India's healthcare bureaucracy

there exists in India a particularly inactive version of beadledom called the healthcare bureaucracy. Its task is to look after, literally, the body politic. To this end, it is required to track down disease outbreaks, and speedily stamp on these its dread authority. Continuous monitoring is also a core function, as is the production of cutting-edge epidemiological knowledge. Now, these tasks must surely be onerous: what else could explain the fact of India's healthcare bureaucracy being completely medically challenged?

Consider that metaphor of ignorance called the 'mystery disease'. Its occurrence is legion. Every year in western Uttar Pradesh, children break out in a fever, and vomiting. Administered arbitrary medicine, they die (see: In denial). What organism causes these deaths? It is not known. Nor the Siliguri fever, or the one that gripped people, every year till 2003, in Andhra Pradesh: diagnosed as encephalitis, it fell to Pune-based National Institute of Virology (niv) to find the causal organism. niv said it was the Chandipura virus, but the nation's healthcare bureaucracy continued to believe it was encephalitis.

The net result? Confusion. Diseases that continue to kill.

Fact: medical officers with nary a clue about epidemics; no samples, no clue as to where samples--if collected--should be sent, or what happens to them thereafter. Fact: district hospitals not prepared to treat patients 'mysteriously' afflicted (forget about primary health care units in remote villages). Fact: recourse to denial the disease exists at all--a standard procedure, an escape route out of the tough business of providing proper healthcare. Fact: authorities maintaining 'control measures have been taken', but a disease running amok. Fact: microbes, mutating faster than the healthcare bureaucracy itself.

sars is a good example of the threat mutating microbes present: first reported in February 2003, it caused 8,000 infections and 800 deaths; by March, 2004, cases were reported the world over. But equally, the sars saga is about how to tackle 'mysterious' diseases. The virus was quick. So was the reaction: the virus was identified; protocol to treat it was prepared, now specific drugs and vaccines against it are being developed. Knowing always helps. But don't tell this to the Indian healthcare bureaucracy. Their non-approach has the potential to put the rest of the world at risk. So: should we call them bio-terrorists?

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