more bottle baby death sparked a global exposé
Every 30 seconds a baby dies
because it was not breastfed. One such bottle baby death occurred
in Sialkot, Pakistan in March 1997. When the doctor returned from
attending the child and informing the parents, he found Syed Aamar
Raza, a Nestlé Medical Delegate still waiting in his office. "Why
did this child die?" Aamar asked the doctor. "Because of people
like you," replied the doctor. So began a crisis of conscience
which led to a young man taking on the World's Largest Food Company.
It is a story of institutionalised malpractice and Aamar's struggle
to be heard.
A respected company
Syed Aamar Raza joined
Nestlé Milkpak as a Medical Delegate in December 1994 at the age
of 24. It was a dream come true to work for a multinational company
and he was quickly indoctrinated with Nestlé's "Be the Best" slogan.
Aamar was responsible
for promoting breastmilk substitutes and infant cereals. One of
his first tasks was to run a baby show, already organised by the
Area Detailing Executive. Baby shows were popular with health
workers and mothers and provided an opportunity for marketing
staff to make direct contact with both and to display the company's
range of breastmilk substitutes and discuss them. Such activities
are banned by Article 5.5
of the International Code of Marketing
of Breastmilk Substitutes and Nestlé's own "Charter".
Aamar says he received
no training from Nestlé on the International Code. But
in December 1996 he received a copy of Nestlé's weak version of
it - known as the "Charter".
confused when I read the 'Charter'. It said Nestlé
does not give gifts to doctors, but we did this. My bosses
signed the cheques. It said we did not make direct contact
with mothers, but we held baby shows and in clinics we used
Cerelac samples as a way of striking up conversations to
push the milks. The "Charter" says Nestlé does not
pay staff by incentives, but my salary revisions signed
by Mr. Roland, Marketing Manager, includes incentives. Infant
formula received the most points in the scheme.
told me to do all these things which the 'Charter' says
we do not do."
Some of the Nestlé Medical Delegates at an annual
sales meeting. Minutes reveal that breastmilk substitutes
receive most points in the company "sales incentive
Crisis of conscience
Several months after
first seeing the "Charter" Aamar was visiting one of the 200 doctors
on his circuit. This doctor was one of the very few who refused
the gifts offered by Nestlé. The doctor was called from his office
to attend a sick child, a child he could not save. "This is
the result of marketing by people like you," he told Aamar
when he returned to his office. He explained that the child had
been breastfed for just one month and then a doctor had prescribed
infant formula. Two months later the child was sick with diarrhoea.
A month after that he was dead.
Aamar says that during
training he had been told to quickly say "breast is best"
before launching into his sales pitch, but the risks associated
with bottle feeding had not been explained. Leaving the doctors
clinic, Aamar understood that unsafe bottle feeding could kill
- had killed the child of the distraught parents he saw grieving
outside the office.
Aamar returned home
to his 2 year old son and pregnant wife and began to think about
what he must do.
resign with immediate effect"
Aamar's first action was
to resign his well paid and prestigious job with Nestlé. He returned
his motorbike, but he kept copies of the documents relating to
his job. These had been gathered following instructions from his
superiors. He had been instructed to maintain records of incentives
to doctors so that he could later use them to pressure the doctor
into prescribing more Nestlé products. He also had to keep copies
of the instructions he had been issued. Aamar realised that he
held irrefutable proof that Nestlé was systematically breaking
the International Code and its own "Charter." It was not enough
to resign his job, he had to do more to stop the unnecessary death
and suffering to which Nestlé contributed by such activities.
Six months after his
resignation, Aamar issued his former employers a Legal Notice
(dated 12/11/1997), attaching nearly 80 pages of evidence of the
company's unethical marketing practices.
Advised by his father
in view of his legal experience, Aamar demanded in his Legal Notice
that the company "stop its business of infant food manufacturing
in Pakistan and withdraw all its infant food products from the
Pakistani market within 15 days of receiving this legal notice".
He also directed the company to "terminate the services
of staff involved in non-professional and unethical practices
of promoting and selling infant formulas within the same period
of 15 days."
The evidence contained
in the Legal Notice and Aamar's other files, is damning and substantiates
the findings of monitoring conducted in 33 cities by a group in
the International Baby Food Action Network (IBFAN)
- The Network, Association for Rational Use of Medication in Pakistan
- published as the Feeding Fiasco
in March 1998. The Network has reproduced some of Aamar's evidence
in the new report Milking
Profits. Here we summarise the evidence presented in the report.
Impress money - bribes
"All the supports
are with you as usual," reads a handwritten note signed by
Aamar's immediate supervisor, the Area Detailing Executive.
"Supports" including cash for gifts. Every month Aamar received
"promotional expenses" or "impress money."
"This budget is
used to fulfill the demands of doctors," Aamar explains, which
could include lunches and air tickets. Nurses were usually given
lipstick and perfume. Aamar was required to keep receipts of this
expenditure and submit them to the accounts department. If sales
were good in his area, he would be given larger sums of money,
in amounts which were two or three times his own salary.
Doctors' details were
recorded on Contact Data Cards, which include entries for date
of birth and wedding anniversary, reminding Medical Delegates
when to give special gifts to the doctor.
