Health

Crackers Outside, Air Purifiers Inside: The Public-Private Conundrum of Environmental Good

For many, the solution is simple: retreat indoors, turn on the air purifier and insulate their private spaces from the public harms of toxic air.

Every year as Diwali approaches, headlines about air pollution in Delhi remind us of the environmental challenges that loom over us. In response, Delhi, Haryana and Punjab instituted a ban on firecrackers this year, aimed at curbing the already deteriorating air quality. Yet, despite these clear government warnings and Supreme Court directives, the festival saw widespread firecracker use, further degrading air quality. For many, the solution is simple: retreat indoors, turn on the air purifier and insulate their private spaces from the public harm of toxic air.

This behaviour underscores a critical issue: when the government fails to ensure public goods like clean air, either you become wealthy enough to shield yourself, or you face the health consequences. In this increasingly materialistic world, where individual wealth is becoming the primary means to shield oneself from collective problems, the concept of collective action and shared responsibility is rapidly eroding. When affluent households can afford to insulate their private spaces with costly air purifiers, the very foundation of social trust and collective efficacy begins to weaken.

Distancing and the public-private conundrum

The phenomenon of ‘distancing’, discussed by Thomas Princen and colleagues, sheds light on the growing reliance on private solutions to shield against public harm. In our globalised supply chain, the environmental impacts of individual consumption are increasingly outsourced and geographically and culturally distanced from consumers. This separation allows people to largely ignore the environmental costs of their actions, as they are far removed from the consequences.

This distancing is apparent in the way air pollution affects different social classes within the same city. As firecrackers fill the skies with smoke and particulate matter, those who can afford air purifiers enjoy some level of safety, while marginalised communities – who cannot afford such luxuries – are left to bear the brunt of the pollution. This public-private divide highlights the shift in the very notion of environmental goods: clean air is no longer a shared public right but an exclusive commodity accessible to those with financial means.

Inverted quarantine

This privatisation of safety is encapsulated by sociologist Andrew Szasz’s concept of ‘inverted quarantine’. Traditionally, quarantine involves isolating a source of harm to protect the public. In contrast, inverted quarantine involves creating personal safe spaces within polluted environments. With air purifiers, bottled water and organic food, affluent individuals build a ‘commodity bubble’ to shield themselves from environmental hazards.

Szasz critiques this approach as it erodes collective action by promoting a sense of complacency. When those with resources can shield themselves from pollution, they feel less urgency to advocate for broader solutions. This cycle risks normalising environmental degradation as something inevitable, something to be managed privately rather than publicly addressed. As air purifiers top Diwali gift lists, the underlying message is clear: safeguarding one’s health is now a private responsibility, affordable only to those who can pay the price.

For Delhi’s marginalised population, however, such protection is out of reach. The cost of a basic air purifier equates to about 15 days’ wages for many, making it an unattainable luxury. Left without the means to shield their homes, they are forced to endure the health risks of pollution, underscoring the growing inequity in access to environmental protection.

Moreover, there is a psychological element driving this behaviour. Firecrackers, although they worsen air quality, provide immediate, short-term enjoyment that is relatively inexpensive compared to the long-term health investments required to mitigate pollution’s effects, such as air purifiers. The transient pleasure of bursting crackers can make it harder for individuals to recognise the long-term harm their actions cause, both to themselves and others. This disconnect between immediate gratification and future health risks creates an even larger obstacle to fostering collective action, further driving the public-private divide.

Decline of collective responsibility

The disparity in public and private environmental protection not only exacerbates social inequality but also weakens collective efficacy and social trust. Development aspirations increasingly revolve around securing wealth as a means to create a ‘clean’ private sphere – achieved through economic gains and consumer products that promise safety from public harm. In today’s system, financial success doesn’t just buy a better lifestyle; it buys the resources necessary for a healthier, safer living environment.

At the intersection of these private-public dynamics lies a pressing question about collective responsibility and environmental justice. How can society address environmental issues as a community if affluent households can insulate themselves from shared harm? The widespread defiance of the firecracker ban underscores this breakdown of collective action, where individual enjoyment takes precedence over public health. As environmental safety becomes a luxury, trust in government efforts to protect public welfare wanes, further undermining any collective response to these crises.

It is crucial to reflect on the notion that environmental goods like clean air are not just a privilege but a public right. When the good life is narrowly defined by the ability to shield oneself from pollution, society loses its collective responsibility to demand better public protections. Reimagining development aspirations – anchoring them in environmental stewardship, collective efficacy, and reinforced social trust – is essential to counter the current trajectory.

To shift this trajectory, we must prioritise a shared commitment to safeguard public goods. The worsening air quality in Delhi serves as a vivid example of how urgent this need is, yet it also shows that achieving it requires collective action. With the affluent few able to buy their way out of the problem and the marginalised left exposed, fragmentation along lines of wealth and privilege is worsening. Let us remember that protecting the environment should not be a private luxury. Only by working together can we ensure a cleaner, healthier and more equitable future for all.

Soumyajit Bhar and Kalpita Bhar Paul are assistant professors at School of Liberal Studies, BML Munjal University.

Is the FSSAI’s Hands-Off Approach Poisoning our Food this Diwali?

In many parameters from ghee to spices to edible oils, the FSSAI has failed to be effective and work in the interest of consumers. The price of FSSAI’s inefficacy is paid by all of us.

The alleged mixing of animal fats in ghee used at Tirupati Temple shocked the nation. No one asked a simple question: If ghee was being contaminated on such a scale, what was the national food safety regulator, FSSAI, doing?

The entire mandate of the Food Safety & Standards Authority of India is to prevent food adulteration. But it seems they are way behind the curve in preventing food contamination of any kind. Forget street food, FSSAI has repeatedly failed to curb adulteration at all levels including big corporates.

This fact is recognised by state governments too, hence Uttar Pradesh brought a special law against contamination of food with human waste. One would imagine if a state government has had to bring a special law in 2024 just to enforce food hygiene 101 this clearly indicates that the FSSAI has failed to curb food adulteration in practice and principle.

Also read: UP to Bring in New Stringent Law Against Contamination of Food With Spit, Human Waste

Let us look at some other instances. Reportedly the UP state food inspection team caught 400 kgs of stone powder being mixed in flour in Aligarh. Stone powder is a waste product from mines and stone processing factories and often times contains highly toxic substances which may cause stomach trouble and even cancer. This was one such instance. Imagine how many more greedy mill owners are working round the clock to poison our rotis.

But its not only stone powder, our food is adulterated with urea and paint for many years now and governments have pushed the issue under the carpet. When we look at the case of milk adulteration, the trends have only gone up. From ghee to sweets, India uses a lot of milk. But if the milk is contaminated can we expect the ghee and other products to be safe?

Inflation, scarcity and greed have prompted farmers and traders to use chemicals like urea to dilute milk. Whether we look at Punjab, Gujarat, Odisha, Maharashtra, etc. it is clear that milk there is highly adulterated and governments have failed to prevent this. The hormone overload in milk products is another major problem in India.

Adulteration of milk sweets during Diwali and other festivals has become a local trend each year. Experts have pointed out improper enforcement lies at the heart of this problem. There are many examples from Modi’s Gujarat where, in the last 15 days alone, contaminated food worth Rs 6.3 crore was seized. It is difficult to estimate how much more contaminated food is floating around the country.

Now moving from the unorganised sector to big corporates. The biggest name of course is Nestle, that was reportedly selling Maggi with excessive lead in it. What penalties were imposed on them? Were millions of Indians who are Maggi during this period ever compensated? The issue is very serious as children are big consumers of Maggi and lead poisoning during childhood could seriously hamper their neurological health. But like most corporates, the polluter here escaped fair punishment.

