Heal our healthcare

With the winter upon us, scores of people are falling ill with upper respiratory tract infections, such as those caused by respiratory syncytial virus, as well as diarrhea, gastroenteritis and pneumonia. Swine flu, TB, bronchitis and other dangerous infectious diseases could soon be rife in Delhi, followed thereafter by dengue, chikungunya, malaria, cholera, typhoid, hepatitis A, B, C, D. and E, crimean congo fever, enteric fever, encephalitis, meningitis, leptospirosis, rabies, plague, west nile virus, and many others.

A German company, Adt Biotech Altona Diagnostic, had offered the Sheila Dikshit government an extremely successful technology, a Central Drugs Standard Control Organisation (CDSCO) certified molecular diagnostic test for re-agents to test for 38 kinds of infection in blood, stool and sputum in government hospital labs. Both cheaply, very accurately and in record time compared to what is now required to get a positive lab result. From June 2012, more than 10 seasonal epidemics have occurred but the government sat on the proposal for several years, leading to loss of precious lives, money and resources, which could have been better utilised elsewhere.

Anjali Ghosh, Senior Marketing coordinator and consultant for Altona in India said, ‘I wanted to work for the benefit of public health and specially poor people who have to run from pillar to post in government hospitals to get blood test done for which the results take ages, by which time the poor person becomes terminally ill and spreads disease to many others, and so I contacted the company, as they are only one in the world providing such tests and they had successfully handled the mad cow infection in Europe, so that this technology can also be used for the benefit of the common man in India. The test can accurately detect the virus (they provide extraction kits for the RNA and DNA for 36 kinds of virus) within three to four hours and predict accurately everyday growth, weekly growth and month-wise growth of viruses up to a window period of six months, from just a single drop of blood. This will lead to immediate treatment and stop the disease spreading into an epidemic and within five years the disease can be eradicated, as has been Altona’s experience in Germany, Singapore, Malaysia, Pakistan, Bangladesh, Sri Lanka, Thailand, South Korea, China, etc. which have successfully utilised Altona’s one-of-a-kind testing method which costs a total of Rs 1200.

In India, the government hospital labs test samples by the Rapid method followed by the Elisa method, where the sample has to be re-tested several times. One time rapid with Elisa now costs between Rs 2,600 to Rs 3,750 and may have to be repeated everyday due to unreliable results (you might have to use as many as 90 strips of Rapid to get positivity as 90 per cent wrong results are given on first try and then again for Elisa you might have to go for 6 successive test strips for accuracy). For instance, in the Platelet count, had Elisa test shown the futuristic, but it doesn’t give futuristic growth of window period in Elisa. Then the question of morbidity would not arise, as doctors can handle the treatment very confidently. But without future growth of the virus predicted, the patient has to go for testing again and again and it is therefore much more inaccurate and time-consuming, not to mention it being much more expensive for the aam aadmi. Many patients cannot afford the present testing method of Rapid repeated. Thereafter are the Elisa six steps to get result and that needs to be done everyday, as there is no window period. They simply opt to go to quack doctors instead and keep spreading the infection among the public.

No government hospital provides free blood test, only free beds and doctors, they outsource tests to private labs and patients have to pay the bill along with the medicine and injections etc. The shortage of bed problem in government hospitals will also be minimised by accurate treatment, and patients can be discharged within a week due to early treatment, as bed space of the hospitals cannot be increased overnight if there is an epidemic.’

These real time-PCR kits are already being supplied to Apollo hospital, Delhi, R&R Army hospital, AIIMS, Lal Path lab, SRLC Mumbai and others. Kits are manufactured at Hamburg, Germany and Kuala Lumpur, Malaysia which also have cutting edge research into various tropical diseases at the R&D divisions there.