At the end of the fasting
month is the festival of Eid. Aamar's supervisor provided him
with gift packs for doctors, made up of Nestlé food products.
Class A doctors received a more generous pack than those of lesser
had to be specifically approved by Aamar's superiors beforehand.
When a doctor asked for an air conditioner, Aamar wrote to his
supervisor, seeking guidance, who consulted the Group Brand Manager
at the national headquarters. The Group Brand Manager authorised
part payment and wrote "Aamar, OK. But Nan and al110 sales
should go up."
from the top
evidence leaves no doubt where the blame lies for these
promotional activities. In this memo Aamar asks for the
company policy after receiving a request for an air conditioner
from a doctor. The Group Brand Manager instructs Aamar to
go ahead, but adds that sales of Nestlé infant formulas
must go up as a result of the gift - making it a clear inducement
to promote products - banned by Article
8.1 of the Code. National Executives are implicated
by other documents and the auditing methods of Nestlé's
Swiss HQ are exposed as either inadequate or culpable. Nestlé
Chief Executive, Peter Brabeck-Letmathé, is ultimately responsible
for this as he claims: "I personally review any hint
of wrongdoing that the auditors uncover."
target sheets are prepared by the Area Detailing Executive for
the Medical Delegates (for breastmilk substitutes Lactogen
1&2, Al110, Nan, Pre-Nan as well as complementary foods
Cerelac, Neslac and Nestum).
The sales team is continuously
reminded of these targets and the importance of meeting them.
They are under pressure to perform.
A notice from Aamar's
supervisor informs him, "Please receive your last quarter achievements
report against target. Your small towns need a lot of improvement
in all products and special emphasis is needed in Sialkot..."
Another time, Aamar
was informed, "Your most concern area is Cerelac [a complementary
food] as well as Nan [an infant formula] also specially in Sialkot.
Also start taking Rx of Al110 also"
Al110 is a formula
for use for the rare condition of lactose intolerance, but even
with this product Nestlé set sales targets. The minutes of an
Annual Delegates Meeting, signed by the Group Brand Manager, state
that "Targets of Al-110 must be rationalised according to the
real potentiality of the towns."
Fruits of their labour
A letter from the Marketing
Manager of Nestlé Milkpak, provides the break up of Aamar's
salary. The letter informs Aamar he "will also continue
to be entitled to participate in the Performance Incentive Scheme...
Please remember your actual performance is regarded to be of key
importance and has therefore been duly considered when revising
Aamar's pay-slips show
the "Incentive to Salesman" payments, which vary from slip
to slip but are sometimes nearly as much as the fixed pay. On
later slips, where fixed pay is broken down into basic pay and
various allowances, the incentive to salesmen is sometimes more
than double the basic pay.
The minutes of an Annual
Delegates Meeting reveal that infant formulas receive the most
points in the "sales incentive scheme" and Delegates receive an
extra bonus for hitting all their targets. Like the promotional
activities already discussed, incentives and sales quotas are
banned by the International Code. Interestingly, Aamar's pay slips
are marked "strictly CONFIDENTIAL."
"Well done tigers"
The entire sales team
was invited to the annual sales conferences at the luxurious hotel,
Pearl Continental Bhurban. The invitation letter informs that
the winners of the Tiger Cup will receive their award during this
event. Awards are given to the "Medical Delegate of the Year".
Winners receive plaques and cash awards of as much as Rs25,000.
Winners are determined by their sales performance.
Aamar did not win an
award, but he received a special commendation for his work in
"crushing" the competition, Japanese company, Morinaga, in CMH
Military Hosptial Sialkot. A military doctor, who will be referred
to as "The Colonel", wrote to the Group Brand Manager, an old
friend, asking for two air conditioners "for my two clinics
(one at CMH and the other at my residence). I am sure that these
air conditioners will keep on reminding me of the efforts your
company makes for the improvement of patient and health care services
Aamar was told that
The Colonel had to first show what he could do for the company.
The Colonel issued a circular to staff stating that only Nestlé
products could be used in the hospital. He then received two air
uses its influence
to doctors give it an influence beyond simply promoting
products. For example, when The Colonel wrote to the Group
Brand Manager, an old friend, requesting two air conditioners
THE MERCIFUL bless you and your team with health honour
and peace of mind, with this short but sincere prayer I
beg leave of you by assuring you of my strong commitment
to any services professional or otherwise which you may
consider me able to perform."
that after he sent his Legal Notice to Nestlé, The Colonel
tricked him into attending his office. There Aamar says
he found the Group Brand Manager, who threatened to have
him killed and his family kidnapped unless he stopped his
Aamar's evidence contains
forms for providing free supplies. The measures adopted by the
World Health Assembly state that there should be no free supplies
in "any part of the health care system."
When Aamar forwarded
one doctor's request for 10 packs of Lactogen 1 for free,
he was advised by the Group Brand Manager to buy the stock from
his impress money for the doctor.
responded to Aamar's Legal Notice
After Aamar issued
the Legal Notice to Nestlé, the Area Detailing Executive
and the Group Brand Manager came looking for him. When they failed
to persuade Aamar to come to the office of a doctor who who is
a friend of Aamar's, they went to the office of The
Colonel. The Colonel called Aamar on a pretext and asked him
to come to his office.