More recently, about 800 kgs of spurious tomato sauce were seized. The fake sauce has formalin, synthetic colouring agents, arrowroot powder, etc. Keep in mind that most tomato sauce is made by big and medium scale factories, which are all regulated under FSSAI, yet due to gaps in enforcement they are being allowed to contaminate the food they produce.

When we look at FSSAI’s performance in checking adulteration in spices, it is safe to say FSSAI fails all tests. Common household spices like chilli powder, turmeric, coriander powder, etc are heavily contaminated with cancerous materials like ethylene oxide. The EU has has also raised serious concerns about chilli powder and peppercorn from India. Even big brands like MDH and Everest are under scrutiny for mixing carcinogenic substances. Many Indian spice consignments are rejected each year from the USA, EU and other developed countries due to their toxicity.

Still, the FSSAI and the government are shying away from punishing the culprits and saving the health of Indians. Spices are an everyday item of consumption and many ailments are also treated with these household spices. If manufacturers are allowed to sell adulterated spices, public health will be a major casualty.

The last instance of FSSAI’s questionable scientific position I will talk about is the cottonseed oil. Contrary to scientific studies, the FSSAI allows for free blending of GM cottonseed oil in all our food and vegetable oils. They treat GM cottonseed oil the same as natural cottonseed oil. This is wrong on many fronts. First, it is allowing for GMOs to enter our bodies through oil even though India doesn’t allow GM food crops. Second, instead of insisting on true labelling, FSSAI is duping the consumer. It is taking away our right to know if our food has GM ingredients or not. In most EU countries and other developed nations, cottonseed oil will either not be allowed to enter their food systems or will carry a clear warning or label indicating that a particular food item has GMOs. The FSSAI brushes the issue in a haughty manner, playing to the GM lobbyists’ tune. If one analyses the biosafety documents for BT cotton at the Ministry of Environment and Climate Change, we find they are based on Monsanto data and the safety data is also provided by Monsanto and FSSAI has not conducted any tests to verify biosafety independently.

So, in many parameters from ghee to spices to edible oils, the FSSAI has failed to be effective and work in the interest of consumers. The price of FSSAI’s inefficacy is paid by all of us. It is time FSSAI takes its mandate seriously.

Indra Shekhar Singh is an independent agri-policy analyst and writer. He was the former director for policy and outreach at NSAI. He also hosts The Wire’s agriculture talk show, Krishi ki Baat/Farm Talks. He tweets at @indrassingh.

This piece was first published on The India Cable – a premium newsletter from The Wire & Galileo Ideas – and has been updated and republished here. To subscribe to The India Cable, click here.

India Is Going to Miss the TB Elimination Deadline Set by the Modi Government

A close analysis of numbers presented in a WHO report clearly indicates that India has missed the goals set for two out of three interim milestones for 2025 as well.

New Delhi: India is going to miss the 2025 target for tuberculosis elimination that the Narendra Modi government had set for itself, the Global Tuberculosis Report 2024 report has revealed. The World Health Organisation, which has prepared this report, has set a global deadline of 2035.

Like all other countries, India has made improvements on many elimination indicators. But a close analysis of numbers presented in the report clearly indicates that India has missed the goals set for two out of three interim milestones for 2025 and is far from keeping to both the Indian government’s own elimination deadline of 2025, as well as the WHO’s deadline of 2035.

Although this trend is visible for a majority of the countries around the world, India is the only country which had set an ambitious deadline of 2025. Prime Minister Narendra Modi announced this target at a public rally in Varanasi in 2023.

There are three major milestones necessary to be achieved for the ‘TB End Strategy’ which the WHO has set for all countries. India’s parameters for elimination by its own deadline are also the same. The WHO has set final targets for 2035 and two sets of interim targets to be achieved till 2020 and 2025.

They include a reduction in TB deaths by 95% from deaths in 2015. Similarly, the incidence of TB has to go down by 90% as compared to the 2015 rate. The number of TB patients who incur ‘catastrophic expenditure’ on TB treatment has to brought down to zero.

India’s performance is as follows.

India’s burden

Historically, India has always had the highest burden of TB cases around the world. As per the current report, India accounts for 26% of all TB cases in the world. The countries that follow India are Indonesia (10%), China (6.8%), the Philippines (6.8%) and Pakistan (6.3%).

At present, the estimated number of TB cases in India are 20 lakh – the highest in the world.

The current incidence rate of TB in India is 195 cases per 1 lakh people, as against the WHO’s target of 55 cases per 1 lakh people by 2025, the interim target.

The world was already not on track to achieve these targets but the COVID-19 pandemic made the task much more difficult as services for TB control were badly hit during that period. This led to some sort of a reversal of progress made in the previous years.

However, no country other than India has fixed the target of achieving TB elimination by 2025. It was not clear whether the Indian government took the reversals into account before deciding on an ambitious target year.

Source: Global Tuberculosis Report 2024.

The reduction in TB deaths is another important indicator. India reduced deaths by 24% in 2023 as compared to the number of deaths in 2015. It failed to achieve the target set even for 2020 – which is a 35% reduction. Going by the current trajectory, it is more than likely that India will miss the interim and the final targets.

Source: Global Tuberculosis Report 2024.

Though the world as a whole also missed the death reduction target for 2020, at least 43 countries reached or surpassed this particular milestone set for the given year. India accounts for the highest number of TB deaths per year.

The third indicator is the amount of money spent on TB treatment. A household usually incurs significant expenditure on TB treatment – a spend of more than 20% of a household’s annual income for the purpose is considered a ‘catastrophic expenditure’. These include direct costs like treatment and diagnoses or indirect costs like transport and lodging, as per WHO.

The loss of income on the part of the patient and family members who accompany the patient to a TB treatment centre for treatment purposes also come under indirect cost.

“These pose barriers that can greatly affect their ability to access diagnosis and treatment, and to complete treatment successfully,” the report states.

In India, out of all households which have TB patients, at least 20% of them face catastrophic expenditure – a significant section if absolute numbers are considered.

The global average of such households in 49%. The TB elimination target had envisaged that the proportion of such families should have been reduced to zero by 2020 itself.

Governments usually get international funding in addition to incurring domestic expenditure to fight TB.

The domestic expenditure of the Indian government has been continuously rising since 2020. However, it is yet to reach the pre-pandemic levels of 2019. In other words, the domestic expenditure in 2023 was US $ 253 million, while in 2019, it was more than US $345 million.

Source: Global Tuberculosis Report 2024.

One of the major challenges with TB elimination is the number of TB cases that are missed. A significant proportion of TB patients remain either undiagnosed or unreported, officially. Cases which fall through the cracks severely affect the fight against TB because the infection spreads from one person to another. An untreated person can pass on her infection to another, in that case, thus increasing the TB burden further.

The measure to understand what proportion of cases are being missed is to look at the notification rate of patients. The higher the notification rate, the better it is. During the COVID-19 years, the notification rates of a majority of countries, except for some in the African region, went south. The current report says notifications in most of the 30 high TB-burden countries has recovered to pre-COVID levels or beyond.

India and Indonesia contributed the highest numbers in this recovery in 2022 and 2023, accounting for 45% of the total increase in reporting in the past three years.

Despite this achievement, there is a gap of around five lakh between reported and unreported cases in India, stymying the overall progress, the report says. It is the biggest gap registered by any country.

A similar and significant gap exists in the case of drug-resistant TB patients.

Patients who become resistant to the first line of drugs are known as multi-drug resistant (MDR) TB patients. Those who become resistant to the second line of treatment as well, are known as extensively drug resistant (XDR) TB patients.

Ten countries accounted for about 75% of the global gap. India leads this category too, followed by the Philippines, Indonesia, China and Pakistan.

