Was watching a televised debate on the state of health system in Orissa. The channel had invited a senior doctor from the Health system and one activist purportedly working in the tribal pockets of Orissa. The channel had set up a classic pro and anti govt. type of debate and after a while one felt like one was watching a tennis match – considering the speed and agility with which the participants were merrily tossing the ball in to each others courts. The point of discussion was the lives lost every year to diarrhea outbreaks that occur every year without fail in the same pockets of Kalahandi, Rayagada, Gajapati and nearby districts. As if the participants were not confusing the issue enough, the anchors decided to throw in the 22 deaths in the State due to swine flu. This naturally turned the already murky discussion in to total chaos. The discussion, as generally happens on Indian TV, rapidly deteriorated in to a free for all. Whenever the anchor tried to put in a word, he was shouted down and was generally reduced to a helpless spectator like all of us. The activist vehemently opposed the govt. and its policies without coming out with a single concrete, doable proposal. He kept mouthing catch words like holistic approach, community empowerment and so on. The senior govt. doctor in the meantime decided to turn aggressive and defensive at the same time and as is the problem with us technical people, when at a loss, we tend to spout figures, numbers and statistics in our defence.
But what everyone forgets is the real issue at stake. Human lives. Imagine that same activitist’s or govt. doctor’s son passing away from diarrhea. Yeah… one can’t even begin to imagine that. Imagine the feelings that these villagers must be harboring at the onset of every monsoon. Whose turn will it be this time? They have no roads, no electricity, no connectivity to the nearest hospital. Even if they somehow manage to carry the moribund patient to the nearest hospital, there is no guarantee that there would be a doctor there.
Actually it doesn’t take much to treat diarrhea. You don’t even need any fancy antibiotics or injections. All that has to be ensured is that we pump in more fluids than is being discharged from the patient’s body till such time that the patient recovers sufficient strength to heal himself. That is all that needs to be done. Just some intravenous fluids. But time, as they say, is of essence in this treatment. You have to start pumping in fluids before it’s too late. Wait for the morning to carry the patient on his cot to the nearest hospital, 15 kms away, on foot, and it might be too late. So the poor villager has two very clear choices:
One – Watch his two year old kid (who is already malnourished) loose fluids the entire night and pray to the village deity that his kid survives the night so that he can be carried to the hospital at first light.
Two – attempt to carry the kid in his arms (if its someone older, then carry the patient cot and all) on a rainy monsoon night, from an area that does not have any form of communication, electricity or roads to the nearest hospital which may be 10-15 kms away in the middle of the night – on foot. Which option would you have chosen?
The surprising thing is that these outbreaks occur every year during the same three months of rains and in the same areas, and yet, we fail to do anything to prevent this from happening. Everyone rushes to bolt the stable doors after the horses have left the area – every year.
The Govt. representative on the news channel has been posted in Bhubaneswar since more than ten years. Ask him to visit any remote district to supervise preparedness and he will promptly quote health grounds for not traveling. All the planning and monitoring is done from his snug office in the Capital over telephone and reports received by emails. If a Medical Officer genuinely tries to report a case of diarrhea then that MO is the first one penalized (how could you let this happen in your area, what all precautions had you taken, and so on) till the poor chap decides that it is best not to report. The activist is no better.
Worst are the news channel guys. Just look at the hype over 22 swine flu deaths in our State over the last one year. Everyone and his uncle are out to procure masks and hand sanitizers. Medicine shops and all sorts of black marketers are making hay left right and centre and the sun continues to shine unabated. Nobody has bothered to inform the poor viewer that these masks are worse than useless. That the deaths due to swine flu are less than a fraction of deaths that occur in our State due to Malaria and TB everyday. Reported deaths due to Malaria are far more than due to swine flu. And here also we are talking of reported figures, which, in all probability, might be less than the tip of the iceberg of actual deaths due to malaria. Same can be said of TB, pneumonia, cancer, and a myriad other diseases. The largest cause of deaths in our country, by far, is road traffic accidents. But due you think media guys would stir up this frenzy over a truck accident. No way.
Death, as is well known, is inevitable. People will die. And people will have to die of something. I mean you don’t expect a perfectly healthy guy to kick his bucket just because he has turned hundred and he feels it is his moral duty to give way for the next generation. So people will continue to die and die of something. No point losing sleep over that. Countries which have controlled infectious diseases are facing an epidemic of life style diseases (diabetes, heart disease and so on). As mentioned earlier, road traffic accidents continue to be the biggest killer. Wars, terrorism, muggings gone wrong, everything contributes. And as if that is not enough, nature too lends her hand once in a while to keep the populace under control. The problem is deaths which could have been prevented easily. Deaths of 2 year old kids. Deaths during child birth. Deaths due to malaria, TB and so on. That, is what gets one’s goat.
Why cant the govt. ask officials from the department of Health, Roads, Electricity and other allied departments (including those responsible for ensuring potable water in every village) to ensure that the roads are motorable, there is electricity, the tube wells are functioning, the wells disinfected, villagers sensitized on what to do with the first outbreak of diarrhea and so on – before the onset of monsoons. Why blame the Health department only? Actually why blame anyone. Has any action been taken on anyone for these deaths - ever?
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