Aamar arrived at The
Colonel's office to find his former superiors there. He says:
"The Group Brand Manager said Nestlé was such a giant company
that I could not harm it. He asked me to withdraw the legal notice
and said that if the company's interests were damaged with legal
action, I would suffer serious consequences. Nestlé is a multinational
company, he reminded me, and has money to do anything to me. My
Area Detailing Executive offered me any amount of money I like.
The Group Brand Manager said that If I continued to be stubborn,
the company would file cases against me in many different cities.
They said anyone from my family could be kidnapped, or I could
even be killed. They said there are lots of gangsters in Karachi
and Lahore ready to kill for money. I told them to go ahead and
do what they wanted to do and I would do what I wanted to do."
To escape the office
and the three men, Aamar said he would discuss the matter with
his family. He did not return, but sent a letter to Nestlé saying
the 15 day period in the Legal Notice had expired and he would
It was a brave move,
but one Aamar realised he could not pursue alone. Accordingly
he wrote to the World Health Organisation office and contacted
the IBFAN group, known as The Network.
WHO says no
WHO wrote back saying
it had only an advisory role and could no take no action against
Nestlé. It forwarded Aamar's letter to the District Health Officer,
without Aamar's permission.
Soon after Aamar says
he received a call to visit The Colonel, who said he was interested
in some pharmaceutical products Aamar was then selling, but again
there were threats and offers of money.
"After that meeting
I told The Colonel I was dropping the issue. Then I made sure
to keep everything very secret."
IBFAN agrees to help
By March 1998 Aamar
had shown his evidence to The Network, who said they would publish
a report if he decided he wanted to go public. He also wrote a
review for the Feeding Fiasco report.
The Network contacted
other groups in IBFAN, first
to evaluate Aamar's documentary evidence and then to prepare a
media strategy. Baby Milk Action and the German group, AGB, have
played key roles in this, putting Aamar in contact with Stern
Magazine and ZDF television in Germany, who spent nearly a year
putting together stories.
was launched on 9th December 1999 in Berlin and on 15th February
2000 in London.
Milking Profits is
from Baby Milk Action for £5.50 including postage and packing
in the UK.
Corporate Communications Director, Francois Perroud, is
the man putting Nestlé's side of the story to journalists.
His tactics include
accusing Aamar of presenting false qualifications (Aamar
responds: "I was good enough an employee to get 'Well
Done' remarks during my three-year job. These are blatant
lies and only started after my legal notice to Nestlé.")
of attempting to blackmail the company (Aamar responds:
"I did not attempt to blackmail Nestlé. They threatened
me and offered me money.")
While Mr. Perroud
claims to have proof of his allegations, he has ignored
requests from Aamar and Baby Milk Action for copies. Indeed,
Baby Milk Action has been asking Nestlé to substantiate
its blackmail allegation for the past year.
Mr. Perroud has
also been reluctant to put his so-called evidence into the
public domain. In a television interview in Germany (still
to be broadcast) he flashed an envelope at the interviewer,
but refused to hand it over. The interview was terminated
as a result and Mr. Perroud stormed out.
We have asked
Nestlé to respond to the evidence of marketing malpractice
and to release its last audit of Nestlé Pakistan.
We are still
Aamar presented his
evidence to a meeting at the House of Commons on 29th February.
Shortly before his family in Pakistan received an anonymous threatening
letter telling him to end his campaign and on 27th February shots
were fired at his house. Nestlˇ was asked to condemn the attack,
but instead distributed a report claiming the attack did not happen.
Baby Milk Action has evidence of the attack and has forwarded
this with NestlˇÕs report to PakistanÕs anti-corruption body which
is investigating AamarÕs evidence.
On 13th April Nestlˇ
announced it had commissioned an external audit of its Pakistan
* Milking Profits
is available from Baby Milk Action for £5.50 including P&P in
the UK.(visit the Virtual
is to be done?
of Milking Profits already demonstrates that it is more
concerned with attacking its critics than protecting infants.
Still, we have asked
Nestlé to respond to specific violations documented in
the report and to reveal results of internal audits if any really
have been conducted. We have received no response to these requests.
Other steps need to be taken.
The new administration
in Pakistan needs to regulate the marketing of baby foods by implementing
the draft law which was sitting with the previous Cabinet.
The Pakistan Paediatric
Association needs to me more proactive in educating its members
on the International Code and Resolutions and ending malpractice.
Finally, Aamar requires
maximum publicity to make it impossible for violent action to
be taken against him or his family.
You can help by sharing
On 27th February
2000, two days before Aamar presented his evidence at
the UK Parliament, shots were fired at his brother at
his house in Pakistan by an early morning caller. On the
left, one of the bullet marks. Below, 6 cartridges found
outside the house after the attacker had fled.
Milk Action asked Nestlé to condemn the shooting
and to call for restraint from all those implicated in
Aamar's Legal Notice. Instead the company has circulated
a report claiming that the attack never took place.