My five year tenure as Secretary ( Health &Family Welfare) and then as Principal Secretary during 2001-2005 was varied , interesting and most challenging. It was an assignment that gave me immense satisfaction and enabled me to learn alot about health related issues and make rich contributions for the health sector of the state.
From the beginning of my stint, I started taking regular review meetings with Heads of Departments, Programme officers and my staff in the Department. In certain cases, I used join the Heads of Departments when they were taking monthly review meetings.It enabled me to have first hand knowledge as to what was happening in the field and what remained to be taken up on a priority basis. It enabled me to initiate advance action against monsoon - related and seasonal out -breaks of communicable diseases, ensure preparedness of the Departments concerned for any major casualty. It also enabled me to identify the missing crucial links in the system.
Dengue Outbreak & Control
In August 2005, the state was realing under a Dengue outbreak and deaths were mounting. Every death, even ordinary death was attributed to Dengue. We immediately called a meeting of the the Head of the Department of Community Medicine of the Trivandrum Medical College to understand the gravity of the situation and worked out a strategy to address the problem squarely. We launched an awareness campaign by giving talks over the television, Radio, Press and launched door to door campaign. We used the school choldren to carry home the messages relating to " Dos" and "Donts". All the hospitals were asked stack test kits and emergency medicines. The Medical Colleges were asked to adopt the most affected villages by this out- break. We requested all the local bodies to focus on cleaning up their clogged drains,waste dumps, backwaters- the source of dengue larvae breeding. These efforts and the commitment shown by the doctors and paramedics enabled us to bring the outbreak under control.
Facility Survey
In order to fill up the critical gaps in any instituion, a "Facility Study" ( of infrastructure,man power, equipment, drugs,beds & furniture,water,drainage etc) is essential. With this in mind, facility surveys were conducted on a war footing against a blue print prepared by experts.This was published as a book titled "Instituion Analysis".
Essential Drug Lists & Drug Procurement Policy
When I joined the Department, almost all Malayalam dailies flashed news repeatedly that there were no essential drugs and even dressing materials. I went into the issue and realised that the Directorate of Health Services had not settled biils for the supply of drugs supplied during the last two years and that amount had mounted to Rs.35 crore. On top of it , the DHS required allocation to the extent of Rs.65 crores for every year. I took it up as a priority item and moved the Finance Department, which released funds in 3 instalments. Once, we got over the pending bills, we thought of ensuring availabilty of Essential Drugs in all the hospitals, for which we had to come out with Essential Drug Lists for Primary, Secondary and Tertiary Hospitals. An expert committee was constituted and Essential Drug lists were prepared and after getting Cabinet approval circulated to all the instituions.
PHOTO OF ESSENTIAL DRUGS
In order to ensure transparency and quality in the procurement of drugs, a Procurement Policy was prepared and Cabinet approval was obtained. This became handy for the DHS officials concerned with procurement of drugs and supplies to ward off complaints.
Rural Service & abolition of Liquidity Damages
Kerala is known for 100% literacy but was poor in public health facilities for want of adequate resources and lack of technical manpower. Most of the doctors and paramedics, who gained their degrees/diplomas at the cost of exchequer flew out of India for better pasture and as a result there were many vacancies across the state. There was a ban on recruitment as well. It affected health delivery. There were only two options before us - one, to deny leave for taking up jobs outside the state and two, to make rural service compulsory for those,who pass out of the Colleges with an MBBS degree. This move resulted in a lot of furore amongst the staff; but we put our foot down and said no. Moreover, the question of "Liquidity Damages" was done away with.
Private participation in Medical Education
