Nipah virus: A successful battle

“Good news: Kerala health model has passed a fire test,” tweeted Kerala Health Minister K K Shailaja on June 10. What she was talking about was the Nipah virus, which had triggered a scare not only in Kerala but also in other states.

After a month-long high alert, the state will be declared Nipah free on June 31. The Minister said the spreading of the virus is under control.

As on June 3, a total of 18 cases of Nipah were reported in the state and only two could survive it.

The Opposition and Kerala High Court, among others, congratulated the health department and the government for handling this health issue with much caution.

Here is a look at what the Kerala health model is:

The Nipah

To understand why is it important to speak about it, one needs to know more about the villain. Nipah is a genus of RNA (an essential molecule regulating genes) virus. Scientists have found that the virus is being 'naturally harboured' by fruit bats and some other species of bats. The bats which carry Nipah will not have any ‘malady’. It will migrate long distances depending upon the environment and availability of food (especially fruits) and shelter.

The virus reaches human beings through the fluids the bat carries. It spreads, again, when the person comes into contact with the fluids of the affected person. So the outbreaks will stick to a small geographical area but are highly dangerous as the death rates are very high. 

The virus, ‘born’ in Malaysia in 1999, had two outbreaks in India before Kozhikode. Those were in Siliguri (2001, 45 out of 68 reported cases died), and Nadiya (2007, 5/30). 

Since there is no way to tackle Nipah medically, the only solution is to stop it from spreading, which requires a great amount of planning and dedication.

What is Kerala model?

In 1975, the Centre for Development Studies conducted a study for the Department of Economic and Social Affairs, United Nations, about the development model of Kerala (the study never used the term Kerala model, but it became popular after the study).

The study was titled ‘Poverty, Unemployment and Development Policy- A Case Study of Selected Issues with Reference to Kerala’. This was the first work which gave international recognition to the Model. The study projected how the implementation of public distribution of food grains, public healthcare systems, government schools and high literacy rates especially among women helped in achieving the standards of human development which can be compared to that of developed Asian countries like Malaysia or China. 

The state is highly saturated with public educational institutions and libraries. The library movement has roots in every village in the state, which played a key role in the literacy movement in the 1980s and many other social developments. Public Distribution System (PDS) is strong here, though not undisputed. It makes sure that no one dies of hunger in the state.

The public health chain is the most commendable one among this and in focus today. 

The state has primary (village level), secondary (taluk level) and tertiary (district level) level health centres. The primary health centre provides all basic facilities with almost zero expenditure. Popularly known as simply ‘health’ in Kerala, the primary centres charge one rupee for registration and provide qualified doctors and nurses (selected through comparatively less corrupted Public Service Commission) and definitely, free medicine. However, it is common for medicines to be out of stock. 

This health centre also maintains the data of all pregnant women in the village to whom they will reach out through Aasha (Accredited social health activists) workers and Anganwadi teachers multiple times during pregnancy and after delivery to provide medicines, nutritional food and most importantly, the vaccines. You don’t have to call them up for medicines. They will turn up at your doorstep one fine morning.

The 'anganwadis' are playschools which provide nutritious food for kids below age four. And you pay nothing for admission (and food!) (It is part of the centre's scheme, Integrated Child Development Services).

The same people will go house to house during monsoon asking people to avoid water stagnation as mosquito-borne diseases are common in Kerala nowadays.

The secondary and tertiary levels of the health centres are enhanced with more accessories including provisions for admissions. For conditions which cost the patient lakhs in private hospitals, these centres have much cheaper solutions. 

UNDP’s Human Resource Report in 1996, comparing the per capita income and the human development, said the state has performed quite well similar to that of Punjab.
 
“Such a pattern of development, defined by success in achieving a high quality of life without success in economic growth was raised to the status of a ‘model’ …and culminated in a paradigm shift in developmental thinking,” the report reads. 

Blots in the model

However, the model is not at all ideal one.

The UNDP report in 2005 reads: “however, a number of doubts have been raised as to the sustainability of such a ‘model’," as it is dependent on higher government spending. The rising dependency on ‘Gulf money’ (since the 1970s, the number of overseas Keralites kept increasing as people went searching for more opportunities) is also another concern, raised by many. Though the 2005 report says “these fears are now receding,”  no alternative has been found yet.

In the health sector, private multi-speciality hospitals are attracting a majority of the cases including those from the economically backward sections. According to Dr Ekbal, former vice-chancellor, Kerala University, the super speciality hospitals are developing a culture of ‘over-medicalisation’ in the state. 

Kerala Sasthra Sahithya Parishath (an NGO working in various fields) says the expenditure of an individual on health in the last 20 years has increased twenty-fold. Of an economically backward family’s budget, 40% is spent on health, according to their study.

Diseases, like malaria, jaundice and typhoid which the state believed to have eradicated, has shown its presence in some places. Communicable diseases like rat-bite fever, Japanese Encephalitis, dengue, H1N1, swine flu are new to the state. But they are making their appearance every year now. Chikungunya, the disease which can be cured with basic treatment, is taking hundreds of lives in Kerala.

The reason for communicable diseases is an unclean environment. Keralites maintain a high level of personal hygiene while not bothering to treat their surroundings in the same way. Solid waste, like any other city in India, is a major issue in Kerala too. It is also notable that the rate of communicable diseases is high in the urban areas as social hygiene is worse there.

Lifestyle diseases like high blood sugar and high blood pressure, heart, liver and kidney ailments are also increasing in the state.

Back to Nipah

The early diagnosis of the infection is the primary reason in curbing further spread of the virus. The very second case raised doubts in Dr AS Anoop Kumar of Baby Memorial Hospital who alerted the whole machinery and made them rise to the occasion.

The health workers, from the primary level to the state minister, developed a plan to curb further spread of the virus. They sorted out possible interactions of the initial victims. From family members and neighbours to doctors who examined them, they made a list of almost 2,000 people to whom they reached out quickly. They were under observation (some are still being observed). The health workers reached out to them every day to check updates.

An isolated ward was created and medical staff treated the patients wearing protective gear. Messages of caution were on social media and TV apart from vehicle announcements in villages and door-to-door campaigns. 

Two of the 18 infected are now breathing a sigh of relief as the system which the state developed had come to their rescue.