New Delhi: Ritu Aggarwal, sitting outside the Swine Flu ward of Safdarjung Hospital is worried. Her husband Mahesh has been admitted and the prevailing sanitary conditions are unsatisfactory. “I’ve spent around Rs 15,000 in my hometown in Uttar Pradesh but they lack the facilities to treat swine flu. They told us to go to Delhi. The government should make swine flu medicine available in other states too.” The Delhi Health Services on Saturday issued show cause notices to two private labs for overcharging more than the specified limit of Rs 2500 fixed by the government for Swine Flu tests. A health ministry team conducted a surprise check on Friday and found that two private laboratories—Healthcare Diagnostics at Yusuf Sarai and Global Diagnostics, Hari Nagar were overcharging possible patients.
The epidemic may have disappeared from the news, but the pandemic continues unabated. The death toll was 774 last week and the number of cases reported is around 12,000. In Delhi, 2060 swine flu cases have been officially confirmed and nine have died. Meanwhile, 98 dengue cases were reported till September 2014, rising at a rate of 30 percent each week. The National Vector Borne Disease Control Programme (NVBDCP) statistics reported 74,454 dengue cases in 2013 and 167 deaths nationally. 18,639 chikungunya cases have been reported till last year. India, fortunately, has escaped Ebola. The bird flu scare had spread so much that meat merchants in Chandigarh were offering free mutton, chicken and eggs to show that their products were healthy enough to eat. Is the country’s medical network and government facilities prepared to deal with epidemics?
A reality check by The Sunday Standard of top Delhi hospitals showed that the country’s premier hospital All India Institute of Medical Sciences does not have a separate ward for H1N1 patients. Infected people are admitted into the general emergency ward putting others at risk. In most of government hospitals, swine flu affected patients are waiting for their turn to get treated in hospitals which lack the infrastructure and manpower to cope with the situation. Says a senior doctor of the AIIMS “People come from all over the city and the country. Even private hospitals have separate H1N1 wards, but AIMS doesn’t.”
At Guru Tej Bahadur Hospital, daily verbal duels take place between patients and doctors in the small, dimly-lit H1N1 ward. At Lal Bahadur Shashtri hospital, patients and doctors wait for almost a week to get Swine flu test reports. They do not even have a laboratory to test viruses. “Because of the sudden rush, we have to wait for a week to get H1N1 reports after taking the samples which are sent to the National Center for Disease Control.” said Dr. Amita Saxena Medical Superintendent, LBS hospital.
As a result, the patients are overcharged at private hospitals. Vijay Khatri hasd admitted his 70 year old grandmother Bhagwati Devi to the Holy Family Hospital in Delhi. “The hospital charged Rs 1.15 lakh for four days but there was no improvement in her health. I was forced to shift her to Safdarjung Hospital,” he said.
Delhi hospitals are recording a rush from Uttar Pradesh, Uttarakhand, Rajasthan and Haryana where no facilities for H1N1 tests and treatment exist. Licenses have been given licences to around 100 medical retail stores to sell Tamiflu, along with around 14,000 retail stores and 100 medical retail stores near hospitals in co-ordination with three Delhi-based chemist associations. National Center for Disease Control, AIIMS and VP Patel Chest have labs to test the samples. “We have directed Maulana Azad Medical College and University College of Medical Sciences to conduct tests at their laboratories,” said a Health ministry official.
“Any 100-bedded hospital, private or government can treat swine flu patients if they have ventilator facilities. We have asked 26 hospitals, of which six are private to create special wards,” he said.
Currently, the Delhi government has a stock of 1.2 lakhs tablets of Tamiflu. To ensure availability of medicines, the health ministry has put up a list of retail outlets on its website, mohfw.nic.in. “Leaves of all the 18 health’s inspectors of Delhi government have been cancelled and we have been conducting raids and private labs and chemists shops to ensure that no one overcharge to stock medicines,” said the officer. The government has also started a helpline number 011-22307145 for information on swine flu. “People can complain of overcharging by private labs,” added the officer.
Apart from the lack of hospital infrastructure and scarcity of trained doctors, the government’s attitude towards the swine flu as ‘seasonal’ also adds to the grim picture of health care in India. Though the World Health Organisation’s protocol to deal with the epidemic is in place, lack of infrastructure affects the system’s efficacy. Union Labour Minister Bandaru Dattatreya recently requested Union Health Minister for special funds to improve infrastructure in government hospitals and setting up a laboratory to handle the swine flu outbreak in his home state Telangana. Andhra Pradesh does not even have testing facilities. The two sanctioned Indian Council of Medical Research (ICMR) Laboratories, where swine flu samples can be tested not fully operational. Private hospitals in Kolkata have refused to set up isolation wards and are referring all cases to government hospitals.
