Rail trail

India's rail safety rests on the shoulders of 200,000 trackmen with 15 kilos of gear on their backs

As more than 130 people die in a train accident in Kanpur, discussion on modern safety systems has been revived.

More than 130 people have died in one of the worst railway accidents India has seen in years, after the Patna-Indore Express derailed in Kanpur Dehat district on Sunday. The incident saw 14 coaches coming off the tracks, leading to horrific scenes of mangled bogies and serious injuries, in addition to the death toll which authorities are concerned may still go up.

Since efforts are still on to rescue people at the site, officials have not yet spoken of the cause of the incident. One official said that another train passed through the route safely just nine minutes before the accident. Yet most seem to have concluded that the derailment was likely the result of a rail fracture – a crack in the tracks.

“A high-level probe has already been ordered and we will take strict action,” said Minister of State for Railways Manoj Sinha, who visited the spot on Sunday. “The engineers and experts will probe the cause of the accident, but it appears there was a rail fracture.”

Rail fractures

Rail fractures occur when a small crack turns into a larger one, usually because of the pressure of heavy bogies traveling over it. Indian Railways, which maintains 115,000 km of track around the country, is particularly prone to it in the season when there is a significant difference between the maximum and minimum temperatures in the day, since those cause the tracks to expand and contract. Poor maintenance and fitting could also be the cause of a small crack that over time could turn into a separation of rails. The result is a break in the tracks, which causes the bogey to go off the rails, affecting all the coaches behind it as well.

The Times of India reported that 50% of train accidents in the last three years have been due to derailments, of which 29% were caused by track defects. Accidents due to derailment have been up by 67% this fiscal year, up to November 15. Those numbers will be even worse once the Kanpur incident has been accounted for, especially since it came just days after another train derailed in Jodhpur.

The accident has also turned the spotlight back on passenger safety, with some claiming that the recent push to increase capacity and redesign business models for the railways has shifted focus away from core safety issues. The Hindustan Times quoted an unnamed senior ministry source saying “somewhere along the line, routine safety drills have taken a backseat and the 1 lakh-odd vacancies in the safety category have remained”. The report also quoted Sanjay Pandhi of the Indian Railways Loco Running Men Organisation saying that the business aim of the railways, running more and heavier trains, has led to a deterioration in the rail tracks.

Track monitors

Some of the focus might turn back to the physical way that Indian Railways actually maintains its massive track length. One of the world’s biggest employers, Indian Railways has an entire department of trackmen – formerly known as gangmen – whose entire job revolves around maintaining tracks. These 200,000 trackmen set out every morning carrying 15 kilos of equipment and walk along a 5 kilometre stretch of rail to check it for defects.

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The work is hard, as well as dangerous. Trackmen spend most of their day on tracks that still have trains plying on them, which leads to an average of more than 300 deaths every year. Added to the danger is the pressure of maintaining the tracks themselves, since mistakes by trackmen could leave trains vulnerable to incidents like the tragic derailment in Kanpur.

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For years, the authorities have promised to develop safety technology that will better alert trackmen when trains are approaching and giving them lighter toolkits.

In addition to the trackmen, Indian Railways uses ultra-sonic flaw detection machines, but these have to be taken out manually and are thus likely to only travel over high-density routes once every two months. The authorities are working with the Indian Institute of Technology-Madras to develop automated detection systems, but for the most part current monitoring is heavily dependent on the trackmen alerting engineers about potential dangers.

Earlier this year, Railway Minister Suresh Prabhu launched the Track Monitoring System, software meant to store information regarding temperature and track-maintenance activity across the railways. However, The Pioneer reported that the new system is not available to those in the safety wing. “As a result, the monitoring mechanism becomes a closely guarded secret defeating the very purpose of the launching of the software application,” an unnamed railway official told the paper.

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.