The Sambhavna Trust was set up as a registered charitable trust in June 1995 with the sole objective of improving the health condition of the survivors of the Bhopal disaster. Through the Bhopal Peoples' Health and Documentation Clinic situated close to the affected communities, the Trust provides medical care, health education, and research and monitoring facilities to the survivors free of charge. The clinic opened on September 1, 1996 and has registered nearlt 10,000 people to date, mostly from the severely affected communities.

Objectives of the Trust

• To provide appropriate medical care through modern medicine as well as Ayurveda, Yoga and other alternative therapies.
• To generate information on the health consequences of gas exposure and to educate survivors on preventive and curative measures.
• To carry out medical research that addresses current and projected medical needs.
• To function as a repository of medical and other information on the Bhopal gas disaster and make such information accessible to all.
• To relate the medical and other activities of the government and other agencies with reference to survivors.
• To support and conduct seminars, conferences, research, training programmes and other educational and academic events towards the welfare of survivors.

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Our Trustees
The seven member Board of Trustees that administers Sambhavna consists of doctors, scientists, writers and social workers who have been involved with various aspects of the disaster since its occurrence. Several members of the board have received national and international recognition for their scientific and social contributions. Except the Managing Trustee who is paid a monthly honorarium of Rs. 4500/-, all trustees work on a voluntary basis and meet three to four times in a year. Decisions are made through a consensus among the members of the Board.

International support
We have a five member International Advisory Group made up of professionals from Italy, the UK and the USA who have provided longterm support to the cause of the Bhopal survivors. The volunteer-based Bhopal Medical Appeal-UK generates awareness and support for the clinic through publicity campaigns. A 14 member panel of medical advisors from Canada, South Africa, Sweden, the UK and the USA provides valuable technical support as needed.

Sambhavna Clinic staff
Among the 20 staff members at Sambhavna: nine are survivors of the disaster; 17 are employed fulltime; eight are women; nine are under 30 and four are over 40. Four are qualified in medicine, two of whom are specialists. Five people are post graduates, four are graduates and seven are educated to school level. We are paid favourably in comparison to other local non-government institutions and a ratio of 1:4 is adhered to in determining minimum and maximum salaries. Most if not all, decisions regarding the day-to-day and longterm work of the clinic are taken by consensus at the weekly meeting of the fulltime staff members. The job of coordinator is chosen (by drawing lots) every two months from among the staff members.

Funds and fundraising
The Sambhavna Trust collects its funds mainly through small donations from a large number of individuals. Appeals for funds are publicised through newspapers in India and abroad. The Pesticides Action Network - UK (formerly The Pesticides Action Network) collects donations on the Sambhavna Trust's behalf and tranfers them to the account of Sambhavna Trust after obtaining the required permission  from the Ministry of Home Affairs. The Trust has so fas received Rs. 3.6 lakhs approx. through individual donations in India and a total of 40.66 lakhs approx. have been transferred from PAN-UK. In the last four years well over 6000 individuals have sent donations towards the running of the Bhopal Peoples' Health and Documentation Clinic.

Expenditures
The clinic runs on a very tight budget requiring judicious attention to all expenditures. The Trust has incurred a total expenditure of Rs. 49.30 lakhs approx, an annual average of Rs. 12.36 lakhs or Rs. 1.03 lakhs in an average month. The bulk of expenditure has been on payment of salaries, purchase of medicines, equipment and the clinic building. Audited accounts of income and expenditures of the Trust are publicly available and displayed every year.

Activities of Sambhavna
We believe that medical care should be based on the principle of "First do no harm" and that therapy should not compound the injuries sustained as a result of exposure. Development of integrated systems of therapy based on the specific symptom complexes presented by survivors (as opposed to attention to individual symptoms) is ongoing. We have also developed our own system of registration to confirm and record history of exposure as well as monitoring the health status of individual patients which we believe to be essential. We are active in five main areas:

• Medical care
• Community health work
• Research and monitoring
• Documentation
• Seminars and training

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Medical care
At Sambhavna we offer both Allopathic and Ayurvedic systems of medicine. We also give Yoga instruction. We have a fully equipped pathology laboratory and we prepare and distribute many of our own medicines.

- Allopathic care
Allopathic care at the clinic distinguishes itself in its attention to development of treatment protocols for specific symptom complexes, weeding out unnecessary and harmful drugs and including Ayurveda and Yoga in the overall treatment regime. We have general medicine, gynaecological care and mental health care units.

- Ayurvedic care
Ayurvedic health care at our clinic includes the use of medicines described in the standard Ayurvedic texts rather than factory-manufactured drugs; predominant use of herbal drugs over mineral preparations and use of modern investigative facilities and tools for objective assessment. We have two units of Ayurvedic care: general medicine and Panchakarma Chikitsa.

- Yoga
We use Yoga at Sambhavna to treat several chronic diseases suffered by the gas exposed including those of the respiratory, musculo-skeletal, neurological and endocrine systems. More than half the people doing Yoga for exposure-induced respiratory disorders at the clinic have been able to discontinue medication they have been dependent on for over 10 years.

- Pathology laboratory
Routine, microscopic and bio-chemical tests for blood, urine, sputum, and vaginal and cervical smears are carried out in house. In addition, samples are collected and sent to the medical college or private laboratories for more specific tests.

- Preparation and distribution of medicines
We make 64 Ayurvedic medicines using locally collected or purchased herbs. Single herb and herbal mixture powders, decoctions, oils, tablets and poultices are all prepared on the premises. In dispensing medicines the utmost care is taken to ensure that people are well informed about their prescriptions.