The resistance to drugs usually happens when a patient stops taking drugs. This may happen either due to their own volition or a shortage of drugs.

India has been battling a shortage of drugs for MDR-TB, intermittently, in the last two years. Although the Indian government has consistently denied claims of any shortage.

Replying to The Wire‘s query in a virtual presser on October 29, WHO’s TB division head Tereza Kasaeva said the WHO is aware of the Indian problem of MDR TB drug shortage.

“Our regional representatives were closely following the situation and tried to support the Indian government. These are purely managerial issues. We hope it will be effectively mitigated and avoided in future because its extremely sensitive,” she added.

The problem still continues to exist. “At least two states – UP and Bihar are still facing a shortage of MDR TB drugs,” Ganesh Acharya, a TB survivor and treatment advocate told The Wire.

To attest to the gap between the actual number of TB cases and the ones which get reported, the governments, including India’s, need to up their game with diagnostic tools.

For the detection of non-drug resistant TB, the WHO has been recommending since 2011 the adoption of rapid molecular tests as against the traditional culture and microscopy methods. The latter not only take more time in giving final results, but are also less accurate than rapid tests.

However, in India, only 20-30% of all TB cases are diagnosed through molecular tests, the report says.

Since TB can be transmitted from one person to another, the WHO recommends giving preventive treatment to the families of patients who have tested positive for TB. India has covered only 31% of such contacts of TB patients.

Source: Global Tuberculosis Report 2024.

The WHO also recommends addressing the causes of TB. In the case of India, the elephant in the room is undernutrition. Undernutrition weakens the immune system of the body thus making healthy patients, especially contacts, vulnerable to TB infections. Those suffering from TB also need a healthy diet to improve treatment outcomes.

Why Bengal Would Do Well to Heed to Junior Doctors’ Demands on Health Infrastructure

The demands could directly address problems arising out of resource constraints and a shortage of medical professionals.

West Bengal has witnessed continuous protests for the last two months after the incident of rape and murder that took place in one of the city’s prominent medical college hospitals. Junior doctors under the West Bengal Junior Doctors’ Front have led the protests, but the spontaneous participation of the common masses from all walks of life has made the protest a movement of the people.

The mode of protest has also changed. Initially, the junior doctors went on a complete ‘cease work’; from there, they resorted to a partial ‘cease work’. At present, the junior doctors have returned to work. Some junior doctors also observed a hunger strike – they ended it on October 22 but their protest is still ongoing.

In a democracy, protest plays a significant role in the expression of dissent. It is also helpful in understanding the context and the reason behind an agitation. This article focuses on the demands of the junior doctors.

Three of their ten demands – that a central referral system be implemented in the state’s hospitals and medical colleges (demand 3 in the list that the doctors gave the state government), that every hospital and medical college have a digital bed vacancy monitor (demand 4) and that vacant positions for doctors, nurses and health workers in hospitals be filled immediately (demand 7) – directly concern the state’s health infrastructure.

There are two views regarding the junior doctors’ demands; they argue that some of their demands will favour the state’s common people, but others deny this claim.

This article attempts to understand demands 3 and 4 and if their fulfilment will serve society at large within the context of the existing medical facilities in the state.

Where does the majority of the population go for health services?

Public healthcare facilities are the primary source of healthcare in the state. According to the latest National Family Health Survey data, around 69.6% of total households – 73.2% in rural areas and 62.4% in urban areas – depend on public sector healthcare facilities. The remaining 25.5% of total households depend on the private sector, mainly private doctors or clinics. Only 3% of total households go to private hospitals.

Thus, any demands concerning the public healthcare system are, in fact, in favour of the majority of the population in the state. The heavy dependence on the public sector motivates us to understand the structure of the healthcare system in the state.

Also read: The R.G. Kar Protests Conquered Fear. But Have They Done Much Else?

Basic structure of the healthcare system in West Bengal

The healthcare system is divided into three tiers: primary, secondary and tertiary.

The primary healthcare system consists of sub-health centres, primary health centres and community health centres. The main aim of primary healthcare facilities is prevention, the promotion of health and addressing health problems. Primary healthcare facilities are found across the rural and urban areas of any state.

Secondary healthcare facilities include district hospitals, sub-divisional hospitals, state general hospitals, multi-specialty hospitals and rural hospitals. The basic aim of secondary healthcare facilities is to provide specialised treatment to patients referred to them from the primary tier.

The highest tier is tertiary care and consists of medical college hospitals. Tertiary healthcare facilities provide highly specialised treatment for a relatively prolonged period of time. In West Bengal, as per official data, there were 913 primary health centres, 75 block primary health centres, 273 rural hospitals, 24 state general hospitals, 36 sub-divisional hospitals, 42 multi super-specialist hospitals, 18 district hospitals and 18 medical colleges in 2018^*.

In 2023, the scenario stood changed. The number of medical colleges increased to 24 and the number of district hospitals declined to 14. The number of sub-divisional hospitals, state general hospitals and primary healthcare facilities increased over the years.

The three-tier structure allows patients to be referred from the primary to the secondary to the tertiary sector. This existing structure can be better understood if we focus on the spatial distribution of some essential indicators as discussed below.

Figure 1: Structure of healthcare facilities in West Bengal in 2018. Source: Health on the March 2018.

Structure of healthcare facilities in West Bengal in 2023. Source: Health Dynamics of India 2022-23.

Spatial concentration of healthcare facilities

As per the data in the 2018 official publication Health on the March, West Bengal had a total of 18 medical college hospitals across all its 23 districts. Of the 18 medical college hospitals, five were in Kolkata. The remaining 13 medical college hospitals were in the following districts: Bankura, Murshidabad, Purba Bardhaman, Birbhum, Darjeeling, Cooch Behar, Malda, Nadia, North 24 Parganas, Paschim Medinipur, South 24 Parganas and Uttar Dinajpur.

Until 2017, there were only 13 medical colleges. However, in 2018, five more district hospitals were upgraded to medical college hospitals.

Between 2018 and 2023, the number of medical colleges increased to 24. Most districts now have at least one tertiary medical college facility, except a few like Alipurduar, Kalimpong, Dakshin Dinajpur and Paschim Bardhaman.

However, the major tertiary government medical facilities continued to be concentrated in and around Kolkata. Below is the spatial distribution of medical colleges in the state in 2018 and 2023 respectively.

Source: Health on the March 2016-17 & 2017-18 & Health Dynamics of India 2022-23.

To fully grasp the challenges and bottlenecks faced by patients in accessing inpatient services, it’s essential to also analyse the infrastructure of lower-level hospitals.

There has been a notable spatial concentration of in-patient infrastructure as measured by the population served per bed in public facilities across districts, with Kolkata and the nearby districts, along with a few northern districts, having better infrastructure (less than 1,000 served per bed).

However, infrastructure scarcity in some districts can force patients to resort to costly and often subpar private care or travel to better-equipped districts and facilities.

Due to the absence of recent data, the number of beds, the bed occupancy ratio, and the percentage of discharged patients who were referred out are given for 2016. This data is taken from Health on the March 2018, which is available on the government’s website.

Source: Health on the March 2016-17 & 2017-18.

Bed occupancy rate

A crucial indicator for assessing in-patient service utilisation is the bed occupancy rate (BOR), representing the percentage of hospital beds occupied during a certain period. A high BOR suggests significant strain on hospital resources, while a BOR exceeding 100% indicates a shortage of beds relative to demand. Elevated BORs also highlight substantial pressure on the healthcare system, potentially jeopardising patient safety.

Official data suggests a shortage of beds in district and medical college hospitals.

Source: Health on the March, 2016-17 & 2017-18.

The significant strain on hospital resources highlights the need to examine referral statistics.

The image below shows the percentage of discharged patients who were referred out in 2016. It reveals that the highest referral rates have been from sub-divisional and state general hospitals, followed by rural hospitals and block-level primary health centres.

Notably, over 18% of discharged patients in sub-divisional or state general hospitals are referred to district and medical college hospitals, which already experience bed shortages.

Source: Health on the March 2016-17 & 2017-18.

Social researcher Kumar Rana also notes that healthcare facilities in West Bengal are largely reliant on the tertiary sector, highlighting the vulnerable state of primary healthcare services.

A reasonable demand

This official data merely skims the surface of the complex issues currently confronting the healthcare system in West Bengal. Nevertheless, the healthcare metrics discussed here highlight the uneven distribution of healthcare infrastructure within the state, shortages, and frequent referrals to higher-level facilities located in specific regions and urban areas, necessitating travel for necessary care.

This situation often leaves patients and their families dealing with high costs, delays and significant uncertainty and confusion. The result is not only a threat to patient health, but also a potential erosion of trust between patients and healthcare professionals.

The healthcare system in West Bengal and India as a whole grapples with significant resource constraints and a shortage of medical professionals. Meeting the diverse needs of a vast population with limited means often compromises patient safety and healthcare providers’ working conditions, exacerbating potential patient-provider conflicts.

A practical and effective step to help patients and their families navigate the healthcare system for appropriate care would be to establish a central referral system and digital bed vacancy monitoring – demands 3 and 4 of the junior doctors.

A central referral system would streamline patient flow towards appropriate hospitals and specialists, while a digital bed vacancy monitoring system would provide real-time information about the availability of beds in facilities. These systems could efficiently narrow the gap between demand and supply, enhance service delivery, prevent life-threatening delays and foster trust between providers and patients.

The recent launch of the pilot project for the central referral system by the West Bengal government in the South 24 Parganas marks a positive first step.

Debolina Biswas is an assistant professor of economics at a college affiliated with the University of Calcutta. Soumava Basu earned his PhD in economics from the University of Utah and is now a researcher in the US. The views of the authors do not represent the position of their affiliated institutions.

*This data is accessed from Health on the March, a report published annually by the West Bengal health department that offers detailed data and insight into the state’s health system. It covers health outcomes, financing, infrastructure utilisation and policy developments. However, the last published report is for 2018. Even though it may not reflect the exact present scenario, we use it to get a broad idea of the state of healthcare in West Bengal.

On the other hand, the recent trend is available in Health Dynamics of India 2022-23, a publication by the Union government. However, this report focuses heavily on primary healthcare facilities and does not give an idea of crucial indicators such as the population per bed, the referral percentage, etc. In the absence of current data, this article takes data from the last available publication, i.e. Health on the March 2018.

However, data related to the population per bed, the bed occupancy ratio and the referred percentage are taken for 2016, as in the 2017 data, the bed occupancy ratio appeared to be zero for the SSKM hospital, which seems to be erroneous. All other indicators are chosen from 2016 data for parity purposes.

On a Hidden Struggle: Unpacking Internalised Ableism

Dismissing help or accommodations when necessary is neither a sign of incapacity nor strength – it is a harmful lie that leads to burnout and mental anguish.

We often hear of the powers of storytelling and the self discovery it brings. This has a positive ring to it – but what if the writing process unearths something unsettling? While reviewing my memoir for possibly the 99th time, in the long arduous process of publishing, I detected a whiff of internalised ableism within me.

The menace gnawing at my insides

You might dismiss the term as jargon that doesn’t resonate with your life, and you’d be partly right. But why do we read books or watch movies? We’re often intrigued by others’ lives, and that curiosity can evolve into empathy. It wasn’t until I read my manuscript for the 99th time that I shuddered, finally recognising the ableism I had unconsciously internalised.

Internalised ableism takes root when people with disabilities adopt ableist beliefs, leading to self-discrimination. It’s the idea that disability is negative and shameful – something to hide or erase. While I can’t conceal many of my disabilities, even if I wanted to, I realised during my first year in business school that I had felt compelled to justify needing more support than my non-disabled peers.

A Counterintuitive Revelation

Reviewing my memoir illuminated a counterintuitive truth: despite spending fourteen years in the development sector, I’d unconsciously treated disability as a negative topic to avoid. I feared that working or even volunteering on disability issues would pigeonhole me in a narrative of endless struggle rather than a facet of human experience.

I believed that disability work as limiting and undesirable – a mindset that revealed just how deeply I had internalised ableism. Living with multiple disabilities myself, I was all too aware of the challenges faced by even privileged individuals with disabilities, yet I couldn’t begin to imagine the daily struggles of those less fortunate.

I questioned why people with disabilities should be confined to disability work. While no one should be forced into a field against their will, it’s a sobering reality that disability rights remain one of the last frontiers in human development.

The struggle for empathy

Despite progress in many areas of social justice, the rights of individuals with disabilities are often overlooked, leading to discrimination and othering. I must admit, on more than one occasion in my previous life, I’ve sighed out loud when a wheelchair user boarded the New York City bus I was on, frustrated by the delay the necessary securing of the wheelchair caused. I prided myself on being a busy New Yorker, blissfully unaware of my lack of empathy for those with disabilities.

Reviewing my memoir clarified my question: why do people with disabilities always work on disability issues? The answer is simple. Those who experience disability or have loved ones who do are often the best equipped to advocate for change. We readily empathise with individuals facing poverty and at least in the developing world, are just beginning to empathise with those in the LGBTQ community. Yet society has conditioned us to believe that people with disabilities lack agency and require fixing.

Also read: How Prisons Perpetuate and Produce Disabilities

A shift in perspective

It’s only natural that I once viewed wheelchair users as lacking something that those without disabilities possess. Beyond the lack of mobility, there’s a more subtle cause at play here too. The absence of accessible spaces reinforces the notion that people with disabilities aren’t equal to those without – after all, individuals with disabilities are (made) invisible. This was more likely to be true in the United States before the Americans with Disabilities Act (ADA) of 1990 than it does today.

A pivotal moment came during the arduous, post-memoir job-hunting process when I spoke with an executive from Microsoft’s Inclusive Design team. What made the difference was that she didn’t push back my assertion that I didn’t want to make disability my entire identity; instead, she encouraged me to reflect on why I felt that way. She could have taken offence on why I spoke of disability with such disdain, but she didn’t.

While rereading my manuscript, possibly for the hundredth time, I landed on the chapter in which I discovered, in my first year of business school at Yale University that seeking official, personal tutoring from upperclassmen and women, who had excelled in the subject, was standard practice. A wave of relief had washed over me as I realised I was not alone in seeking help from peer tutors. Yet, I had prided myself on “pushing through” my disability, viewing it as a strength. I glowed with pride when I received praise for my resilience, but the thought of needing help made me feel like a grape, withering into a raisin – diminished and less capable. It took me four years after graduating to recognise this for what it was – internalised ableism.

Embracing change

Dismissing help or accommodations when necessary is neither a sign of incapacity nor strength – it is a harmful lie that leads to burnout and mental anguish. Worse still, the refusal to ask for or accept help perpetuates the stereotype that disabled people are “strong” or “inspiring.” I, myself, cringe whenever strangers and acquaintances call me an “inspiration” just because I use a wheelchair.

Determined to confront this unwelcome internalised ableism, I acknowledged its existence as the first step toward change. Gradually, I sought work in a disability-related field that genuinely appealed to me. Over time, I’ve come to view disability not as a negative but as a natural and valuable part of the human experience.

Tarini Mohan is a a writer and a development professional.

