How did Odisha’s healthcare system become such a mess?

Japanese Encephalitis (JE), a vector borne disease, has claimed more than seventy lives in Malkangiri, one of the poorest, besides Maoist-affected, districts of India. If this tragic incident had happened in Delhi, by now, it would have become the hottest debating point in the prime time and editorial pages of most of the main stream media of the country. But the cruel twist of irony is that no politicians, health experts etc. rivet about the dismal condition of the poor.

Culex mosquito sprawls the JE virus from pigs to humans.  Over the years, Odisha government has been distributing mosquito nets to every citizen. It also claims that government has already dispensed millions of nets to the people. Between 2010 and 2013, the state had distributed 43 lakh long-lasting insecticidal nets, a type of medicated mosquito nets, in high-malaria prevalence areas. Of them, the Centre had provided 38 lakh. The state had provided the rest under ‘Mo Masari (my mosquito net)’ scheme meant for pregnant women and students of residential tribal schools. The mosquito nets were cited a major success story to check rising malaria and dengue cases in the state. Then the question arises, why are the people not using nets?  Moreover, government has instructed people to keep pigs in the outskirts of the radius of five kilometres from human habitations. But how is it possible?  In Malkangiri, raising and breeding of domestic pigs is one of the crucial components of their livelihood.  If they will locate their pigs in a distance of five kilometres from themselves, then who will take care of it?  Who is going to compensate their losses? At least five hundred pigs have so far been killed by the panicked villagers in far-flung areas of the district.  A citizen from Malkangiri has lodged an FIR against Odisha Chief Minister Naveen Pattanik for not showing eagerness to handle the situation.

 ‘India  to sign defence deal of  39,000 cores with Russia’,  ‘India  signed Raffle deal with France’, ‘India to counter China at BRICS summit’ et al, have been some of the headlines of newspaper across the country, but no national level media is talking about lack of effective healthcare in the rural India. Who is responsible for this alarming situation in Malkangiri? Of course, both the state and central government failed to provide vaccines on time, and JE bares its fangs across the district. Where is the Article 47 of Directive Principle which says that it is the moral duty of the state to raise the standards of living and nutrition of its people?

Surprisingly, in the entire Malkangiri district, only 23 doctors are working in different hospitals as against the required number of 115. The district headquarters hospital had 13 doctors, including two dentists, when it should have at least 40 doctors to meet the requirement during normal months.

‘Innumerable policies, schemes but no panacea’ and the abysmal situation is continuing even after 69 years of independence.  There are programmes like Integrated Child Development Services (ICDS), Mid-Day Meal Scheme (MDMS) and Public Distribution System (PDS) etc. to develop the situation but we are still home of 194.5 malnourished – which is a quarter of world’s malnourished.

India is ranked 97 among 118 developing countries in the Global Hunger Index (GHI). India is worse than Chad, Niger, and Ethiopia like extreme poor African countries.  Most of the neighbours –China, Bangladesh, Myanmar, Sri Lanka, and Nepal – are ranked above India. Most probably, India is going to be the most populous country of the planet by 2022.  On the edge of demographic dividend, the nation should give first priority to human resources of the country. In India, politicians encompass tall claims such as ‘Garibi Hatao’, ‘India is shining’, ‘NREGA’ ‘ Bharat Nirman’, ‘Swachh Bharat’ etc. and on the other hand there is endemic poverty, ‘lack of safe drinking water and sanitation’, ‘unemployment’ etc.  The implementation of the developmental programmes remains patchy, and it is clearly visible in the grass root level.  The Hindustan Times reported that  there were 17 Korku tribe children lost their lives due to malnutrition at Khandwa district in Madhya Pradesh in the last three months.

Here it is noteworthy to mention that what is the need of Skill India, Digital India etc, if children could not develop their physical and cognitive capacity fully? ‘Smart Cities’ will achieve nothing, if the inhabitants are remained under ‘chronic hunger’.  As long as, Indian goes to bed with empty stomach, ‘sabka saath sabka vikash’ lingers   as a hollow slogan.

The tragic tale of SUM tragedy

On October 17, 2016, a dreadful fire tragedy brought horrific end to twenty-seven people’s lives in a private hospital in the capital city of Odisha, Bhubaneswar. They did not breathe their last breath for ailments, but because they consumed fire which broke out at the dialysis unit of the SUM hospital.  There are several people injured, who are undergoing treatment in various hospitals across the country including AIIMS, Delhi. ICU is for the most vulnerable patients and the blaze was engulfed it, shows authorities heights of insensitivity towards safety. It is reported that SUM hospital does not possess ‘fire safety certificate’ as it had blatantly overlooked Odisha government’s 2013 advisory to improve fire fighting mechanism. Odisha has 1200 private institutions, shockingly only three have the fire safety certificates.  It is not only a sorrowful incident but also a cautioned juncture for the state as well as country.

In 2011, fire was broken out at Advanced Medical Research Institute (AMRI) in Kolkata and ninety people lost their lives. Investigations showed that there was litany of violations before the tragedy.  The basement of hospital was packed with various ignitable chemicals and medical waste. Hospital was short of adequate fire-fighting apparatus. Most appalling information is that, hospital staffs informed fire-brigade an hour-and-half after the broke out.  The hospital had many loopholes to control the fire explode. SUM hospital tragedy, is India’s second biggest causalities at hospital of this kind. Aftermath of AMRI incident, government has pursued safety measures of the each and every hospital of India and ordered to follow the rules and regulations strictly. However, ‘The black takes no other hue’ like this adage, every institution, both government and private hospitals, forgot the law and regulations, and started working as usual.

 After the AMRI misfortune, although Odisha government ordered every institution to follow the instructions, but fires broke out at SCB, the state’s biggest, hospital and Acharya Harihar Regional Cancer Centre and Sishu Bhawan. Although, nobody lost life in these incidents, but public properties   went to vain. The government had investigated the incidents, but so far no actions have been taken against the culprits.  Most of the hospitals have no necessary occupancy and fire safety certificates, which are required under the Odisha Clinical Establishments (Control and Regulation) Act, 1990, National Building Code and Odisha Fire Service Act, 1993.  The Director of Medical Education and Training (DMET) should have scrutinized all measures before renewal of licences of the hospitals, but wilful negligence of institutions is clearly visible. Hospitals, also hotels, company buildings etc., hang some fire extinguishers in the walls and use to put an end to their accountability.

Moreover, most of the staffs don’t familiar with the use of fire extinguishers, but it is in the rule that every employee must be trained to use of fire extinguisher. According to National Building Code, 2005, there must be Sprinkler, Fire Alarm & Smoke Detection System, Wet raiser, Yard Hydrant in the every 15-metre high building. Nonetheless, no institution is following the rules.

On the other hand, good number of people from neighbouring Chhattisgarh, Jharkhand and West Bengal come to Odisha for two reasons. One is for better medical treatment in low cost in comparison to metros and another is to spend holidays in the amalgamation temples and scenic beauties of state.   The SUM incident is major setback of Odisha’s growing medical tourism. If such incident occurs regularly, the dream to make hubaneswar a medical hub will remain a distance dream. However, we never learnt any lesson from such horrendous tragedies.  People came to the SUM hospital to cure various ailments, but they got unnatural death, and such heart-broken tragedy is always condemnable. Now, the time has come to introspect the situation and implement every safety measures, so that no human being thinks twice before he/she comes to hospitals.  State government should use this incident as an occasion to transform the system and reinstate public’s faith on hospitals.

by Sanjay K Bissoyi