At the time of assuming office as Secretary ,Health, there were only 5 Govt Medical Colleges, two Dental Colleges and few Nursing Colleges in the State. The number of MBBS seats totalled upto 900 and there was heavy competiton amongst students to get into anyone of the Medical Colleges in the state. Kerala parents would not mind selling their properties to educate their children. When their wards could not make it into the local Medical Colleges , they admitted them in the colleges in the neighbouring states paying hefty capitation fee. During one of my trips to the Ministry of Health , I discussed with Mr.Rao, Director in charge of Mediccal Education and asked him the way to go about to set up Medical Colleges in the private sector in Kerala. Of course, Kerala politicians would detest anything that is private . Of course, there have been lot private management run colleges of Arts & Sciences. On return from Delhi, I initiated a put up a note to the Chief Minister for orders. The initial response was "No". However, my logic was appreciated when I circulated the second note. We, therefore, issued a press release calling for applications for setting up Medical Colleges in the state.We got about 42 applications and on scrutiny with reference to the Medical Council Regulations, it was found that only 7 of them had the where withall to start a medical college the same year ie 2002.
When the issue came up before the Cabinet for consideratuion, I was called in to explain the logic and I did to the satisfaction of the Cabinet. It gave its not for consideration of all the 42 applications and issue Essentially certificate. I though it was a wrong move. Only subsequently, I realised that the Cabinet, in its collective wisdom took a practical decision. They knew pretty well that if only few were given and the others were denied, the decision of Govt. would be stalled by filing Writ Petitions. The same year, Amrita Institute of Medical Sciences,Kochi opened the first ever Medical Ciollege in the private sector. Now, few batches MBBS students have come out of this institution and it has also started offering P.G Courses. In the next few years , another 8 colleges sprang up making available 800 seats.This has provided lot of relief to the parents of chidren,who are intelligent but could not go out of the state for education .Of course, commercialisation by all these instituitions belied our hope and instructions. The plus points of this opening up of Medical ducation for private participation are that specialty care is available to all those who could afford, lot of infrastructure came up besides commercial establishments . It also provided for lot of employment opportunities for both skilled and semi skilled labour.
Setting up of Paramedical Council
The services of Paramedical Staff is inevitable for health care delivery. But, unfortunately, the instituions that impart paramedical courses are not regulated and the personnel who come out of sizeable number of instituions are poorly trained and they play havoc with the lives of patients. Kerala was the first state to set up the Paramedical Council in India. I provided leadership in setting up this council to regulate paramedical instituion.
Telemedicine & CArdiac Emergency Hospital at Pmapa
Sabarimala is a pilgrim centre in Pathanamthitta district of Kerala. Located amidst forests, it has no medical facility worth mentioning for the lakhs of pilgrims, who throng the hills for darshan of Lord Ayyappa. I had the fortune of serving as Special Officer,Pmpa during my Adoor Sub Collector days. As Secretary, Dept.of Health & Family Welfare, I arranged for first aid posts, a Govt. run Hospital at Pampa and presssed into service lot of doctors and paramedics. In addition, I approached the Director of ISRO Dr.Madhavan Nair and appealed to him to station a telemedicine unit at Pampa so as to get tele consultation with specialists from Super Specialty hospitals in other parts of the state. He readily obliged. I also approached Amrita Institute of Medical Sciences,Kochi and also the Apollo Group of Hospitals, Chennai for their support. Amrita Institute of Medical Sciences responded the same year by establishing a 10 bedded cardiac emergency hospital and Apollo Group followed their steps next year. Since then, bith these institutions run cardiac emergency hospitals at Pampa, which are beneficial for the devotees.
Tsunami and the relief Operations
