Snowy Owl
Retired in 2010, In Memoriam
Aedes of October
Pamela Philipose
Posted online: Thursday, October 19, 2006 at 0000 hrs
http://www.indianexpress.com/story/14947.html
Pamela Philipose
Posted online: Thursday, October 19, 2006 at 0000 hrs
http://www.indianexpress.com/story/14947.html
?I?ve been bitten! Search the bed! Find and strike the creature dead!? When they made a close inspection The mosquito foiled detection...
It takes a Vikram Seth to provide personality to the pesky mozzy. In his lively collection of rhymes, Beastly Tales, he resurrects an Indian fable about how the mosquito, by taking a nip off the king, actually woke him from deep slumber, something that the lice lodged in the royal quilt had failed to do.
Question is, with the Aedes aegypti mosquito taking a nip off Delhi ? the royal in the fable we are at present living through ? will the country shake off its sloth over public health? The trauma in its hospitals is palpable.
When the Delhi High Court directed the Delhi government earlier this week to file a fresh affidavit on the steps it has taken to prevent the spread of dengue, it was in response to a very real public health crisis.
The present dengue-chikungunya onslaught in the country throws up five stinging truths. One, India has not succeeded, despite decades of experience and the excellence of its medical professionals, in building a dependable, public health system. The gains of the past have been run to the ground through a combination of fund and human resource withdrawal as well as a policy disengagement at the highest levels of the government. Studies have found that the national shortfall in medical personnel to staff a basic health system is in the region of 80,000 and more, even as public health infrastructure has remained stagnant. Today only 70 per cent of primary health centres in the country has even one bed; and only 20 per cent have telephone links.
It is acknowledged the world over that the government has a pivotal role in delivering basic health and basic education. Yet successive governments in India, both at the state and Centre, have neglected healthcare to the extent that only a fifth of total health expenditure today is met through public funds. Most people ? including the desperately poor ? pay out of their own pockets for the pathetic healthcare they receive. Health is one of the biggest reasons for personal debt in India, including the kind of rural indebtedness that drives people to suicide.
Two, proliferation of diseases ? because of a lethal combination of governmental apathy and public indifference/ ignorance ? has become a fact of life. We have over the last few months faced not just the continuing presence of familiar killers like tuberculosis, malaria, cholera, not just the scare of ?re-emerging? diseases like dengue, chikungunya and Japanese encephalitis, but unexpected setbacks like the new incidence of polio. Mumbai, a metropolis that had bid farewell to it two years ago, is suddenly vulnerable to polio all over again. Here the preliminary findings of the National Family Health Survey-3 are revealing: immunisation coverage in ?developed? states like Maharashtra, Gujarat and Punjab has actually declined since the earlier NFHS survey of the late ?90s.
Three, disease control is also about disease surveillance, because what happens in one part of India can potentially affect the whole country. If Moradabad in Uttar Pradesh is ground zero for polio, it has implications for regions everywhere else. If chikungunya rears its head in Andhra Pradesh or Karnataka, it should set the siren going in Chhindwara and Imphal. If there is one lesson we can profitably learn from Singapore?s handling of dengue, it is the need for the systematic collection of data on disease outbreak; the mapping of regions where the disease is endemic and the pattern of its sway. Treating diseases on an episodic, rather than continuous, basis is one of the major reasons why we suddenly find ourselves in the midst of a serious health scare like the present one.
Four, secrecy is bad for public health. The whole controversy about whether the government should declare the dengue/chikungunya outbreak an epidemic is revealing. It signals a third actor in our public health management: those who desire to ?protect? India?s image. But if ?Incredible India? has to appear a sylvan paradise where elephants bathe themselves to the music of the shehnai, then national effort must go into ensuring that this is indeed the case.
We can learn a lot from China?s handling of the Sars outbreak of 2003 on how not to respond to a serious health crisis. So obsessed were the Chinese authorities about not giving the country ?a bad name?, they instructed airport personnel in cities like Shanghai and Beijing not to wear face masks or gloves when the outbreak was at its height, even while the authorities in other major cities in the region did not feel the need to indulge in such subterfuge. The bland, reassuring deceits of officialdom do not convince beyond a point. China?s handling of that particular episode is universally regarded as the worst possible model for disease control. It is of course far more difficult to control information in India with its lively media and democratic polity, but it is discomfiting nevertheless to discern elements of Controlspeak, a tendency to be economical with the truth, in New Delhi?s response to dengue/chikungunya.
Five, India has still not learnt from the various good practices thrown up within the country. If Himachal Pradesh is among the top three performers in India Today?s ?The state of the states? survey, it is also because 45 per cent of its Eight and Ninth Plan budgets went into schools, health and, crucially, rural water supply. There must also be something to the fact that while all its neighbours have done poorly ? Andhra Pradesh and Karnataka both registered a sharp rise in the incidence of chikungunya, and health-proud Kerala was also beset by a killer fever ? Tamil Nadu seems to have largely bucked the trend. Could this be because it has one of the best and most innovative public health delivery systems in the country?
