Bihar can’t even count how many dengue cases it has had, let alone fight the disease

In Bhagalpur, the historic Bihar city on the southern banks of the river Ganga, doctors disagree about the threat of dengue in the area. Vijay Kumar, the civil surgeon for Bhagalpur, says dengue is under control. His statement has been flatly contradicted by doctors at Bhagalpur’s Jawaharlal Nehru Medical College and Hospital. The hospital identified its first dengue case about four or five years ago. Since then, said an administrator, the number of cases has grown. “We had 441 confirmed cases last year – almost double from the previous year.”

Bihar’s exposure to dengue is relatively recent but the state needs to start fighting the disease. Fighting dengue can be easy because there are clear measures that need to be taken. Since there is no cure and no vaccines for the disease, doctors can only treat symptoms – pain, chills, fever, nausea and vomiting, rashes and bleeding. In most cases the disease subsides but a few cases may be so severe that without hospitalisation and treatment it can lead to death. If a patient has excessive bleeding or a very low platelet count he might be given a platelet infusion.

But fighting dengue is also difficult because it requires meticulous and consistent control of the Aedes aegypti mosquitoes – the main species of mosquitoes that carry and spread the dengue virus. This can be done using anti-mosquito sprays to kill the mosquitoes that are normally active during the day. Dengue control also involves thwarting the mosquitoes from breeding, which can be done by reducing places – any stagnant water – where they can lay eggs. To ensure this, regular water supply is essential so that people stock less water. Also important is good garbage disposal.

Given the meticulous work needed to combat diseases like Dengue, how is Bihar doing? And what does its response tell us about the state?

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Lessons from Bihar’s 2016 dengue outbreak : Migration, poverty, garbage are spreading new diseases

In 2016, dengue hammered Krah. As many as 100 people living in this densely-packed, predominantly Muslim ghetto of about 1,000 families near Biharsharif contracted the disease, say residents. The scale of the outbreak was unprecedented. As Mohammad Ilyas, a young tailor who works and lives in Krah, said: “We never had such an outbreak earlier.”

The disease itself is a newcomer to the region. Krah and surrounding areas have been battered by many diseases. But many of the old diseases are in decline now, according to Dr Lakshmi Chaudhary who runs a clinic in adjacent Silao. “There were only two-three cases of jaundice last year,” he said. “Hepatitis B is even lower. We now almost never see cases of diarrhoea.”

Here, people now suffer from other ailments. There is more cancer, dengue and chikungunya, said Chaudhary.

This is the story across Bihar. Doctors, epidemiologists and people living across the state say that in the last ten years the state’s disease burden has seen three large changes. First, some infectious diseases like kala azar, measles, diphtheria, pertussis and polio that used to wreak havoc earlier are far less common now. Second, people are falling to new diseases like drug-resistant tuberculosis, dengue, chikungunya, Japanese encephalitis and arsenic poisoning. Third, some of the old infectious diseases – hepatitis A and E, malaria, pneumococcal meningitis and typhoid – are claiming more patients than before.

This, as the article says, is very different from the epidemiological transitions in other states. And gets into the reasons why. Part two, out tomorrow, will look at the state’s response to these causal factors.

Cancer has exploded in Bihar as lakhs of people drink water poisoned with arsenic

It is a day like any other at Mahavir Cancer Sansthan.

The driveway is lined with people who have travelled a long way to get to this charitable hospital in Patna. Families sit huddled, holding their bags close. The lobby is even more crowded, rather like the ticket buying hall of a train station.  The hospital gets between 60 and 100 patients every day – a substantial number for a 400-bed hospital. Ashok Ghosh, who heads research at the hospital, said that the load is such that “surgery has a two-month waiting list even though the disease might become inoperable by then”.

On the morning this reporter met him, Ghosh made a wry comment about the rush, asking: “When you entered this hospital, did this look like a cancer hospital or a general hospital?”

One reason this hospital is receiving so many patients is the dismal state of public healthcare in Bihar. Government hospitals are understaffed and poorly equipped. While the state has seen a jump in the number of private hospitals, most of them are too expensive for middle income and poor families in the state. Most of them, Ghosh said, end up coming to Mahavir Cancer Sansthan.

