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Swasthya siksha unnayan patrika
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Prabir Chatterjee
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''اللهم إني أسالك إيمانا دائما وأسألك قلبا خاشعا وأسألك علما نافعا وأسألك يقينا صادقا وأسألك دينا قيما وأسألك العافية من كل بلية' اللهم اجعل خير أعمالنا خواتمها وخير لحظاتنا لحظة الموت وخير أيامنا يوم نلقاك فيه اللهم اغفر للمؤمنين والمؤمنات والمسلمين والمسلمات الاحياء منهم والاموات اللهم صل على سيدنا محمد و آله و صحبه و سلم تسليما كثيرا عدد خلقك و رضى نفسك و زنة عرشك و مداد كلماتك و عدد ما علم الله السميع العليم سبحانك اللهم وبحمدك اشهد ان لا اله الا انت استغفرك واتوب اليك واؤمن بك واتوكل عليك لا اله الا انت سبحانك اني كنت من الظالمين اللهم إني أعوذ بك من زوال نعمتك وتحول عافيتك وفجاءة نقمتك وجميع سخطك . اللهم صلى وسلم على سيدنا محمد عدد ما ذكرك الذاكرون وغفل عن ذكرك الغافلون اللهم صل على سيدنا محمد و آله و صحبه و سلم تسليما كثيرا عدد خلقك و رضى نفسك و زنة عرشك و مداد كلماتك و عدد ما علم الله السميع العليم الْحَمْدُ لِلَّهِ عَدَدَ مَا خَلَقَ، وَالْحَمْدُ لِلَّهِ مِلْءَ مَا خَلَقَ، وَالْحَمْدُ لِلَّهِ عَدَدَ مَا فِي السَّمَاوَاتِ وَمَا فِي الأَرْضِ، وَالْحَمْدُ لِلَّهِ عَدَدَ مَا أَحْصَى كِتَابُهُ، وَالْحَمْدُ لِلَّهِ مِلْءَ مَا أَحْصَى كِتَابُهُ، وَالْحَمْدُ لِلَّهِ عَدَدَ كُلِّ شَيْءٍ، وَالْحَمْدُ لِلَّهِ مِلْءَ كُلِّ شَيْءٍ، نستغفر الله ونتوب اليه سبحان الله يافارج الهمّ وياكاشف الغم فرّج همي ويسرّ أمري و أرحم ضعفي و قلة حيلتي وأرزقني من حيث لا أحتسب يارب العالمين . قال الرسول صل الله عليه وآله وسلم: مَن أخبَرَ الناس بهذا الدعاء فَرج الله هَمه اللهم اعني على ذكرك وشكرك وحسن عبادتك قل 3 مرات( سبحان الله وبحمده عدد خلقه سبحان الله وبحمده رضا نفسه سبحان الله وبحمده زنة عرشه سبحان الله وبحمده مداد كلماته تريد كنز في الجنة قل (لا حول ولا قوة الا بالله العلي العظيم) الحمد لله الذي أطعمنا، وسقانا، وكفانا
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''اللهم إني أسالك إيمانا دائما وأسألك قلبا خاشعا وأسألك علما نافعا وأسألك يقينا صادقا وأسألك دينا قيما وأسألك العافية من كل بلية' اللهم اجعل خير أعمالنا خواتمها وخير لحظاتنا لحظة الموت وخير أيامنا يوم نلقاك فيه اللهم اغفر للمؤمنين والمؤمنات والمسلمين والمسلمات الاحياء منهم والاموات اللهم صل على سيدنا محمد و آله و صحبه و سلم تسليما كثيرا عدد خلقك و رضى نفسك و زنة عرشك و مداد كلماتك و عدد ما علم الله السميع العليم سبحانك اللهم وبحمدك اشهد ان لا اله الا انت استغفرك واتوب اليك واؤمن بك واتوكل عليك لا اله الا انت سبحانك اني كنت من الظالمين اللهم إني أعوذ بك من زوال نعمتك وتحول عافيتك وفجاءة نقمتك وجميع سخطك . اللهم صلى وسلم على سيدنا محمد عدد ما ذكرك الذاكرون وغفل عن ذكرك الغافلون اللهم صل على سيدنا محمد و آله و صحبه و سلم تسليما كثيرا عدد خلقك و رضى نفسك و زنة عرشك و مداد كلماتك و عدد ما علم الله السميع العليم الْحَمْدُ لِلَّهِ عَدَدَ مَا خَلَقَ، وَالْحَمْدُ لِلَّهِ مِلْءَ مَا خَلَقَ، وَالْحَمْدُ لِلَّهِ عَدَدَ مَا فِي السَّمَاوَاتِ وَمَا فِي الأَرْضِ، وَالْحَمْدُ لِلَّهِ عَدَدَ مَا أَحْصَى كِتَابُهُ، وَالْحَمْدُ لِلَّهِ مِلْءَ مَا أَحْصَى كِتَابُهُ، وَالْحَمْدُ لِلَّهِ عَدَدَ كُلِّ شَيْءٍ، وَالْحَمْدُ لِلَّهِ مِلْءَ كُلِّ شَيْءٍ، نستغفر الله ونتوب اليه سبحان الله يافارج الهمّ وياكاشف الغم فرّج همي ويسرّ أمري و أرحم ضعفي و قلة حيلتي وأرزقني من حيث لا أحتسب يارب العالمين . قال الرسول صل الله عليه وآله وسلم: مَن أخبَرَ الناس بهذا الدعاء فَرج الله هَمه اللهم اعني على ذكرك وشكرك وحسن عبادتك قل 3 مرات( سبحان الله وبحمده عدد خلقه سبحان الله وبحمده رضا نفسه سبحان الله وبحمده زنة عرشه سبحان الله وبحمده مداد كلماته تريد كنز في الجنة قل (لا حول ولا قوة الا بالله العلي العظيم) الحمد لله الذي أطعمنا، وسقانا، وكفانا
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自作言語OpeLaでSDLを使い絵を描く方法を説明します。SDLはC言語で作られており、OpeLaから簡単に使えます。後半は可変長引数の対応方針を紹介します。
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¿ßÂåÅ ß±¿ýòÏ õù± û±ß¼ Û¿õþß± ÎäÂß •Erica Check— ¿õàɱî Îòä±õþ Âó¿Sß±õþ Û¶õÏò ü±Ñõ±¿ðß¼ Õ±Ë÷¿õþß± ÎïËߠ۶߱¿úî ôÂËõþò Âó¿ù¿ü Âó¿Sß±õþ æÅù±ý×-Õ±áˆÂ 2006 üÑàɱûþ Quest for the Cure õËù Ûß¿é Û¶õg ¿ùËàËåò¼ ¿î¿ò æ±ò±ËBåò, 1975 ÎïËß 2004-Ûõþ ÷ËñÉ Îû 1556 ¿é Ýø¸Åñ Õ±¿õ©¨Ôî ýËûþËå Ûõþ ÷±S 1%-Ûõþ õÉõý±õþ ¿õ¿öÂi§ ÕõËý¿ùî õ± ¿é¿õ-õþ ÷Ëî± ÕüÅËàõþ æòɼ ûàò Ûý×ëÂüÄ-Ûõþ ÷Ëî± Îõþ±Ëáõþ æòÉ Îß±¿éÂ-Îß±¿é ëÂù±õþ õÉ¿ûþî ýËBå ý±üÂó±î±Ëùõþ ðÔ¿©†Ëß±í ÎïËßÂ, îÂàò Îõþ±áÏõþ õ±™¦¸õ Û¶±ûþ ßÂàËò±Ýý× Õ±÷±Ëðõþ ß±Ëæ ñõþ± Îðûþ ò±¼ ¿ä¿ßÂÈüËßÂõþ õ±™¦¸õ Õ±õþ ¿ä¿ßÂÈü±õþ õ±™¦¸õ öÂÏø¸í ÂóÔïß ýûþ û±ûþ¼ Õ±Ëõþ± ü±¥x¿îÂß ÂóûÇËõ•ÂËíõþ ßÂï± ö±õ± ÎûËî Âó±Ëõþ¼ üÅü±õþ õvß ÛõÑ Õɱòh ³Â ¿õ¿ùÑ-Ûõþ Îùà± “Learning from Dying” Û¶õg¿éÂõþ ßÂï± õ¿ù¼ Û¶õgÂß±Ëõþõþ Û¶•Ÿ ßÂËõþËåò, Õ±÷±Ëðõþ ä±õþÂó±Ëú Îõþ±áÏËðõþ õÅçÂËî ¿áËûþ Îû model of detachment-Ûõþ ÷ñÉ ¿ðËûþ Õ±÷õþ± û±ý× Îüà±Ëò ¿ä¿ßÂÈüËßÂõþ± “how they can be healers, even in the face of terminal illness.” ÝÒËðõþ ÷™LÃõÉ, “Unfortunately, the ‘hidden curriculum’ of contem- porary medicine - especially the hurried, disease-centered,impersonal, high-thorough-out clini- cal years - stil tends to undermine the best interests of students and faculty members and the best interests of patients and families.” •¿òëÂ× ý×Ñùɱ` æ±òDZù Õõ Î÷¿ë¿üò 2005 5 ÎüË›I×Â¥¤õþ, 1313- 1315— ÛßÂ-ý× üÑàɱûþ Îõþ¿ò ô' îÒ±õþ “Cultural Competence and the Culture of Medicine”-Û Ã›¶•Ÿ îÅÂùËåò - ÛõþßÂ÷ Âó±êÂÉ õý×-ê±ü± ¿ä¿ßÂÈü± ¿ú•Â±õþ æáËî ü¿îÂÉ-ý× ¿ß ÷±ò¿õß ýËûþ Ýê±õþ Îß±Ëò± üÅËû±á Õ±Ëå· ‘‘Î÷¿ëÂßÂɱù ¿ýëÂ×÷ɱ¿ò¿éÂü’’ õ± ‘‘òɱ¿õþ¿éÂö Î÷¿ë¿üò’’ -Ûõþ ÷Ëî± Âó±êÂÉS•÷ Æî¿õþ ýËBå¼ ‘Î÷¿ëÂßÂɱù ¿ýëÂ×÷ɱ¿ò¿éÂü’ õËù Ûß¿é ձù±ð± Âó¿Sß± ¿òûþ¿÷î Û¶ß±¿úî ýËBå ßÂËûþß õåõþ ñËõþ¼ ÛË•ÂËS Õ±÷±Ëðõþ ÎðËúõþ ¿ú•Â±S•÷ úîÂËû±æò ðÅËõþ¼ ÛàËò± Ûà±Ëò Û¶ñ±òî ü±Ëõ¿ß ձ÷Ëùõþ ÂóêÂò-Âó±êÂò ÕòÅüõþí ßÂõþ± ýûþ¼ ôÂùî ÷±ò¿õß ¿ä¿ßÂÈüß ¿ýËüËõ ûÒ±õþ± Õ±R۶߱ú ßÂËõþò îÒ±õþ± ¿òËæËðõþ Õ±ðúÇáî Õõ¦š±ò õ± õÉ¿M•áî ä¿õþËSõþ &Ëí ßÂËõþò¼ ¿ú•Â±S•Ë÷õþ Îß±Ëò± ßÔ¿îÂQ Õ±¿÷ Õ™LÃî Ûà±Ëò àÅÒËæ Âó±ý× ò±¼ ÛõÑ Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ Õ±öÂÉ™Lÿõþò ß±ê±Ë÷±õþ ÷ËñÉ ÷±ò¿õß ýËûþ Ýê±õþ ëÂ×Âó±ð±ò Û¶±ûþ Îòý× õùËùý× äÂËù¼ õåõþ ÂóÒ±ËäÂß ձËá ¿òëÂ× ý×Ñùɱ` æ±òDZù Õõ Î÷¿ë¿üò-Û õ±õþõ±õþ± Îæ ÷Éß¿òù Ûß¿é Û¶õg ¿ùËà¿åËùò “Hidden Barriers to the Improvement of Health Care”. Û Ã›¶õg Û¶ßÔÂîÂÂóË•Â 2001-Ûõþ &•QÂóÓíÇ õ±Èü¿õþß ‘‘ú±éÂß ÎùßÂä±õþ’’¼ Îü Û¶õËg ¿î¿ò æ±ò±ò, “Uncertainty can be interpreted not only as lack of convincing evidence but also as impaired access to convincing evidence... Uncertainty influ- ences virtually all of medical decision making...The lack of data persists despite enormous efforts to improve clinical decision making... The well-reported underrepresentation of women in clinical trials similarly limits informed decision making...the results of clinical studies sug- gest that varying perceptions of the same data can lead to different clinical decisions.” üõ ÎúËø¸ îÒ±õþ ¿üX±™Là ýù, “Once we know more definitively what to do for our patients and at what cost (average and marginal), we will have a clearer road map for thinking about priorities...” •õ±õþõ±õþ± Îæ ÷ɱß¿òù, ¿òëÂ× ý×Ñùɱ` æ±òDZù Õõ Î÷¿ë¿üò, 21 òËöÂ¥¤õþ 2001, ÂóÔ 1612-1620— ¿ß ¿ß õùËùò ÷ɱß¿òù· Û¶ï÷îÂ, ¿ä¿ßÂÈü±õþ Û¶±ûþ ü÷™¦¸ ú±à±Ëî տò}Âûþî± Ûß¿é ëÂ×Ë{¡àËû±áÉ ¿õø¸ûþ, ¿ZîÂÏûþîÂ, Õ¿ò}Âûþî±õþ ð•í ü±õÇæòÏòö±Ëõ ü¿êÂß Û¶÷±í ¿òöÇÂõþ Îß±Ëò± ¿ä¿ßÂÈü±õþ ßÂï± õù± Û¶±ûþ ðÅÐü±ñÉ Ûß¿é ß±æ îÔÂîÂÏûþîÂ, ¿ä¿ßÂÈüËßÂõþ Îõ±Ëñõþ Âó±ïÇËßÂÉõþ æòÉ ÛßÂ-ý× îÂËïÉõþ ¿öÂi§ ¿öÂi§ õɱàɱ üyÂõ äÂîÅÂïÇîÂ, ¿ù/-Æõø¸Ë÷Éõþ æòÉ Îû üõ îÂïÉ 7
8.