This molecular diagnostic technology is the only one of its kind in the world and had the approval of the Directorate of Health Services in the Delhi government. The proposal for setting up RT PCR testing equipment in government hospital labs had been forwarded by DHS to medical superintendents of various government hospitals such as GTB hospital, LNJP, DDU and BSA, and they had viewed the scheme with enthusiasm but had been unable to implement it due to inertia and obstruction by vested interests in the corridors of power.

Adds Anjali Ghosh, ‘The health department prefers to outsource the blood samples collected in government hospitals to private labs which take more than four to five days to get the test results and poor patients are charged heavily for their tests. If the facilities are present in the government hospitals own labs, it can minimise the treatment cost to the under privileged class and middle class. In June 2012, I did a survey of 42 government hospitals of Delhi state and 12 hospitals under Delhi Central government. I got the Project scrutinised at DHS (Directorate of Health Services) at Karkar Dooma, Delhi and NCR along with the audio-visual presentation by Dr. Finn Zedler of Adt.

Biotech, Altona. Where 24 doctors, MS, HOD where present. We have given Audio-Visual presentation to the Health Minister, Health Secretary and Directorate of Health Services in the month of August 2013 with similar offers by other companies as comparison to show where they fell short. DHS gave green light to four nodal hospitals to start this Project after the approval of technical head,  N V Kamath, DHS at Karkar Dooma. On our visit with the Microbiologists and Virologists at all the nodal hospitals, they showed they were keen to upgrade their labs. There are big hospitals in Delhi whose lab rooms are under great pressure and they are thirsty for such products because it will help them to minimise morbidity rates by giving accurate treatment in the shortest time which will further stop spreading of infection.

Safdarjung hospital’s HOD asked us to develop two virus kits, one for enteric fever and one for cholera, which we already did at our R&D division in Kuala Lumpur. Our re-agents gives 100 tests and even if the lab boy wastes some, it still cannot give less than 96 tests per re-agent. ‘I designed a “Pilot Project”, and with great persuasion I got the overseas principal to agree to invest for five years in one government hospitals. The molecular biological lab was initially proposed for GTB hospital, Tahirpur, whose test load is highest at 10,000 test loads per day. We selected this hospital as there lab room is totally empty, and the numerous meetings with HOD and professors had already taken place and the list of required Re-agents were collected by us.

All the investment would be at our cost, starting from installation of all the new and very expensive equipment, warming up, training by the German technical experts and further, an experienced head-count from the company will remain to supervise the respective lab technicians for the next five years. The government of Delhi has to only import different kind of re-agents. Being a perishable item, as per the requirement list received from the specific hospital month-wise. We are not supplying Chinese-made, date expired, reduced quantity of re-agents like the Chinese, who replace the stickers on the re-agents which are already stale with false manufacturing and expiry dates. Re-agents are dumped by Chinese in Indian market, which have already been banned by US Food and Drug Administration and are totally non-effective.’

Adds Anjali Ghosh, ‘Our VIPs, ministers, cabinet rank officers go to private hospitals for check-ups or even go to foreign countries on tax payers money. What is the use of bringing sophistication on the roads, metros, airport, interstate terminals? But upgradation of government hospital labs are much more important for the aam aadmi/voters. ‘The Chief secretary’s office had also written to the department of health and family welfare to examine the proposal but the file was held up by the secretary, health, in the previous government. The government does not take decisions within weeks, month and even years which creates huge problems for overseas companies due to price changes, freight changes, cost of insurance changes due to passage of time after proposal is made. And nothing moves without money upfront or under the table.

A senior government official is sitting on the file without giving any positive, practical reply or a valid reason on such a life-and-death matter, in-spite of numerous reminders by e-mail, hard copy and personal visit. The office of finance secretary has explained that payment in Euro is not the problem, and as soon as the health secretary clears the file the rest will immediately be taken care of. Now with a change of government and the Aam Aadmi Party in power, whose main concern are the poorer sections of society, hopefully this proposal will be given a positive and productive look in the shortest period of time.’
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