PERSPECTIVE

India’s health : Is anyone listening?

In the last issue of the Pediascene, the frontline article was on “ Role of International Health Agencies”. I think it is also time for us to put our own policies under scanner. Let’s see how we go about our things.
We have a long history of social injustice. Instead of standing up against it and ensuring equality, we have adopted reservations as the ultimate panacea – the scope and time of which continues to get extended indefinitely. It is a different matter that children of some of these (not all) and other unfortunate sections of society do not get even the primary education 60 years after independence. They continue to work as child labour. These reservations have been lollipop for these sections and their extension has been a pain for others.
Nearly just a decade before our a country became independent, the health scenario of most countries in the world (including the now developed countries), was not very different from ours. The main concern was the Infections. Post independence, population explosion was an additional issue for us. We talked about population control for quite sometime. We failed. We have masked our failure by calling a population a great asset – “a great human resource”.
The enlightened countries of the world tackled the problems of health and infections not by making more doctors but laying down a strong infrastructure of public health system viz foolproof sewage lines and safe drinking water. This brought a dramatic fall in infections. The rightful credit for this went to the sanitary and civil engineers and not to the doctors.
We try to solve our health problems by making more doctors. We continue to open new medical colleges inspite of an acute shortage of staff and material in the existing ones. For dealing with infections we have yet to conceive the idea of a proper public health system. As one wag put it in the Laughter Channel- the actor turned MP Govinda has fulfilled his promise of providing sanitary latrines to his constituents by getting laid a railway line from one part of its constituency to the other.
We chose curative medicine and immunization as the main planks. The word Prevention has become synonymous with Vaccination. It may be lucrative business for some but it makes our nation poor. Even the huge amount of money being pressed for Polio Eradication Program is a loan, which has to be paid back. Neither polio nor typhoid nor diarrhoeas are going to be eradicated given the hard facts of our public health system. Not all the new vaccines like IPV, conjugate typhoid and rotavirus vaccines will help us. Even if, with so much of effort, we are able to eradicate (hypothetically) even one of these diseases, it is bound to return. We will continue to discuss them under “ Emerging and Re-emerging infections”.
It would be interesting to quote the following in this respect:
“Undoubtedly, good sanitation explains the virtual eradication of Polio from the United States in the early 1960s, when only about two-thirds of the population was immunized with the Salk vaccine, and the subsequent absence of circulating wild – type polio viruses in the United States and Europe. In contrast, poor sanitation has permitted the continued transmission of poliovirus in certain poor countries in Africa and Asia, despite massive global efforts to eradicate polio, in some areas with an average of 12 – 13 doses of polio vaccine administered to children younger than 5 year of age.”
-Nelson’s Textbook of Pediatrics, 18th edition, 2004, page 1037.
A long time has passed. What should have been done sixty years back still remains a dream. Let us put first things first. The issue of Public Health System needs to be taken up as a crusade.
I have some hope. Hope that this will be taken up now under the new Jawaharlal Nehru Urban Renewal Mission and equivalent programs for rural development. Hope all the money dose not go waste this time in making drains and sewage systems which run upstream instead of downstream. But I have more hope from the new set of proactive of the present and generation next who have the vision and the ability to change things. Our IAP can also take the lead
PS : After having penned the above article, I opened today’s Hindustan Times (page 3, August 4, 2006). The headline reads “Meerut residents use pulse polio campaign to voice their concerns.” Dwelling further, the news item says…. “During a pulse polio drive on Sunday, officials had to face the opposition from the locals who furnished a list of their demands……the government is spending hefty amount of money on the pulse polio drive, which is useless unless our living conditions are improved, charged the local residents.” Is anyone listening?

Ajay Kalra, Agra.


The Contribution of Hemolysis to Early Jaundice in Normal Newborns
OBJECTIVE. Neonatal jaundice is the result of an imbalance between bilirubin production and elimination, and our objective was to clarify the contribution of an increase in bilirubin production to hyperbilirubinemia in newborns.
CONCLUSIONS. Before hospital discharge, most infants with bilirubin levels >75th percentile are producing significantly more bilirubin than those with lower bilirubin levels. Because the ability of newborns to conjugate bilirubin is significantly impaired in the first few days, even a small increase in the rate of production can contribute to the development of hyperbilirubinemia. These data suggest that increased heme catabolism is an important mechanism responsible for hyperbilirubinemia in the first 4 days after birth. (Pediatrics July 2006; 118: 276-279)

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