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ÂóÅËõþ± ¿òöÇÂõþËû±áÉ òûþ¼ ÛõÑ üõËúËø¸ ¿üX±™Là ¿òËBåò, Îõþ±áÏõþ ¿õËúø¸ Õõ¦š±Ëòõþ ÝÂóõþ ¿òöÇÂõþ ßÂËõþ ¿ä¿ßÂÈü±õþ Õá豿ñß±õþ ¿êÂß ßÂõþËî ýËõ¼ Û å±h± Õ±Ëõþ± ÕËòß ձËù±äÂò± õþËûþËå Û¶õg¿éÂËî - Îû÷ò, ¿öÂi§ Æð¿ýß ÛõÑ æiœáî Õõ¦š±Ëòõþ æòÉ ÛßÂ-ý× Ýø¸ÅËñõþ ¿õ¿öÂi§ ôÂù±ôÂù, ¿õ¿öÂi§ ü±Ñ¦Ô¨¿îÂß Âó¿õþËõËúõþ æòÉ ¿ä¿ßÂÈü±õþ ôÂù±ôÂËùõþ ¿õ¿öÂi§î± ý×îÂɱ¿ð¼ ÷ɱß¿òËùõþ ßÂï±õþ üÅS ñËõþ õùËõ± Û¶÷±í ¿òöÇÂõþ ¿ä¿ßÂÈü±õþ Û¶¿î ձ÷±Ëðõþ Îû Õ±Båi§î± Îõ±ñ ß±æ ßÂËõþ î±õþ ÕËòßÂé± ¿õÂóõþÏËî ÷ɱß¿òËùõþ õM•õɼ Û å±h± Âó¿ù¿éÂßÂü Õõ Û¿öÂËëÂk-Îõüë Î÷¿ë¿üò ¿òËûþÝ Ã›¶äÅÂõþ Îùà±Ëù¿à ýËBå¼ ôÂËù EBM (Evidence-Based-Medicine)-Ûõþ ¿÷ï Ûàò ÕËòßÂé±ý× ðÅõÇù¼ ÛîÂüõ ¿õ¿öÂi§î±õþ ÷±Ëç ձ÷õþ±, Û¶ï÷ ðÅ¿òûþ±õþ ¿ä™Lñûþ ü÷ÔX ÷±ï± ¿òËûþ ß±æ ßÂõþ± îÔÂîÂÏûþ ðÅ¿òûþ±õþ ¿ä¿ßÂÈüËßÂõþ± ßÂî üýËæ ÛßÂ-ý× Îõþ±Ëáõþ Î|íÏ-öÓÂM• ü÷™¦¸ Îõþ±áÏõþ æòÉ •Ûõþ± ÎßÂëÂ× Õ±÷±Ëðõþ ß±Ëå õÉ¿M• õ± Û¶ßÔÂî ÷±òÅø¸ òûþ, ÎßÂõù÷±S Îõþ±áÏ— áî 150 õåËõþ ¿ä¿ßÂÈü±õþ æáËî Îû Âó¿õþõîÇÂò ýËûþËå î±õþ ÷ËñÉ &•QÂóÓíÇ ýù - õÉ¿M• ¿ä¿ßÂÈüß Îõþ±áÏõþ áÔËý ¿áËûþ ¿ä¿ßÂÈü±õþ Îû ð±¿ûþQ ¿òËîÂò î±õþ Âó¿õþõËîÇ Ûß¿é æ¿éÂù, ï±ßÂõXÂ, Û¶ûÅ¿M•-¿òöÇÂõþ, ÎÂóú±ð±õþ ¿ä¿ßÂÈüßÂ Ý ¿ä¿ßÂÈü±ßÂ÷ÇÏ-ü÷ÔX ¿ä¿ßÂÈü± õÉõ¦š±¼ •üÓS “Tavistock Group ; A shared statement of ethical principles for those who shape and give healthcare”, British Medical Journal, 1999; 318 : 249- 51.) Ûüõ ¿ßÂåÅõþ Îû±áôÂËù Îû üõ ÷±òÅø¸ ÛßÂü÷ûþ ¿òËæËðõþ ¿õ¿öÂi§ ú±õþÏ¿õþß ü÷üɱ ¿òËæõþ± ü±÷Ëù ¿òËîÂò î±õþ± Ûàò ÕËòß ÎõúÏ ¿ä¿ßÂÈüßÂËðõþ úõþí±Âói§ ýËBåò - “an unquestioning media and drug companies turn everything into a ‘disease’ in need of treatment.” Û ÷™LÃõÉ Õ±÷±õþ òûþ, Õõü±öDZõþ Âó¿Sß±õþ ò±÷Ï ü±Ñõ±¿ðß ÕɱKé¿ò õè±ëÂ×Ëòõþ¼ •Observer, Sunday, April 14 2002). Û å±h± Õ±Ëá Õ±Ëù±¿äÂî õþûþ ÷ûþ¿òý±Ëòõþ Îùà± Õ±Ëõþß¿é &•QÂóÓíÇ Ã›¶õg “The making of a disease : female sexual dysfunction” ÎïËß ÛßÂéÅÂ౿ò ëÂ×Ë{¡à ß¿õþ, “ The corporate sponsored creation of a disease is not a new phenomenon, but the making of female sexual dysfuction is the freshest, clearest example we have.” •¿õè¿éÂú Î÷¿ëÂßÂɱù æ±òDZù, 4 æ±òÅûþ±¿õþ 2003, 45-47—¼ 1998 ü±Ëù ö±ûþ±áè± õËù ÂóÅ•ø¸Ëðõþ æòÉ ¿õËúø¸ Ýø¸Åñ¿é ձ¿õ©¨±õþ ýõ±õþ Âóõþ ÎïËß 2003 ÂóûÇ™Là 1 Îß±¿é 70 ù•Â ÂóÅ•Ëø¸õþ æòÉ Û Ýø¸Åñ Îùà± ýËûþËå - ôÂù±ôÂù û± Îý±ß ò± ÎßÂò¼ ÛËî ô±ý×æ±õþ Îß±¥ó±òÏ-õþ 2001 ü±Ëùõþ ¿õS•Ïõþ Âó¿õþ÷±í 150 Îß±¿é Âó±ëÂ×`¼ ÛõþßÂ÷ ôÂù±ôÂËù ëÂ×Èü±¿ýî ýËûþ Ýø¸Åñ Îß±¥ó±òÏ&Ëù±õþ Ûõ±õþ Û¶Ëûþ±æò “To build similar markets for drugs among women, companies first require a clearly defined medical diagnosis with measur- able characteristics to facilitate credible clinical trails. Over the past six years the pharmaceu- tical industry has funded, and its representatives have in some cases attended, a series of meetings to come up with just such a definition.” ôÂËù Îß±¿é Îß±¿é é±ß±õþ ß±õþõ±¿õþ Õ¿îÂ-õÔýÈ Ýø¸Åñ Îß±¥ó±òÏ&Ëù±õþ ÂóË•Â female sexual dysfunction-Ûõþ ÷Ëî± Ûß¿é ÕüÅËàõþ æiœ Îðûþ± ¿òî±™Là æ•õþÏ ýËûþ ÂóËh¼ Û Ã›¶üË/ Õ±õ±õþ Ûß¿é ëÂ×XÔ¿îÂ, î±-Ý Õ±ËõþßÂõ±õþ ý×ÑËõþ¿æËîÂ, Îðõ±õþ Îù±ö ü±÷ù±Ëî Âó±õþ¿åò± •Âó±êÂËßÂõþ± ÷±ô ßÂõþËõò Õ±ú± õþ±¿à—, “The potential risk, in a process so heavily sponsored by drug companies, is that the complex social, personal, and physical causes of sexual difficulties and the range of solutions to them will be swept away in the rush to diagnose, lavel, and prescribe. Perhaps the greatest concern comes from the flip side of inflated estimates of disease prevalence the ever-narrowing definitions of ‘normal’ which help turn the complaints of the healthy into the 8
9.
