MFC STATEMENT ON ESCALATING CHALLENGES TO HEALTH IN INDIA

It is an established and accepted fact that the health of the people in a country depends on the access to a network of basic needs that includes nutritious food and health care. A conducive physical and biological environment at the place of living and work, egalitarian social relationships, emotional well being as and a peaceful social environment are all recognised determinants of health of any population. 

To those of us working in the field of health, it is clear that there is a significant deterioration in the conditions needed for people’s health.

Vital for health are not only the number of doctors, drugs and hospitals but also the distribution of these resources and the access to these by all groups within the community. The functioning of the state and the orientation provided by the political leadership of the nation are crucial to the administration of health care and all the resources needed to lead a healthy life with dignity and freedom.  Also critical is a varied and balanced diet according to availability.

Challenges of Public Health Administration

Indeed the health system is a core social institution whose development, effectiveness and accessibility are determined by the political will. The past two years’ central budgets have effectively reduced allocations on health. The previous government has dragged its feet in meeting the promise of doubling the health budget to 2.5% of the GDP.  The present Niti Aayog has made the situation worse by backing the reduction of public health expenditure from its already abysmally low levels even further.  The withdrawal of the government services will have catastrophic effect because the private health services will exploit not only the poor and marginalised strata, but also many in middle classes. The worst affected would be those in 'unprofitable' backward areas where the privatised health care will not go. 

The slashing of governmental health expenditure has now entered a multi-sectoral phase:

The changes being brought about in labour and environmental protection laws are also in directions that will create unhealthy conditions for a vast majority of the marginalised sections and regions.

The food supplementation schemes such as the ICDS programme are under threat. 

Food fundamentalism, society and government
India has one of the most varied food preferences ever seen in the world: wheat in the north,  rice in the south, over 10-15 kinds of millets like ragi, bajra, makai,etc. , several varieties of pulses.   India has the largest number of oilseeds in the world, til, groundnut, sunflower, mustard, mahua, safflower, castor, rice bran, and many more minor oilseeds etc.

In addition we have a few vegetarians (less than 20%), many non-vegetarians (around 70-80%), vegans, non-vegetarians who do not eat pork, non-vegetarians who do not eat beef, tribals who will not drink milk, but will eat beef, entire populations who live on small animals, birds, insects which they hunt for survival. In addition, we have vegetarian Jains who will not eat root vegetables, including garlic and onions, and one can go on. 

The development of any food culture is a long term historical adaptation to what is available in specific situations.

Despite this we are also home to the largest number of hungry undernourished populations (adult and children) in the world who are anaemic, with multiple nutrient deficiencies (50--80%.)  Of course one justification made by the Vice Chairman of Niti Aayog is that Indians are not meant to be tall! 

On the one hand, it is disturbing that the Govt. has failed to feed populations in India.  It has failed to control the price of important sources of proteins like pulses.  The Right to Food Act has not yet been rolled out.   

On the other hand, attacks on meat eating populations belonging to certain communities in the name of a sacred Hindu vegetarianism will tear the already weak fabric of this country.  This is nothing less than an attack on the eating cultures of the country, and can have a catastrophic avalanche effect. 

The current governmental climate of aggression on food culture—whether the pressure to eliminate eggs in the school lunch programme, or the banning of beef in Maharashtra—presents alarming tendencies in the domains of health, economics and culture.

The lynching at Dadri and the lackadaisical governmental response to it are the tragic outcome of the wider structural problem we have described.

Administrative cutbacks, political apathy and passive encouragement
Overall, a) the freezing of health and social sector budgets; b) the weakening and dilution of critical labor protection and environment protection laws in the name of development; c) the overwhelming influence of the private sector and its vulgar profit logic on all decision making; d) the harping on a farcical notion of an ancient India that had discovered everything that was worth knowing'; and e) the consequent subversion of  any rational mindset, are all aspects of the present public health crisis. The price will be paid in both short term increases in illnesses, in long term morbidity, in the tragic and avoidable loss of lives, and the decline in well being of all.

The lack of a strong message from government’s political leadership that all are to be treated as equal citizens is directly responsible for criminal acts such as lynching, murder, aggression and vandalism perpetrated on the people (dalits, religious minorities, women, tribals and rationalists).  This passive response to cultural aggression serves as an active encouragement given to a majoritarian, coercive mindset. It results in direct increase in the blatant incidents that are taking lives of Indian citizens. Such an atmosphere has a telling effect on the emotional and physical well being of the population.  The government has to forcefully convey its commitment to justice and democracy, punish those who disobey, and expel from government and police posts all who actively or passively encourage such activity.

***
Medico Friend Circle is an organization of committed physicians, experts from academia and activists from civil society.  We have worked over forty years on various aspects of health in India.  Ever since the Indian state embarked the neo-liberal pathway of development (and even before), Medico Friend Circle has consistently criticised the governments for their blinkered approach and lack of vision in the health care sector and its public responsibility.  We are deeply concerned at this state of affairs that is in short terrible for the idea that is India, and the health of the Indian people. 

