In sickness and death
The recent spate of infant deaths prove that subsidised public healthcare for the poor exists only in name, writes Lalita Panicker.Updated: Jul 05, 2011 21:25 IST
Our irrepressible health minister Ghulam Nabi Azad is rarely seen or heard when it comes to his ministry. When he is, it is usually for the wrong reason, like his latest comment on homosexuality being unnatural and a disease. But once in a while when he makes a pertinent suggestion on healthcare, we are all ears. Earlier this year, he said that we need out-of-the-box solutions for healthcare in remote areas. How very right. But, what about run-of-the-mill solutions that we need in healthcare even in premier public hospitals in metropolises? The deaths of around 20 children in two days in a top government-run hospital in Kolkata have evoked little reaction at the national and state level. Surely, this merited a comment from the health minister more than his odd remark on sexual orientation.
The curious antidote of a top politician dashing to the site of the deaths has been administered. Chief Minister Mamata Banerjee took a bit of time off from telling off 'exploitative' industrialists to go across to the hospital, an act which no doubt sent shivers down the administration's spine. The hospital is just one among the many, many government hospitals which seem to have no clue about paediatric and neo-natal care.
In Kerala, held up a model for its low infant mortality, government hospitals are a fright to behold. It was not long ago that we saw pictures of poor mothers lying on the floor with their newborn infants while stray dogs roamed about the wards. When confronted with mounting child deaths in government hospitals in 2007, the CPI(M)'s state secretary Pinarayi Vijayan suggested that this was a conspiracy to facilitate the entry of private players into the health sector. What Vijayan did not mention is that the private sector is very much there, with 70% of people's health needs catered to by it, often at usurious rates thanks to a failed public health system.
In the meantime, we blithely sign on to every international convention on reducing infant mortality. The figures on the ground show that we don't take these very seriously. If we did, surely we would have given the health portfolio to a proactive person who would really think out of the box and come up with innovative solutions. It is inexplicable how we take such great pride in our young population while at the same time calmly accepting these appalling levels of infant deaths.
The cavalier response to such deaths, both on the part of hospital administrations and the governments at the Centre and the state, seems to suggest that babies somehow are identity-less and therefore, their deaths matter less. Invariably, it is the poor whose children die in such numbers. It is the poor who have to rely on the mirage of a public health system for the survival of their children. In most cases, the babies die of septicemia, asphyxia, infections facilitated by prematurity, diarrhoea or respiratory infections. Many ailments among infants can be prevented by vaccines. If the child is brought to the hospital with almost all the problems listed above, she can be treated with basic medicines.
The problem with our so-called subsidised government healthcare is that like free electricity, it is there only in name. It is not uncommon to see the parents of poor children scurrying around trying to buy medicines and syringes which the supposedly free government hospital conveniently does not stock. For a child already weakened by illness with no immune system to speak of, the delay in treatment of a few minutes could be fatal.
The attitude even in premier hospitals like the All India Institute of Medical Sciences in Delhi to the poor whose legitimate right it is to avail of subsidised, if not free, healthcare is appalling. While the influential glide into laughably cheap rooms and are waited upon by specialists, the poor end up on the pavements outside, begging for attention.
How delightful is our rhetoric of raising an army of barefoot doctors, who will repay the state that has provided them subsidised education. But we need to get real. No one who has lived through the post-economic reforms era is going to be filled with the milk of human kindness and waste a year of potentially high earnings in the greater good of the nation. Which of us would be willing to send our children to villages with no medical equipment or medicines to repay a debt of gratitude to the nation? We should, but we wouldn't.
And we don't really need to get very much out of the box to reform the health system. It is at birth that the greatest input can be made for the future welfare of a baby. The mother needs a safe and clean delivery and should be made aware of the importance of safe nutrition, in this case breastmilk, for her child. For this, we need to strengthen the National Rural Health Mission (NRHM) and induct more local workers into the system. If the National Rural Employment Guarantee Scheme were to dovetail with the NRHM, then half the problem could be licked.
We can only be grateful that Mamata Banerjee did not discern a dastardly CPI(M) plot in the recent spate of baby deaths in Kolkata. Such attempts to politicise problems brought about by neglect and lack of priorities have served to deflect attention from the fact that it has been a walkover for the private sector in healthcare with the public health system having all but abandoned the field. We hear that India is only interested in attracting medical tourists in order to make money. But it is not that they are coming here at the cost of our dying children. On the contrary, the money they bring in for a nip and tuck would be useful to make healthcare cheaper even in the private sector, if it were so inclined. And it might if the government, instead of casting itself in an adversarial role vis-à-vis the private sector, were to incentivise care for the underprivileged.
The parents of the children who are dying in government hospitals have no spokespersons like Anna Hazare or Kiran Bedi, they have no one to file a PIL on their behalf, they have no one willing to hold a candlelight vigil for their dead children. They unfortunately only have the State to turn to, a State which has for a long time now turned its back on them.