conditions of the
sick.” ¿ä¿ßÂÈü± ÛõÑ ¿ä¿ßÂÈüËßÂõþ ý±î ñËõþ ÷ÅËå ÎûËî q• ßÂËõþ healthy ÛõÑ sick-Ûõþ ÷ËñÉß±õþ üÏ÷±Ëõþà±¼ ÛæòÉ normal-Îß òîÅÂò ÎäÂý±õþ±ûþ ü/±¿ûþî õ± ¿òñDZõþí ßÂËõþ Îòõ±õþ Û¶Ëûþ±æò ÂóËh¼ Õ±õþ ÂóÅËõþ± Û¶¿S•ûþ±¿éÂËî ÷ñɦšî±ß±õþÏ ¿ýËüËõ ï±Ëß տîÂ-õÔýÈ Ýø¸Åñ Îß±¥ó±¿ò&Ëù±¼ Healthy ÛõÑ sick, Ûý× ðÅý× binary-õþ ÷±Ëç ¦¤±¦šÉ õ± health-Ûõþ Õõ¦š±ò - Îß±ò ¦¤ûþÑ-ü¥óÓíÇ üM± ¿ýËüËõ òûþ, ¿õ¿öÂi§-÷ÅàÏ ¦¤±ËïÇõþ é±ò±ËÂó±ËhÂò Ûõþ ÎäÂý±õþ± ¿òXDZ¿õþî ýûþ¼ ¦¤±¦šÉ Ý õþ±æòÏ¿î Õ÷îÇÂÉ ÎüËòõþ ü±¥x¿îÂß õM•õÉ Îõ±ñ ß¿õþ ÕËòß ¿ú¿•Âî ÷±òÅø¸Ëß ö±¿õî ßÂËõþËå¼ îÒ±õþ õM•õÉ ÕòÅû±ûþÏ ¦¤±¦šÉ Û¶ßÔÂîÂÂóË•Â Ûß¿é õþ±æËò¿îÂß ÎÛ¶±áè±Ë÷õþ ÷ËñÉ ÂóËh¼ ßÂﱿé àÅõ òîÅÂò òûþ¼ ¿õàɱî æ±÷DZò Âóɱïù¿æˆÂ, Æõ:±¿òß ÛõÑ õþ±æÍò¿îÂß õÉ¿M•Q •ëÂùô ¿öÂõþßÂ±Ý õ± ¿öÂõþËú± •Rodolf Virchow— 1848 ü±Ëù æ±÷DZ¿òõþ Õ±Âó±õþ ü±ý×Ëù¿üûþ± Õ=ÁËù é±ý×ô±ü Îõþ±Ëáõþ ß±õþí ÕòÅüg±ò ßÂËõþ 4¿é àËG “Report on the Typhus Epidemic in Upper Silesia” ۶߱ú ßÂËõþò¼ Îü ¿õþËÂó±ËéÇ ¿î¿ò õËùò – “Medicine is a social science, and politics is nothing but medicine on a large scale.” ÕïDZÈ, ÛßÂéÅ òæõþ ßÂõþËù õÅçÂËõ±, Û¶±ûþ 165 õåõþ ýËù± Î÷¿ë¿üò ÛõÑ ¦¤±¦šÉËß õþ±æòÏ¿îÂõþ ÕÑú ¿ýËüËõ ñõþ± ýËBå¼ Õ±÷õþ± ò± ýûþ ÛßÂéÅ ÎÂóåËò ýÒ±éÂ¿å¼ î±õþ ÷±Ëò Îî± Ûé± òûþ Îû ¿õø¸ûþ¿é ¿ú¿•Âî æáËîÂõþ äÂäDZõþ ÷ËñÉ Îòý×¼ Û¶ü/î ëÂ×Ë{¡àËû±áÉ, Journal of Epidemiology and Community Health-Ûõþ Õ±™LÃæDZ¿îÂß Âó¿Sß±õþ Õ±áˆÂ 2011-õþ üÑàɱ¿éÂõþ ¿õø¸ûþ ýËù± – Politics, primary healthacre and health : was Virchow right ? Ûõ±õþ Õ±÷õþ± ö±õþËîÂõþ æò¦¤±Ë¦šÉ üõþ±ü¿õþ Û¶Ëõú ß¿õþ¼ ö±õþËî æò¦¤±Ë¦šÉõþ ÕîÂÏîÂ Ý õîÇÂ÷±ò æò¦¤±¦šÉ ús¿é ðÅ¿é úËsõþ ÎûÌáÂóð - ÛËî± üõ±õþ æ±ò± ßÂï±¼ ÛéÂ±Ý üõ±õþ æ±ò± Îû Û ús¿é ձ÷õþ± áèýí ßÂËõþ¿å ý×ÑËõþ¿æ public health -Ûõþ Û¶¿îÂús ¿ýËüËõ¼ áèýí ò± ßÂËõþ ëÂ×Âó±ûþ Îòý×¼ Õ±õ±õþ áèýí ßÂõþ±õþ ÷±ËçÂÝ ¿ßÂåÅ ü÷üɱ ùÅ¿ßÂËûþ Õ±Ëå¼ Û ¿òËûþ ÛßÂéÅÂ౿ò ßÂï± õËù ÷Óù Õ±Ëù±äÂò±ûþ Û¶Ëõú ßÂõþ± ýËõ¼ 27Ëú æ±òÅûþ±¿õþ 2011-Îî Û¶ß±¿úîÂ Û ÷ÅýÓËîÇ ÂóÔ¿ïõÏõþ üõËäÂËûþ ÷±òÉ Î÷¿ë¿üËòõþ æ±òDZù New England Journal of Medicine-Û Ã›¶ß±¿úî Û¶õg “Public Health in Haiti - Challenges and Progress”-Û õù± ýËBå - Nevertheless, long-standing public health problems remain. Efforts to improve roads to reduce traffic injuries, provide lifesaving community and obstetrical services, and repair, upgrade, or build safe water and sanitation systems are just beginning to be scaled up. Û¶õËgÂõþ ÎúËø¸ ÂóûÇËõ•Âí¿é ÛõþßÂ÷ “Political stability will be essential, and a central challenge will be to train and employ an adequate public health workforce to carry on the work of the small cadre of public health leaders...” ëÂ×ÂóËõþõþ Õ±Ëù±äÂò± ÎïËß üýæËõ±ñÉ Îû public health-Ûõþ ü±Ëï æ¿hÂËûþ Õ±Ëå õþ±™¦¸±-â±ËéÂõþ Õõ¦š± ÎïËß Âó±íÏûþ æù, üɱ¿ò鱿õþ õÉõ¦š± ÎïËß õþ±æÍò¿îÂß üÅ¿¦šõþî± ý×îÂɱ¿ð üõ¿ßÂåÅý× Õ™LÃáÇî ýËûþ Õ±Ëå æò¦¤±Ë¦šÉõþ õ±™¦¸õ±ûþËòõþ ÷±Ëç¼ Ûõþ ÕïÇ ýù æÏõËòõþ Û¶¿î¿é ΕÂS Õ±ò±äÂ-ß±ò±ä Î÷¿ë¿üËòõþ òæõþð±¿õþõþ ÷ËñÉ äÂËù ÛËù±, û±Ëß õù± ýûþ ‘‘Î÷¿ëÂßÂɱù±ý×Ëæúò Õõ ù±ý×ôÂ’’¼ ßÂùß±î± Õ±ñÅ¿òß ëÂ×Âó¿òËõ¿úß òáõþ ýËûþ áËh Ýê±õþ ûÅËá æòæÏõòËß ý±üÂó±î±ù Ý Î÷¿ë¿üËòõþ òæõþÂóËï ¿òËûþ Õ±ü±õþ æòÉ Ã›¶õ¿îÇÂî ‘‘öÂõâÅËõþ Õ±ý×ò’’, “Lunacy Act” ý×îÂɱ¿ðõþ ßÂï± Õ±÷±Ëðõþ ¦œõþËí Õ±üËõ Õ±ú± ß¿õþ¼ õþ±©†˜ Ý ¦¤±Ë¦šÉõþ Õ¿òõ±ûÇ ü¥óßÇ Îõ±ç±Ëî 1779 ü±Ëùý× æ±÷Ç±í ¿ä¿ßÂÈüß Îû±ý±ò ¿Âóé±õþ 9
10.
ô豩¨ õÉõý±õþ ßÂËõþ¿åËùò
¿õàɱî Îü ús¿éÂ-õg¿é Medical Police, îÒ±õþ A System of Complete Medical Police áèËLš¼ 9¿é àË` ¿õöÂM• Û áèËLšõþ 4ïÇ ÕÑËúõþ îÔÂîÂÏûþ ÕñɱËûþ ô豩¨ õùËåò - In dealing with this important subject of Medical Police, I must refer to all that I have said elsewhere about necessary cleanliness of the air... of large towns, etc.. so that now I can lecture on pertinent matters... public health cure is necessary. (A System of Complete Medical Police : Selections from Johann Peter Frank, ed., Erna Lesky, Johns Hopkins University Press, Baltimore, Mary- land, 1976, p. 183) ÛËßÂõ±Ëõþ ¿öÂi§ Ûß¿é ¿õø¸Ëûþõþ Õõî±õþí± ß¿õþ Ûàò¼ ý×ÑËõþ¿æËî û±Ëß ձ÷õþ± áè±÷±õþ õ¿ù õ±Ñù±ûþ Îüé± õɱßÂõþí¼ ðÅËé± ¿ß Ûß· ýõþÛ¶ü±ð ú±¦aÏ õËù¿åËùò - üѦԨî õɱßÂõþí úËsõþ ÕïÇ õɱ¿S•ûþË™Là õÅÉÈÂóðË™Là ús± Õ±Ëòò - ÕïÇ±È ý׿éÂûþù¿æ - Îë¿õþËöÂúò¼ õ±™¦¸¿õßÂý× ÷Å*Ëõ±ñ±¿ðËî Âóð¿é ÆîÂûþ±õþ ß¿õþûþ± ÎðÝûþ± ÂóûÇ™Là õɱßÂõþËíõþ ß±ûÇ... õɱßÂõþí qX Aetiology ÷±S Îüý× õɱßÂõþíËß grammar-Ûõþ ù•ÂËí ù¿•Âî ßÂõþ± ëÂ׿äÂî ¿ß ò±, üýËæý× Îõ±ñ ßÂõþ± û±ý×Ëî Âó±Ëõþ¼ •Ùí ¦¤Ïß±õþ Âó¿õS üõþß±õþ - õɱßÂõþí ÷±Ëò ¿ßÂ, Û¶ü/ õ±Ñù± õɱßÂõþí 2, Âó¿}Â÷õ/ õ±Ñù± ձ߱Ëð¿÷, 2006— ÕïÇ±È üѦԨî ÎïËß ձý¿õþî õ±Ñù± õɱßÂõþí ús¿éÂËß ý×ÑËõþ¿æ áè±÷±õþ ús¿é ¿òËæõþ ÷Ëî± ßÂËõþ ÂóÅòáÇ¿êÂî ßÂËõþ ¿òËûþËå¼ Û•ÂËS ÷Óù õɱßÂõþí úËsõþ Õ±öÂÉ™LÃõþÏò õÉ?