If the Indian healthcare is run with the highest commercial interests, what happened in Gorakhpur or Kerala can never be prevented. Funds alone are not the solution. Healthcare must be treated as national emergency
Tragedies shake the nation. The recent deaths of over 70 children in a Gorakhpur hospital was shocking. So were the diarrheal and dengue deaths in Kerala in the month of June. Be it Kerala, Uttar Pradesh or any other Indian State, the healthcare system in the country is abysmal. According to United Nations Children’s Fund, 22 per cent of the 11 million global child deaths take place in India and most child deaths are attributed to just six largely preventable causes — pneumonia, diarrhoea, 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 Ministry of Health and Family Welfare figures state that 13 children under the age of five succumb to diarrhoea every hour in the country. This means, the quality of drinking water is poor.
However, politics on health, and the subsequent blame-game is not the solution. Healthcare 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 healthcare centres and primary healthcare centres. The Ministry of Health and Family Welfare and official figures of 2012 states 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 infrastructure is in place, there is a shortfall of 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 India on Hospital Acquired 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 Jai Prakash Narayan Apex Trauma Center, at 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 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 possible reason for the general apathy is that Government facilities are availed by those who cannot afford treatment at private facilities. The country talks of the poor but most of them remain marginalised.
Else the kind of deaths the Baba Raghav Das (BRD) Medical College 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 Japanese Encephalitis (JE).
It was highlighted that deaths on August 20 happened due atrocious stoppage of oxygen supply. The Gorakhpur District Magistrate’s report says such emergency supplies should not have been stopped. The hospital’s records reported in newspapers, including the Mint, say that most children were not suffering from JE. So, this indicates graver mismanagement.
A former Secretary of the Ministry of Health and Family Welfare, K Sujatha Rao, who spent close to 20 years in the health sector, recently wrote that systems recognise the lapses 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 Dana Majhi, carrying the dead body of his wife Amang Dei back home on his frail shoulders as he could not afford an ambulance. And again when in the Guntur Medical College’s intensive care unit, a 10-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 much as it is on the Government.
Are private hospitals betterIJ They are often not. Apart they are known, the bigger the brand name more so, to fleece through various means and unnecessary tests, computerised tomography (CT) scans and Magnetic resonance imagings (MRI). 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 meagre wages of less than Rs 10,000 a month.
Australian medical practitioner, David Berger, who volunteered as a physician at a charitable hospital in the Himalayas, in June 2014, says that there is a lack of will to reform the evil practices in the Indian healthcare system. Writing for the British Medical Journal, Berger highlights, “how kickbacks and bribes lubricate every part of the healthcare machinery”.
Berger’s article draws the attention to the “unvirtuous circle” of donations and fees in private institutions, hence 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, 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, degrees are virtually for sale, it has been repeatedly alleged. The price varies from Rs 30 lakh for Medicinae Baccalaureus and Bachelor of Surgery (MBBS) to over a crore for post graduate degrees.
If healthcare is run with the highest commercial interests, could what has happened in Gorakhpur, Kerala or elsewhere be ever preventedIJ 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. The healthcare has to be treated as national emergency and the Government must hold 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.
(The writer is a senior journalist)