(Weekly Organ of the Communist Party of India (Marxist)
October 10, 2010
Games in the Time of Dengue
Amit Sen Gupta
THERE are genuine reasons
nation to exult as
This column, however, is
the Commonwealth Games. It is about another
The grand facades that
visitors to the Games do not stand testimony to the efforts of the now
completely discredited Organising Committee of the Games – they are a
of the blood and sweat of tens of thousands of workers who were brought
the city to showcase modern
The poor are much more
than the rich and famous that they are forced to serve. They do not
fact that a few shall have a place in the sun at their behest. They are
to be Indians and want to see the nation of 1.2 billion people take its
rightful place among the community of nations. They are even willing to
overlook the severe disruptions in their daily lives caused by the
the Games – for they do not have the luxury to go on an extended
some of the rich and famous have declared their intentions to. All they
would like, is to be seen, and acknowledged, and heard. For they have
to tell that completes the picture of the real
As the cacophony regarding
reaches a crescendo, something else -- that has affected the life of
citizens in the city -- has been quietly buried. Few in the media even
report any more that
Dengue has been a constant
of the citizens of
Dengue is a viral disease transmitted by mosquitoes. The reason why Dengue epidemics occur just after the rains is twofold. First, rainwater collection promotes mosquito breeding. Further, moderate temperatures in the monsoon season provides optimum conditions for both mosquitoes to breed and survive and for the virus to thrive. This is also why the epidemic starts petering out as winter sets in – Delhi’s harsh winter acting as a deterrent to both mosquito breeding and the transmission of the virus.
While in most people Dengue runs a relatively benign course, with a few days of fever and pains, in a small percent of those affected it can acquire a much more severe and life threatening form. In these patients there is a sudden drop in a kind of blood cells, called platelets that are vital for the clotting of blood. When the number of platelets fall below a certain level, the person affected can have spontaneous bleeding from different sites of the body. If not treated in a hospital setting such patients can die due to blood loss or other complications. This form of Dengue – called Dengue hemorrhagic fever – affects children and adolescents more than others, but other age groups can also be affected. The reason why Dengue patients have to be treated with extreme care is that there is no way to anticipate which of the infected patients will eventually get Dengue hemorrhagic fever. Consequently, all Dengue patients need to be observed carefully for symptoms of Dengue hemorrhagic to be expressed.
This is why a Dengue epidemic is a major public health problem. Unfortunately, the Delhi government has mastered a unique manner of addressing this problem – every Dengue season the government goes into a state of masterly inactivity! The reason for this lies in the almost total lack of a public health system in the city – not just health facilities but other public health measures such as mosquito control, sanitation, etc. Delhi’s health system, is afflicted with the same malaise that affects the entire country’s public health system. Every year, during the dengue season, we see ritual pronouncements about public health measures being undertaken such as spraying of mosquito repellants, and destruction of breeding sites. Clearly, such measures are far too inadequate. Moreover such measures do not have a major impact once an epidemic is established – they have to be continued throughout the year. Unfortunately every year is a new experience for the Delhi government, having learnt nothing from the experiences of previous years!
When an epidemic does get established, it is natural that a large number would be affected – not a few thousand as the government claims but tens of thousands. Again it is important to understand what the figures the Delhi government really means. There is no legal requirement to notify Dengue cases – so an overwhelming number of cases are never notified. This is especially so for the private sector, where a majority of Delhi’s citizens seek care, given the very poor state of public facilities. Second, Dengue can be conclusively diagnosed only through an expensive test for the antigen of the virus. A very large majority of people, who contract Dengue, are not tested for this antigen. In other words, the reported number of cases are those that by some miracle actually get reported. This failure is a failure of health surveillance – a necessary requirement for any epidemic control mechanism is a public health system.
The story does not end here. The Dengue season is a bonanza for the private health system. Private hospitals rake in huge amounts as people flock to these facilities, in the absence of public health services. Most of these facilities pump unnecessary drugs into Dengue patients though the disease runs its own course and does not respond to antibiotics. In a functioning health system almost all Dengue patients could be cared for at home under the care of a primary care physician. Those that would eventually require hospitalisation (a small fraction of all dengue patients) can be detected in time if they are monitored by the health system. In the absence of such a system incidence of expensive hospitalisation is much greater than what it should be.
Before we finish let us once again return to the Games. It is estimated that the total expenditure on the Games was twice that of the annual public expenditure on health in the entire country. We contrast these two figures, not as an argument for not organising the Games. But it is definitely an argument for balancing the need to showcase “shining India” with the need to address the needs of the real India! The Delhi government’s negligence of the Dengue epidemic is but a small example of the systematic and deliberate neglect of the needs of an overwhelming majority of people in this country.