Why diseases are "mysterious"

The government's public health system is completely defunct. Of late, there has been an alarming rise in disease outbreaks in the country. Western Rajasthan is currently in the grips of malaria. The recent death toll from a disease not endemic to the state is an issue of grave concern. Bikaner district has a 40 per cent rise in cases in hospitals and primary health centers. Elsewhere, May and June saw more than 10 children die of measles in and around Phek district in Nagaland. The blame game began soon after. Sources claimed that a poor immunisation programme, and an absent district immunisation officer, led to the crisis. The level of poor governance can be gauged from the fact that while deaths were reported to the medical department on May 20, 2003, the district commissioner was informed as late as June 10...

 
By Animesh Roul
Published: Wednesday 15 October 2003

Why diseases are "mysterious"

-- In his Independence Day speech from the Red Fort, Prime Minster Atal Bihari Vajpayee promised six hospitals akin to the All India Institute of Medical Sciences (aiims) in backward states of the country. He made this announcement under the Pradhan Mantri Swasthya Suraksha Yojana, while admitting "people in underdeveloped states have to suffer due to the lack of good hospital services". Recently, health minister Sushma Swaraj confidently declared that these medical facilities will be operational within three years. Though the foundation stones of two of these hospitals have already been laid -- in Bhubaneswar (Orissa) and Raipur (Chattisgarh) -- skeptics belive these statements are just election gimmicks.

Of late, there has been an alarming rise in disease outbreaks in the country. Western Rajasthan is currently in the grips of malaria. The recent death toll from a disease not endemic to the state is an issue of grave concern. Bikaner district has a 40 per cent rise in cases in hospitals and primary health centers.

Elsewhere, May and June saw more than 10 children die of measles in and around Phek district in Nagaland. The blame game began soon after. Sources claimed that a poor immunisation programme, and an absent district immunisation officer, led to the crisis. The level of poor governance can be gauged from the fact that while deaths were reported to the medical department on May 20, 2003, the district commissioner was informed as late as June 10.

At least 50 children died of a 'mysterious' disease, suspected to be encephalitis, in West Bengal's Murshidabad district in June. The state government's dependency on Pune (National Institute of Virology, niv) and Delhi (National Institute for Communicable Diseases, nicd) laboratories for basic virological tests to ascertain the disease led to delays, with deadly consequences.

In July-August, a killer virus played havoc in Andhra Pradesh and Maharashtra, killing more than 250 children. While the health department fumbled once again in the identification of the causative organism, initial reports pointed to mosquito-borne Japanese encephalitis. Soon, however, the niv identified Chandipura, a rhabdovirus, as the killer. Even after identification, health authorities at the Centre unnecessarily delayed in responding to the niv report.

These are not isolated cases. Disease outbreaks and subsequent deaths are regularly reported from Bihar, Orissa, Assam and Uttar Pradesh. The trend is reflective of government's apathy, ridiculing not only health authorities' claims of proper surveillance and preparedness, but also the National Health Policy of 2002.

The policy proudly envisages the full operationalisation -- from the lowest rung of public health administration to the level of Union government -- of an "integrated disease control network" by 2005. It is imperative to note here that creating another centralised system to monitor and manage outbreaks will not be of much help. This is evident from the failure of our national programmes on malaria, which staged a dramatic comeback in India after its near-disappearance during the initial years of the National Malaria Eradication Programme (1958). To be successful, strategies have to be designed for, and action taken, at the local level.

Most distressing is the fact that in a country where the ailing regularly die unattended, the Centre plans to spend millions of rupees to build an anti-nuke and anti-chemical and biological weapons bunker inside Parliament to save 500-odd politicians. Ignorant, ill informed, and yet remarkably complacent, those occupying the seats of power remain preoccupied with transboundary military threats. While the concepts of human security and non-military threats to national security -- which include environmental problems and disease outbreaks -- are gaining momentum and acceptance worldwide, India is focusing all its attention on a possible military threat from across the border.

Ironically, after 56 years of independence, when the country is planning to send its own spacecraft, 'Chandrayaan', to the moon by 2008, its citizens are still deprived of basic health facilities and regularly die at the hands of so-called 'mysterious' diseases. The crux of the problem lies not in the virus or disease-causing organism alone, but in our public health system. Inadequate infrastructure, poor surveillance mechanisms, lack of public awareness and poor political will to formulate policies are some of the issues that need to be addressed urgently, if we really wish to see ourselves on the moon.

Animesh Roul is Senior Research Scholar, Jawaharlal Nehru University, New Delhi

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