ON 25 December,2004 Tsunami struck the coastal belt of Tamil Nadu Kerala. The coastal belt from Trivandrum to Alleppy was the worst hit. We set up a round the clock Control Room and monitored the situation. I had instructed the DHS And the DME to press into service their doctors and paramedics and render relief on a war footing. The Medical Colleges were asked to send teams of specialists and paramedical staff to the affected areas well within their district. District Medical Officers and the Principals of Medical College were asked to draw medicine from their stores and buy from the open market in case of need. The local private hospitals were requested to offer medical services to those who were affected and Govt. undertook to settle the bills. Ambulances carrying doctors, paramedics and emergency medicines and equipment were asked to patrol the area and render services. The Secretary of the State Mental Health Authoriyu was asked to send Psychiatrists to the relief camps and asked to offer counselling. As suggested by me the Cabinet despatched senior Secretaries, who had workedd in those disricts to oversee relief operations and take on the spot decisions and help the District Collectors in carrying out effective relief operations.
A Fight Against Stigma
The Govt in general and the Health department in particular was shocked, when the news broke out that Benson and Bency , HIV-infected siblings of Chathannoor Village had been thrown out of the local Kaithakuzhy Lower Primary School and were forced to confine themselves to their home because of their HIV status . The efforts of the state machinary consisting of the Secretary , School Education, Director, Kerala AIDS Control Society and the District Collector,Quilon to allay the fears of the parents of the children studying in the school and the local panchayat did not yield results. These two children were virtually ostracized by the entire village community which also trampled upon their fundamental right to education.
Parents did not to want their children to share the classroom with Benson And Bency and the Parent Teachers Association voiced exaggerated fears of a risk of HIV transmission from these siblings. Exposing the deep-seated stigma that hounds HIV-infected victims, belligerent parents threatened to withdraw their children from the school if Benson and Bency were in.Eventually, the school gates slamed shut on the children.
Deprived of their fundamental right to education, the orphans, who are under the care of their grandparents, were forced to remain at home. Having found that my colleagues could not succeed in their attempt,I entered into the frey even though AIDS Control was the subject handled by Secretary ( Family Welfare). I made it a point to spend weekends with the children, invariably taking them for a stroll on the streets. My efforts to erase the stigma that surrounded them paid dividends. The following unpublished article written " Walking With +Vesby me would throw some light on my efforts to fight the stigma.
WALKING WITH +ves
POSTER ( FILM TO BE POSTED)
During this period, I was handling, interalia, Relief and Rehabilitatin. I was closely monitoring the facilities provided to 1.4 lakh Sri Lankan Tamil refugees sheltered in various camps across the state of Tamil Nadu. A brief look at India’s experience in Refugee Administration and the reason why the Tamils fled Sri Lanka and sought refuge in Tamil Nadu would enable us to appreciate the issues in a better perspective.
India, even before attaining freedom from the clutches of Britishers, had to grapple with refugee situations. 9.5 million non-Muslim refugees filed East and West Pakistan fearing persecution and sought refuge in India just before and after her independence. 8.5 million fled former East Pakistan (now Bangaldesh) and took shelter in India. 66,120 Tibetan refugees came to India since 1959. About 78,000 Chagma refugees from Bangaldesh are in our Camps in Tripura. Thus, we find that more than 18.3 million refugees (including the Sri Lankan Tamil refugees) had been provided with shelter in India since independence. Our experience in handling them is unique and unprecedented.
It was for the first time in 1983, that Tamil Nadu had to handle 0.13 million refugees of Tamil origin from Sri Lanka. Again in 1989, she had to offer asylum to 0.12 million Sri Lankan in handling refugees single handedly is remarkable and praise worthy. She can now boast of a well-oiled and well- experienced machinery in refugee administration.
INFLUX OF REFUGEES – PHASE I
The frightened and persecuted Tamils in thousands started fleeing the country and landing on the shores of Tamil Nadu in July, 1983. Thus, began the first influx of Sri Lankan refugees and continued till August, 1987.

