Together with great novelist Charles Dickens (borrowing from the opening lines of his famous novel A Tale of Two Cities), we could say that we are going through the best of times and the worst of times as far as health care in India is concerned.
In the wake of globalization, we are singing paeans of praise on our world class hospitals and even medical tourism. We seem to gloat over the fact that patients from come all the way to India for treatment and at one-third of the cost in their own country.
And sure are reports that some of our top multi-specialty hospitals are opening branches in other countries.
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There is no doubt that first class medicine is available for those who can afford it. And again, India is among the largest producers of vaccine and the Serum Institute of India in Pune (Maharashtra) makes 675 million doses of vaccine each day and sends them across the world to as many as 137 countries.
And we are conducting trials of vaccine against HIV/AIDS and forging ahead in stem cell research. All this makes India ‘shine’
But how can we ever ignore the plight of millions in urban and rural India who do not have any access to the minimum basic Medicare.
This is reflected in the high infant mortality rate, child mortality rate, maternal mortality rate and mortality on account of such diseases as TB (tuberculosis), Malaria, Japanese encephalitis, dengue fever or dengue hemorrhagic fever.
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When TB has been by and large eradicated from most of the developed world, one fails to understand why India still accounts for nearly one-third of the global TB burden.
There are approximately 18 lakh fresh cases in the country every year, of which approximately 8 lakh cases are highly infectious and sputum positive.
Each sputum Positive case, if not treated, infects ten to fifteen persons a year. Two persons die from TB in India every three of minutes and over 1,000 people every day.
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Isn’t it a matter great shame that India, poised to become a great economic power, is witness to 4.17 lakh deaths annual caused byte? Can’t we avoid this great tragedy if we care? The crux of matter is that the so called National Tuberculosis Control Programme, initiated in 1962 alone cannot tackle it.
The programme was revised in 1997 and still we are getting nowhere even six years after the new millennium. TB is essentially is disease of poverty, poor housing and lack of nutrition and it is mostly the poor who are the cross-bearers.
According to a recent World Bank report, more than 60 per cent of the population (12 million) of our proud commercial capital, Mumbai (Maharashtra) lives in slums.
Slums in any city provide the epidemiological conditions for any infection with ill-ventilated housing, lack of sanitation and drinking water facilities and the poor purchasing power of the slum-dwellers to go in for basic Medicare when his/her daily survival itself becomes a luxury.
Add up the numbers of the urban poor in other cities in India and bracket them with the vast multitude of rural population struggling for basic subsistence.
Don’t we have enough epidemiological grounds for a vast range of diseases such as TB, Japanese encephalitis, dengue, filarial, malaria and the like? Poverty, together with ignorance, takes a heavy toll in India.
Recently, the World Health Organization (WHO) Commission on Social Determinants of Health has advised India to make its public health system more operative and effective. “Technical knowledge and effective public health system may not always be the answer.
Sometimes, understanding the social terminates of diseases can help prevention, “said Prof. Michael Marmot, Commission Chairperson and Director for International Institute for society and Health at University College, London (UK).
Citing the example of HIV/AIDS and malaria, which could be prevented primarily by creating awareness, Prof. Marmot said that the outbreak of Japanese encephalitis in Uttar Pradesh in recent times could have been checked, had there been enough awareness and “partnership” with society.
We have the infrastructure and services, but the only problem is they are not functioning. We boast of our extensive network of 3,043 Community Health Centers, 22,842 Primary Health Centers and 1, 37,311 Sub- centers. But we are blissfully ignorant as to how many of them are really functioning.
The villagers crib that there are no doctors in these centers, and if there is a doctor, there is no medicine. And there is no accountability at the grassroots medical level. Will any villager dare to become the whistle-blower?
None would dare if they have learnt the fate of the whistle-blowers who were killed for exposing adulteration in petrol and corruption in the National Highway projects. So despite doctors, primary health centers and other infrastructures, the poor must pay with their lives.
Both Prof. Marmot and Prof. Mirai Chatterjee, a WHO Commission member and coordinator of the Ahmedabad-based SEWA (Self-Employed Women’s Association), an NGO working for women in the organized sector met Prime Minister Dr. Man Mohan Singh in September 2005 to discuss policies for lowing health inequities through action on social terminates.
Crores are spent on the health sector, there are thousands of doctors and lot of infrastructure, but then see no reason why the system could not react to the tragedy (deaths on account of encephalitis in Uttar Pradesh).
Prof. Marmot painted a grim national scene’ “The problems in India are known to everyone and there are no easy solutions. There have been dramatic improvements, but these are not universally enjoyed and I see no reason why these gains cannot be across the board.”
The incidence of leprosy in India has come down sharply thanks to a sustained campaign and multi-drug therapy. At least by March 2004, as many as 17 States/ Union Territories had achieved the elimination of leprosy in their territories. But we have yet to grapple with TB, Japanese encephalitis, Kala-Azar and other diseases.
Japanese encephalitis is an acute viral illness with high case fatality and ‘long-term complications. This vector breeds in large paddy fields and water bodies. The habit of vector mosquito makes the control strategy difficult. An indigenous vaccine was developed by the Central Research Institute, Kasauli (Himachal Pradesh), and it has been found to be effective, but its production is limited. Kala-Azar is found among the poor in Bihar, Jharkhand, West Bengal and parts of Uttar Pradesh. In 2003, 18,214 cases were reported from these States.
Addressing a meet of the Global Forum for Health Research, in New Delhi, on September 12, 2005, Hon’ble President Dr. A.PJ. Abdul Kalam stressed the need for having mobile clinics in rural areas in India, which, besides treating the poor villagers, could help to gather vital data on diseases and health profiles. He cited example of Uttaranchal where mobile clinics were launched in October 2002, and said that their success resulted in the expansion of the programme and its extension not only to other States, but also to neighbouring countries. Dr. Kalam told the forum that while working on diseases and their cure, they should look into other aspects that influence health of individuals. These include nutrition, lifestyle and incidence of diseases in a community area. Such an integrated approach is necessary for evolving preventive medicine.
Lifestyles and the fret and fever of modern living are taking their toll. And many of these diseases — cancer, diabetes, cardiac problems, respiratory diseases — affect people of all classes.
Awareness could do a lot, but still the incidence of all these ailments is ever on the rise. Regional cancer centers and well-equipped cancer hospitals have come up to treat different forms of cancer, but the cases are increasing. Diabetes cases are on the rise all over the country with consequent complications such as diabetic foot, retinopathy, malfunctioning of kidneys and silent heart attacks.
The number of amputations is increasing with the disease causing irreversible damage, despite the mushrooming of diabetic clinics and diabetic camps. Awareness is a must for diseases control, together with exercise and Proper diet control. Since many of the diseases are Psychosomatic, patients are prepared to go in for Yoga and meditation classes.
Healthy living, and prevention and control of diseases hinge on several factors — the individual and his family, his style of living, outlook towards life, diet, exercise, his environment, purchasing power and awareness.
Poverty and health cannot go together. It is the duty of the government to provide the minimum amenities that pave the way for healthy living — good housing, proper sanitation, access to affordable healthcare, access to potable water, proper drainage and sewerage, monitoring the functioning of the vast medical center network and generation of awareness by all possible means.
The citizens, too, have to work in tandem with the government. In fact, there could be user committees in villages/wards that could monitor the working of every facility, advising authorities to take up timely remedial action.
“Health for All” has all along remained a mere slogan all these years. If this slogan has to become a reality, the government and the community have to work in unison on different fronts. Healthcare should be accessible to all irrespective of the socio-economic status.
Elimination of poverty and ignorance will go a long way in providing healthcare for all. Every citizen must enjoy the right to health.