Consent and Pleasure: An Alliance Between Sex Work and Kink

Just as sex work is often laden with stigma, kink is taboo and deemed to be a product of sexual deviancy. Both communities are thus severely underrepresented in the rights landscape due to the moral judgment endured by them.

On the weekend of September 13-15, 2024, Kinky Collective (a community-funded group raising awareness around kink in India) organised the second edition of Kink Con: A National Convention in Celebration of Kink, Consent, Queerness and Acceptance.

The first panel was a Report launch titled “Conversations on Kink and Sex Work: Consent, Desire, and Power.” The Report was a summary of an Institute (workshop) organised by Kinky Collective (KC), and VAMP (Veshya Anyay Mukti Parishad, a collective of cis and trans women engaged in sex work in Maharashtra and North Karnataka) on 19th of October 2022 at Sangli, Maharashtra. The Institute facilitated a conversation around kink and sex work, and held space for questions, experiences and challenges faced by persons engaged in sex work. At the outset, the purpose of the Institute was to build alliances between the shared experiences of the two communities, and to debunk the idea that kink was an urban, western, capitalist phenomena since the sex workers predominantly experienced requests for kink from clients from villages and small towns.

At the report launch, two participants of the institute were present from SANGRAM, a collective of empowerment groups for sex workers, MSM and transgender individuals. They were Meena Seshu (founder of SANGRAM), and Aarthi Pai (director). Seshu and Pai served as the Marathi translators and intermediaries between members of KC, who predominantly spoke in a mix of English and Hindi. Members of KC shared that it was an interesting experience to find a shared vocabulary to articulate the experience of kink among the participants. The usual English vocabulary could not accurately capture the experiences, feelings and power dynamics of the participants. For example, ‘domination’ in the kink context translates plainly to Hindi as ‘havi,’ which bears a negative connotation of being oppressive or overbearing, thus, lacking the kink essentials of pleasure and consent. The word ‘satta’ ordinarily translates to ‘power,’ and was deemed to be a more suitable representation of the kink dynamic. In other instances, no attempt was made to create a word – instead, space was held to capture and translate the complexity of experience.

Also read: ‘A Twist in a Straight Line’: Inside India’s Kinky Networks

The workshop was an important space to build alliances between sexualities that are experienced outside ‘normalcy.’ Sex work is often categorised under the misnomer of ‘trafficking’ and ‘prostitution’ which has invited heavy-handed state surveillance, rescue, and rehabilitation.

Some of the slogans of the sex workers’ movement such as ‘Sex Work is Decent Work,’ ‘Rehabilitation is Redundant, Recognise Rights,’ and ‘Save us from Saviours,’ capture the battle of the community. These slogans were written on red umbrellas which were arranged on the backdrop of the report launch. The hetero-patriarchal Indian state also struggles to accept sex as a commercial service, an act that occurs outside the familial, procreational goal. Sex work is thus often laden with stigma.

Similarly, kink is taboo and deemed to be a product of sexual deviancy, and thus, remains far removed from any mainstream sexual rights activism.

It is notable that both these communities are severely underrepresented in the rights landscape due to the moral judgment endured by them. The report was thus wrapped in red and black ribbon to signify the coming together of the colours of sex work and kink respectively. Seshu and Pai argued for building more underground allied networks for sex workers and kinksters rather than waiting on the approval of the state, whose intentions are not to prioritize the needs and voices of these communities.

Another meeting point between sex work and kink is the clear negotiation of sexual acts, and therefore, the priority placed on consent as a central tenet to their relationalities. Seshu and Pai shared that their interaction with members of VAMP and SANGRAM revealed that they had very advanced approaches to consent, identity, and relationships due to their forthright and non-judgmental articulations with clients. Like the kink community, sex workers self-regulate around violations of consent, such as to end sessions when pain thresholds were crossed. When clients were aggressive, sex workers raised an alarm in their chambers, for example, some transgender participants shared the strategy of clapping loudly to call out for help. Similarly, in the kink space, munches (safe, social spaces) often serve as a space for raising concerns of consent violations in the community. It is important to note that due to their stigmatised nature, these communities don’t usually rely upon police support in fear of harassment and threat to their livelihoods and identities.

Seshu and Pai shared that one of the needs to have an Institute with KC arose due to the sense of intrigue and curiosity sex workers felt when clients would approach them with kinky desires and fetishes to offer larger than usual sums of money. They shared on behalf of the sex workers that because they were the primary act in the exchange, and penetrative sex was ancillary; for instance, one client only wished to oil, braid and smell the hair of a sex worker.

Members of KC shared that the affective atmosphere of the Institute was replete with laughter and teasing, and the reciprocity of sharing experiences without judgment, shame, but rather, curiosity and erotic fulfillment. This cheeky and arousing atmosphere among both communities foregrounded that their preoccupation with activism sidelined a discussion of their personal desires in daily dialogues. Seshu and Pai shared that while sex workers were completely non-judgmental about their clients’ kinky desires, most were not able to connect yet with kink due to their everyday experience of violence. KC shared that they would organise a joint workshop with SANGRAM in the future to create an avenue for sex workers to safely explore their own desires too. Some trans women sex workers shared that they had enjoyed spanking and hitting while engaging with kinky clients.

The kink terminology of ‘aftercare’ (acts of intimacy to wind down after the intensity experienced) also seemed relevant where kink and pleasure were aligned, especially when there were consent accidents/ incidents of excess; clients would offer cajoling, massages, and thereby support in the recovery.

Seshu and Pai also shared that the desires and pleasures of sex workers too, were ‘not mainstream,’ for instance, they would prioritise pleasure over physical appearance of clients. Similarly, in kink exchanges, identity and orientation often has very little to do with the exchange of kink, pleasure is the central endeavor. For instance, a gay male submissive and a lesbian female dominant both might engage in a play of spanking and flogging and both give and receive optimum pleasure in the act without being sexual

The convergences between kink and sex work thus reveals the importance of bringing together sexually marginalised groups to engage in productive and joyous camaraderie. As an audience member at Kink Con 2024, it was powerful to witness the importance of a safe space for members of the kink community to come together. Community provided by platforms like VAMP and SANGRAM have been critical for the empowerment of sex workers. The kink community urgently needs the strength of each other and that of allies to battle with silence and stigma that surrounds their desires. Kinky Collective’s efforts to create a platform like Kink Con provided an affirmative space around consent and negotiation, through the values of safety and communitarian care, in an atmosphere of joy, erotic energy and unabashed pride.

Katyayani Sinha is a PhD student at Melbourne Law School. Her project examines negotiation, informal contracts, and dispute resolution in the kink and polyamory communities in India.

67 Drugs Found Substandard in September; 6 Manufacturers Also Appeared in List For August

While the drug controller said that those companies whose named figured in earlier monthly lists were asked to withdraw their NSQ drugs, it is unknown how many withdrawal orders were implemented.

New Delhi: As many as 67 medicines were found to be ‘not of standard quality’ (NSQ) in the course of their random sampling conducted by drug regulatory authorities in September. The laboratories of the Union government drug regulator, the Central Drugs Standards Control Organisation (CDSCO), found 49 drugs to be NSQ, while state labs found 18 to be NSQ.

In an exclusive press interaction with ANI, Doordarshan and NDTV, drug controller general of India (DGCI) Rajeev Raghuvanshi said the CDSCO had collected 3,000 samples for testing in September.

The results of the lab investigation carried out on these samples were released on Friday (October 25).

The results of the random sampling conducted in a particular month are released in the next month.

Two lists of NSQ drugs – one made by the CDSCO and one compiled by the CDSCO from lists by state drug regulatory authorities – are released every month.

An analysis of the lists for August and September reveals that the names of six companies appear in both months. That is, they were found to be offenders not once but twice as far as the two months are concerned.