ò± õðËù Îáù¼ õɱßÂõþËíõþ õ±ý×Ëõþ Û¶±ßÔ¿îÂß æáËî ձ¿ü¼ ÷Óù üѦԨËî æ±/ù ús¿é õÉõý+î ýËûþËå Û÷ò Ûß Õ=Áù Îûà±Ëò öÓ¿÷ ••Â, &{œ õ± ß񱎱 æ±îÂÏûþ ëÂ׿¾ð æiœ±ûþ¼ Ûõþ ¿õÂóõþÏËî õþËûËå ÕòÓÂó ús¿é û±õþ ÕïÇ æù±öÓ¿÷¼ ÷¿òËûþõþ-ëÂ×ý׿ùûþ±÷Ëüõþ üѦԨîÂ-ý×ÑËõþ¿æ Õ¿öÂñ±ò æ±ò±ËBå æ±/ù úËsõþ ÕïÇ - arid, sparingly grown with trees and plants (though not unfertile)¼ Õ±÷õþ± Îðà¿å Û ús¿é ¿ßÂö±Ëõ õòöÓ¿÷ õ± ôÂËõþˆÂ-Ûõþ ü÷±ïÇß ýËûþ ëÂ×êÂËù±¼ Õ'Ëô±ëÇ ý×Ñ¿ùú ¿ëÂßÂúò±¿õþ õùËå - The change in Anglo-Indian use may be compared to that in the historical meaning of the word forest in its passage from a waste or unenclosed tract to one covered with wild wood. In the transferred sense of jungle there is apparently a tendency to associate it with tangle. Û ¿õø¸Ëûþ äÂ÷Èß±õþ Õ±Ëù±äÂò± ßÂËõþËåò ôè±ò¿üü ¿æ÷±õþ÷ɱò îÒ±õþ The Jungle and the Aroma of Meats (Motilal Banarsidass, 1999) áèËLš¼ ¿î¿ò ÷™LÃõÉ ßÂõþËåò - The Hindi name terai (“marshy lands”) - the exact semantic equivalent of the Sanskrit anupa - now becomes the aberrant synonym of jungle. (Ibid, p. 15) Õ±Ëõþß¿é ús û± Õ±÷±Ëðõþ Õ±Ëù±äÂò±õþ Û¶ñ±ò ¿õø¸ûþ î± ýù ¦¤±¦šÉ¼ Õ±ûþÅËõÇËðõþ õ±ý×ËõþÝ õþ±÷±ûþí ÷ý±ö±õþî üý Û¶±ûþ ü÷™¦¸ üѦԨî áèËLš ¦¤±¦šÉ Ý ¦¤¦š úËsõþ õÉõý±õþ Âó±Ýûþ± û±ûþ¼ ¦¤±¦šÉ-õþ üѦԨî ÕïÇ ýù ¦¤-Îî ¿¦šî ýÝûþ± õ± ¿ôÂËõþ Õ±ü±¼ ¿÷Ëõþ±• ý±õþ± îÒ±õþ “A Note on the Sanskrit Word Svastha” (European Journal of Ayurvedic Society 4, 1995, pp. 53-87) Û¶õËgÂ Û ¿õø¸Ëûþ ¿õúËð ÕîÂÉ™Là ÷Ëò±: Õ±Ëù±äÂò± ßÂËõþËåò¼ îÒ±õþ ßÂï±ûþ - It implies not only a healthy physical condition, but also a serene state of mind The usage, however, is not limited to the state and condition of individual human beings, but is extended to those of the state and government. Û ü÷™¦¸ Õ±Ëù±äÂò± ÎïËß ՙLÃî Ûß¿é Û¶±ï¿÷ß Îõ±Ëñ ÎÂóÌÒåËò± ÎûËî Âó±Ëõþ Îû Alma Ata üË¥œùËòõþ ÷ñÉ ¿ðËûþ æiœ ÎòÝûþ± health-Ûõþ ¿õ•«æòÏò ñ±õþí±õþ ü±Ëï ö±õþîÂÏûþ ¦¤±Ë¦šÉõþ ñ±õþí±õþ Ûß¿é ÷Óùáî տ÷ù Õ±Ëå¼ û¿ðÝ õù±õþ ÕËÂó•Â± õþ±Ëà ò±, ¦¤±¦šÉ Ý health ü÷±ïÇß ýËûþ ÂóËhÂËå¼ Õ±Ëõþß¿é Û¶ü/ ëÂ×O±Âóò ßÂËõþ Û Ã›¶±ï¿÷ß ձËù±äÂò±ûþ û¿î é±ò± ÎûËî Âó±Ëõþ¼ Õ±÷±Ëðõþ ü±ñ±õþí Îõ±ñ-õÅ¿XÂËî õÅ¿çÂ, Õ±ûþÅËõÇË𠦤±¦šÉ ¿òËûþ üõËäÂËûþ ÎõúÏ Õ±Ëù±äÂò± ýõ±õþ ßÂï±¼ ÛõÑ õ±™¦¸Ëõ î± ýËûþËåݼ Õ±ûþÅËõÇð ¿ßÂcà Û¶ßÔÂî ÕËïÇ Îß±ò ¿ä¿ßÂÈü± ¿õ:±ò òûþ¼ ÛßÂæò ÷±òÅËø¸õþ Õ±ûþÅ ÕïÇ±È 10
11.
ðÏâÇæÏ¿õî± ¿òËûþ Õ±Ëù±äÂò±
ýËûþËå Û ú±Ë¦a¼ Û¶îÂɱ¿úîÂö±Ëõý× Õ±ûþÅËõÇð ú±Ë¦aõþ Õ±Ëù±äÂò±õþ Û¶ñ±ò ÕÑú õÉ¿ûþî ýËûþËå ÷±òÅËø¸õþ ¿ä¿ßÂÈü± üÑS•±™Là ¿õø¸Ëûþ¼ Õ±ûþÅËõÇËðõþ ý׿îÂý±ü Û¶±ûþ 2500 õåËõþõþ¼ ôÂËù õÔ¿éÂú ú±üËòõþ 200 õåõþ õ±ð ¿ðËù ÂóÅËõþ± ü÷ûþß±ù æÅËh ձûþÅËõÇËð Õ±Ëù±¿äÂî æÏõò±äÂõþËíõþ Îõ±ñ ¿ò÷DZí ßÂËõþËå ö±õþîÂÏûþ üM± õ± subjectivity¼ ÕËòËßÂõþ æ±ò± äÂõþßÂ-üÑ¿ýî±õþ Âó¿õþ¿äÂî Ε-±ß - ¿ýýîÂÑ üÅàÑ ðÅ à÷±ûþÅ™¦¸üÉ ¿ýýîÂ÷÷ “ ÷±ò=ÁîÂBä ûËS±S•÷±ûþÅËõÇð ü ëÂ×BäÂËî •üÓS¦š±ò - 1¼41— Ûõþ ÕïÇ - Õ±ûþÅ ä±õþ ۶߱õþ¼ ¿ýî±ûþÅ , Õ¿ýî±ûþÅ , üÅà±ûþÅ Ý ðÅ à±ûþż ÕïDZÈ, üýæ ßÂËõþ õùËù, Õ±ûþÅ üÑS•±™Là Îû üõ ¿õø¸ûþ ÛõÑ î±õþ Âó¿õþ÷±í Ý ¦¤õþ+Âó ¿òíÇûþ Îû ú±Ë¦a Õ±Ëå î±Ëß ձûþÅËõÇð õËù¼ Û Ã›¶üË/ ÛËüËå ÙîÅÂ, ¿ðò Ý æÏõËòõþ ¿õ¿öÂi§ ÂóûDZËûþ ÛßÂæò ÷±òÅø¸ ¿ßÂö±Ëõ æÏõò û±Âóò ßÂõþËõ •¿õõ±¿ýî ÎûÌò æÏõò üý—, ü™Lñò ñ±õþí Ý Ã›¶¿îÂÂó±ùò ßÂõþËõ, Û¶ßÔ¿îÂõþ ü±Ëï ö±õþü±÷É ÎõþËà Û¶ßÔ¿îÂËß ùãâò ò± ßÂËõþ äÂùËõ, ¿ú•Â±õþ ñõþò ÎßÂ÷ò ýËõ ý×îÂɱ¿ð ü÷™¦¸ Æò¿îÂßÂ, Û¶±îÂÉ¿ýßÂ, Âó±õþËùÌ¿ßÂß ¿õø¸ûþ Ûõþ ÷±Ëç ՙLÃöÇÓÂM• ýËûþËå¼ üõÇæò÷±òÉ Âó¿`ÂîÂ Ý Õ±ûþÅËõÇð: ¿Âó ¿ö ú÷DZ Ûß ßÂï±ûþ õùËåò - In fact Ayurveda is not a system of medicine but a dynamic philosophy of life by which one can attain healthy individual and social life so as to perform the functions efficiently and blissfully, at the end to attain perfect bliss of liberation. (Essentials of Ayurveda, Motilal Banarsidass, 1998, p. xliv) Õ±õ±õþ äÂõþßÂ-üÑ¿ýð± - Û¶±Ííø¸í± ñÍòø¸í± ÂóõþËù±ÍßÂø¸Ëí¿î “ •üÓS¦š±ò - 11¼3— Õ±ËßÂî ¦š±Ëò ëÂ×Ë{¡¿àî - ۶±íÂó¿õþîÂɱËá ¿ý üõTÇîÂÉ±á ¼ îÂüɱòÅÂó±ùòÑ ¦¤¦šüÉ ¦¤¦šõÔ¿Mõþ±îÅÂüÉ ¿õß±õþÛ¶ú÷Ëò ýÛ¶÷±ð “ •üÓS - 11¼4— Ûõþ üõþù ÕïÇ ýù - ÎßÂò ò± Û¶±íîÂɱËáý× üõÇîÂɱἠüõDZËáè Û¶±í±òÅÂó±ùò ßÂõþ± ¿õËúø¸ ßÂîÇÂõɼ üŦš Õõ¦š±ûþ ¦¤±¦šÉõþ•Â± Z±õþ± ÛõÑ ÕüŦš ýËù ëÂ×ËÂó•Â± ò± ßÂËõþ Îõþ±á ú±¿™Là Z±õþ± Û¶±í±òÅÂó±ùò ßÂõþ± ýûþ¼ Îõ±ç± û±ËBå, Û¶±í, ñò Ý ÂóõþËù±ËßÂõþ ü±Ëï Îõþ±á ÛõÑ ¿ä¿ßÂÈü± ûÅM• ýËûþ Æî¿õþ ýù Õ±ûþÅËõÇËðõþ Âó¿õþüõþ Ý Âó±ËêÂõþ ß±ê±Ë÷±¼ qñÅ î±ý× òûþ¼ Û ú±¦a Õ±Ëù±äÂò±õþ ü±Ëï æ¿hÂËûþ Õ±Ëå õþ±æñ÷Ç, ü±÷™L¸ Ý ßÔ¿ø¸-󦕱 ¿òöÂÇõþ Ûß ü÷±æËõ±Ëñõþ ¿ö¿MöÓ¿÷¼ ÛõÑ üËõDZÂó¿õþ, Õ±ûþÅËõÇð ÕîÂÉ™Là ðÔìÂÿö±Ëõ ÂóÅ•ø¸î±¿Laß òæõþð±¿õþõþ ¿òöÇÅÂù ÎðɱîÂß¼ Û üõ üËQÝ Û ¿õø¸ûþ¿é ¿òËûþ ßÂï± àõþä ßÂõþ±õþ ß±õþí ýù, Û ¿ä¿ßÂÈü± õÉõ¦š± Û¶±ßÂ-õÔ¿éÂú ö±õþËîÂõþ ¦¤±¦šÉ Ý æÏõò Îõ±ñËß Û¶õùö±Ëõ ¿òûþLaí ßÂËõþËå¼ ÛËß ¦š±òäÓÂÉî ßÂËõþý× q• ýËûþËå Õ±ñÅ¿òß æò¦¤±Ë¦šÉõþ ÕË÷±â û±S±¼ äÂõþßÂ- ÛõÑ üÅ|ÅîÂ-üÑ¿ýî±ûþ Û÷ò ¿ß Û¶±ï¿÷ß ™¦¸Ëõþõþ ý±üÂó±î±Ëùõþ ßÂï±Ý õù± Õ±Ëå¼ äÂõþßÂ-üÑ¿ýî±ûþ õù± ýËBå - ÎðËýõþ üÑËú±ñËòõþ æòÉ Ýø¸Åñ ÎüõËòõþ Õ±Ëáý× Ûß¿é áÔý ¿ò÷DZí ßÂõþËî ýËõ¼ áÔý¿é ðÔìÂÿ Ý õ±ûþÅõ±¿ýî ýËõ¼ ÛËî ¿õäÂõþí ßÂõþËî Îûò Îß±ò ß©† ò± ýûþ¼ Õ¿ò©†ßÂõþ Îß±ò õd Îû÷ò, ñÓ÷, ÎõþÌ^, ñÓù± Û¶Ëõú ßÂõþËî ò± Âó±Ëõþ¼ áÔý¿é Îûò Õ¿ò©†ßÂõþ ús, ¦óúÇ, õþ+Âó, õþü Ý áËgÂõþ Õá÷É ýûþ¼ Îüà±Ëò Îûò Îü±Âó±ò, ëÂ×ðÓàù, ÷Óø¸ù, ÷ùîÂɱËáõþ ¦š±ò, ¦§±òöÓ¿÷ Ý õþgÂòú±ù± ï±Ëß¼ •üÅS¦š±ò - 15¼6— Û ßÂï±Ý õù± ýËBå Îû Îüà±Ëò Îûò àõþËá±ú, ý¿õþí, ßÔÂø•ü±õþ ÷Ôá, Î÷ø¸, òÏËõþ±á æÏõõÈü± ðÅ*õîÂÏ á±öÂÏüßÂù ý×îÂɱ¿ð ï±Ëß¼ Îõþ±áÏõþ üÅ|Åø¸±ß±õþÏ Ý Þø¸ñËÂóø¸Ëí ü÷ïÇ Âó¿õþä±õþßÂõÔj ï±Ëß¼ •üÅS¦š±ò - 15¼7— Ûõþ ü±Ëï ûÅM• ýËûþËå õUùüÑàÉß ÎöÂø¸æ Ý ÎöÂø¸æ ëÂ×Âó±ð±Ëòõþ ò±÷ Îû&Ëù± Û ñõþËíõþ áÔËý õþ±àËî ýËõ¼ õÅçÂËî ÕüÅ¿õËñ ýûþ ò±, ü±ñ±õþí ÷±òÅËø¸õþ ¿ä¿ßÂÈü±õþ Ûß¿é Û¶ßÂõþí Ý ÂóX¿î üõùö±Ëõ ä±ùÅ ¿åËù±¼ Ûõþ ü±÷±¿æß áèýíËû±áÉîÂ±Ý ¿åËù± ¿ò}Âûþ-ý×¼ ¿ßÂcà ü±÷±¿æß õ± õîÇÂ÷±ò Âó¿õþö±ø¸±ûþ æò¦¤±Ë¦šÉõþ Û ¿ä™Lñõþ ÷±Ëç ÎðËýõþ Îû ñ±õþí±¿é ¿åËù± î± Îß±ò Õɱò±é¿÷ß±ù Îðý òûþ, Ûß¿é Îðý ß±ê±Ë÷± û±õþ ÷ñÉ ¿ðËûþ Îð±ø¸, ñ±îÅÂ Ý ÷ù Û¶õ±¿ýî ýûþ ÛõÑ, ¿õËúø¸ ßÂËõþ, ÎðËýõþ õ±ý×Ëõþõþ õÔýÈ ¿õË•«õþ ÷±Ëç ¿¦šî Ûß¿é Û¶±í ÛõþßÂ÷ Ûß¿é Îõ±ñ¼ Û ß±õþËí Û¶±ßÔ¿îÂß æÏõËòõþ Î÷é±ôÂõþ õÉõý+î ýûþ ÎðËýõþ ¿ô¿æÝù¿æ Îõ±ç±Ëò±õþ æòɼ üÅ|nîÂ-üÑ¿ýî±-ÎîÂ Û ¿õø¸ûþ¿é ¿ò¿ðÇ©†ö±Ëõ Õ±Ëù±¿äÂî ýËûþËå - ¿õüáÇð±ò¿õË•ÂÂó Îü±÷üÓûÉDZ¿òù± ûï± ““ ñ±õþûþ¿™Là æáËVýÑ ßÂô¿ÂóM±¿òù±™¦¸ï± ““ •üÓS¦š±ò - 21¼8— õ±Ñù± ÕïÇ ßÂõþËù - Îû÷ò 11
12.
äÂf, üÓûÇÉ Ý
Õ¿òù - ¿õüáÇ, Õ±ð±ò Ý ¿õË•ÂËÂó Ûý× ¿îÂò ¿S•ûþ± Z±õþ± æáÈËß ñ±õþí ßÂõþ - Îüö±Ëõ ßÂôÂ, ¿ÂóM Ý õ±ûþÅÝ ¿îÂò۶߱õþ ¿S•ûþ± Z±õþ± úõþÏõþËß ñ±õþí ßÂËõþ¼ [éÂÏß± ß±Ëõþõþ üÑËû±æò, ¿õüáÇ úËsõþ ÕïÇ ÎüÌ÷É-&í ¿õîÂõþí, Õ±ð±ò úËsõþ ÕïÇ Îú±ø¸í ÛõÑ ¿õË•ÂÂó úËsõþ ÕïÇ ÎÛ¶õþí¼] üýËæý× Îõ±ç± û±ûþ, äÂËfõþ ßÂ±æ ¿õüáÇ, üÓËûÇÉõþ ß±æ Õ±ð±ò ÛõÑ Õ¿òËùõþ ß±æ ÎÛ¶õþí¼ Ã›¶±ßÔ¿îÂß õþ+Âóߊ ñÔî ýËûþ ï±ßÂËù± ÎðËýõþ ß±Ëæõþ õɱàɱûþ¼ Õ±Ëõþß¿é Û¶üÑá ÎöÂËõ Îðà±õþ ÷Ëî±¼ ÎðËýõþ õ± microsm-Ûõþ Îû Âó¿õþüõþ Ûà±Ëò Õ±Ëù±¿äÂî ýËûþËå Îüé± Û¶ßÔÂîÂÂó˕ Û¶ßÔ¿î õ± macrocosm-Ûõþ üÏ÷±¿ûþî õþ+Âó¼ Ûà±Ëò ¿ä¿ßÂÈü±õþ Õ¿öÂ÷Åà ýËBå Û¶ßÔ¿îÂõþ ü±Ëï ö±õþü±÷É ¦š±Âóò ßÂõþ±, Û¶ßÔ¿îÂËß ¿òûþLaí õ± ÂóÅòáÇ¿êÂî ßÂõþ± òûþ¼ Û ßÂï± qñÅ Õ±ûþÅËõÇËðõþ æòÉ òûþ, Û¶±äÂÏò Îû Îß±ò ¿ä¿ßÂÈü± ÂóX¿î Îû÷ò ü÷ü÷Ëûþ Õ¿î ëÂ×i§î áèÏß ¿ä¿ßÂÈü±õþ ÷±ËçÂÝ Õ±÷õþ± ÛßÂý× ñ±õþí± ÎðàËî Âó±Ëõ±¼ ¿ßÂcà ÛËî±é± ö±õò±ü¥ói§ ¿ä¿ßÂÈü± õÉõ¦š± Ý æò¦¤±Ë¦šÉõþ ñ±õþí± ¿ßÂö±Ëõ Û¶±ûþ ÕõùÅl ýËûþ ÂóÂóÅù±õþ Î÷¿ë¿üò Ý Õ¿ú¿•Âî ÷±òÅËø¸õþ ¿ò榤 ¿õ•«±ü ¿òöÇÂõþ ý±îÅÂËh ¿ä¿ßÂÈü± ýËûþ ÎáËù±, î± Û Õ±Ëù±äÂò±õþ Âó¿õþ¿ñõþ õ±ý×Ëõþ ýËùÝ Ûß¿é &•QÂóÓíÇ ÂóûÇËõ•Âí Ûà±Ëò ëÂ×Ë{¡à ßÂõþ± ðõþß±õþ¼ ülðú úsõþ ¿õàɱî ôÂõþ±¿ü ÂóûÇéÂß õ±¿òÇËûþõþ ÎðËà¿åËùò – It should be noted that in all the countries we have just passed through, both in the Kingdom of Carnatic and the Kingdoms of Golkonda and Bijapur, there are hardly any physicians except those in the services of the Kings and Princes. ¿î¿ò ÛéÂ±Ý ù•ÂÉ ßÂËõþ¿åËùò – when the rains have fallen and it is season for collecting plants, mothers of families may be seen going out in the mornings from the towns and villages to collect samples which they know to specifics for domestic diseases... It is true that in good towns there are generally one or two men who have some knowledge of medicine... They first feel the pulse, and when giving medicine, for which they take only the value of two farthings, they mumble some words between their teeth. (Francois Bernier, Travels in the Mughal Empire, trans., lrving Brock, Vol. II, London, William Pickering, 1826. p. 240. òæõþé±ò Û¶õgÂß±Ëõþõþ¼— Õ±ñÅ¿òß æò¦¤±¦šÉ - ëÂ×Âó¿òËõ¿úßÂ Ý ëÂ×Âó¿òËõËú±Mõþ ö±õþî - ÛõÑ Õ±÷õþ± ô豂 ÎïËß q• ßÂËõþ äÂɱëëÂ×ý×ß õ± æò Φ§± ûÒ±Ëðõþ ý±î ñËõþ Õ±ñÅ¿òß æò¦¤±Ë¦šÉõþ üÓäÂò± îÒ±Ëðõþ Û¶ËîÂÉËßÂõþ Õ±Ëù±äÂò± Ý Îõ±Ëñõþ Ûß¿é üÅ¿ò¿ðÇ©† ß±ê±Ë÷± Õ±Ëå¼ ÛõÑ î± ýù, æò¦¤±¦šÉ Û÷ò ÛßÂé± Õ=Áù Îûà±Ëò ÎðËýõþ Õɱò±é¿÷ß±ù Φóú-Îû ÕÑú Îû÷ò QßÂ, ÷ÅàáýWõþ ý×îÂɱ¿ð üɱ¿ò鱿õþ ü±ûþ±k-Ûõþ Õ™LÃöÓÇÂM• ýù¼ Ûõþ Õ±Ëá ¿ßv¿òßÂɱù Î÷¿ë¿üò Ý ýü¿Âóé±ù Î÷¿ë¿üËòõþ üÓäÂò± âËéÂËå¼ ÎðýËß Îõþ±áÏõþ ÎäÂò± Âó¿õþ¿äÂî Âó¿õþüõþ ÎïËß ü¿õþËûþ ¿òËûþ ý±üÂó±î±Ëùõþ noise-free ÛõÑ Ã›¶±ßÔ¿îÂß ¿õ:±Ëòõþ Âóõþϕ±-¿òõþϕ±õþ ÷Ëî± ëÂ×ÂóûÅM• ý±üÂó±î±Ëùõþ Âó¿õþüËõþ ¿¦šî ßÂõþ± ýËûþËå¼ Îüà±Ëò ÷ÔîÅÂÉõþ ÂóËõþ •ÛõÑ Õ±ËáÝ— Îðý ò±÷ß ¿S-÷±¿Sß Õɱò±é¿÷ß±ù Φóü-Îß úõ-õÉõËBåËðõþ ü±ý±ËûÉ ß±é±- ßÅ¿é ßÂËõþ ÂóÓíÇî ÎæËò ÎôÂù± û±ûþ ÛõþßÂ÷ :±ò Ý Ã›¶îÂÉûþ Õ¿æÇî ýËûþËå¼ Îü :±ò ¿ú•Â± ¿ðËBå õ±ý×Ëõþõþ Âó¿õþËõú ÎðËýõþ ÕöÂÉ™LÃõþ Ý õ¿ýõþ±ÑúËß ձS•±™LÃ Ý ßÂùÅ¿ø¸î ßÂõþËî