Tertiary care plays an important role in determining the structure of the healthcare system and universal access to it. Breaking away from western-oriented tertiary care medical knowledge, a number of issues have to be rethought to defi ne tertiary care in the Indian setting that can be provided by the existing system. Providing tertiary care with district health services will mutually reinforce both and provide healthcare that is affordable and appropriate to local conditions.

We are writing to make known to the international medical community the shocking imprisonment of Binayak Sen on May 14, 2007, in the central Indian state of Chhattisgarh. A well known paediatrician and public-health specialist, Sen's is a rare example of the cost of involvement in civil rights activism by physicians. He is being charged by the local police with illicit communication with Maoists in custody. (Correspondence)