The Centre has asked all states to set up helplines and round-the-clock functioning of monitoring cells. Union Health secretary BP Sharma is reviewing the swine flu situation on a day-to-day basis. Health Ministry officials said there is no dearth of medicines and hospitals are equipped to deal with H1N1. The Ministry has placed orders for testing kits, Tamiflu tablets and syrup. It is procuring 2000 vaccines for healthcare workers. Union Health Minister JP Nadda said “Tamilflu is available by prescription at licensed stores. Our website has details of registered stores,” he said.
The Drug Controller General of India (DCGI) has instructed all state drug controllers to ensure that antiviral medicine, oseltamivir be made available.
States are on high swine flu alert. In Maharashtra, around 1,200 cases have been detected so far and 78 have died. The state government’s initiative to keep one isolation ward in every government hospital has helped. The state government has evoked Epidemic Act to check swine flu cases authorising district Collectors to act to contain the epidemic. The Odisha government has stocked up drugs and kits after nine H1N1 positive cases. The Kerala health secretary Dr K Elangovan has ruled out swine flu in the state. “We have well-equipped hospitals and training has been imparted to doctors, nurses, ASHA workers and Public Health inspectors.
Swine flu apart, Dengue has become so common that it is treated as a yearly unavoidable infection. According to government figures, 205 cases have been recorded in Delhi until Oct 18, 2014. Dengue is a mosquito borne disease, bred in swamps, dirty water collected in colonies and around houses. In a bizarre turn of events, health authorities found 45 cases of dengue mosquitoes breeding in Lok Nayak Jaiprakash Hospital (LNJP) and the headquarters of the North Delhi Municipal Corporation itself. Three schools were also found to be breeding places for dengue carrying mosquitoes.
India may be grossly under reporting dengue cases, say experts. A National Institute of Health and Family Welfare (ICMR,) joint study has found that Indian official data on dengue is under-reported: from 2006-12, six million were affected every year—a 282 percentage increase from the 20,474 cases reported by the Ministry of Health in 2013. In Maharashtra 135 died in 2010. India is first in the world’s dengue list. The spread of dengue in Kalinganagar in 2014 showed that the Odisha government has not learnt any lessons from the past, when the fever had gripped the Angul industrial belt in 2011. Nine died, and over 4000 tested positive. Jajpur district had more than 1250 patients in 2014.
Other epidemics too keep claiming lives. Total number of cases and deaths due to Viral Meningitis were 3380 and 176 respectively in 2013. Delhi accounts for maximum number of cases (876) and deaths (53); 18639 cases of chickungunya were reported across the country in 2013. There were 13827 Kala-Azar cases of which 20 died in 2013. Acute Encephalitis syndrome claimed 1270 in 2012 while Japanese Encephalitis recorded 1078 cases and 1270 deaths.
Acute Respiratory Infections has accounted for maximum number of cases.
As per the government data provided by the National Health Profile-2013, there are 19817 hospitals having 6.28,708 beds in the country; 15,398 hospitals are in rural areas with 1, 96,182 beds and 4,419 hospitals are in urban areas with 4, 32,526 beds.
A large number of posts of doctors are lying vacant in rural areas. As per the National Health Profile, the total number of Allopathic Doctors registered (up to 2013) were 9,18,303. In Annual Plan 2012-13, 2013-14 and 2014-15, the total allocation of funds on health sector is Rs 30,477 crore, Rs 32,745 crore and Rs 33,725 crore respectively. Per capita expenditure on health is maximum in Sikkim among all the states.
Lack of awareness, unsanitary conditions of living and overcrowded housing are some of the problems that India faces in checking epidemics. It could prove to be a tough task after years of negligence.
● Lack of doctors. As per the National Health Profile, the total number of Allopathic Doctors registered (up to 2013) were 9, 18,303. This is far below the 1:1700 ratio recommended by WHO
● Lack of infrastructure: Hospitals in other states refer patients to Delhi hospitals which are overpopulated.
● Treating infected and uninfected patients at par in government hospitals until screening is over. This puts uninfected patients in danger of catching epidemics.
● Lack of masks puts medical staff and family members at the risk of catching infection
● Testing labs: states like Andhra Pradesh and some in the North east do not have testing labs
● Refusal of treatment by private hospitals in some places like Calcutta.
● Not enough monitoring: the government treats epidemics as seasonal and do not put in place mechanisms to detect virus.
The news report, ‘Struggling to Contain’, in the February 22 edition had quoted a relative of a Holy Family Hospital patient in Delhi as saying that “the hospital charged Rs. 1.15 lakh for four days but there was no improvement in her health.” However, the hospital has said the 70-year-old patient was there for seven days and “she was constantly on ventilator, other critical support and costly, complex medical regime of drugs and nursing. For all that she was charged Rs. 94,184, not Rs. 1.15 lakh.” We regret if any damage has been inadvertently caused to the image of the hospital due to the report.