Development economist Jean Dreze had cited one reason why this is possibly the case: health has moved into the ambit of democratic politics in Tamil Nadu.
We need to achieve this in the country as a whole. Governments that do not deliver on health must be made to feel the sting of the mosquito: the wrath of the voter.
Question is, with the Aedes aegypti mosquito taking a nip off Delhi ? the royal in the fable we are at present living through ? will the country shake off its sloth over public health? The trauma in its hospitals is palpable.
When the Delhi High Court directed the Delhi government earlier this week to file a fresh affidavit on the steps it has taken to prevent the spread of dengue, it was in response to a very real public health crisis.
The present dengue-chikungunya onslaught in the country throws up five stinging truths. One, India has not succeeded, despite decades of experience and the excellence of its medical professionals, in building a dependable, public health system. The gains of the past have been run to the ground through a combination of fund and human resource withdrawal as well as a policy disengagement at the highest levels of the government. Studies have found that the national shortfall in medical personnel to staff a basic health system is in the region of 80,000 and more, even as public health infrastructure has remained stagnant. Today only 70 per cent of primary health centres in the country has even one bed; and only 20 per cent have telephone links.
It is acknowledged the world over that the government has a pivotal role in delivering basic health and basic education. Yet successive governments in India, both at the state and Centre, have neglected healthcare to the extent that only a fifth of total health expenditure today is met through public funds. Most people ? including the desperately poor ? pay out of their own pockets for the pathetic healthcare they receive. Health is one of the biggest reasons for personal debt in India, including the kind of rural indebtedness that drives people to suicide.
Two, proliferation of diseases ? because of a lethal combination of governmental apathy and public indifference/ ignorance ? has become a fact of life. We have over the last few months faced not just the continuing presence of familiar killers like tuberculosis, malaria, cholera, not just the scare of ?re-emerging? diseases like dengue, chikungunya and Japanese encephalitis, but unexpected setbacks like the new incidence of polio. Mumbai, a metropolis that had bid farewell to it two years ago, is suddenly vulnerable to polio all over again. Here the preliminary findings of the National Family Health Survey-3 are revealing: immunisation coverage in ?developed? states like Maharashtra, Gujarat and Punjab has actually declined since the earlier NFHS survey of the late ?90s.
Three, disease control is also about disease surveillance, because what happens in one part of India can potentially affect the whole country. If Moradabad in Uttar Pradesh is ground zero for polio, it has implications for regions everywhere else. If chikungunya rears its head in Andhra Pradesh or Karnataka, it should set the siren going in Chhindwara and Imphal. If there is one lesson we can profitably learn from Singapore?s handling of dengue, it is the need for the systematic collection of data on disease outbreak; the mapping of regions where the disease is endemic and the pattern of its sway. Treating diseases on an episodic, rather than continuous, basis is one of the major reasons why we suddenly find ourselves in the midst of a serious health scare like the present one.
Four, secrecy is bad for public health. The whole controversy about whether the government should declare the dengue/chikungunya outbreak an epidemic is revealing. It signals a third actor in our public health management: those who desire to ?protect? India?s image. But if ?Incredible India? has to appear a sylvan paradise where elephants bathe themselves to the music of the shehnai, then national effort must go into ensuring that this is indeed the case.
We can learn a lot from China?s handling of the Sars outbreak of 2003 on how not to respond to a serious health crisis. So obsessed were the Chinese authorities about not giving the country ?a bad name?, they instructed airport personnel in cities like Shanghai and Beijing not to wear face masks or gloves when the outbreak was at its height, even while the authorities in other major cities in the region did not feel the need to indulge in such subterfuge. The bland, reassuring deceits of officialdom do not convince beyond a point. China?s handling of that particular episode is universally regarded as the worst possible model for disease control. It is of course far more difficult to control information in India with its lively media and democratic polity, but it is discomfiting nevertheless to discern elements of Controlspeak, a tendency to be economical with the truth, in New Delhi?s response to dengue/chikungunya.
Five, India has still not learnt from the various good practices thrown up within the country. If Himachal Pradesh is among the top three performers in India Today?s ?The state of the states? survey, it is also because 45 per cent of its Eight and Ninth Plan budgets went into schools, health and, crucially, rural water supply. There must also be something to the fact that while all its neighbours have done poorly ? Andhra Pradesh and Karnataka both registered a sharp rise in the incidence of chikungunya, and health-proud Kerala was also beset by a killer fever ? Tamil Nadu seems to have largely bucked the trend. Could this be because it has one of the best and most innovative public health delivery systems in the country?
Development economist Jean Dreze had cited one reason why this is possibly the case: health has moved into the ambit of democratic politics in Tamil Nadu.
We need to achieve this in the country as a whole. Governments that do not deliver on health must be made to feel the sting of the mosquito: the wrath of the voter.