Beyond Money
A place where she could study, laugh and make friends
AAWC seeks to empower the second generation to escape the cycle of prostitution
As a child, Shweta endured daily taunts about her dark skin and survived sexual abuse by her mother’s live-in partner. Yet, she thrived for eight years in AAWC’s (Apne Aap Women’s Collective) Udaan programme, where she was one of the only girls to come to the centre in the morning before school and again for regular after-school tuitions.  Today, Shweta is studying psychology at Bard College, USA and plans to return to Mumbai after her graduation to help other girls like herself escape the red light area. She remembers AAWC’s shelter as “A place where she could study, laugh, and make friends!” 
By providing services not only for women in prostitution but also for their daughters and young children, AAWC seeks to empower the second generation to escape the cycle of prostitution, secure well-paid skill-based jobs and, eventually, bring their mothers out of prostitution. 
Sudarshan Loyalka founded AAWC in 1998 as a women’s collective as an anti-trafficking organisation that serves the women and children of Kamathipura, the red-light area of Mumbai. Initially, a single-room drop-in centre, AAWC developed into a resource centre to address the women’s needs, providing them with professional counselling, medical care, micro-savings facilities and other services.
Today, it claims to provide almost everything that a mother can provide to the children, even as they grow up in Kamathipura. Manju Vyas, who joined AAWC in October 1998, has served as its director since April 1999. As its CEO, she has a professional team working with her, including women with a master’s degree in social work.
AAWC operates three programsme: Umeed for women in brothel-based prostitution (ages 18+), Udaan for daughters of Umeed members and other girls living in the red light area (ages 6-18), and Umang for toddlers of Umeed members (ages 2-5).
Since 1998, AAWC has served more than 2,800 women and children. Among AAWC’s VIP visitors has been Michelle Obama, in November 2010.
Apne Aap operates from two locations—Kamathipura, where they have a school and a night shelter, and Falkland Road where they have a school only. As you walk up to the Pochammadevi Temple in Kamathipura, you may still wonder about the location of the Apne Aap office. However, the bright pink entrance right opposite the temple and the excited squeals of the children within are landmarks enough,” says the newspaper DNA, describing the NGO’s work. 
Ashika Mehta, president of AAWC claims, “Not a single daughter from our NGO has gone into prostitution. And that’s something, because otherwise the chances are anywhere between 50% to 80%.” AAWC is also fortunate to have support from celebrities like actress Rani Mukerji and designers Anju Modi, Surily Goel, Atsu and Reema Zaveri, among others.
Interestingly, The Standard Chartered Mumbai Marathon (SCMM) is an important fund-raising platform for AAWC, since 2009. You too can contribute to its work by volunteering, partnering or donating to AAWC. Cheques in any currency can be made in favour of Apne Aap Women’s Collective and sent with a covering letter stating: (i) PAN (ii) full address (iii) email address and (iv) purpose of the donation (e.g., general purpose, Udaan, etc). Indian donors are entitled to tax benefits under Section 80 G of the Income-Tax Act.



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A Pill for every ill? - II

There is no free lunch in this world. Pharmaceutical companies try and catch doctors very young when they are still house officers. These young doctors then learn from pharma companies that every ill can be cured with a pill. This is concluding part of a two part series


For one thing, even hospitals have come under the latter umbrella! It is argued that ties between industry and academia are necessary for “technology-transfer”, a word invented after 1980s, when the American Government passed the Bayh-Dole Act which allowed academic institutions supported by Federal grants to patent and license new products discovered by their faculty in return for royalties. This law is cited when large-scale tie-ups go on between these two institutions. It is needless to say that we follow that rule blindly in our country. The second reason given is that academic institutions needed the money very badly. These are the main reasons why we are where we are today. The business goals of the companies influence the mission of the research institutions and also influence their final results.

One of the reasons why the cost of modern medical treatment, both medical and surgical, has skyrocketed is because the expenses incurred by the industry for its sponsored trips of medical scientists, meals in top of the range hotels, gifts, honorariums, conference and symposia expenses, consulting fees, and research grants eventually are paid by the consumer! There is no free lunch in this world. Companies try and catch doctors very young when they are still house officers. Rothman records in a report that the companies’ gifts are intended to buy the goodwill of young physicians with long prescribing lives ahead of them. Similar is the situation in many areas where the industry uses the talent of the academia for their research. Ultimately, it is a Faustian bargain.

Clinical research organizations (CROs) are mushrooming in India at alarming pace.  The brokers for the western drug companies want to test their new molecules in the third world countries, as many of the western countries have banned such studies. Especially after the Northwick Park Hospital tragedy in London where, a single drug put all the volunteers into serious near fatal unknown adverse effect costing the hospital millions of pounds! These CROs are a menace to us, as we do not have the genuine informed consent in our set up with most of our patients still very poor and illiterate to understand the intricacies that are built into every new drug trial! I wonder if it is ethical to do such studies at all. Who cares for ethics these days, anyway?  

In fact, there are a few “researchers” who would not have seen a single patient all their lives, but profess to the world about the drug treatment of major illnesses. The companies mainly target those diseases that are likely to be life long business for them like diabetes, high blood pressure, coronary artery disease etc. There are many guidelines all over the world for the treatment of these diseases. If one takes care to carefully scrutinize them, one quickly realizes how fallacious they are. To give an example of hypertension, there are six guidelines in all: we in India are trying to have our own guidelines, in addition. If all of them are computed together they cover just about 39% of the patients. For the rest, there are no guidelines. Young, but enthusiastic, doctors are getting frustrated looking at these. If any of the guidelines are not convenient to the drug makers, the companies get their “great brains” to refute them and have new guidelines. This happened with the American National Guidelines for high blood pressure management some time ago. (JNCV).

