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Born To Die

Born To Die

Last week, Prime Minister Narendra Modi mounted a scathing attack on the Congress in the Lok Sabha. His address primarily focused on his grudge that political parties, especially the Congress, never praised any leader except from the Nehru-Gandhi family, be it the late Atal Bihari Vajpayee or the late PV Narasimha Rao. 

Modi resents the fact that no one celebrated when India achieved the sixth position in terms of GDP. On the other hand, it was termed as a great achievement when India was ranked the 11th largest economy during the UPA rule.

The video went viral. Almost all news channels showed the clip. Some questioned the opposition approach, while some praised Modi to the hilt. A third group raised questions about the GDP calculations. 

Whether we have achieved the 11th or the sixth position, one fact remains the same. We could not provide our children either good quality education or a healthy life. The positions may have helped India in projecting itself as a better economy globally for attracting foreign institutional investors but we still struggle to provide basic amenities to our citizens.

True, we have established ourselves as one of the most-wanted destinations as far medical tourism is concerned. However, we are unknowingly endorsing the message that good health is the prerogative of the rich and the elite. We still are susceptible to epidemics like the one that recently broke out in Muzaffarpur, Bihar.

Within a few days, we lost more than 150 children because they ate litchi on empty stomach, as claimed by many media and medical reports. They were not nourished enough to digest the complex “hypoglycaemic agent methylene cyclopropyl glycine (MCPG)”, as defined by medical practitioners, that litchi produces.

Doctors label the fruit as absolutely safe and healthy, though only for well-nourished children and adults. Unfortunately, our children in Bihar, had no food to eat. It is a pity that our “new India” could not take care of the bare minimum — two square meals a day. 

Yes, the rich have numerous meals (maybe five or even six) as their children can have expensive Italian delicacies, wherever and whenever they want. But poor children in Bihar had no option to eat except the fruit that is grown in abundance in their region. They might have struggled or risked their lives even to get hold of the fruit, only to find themselves on the verge of death.

The complex MCPG in malnourished children lowers the glucose levels, restricting its mobility from liver, affecting their brain, which direly needs glucose. And this need is fulfilled from an alternative source. The fatty acids present in the body get converted into glucose. 

However, if these children go to bed after consuming litchi, the MCPG present in the fruit stops the conversion process. Instead of glucose, it produces amino acids harming the brain cells. This is exactly what happened with more than 150 children in Bihar. The disease is called hypoglycaemic encephalopathy (not the popular term AES) as claimed by doctors.

Now who owes responsibility for these deaths? Is our system not at fault? Of course yes. It is at fault for not creating necessary awareness at the appropriate time. It is at fault that our children still struggle to get adequate food. And what about medical facilities? There are numerous questions.

It is unfortunate that 98 out of 103 primary health centres (PHCs) in the district were not considered fit even for recent evaluation. The remaining five centres were given zero rating out of five by the Health Management Information System (HMIS) evolved by the health ministry. The only community health centre (CHC) that the district has tells the same story.

The mandatory requirement for a PHC to be evaluated is that it must have at least one medical doctor over two mid-wives or nurses and a labour room, if the PHC is a 24x7 centre. For a non-24x7 centre, all it should have is a medical officer and a nurse. And these 98 PHCs could not meet these bare minimum requirements and hence they were not evaluated for grading in 2018-19. The remaining five PHCs got a zero rating as they neither had infrastructure nor basic services.

The lone CHC could also not meet the minimum requirements for evaluation. And what are those requirements – at least two doctors, six nurses or ANMs, one lab-technician in terms of staff, an operation theatre, a generator and separate toilets for men and women in terms of infrastructure. Is this something so Utopian that the government could not provide for?

Moreover, as per norms, Muzaffarpur should have 170 PHCs and 43 CHCs based on the population criterion. Ironically, every year, this area has been facing deaths of children during summer for the last two decades. Yet, the government has not bothered to beef up basic public health infrastructure to take care of routine health needs, forget emergency. It is now amply clear how serious the state and the centre are for the health of fellow citizens.

It is not Bihar alone. The entire country has the same story. The MIS report for the financial year 2016-17 also shows that there is a shortfall of manpower needed to run these PHCs and CHCs. An extract of the report says, “As compared to the requirement for existing infrastructure, there was a shortfall of 86.5 per cent of Surgeons, 74.1 per cent of Obstetricians & Gynaecologists, 84.6 per cent of Physicians and 81 per cent of Paediatricians. Overall, there was a shortfall of 81.6 per cent specialists at the CHCs as compared to the requirement. 

Even out of the sanctioned posts, a significant percentage of posts were vacant at all the levels. For instance, 13.2 per cent of the sanctioned posts of Female health worker/ ANM were vacant as compared to 37.5 per cent of the sanctioned posts of Male Health Worker. 

“At PHCs, 34.7 per cent of the sanctioned posts of Female Health Assistant/LHV, 47.2 per cent of Male Health Assistant and 24.4 per cent of the sanctioned posts of Doctors were vacant”.

For our children at Muzaffarpur, a petitioner filed a public interest litigation in the Supreme Court seeking formation of a team of medical experts and provision of medical equipment. The court has sought answers from both the state and the Centre in the wake of the alarming rate at which children were succumbing to Encephalitis. Meanwhile, the Bihar government lodged FIR against 39 people as they were protesting against water shortage and death of several children. Is that all that we can expect from a government!

Ironically, these children could have been saved, if enough awareness was generated and if they were given a dose of 10 per cent glucose within four hours of the first symptoms of the disease. But our political leaders were, perhaps, busy in campaigning for elections. Who cares for poor children after all? Electoral win was more important.

And what happened to Modi’s flagship scheme – Ayushman Bharat, which has been termed as the harbinger of the poor during medical emergencies. Reports suggest that only 36 people could avail of the benefit. The national health authority (NHA) attributes low subscription to the scheme as Bihar government made the treatment free. This outbreak also laid bare a fact that out of 500 private hospitals that applied for empanelment for Ayushman Bharat in Bihar, only 84 could meet the mandatory criteria. This shows that the condition of private hospitals is no better than that of the government hospitals. In Muzaffarpur, which has the largest number of cases, only three hospitals are equipped to treat this disease!

Coming back to the GDP, a lay man would ask what kind of growth is this. If people do not have access to basic health infrastructure, then it does not make any sense, whether we are placed at sixth or 11th position globally. Bihar is worse than most of the African countries if stunted growth amongst children is a parameter to compare.

The national family health survey (NFHS)-4, the country’s biggest survey on health status, shows that nearly 48 per cent children below the age of 5 have stunted growth (short for their height), 17.5 per cent are wasted (too thin for their height) and 42 per cent are underweight. This is the situation in Muzaffarpur. In comparison, Africa has 31.3 per cent children with stunted growth and only 6.3 per cent as wasted.

But for our prime minister, the growth rate is the only indicator that keeps him ticking. Modi seems to be a follower of Mahatma Gandhi, considering his pet campaign – Swachh Bharat Abhiyan. However, Gandhi believed in  Antyodaya – uplifting the poorest of the poor – and  Sarvodaya – development of all. Our growth will make sense if he follows the idea of “ Sarvodaya through  Antyodaya”. Till then, even double-digit growth would be meaningless.

(The writer, a company secretary, can be reached at jassi.rai@gmail.com)

(Published on 01th July 2019, Volume XXXI, Issue 27)