Community health work
Our approach to community health consists of empowering the community and its individuals to take control of their own health. Our four community health workers are the only ones of their kind in all Bhopal.

- Health and health care surveys
We have carried out door-to-door surveys of five communities with a total population of about 10,000 in order to generate a database on the demography, health and health care status as well as the social, economic and environmental condition of the residents. While outlining priorities these surveys have also been a means of making contacts in the community and building local health committees. Our health workers also identify people in need of special medical attention and ensure that this is made available either at Sambhavna or elsewhere.

- TB care and health education
Despite official knowledge regarding the unusually high prevalence of TB in the survivor population (over three times the national average) there are no official initiatives in this direction. Our work in TB care consists mainly of education, identifying those with symptoms of TB, having their tests done and, where required, ensuring medicine availability. We also follow up to ensure compliance with dosage. Much of this work is shared by "patient leaders", former TB patients who provide much effective inspiration in the community.

- Monitoring and house visits
We evaluate the quality of our care and patient satisfaction in order to find out the efficacy of treatment and to ensure compliance of treatment regimes by visiting a random sample who have dropped out of care at Sambhavna. Our health workers find out the reasons for dropping out, whether the person found relief of their symptoms and whether he/she is receiving treatment elsewhere. People thought to be in need of continued care are encouraged to revisit the clinic.

Research and monitoring
The government stopped monitoring exposure-related mortality in 1992. We have picked up this activity by employing a technique called Verbal Autopsy - a scientific method of proven validity used for establishing the cause of death of individuals in a community. Other research projects include an assessment of drug distribution in gas affected Bhopal and the effects of Yoga therapy on chronic respiratory disorders related to the disaster.

Documentation
Much of the information on the disaster and its aftermath is lost, unavailable or classified. Of the information that is actually available, a large part remains within a tight-knit circle of bureaucrats, scientists, medical researchers and academics. Government efforts to collect and distribute this information are absent and non-government initiatives towards documentation of the continuing disaster are rare. We collect, collate, and distribute medical and other information related to the disaster. Quite possibly this is the only public repository of its kind.

Seminars and training
We have organised several seminars involving local, national and international medical professionals, scientists, environmentalists and survivors' organizations. We have also participated in various local and national seminars. Our research paper "Effects of yoga practices for respiratory disorders related to the Union Carbide gas disaster in 1984" was presented at the XVI World congress of Asthma in October 17-20, 1999.

Our vision for the future
The medical situation in Bhopal is likely to remain an issue of serious concern for at least the next 30 to 50 years. An estimated 35,000 children exposed in utero or conceived by exposed parents in the three years following the disaster are likely to require special medical attention all their life. Late manifesting cancers also call for longterm health surveillance and treatment facilities. Chromosomal aberrations, observed in an unusually large number of those exposed, warrant that health surveillance of the exposed population is carried out at least for two generations.

Over four years of work have produced encouraging results and given us some degree of confidence regarding our role and relevance. They have also instilled the courage to dream and plan for the future of the clinic. For the next five years these consist mainly of upgrading and expanding facilities (medical care, diagnostic equipment, the pathology laboratory and medicine manufacture), creating new services and becoming further involved with the affected communities. The increasing patient-load on the doctors calls for the appointment of at least two additional physicians/specialists and corresponding increase in space and para-medical personnel.

The results of our community health work have been most encouraging, particularly in terms of involving more and more people. There is a strong possibility of building on this to create a community-based network for monitoring activities. We have collected information from different parts of the world on the development of health surveillance techniques that are implemented by lay members of the community. It is possible to train survivors in Bhopal in such techniques as 'lay epidemiology' and 'verbal autopsy' and in using simple equipment for water/air quality monitoring so that a community can be self sufficient in longterm monitoring of its health and that of its future generations.

We believe:

• That the disaster in Bhopal is not an isolated event. Workers and communities are routinely poisoned all over the world.
• The reduction and eventual elimination of hazardous chemicals from the planet and our daily lives is the only solution to the growing number of slow and silent Bhopals in our midst.
• Until that happens, the safety of our health and lives depends on watchful monitoring, strict enforcement of regulations and exemplary punishment to offending agencies. In this respect, ensuring justice in Bhopal can be seen as a public health initiative with potential for significant and widespread change.
• The limits of modern medicine in taking care of modern industrial diseases are becoming increasingly apparent. Evolution of an appropriate system of health care, monitoring and research for survivors of Bhopal is of consequence to all people worldwide.
• It is possible to combine traditional and western systems of health care to provide sustained relief to the chronically ill survivors of Bhopal.
• It is possible for an individual to be an active participant in the process of healing and the community to be involved in all aspects of public health.
• It is possible to evolve systems of health surveillance and environmental monitoring through active participation of the community of survivors. Our work in documenting longterm consequences of exposure is part of the survivors' ongoing struggle of memory against forgetting.
• It is possible to depend upon the compassion of ordinary individuals and generate enough funds to run our clinic without the help of corporate charities, big business, large grants from foundations or government assistance.
• It is possible to generate opportunities for hope through creative and collective intervention in a situation of despair.

We welcome everyone to visit Sambhavna and find out more about the ongoing medical disaster in Bhopal and our efforts towards caring for survivors. We have a steady stream of volunteers both from home and abroad who have contributed their time and skills to help.

If you would like to contribute financially you can send a cheque in rupees directly to the clinic (if you are in India). If you outside of India then please send a cheque or postal order to the Pesticides Action Network office closest to you: