History Issue 43
and educational campaigns. These developmentscontributed to a decline in the incidence of kala-azarin the following years, even though these successesappeared transitory; insecticide spraying and activecase detection work was not, for example, carried outin Bihar from mid-1994, even though 30 districts inBihar and nine districts in West Bengal were foundto be severely affected by kala-azar at the very time.Disease surveillance activities, widely accepted asessential to any eradication programme, continueto be poorly organised in affected areas of India.The bulk of cases are concentrated in tribal villages,which have limited access to health facilities. Kala-azar has, for instance, been spreading rapidly in andaround the tribal hamlet of Sarbamangal in SouthDinajpur district in West Bengal; my investigationsthere reveal that its inhabitants have minimal accessto healthcare facilities capable of treating the disease.The Public Health Centre is not even equipped withthe pathological facilities to identify the kala-azarparasite; moreover, the health workers rarely invest timein case detection work or the spraying of insecticide.Acute shortages of effective drug treatments do nothelp either – indeed, sodium antimony gluconate,which is in use for the treatment of this disease, isnot currently manufactured in India. Pentamidineisethionate, a product manufactured outside India, isfrequently considered too costly to import by hard-pressed state governments. The widespread circulationof spurious drugs has created further problems forpatients and health ofcials. Indian bureaucrats andadministrators are also culpable, by refusing givepriority to tackling the kala-azar problem. The availableevidence shows that the disease generally affects themost disadvantaged sections of society. This oughtto stoke more – rather than less – concerted action.The persistent neglect of health matters in public policyis evident from the relatively low levels of expenditureon health. Investment has fallen away gradually afterthe second ve-year plan period; federal support fordisease control programmes, which stood at 41 percent in 1984/85, was reduced to 29 per cent in 1988/89and scaled back further to 18.5 per cent in 1992/93.Health centre efciency in several states continues to beadversely affected by insufcient facilities, medicinesand staff. There is, thus, an urgent need for radicalreform. The political visibility of health issues needs tobe raised, and shortcomings in health delivery need toanalysed, debated and countered both before and afterparliamentary and local authority elections. Diseasessuch as kala-azar can only be eradicated through well-knit integrated campaigns. It is essential to mobilisecommunity participation in health programmes,and special attention needs to be paid to ensuringthe participation of women, since they are often theprimary carers of children and the elderly. The Ministryof Health and Family Welfare recently constituted anexpert committee on kala-azar elimination from India,with the declared aim of eradicating the disease by 2012– this important goal can only be achieved throughthe committed determination of all stakeholders.
Proessor Achintya Kumar Dutta
is attached to theDepartment o History, Burdwan University, India(
A man with post-kala-azar dermalleishmaniasis.
Cholera and Confict: 19th century cholera inBritain and its social consequences,
edited byMichael Holland, Georey Gill and Sean Burrell
This collection o essays presents some local studies on Asiatic cholera, predominantly or the 1832 pandemic;there is a chapter on cholera treatments in the early 19thcentury, some groundbreaking work on Asiatic cholera inIreland, a chapter on the treatment o cholera during theCrimean War, and the intriguingly titled ‘When the FourthHorseman Rides’, which examines art and literature or theperiod based on the belie that the 1832 pandemic was o apocalyptic proportions. The volume came about as a direct result o the CholeraProject that was launched to ascertain the true level o civilunrest associated with the outbreaks o Asiatic cholera orthe years 1832 and 1849 in the UK. A secondary aim wasto identiy medical innovation that was used in thetreatment o the disease. The researchers or the project were recruited rom theOpen University, amily history societies, medical societiesand the Family and Community Historical Research Association, and operated under the auspices o theSchool o Tropical Medicine at the University o Liverpool. Their brie was to trawl through local documents,newspapers etc. or evidence o unrest associated withoutbreaks o cholera and then to eed their ndings to theacademic advisers or inputting onto a database. The Thackray Medical Foundation provided unding or theresearch and the publication o the ndings.Published by the Thackray Museum, Leeds (
). ISBN 9781897849095.