentage of senior citizens in the global population! And yet some of us continue to show gross indifference and disrespect to our elders in our own families and in the society! Each of us might have countless reasons, logics and excuses for this behavior but this could be due to a combination of many problems. Let us try to put into a right perspective these various problems and what we could do to keep our elders happy.
Remember, by helping our elders stay physically fit and mentally happy, we are only helping ourselves and our future. If we fail to give proper care and respect to our elders at home now we will get the same ugly treatment from our children later on in our lives!


Prizes:
The First (1st) best in each category will be given Prize of Rs.500/- by Indian cheque only, to each 1st winner and Certificate.

The Three (3) best essays in each category will be given Certificate each and their essay will be published on Blogs: http://peopleforsocialcause.blogspot.com/ ; http://silverinnings.blogspot.com/  and best Ten (10) in each category, with India postal address will be given Participation Certificate.
  
All the essays will be property of and used by Silver Inning Foundation as database/Talk / Reference / Lecture / Book/ Paper presentation for its strategy to Tackle Elder Abuse and issues of Elderly. The verdict of management of Silver Inning Foundation & Silver Innings for selection of best essay will be final.

Silver Inning Foundation consists of a dedicated team of professionals contributing to the cause of the elderly. Silver Inning Foundation conducts seminars, camps, lectures, awareness modules, advocacy, networking, Dementia management services and also has support groups for home based advice. At Silver Innings we are working towards creating Elder Friendly World where Ageing becomes a Positive and Rewarding Experience.

The Last date for submission of Essay is 20th June 2011.

Email your essay with complete Postal Address, Telephone Number and Date of Birth on or before 20th June 2011 to info@silverinnings.com and copy to silverinnings@gmail.com . Only soft copy by email i.e. email entries will only be accepted for this competition.

The winners will be announced online by email after 15th July 2011. For further information please call on Tel no. 09987104233 – Monday to Friday 10am to 5pm.

Terms and Condition:
  • Essay should not be more than 2000 words
  • Essay should only be in English language
  • Essay should be sent by Email only (soft copy only)
  • No hard copy will be accepted
  • It’s open to all Indian Residence / POI / NRI
  • People from other country can also participate, but they will not be part of competition and they will be given virtual participation certificate.

This Programme is supported INPEA (International Network for Prevention of Elder Abuse) Indian Chapter through Development, Welfare and Research Foundation (DWARF) and 'Little Things Matter Initiatives' (LTMI); SSS Global; FESCOM (Mumbai) ; 1298 Senior Citizens Helpline, Mumbai; AISCCON  & Harmony for Silvers Foundation

Together, we all have the power to prevent elder abuse

My World…  Your World…Our World…Free of Elder Abuse


Forget yourself for others, and others will never forget you.

Thursday, May 19, 2011

Her victory marks a milestone in the domestic workers’ struggle in India

Papamma, a Elderly domestic worker in Bangalore, took her employers to court and managed to receive a favourable judgment. This is a historic victory for perhaps the most vulnerable segment of unorganised workers, made possible by the support of a trade union, a dedicated team of advocates and a labour officer who adjudicated objectively.

 With the upcoming International Labour Conference later this year, there is a buzz about a new legal international instrument providing ‘decent working conditions’ to domestic workers globally. However, as of now, laws benefiting unorganised workers in India, including domestic workers, are few, and the sad reality is that even these most often remain on paper. 

It is heartening therefore when the law is actually applied, giving these workers their due. This happened recently to Papamma, a domestic worker in Bangalore who was paid a pittance during her long years of service -- 1978 to 2007. Worse, she was discharged abruptly with no provision for retirement. In her words: “I came with empty hands and I left (after 31 years of working) with empty hands.”

A trajectory of her employment shows Papamma received a wage of Rs 60 for 22 years, for eight hours of work a day spanning the entire gamut of household chores from washing clothes to cooking and shopping for vegetables. In 2003, her wages were raised to Rs 500. (Incidentally, the minimum wage for domestic workers was notified for the first time in 2004 -- Rs 2,279 for an eight-hour day.)  In 2007, before she was unceremoniously dismissed during the last six months of her employment, and following repeated demands, Papamma’s wages were grudgingly raised to Rs 1,500. Even this fell short of the legal minimum wage for that year (2008).  