These firms are Hindustan Antibiotics, Life Max Cancer Laboratories, Alkem Health Sciences, Digital Vision, Nestor Pharmaceuticals and Kerala Medical Services Corporation.

Four companies – Zee Laboratories, ANG Lifesciences India, Himalaya Meditek and Protech Telelinks – saw their names figure only in September, but more than one of their products that month was found substandard.

The list of these companies, the names of which appeared in the lists of both months or multiple products of which were found to be NSQ drugs, can be found in the table below.

Please scroll down within the table to see the full list.

Also read: The Curious Case of a ‘Killer’ Drug With Contradictory Toxin Test Results at Different Govt Labs

What are substandard drugs?

According to the Drugs and Cosmetics Act, 1940, medicines that are unfit for consumption are divided into three broad categories:

1. Contaminated or adulterated drugs are medicines in which an adulterant has been found mixed. This can lead to serious injuries, including death due to contamination, especially with a toxin.

2. Spurious drugs are fake drugs that contain the label of a particular pharmaceutical company but are not manufactured by it.

3. Substandard or NSQ drugs are medicines in which a particular ingredient is not present in the quantity in which it is supposed to be. This, in turn, would make the drug less effective against a particular disease and, therefore, aggravate it. But unlike a contaminated drug, death may not necessarily occur due to the poor quality of the drug per se.

The Drugs Consultative Committee (DCC) of the CDSCO specifies two kinds defects in substandard drugs – minor and grossly substandard. A drug is usually declared substandard by a regulator mostly when it is grossly substandard. The parameters for this are:

(i) Active ingredient contents are 5% below the quantity in which they are supposed to be for thermostable drugs (drugs whose efficacy is vulnerable to fluctuations in temperature); and 70% below for thermolabile products (drugs not vulnerable to temperature changes).

(ii) Tablets/capsules fail the disintegration or dissolution test (to check the drug’s ability to be absorbed in the body)

(iv) Liquid preparations show presence of fungus in the drugs

(v) Drugs are not sterile, fail the pyrogen/endotoxin test or have undue toxicity (caused due to bacteria that might creep in due to unhygienic conditions at any step of drug manufacturing)

(vi) Vaccines fail in potency, sterility, toxicity or moisture content.

Drugs failing standards test

A majority of the 67 drugs that found mention in the September lists were anti-hypertensive drugs like telmisartan; antibiotics like metronidazole, gentamycin and ceftriaxone; calcium and vitamin supplements; antacids like pantoprazol; antidiabetics like glimepiride and metformin; cough syrups; drugs to prevent blood clotting; and pain-relief drugs like diclofenac and nimesulide plus paracetamol.

The full list of drugs found NSQ by the CDSCO in September can be found here, and by state labs, here.

It must be noted here that results from only seven states or Union territories are present in the state list for September.

The others did not submit data to the CDSCO and it is hence unknown if they conducted random sampling or did conduct it but did not release the results. These include Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Goa, Gujarat, Haryana, Himachal Pradesh, Manipur, Rajasthan, Meghalaya, Mizoram, Nagaland, Odisha, Punjab, Sikkim, Tamil Nadu, Pondicherry, Telangana, Delhi, Uttarakhand, West Bengal, Andaman and Nicobar Islands, Dadar and Nagar Haveli and Daman and Diu, and Lakshadweep.

Most of the 67 drugs failed the assay test (done to measure the amount of ingredient present), dissolution and disintegration tests and endotoxin tests.

DGCI Raghuvanshi clarified at the press event that if a particular drug’s name figures in the list, it should not be construed that the drug as made by all manufacturers is NSQ.

A drug maker’s name is mentioned against an NSQ drug in the list. It is only that particular manufacturer whose drug is under the radar.

Action taken

Asked about action taken against companies whose names figured in the previous monthly lists, Raghuvanshi said during the press meet that they were served notices and asked to withdraw their NSQ drug from the market.

However, there is no clarity on whether these withdrawals really occurred and if the CDSCO or the state drug regulators have a system to track the process.

DCC guidelines say that if drugs are found to be grossly substandard, if “criminal intent” or “gross negligence is established” and where it is found that “administrative measures would not be sufficient to meet the ends of justice”, a case should be filed in a court of law.

In the absence of any of these conditions, “[the] weapon of prosecution [filing a case in court] should be used judiciously, where it is felt that administrative measures like suspension or cancellation of licences or compounding of offences would not meet the ends of justice,” the guidelines say.

It is not certain whether any drug makers who figured in previous monthly lists were found to have “criminal intent”, if “administrative measures” like the suspension of their licence took place or if a case was filed against any of them in court.

The Wire called and texted Raghuvanshi to seek these clarifications but did not immediately receive a response.

Law Made ‘Toothless,’ Will Take Union Govt to Task: What SC Said on Delhi’s Worsening Air Quality

The apex court also came down heavily on the Punjab government for imposing only nominal fines on farmers who were burning stubble.

New Delhi/Bengaluru: The Supreme Court on October 23 reacted strongly to the air quality in New Delhi which has worsened over the past week, slipping from the ‘Poor’ to ‘Very Poor’ category. It came down heavily on the union government and governments of Punjab and Haryana for inaction and the imposition of paltry penalties for stubble burning, respectively.

The court said that an amendment to the Environment Protection Act (1986) in 2023 – which provides for imposing penalties on individuals who go against the Act (in this case, farmers who are burning stubble) – has made the legislation “toothless” because there is no adjudicating officer to enforce this provision. It said that it would take the union government to task for this.

The court also noted that the Punjab government was imposing only nominal fines on farmers who were burning stubble.

Delhi’s deteriorating air quality

New Delhi’s air quality has witnessed a huge dip over the last fortnight.

On October 14, the Air Quality Index (AQI) as measured by the Central Pollution Control Board (CPCB) in Delhi was 235, dipping to the ‘Poor’ category. An AQI between 200 and 300 is categorised as being ‘Poor’, as prolonged exposure to such air quality levels will cause discomfort to most people in the area and not just people with respiratory illnesses such as asthma.

On the same day, the Commission for Air Quality Management (CAQM) ordered that all 27 actions as part of Stage 1 measures be implemented under the Graded Response Action Plan (GRAP). This included intensifying the use of anti-smog guns, water sprinkling and dust suppression measures in road construction, widening or repair projects and maintenance activities; enforcing the ban on firecrackers and making sure that hotels, restaurants and open eateries use only electricity, gas-based or other clean fuel for appliances.

Air quality in the city got worse in the following days. On October 21, the AQI was 310: in the ‘Very Poor’ category. Prolonged exposure to such poor air quality can result in respiratory illnesses to people in the region. So on the same day, the CAQM ordered the implantation of Stage II emergency measures to reduce air pollution in the National Capital Region (such as increasing parking fees to dissuade people from using private transport), along with Stage I measures.

The AQI in Delhi as of 4 pm on October 23 was 364 as per data released by the CPCB, and measured based on levels of particulate matter (both PM10 and fine particulate matter or PM2.5) as logged by 31 of the 40 automatic weather stations in the area. This is still in the ‘Very Poor’ category, but increasingly closer to 400 which will then switch to the ‘Severe’ category. Prolonged exposure to such air quality will affect healthy people and cause serious impacts to people who are already struggling with respiratory and other illnesses.

Nominal fines, cherry-picking prosecutions

On October 23, Wednesday, a bench of judges of the Supreme Court (Justices Abhay S. Oka, Ahsanuddin Amanullah and Augustine George Masih) came down heavily on both the Union government and the state governments of Punjab and Haryana. It had called on the chief secretaries of both states to give their submissions on the issue of stubble burning and actions taken to curb it.