One could take any area for scrutiny. Anti-cholesterol drugs, anti-arrhythmic drugs, heart failure drugs, anti-hypertensive drugs, anti-diabetic drugs, pain killers, anti-cancer drugs or, for that matter, many of the procedures for surgical corrections and even some of the untested technologies like coronary care units, terminal care units, flow catheters and many other areas have their loads of skeletons in their cupboards. An unbiased audit would get these skeletons out of the cupboards. In fact, in a recent article in PLOSmedicine, Richard Smith, the former editor of the British Medical Journal and the present editor of the Cases Journal in London, showed elegantly how doctors today have become just puppets in the hands of the drug company barons.

“How much longer will medicine’s flagship educational events fly the colours of the drug industry”, asks Ray Moynihan, the editor of PLOS medicine and goes on to add, “In the heart of Manhattan Island one misty morning a few years back, I watched as hundreds of psychiatrists streamed into their flagship educational event, the annual congress. Even before arriving, they were welcomed by giant advertising billboards on the streets outside, plastered with the name of a major sponsor, Pfizer, the biggest drug company in the world and the maker of Zoloft, the world’s top selling antidepressant. Once inside, their first port of call was the huge exhibition hall, where well dressed salespeople moved among high-tech booths and hypnotic neon, exchanging pleasantries with doctors lining up to play video games and win prizes. And then, of course, there were the sponsored educational sessions. That year—2004—psychiatrists learnt about bipolar disorder over breakfast at the Marriott Marquis Hotel, courtesy of Eli Lilly. Over lunch at the Grand Hyatt they studied maternal depression, thanks to GlaxoSmithKline, and for dinner it was generalised anxiety disorder in the grand ballroom of the Roosevelt Hotel, funded by Pfizer,” in a recent article in the BMJ.  

When the gulf between the industry and the academia narrows, medical students and house officers, under the constant tutelage of industry representatives, learn to rely on drugs and devices. This is more often than they should do. Young doctors learn that there is a pill for every ill and a surgical correction for every anatomic deviation from the normal. Faculty members could get distracted from their teaching commitments. Doctors get used to these company courtesies of receiving gifts and favours to further their continuing medical education. In this generation, there is always an overemphasis on drugs and devices that could ultimately work against patient interests. The Hippocratic Oath really becomes hypocrates’ oath.

It is time to do a bit of introspection before it is too late in the day for us do even that. We should see that we are not open to the charge that we are for sale. Academic medical schools should educate their students on the ills of the prevailing scenario and have to inculcate in their students the love for ethics and give them a good idea of pharmaco-economics and the ways of the business world that may be alien to them at that stage in life.

Let us not forget that 80% of the world population even today does not have any touch with modern medicine, 62% of upper middle class Americans can not afford health insurance as the premia are sky high for them, 57% of Britons do wish to have alternative systems of medicine when they are ill, despite the fact that they have the free National Health Service. Let us also remember that patients could very well live without doctors, but doctors could never survive without patients!  For this write up, I have drawn heavily from my articles published earlier on similar subjects in 2001 and 2006.

“People are never satisfied. If they have a little, they want more. If they have a lot, they want still more. Once they have more, they wish they could be happy with little, but are incapable of making the slightest effort in that direction.”       Anon.


Read first part here

(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also Editor-in-Chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London.)





2 years ago

Very good write up ! Indeed. The working in the industry and the profession is well documented.Unfortunately that is only half the story.

Introspection is necessary for the medical fraternity but also for the society at large. You have chosen to not look at socio - economic parameters which is the fundamental reason for the ill that is seen and experienced by you. Most of them want to agree with you and also support you but for the socio- economic reality. Let me highlight some of them :

Socially medical profession is the most regarded profession irrespective of the ills known. Hence most of the brilliant students compete to enrol.

Costs of medical education is huge in money terms and time ( around 12 - 20 years ). By this time their little known classmates have started building their fortunes and family

Lesser performers but aspirers for medical practice pump money to make good with their brilliant batchmates. System happily encourages this.

Competitive spend land them up with huge costs putting massive pressure for making good their money. Where will ethics feature ?

Most of them have to go in for individual practice at some time in life - both real estate and equipment are exorbitant for the financially depleted brilliant professionals.

Here walks in the bankers / investors to lend and in the bargain make much more than their borrowers.

Pushed to a corner, these medical professionals are offered ways and means to make good their losses and more. Some of them become investors/funding agencies themselves.

Coupled with above they are encouraged to earn in cash ( atleast in India) saving them so much on Tax.

Where is the scope, time and energy for Ethics ?

Introspection has to happen not by medical professionals alone. Changes and correction has to happen at all levels like society ,financial , educational and Governmental. Surely things will change. What these can be is well known to the profession and also to the learned author. We have to be the instrument of that change in the society at Large. It is a long haul but it cannot be expected of the medical profession alone.

Finally if changes are not done doctors surely will lose patients faster but patients might also get surgical corrections with organs of animals - like the infamous Assam case of a Pig Organ used for organ transplant.

It is a good call by the learned author, who is respected both in the profession and outside but it needs to be complete.

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