Our sickening health system

Published: Sunday 15 December 1996

ON OCTOBER 17, two-and-half year old Kanika Agarwal bled to death due to dengue fever. That is nothing new to the citizens of Delhi, who saw close to 300 people (if the government is to be believed) die in the epidemic (which the government denies). But the fact that she and 20-year-old Abdul, who also died of dengue, were both residents of the campus of the country's premier medical institution, the All India Institute of Medical Sciences (AIIMS), makes those two deaths the symbols of how far down the abyss the government has pushed the country's health care system.

The tragedy was marked by an obnoxious drama of denials and trading accusations between government agencies and experts. The first cases of dengue deaths were reported as early as August 29. The first official high power commission for a day-to-day monitoring of the situation was set up as late as October 15, that too, on the insistence of the Delhi High Court. By then, at least 179 lives had been lost, most of them either children below 10 or youths below 20. And it is worth remembering that the entire health establishment seemed to be oblivious, or unwilling to react to what a judge of the High Court could on her own sense as a major crisis.

In fact, the roots of the tragedy lie much deeper. It is in the complete collapse of the scientific management of the health care system. It is the business of science to predict and thus pre-empt such crises. But the government agencies had no clue as to what might have been in the offing, despite the fact that the World Health Organization (who) had actually predicted the crisis. The mandarins of the health ministry had chosen to ignore them. The Aedes aegypti mosquito, which carries the dengue virus, breeds only in fresh clean water. The government could have easily prevented the crisis by heeding the who warning and telling the people to keep their room coolers and overhead water storage tanks clean.

The dengue vector strikes in daytime, while the temperature is above 28c, which is one reason why school children contracted the disease on such a large scale. Some experts bemoaned the absence of any agency to de-infest schools. But that is simply amazing. The National Capital Territory of Delhi is managed by two of the country's most opulent municipal bodies, the New Delhi Municipal Council and the Municipal Corporation of Delhi, with huge corpus of workers. There's no excuse, either in terms of cash crunch or working hands. Only, the minds that make those hands work, the decision-makers' will to act has been eaten out by the virus of corruption.

It is a shame that despite all this money and humanpower, the government called in the army to undertake mass-scale fogging. The latter did its job well, but the health authorities failed to, or did not have the ability, nor willingness, to anticipate what would inevitably follow: a heightened incidence of other diseases due to inhalation of the fogging chemicals. So, the government created another crisis to solve the first. But even that was not all. Experts revealed that due to the magnitude of the crisis, people were being given fresh blood transfusions. Though the samples were being tested for the usual diseases, including Hepatitis-b, none of the Capital's laboratories -- government or private -- have the technology to check the samples for Hepatitis-c. Naturally, the dengue patients who have received fresh blood have become more vulnerable to that disease. Experts are already gloomily predicting a liver- diseases outbreak.

This, however, is not new. The Surat plague outbreak, and the recent tarantella of killer malaria -- with dengue epidemic sandwiched in between -- shows that the government can only act, that too absurdly, only after a major crisis has kicked it out of somnolence. Now, another outbreak has been predicted: the yellow fever might be visiting India after about a century, the who has warned. The vector for yellow fever is the same as that for dengue, A. aegypti. who has been saying that widespread travel is one of the reasons why epidemics become frequent. There's a large volume of traffic between India and the countries of East African coast, where the disease is endemic. The disease can break out any time. But the government has decided, and announced as much, that this won't happen. It feels that an epidemic can be pre-empted by denying its possibility.

Perhaps the people who now need to do some straight talking to the government is the middle class, which sometimes politicians listen to. The marauding A. aegypti showed that it did not care for class; the dengue bred most comfortably in the middle class room coolers. The same vector might now bring in a worse scourge. But will the middle class talk? It has been complacent in its consumptive lifestyle. Not even the deaths of a Kanika or Abdul has shaken it up. Yet, it is they who must tell the government that much of the cost of our annual economic gains are borne out by the people in the form of health crisis, which the government was created by neglect.

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