Our Healthcare System Just Isn't Enough
Do we really have a healthcare system in place that can take care of our millions to speak of leave alone boast about? Let’s look at the past one week or so: Over 130 fresh cases of dengue have been reported during the last week in Delhi, taking the total number of people affected by the vector-borne disease this season to nearly 500.
The number of people affected by malaria this year till now has climbed to 385 while the figure for chikungunya stands at 283. Of the 496 dengue cases, 251 affected people were residents of Delhi while the rest of the cases diagnosed here were traced to other states. At least 79 cases have been recorded this month.
Nearly 120 cases of dengue were reported last month, while 15 were recorded in June. Notwithstanding the rising number of cases of vector- borne diseases, the Delhi government had last week said there was "no need to panic" and the administration was "adequately equipped" to handle any situation – which in reality is not true!
The stark reality of UP’s failing public healthcare system has been highlighted by the Gorakhpur tragedy, where over 70 children died at the Baba Raghav Das Medical College last week. But on the most disturbing charge that children died in the neonatal and encephalitis wards because their oxygen supply was cut off, government’s denials remain unconvincing. If this charge is proved, it would be a case of criminal negligence or worse.
The blame game is on…no one is ready to take responsibility of course and the media has been doing a great job in highlighting all the wrong things instead of concentrating on the real issue – which is the catastrophe that has occurred. Governments come and go but all of them are good at one thing: avoiding the problem, skirting around the main issues, sidestepping the tragedy and not taking adequate measures in the aftermath.
At the end of the day, we need to concentrate on the heart-rending situation in that hospital and the events leading to such a disaster. Sadly, this national catastrophe is nothing more than a media circus now.
It is a known fact that Gorakhpur and its adjoining districts have borne the major brunt of the dreaded Japanese encephalitis. It’s reported that with fatality rates for severe infections ranging between 20-30%, the disease has been claiming the lives of over 500 infants in this area every year. Uninterrupted oxygen supply is actually the only lifeline for critically infected children.
The broader problem is that no matter which governments are in power, lack of sanitation, open drains and waterlogged streets remain, and during monsoons they spike Japanese encephalitis cases in eastern UP. What is needed is an extensive door-to-door immunisation programme, where health officers reach out to people rather than the public scrambling to hospitals for basic treatment. Also required is a massive upgrade of healthcare facilities especially at the district and village levels, where the needs of a burgeoning population are dangerously underserved by a shortage of doctors and public hospitals.
The Gorakhpur tragedy is a blot on India. In any other country with a conscience, morals and a rule of law, this would have been unequivocally called murder by dereliction of duty. Instead, we have become a nation without common decency, common practicality and basic compassion.
Gorakhpur has been the epicentre of encephalitis since 1978, when the first case was reported. Since 1978, BRD Hospital has an average of over 200 deaths per bed, making Gorakhpur highly endemic to the disease. Encephalitis is a disease carried through mosquitoes, which breeds in unclean environments. Japanese encephalitis, transmitted through the culex mosquito, cripples the affected individual.
The disease is curable through vaccinations but the poor healthcare system is a major impediment to its eradication. According to one report, India ranked 154 out of 195 countries in terms of access to healthcare, lagging far behind countries such as Bangladesh, Nepal, Ghana and Liberia.
Nevertheless, the Gorakhpur tragedy seems to have forced the Centre to rethink its public health policy. Due to various factors such as non-availability of expert doctors, manpower, lack of funds and red tape, it becomes difficult to provide professional healthcare to patients at government health facilities.
However, stress should be on preventing disease before it becomes a public concern. No other spot in post-Independent India may have witnessed deaths of as many children with a mind-numbing regularity as has been seen in just one medical institute — Gorakhpur’s BRD Medical College.
It isn’t just the lack of oxygen that’s killing the children. There are medical staffers in this college who haven’t been paid for the last 27 months. Urgently required funds to set up Encephalitis care units, considering that people from several states and even Nepal come here from treatment, haven’t been released for the last several years. Land meant to be allotted for special care units hasn’t been released because of which plans to set up specialized units have been hatched and buried. Requests for funds to help save patients, being made for last 10 years by successive principals of the colleges, have been ignored.
Healthcare has become one of India’s largest sectors - both in terms of revenue and employment. In India the constitution grants free healthcare for all. In fact each district headquarters in most states have one or more Government hospitals where everything from diagnosis to medicine is given for free. In fact most experts agree that building on this Government and public healthcare units across the nation is crucial to India's future and that private insurance is probably not conducive to India's conditions.
The private healthcare sector is responsible for the majority of healthcare in India. Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. Penetration of health insurance in India is low by international standards. Also private health insurance schemes, which constitute the bulk of insurance schemes, availed by the population, do not cover costs of consultation or medication. Only hospitalisation and associated expenses are covered.
Five areas that need concentration are:
1. Rural Versus Urban Divide
2. Need for Effective Payment Mechanisms
3. Demand for Basic Primary Healthcare and Infrastructure
4. Growing Pharmaceutical Sector
5. Underdeveloped Medical Devices Sector
India’s existing infrastructure is just not enough to cater to the growing demand. And then we also have reports of astrology consultations coming up? Are we progressing or regressing?