Why's malaria taking its toll?

Assam faces a spate of malaria deaths. As the disease assumes near epidemic proportions, it is becoming increasingly clear that the government does not have the will or infrastructure to cope -- either in Assam or other affected regions. But what is most damaging is that health authorities seem to be in denial. vibha varshney in Delhi and maureen nandini mitra in Assam piece together a story of health mismanagement

By Maureen Nandini Mitra
Published: Thursday 15 June 2006

Why's malaria taking its toll?

imageavaged by malaria, Assam is struggling to control the dis-ease. Like in most other parts of the country, the health infrastructure is in a state of terminal decay. Forget the  remote villages, even the district health centres are in shambles.

Check out Lakhimpur district — a microcosm of Assam, if not the whole country. Hollow-eyed patients lie in rows on the mud floor of an unfinished rural school building. Saline drips are strung across a dark room. At the door, a small group of patients and their families wait their turn, with the two harried

doctors in charge of the peripheral malaria ‘hospital’, a makeshift unit housed in Rampur ME

School, at sea. So far, over 200 villagers have been brought to the school in the remote interior of Lakhimpur to have their blood tested and, if lucky, get the right treatment. Pathologists from the Union health and family welfare department conducting rapid blood tests said 100 per cent of those who tested positive for malaria

carried the deadly variant of the pathogen that causes the dis-ease —Plasmodium falciparum(Pf). 

The doctors are despairing. “We have been sent here with only 16 ampoules of quinine. It’s horrible,” says U N Dutta, one of the two doctors at the emergency hospital. “We don’t have enough doctors or paramedic staff or medicines,” adds Dutta, who is also the joint director of health services, Lakhimpur district. Yet, some 370 km away, sitting in his air- conditioned office at Dispur, a senior health official says casu-ally, “There is no shortage of either medicine or doctors.” Emergency health camps like these, set up around the dis- trict and other malaria-affected regions across the state, rely on NGOs like Jan Kalyan, Voluntary Health Association of Assam, and Medecins Sans Frontieres (MSF) for doctors, drugs and ambulance services. 

 The situation isn’t much better at Lakhimpur Civil Hospital in Khelmati town. Malaria patients line hospital cor-ridors, some on metal beds, some on rags laid out on the floor. The 200-bed hospital is scrambling to deal with an influx of nearly 500 patients, most suffering from malaria. More arrive in droves everyday from surrounding villages. The official malaria death toll in Lakhimpur, which appears to be worst affected this year, was 60 as of May 16. Statewide the toll was pegged at 138. The figures are based on the number of reported deaths at the civil and peripheral hospitals.

But Dutta and Jan Kalyan workers, who have been treating patients in villages since April, say at least 300 people had succumbed to the disease in Lakhimpur. They cite late, poor quality testing as possible reasons for the low official fig-ures. According to government guidelines, only patients test-ing positive for the Pf parasite at time of death are listed as malaria victims. “Government hospitals cannot test the blood samples in time,” says Irshad Ali of Jan Kalyan, Lakhimpur. “Hundreds of samples are still lying at the hospitals. By the time they are tested, who knows how many patients will have died of Pf .”

Besides, says Dutta, “once Pf enters vital organs like the liver and brain, it can’t be found in the blood anymore. Blood smear tests conducted at this stage won’t show he parasite.” And of course, there are people in remote areas who don’t even make it within sniffing distance of a medical facility. Unhealthy system Malaria has been endemic to Assam and other northeastern states for long. Excessive rainfall and humidity in the region spawns large mosquito populations. Official estimates say the

disease claims about 500 lives annually. In Assam, the official toll last year was 230. Independent estimates, however, say the figure probably runs into a few housands. 

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