No place that's clean

India's problem with hygiene continues

The various reports sent to the Indian pharmaceuticals giant Ranbaxy by the United States' Food and Drug Administration after a series of inspections it carried out in a Mohali drug-manufacturing facility late last year make for depressing reading. The USFDA found an unidentified "black fibre" in an inspected batch of medicines that might be from tape attached to a mechanical nozzle - or hair from an employee's arm. Another tablet had compressed black spots that appeared to be dripping engine oil from the machine that compressed the medicine. Even worse, toilets in the complex lacked running water; and there were no reminders to employees to wash their hands after using them. The USFDA has already banned the import of drugs made at Ranbaxy's other facilities in Dewas and Paonta Sahib. It would not be surprising if Mohali, too, came under similar stricture - especially as the American government agency complained that the management of the Indian company consistently failed to review the errors it had found, and make any necessary corrections. Ranbaxy has since stated it will take "all necessary steps".

That such carelessness has penetrated into even the supposedly sanitary area in which a major drug-maker conducts its manufacturing also reflects the broader Indian problem with public hygiene. There will likely be a reflexive negative response to the USFDA's criticism, noting that the foreign regulator has no concept of Indian realities. Indeed, that foreign-bred eyes for many decades have noted problems with Indian public hygiene has always been a touchy subject in this country. When Katherine Mayo, a conservative American writer, wrote the best-selling Mother India in 1927, Mahatma Gandhi singled out the parts about India's difficult relationship with hygiene for negative comment: "a drain inspector's report", he called it. This was in spite of the fact that Gandhi himself was more than cognizant of the cultural embeddedness of poor hygiene - he wrote frequently on the subject, and in fact stressed that he had learnt the importance of the issue in the West. He went so far as to link the dismissal of hygiene in India as a major issue to the persistence of caste hierarchy, which led to some things being considered less worth public care or even debate.

It is clear from the Ranbaxy example that the private sector may not be able to take the lead in reforming this attitude. What is unfortunate, however, is that the state has also been unwilling or unable to prioritise the problem, perhaps reflecting deeply held cultural priorities. For example, India has made major progress towards almost all the Millennium Development Goals - especially on reducing poverty, improving maternal health and so on. But the progress on sanitation-related goals has been slow. This is in spite of the fact that recent research has demonstrated that, for public health in general and for the physical health and educational attainments of young people in particular, good sanitation is perhaps the most crucial ingredient. Many of the symptoms of child malnutrition - so prevalent that the prime minister called malnourishment "a national shame" - might actually be attributed to poor sanitation.

Another example of the deleterious effects of carelessness about the standards of public hygiene is the continuing impact of dengue in urban centres. Even in well-funded Delhi, which has the benefit of relatively independent urban governance, attempts to clear the city of stagnant water, which breeds dengue- and malaria-carrying mosquitoes, have not been successful. Intriguingly, Gandhi, writing in 1919, commended the British administration for "filling hollows" around Delhi that earlier contained stagnant water, thereby reducing the incidence of malaria. It is unfortunate that independent India has not learned the lessons that Gandhi did. Neither state nor private sector has sufficiently internalised global best practices about hygiene - or even its importance.