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Spurred by apathy

Spurred by apathy
The deaths of Kamal and Kishor Chand present the grim picture of the level of preparedness of Vasundhara Raje-led the Bharatiya Janata Party (BJP) government in Rajasthan. Kamal and Kishore Chand are not the only victims of the lackadaisical approach of Narendra Modi-led National Democratic Alliance (NDA) government at the Centre and other state governments of Rajasthan, Gujarat, Madhya Pradesh, Maharashtra, Telangana, etc. There are many such Kamals who have lost their lives either due to unavailability of medicine in their district hospitals or due to late reporting of the case.

Rajasthan and Gujarat are in a tight grip of swine flu as over 4,000 cases and 200 plus deaths have been reported from Rajasthan, followed by over 2,000 cases and 180 plus deaths from swine flu in Gujarat, the home state of Prime Minister Narendra Modi. Other states where cases of influenza virus are on the rise include Telangana (over 1,100 cases and more than 50 plus deaths), Maharashtra (over 600 cases and 90 plus deaths), Madhya Pradesh (400 plus cases and 90 plus deaths), Delhi (1,700 cases and 6 deaths), Karnataka (350 plus cases and 25 plus deaths), Punjab (25 plus deaths) and Uttar Pradesh (115 plus cases and five deaths).

Had the Union Health Ministry acted swiftly, several lives could have been saved. It is simply the laid back approach of the ministry that despite procuring the medicine in its stock, the Centre directed states and medical colleges to maintain the stock from their own funds. It is well-known that states are always dependent on Centre for funds to invest in public healthcare and following Centre’s diktat, states procured medicine at their pace that did not match with the urgency of the situation. This is the reason swine flu patients of Jodhpur, Nagaur, Sikar, Ajmer, etc. are battling for their lives, due to shortage of drugs.

The situation in Rajasthan is so pathetic that people die before their test result is confirmed. As per the guidelines of swine flu treatment, a patient is to be prescribed Tamiflu tablets after they are tested positive. “With no labs at panchayat level, patients living in remote villages have to visit district hospitals to submit their samples for the test. As district hospitals take two-three days to give the test report, the patient dies. There have been several deaths due to late reporting in Sikar,” said Nechwa village resident Rakesh Pareek. Adding to the woes of patients, the hospitals are short on Tamiflu stock. The state of affairs in Rajasthan’s Nagaur district, where most causalities are reported from, is very worrisome. “Even though, hospitals in Nagaur are flooded with swine flu patients, hygiene at hospitals is barely there. Apart from medicines, there is also a shortage of masks at hospitals,” said Tarachand, a resident of Nagaur district.

“In Jodhpur, doctors prescribe medicines to ‘selective’ patients. People are dying due to unavailability of Tamiflu. A relative of mine has just died due to the flu as doctors did not prescribe the medicine even after he was tested positive for swine flu”, a Jodhpur resident Afsar Bhandari said.

Total swine flu cases in 2015 have crossed over 12,000 mark in just eight weeks of the year with death toll mounting to 800. According to Health Ministry officials, they are waiting till February end and if the death toll figures do not come down, the ministry may announce 2015 as a pandemic year. In 2009, out of total 27,236 cases, there were 981 deaths while in 2010, there were 1,783 deaths reported out of 20,604 cases of swine flu.

Even though the strain of H1N1 virus, which causes swine flu, has not changed in six years of its presence in India, the Health Ministry failed to initiate any programme dedicated for the prevention and cure of this life-threatening disease. A senior Health Ministry official, who requests anonymity, has “valid” reasons to substantiate his justification that there is no need to initiate a programme for swine flu, even though above 5,000 people have died in just six years starting from 2009.

“The government of every country formulates national-level programme on the basis of publical disease burden, which is not applicable in the case of H1N1. The programmes such as DOTS (Directly Observed Treatment, short-course), polio vaccination, etc. have been introduced in the country as the instances of Tuberculosis (TB), polio are much higher than swine flu,” the senior Health
Ministry official said.

The annual count of TB comes around 40 lakh and death toll due to it is over 10 lakh, so is there a need of a national plan for TB or not? “Of course there is,” the official said, adding that the 700 plus deaths from swine flu is nothing compared to other public-illness. “But when over 700 people die due to swine flu in a short span of time, it creates a panic”, the official added.

About the nature of swine flu, the official said, “Influenza is a disease which has seasonal trend. Prior to its pandemic history in 2009, the H1N1 virus was tested after testing labs were established in the country. Now, since there are so many labs for testing, the cases are also mounting.”