PHOTOS
During the above period, 134,053 took refuge in Tamil Nadu. 40,000 of them were destitutes and hence they were accommodated in 172 camps spread over the State of Tamil Nadu. The remaining number of refugees opted to stay with their relatives and friends or on their own in rented houses. Since the influx was sudden and very heavy, a reception centre was opened at Rameshwaram. On arrival, the refugees were given food and medical attention.

PHOTOS

After completing Customs and Immigration formalities, they were shifted to the Transit Camp at Mandapam which can provide shelter for 10,000 refugees. The District Collectors were instructed to set up temporary camps to accommodate refugees who were piling on.
Public and Private buildings, Regulated Market buildings, cyclone shelters, school buildings, Housing board and Slum Clearance Board building etc. were taken over and converted into temporary camps. The refugees were transported from the transit caps at Mandapam and Kottapattu to various other camps in the state by engaging Govt. Transport Corporation buses. They were all inoculated against epidemic diseases and issued with Family Identity Cards with photos of the family affixed on them.

Out of my compassion for the deprived and the destitutes, I used to visit the major camps to get first hand information on the facilities provided and what more to be done. These visits, borne out of compassion proded me to work on a documentary for which I started collecting photos of exodus of refugees since 1983, paper clippings and also film footages from the archives of Tamil Nadu and Govt. of India Films Divisions. I also collected these materials with an intention of writing a book and doing a P.hd in Refugee Administration. Of course, my first aim of producing a documentary, with my experience in mass media before getting into the Indian Administrative Service, materialized with the production of a documentary entitled “ Back To The Nest”. But the second one is yet to materialize for want of time and resources.

During the year 1992-‘94, I organized the process of repatriation of 39,063 Tamil refugees, who had expressed their willingness to return to Sri Lanka. With Govt. of India’s support and Govt. of Sri Lanka’s willingness, we undertook the mammoth task of ascertaining the willingness of refugees to return by circulating an application form in Tamil. We had clearly instructed the officials down the line not to coerce anybody into offer willingness for repatriation. Once we got the willingness of little over 16000 people, we informed Govt. of India in the Rehabilitation Dept. Ministry of Home Affairs. They, in turn, got in touch with the Sri Lankan Govt. to initiate necessary steps to receive the returnees and arrange for their rehabilitation back home.
Once the Sri Lankan Govt. committed in writing the way they would receive the returnees and rehabilitate them in their original settings, Govt. of India arranged for ships M.V.Akbar, M.V. Nicobar, M.V. Ramanujam and Aircrafts of the Indian Airline.
Initially of course, the process of repatriation was net very smooth as international agencies like World Watch, BBC and others raised doubts about the voluntariness of repatriation. We had to not issue clarificatory statements/ interviews. I was particularly interviewed by World Watch and BBC on this issue. As we were sure of our intention and methodology, we requested the chief of UNHCR of Mission in India (representative of the United Nations High Commissioner for Refugees) to send his team of officials to interview the willing refugees at the transit camps at Chennai and Rameshwaram.