Papamma’s case illustrates the predicament of the domestic worker. Verbal agreements govern working conditions; there is no formal record of employment, only oral undertakings given by the employer that are often retracted later; demands for better wages are met with promises of future settlement which never materialises. 

In her employers we see a not-uncommon feudal attitude which manifests in the belief that the domestic worker does not require a weekly day off or extra payment should her workload increase because of guests. And the notion that the occasional help extended when she falls sick, or providing her children school uniforms justifies non-payment of a higher (adequate) wage. 

In Papamma’s case we also see loyalty towards her employers that ultimately soured when they refused her employment after a bout of illness. 

These were the circumstances that led Papamma to seek legal recourse. 

The favourable conclusion of Papamma’s case is a rare example of a domestic worker getting justice from the courts. An instance, perhaps, of institutions coming together to work the way they are meant to -- the trade union that provided Papamma a forum, a dedicated team of advocates (from the Alternative Law Forum), and a labour officer who adjudicated objectively.

According to one of the litigators for Papamma, Maitreyi Krishnan, a major reason for the case’s success was Papamma’s persistence; in her experience, due to the vulnerabilities of their situation, many domestic workers don’t see their battle through. Papamma went to the court or to the lawyer’s office whenever required in the course of the litigation which carried on for one-and-a-half years. Secondly, and perhaps equally important, was the support of the Karnataka Domestic Workers Union. 

The union was registered in 2003 by Sr Celia who had been working with domestic workers for a number of years. During that time she became convinced that true empowerment of domestic workers would only come about through their unionisation. She believes that any organisation, no matter how well-meaning, will only ‘work for’ and ‘speak on behalf of’ the workers. In the case of a non-worker-headed organisation, the workers become the beneficiaries and are therefore dependent on what is provided to them. There is a difference when those who are actually the ones suffering speak about their own situation, Sr Celia says. As a union, they can represent their own case. 

A worker asking for her own rights is different from a human rights activist asking for her rights. There is a sense of empowerment and dignity that does not come through social service, however well intended.
In Papamma’s case, there was a body she could take her grievances to and avail of the support of union members. Initially, this took the form of going with her to the employer’s house. There the employer did not even speak with them, instead he complained to the police about the visit. Papamma, in turn, filed a complaint at the local police station about her wage grievances. They took no action. She then went to the police station, accompanied by some union activists. When the police sub-inspector did not grant them an audience they sat outside the station until he gave in. The police then called the employer to the station where the sub-inspector suggested he pay Papamma a minimal amount of money so that she would not create any further trouble for them. Papamma turned down the employer’s offer as it was far less than what she had been promised. The police told her not to confront the employer and that the appropriate forum for her was the courts. Members of the union went with Papamma to court to attend the hearings.

Krishnan believes it also helped to have a good labour officer hearing the case. In the order that followed a well-researched case, not only were back wages granted but hefty compensation equalling the amount of back wages as well as overtime for all the Sundays Papamma had worked. Stating his reasons, the judge observed in his ruling that the employer was an educated senior citizen and that his lack of awareness about the law showed he had failed in his duty. 

Papamma herself does not appreciate the verdict much. She points to her home: an unlit small two-room house in a Lingarajpuram slum. An asbestos sheet forms the roof. The only furniture is an assembled double bed with a thin sheet covering its hard surface, and a plastic chair. Papamma says they wanted to use the money that was promised by her employer to carry out basic structural improvements to the house. The compromise amount she finally got would not serve this purpose. Further, at the age of 65, she would have to continue working.