On the question of vaccination, the health official said, “Vaccination is not advisable at primary stage, simple precautions are more effective. The vaccines available in the market do not have 100 per cent efficacy. Even World Health Organisation (WHO) says that the vaccination has only 60 to 70 per cent efficacy. It has also come to notice that the medicine is not effective on those who are more prone to this influenza, such as old people, kidney patients, those who had contracted to H1N1 virus in the last three years, etc.”

Similar views have been expressed by Ritu Priya, Professor, Centre for Social Medicine and Community Health, at Jawahar Lal Nehru University. “According to my medical and public health understating, it is not as serious as it is reported to be. Since we have testing facilities for this virus, we are able to get numbers. The cases of swine flu are seasonal as well as cyclic. It repeats after a gap of three-four years,” Professor Ritu Priya said. Hygiene plays a vital role to prevent it, affirmed the JNU scholar. However, alarmed over the surge in swine flu cases, the Health Ministry has revised the H1N1 virus treatment guidelines. According to the new guidelines, the government has mandated vaccination to people more vulnerable to contracting the flu. While briefing about changes in new guidelines, Director General of Health Services, Jagadish Prasad told Millennium Post that even at primary stage, where there is no testing facility available and a patient appears to have caught the flu, a tablet of Tamiflu could be immediately given to that person. The new guideline also provides for vaccination to health workers or anybody in direct contact with the H1N1 virus contracted patient.
Speaking about the shortage of medicine, Prasad said, “Medicines are available in adequate amount in every hospital. The ministry has authorised 2,450 private medical stores to procure medicine. Drug manufactures have also been told to maintain the stock, so that general masses do not suffer due to shortage of drugs. The facility to get Tamiflu is for those patients who would be prescribed by their doctor.”

Giving details about the opening up of counters, Central Drug Controller, GN Singh said, “Any dealer who has the licence to sell, stock or distribute the drugs specified under the Schedule X of the Drugs and Cosmetic Rules, is authorised to sell the formulation of Oseltamavir Phosphate used for the treatment and prevention of swine flu.”

Replying to a question on why the western part of the country has become pandemic, including dengue, bird flu, eye flu, plague, etc, Prasad said, “It may be considered as a coincidence. But we have asked ICMR to make surveillance as to why this disease is spreading mainly in western parts. Ministry is also findings out the reasons of this outbreak.”

Compared to other states, Delhi is in comfortable position. Though swine flu cases are touching the 2,000 mark, Delhi has reported just six deaths since January 1 of this year. Additional Medical Superintendent of Ram Manohar Lohia Hospital Dr AK Gadpal said, “We have created separate wards to avoid the spread of H1N1 virus among other patients of the hospital.”

“We have created dedicated wards and trained health workers on handling H1N1 patients. All staff has been trained in inflection control practices. The emergency relief doctor has been nominated as the nodal officer for H1N1 patients,” said Dr R K Singal, who is Director (Internal Medicine) at BLK Hospital. The hospital has so far treated above 200 swine flu positive cases out which three deaths have been reported.

Advising the do’s and don’ts of swine flu, Dr. Vinay Goyal, who is Intensive and Thyroid specialist, said, “Frequent hand-washing, hands-off-the-face approach and resisting all temptations to touch any part of the face play key role to contain the virus.”

Goyal also suggested gargling twice a day with warm salt water to restrict the spread of H1N1 virus in body, as the virus takes two-three days after initial infection in the throat/nasal cavity to proliferate and show characteristic symptoms. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one.

Warning signs in children

  Fast breathing or trouble in breathing

  Bluish skin tone

  Not drinking enough fluids/not eating food

  Not waking up or not interacting

  Being so irritable that the child does not want to be held

  Flu-like symptoms improve but then return with fever and worse cough

  Fever with rashes

Warning signs in adults

  Difficulty in breathing or shortness of breath

  Pain or pressure in the chest or abdomen

  Sudden dizziness

  Confusion

  Severe or persistent vomiting

DO’S
  Wash your hands
  Avoid crowded places
  Stay more than an arm’s length from persons afflicted with flu
  Get plenty of sleep
  Drink plenty of water and eat nutritious food

 DON’Ts
  Shake hands or hug in greeting
  Spit in public
  Take medicines without
consulting a physician

Source: Ministry of Health
Dhirendra Kumar

Dhirendra Kumar

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