Shocking apathy

By S N Chary  

Swine Flu, which was a terror a few months ago, has now gone out of the radar of public and government attention these days. No one talks about it and the episode - while it lasted – typified the pathetic initial lethargy followed by subsequent delayed and unsustained knee-jerk reaction characteristic of our country’s health administration to various communicable diseases.

Preventive and social medicine, which should occupy a position of huge importance in a country like ours that still has one-third its population going hungry and a similar one-third illiterate, has been woefully neglected.  

Compare the following two real scenarios, just four months ago, regarding our dealing with the Swine Flu. Scene 1: You are travelling to Beijing or Hong Kong from Delhi or other foreign city. Fifteen to twenty minutes before the plane touches down at Beijing airport, the air hostesses scan every passenger systematically for body temperature using the electronic scanner. It takes only a couple of minutes to scan all the passengers.

The flight now touches down at Beijing. Immediately, two small groups of medical technicians attired in the white protective gear scan the body temperature again and in suspected cases they investigate further. The procedure takes only a couple of minutes. Of course, you would have already filled in a short voluntary declaration form in which you state the countries you have visited recently and if you have fever or cough.

Scene 2: You are travelling from Beijing to Delhi. You fill up a longish voluntary declaration form regarding any fever, cough and countries recently visited. At the point where you immigrate, there are at least a dozen medics who just ask you if you are running temperature.
You shake your head in the negative and you walk off. The authorities even forget to collect the form you had filled. Then you also realise that to ask the question “Do you have any fever?” the government has employed qualified degree-holding doctors on a night shift.

Which scene, from the above two, is more effective and efficient in the effort to prevent the spread of H1N1 virus or swine flu? The answer is obvious. The contrast between the purposeful and meticulous approach of the Chinese and the laid-back and resource-wasting approach of the Indians is, to say the very least, shocking. Why have a façade of having employed qualified doctors when the effort is going to be so lackadaisical and farcical?

But then, this is how our Indian government’s approach has been over the past decades regarding health administration all over the breadth and length of the country. The case of H1N1 presented here was only an example. A sloppy approach can always have a justification. The H1N1 cases reported worldwide were then in excess of a few thousand while only about a hundred cases had been registered in India.

Mindless advisories
What is the point in giving mindless government advisories asking people to desist from visiting several countries that have reported H1N1 cases when our people go abroad mainly for compulsions of employment, business and university studies?
Instead of doing its job of thoroughly screening the incoming passengers, quarantining suspect cases, and making adequate treatment facilities available and accessible across the country, why does our government start telling others – the foreign nations and the already helpless Indian citizens – as to what they should be doing? When is our government going to get really serious about public health?  

Tracking records
Let us track our record with respect to other communicable diseases. Of the 1315 polio cases reported worldwide during 2007, 60 per cent of the cases – 874 cases – occurred in India. Despite the much media-hyped pulse polio programme, a really essential ‘house- to- house search and vaccinate’ programme to break the final chain of polio virus transmission has not taken place.

India has more number of TB cases annually than any other country, ranking first among the 22 ‘high-burden TB countries’ worldwide, according to WHO’s Global TB Report 2008.There are 1.9 to 2.0 million new TB cases every year in India with 1.2 per cent infected with HIV and 2.8 per cent with Multi-Drug Resistant TB (MDR-TB). Easily, 30 per cent of the cases do not even get detected.

Leprosy is supposed to have been ‘eradicated’ from our country. But, as per experts, this programme too is under a cloud. Government of India seems to be in an undue hurry to show the ‘eradication’ target numbers, while relaxing the definition of ‘eradication’.

 The official policy calls for (i) stopping all active case detection, (ii) declaring patients as ‘released from treatment’ (RFT) and delete their names from registers as they receive the last dose of drug. Reportedly, there are instructions for not registering single lesion cases for now. Thus, active surveillance has been discontinued. Questions are being raised about this early dismantling of ‘leprosy eradication’ services.

In short, our approach to community health services lacks real intent, focus and drive. Every issue seems to be viewed more in a short-term perspective than in the long-term. The whole approach is lackadaisical and populist. After all, elected offices and bureaucratic chairs may not be there for long. In a game of rocking musical chairs, there is little time to think of anything other than the chair and the music faced then. Purposeful long-term policies and measures will take back seats.
(The writer is a former professor at IIM, Bangalore)