We demand:
An immediate reversal to the cuts in health and social sector spending.
Immediate reversal of the dilutions introduced to labor law and environmental law.
Strengthening and improvement of the ICDS programme.
Immediate price control of all essential food commodities.
Action to fulfill the government’s responsibility to create an environment in which all sections feel a sense of justice, especially the more vulnerable, that fosters social harmony, and the health and wellbeing of all.

Signed
Medico Friend Circle www.mfcindia.org

Mobile Map Mania (MMM) Chattisgarh

 This is an attempt to simplify the map. This time have used Mapbox.  Try clicking on it. There is also a pointer at Raipur. By the way mmm is www upside down

Dhiren Malpaharia

 He had a burn from before Durga Puja. The skin was gangrenous- so Pradipan (pradipan.slg@gmail.com) took him with Janaki Malpaharia to NBMCH for treatment. After the gangrenous skin was excised in early November he came back to the closed Dheklapara Tea Estate. (http://www.youtube.com/watch?v=HYL72iDe5Hw) The Rs 35 a day his relations earned was not enough. He was given Burnol for the ulcer. He died on the night of 4th December at Birpara State General Hospital. He deserved Universal Health Care. He deserved 100 days work at minimum wages. He deserved to be protected from his unjust employer by the courts and the administration. there are just 100,000 Paharias in the world- most in "Santal" Parganas of Jharkhand. They are a priority tribe. 25 Mal Paharia families live at Dheklapara Tea estate (settled here since around 1926). There are a total of 350 families (many are Tanti or Nayek, some are Oraon) in the Main Division and 250 in Niparnia. Dheklapara is closed for 11 years. The neighbouring Bandapani TE is also closed now.  

Dheklapara TE (Madarihat-Birpara, Jalpaiguri) Visit 25th November 2012
 Siliguri Welfare Organization and Peoples Health Forum organized a camp at Dheklapara Tea Estate Main Division from 11am to 3pm on Sunday 25th November. Uttar Banga Sambad and another organization had arranged for around 350 blankets and mosquito nets for the labourers. The Tea Workers Cooperative helped and a UTUC representative attended. There were around 25 volunteers from SWO and 4 doctors. We passed Sulkapara, Binnaguri and Ethelbari on our way (since we traveled via Sevoke and Odlabari). Dheklapara is 9 km from Birpara. Niparnia is 3 km away from the Main Division.

 Dr Debashis Mukherjee, Dr Prakash Baag and Dr Anita Mazumdar saw around 250 patients. Weight, height, age and names of all patients were recorded and BMI of all adults will be calculated. 4 health volunteers- one girl from Niparnia Division, Kunu Malpaharia, Rajib Malpaharia and one other male volunteer from the Main Division- were identified. If trained and supplied an infant weight machine they could (with the help of Salter scales from the Anganwadis) take the weights of all children. There are an estimated 250 under 5 children in Niparnia and estimated 350 in the Main Division. The ANM attends the Dheklapara Dispensary on Fridays, Record keeping is excellent. Immunization is given, BP of pregnant women is taken.
This Tea Garden is in Bandapani GP. Recently the Bandapani Tea Estate also closed down. Earlier many worked in the Stone “jhalna”- sorting and loading at Rati River. They earned Rs 250 or more there. The Cooperative gives them Rs 35 a day for Tea Plucking. Joy Birpara Tea Estate is functioning. The Health sub Centre is at Joy Birpara. Dim Dima Tea Estate has a CNI Primary School and Fatima High School run by catholics. There are 25 Malpaharia families here. There are also Malpaharias at Chunabati, Raipur, Rayabari, Kathalguri, Totabari (near Banarhat)

 Janaki Malpaharia is wife of Kunu. Her maiden name was Kahar. She has an 11 year old daughter. She had 2 miscarriages. Most recent delivery was a girl 2 months ago who died and was not breastfed. Since then she can not walk and has “some irregularity in her periods”. After the MRI at AMRI (PPP connected to NBMCH) she was found to have narrowed spinal spaces. She has recovered to the point of sitting up. The treatment with Phenytoin has helped her. Apparently she has epilepsy. No CT scan done to look for tuberculoma or cysticercosis. Her Hemoglobin is 6.9 gm% and Total Count WBC is 3800/cu mm. No enlargement of spleen however. She has cough for one month. We advised Sputum for AFB. Maybe Gp Rh and VDRL need to be done later. She was given a mouth wash for halitosis. She had urinary tract infection as well.
Dhiren Malpaharia is 60 years old. He fell and burnt himself before Durga Puja (October). There was near gangrene- his dead skin was removed at NBMCH. The large ulcer covers half his forearm and most of the upper arm. His elbow is stiff in a flexed position. The raw area is red and clean- but the piece of shirt covering it has marks and may not be clean. Advised silver sulphadiazine in preference to Burnol. Also clean gauze or other light cotton cloth to be changed every day. Rajib Malpaharia who cycles to school at Birpara is in class 11. He had phimosis and was also operated at NBMCH. We met the father of Jarain Nayek 23/ F, unmarried, who died after 3 days of fever. They are originally from around Mayurbhanj/ Jamshedpur.
 We visited the home of Urvashi Bedia daughter of Pradeep. She is 12 years old. They are originally from near Hazaribagh. About 4 months ago she stopped walking. This continued for 2 months. Now she can walk again. She is quite thin. She studies in class 6. She had pus discharge from her ears (CSOM). Her eyesight was also affected. Now she has swelling of the right knee for a week.
 On the way back we stopped for lunch at Sangam Line Hotel. They have a stone sorter machine.



