Economic
Highlights
New Delhi, 21 August 2017
Gorakhpur Tragedy
NATIONAL DIALOGUE CRITICAL
By Shivaji Sarkar
Tragedies shake the nation. The recent 70-odd
deaths of children in a Gorakhpur hospital were a shock. So were the diarrheal and
dengue deaths in Kerala in June. Be it Kerala, Uttar Pradesh or any other State,
the health care system is abysmal across the country.
According to UNICEF, 22 per cent of 11
million global deaths take place in India and most child deaths are attributed
to just six largely preventable causes, pneumonia, diarrhea, malaria, neonatal
pneumonia, pre-term delivery and asphyxia. Most of these diseases spread like
epidemic in different parts of the country with the onset of monsoon. The Union
Health Ministry figures state that 13 children under the age of five succumb to
diarrhea every hour in India. It means the drinking water quality is poor.
The politics on health and blame game is not
the solution. The health care remains abysmal despite one of the largest
network of district hospitals. Funds alone are not the solution.
According to government norms, urban areas
are supposed to have a two-tier system with urban health centres for every one
lakh population, followed by general hospital, community health care centres
and primary health care centres. The Health Ministry and official figures of
2012 state that there were 1.48 lakh sub-centres at the gram panchayat level.
At that the shortfall was 35,762. It looks good, but most of these are at best
semi-functional with inadequate number of doctors. Even in places where the
infrastructure is in place, there is a shortfall in trained doctors and support
staff and even the hospitals of All India Institute of Medical Sciences (AIIMS)
unfortunately suffer from it.
Little data is available in the country on
hospital affected infections (HAI) as hospitals are not mandated to report
incidences. However, according to a 2014 study, the World Health Organisation
found figures from India “alarming, with an incidence rate varying from 11 to
83 per cent for different kinds of HAI”. A study from 2011 to 2012 at the JP
Narayan Apex Trauma Centre at the AIIMS in New Delhi showed an infection rate
of 10.6 per cent. Of those infected, 83 died -- implying a mortality rate of
34.5 per cent.
So Gorakhpur and Kerala are not the only aberrations.
What they do is to highlight the grave problem and raise questions why the
country has not been able to have a humane, empathetic and effective system.
One reason possibly of the general apathy is the government facilities are
availed by those who cannot afford treatment at private facilities. The country
talks of the poor but they mostly remain marginalised.
Else the kind of deaths the BRD Hospital has
seen during the past few years should have led to war-footing efforts. There
were deaths of 557 children in 2012; 650 in 2013; 525 in 2014; 491 in 2015, 641
in 2016, and over 70 till now this year. Most of these were attributed to
encephalitis.
The recent incident was highlighted due the
atrocious stoppage of oxygen supply, and in August 207 deaths occurred. The
Gorakhpur District Magistrate’s report says such emergency supplies should not
have been stopped. The hospital’s records reported in newspapers, including Mint,
say that most children were not suffering from encephalitis. So that indicates graver
mismanagement.
Former Secretary of the Ministry of Health
and Family Welfare K Sujatha Rao, who spent close to 20 years in the health
sector, recently has written that systems
recognise that when people are sick, they are equally vulnerable, regardless of
means, age, or gender. Such a system would foster patient-centered health
delivery and a culture of values such as honesty, integrity, and the pursuit of
knowledge.
As
a society, we do not seem to give these issues much importance. But then it
hurts when one recalls and reads about the poor tribal Manjhi carrying the dead
body of his wife Amang back home on his frail shoulders as he could not afford
an ambulance. And again when in the Guntur Medical College ICU, a ten-day-old
infant dies of rat bites. What is disturbing is that such instances of
indifference are rapidly becoming the norm. Such disregard for human life is a
strong indictment on us as a people as much as it is on the government.
Are private hospitals any better? They are
often not. This apart they are known, the bigger the brand name more so, to
fleece through various means and unnecessary tests, CT scans and MRIs. A
one-night emergency stay for a simple ailment costs a minimum of around Rs
10,000 in such hospitals. It is in a country where over 98 per cent of the
people get measly wages of less than Rs 10,000 a month.
Australian medical practitioner Dr David
Berger, who volunteered as a physician at a charitable hospital in the
Himalayas, in June 2014, says there is a lack of will to reform the evil
practices in the Indian healthcare system. Writing for the British Medical
Journal, Dr Berger highlights, “how kickbacks and bribes lubricate every part of
the healthcare machinery”.
His article draws attention to the
“unvirtuous circle” of donations and fees in private institutions generating
debt burden, making doctors more open to corruption (an allegation that is
being rampantly made in the case of officials of BRD Hospital in Gorakhpur). He
also talks of unscrupulous doctors prescribing unnecessary drugs and specific
brands at the pecuniary urging of the pharmaceutical companies and order
irrelevant tests for dodgy means. These too are known evils, Dr Berger says.
In reality, the malaise begins with the
admissions to medical colleges. In Madhya Pradesh, what VYAPAM has done is
well-known. In private medical colleges, the degrees are virtually for sale, it
has been repeatedly alleged. The price varies from Rs 30 lakh for MBBS to over
a crore for post graduate degrees.
If healthcare is run with the highest
commercial interests, could what happened in Gorakhpur, Kerala or elsewhere be
ever prevented? If this remains the sine qua non, improvements despite
government efforts would be difficult. Sujatha Rao says funds alone are not the
solution. It requires organisational structures to be put in place and where
like HIV or polio, it has been done it has helped create results faster.
This shows that the system can function. Healthcare
has to be treated as a national emergency and the government must hold a national
dialogue for a pan-India system. The nation needs to understand what ails us
because that alone would provide the opportunity to go forward. ---INFA
(Copyright, India
News & Feature Alliance)
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