From a larger perspective, however, the judgment is unprecedented in Karnataka: that someone from the most disadvantaged even within the unorganised sector managed to access the formal legal system and receive a favourable judgment. The fact that Papamma ultimately got a compromise amount, not what the judge ordered, is today’s reality. If she had not gone to court she would not have got even this amount. The judgment is an important step towards recognising that domestic workers too are workers with enforceable rights.

When the minimum wages notification for domestic workers in Karnataka was first passed in 2004 there was a lot of deliberation between the government, labour advocates and civil society about implementing the law. This was because the notification did not provide for implementation mechanisms such as regular inspections and regulations for the maintenance of wage registers by the employer. The labour commissioner of the time suggested that in a scenario of non-payment, if just one claim was filed before the department the successful outcome of the case would have “a multiplier effect”. He suggested that news of the case would spread and serve as a strong deterrent to employers who failed to pay adequate wages. Perhaps Papamma’s case will serve as just such an example.  

By Anuja Mirchandaney a legal researcher and freelance writer with the Alternative Law Forum, Bengaluru. Her primary interest is in research and writing on socio-legal issues.


Source:  http://infochangeindia.org/livelihoods/features/papamma-s-victory-marks-a-milestone-in-the-domestic-workers-struggle.html

Forget yourself for others, and others will never forget you.

SC denies plea for enhanced punishment for Bhopal gas tragedy accused

The Indian Supreme Court, on May 12, 2011, threw out the curative petition filed by the Central Bureau of Investigation (CBI) seeking enhanced punishment for top officials of Union Carbide, the multinational at whose Bhopal plant an accident led to a massive leak of poisonous gas that killed over 4,000 people instantly and disabled many thousands more.

The deadly leak occurred on December 4, 1984. Compensation for the victims, negotiated by the Government of India, was paltry by any standards and has been hotly contested for more than 25 years by groups fighting for the victims. In a 1996 judgment, the Supreme Court diluted charges against the accused from Section 304 (II) of the Indian Penal Code (culpable homicide not amounting to murder) to Section 304 (A) (criminal negligence). In 2010, a Bhopal court convicted seven accused who were sentenced to two years in jail. All seven secured bail immediately. The then Union Carbide Chairman Warren Anderson, also accused in the case, was declared a fugitive in 1992.   

The sessions court verdict and sentence was criticised strongly by civil society and the media, and a group of ministers was set up to look more closely into the matter. The GoM recommended stricter punishment for the seven officials. The CBI filed a curative petition against the light punishment and sought direction from the SC for framing of charges against the accused for culpable homicide not amounting to murder that carries a maximum imprisonment of 10 years (curative petitions have only been allowed since 2002). 

A five-judge bench including Chief Justice of India S H Kapadia dismissed the CBI’s petition saying it was based on a “wrong and fallacious plea”, and filed after 14 years. It said there was not enough reason to build a case of culpable homicide. “The materials produced do not meet the requirement (for homicide),” Kapadia said.

However, the court said that its 1996 judgment in no way prevented the trial court from framing charges under the stringent provisions of the Indian Penal Code. 

It said the Bhopal sessions court was free to examine the charges against the accused and decide, if the evidence available so warranted, that they could be tried for a more serious offence such as culpable homicide not amounting to murder. The SC bench clarified that the 1996 judgment was based on evidence presented before it at that time, and it was wrong to assume that it was binding on the trial court when additional facts and material were forthcoming.

On May 13, a day after the SC judgment, the Indian government said it would ask the CBI to move the sessions court in Bhopal for an early hearing of its revision application and appeal filed by the Madhya Pradesh government for stricter punishment for the accused. 

Source:  http://infochangeindia.org/environment/news/sc-denies-plea-for-enhanced-punishment-for-bhopal-gas-tragedy-accused.html

Forget yourself for others, and others will never forget you.

Sunday, May 15, 2011

Regulation of Surrogate Parenthood in India

 The advances in human reproductive sciences have made it possible for couples and others to have biologically their own children who otherwise cannot for a number of reasons. This has given rise to the concept of surrogate mothers. Surrogacy is a method of assisted reproduction. More common form is IVF/Gestational surrogacy in which the surrogate child biologically belongs completely to the social parents. The other type is gestational surrogacy where the surrogate child is genetically related to the male parent and the surrogate mother.

