The silent health crisis - Shafqat Mahmood - Friday, November 05, 2010

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No one can ignore the floods, their impact being so immediate and persistent. Other natural disasters, such as earthquakes, also announce themselves with passion, having a visible impact on people and places.

The march of sickness across the land is in comparison a silent, stealthy, whispering reality. The newspapers report about it sporadically, and the TV channels show some pictures, but the nature of the calamity is such that the scale of its true devastation is seldom obvious.

It is also not a topic that normal, ordinary people have much interest in. It has boring arcane details and some of the issues would apparently only be of interest to doctors. But, to ignore it would be a mistake as the fever that stalks the land this autumn is an unusual phenomena. It is beginning to reach epidemic proportions.

The number of people affected is huge, perhaps hundreds of thousands or even more. No one has exact statistics. Various governments keep giving what seem like precise figures but they are only a tip of the illness iceberg. At best, they report confirmed cases of only dengue coming to government hospitals. At worst, they are a deliberate lie.

This fever epidemic is not only about dengue although dengue is the scariest of the lot. It is also about malaria, typhoid, and virus-induced high temperatures. Public and private hospitals in all major cities and towns are reporting sick people coming in droves. Facilities are running short and treatments disappearing.

Take dengue as an example. We all know now that it is triggered by a mosquito bite and after a fifteen day incubation period manifests itself as very high fever. Its immediate impact is on blood platelets that start to go down. The normal level is between 150 and 400 thousand but they can drop to under 20,000. At this stage, transfusion of platelets is required.

Seems straight forward enough except that with the huge rise in cases, blood supplies are low and platelet extrusion kits have started to run short. The deaths reported because of dengue could be for many reasons but an important one is that platelets have not been replenished.

This is where the government and the civil society are both failing. Governments have to make sure that platelet extrusion kits are imported on an emergency basis and distributed around the country. Civil society groups, which were very active in floods, need to ensure that enough blood is donated or volunteers put on standby to donate whenever the need arises.

We also need to create some kind of a health-crisis task force, in the Ministry of Health. The hard core politicos and their attendant media is only interested in the political give and take. Long commentaries are apt to be written about obviously useless issues. It is foolhardy to expect this lot to focus on the health crisis.

But, impetus has to be generated by the medical community and the civil society. A health-crisis task force must exist as standing body in the ministry of health and monitor data from all the hospitals in the country. This should not just be from government hospitals. A mechanism needs to be developed to tap into the vast network of private doctors throughout the country. This is the only way to ensure that an accurate picture of the health status of the country is available.

At the moment, there is incomplete information and only peripheral interest among the political leadership. Reading their statements on all sorts of issues, one would be hard put to imagine that right now, we are in the midst of a serious public health crisis. Since they are unaware of the problem, they can't be expected to do anything about it.

Another aspect that has been ignored for a long time in the health field has come to the fore during this crisis. A majority of the less affluent people first choose government hospitals for treatment. They do this because the consultancy aspect costs little and in case of hospitalisation, the bed cost is negligible.

But, they still have to get tests conducted for diagnosis and then buy medicines for cure. This is an area where the government health service completely fails. It can give advice and if the patient is lucky provide a bed but it cannot provide a cure because medicines are up to the patient.

For a long time the idea of a health insurance scheme for the poor has been mooted about but without any move forward. Time has come to bring it to fruition. It could be a classic case of public-private partnership where government and insurance companies collaborate to produce affordable packages for the poor.

It won't be easy in the beginning because poor people have no experience of giving money away to an outside agent for a possible future benefit. But, this is where demonstration effect will work wonders. Once some people start to get benefits the news will spread quickly to others. If the system is made easy without too many bureaucratic hurdles, more and more people will sign on.

We keep talking of doing something for the poor. A health insurance scheme would be a demonstrable example of our commitment. It would also give poor some dignity.

As illnesses spread, the number of poor seeking some benefactor to buy them medicines is increasing. Literally, every door is being knocked at and that cannot be good for their spirit.

The government's fundamental role is to provide health and social services to the people. But, in our context at least wherever too much bureaucracy gets involved, things stop working. A health insurance scheme is a perfect mix where the government creates the enabling environment but does not handle everything itself.

All this can become possible only if there is recognition among the leadership of the crisis we face. At the moment, they are just too busy having fun with each other.

TAILPIECE: Since I was myself laid low last week with high fever, I missed commenting on two things. One, to congratulate Asma Jahangir on a brilliant victory. I have long admired Asma's courage and her standing up for causes where others fear to tread. I have not always agreed with her but admire the forthright manner with which she expresses herself. I also know that she has been offered high offices many times but has always refused. More power to you Asma, and good luck.

The second issue is the demonstration organised around Sherry's house. One could be tempted to slot this as an internal party issue but it is more than that. It shows a certain mindset in the party leadership where people either bend to its will or are subjected to intimidation. This is unacceptable and borders on fascism. It deserves our wholesale condemnation.


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