Also read: Can Either the SC’s Anger or the Govt’s Winter Action Plan Save Delhi From Another Toxic Winter?

With the rice harvesting season in these states coming to a close, stubble burning – the process of farmers setting fire to the stubble remaining in their fields after harvest to prepare for the next cropping season – is slowly seeing a rise. For instance, as per a report by The Hindu, a bulletin of the CREAMS-Indian Agricultural Research Institute (IARI) recorded 872 fires in Punjab between September 15 and October 13, while it reported only 300 fires from September 15 to October 7. That’s a jump of more than 500 fires in less than a week. Several studies have shown that stubble burning in the states of Punjab and Haryana are responsible for Delhi’s bad air quality during this season. As per a report released by research and communication consulting organisation Climate Trends on October 22, the number of stubble fires has decreased in these states from 2019 to 2023; the years of 2022 and 2023 showed “substantial reductions” in fire numbers across several districts in these two states. It also found that fire incidents in the two states had a huge impact on Delhi’s air quality. On days that did not witness fires in these states during the stubble burning season, Delhi’s AQI remained in the ‘Moderate’ category. However, it dipped to the Poor and Very Poor categories on days that witnessed fires.

On October 23, the Supreme Court came down heavily on the Punjab state government because it was imposing only nominal fees (of Rs. 2,500) on farmers burning stubble in their fields.

“Giving license to violate by paying such nominal amount. That’s incredible…We will tell you very frankly that you are giving signal to violators that nothing will be done against them. This has been for the past three years,” Bar and Bench quoted the Supreme Court judges as saying.

The bench also noted that the Punjab and Haryana governments were “cherry-picking” individuals for prosecution. Per the Bar and Bench report, the court directed the Union government to amend the law “to increase the environment compensation cess levied on farmers who indulge in stubble burning and officials who fail to act on the same”.

‘Everybody been made a fool’

The bench said that an amendment to the Environment Protection Act (1986) in 2023 – which provides for imposing penalties on individuals who go against the Act (in this case, farmers who are burning stubble) versus penal provisions previously – has made the legislation “toothless”. The court said that this was because there is no adjudicating officer to enforce this provision: it would take the union government to task for this, the court added.

“We will take Union of India to task as they submit that Section 15 which provides for penalty has been amended. You don’t have the adjudicating officer to enforce it. The Environmental Protection Act, 1986 has been made toothless,” the Bench said.

“If these governments and you were seriously ready to safeguard environment then everything would have been done before amendment to Section 15. This is all political nothing else,” Bar and Bench quoted Justice Oka as saying.

Additional Solicitor General Aishwarya Bhati, appearing for the CAQM and the Union government, said in reply that the rules for the proper implementation of Section 15 would be made applicable in 10 days.

“Also on a lighter vein, Central Government amends Section 15 of the 1986 Act without formulating any area of enforcing the same, no adjudicating officer. The amendment has been done that too on 1st April, everybody has been made fool. ASG, please ensure Section 15 has to be made applicable in letter and spirit,” Bar and Bench quoted Justice Oka as saying.

“Time has come to remind the Union, and both the States, that there is a fundamental right subsisting with the citizen to live in a pollution free environment. These are matters of blatant violation of fundamental rights under Article 21,” the bench noted.

R.G. Kar: An MD Thesis I Could Submit, an MD Thesis She Could Not

One of the junior doctors who was a part of the 17-day fast-unto-death protest in the aftermath of the R.G. Kar rape and murder of a trainee doctor writes about life, the protests and the role of humans in each others’ lives.

On August 9, 2024, a trainee doctor was found raped and murdered at the state-run R.G. Kar Medical College and Hospital in Kolkata. What followed was an outpouring of anger. Protests erupted and sustained across Bengal. People demanded an overhaul of a system of corruption in medical education and justice for the young victim. After fiery parleys with chief minister Mamata Banerjee, a group of doctors participated in a 17-day hunger strike to press for multiple demands. The strike ended on October 21 after the doctors sat in a meeting with Banerjee.

This author was among those who participated in the fast.

I had written something after officially becoming a doctor. January 28, 2019 – the day of our convocation…that was the day I had become a doctor, officially. While critics now question the doctor’s ethos in me, what I wrote then is now alive again.

Months and years have passed since that date. I have not written anything of value in the meantime. Most of what I wrote was private, never published online. These days I don’t even write for myself. But today is an exception, an exception I have made for myself, because sometimes the personal is social too.

Memory returns in waves. Sometimes, I think, we need to measure ourselves against ourselves. The spirit, emotion and faith I had in 2019 is like a debt I need to repay to society. Today I am moved by the same emotion and faith. It is because of that that I walked in the rally on August 12. It is because of that that I tried to participate in this protest, like so many others. It is because of that faith that I raised slogans and gave voice to a collective demand. I stepped onto the streets with my faith in the lessons that the medical college taught us – on becoming a good human and remaining responsible towards society. I had faith also in the lessons that everyday humans leading their everyday lives taught us.

Worship of a person is a problematic concept – for the person and for the society. It is a source of discomfort.

Also read: Doctors Versus Mamata: A Battle of Wits Ends in a Masterclass in Political Manoeuvring

The fact that my likeness and my words have permeated news media has not just given me strength, the love of people and reminded me of my responsibilities, it has also given me discomfort. This is a discomfort born from the focus on me as a person. I am not the face of the protests. The protests saw many participate with their all – I was one of them. I was one in a rally. One in a protest. When everyone spoke, I spoke too.

I behaved the way people in the movement behaved. When tiny kids would come with flowers, cards and the small notes they had salvaged from their piggy banks, I would listen intently to their voices. They would come and say, “We want justice.” People from Kalyani, Birbhum, Purulia and Siliguri came everyday and joined in with a symbolic fast. There was a grandmother from Memari who sat at our fasting dais. The 1951 graduate from Bethune College. The lemon tea-seller, our dada, who would clear the way when we had to use the bathroom. The senior citizen who would man the barricades every day. The dada who would clean the Sulabh public toilets a little better out of concern for us. The person from Belgium who spent nights at the fasting dais. The volunteer team who also did the same. Absolutely everyone who was with us for so long, from R.G. Kar to Swasthya Bhavan to Dharmatala – our sites of protest. Those who raised their voices, who embraced us, who blessed us. All of them are the faces of the protest. Not Rumelika, not the person, not the personality, not me, these people. It is because they were with us that the agitation remains alive and will remain alive.

Aniket Mahato, a doctor on hunger strike, is taken for treatment. Photo: Joydeep Sarkar.

The person I am is not simply the person I am. Behind my becoming of me have been and will be the roles of many. Parents, teachers and many others. My patient from Baruipur has a role. Her husband lives in a mazhar. Her son is HIV positive and has taken to drugs. Her brother has coerced her into signing away her property to him and driven her from from. She works as a caregiver and gives away all the money that she makes to her son and husbands. She has two days off in a month. One day, she spends at the mazhar, the next to repay her husband’s debts at the tea shop and give the rest of her money to her son. She has no time to stand in a line to get tests done. She has no time to stand in a line to be seen as an outpatient. She has no time to stand in line to buy subsidised medicines from a shop where after two hours in a queue, she will be told to buy medicines from outside.

Her story, her life makes me who I am.

The 15-year-old girl who left home to escape child marriage makes me who I am. She is living – and studying – at a friend’s house now.

Those kids at College Street who embraced us and began saying, “Didi, please eat something, please” – they make me who I am.

The family that lives on the footpath outside my college and asks everyday when I enter if I am well, they make me who I am.

The patients who tell us of their lives everyday makes me who I am.