India has emerged as a favourable destination for surrogacy and its Assisted Reproductive Technology (ART) industry has evolved into a 25-billion rupee business annually, with Law Commission describing it as “a gold pot”. The phenomenal rise in surrogacy in India has been due to it being cheap, socially accepted. Moreover, surrogacy has emerged as a preferred option because of complicated adoption procedures.

Foreigners including NRIs seeking surrogacy for various reasons, both medical and personal, have also contributed to the rise of the Indian surrogacy industry predominantly because of it being at least ten times cheaper than in their respective countries. No statistics exist on the number of foreign couples coming to India to have a child. But ART clinics say that their numbers have been appreciably growing.

In India surrogacy heralded with the delivery of its first surrogate baby on June 23rd, 1994, but it took eight more years to draw world attention to it when an Indian woman in 2004 delivered a surrogate child for her daughter in the U.K. Surrogacy as a medical process has matured over the years. India has become a booming centre of a fertility market, partly surreptitiously, and today there are an estimated 200,000 clinics across the country offering artificial insemination, IVF and surrogacy. They call it Assisted Reproductive Technology (ART).

There is at present no law governing surrogacy in India, eventually the activity including renting a womb (commercial surrogacy) is considered legitimate. In the absence of any law the Indian Council of Medical Research (ICMR) in 2005 issued guidelines for accreditation, supervision and regulation of ART clinics in India. But the need for legislation became pressing with ICMR guidelines being often violated and reportedly rampant exploitation of surrogate mothers and even cases of extortion.

At the instance of the Indian government an expert committee has drafted a legislation known as Assisted Reproductive Technology (Regulation) Bill, 2010 for legalizing surrogacy. The proposed legislation earlier floated in 2008 envisages legalizing commercial surrogacy as well. It defines a ‘couple’ as two persons living together and having a sexual relationship and as such, following Delhi High Court’s verdict on homosexuality, gives gays besides the singles the legal right to have surrogate babies. It also stipulates the age of surrogate mother to be within 21-35 years and limits her deliveries to five including her own children. The surrogate mother will have to enter into a legally enforceable surrogacy agreement as per the proposed legislation.

Foreign couples including NRIs seeking surrogacy in India will have under the proposed law to submit certificates that their country recognizes surrogacy as legal and also that the surrogate child after birth would get their country’s citizenship. The Law Commission of India in its 228th Report on “Need for legislation to regulate assisted reproductive technology clinics as well as rights and obligations of parties to a surrogacy,” has by and large supported surrogacy in India, but is not favourable towards commercial surrogacy. The Commission said, “It seems that wombs in India are on rent, which translates into babies for foreigners and dollars for Indian surrogate mothers.”

But according to an infertility specialist in Mumbai the Commission favouring altruistic surrogacy only may not be the solution either. “It will be very difficult to get altruistic surrogates and relatives could end up being pressured to become surrogates,” says the specialist. This could be a reality in view of poverty, illiteracy and the lack of power that women have over their own lives in India.
But many legal experts are of the view that the draft Bill is a step in right direction as it will end the present confusion and help regulate the functioning of the IVF centers and ensure quality check and accountability of ART clinics. It is expected to protect the interests of both the surrogate mother and child and help the commissioning parents to realize their dream of having their own baby more or less hassle free.

There are worries too as to what impact it will have on the society in terms of commercialization. Poor illiterate Indian women with the lure of money could be forced into repeated surrogate pregnancies risking their lives. There are also ethical and moral issues as well as the human dignity involved besides questions about the rights of surrogate mother. As such the draft legislation on surrogacy needs to be debated threadbare in social, legal and political circles as well as by the civil society before it becomes a law.

By M.L.Dhar

Disclaimer: The views expressed by the author in this feature are entirely his own and do not necessarily reflect the views of PIB or WBRi.


Forget yourself for others, and others will never forget you.