Âó±Ëõþ¼ üÅîÂõþ±Ñ üɱ¿ò鱿õþ ü±ûþ±k-Ûõþ ß±æ ýËõ •Â¿îÂßÂõþ Û¶±ßÔ¿îÂß Âó¿õþËõËú ý™¦¸Ë•ÂÂó ßÂõþ± Ý ÂóÅòáÇ¿êÂî ßÂËõþ ÎòÝûþ±¼ Õ™LÃî ¿îÂò¿é ΕÂËS Û¶±ßÂ-Õ±ñÅ¿òß æò¦¤±Ë¦šÉõþ ñ±õþí±õþ ü±Ëï Û ñ±õþí±õþ ÷Óùáî Âó±ïÇßÂÉ âËé ÎáËù± - •1— ÎðËýõþ Õɱò±é¿÷ß±ù Φóü Ý Âó¿õþËõúáî Φóü-Ûõþ üÅ¦ó©† ¿õö±æò, Ý •2— Û¶±ßÔ¿îÂß Âó¿õþËõËú ý™¦¸Ë•ÂÂó ßÂõþ± Ý ¿òËæõþ ëÂ×ÂóËû±áÏ ßÂËõþ ÂóÅòáÇ¿êÂî ßÂËõþ ÎòÝûþ±õþ Õ±áè±üÏ ÎäÂîÂò±¼ Ûà±Ëò Û¶±ßÔ¿îÂß ö±õþü±Ë÷Éõþ Îß±ò õþßÂ÷ Îõ±ñ ÕòÅÂ󿦚îÂ, Û¶ßÔ¿î Ûà±Ëò ÷±òÅËø¸õþ öÔÂîÂÉ, Ûß¿é Õ-ÎðýÏ Õ=Áù Îûé±Ëß Îû÷ò àÅ¿ú ÷±òõ ÎðËýõþ ÷Ëî±ý× ß±é±-ÎåÒh± ßÂõþ± û±ûþ, ÛõÑ üËõDZÂó¿õþ, •3— Û ß±Ëæõþ Û¶ñ±ò ð±¿ûþQ ýù õþ±Ë©†˜õþ¼ õþ±©†˜ Ý õÉ¿M•õþ ÷±Ëç Ûß ñõþËíõþ òæõþð±¿õþ õ± surveillance Î÷¿ë¿üò-Ý õËé¼ Îë¿öÂë ձ÷Ǧ†˜Ñ-Ûõþ ñ±õþí±ûþ òîÅÂò ñõþËíõþ æò¦¤±¦šÉ Âó¿õþߊò±ûþ ‘‘Âó¿õþËõú õ±gÂõ’’ õþ±æÍò¿îÂß ß±ûÇS•Ë÷õþ Û¶Ëûþ±æò ÂóËh ÛõÑ “it calls 12
13.
for an ecological
approach to health; and, for the individual, it requires an extension from concerns with body boundaries or individual psychology to examination of ‘lifestyle’. In its new guise of health promotion, public health is now concerned with generating and monitoring ‘political awareness’ in its widest sense.” (David Armstrong, “Public Health Spaces and the Fabrication of Identity”, Sociology 1993, 27 (3), pp. 393-410.) Õ±÷LjÂÑ-Ûõþ ñ±õþí±õþ Ûß üÅjõþ ëÂ×ð±ýõþí ¿÷ùËõ ¿÷Œò Îõþ±÷±õþ-Ûõþ õM•Ëõɼ 1965 ü±Ëù ßÂɱ¿ùËô±¿íÇûþ±õþ Watts Õ=ÁËù &•îÂõþ ¿ýÑü±Rß âéÂò± âé±õþ ÂóËõþ Îõþ±÷±õþ-Îß Âó±ê±Ëò± ýËûþ¿åù üËõþæ¿÷ò îÂðË™LÃõþ ß±Ëæ¼ îÒ±õþ õM•õÉ ÕòÅû±ûþÏ - among other things, recommended the establishment of three or four general ambu- latory health care at “locations of greatest poverty” in the riot area. (Milton I. Romer, “Resis- tance to Innovation : The Case of the Community Health Center”, American Journal of public Health 1988, 78, 9, pp. 1234-1239) æò¦¤±Ë¦šÉõþ ÛõþßÂ÷ Ûß ÎÛ¶¿•Âî ëÂ×Ëiœ±¿äÂî ýõ±õþ ÂóËõþ Õ±÷õþ± Û¶Ëõú ßÂõþËî Âó±¿õþ ö±õþËîÂõþ ¿ò¿ðÇ©† ÂóéÂöÓ¿÷Ëî ¿ß ö±Ëõ Ûõþ ¿õß±ú Ý ¿õ™¦¸±õþ ýù î± õÅçÂËî¼ Îë¿öÂë ձòÇ‹ ÛËß Ûß ßÂï±ûþ õËùËåò “enclave medicine” ÎïËß “public health”- Û û±S± (David Arnold, Colonizing the Body, California University Press, 1993) ö±õþËî õüõ±üß±õþÏ õÔ¿éÂú ÆüòÉõ±¿ýòÏ Ý ý×ÝÎõþ±ÂóÏûþ æòî±õþ ¦¤±¦šÉËß ö±õþîÂÏûþ ßÂùÅø¸ Ý •Â¿îÂßÂõþ æùõ±ûþÅ ÎïËß õÒ±ä±Ëò±õþ æòÉ ¿õ¿öÂi§ ñõþËòõþ ßÂ÷ÇüÓäÂÏ ÎòÝûþ± ýËûþËå Îû÷ò, éÂÏß±ßÂõþí ý×îÂɱ¿ð¼ ÎÛ-á ð±/±õþ ßÂï± Îî± ý׿îÂý±Ëü üÅ¿õ¿ðî¼ ëÂ׿òú úîÂËßÂõþ ¿îÂò-äÂîÅÂïDZÑú ü÷ûþ æÅËh æò¦¤±¦šÉ õ± õÔ¿éÂú ÆüËòÉõþ ¦¤±¦šÉõþ•Â±õþ æòÉ ÕüÑàÉ õý× ÛËßÂõþ ÂóËõþ Îùà± ýËûþËå¼ Ûß¿é ëÂ×ð±ýõþí ýù Edmund A. Parkes-Ûõþ 1866 ü±Ëù Îùà± A Manual of Practical Hygiene Prepared Especially for Use in the Medical Service of the Army¼ ÛõþßÂ÷ Îùà±Ëù¿àõþ üÓSÂó±î թ†±ðú úîÂËßÂõþ Îúø¸ ö±á ÎïËß¼ 1830-Ûõþ ðúËß ö±õþËî Î÷±é ÆüòÉ ¿åËù± 2,50,000¼ Ûõþ ÷ËñÉ ÷±S 40,000-Ûõþ ß±å±ß±¿å ¿åËù± õÔ¿éÂú Æüòɼ ÆüòÉõ±¿ýòÏõþ æòÉ Indian Medical Service (IMS) Æî¿õþ ýËûþËå¼ 1920-1930-Ûõþ ü÷ûþß±ù ¿ðËûþ ö±õþËî Î÷¿ë¿üËòõþ õþ±¿©†˜ûþ òÏ¿îÂËî ¿ßÂåÅ Âó¿õþõîÇÂò Õ±üËî q• ßÂËõþ “away from the old enclavism and towards a more Indian oriented sytem of public health. Nonetheless, the change was more a shift of emphasis than a complete transformation.”(David Arnold, “The rise of wsetern medicine in India”, Lancet 1998, 348, pp. 1075-78) Û¶ñ±òî Îû ¿õø¸ûþ&Ëù±õþ ÝÂóËõþ Îæ±õþ ÎðÝûþ± ýûþ Îü&Ëù± ýù - éÂÏß±ßÂõþí, üɱ¿òËéÂúò, ý±ý׿æò ÛõÑ, Õ¿ñß &•QÂóÓíÇ, Õ±ñÅ¿òßÂî± Ý Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ ëÂ×ÂóËû±áÏ æÏõòËõ±ñ Æî¿õþ ßÂõþ±¼ Îúø¸ ¿õø¸ûþ¿éÂõþ õ±™¦¸õ ¿ö¿M ýËBå Îû ö±õþîÂõø¸Ç ßÂàËò±ý× ü¥óÓíÇö±Ëõ îÂï±ß¿ïî ÕɱËù±Âóɱ¿ïß ¿ä¿ßÂÈü±Ëß áèýí ßÂËõþ ¿ò¼ Îû Îß±ò ü÷Ëûþ Ûà±Ëò Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ ÎäÂËûþ ÕËòß Îõ¿ú Âó¿õþ÷±Ëí ß¿õõþ±¿æ õ± ÕòÉ ñõþËòõþ ¿ä¿ßÂÈü± ä±ùÅ ¿åËù±, ÛàËò± Õ±Ëå¼ 1864 ü±Ëù üÓûÇÉ &¿ëÂö äÂS•õîÇÂÏ õÔ¿éÂú Î÷¿ëÂßÂɱù æ±òDZù-Û Ã›¶ß±¿úî îÒ±õþ Ûß ¿õþËÂó±ËéÇ ÛßÂæò ß¿õõþ±Ëæõþ ëÂ×Ë{¡à ßÂõþËåò ûÒ±õþ ð¿•Âí± ÛõÑ ü¥œ±ò ý×ëÂ×Ëõþ±ÂóÏûþ ¿ä¿ßÂÈüßÂËðõþ ÎäÂËûþ Îõ¿ú ¿åËù±¼ 1907 ü±Ëù ¿ä¿ßÂÈü±-ü¿¥œùòÏ Âó¿Sß±ûþ ‘‘ÎðúÏûþ ¦¤±¦šÉ-¿õ:±Ëòõþ Ûß±ù Ý Îüß±ù’’ úÏø¸Çß Û¶õËg Îùà± ýËBå - Ü¿îÂý±¿üß ß±Ëùõþ ßÂï± ò± ñ¿õþËùÝ, áî Øò¿õÑú úî±sÏõþ ÷ñÉö±á ýý×Ëî õ±/±¿ù汿îÂõþ ú±õþÏ¿õþß Õõ¦š±õþ ¿òî±™Là Îú±äÂòÏûþ Âó¿õþõîÇÂò Îðà± û±ý×ËîÂËå¼ Ûõþ ß±õþí ¿ß· ü±÷±¿æßÂö±Ëõ Ûî¿ðò ñËõþ Âó±¿ùîÂ Ý Ã›¶¿î¿‡Âî ձä±õþ-õÉõý±Ëõþõþ Âó¿õþõîÇÂò ýËûþËå - ¿ýjÅñ÷Ç õ± ü÷±æ ü¥¤Ëg Îû üßÂù õþÏ¿îÂòÏ¿î õ± Õ±ä±õþõÉõý±õþ Û¶ä¿ùî ձËå, îÂÈü÷™¦¸ý× Ã›¶±ûþú ÛîÂËVúÏûþ æòáËòõþ úõþÏËõþõþ ÂóË•Â Ûß±™Là ÕòÅßÓÂù... ¿õñ±î±õþ ¿õhÂ¥¤ò±ûþ ¿ýjÅü÷±æúõþÏõþ ò±ò±¿õñ Îõþ±Ëá Õ±S•±™LÃ Ý ¿òî±™Là æÏíÇ-úÏíÇ ýý×ûþ± 13
14.