PHOTOS

This enabled the UNHCR to appreciate our efforts and methodology adopted and Mr. Fazlul Karim, Chief of Mission in India of New Delhi in a press statement dated 15.08.1992 captioned “Kudos for repatriation work”. Of course, UNHCR officials cross checked by interviewing returnees before they were put on bound the ship before every voyage.
PHOTO
Sh. C.N.Ramdas. Commissioner, for Revenue Administration and State Coordinator of Relief and Rehabilitation and the late Sh. Bhujanga Rao, Commissioner for Refugees, not only provided leadership but also visited the transit camps, interacted with the returnees and even accompanied them on a trip to Trincomalee.
The first trip from Chennai harbour to Trincomalee(on 11-13 August,1992) was little tense both for us, who accompanied the returnees on board M.V. Akbar, but also for the refugees themselves. The 36 hour long trip back home was the happiest moment for the returnees till late in the night of the second day. The captain of the vessel when we were hardly 12 nautical miles from Trincomalee harbour picked up repeated signals “Vikrama Calling” over his communication system. Having failed to figure out whether it was a signal from LTTE or the Sri Lankan Naval Veasel, he communicated his concern to Sh. C.N.Ramdas. Immediately, he convened a meeting with me, the captain and Sh. Mohan Kumar of the Ministry of External Affairs. After a detailed discussion, we presumed that the call was from an LTTE sea hawks, who had expressed reservation about the timing of repatriation prior to our departure for Trincomalee. We decided to contact New Delhi and asked the captain the way to go about. As suggested by him, we called up the Joint Secretary, Dept. of Rehabilitation Mr. Sandhu when got to him via telecommunication network through Doha. He advised us to inform the “War Room” of the Defence Ministry. When we informed the “War Room”, we are asked to stay calm and that appropriate steps would be taken. Keeping our fingers crossed we attempted to take a map during the hours of the second days of our sailing yet we could not get even a bit of sleep. As it dawned, we heaved a huge sigh of relief, when we sighted an Indian naval war ship escorting us and an Indian Air Force helicopter hovering over M.V.Akbar. The refugees, who had not slept that night out of fear on the one hand and excitement over the prospects of uniting with their dear and near ones. Once they spoted boats of Tamils gleefully waving their hands and welcoming them, they got excited. They quickly picked up their luggages and were waiting for the vessel to anchor at the Trincomalee Harbour. The Sri Lankan authorities including army officers came on boars the ship and met us in the conference hall.
PHOTOS
After exchanging pleasantries, Sh. C.N.Ramdas briefed the Sri Lankan Authorities of the number of returnees on board and the need for providing immediate relief to the returnees and quick rehabilitation.
PHOTOS
The list of returnees was handed over. He also added that few more thousand refugee families had opted for return and there was a need to plans for appropriate logistics.
The crew of the ship and the Tamil Nadu Policemen who accompanied us picked up the siblings of women returnees so that they could take down their bags and baggages. It was indeed “a helping hand till the end”. On disembarking, we were welcomed by the Minister for Relief and Rehabilitation and Mrs. Samantha, Minister for Social Welfare.






PHOTOS
Then, we were moving towards China Bay, the air base of Sri Lanka to board a helicopter to go to Colombo on our way to Chennai. To our horror, we found mutilated bodies of soldiers and the injured being air lifted. We learn that there was a suicide balm attack at the Bay few hours before M.V.Akbar anchored at Trincomalee harbour.

These were many more sorties from Chennai, Trincomalee, Rameshwaram and Talaimannar. The then Chief Secretary Sh. T.V.Venkataraman gave a “Letter of Appreciation” for the work done by me and the staff.

LETTER OF APPRECIATION
My research into the breaking out of the violence against Sri Lankan Tamils from June 83, the exodus of refugees into India in III phases, the way Govt. of India and Tamil Nadu Govt. provided them shelter and other essentials led into “Back To The Nest”- a documentary of 67 minutes duration.
PHOTO OF THE BROCHURE
“Back to the Nest” is a docudrama about the amazing concern of the human species for their fellow beings, who are in distress and difficulties irrespective of the man-made territorial barriers and offer them asylum. In this film an idealist painter- a Sri Lankan Tamil- visualizes the pathos of the Sri Lankan Tamils who took refuge in the neighbouring Tamil Nadu since 1983.
This documented reality is symbolized through birds that migrate from extreme and harsh climatic conditions. It focus on the 3 phases of exodus of Sri Lankan Tamils across the Palk Strait in 1983, ’87 and ’90 and also the voluntary return of 54,000 of them since 1992 duly certified by the Sensor Board. This video documentary was an entry into the 6th Mumbai International Film Festival for Documentary Short and Animation Films held in Mumbai on 3-9 February 2000.
PARTICIPATION CERTIFICATE

I profusely acknowledge with thanks the contribution of Film Editor B.Lenin, who guided me in shooting the missing links,writing the story board and edited the documentary. He also help get the theme music scored by Premji. The script for this documentary was written by me. It is reproduced along with my other writings at the fog end of this book.
The concept of this video documentary was adopted by Sirpi Jayaraman, presently Principal of Bharathiar Palkalai Koodam,Puducherry for drama called “Kootaithedi”. The script of this drama is reproduced along with my writings.
My interaction with the refugees particularly with single women made me realize that women in refugee situations are the most exploited lot. That led me to pen a poem entitled “Flies, Flies all around”. (unpublished). It is reproduced below:
Counseling and care,





