Of the dengue epidemic and cartoonists

Keshav in the Hindu on 16th September 2015

Cartoonists really catch the public mood – and Keshav always hits the right spots!!! These 2 cartoons give a great commentary on the current ‘Headlines’ – the dengue epidemic.

Keshav in the Hindu on 17th September 2015

The official statistics is that about 2000 cases have been diagnosed and as of now 15 people have died. (For Delhi, not NCR) This is disgraceful, as it is an infectious disease, which can be completely prevented but has no definitive treatment. And in any modern, functional city, such vector borne outbreaks should NOT happen. But we have to accept that Delhi, or for that matter, any of our other cities, is neither modern or functional.

But let me come to Keshav’s cartoons. The upper one says ‘System of health care’ on the back of a doctor who is examining a dengue patient, and looking at the money. And that is public perception – healthcare means doctors and doctors only look at patients as cash cows. However, healthcare or looking after the health of a group/community/nation is the responsibility of the Government. It starts with intention to provide health care, allocation of adequate funds for this and policies and governance to  achieve desired results. Doctors only form part of the terminal delivery mechanism, along with other health care providers. However, since the health care provider is the point of public interaction, they are who are most often held to blame for failures. And while, many levels and cadres of health care providers play a prominent role in most countries, including our neighbors in Sri Lanka, Thailand etc., we in India have continued a doctor centric policy, that works to the detriment of the profession.

And of course, the failure of the State to take responsibility for the health of its citizens, has encouraged the growth of private providers –  stand alone practitioners, un-regulated nursing homes and hospitals and the more prominent face of healthcare today, the corporate hospital. Corporate hospitals are large businesses, like any other,  with investors and and often share holders to whom they are responsible. Regulating their pricing, goes against the principles of encouraging business.

The lower cartoon captures the essence of governance – problems land on the politicians desk and just stay there. Hollow promises are made at election time, with either no intent to fulfill or inability to do so for any number of factors. In the case of healthcare, it does not even come into the ambit of ‘issues’ that can harvest dividends. And for that we have no one but ourselves to blame – we have accepted that health is a personal issue and so do not make it a ‘political’ issue. Only when something like the dengue outbreak hit us, do we demand the Government to magically deliver.

All this is not to absolve the doctors of their responsibilities. Or to override the fact that the profession itself has played its part for the current state of things  – it has systematically obstructed efforts to regulate hospitals, share the delivery mechanism with other professionals or allow other cadres to be empowered. In actual numbers, the hue and cry is not proportional to the extent of morbidity and mortality – 1671 people (80% young men) died in Delhi last year in road accidents!!! How many of these lives could have been saved with better emergency facilities,. And we are not even talking of the many times larger numbers who are temporarily or permanently maimed/handicapped and have to deal with prolonged treatment and often a life time of handicaps.

The bottom line is that a private sector ‘dominated’ health delivery has not worked in any country – and the promises of ‘health for all’ in the election manifesto has not seen any actual translation into action by this Government. From recent news items it also seems that the Government is leaning towards a PPP/private insurance model for healthcare. THis does not bode well for the future.

But to come back to dengue, there is NO EXCUSE for any death due to preventable conditions. ANd everyone involved has to share the blame – but do they? Will they? And as on so many issues, I bow to the political cartoonist to show us some glim0ses of the truth>

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