Âó¿hÂûþ±Ëå... òîÅÂò æù±úûþ
Û¶¿î‡± ýÝûþ± ðÓËõþ ï±ßÅÂßÂ, Û¶±äÂÏò&¿ùÝ S•÷ú q©¨ ýý×ûþ± û±ý×ËîÂËå, ÕËòß áè±Ë÷ ÛËßÂõ±Ëõþý× qß±ý×ûþ± ¿áûþ±Ëå¼ •¿ä¿ßÂÈü±-ü¿¥œùòÏ, òîÅÂò ձ߱Ëõþ 2ûþ à`Â, 5÷ Ý 6‡Â üÑàɱ— Û Âó¿Sß±õþ 1888 ü±Ëù ۶߱¿úî 2ûþ àË` ‘‘Õ±ûþÅËõÇð Æõ:±¿òß ¿ß ÕÍõ:±¿òß·’’ ¿úËõþ±ò±Ë÷ Û¶õg Îùà± ýËBå¼ û± Îý±ßÂ, ÛõþßÂ÷ ÎÛ¶•Â±ÂóËéÂ, æ±îÂÏûþî±õ±ðÏ Õ±Ëj±ùËòõþ ü÷Ëûþ ÎðúÏûþ æòî±õþ Õ±Ëõá Ý ü÷ïÇò-ÂóÅ©† Õ±ûþÅËõÇð Ý Õ±ñÅ¿òß ¿ä¿ßÂÈü±õþ ÷ËñÉß±õþ üÑâ±î äÂõþ÷ õþ+Âó Îòûþ¼ üõ¿ßÂåÅõþ Õ¿öÂâ±Ëî 1946 ü±Ëù Æî¿õþ ýù Îö±õþ •Bhore— ß¿÷úò¼ Primary Health Care õ± Û¶±ï¿÷ß ¦¤±¦šÉ õÉõ¦š±õþ üÓSÂó±î ýûþ Û ü÷ûþ ÎïËß¼ Ûý× ß¿÷úò Îû üõ üÅÂó±¿õþú ßÂËõþ î±õþ ßÂîÂßÂ&Ëù± ýù - Û¶ï÷, Û¶ú±ü¿òß ÂóûDZËûþ preventive ÛõÑ curative Âó¿õþËø¸õ±Ëß Î÷ù±Ëî ýËõ ¿ZîÂÏûþ ¦¤Šß±ùÏòö±Ëõ 40,000 æòüÑàɱõþ æòÉ 1¿é Û¶±ï¿÷ß ¦¤±¦šÉ-ÎßÂf Æî¿õþ ýËõ ÛõÑ ðÏâÇË÷ûþ±ðÏ ¿ýËüËõ Û¶¿î 10,000-20,000 æòüÑàɱõþ æòÉ 75 úûɱ-¿õ¿ú©† Û¶±ï¿÷ß ¦¤±¦šÉ-ÎßÂf Æî¿õþ ýËõ îÔÂîÂÏûþ, áè±÷Ïí ¦¤±¦šÉ ß¿÷¿é Æî¿õþ ßÂõþËî ýËõ ý×îÂɱ¿ð¼ Û÷ò ¿ß 1937 ü±ËùÝ ßÂÑËáèü ûàò Û¶ï÷ Û¶Ëðú&¿ùõþ •Â÷î± ù±ö ßÂËõþ îÂàËò± ö±õþËîÂõþ ‘骱¿ëÂúò±ù’ ¿ä¿ßÂÈü± ÂóX¿î õþ±Ë©†˜õþ üý±ûþî± ù±ö ßÂËõþËå¼ Îö±õþ ß¿÷¿é Ûß¿é õUQÂóÓíÇ ü±÷±¿æß ¿ä¿ßÂÈü± õÉõ¦š±õþ ÷±Ëç Âó±}±îÂÉ ¿ä¿ßÂÈü± õÉõ¦š±õþ Û¶±ñ±òÉËß õþ±Ë©†˜õþ îÂõþËô ÕòÅË÷±ðò ¿ðËù±¼ Îë¿öÂë ձòÇ‹ Ûß¿é &•QÂóÓíÇ ÷™LÃõÉ ßÂËõþËåò - The Bhore Committee presented a Beveridge-style blueprint that no colonial government of India would ever have put into practice. Its ambitious and idealistic public-health programme could only begin to be realised under an independent regime. Western medicine was never so powerful in India as when it shed its colonial identity. (Arnold, “The rise of western medicine”.òæõþé±ò Û¶õgÂß±Ëõþõþ¼— Ûà±Ëò ßÂËûþß¿é ¿õø¸ûþ Õ±÷±Ëðõþ ¿ä™Lñõþ Âó¿õþ¿ñõþ ÷±Ëç ï±Ëß ðõþß±õþ¼ õþõÏfò±Ëïõþ ü±Ëï îÂÈß±ùÏò æ±îÂÏûþî±õ±ðÏ ÎòîÔÂËQõþ Û¶ñ±ò üÑâ±ËîÂõþ ÕòÉîÂ÷ æ±ûþá± ¿åËù± Ûß¿ðËßÂ, ö±õþîÂõø¸ÇÏûþ ü÷±Ëæõþ áè±÷Ïí üö±&Ëù± ëÂ×ÂóûÅM• &•Q Âó±Ëõ ¿ß ò±, ÕòÉ¿ðËßÂ, Õ±Ëj±ùËòõþ Õ¿öÂ÷Åà õþ±©†˜÷ÅàÏ ýËõ õ± ü÷±æ÷ÅàÏ ýËõ¼ Îö±õþ ß¿÷úËòõþ ÷Óù ÎçұߠÂóhÂËù± ü¥óÓíÇö±Ëõ õþ±©†˜-¿òûþ¿Laî Âó±}±îÂÉ ¿ä¿ßÂÈü±õþ ÝÂóËõþ¼ ö±õþîÂõËø¸Çõþ ÷Ëî± ¿õÂóÅù æòüÑàɱõþ ÂóõþËî ÂóõþËî õUQ æh±Ëò± ÎðËú ÎßÂõù Âó±}±îÂÉ ¿ä¿ßÂÈü± ¿ðËûþ ü÷±ñ±ò ýËõ ò± õËù áè±÷Ïí ¦¤±¦šÉ ß¿÷¿éÂ-õþ ÷Ëî± ¿õø¸ûþ&Ëù±õþ Û¶™¦¸±õò± ÛËüËå¼ ÛËðËú öÂûþÑßÂõþ Õ±áè±üÏ ëÂ×Âó¿òËõ¿úß õÉõ¦š±õþ Û¶¿îÂôÂùò âËéÂËå Ûõþ õþ±æÍò¿îÂßÂ, ü±÷¿õþßÂ, ü±÷±¿æßÂ, ü±Ñ¦Ô¨¿îÂßÂ, Û¶ú±ü¿òß ý×îÂɱ¿ð ü÷™¦¸ ß±ûÇS•Ë÷¼ Îß±ò ü÷Ëûþý× ¿õߊ Îß±ò ñ±õþí±Ëß •û¿ð Îüé± ü±÷±¿æß •Â÷î± üÔ¿©†õþ ÷ñÉ ¿ðËûþ õþ±Ë©†˜õþ ßÂîÇÔÂQËß äÂɱËù? æ±ò±ûþ— ÕòÅË÷±ðò ßÂËõþ¿ò, ¿õÂóõþÏËî ð÷ò ßÂËõþËå¼ Î÷¿ë¿üËòõþ æáËîÂÝ Ûé± ü¿õËúø¸ ü¿îÂɼ Î÷¿ë¿üò Ý æò¦¤±Ë¦šÉõþ Û ÷î±ðúÇ Îö±õþ ß¿÷¿éÂõþ ÷±ñÉË÷ Æõñî± Âó±ûþ •ÕòÉ ß¿÷¿éÂõþ ÷±ñÉË÷Ý ÎÂóËî Âó±õþËî±—¼ ¿õò±ûþß ÎüËòõþ âéÂò± æò-¦¤±Ë¦šÉõþ Û Ã›¶ü/¿éÂËß Îä±Ëà Õ±/Åù ¿ðËûþ Õ±ËõþßÂõ±õþ òîÅÂò ßÂËõþ Îð¿àËûþ Îðûþ¼ ¿î¿ò Âó±}±îÂÉ Î÷¿ë¿üËòõþ Ûß¿é ¿öÂi§ ñõþËòõþ Û¶Ëûþ±á ÂóX¿îÂõþ õ±™¦¸õ±ûþò ßÂËõþ¿åËùò¼ Û õ±™¦¸õ±ûþËòõþ ôÂËù ü±ñ±õþí ÷±òÅËø¸õþ ¦¤õþ ú¿M•ú±ùÏ ýËûþ ëÂ×Ëê¿åËù±, ¦š±òÏûþö±Ëõ Âó±Ýûþ± üyÂõ ÛõþßÂ÷ ÷±òõ ú¿M• Ý ü±÷ËïÇÉõþ õÉõý±Ëõþõþ õ±™¦¸õ ÎäÂý±õþ± ÆîÂõþÏ ý¿Båù¼ Ûß ßÂï±ûþ õþ±Ë©†˜õþ ¿òûþLaí Õ¿îÂS•÷ ßÂËõþ Î÷¿ë¿üò ýËûþ ëÂ×Ëê¿åËù± ÷±òÅËø¸õþ ¦¤±¦šÉõþ•Â±õþ ¿ò榤 ý±¿îÂûþ±õþ¼ ëÂ×Âó¿òËõ¿úß ðúÇò-æ±î ձáè±üÏ õþ±Ë©†˜õþ ÂóË•Â ÛËß Îõ¿ú ¿ðò ñËõþ ÕòÅË÷±ðò ßÂõþ± üyÂõ òûþ - û± ßÂõþ±õþ õþ±©†˜ ßÂõþËõ¼ ÛæòÉ ¿õò±ûþßÂËß ß±õþ±™LÃõþ±Ëù ÎûËî ýûþ¼ Û¶ä¿ùî æò¦¤±Ë¦šÉõþ Û ¿ðß¿é ձæ ÷Ëò±Ëû±á ¿ðËûþ ö±õ±õþ ¿õËúø¸ Û¶Ëûþ±æò¼ æò¦¤±Ë¦šÉõþ Ûß¿é Îß±ò ÷ËëÂù Îá±é± ÂóÔ¿ïõÏ æÅËh Îòý×¼ ö±õþËî ձñÅ¿òß æò¦¤±Ë¦šÉõþ üÓäÂò± Ý ¿õß±ú âËéÂËå ö±õþîÂõËø¸Çõþ ÷±òÅËø¸õþ, ¿õËúø¸î úUËõþ ¿ú¿•Âî ü¥xð±Ëûþõþ, ¿ä¿ßÂÈü± Ý ¦¤±¦šÉ-üÑS•±™Là ¿ò榤 Îõ±ñËß ÂóÅòáÇ¿êÂî ßÂËõþ¼ Õ±õ±õþ, Îü æò¦¤±Ë¦šÉõþ ÷ËëÂùËß õ±Ëõþ õ±Ëõþ ¿ôÂËõþ î±ß±Ëî ýËBå ¦š±¿òß տöÂ:î± Ý ÷±òõ ü¥óËðõþ 14
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16.