The junior doctors’ protest site in central Kolkata. The doctors are protesting against the Mamata Banerjee government’s refusal to engage with them on a host of issues stemming from the R.G. Kar rape and murder. Photo: Joydeep Sarkar

People influence us – sometimes a great deal, sometimes in simple ways. These influences shape our thinking and our faith. We can count on this faith during our fights. Thanks to them, we can say that we will see a struggle to the end.

Today is 75 days since August 9, 2024. The life I have lived in the last 73 days is not anything like the life I had in the last 29 years. I think this is a line many others will say too. My insides were churned by August 9. That anger still lives in me. That Pandora’s box, preserved shut for so long, has opened in waves of protest. This has scared rulers. This has surrounded rulers. The rulers, unnerved, have shown their true colours and descended on us.

But this will not dent the struggle. It will spread. Our experiences and the weight of our stories will increase. I cannot say into the ether, “I have done so much, look.” I cannot arrange lies neatly at a livestream. All of you have not made me that person.

I will complete my MD in a few days. In our academic lives, the thesis is a milestone and a source of pain too. When I was getting my thesis printed, I was thinking of just one thing – I was able to submit my thesis. I was able to print it, give it to my guide, co-guide and everyone else. I would have possibly smiled through the process in any other circumstance.

Tilottama could not. Tilottama would not be able to. She wasn’t allowed to. Some creatures stopped her from becoming a doctor. They stopped her from staying alive. I want to remember this. This is a small effort on my part to make my MD thesis her’s, too.

Rumelika Kumar’s thesis, in which she has referred to the R.G. Kar victim.

Don’t forget. Don’t let others forget.

Rumelika Kumar is a junior resident at the All India Institute of Hygiene and Public Health. This account was published on her Facebook page and has been republished with her permission.

Translated from the Bengali original by Soumashree Sarkar.

How Prisons Perpetuate and Produce Disabilities

Carcerality negates disability justice because it is ableist.

Inside the prison, G.N. Saibaba used the toilets once every two days. A wheelchair user due to polio, he was 90% disabled. The Delhi University professor was not provided with a wheelchair for more than eight years.

He had been accused, many say wrongfully, under the Unlawful Activities Prevention Act. When those who were near and dear to him visited him, they could not even see him because the architecture was such that a prisoner would need to stand to be visible to visitors.

Having spent close to a decade behind bars, Saibaba developed several health complications, including hypertrophic cardiomyopathy and gall bladder stones. Post-operative complications from removing these stones led to his demise on October 12, 2024.

Miles away, on October 17, in Texas, Robert Roberson was set to be executed for the murder of his two-year-old daughter, a crime he is largely believed to have never committed. Roberson’s apparent lack of emotion for the death of his child led to his incarceration two decades ago. The carceral system could not fathom Roberson’s autism and framed him with the charges despite clear and concrete evidence against the charge. Roberson acquired a temporary stay on his execution just 90 minutes before it from a Travis County judge, thanks to public pressure. However, his disability has been under trial for 22 long years, and the onus is upon Roberson’s team to prove that he is not guilty.

The cases of GN Saibaba in India and Robert Roberson in the United States brings to the fore the twin aspects of the relationship between carcerality and disability. Carceral institutions are inherently designed to make the space extremely dehumanising to the disabled by paying no attention to their unique needs. Cases in point are the construction of autism as a crime or the presence of disabled-unfriendly architecture in prison visiting spaces.

Also read: G.N. Saibaba’s Death Was Not Unexpected but It Remains Unacceptable

Further, the carceral system enforces and perpetuates disability. It creates disabled bodies like in the case of G.N. Saibaba, who had come out of prison with more suffering – physical and mental. From Saibaba to Roberson, carcerality is antithetical to disability rights.

Carceral institutions, those concerning policing and imprisonment, are exclusionary. They are built on the foundations that ensure that the personnel working in these institutions fail to recognise and distinguish disabilities from criminality. The Mapping Police Violence Organization, based in the United States, maintains a public record of statistics of police violence in the US. Police violence here includes shooting lay people, usage of tasers, impact weapons, and force. They reported over a million such cases in the US. Such police violence, especially against the marginalised and disabled, is not a new phenomenon. On August 22, 1979, the New York Police Department shot Luiz Beaz, a “mentally distressed” person, 24 times because he had been wielding a pair of scissors in a slashing motion. In 1984, the US police killed Eleanor Bumpers and, in 2016, Deborah Danner, both of whom were identified as having had mental health disorders. According to the Prison Policy Initiative, 40% of the people in state prisons in the US are disabled, making them an overly-represented population in the jails.

India lacks information on its disabled incarcerated population. The mere lack of statistics furnished by the state signals their lack of consideration for the disabled. However, certain instances get popularised by virtue of the incarcerated being political prisoners. These shed light on the brutalities that disabled people have to endure.

For example, Stan Swamy’s tremors from Parkison’s disease did not allow him to drink water without a straw and a sipper. The state institutions were hell-bent on not making a straw available to him. Eventually, he was given a sipper and straw after a court order. A cardiac arrest, combined with the carceral institution’s inhumanity, took his life on July 5, 2021. Stan Swamy is one among several such prisoners. Indian governmental agencies are notorious for hiding data. However, if we were to rely on the National Crime Records Bureau’s data, about 2,000 people die inside prisons annually.

The argument then is not to make inclusive, humane or disability-friendly prisons. The history of prison reform shows that state-sponsored reform – for instance in the US – has only meant increased surveillance, strict separation of prisoners into solitary cells, and expanding the carceral regime by placing GPS trackers on prisoners released on parole. Instead, the indignities perpetuated by carceral institutions should be understood as a design of carceral regimes rather than accidents that could be reformed. The very thrust of carcerality is to incapacitate deemed “criminals” in an effort to reform them. The reliance on torture inside these spaces is prevalent and well-documented. The design of carceral institutions becomes more pronounced when we understand how these institutions also produce disabilities.

Also read: G.N. Saibaba’s 2017 Prison Letter Sheds Light on the Rights of Disabled Prisoners

The usage of torture on Saibaba, for instance, is one example. As Saibaba’s book notes, sustained imprisonment and manhandling caused him to lose the grip in his hands – which he banked on for movement. The police are also notoriously known for disabling protestors using lathis, tear gas, rubber bullets, pellet guns, and other harmful technologies of control, exacerbating existing disabilities or creating new ones. In 2016, the police in the United States almost severed the arm of Sophia Wilansky by launching a grenade. She was merely protesting the Dakota Access Pipeline construction in the US. In the same year, the Indian Army used pellet guns against civilians in Kashmir, blinding several. During the anti-CAA protests in 2019-2020, the police were recorded thrashing four Muslim youths. One of them, Faizan, succumbed to injuries, and those alive are enduring physical and mental disabilities of various kinds. Besides, isolation and torture have been known to breed mental health issues inside a prison since its very inception in the 18th century. More recently, Israel’s actions had made Gaza open-air prison. Its genocidal strikes have left its people, especially children, with fewer body parts and a lot of psychological trauma.

It is crucial to reimagine carcerality in terms of its relationship to disability. Bluntly put, carcerality negates disability justice because it is ableist. Further, it creates disabled bodies. The irony is that carceral institutions use the cloak of justice to cover up the nasty mess they make. No institution of justice can possibly have a massive proportion of the incarcerated and affected population from the most marginalised sections of society. In India, it is the lower caste, lower-class, and Muslims; whereas in the United States, it is the Black and other people of colour.

The inner logic of the working of carceral institutions is not bound by national boundaries.

When institutions that claim to be promoting justice through punishment across the world are, in fact, violently disabling or slaughtering the population, how useful are they in promoting their stated goal of justice? It is high time we think of a world that is devoid of unjust carceral institutions.

Vipanchika Sahasri Bhagyanagar is a history PhD student at Purdue University, West Lafayette.