 The Dheklapara Tea garden is closed for 11 years. There are around 700 families living here. An old lady and her grand child live alone
Indo Tanti had Hemoglobin of 5 gm %. She had her ECG taken. Death Certificate says Congestive Cardiac Failure. No X Ray. Possibility of TB does not seem to be ruled out. There has been Dengue recently in the area. There has also been proven Chikungunya. Malaria is rampant. Stone related work could lead to Silicosis in future- urgent need for Spirometry and follow up. At least 5 patients were referred for Sputum AFB. Niparnia has a problem of elephants attacking houses

 Trip 20th November Debijhora Tea Estate (Chopra, U Dinajpur)
 Break in Tea Gardens here is between 11.30 am and 1.30 pm. BMOH, second ANM Augustina Kullu and ASHA Sugandhi Baraik took me to meet 6 year old Prima Beck who has Kala Azar. Another family with a treated KA patient has relations in Manjha/ Betbari in Naxalbari Block (where PHN Krishnamoyee Bala is now posted). We heard that the first case was diagnosed by doctors in Kishanganj. There were 72 Oraon tribal patients (largest group in Bohura Line) last year out of 106 in Chopra. There were 74 more cases in the other 8 blocks of U Dinajpur. Bohura Line is on the border with Bangladesh and frequent cattle thefts occur. Only one family- from Azamgarh (near Gorakhpur) and Jaunpur (husband and wife) - still have cattle. Some people are working in Kakarvitta in Nepal and many in other areas (Rajasthan, Tamil Nadu, and Delhi) especially in plywood factories. There were a lot of pigs- but this has been done away with following pressure from health workers. In another KA patient’s home we found a dehydrated old gentleman with one day history of diarrhea. We suggested he go to the Tea Estate dispensary for re-hydration. This family brews alcohol using gur [molasses]. Yesterday I read that there is cholera in one tea garden [probably in Jalpaiguri]

 16th October Gulma Tea Estate (Matigara, Darjeeling) On the 16th of October members of SWO, Forum for Peoples Health, APDR and Binayak from PUCL went to Gulma Tea Estate (Matigara, Darjeeling). Here 160 acres of common land- used for subsistence farming in the past- had been fenced off by the Tea Estate. They claimed that this land had been rented to them 30 years ago- though they had not used it in this period. Now they plan to turn it into real estate- possibly taking advantage of the river, rail line, and view of the mountains to build a tourist site or upper class residential colony (like Ambuja). They were harassing workers who opposed this land grab. We spoke to a worker Mr Samad and his wife (a nurse) who was cooperating with NAPM.
Also see:
http://www.scribd.com/doc/ 114257496/Tea-Wages-and-Land

http://www.scribd.com/doc/113612123/Pokhoria-TE

http://www.thestatesman.net/index.php?option=com_content&view=article&id=414530:elite-from-the-boondocks-&catid=52:north-east-page&from_page=search




He has finished the intensive phase of his DOTS Category I treatment. He was sputum positive again and started an extension packet. Now we are waiting for his next sputum. Will he need to go for a DOTS Plus course? Fortunately training for DOTS Plus has begun in Uttar Dinajpur. Better late than never!

HIV Screening for Every Mother

HIV Screening using blood from a finger prick in resource poor settings- See http://cid.oxfordjournals.org/content/50/Supplement_3/S77.full for more on use of these easy finger prick HIV screening tests in other countries.
Whole Blood Finger Prick HIV Screening Tests are being kept in Vaccine ILR-s in some blocks
Health workers have been instructed to take these tests in Vaccine Carriers on Immunization Day and do the tests on pregnant women. Opt-out verbal consent system is being followed.

This will identify mothers for screening at PPTCT centres/ ICTC

Institutional deliveries are on the rise. The same pregnant mothers are rarely weighed at sub centres. Their BP is often missed and fundal height is also missed. Pregnancy test and Hemoglobin test are done by ASHA workers usually. Some of the waste from testing is disposed of outside the centres. VDRL testing is unheard of at the level of State General Hospital and Blood Group or Rhesus testing has never been done. There are frequent shortages of Hepatitis B vaccine. There is a doubt about the quality of maternal mortality data.


So malnutrition, miscarriages, anemia, malpresentation, eclampsia and rhesus incompatibility might be missed.

Our slogan- HIV screening for every mother!