But lack of affordable care is not the only reason. Tata Memorial Hospital in Mumbai, one of the best cancer treatment facilities in India, gets about 25,000 patients every year from around the country. In contrast, Mahavir Cancer Sansthan gets nearly as many at about 22,000 patients last year despite drawing patients from just Bihar, Uttar Pradesh and Nepal. Many of these patients suffer from cancers of the gall bladder or liver, both which are associated with arsenic toxicity.

Think Tamil Nadu has good public healthcare? It’s hard to find it on the ground

the concluding part of our story on why Tamil Nadu’s healthcare system is weakening.

In India’s development circles, Tamil Nadu is viewed as one of the best performing states in the delivery of public welfare like education and healthcare.

But, as the first part of this story reported, the state is improving on some public health indices (institutional deliveries), plateauing in others (infant and maternal mortality), and slipping backwards elsewhere (vaccinations, awareness about HIV/AIDS).

Why is it yielding such contradictory outcomes? Part of the answer lies in the weakening of its public health system.

Tamil Nadu’s healthcare numbers look good – but its people aren’t getting healthier

Out today, the first part of our final #ETTG story from Tamil Nadu. This one says the state’s much-vaunted healthcare system is weakening.

On some fronts, the state’s public health system continues to work well. Today, nearly all babies in Tamil Nadu are delivered in clinics – from 87% in 2002-’04, institutional deliveries climbed to 98.9% in 2012-’13.

But in many other areas, the state’s progress is plateauing. Improvement in infant and maternal mortality rates, for instance, has drastically slowed down in recent years.

On a few parameters, however, the state is moving backwards. The number of pregnant women visited at home by health department staffers, for instance, has fallen between 2002 and 2014.

As the story asks: “Why is the state’s healthcare delivery system delivering such starkly different outcomes?”

Has Punjab’s obsession with cancer robbed its poor of healthcare?

Private waley kehte hain ghar le ja kar sewa karo.” Private hospitals tell us to tend to the patient at home if we cannot pay their fee.

That was Mohan Lal Shonky’s response when asked how he and others in the poor quarter of Nurmahal town in Punjab’s Jalandhar district use medical services.

Shonky, 55 years old and in poor health, is in the ghoda gaadi business. He and his sons rent out their horses and carriage during the wedding season. In a good year, they make about Rs 1.5 lakh between January and March. But this season, given the poor cotton and paddy harvests in Punjab, he expects no more than Rs 1 lakh. This, along with his sons’ earnings as labourers – will have to support them through the year.

Everywhere in Nurmahal’s Kuchapakka colony, you hear the same story, with some variations.

What a primary school in Keonjhar tells us about Odisha’s misplaced government spending

Pradip Kumar Behera is trying to beat the odds.
A bespectacled man in his late thirties, he is the headmaster of the government school in Unchabali, a village in Odisha’s mineral-rich district of Keonjhar.
Under his watch are 144 students, mostly from the poorer families in the village, studying in classes from the first grade to the eighth. The school has a tree-filled playground and pucca buildings for its classrooms, but just four teachers.
Behera is trying to cope by running four – not eight – classrooms. Students in the first grade share a room with those in the second. The third and fourth graders sit together, as do those in the fifth and sixth, and the seventh and eighth grades.
While the seventh graders sit to the left of the aisle, the eighth graders sit to the right. The teacher spends an hour with the seventh graders, gives them an assignment, moves to the other side of the room, gives the eight graders an assignment before swinging back to the seventh graders.
The solution is unsatisfactory and troubles Behera. The school runs between 10 am and 4 pm – that’s six hours, not counting the time taken out for the midday meal. “The kids are getting an education for less than three hours every day,” he said. “The education we got was better. We need at least six-seven teachers.”

It’s the same story in health as well. Which leads to the inevitable question on why state funding of health and education is so low in Odisha.

ps: have reached Punjab now. State 3. 🙂