POLITICAL DIARY

New Delhi, 13 August 2009

Death Of Civic Sense

WHAT’S THE AMBULANCE NUMBER?

By Poonam I Kaushish

It was detected in Mexico, travelled to 168 countries all over the world and landed it India. No guesses we talking of swine flu. While the rest of the world went about dealing with the H1N1 endemic efficiently, our neta’s and babudum tom-tommed their (un)healthy intensions, reeled out do and don’ts, designated hospitals for treatment, figures et al. Satisfied they patted their derriere for taking care of the ailment and treated themselves to a well deserved(sic) rest. After all, the aam aadmi translated only into sterile statistics! Sanding testimony to a callous, heartless and selfish country. 

One death in Pune and all hell broke lose. The Maharashtra State Government declared two districts pandemic, serpentine queues of people thronged hospitals, one sniffle and a hiccup were reason enough to charge for the doctor. All cries of help were met with either deafening silence or more of the same: don’t panic everything is under control. Really, you could have fooled me?

We have increased the number of hospitals, testing labs, stay home don’t crowd hospital etc. Given a nation natured on short-cuts and quick-fix solutions, what else can one expect, but a ghisa-pitta reply? Does it condone and justify the State Government’s delayed action, bad planning and mismanagement?

Compounding the people’s paranoia and panic attack was a callous Health Minister Ghulam Nabi Azad who grandiosely asserted, “Over 33% of Indian will suffer from swine flu in two years.” Spotlighting once again our cavalier and churlish attitude and approach to a crisis. Not just a crisis of character, but of crass casualness, which has become the touchstone of our present-day culture. Not for him the need to elucidate damage control measures, put the disease in proper perspective and keep calm.

But why blame him alone. More scandalous is that we are fighting this pandemic influenza virus with an archaic and inadequate 112-year-old Epidemic Diseases Act, 1897 while an updated Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Bill, 2008 has been regaled to the administrative dust bin, as it was “too stern.”

No matter that the Bill specifically listed 32 diseases and 34 bio-terrorism agents including bird flu, HIV, cholera, malaria, dengue, rabies, small pox, polio, SARS, plague, TB, and measles. And was badly needed to overhaul our pathetic health care system and the accompanying ki pharak painda hai attitude. Clearly, underscoring the real filth is more administrative and political. It highlights the inability of the leadership in the Government to manage a crisis. As also the collapse of the administrative system.

The tragedy of India is the appalling state of our healthcare systems which makes us particularly vulnerable to a disease taking on epidemic proportions. Worse, none is willing to learn the ABC of health and crisis management or finding lasting solutions. Scandalously, the Indian Government spends less than one per cent of its GDP on public health care. A National Sample Survey Organisation study of village infrastructure in 2003 found that 54 per cent of villages were more than five km away from the nearest Primary Health Centre and 27 per cent were more than 10 km away. Only 10 per cent had a dispensary and only 20 per cent had a private clinic or a doctor.

According to the WHO, India has a national average of only 45 doctors and 8.9 beds for every 100,000 patients, with the levels far lower in the poorest States. Add to this the reputation of having the highest annual death toll due to tuberculosis, many dying from malaria, dengue and cholera, preventable and treatable diseases. The country is ranked 127th out of 177 countries in the Human Development Index. An example: Maharashtra’s rural people live in densely-populated hamlets in close proximity to fowls and pigs, which they breed as additional food supplements. There is only one doctor for 28 villages with over 20,000 people. When he is away on call all is left to God.

More. Our nutritional and health indicators are extremely low. According to UNICEF nearly 136,000 maternal deaths out of 30 million pregnancies occur annually, most of which are easily preventable. The worst affected States include Rajasthan, Madhya Pradesh, Orissa, Jharkhand, Uttar Pradesh and Bihar. On top of this 9 out of 10 pregnant women aged between 15 and 49 years suffer from mal-nutrition and anemia which causes 20% of infant mortality.

More than half of the children under five are severely malnourished, or suffer from stunting. Nearly 50% of the world's hungry live in India, of which over 35% (350 million) are food-insecure, consuming less than 80% of the minimum energy requirements. Consequently malnutrition causes high rate of infant mortality which, in turn, inhibits population control. Thus, we are busy procreating diseased infants which eventually will translate into a sick nation.

Swine-flu is only the latest in a series of reversals in public health hazards which India has been experiencing in recent times. Chikgunaya, influenza, malaria and gastro-enteritis are spreading like wild fire. There is resurgence of Kala Azar. Besides the Japanese encephalitis, viral hepatitis and protein energy malnutrition. Worse, the medical authorities continue to drag their feet. “If a child doesn’t die within five years from birth due to malnutrition and diarrhea, acute respiratory infections will get him later”, remarked a WHO official. While doctors medicate prayer to combat these!

There is a combination of various factors that has led to this pass. First, the continuous neglect and disregard for the poor and the lack of respect for human life. Second, the gradual collapse of the administrative and political machinery. Third, abysmal sanitary conditions (only half of the country’s garbage is cleared). Fourth, poor health care system and no solid waste management. A number of large cities have no sanitary landfills or dumping grounds. There are over 14 lakh manual scavengers to clear human and animal excreta, no matter a legislation banning this practice.

Perhaps it is time for the Government to realize that economic reform without reforms in the social sectors can become a bane in themselves. In an open economy, as the present crisis shows, the entire system can crumble if the social sectors are weak and fragile. Resulting in a total urban breakdown, neglect of rural poverty and accompanying ill-health, unpaved roads, insanitary environments and a collapsing sewage and drainage system. Example: Only 68.15 and 9.60 per cent of the urban and rural population have toilet facilities respectively!

It is now imperative for India to rethink its strategies and approaches to safeguard public health infrastructure, establish fresh priorities, improve service delivery and public hospitals and establish close links between research, policy and service; with people at the centre of health development. Special attention needs to be paid to the problems created by burgeoning population and its impact on local eco-systems, growth of urban slums, environmental insanitation and decay and changing life styles. Protection of public health is a matter of eternal vigilance. To foresee is to govern.

Where do we go from here? It all depends on our netagan. The Government can no longer bury its head in the sand. Conferences of Health Secretaries, Health Ministers and directives from the Centre to the States do not constitute a public health policy. The time is for gone for the Government to play the pied piper. Will the future generation be weighed down by the disease albatross round its neck? And aver: Achcha who mar gaya kya? ----- INFA

(Copyright, India News & Feature Alliance)