National dialogue critical

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.

By Shivaji Sarkar