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Âó±õþËüÂóúò õ± Îõ±ñ-ý× ßÂ÷, ÛæòÉ ¿ä¿ßÂÈüËßÂõþ úõþí ßÂ÷ üÑàÉß ÷±òÅø¸ Îòûþ¼ æò¦¤±¦šÉ ßÂ÷ÇÏËßÂ Û ¿õø¸ûþ¿éÂËß Îõ±Ëñõþ ÷±Ëç õþ±àËî ýËõ¼ ÛæòÉ Ûé± Û¶±ï¿÷ß &•Qü¥ói§ Ûß¿é ðúÇòáî Û¶•Ÿ¼ 2020 ü±Ëùõþ ÷ËñÉ ö±õþËî ü±õÇæòÏò ¦¤±Ë¦šÉõþ Õ±ýW±ò õþ±à± ýËûþËå¼ Û Õ±ýW±Ëòõþ ÷±ËçÂ, ÛßÂéÅ ö±õËù Õ±÷õþ± ÎðàËõ±, ðÅ¿é õËh± ôұߠձËå – •1— Û Õ±ýW±Ëò ñËõþ ÎòÝûþ± ýËûþËå ö±õþËîÂõþ ÕïÇÍò¿îÂß ü÷Ô¿X ¦¤±Ë¦šÉõþ Õü±÷ÉËß ðÓõþ ßÂõþËõ¼ õõþ=Á ëÂ×ËŒ±é± ü¿îÂɼ ÕïÇÍò¿îÂß ¿õß±ú Ý ü÷Ô¿X ¿õ¿öÂi§ö±Ëõ Ûý× Õü±Ë÷Éõþ ¦ÚˆÂ±¼ ÛàËò± 77% ö±õþîÂÏûþ Æð¿òß 20 é±ß±õþ ßÂË÷ æÏõòñ±õþí ßÂËõþ¼ •2— Û Õ±ýW±Ëò õîÇÂ÷±ò ¦¤±¦šÉ Âó¿õþËø¸õ±õþ Îû ß±ê±Ë÷± Õ±Ëå Îüé±Ëß ՕÂî ÎõþËà ÛáËò±õþ ßÂï± õù± ýËûþËå¼ õîÇÂ÷±ò ß±ê±Ë÷±õþ Ûß¿é õÔýÈ Õ±Âóð ýù Û¶±ý×ËöÂé Îü"õþ¼ ÛËß õîÇÂ÷±ò ß±ê±Ë÷±õþ ÷±Ëç Õ/ÏöÓÂî ßÂõþ±õþ ßÂï± õù± ýËûþËå¼ Û ¿õÂó#òß Û¶õíî± ü¥¤Ëg Lancet Âó¿Sß±ûþ ÷™LÃõÉ ßÂõþ± ýËBå – The corporate-led private sector in India cannot be controlled by integration – it has to be confronted by being made to compete against a well resourced and managed public system that is run with public funds, rather than building public assets and infrastructure only in areas where the private sector does not exist. (“Towards a truly universal Indian health system”, Lancet January 12, 2011. pp. 1-2) 1947-Û ü÷áè ¿ä¿ßÂÈü± Âó¿õþËø¸õ±õþ ÷±S 5-10% Îû±á±Ëî Û¶±ý×ËöÂé Îü"õþ¼ 2005-Û Õ±ëÂ×éÂËë±õþ Îõþ±áÏõþ 82%, 58%, ö¿îÇ ï±ß± Îõþ±áÏ ÛõÑ ý±üÂó±î±ù õ± ò±¿üÇÑ Îý±Ë÷ æiœ ÎòÝûþ± ¿úqõþ 40%-Ûõþ ö±áÏð±õþ Û¶±ý×ËöÂé Îü"õþ¼ •“The private health sector in India”, BMJ November 8 2005, pp. 157-158) ÛàËò± ö±õþËî û•Â± Îõþ±Ëáõþ Û¶¿î õåËõþ ÷Ôî ÷±òÅËø¸õþ üÑàɱ 5,00,000- Ûõþ Îõ¿ú, ë±ûþ±¿õþûþ± ñõþËíõþ Îõþ±Ëá ÷±õþ± û±ûþ Û¶¿î õåËõþ 600,000-Ûõþ Îõ¿ú¼ Û¶±ý×ËöÂé Îü"õþ ÛüËõõþ ð±¿ûþQ Îòûþ ò±¼ ÕïÇÍò¿îÂßÂö±Ëõ ÛËßÂõ±Ëõþ ÝÂóËõþõþ Î|íÏËî ï±ß± ÕŠüÑàÉß ö±õþîÂÏûþõþ curative ¿ä¿ßÂÈü±õþ ð±¿ûþQ Îòûþ ÛõÑ üôÂùö±Ëõ ßÂËõþ¼ ý×ëÂ×Ëõþ±Âó, Õ±Ë÷¿õþß± õ± ÷ñÉ-Û¶±ËäÂÉõþ îÅÂùò±ûþÛà±òß±õþ ¿ä¿ßÂÈü± ÕËòß ü™¦¸± õËù õU ¿õËð¿ú Âó±¿h æ÷±ûþ ÛËðËú¼ Æî¿õþ ýûþ Ûß¿é òîÅÂò Âó¿õþö±ø¸± medical tourism. Îúø¸ ßÂï±Â ¦¤±Ë¦šÉõþ æòÉ ù¿¢Ÿ, ¿õËúø¸î ûàò Û¿é õÔýÈ õU汿îÂß Ýø¸Åñ Îß±¥ó±¿òõþ ¦¤±ËïÇ âËéÂ, Ûß¿é J curve-Ûõþ ÎäÂý±õþ± Îòûþ¼ Ûý× curve-Ûõþ Îõ¿úõþ ö±á ÕÑËú ûËî± Îõ¿ú ÕïÇ ù¿¢Ÿ ýËõ îÂËî± Îõ¿ú ý׿îÂõ±äÂß ôÂù±ôÂù ¿÷ùËõ¼ ¿ßÂcà Ûß¿é üÏ÷±õþ ÂóËõþ, ÷±òÅËø¸õþ æÏõòû±S±õþ ÕòÉ ÕÑËúõþ ¿õ¿ò÷Ëûþ ûËî± Îõ¿ú àõþä ßÂõþ± Îý±ß ò± ÎßÂò ÕËòß ¿ò¥§ ÷±Ëòõþ ôÂù Âó±Ýûþ± û±Ëõ¼ Û¶±ý×ËöÂé Îü"õþ-¿òöÇÂõþ ¦¤±¦šÉ-õÉõ¦š±ûþ Û âéÂò±¿é âËé¼ Û÷ò¿ß ÷ñÉ Õ±Ëûþõþ ÷±òÅø¸-Ý curative ¦¤±Ë¦šÉõþ æòÉ Îõ¿ú ¿õ¿òËûþ±á ßÂõþËù æÏõòû±S±õþ ÕòÉ ÕÑËú ßÂ÷ ¿õ¿òËûþ±á ßÂõþËî Âó±Ëõþ¼ Ûõþ ôÂËù ü±Ñü±¿õþßÂ, ÷±ò¿üßÂ Ý Õ±Ëõþ± ¿ßÂåÅ ü÷üɱõþ üÔ¿©† ýûþ Îû&Ëù± Õ±õ±õþ Îúø¸ ¿õä±Ëõþ ¦¤±Ë¦šÉõþ ü±Ëï æ¿hÂËûþ û±ûþ - æÏõËòõþ Ûß òîÅÂò ñõþËíõþ Î÷¿ëÂßÂɱù±ý×ËæúËòõþ ΕÂËS Æî¿õþ ýûþ¼ Û ß±õþËí æò¦¤±¦šÉõþ ü±Ëï ûÅM• ¿ä¿ßÂÈüËßÂõþ ¿ä¿ßÂÈüß ¿ýËüËõ ð±¿ûþQ õîDZûþ Îõþ±áÏõþ æÏõËòõþ ü±Ëï õUË•ÂËS ÕÑúáèýí ßÂõþ±¼ ü±÷±¿æßÂ Ý ü±÷¿áèß ¦¤±Ë¦šÉõþ ñ±õþí± ¿òËûþ ñ±õþ±õ±¿ýßÂö±Ëõ ÷±òÅËø¸õþ ÷±Ëç ¿ò‡Â±ÂóÓíÇ ß±Ëæõþ ôÂËù Ûß¿é üy±õò± æiœ ¿òËî Âó±Ëõþ Îûà±Ëò J curve-Ûõþ ðÅ¿é ¿ðËßÂý× ¦¤±Ë¦šÉõþ æòÉ àõþËäÂõþ ü÷î± ï±ßÂËõ¼ Ûß¿é ¿õÂóòÅÉM• ö¿õø¸ÉÈ ü±÷Ëò Õ±üËõ¼ ÛüËõõþ æ¿éÂù Îû±á±Ëû±Ëá Ý ôÂù|n¿îÂËî æò¦¤±Ë¦šÉõþ ¿ò榤 Õõ¦š±ò ¿òñDZ¿õþî ýûþ¼ Îß±ò Î÷¿ëÂßÂɱù ßÂËùæ ÎïËß ëÂ×ÂóûÅM• Û¶¿ú•Âí ÎÂóËûþ Âó±ú ßÂËõþ ÎõËõþ±Ëùý× æò¦¤±¦šÉ ßÂ÷ÇÏ ýËûþ Ýê± û±ûþ ò±¼ ÷±òÅËø¸õþ æÏõòËõ±Ëñõþ ΕÂS¿é æò¦¤±¦šÉ ßÂ÷ÇÏõþ ÎäÂîÂò±ûþ ¿¦šî ýËõ¼ Û ß±õþËí ö±õþËîÂõþ ÷Ëî± ÎðËú æò¦¤±Ë¦šÉõþ ß±Ëæ ¿òËûþ±¿æî ßÂõþ±õþ ÕïÇ Ã›¶ß±õþ±™LÃËõþ ÕïÇÍò¿îÂß Õü±Ë÷Éõþ ÷ÅËà±÷Å¿à ýÝûþ±, ÷ÅËà±÷Å¿à ýÝû± õÔýÈ õU汿îÂß Îß±¥ó±¿òõþ, õþ±©†˜ Ý ü÷±Ëæõþ 16
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