Critical analysis of health system in Manipur
- The fault in our stars -

Lempu Rangla *

Regional Institute of Medical Sciences (RIMS), Imphal in June 2021 :: Pix - Shankar Khangembam

When I was a kid, my mom would tell me, "It is already written in your stars by the Pithi*, when you will die, how and where". Gone are the days when we attribute any events in our lives to Pithi's predictions and the fault in our stars.

We're today living in a rational world where we are accountable for our own action and its intended and unintended consequences. This writing will try to analyze the present health situation in Manipur in context with the disparity between the rural and the urban; the haves and the have-nots.

It was during 1995 when I witnessed my elder brother passed away because of typhoid. I was still a kid but I can recollect that he wasn't doing well for a couple of weeks and was laid to rest in the sun by my parents.

The reasons he wasn't taken to hospital was the blockade by some ethnic group on the highway and burning down every vehicle that passed by. We can't take him for medication and at midnight he was vomiting blood and then he passed away. The pain that I had to undergo despite being young was tremendous, it still is fresh even today.

On 15th Oct. 2021 my nephew passed away again after being diagnosed with Typhoid (IGg) at RIMS around 1 am. He was just 10 years old. He still had a long life to live if he was diagnosed and treated at an early phase. I was told he had been suffering some pain on his back for the last couple of weeks.

But he was given some antibiotics prescribed by some local expert who happened to have witnessed the same sign and symptoms like my nephew. He was brought to hospital on Monday 10 Oct. 2021. He was then treated at emergency and at the last moment when his oxygen level was at 30% he was then shifted to the ICU.

But it was already too late. He had lost consciousness and there was acute hemorrhage where the blood would just come out from almost every opening and just won't stop. By 1 am he was declared dead.

Let us now compare and contrast between the two deaths. Both of them have similar characteristics in various ways.

1. Villagers self-prescription of medicine : This is pretty much a common practice not only in the village but even in urban areas where we tend to ask from those who happened to have experience whatever the pain we are going through and they would then prescribe us a medicine in turn.

If they have some left over from their purchase they shared with us. This sometime can prove to be life-saving but in many cases this is much more dangerous than what it looks like. As we all know that fever can be a sign of various illness, instead of diagnosing the cause of fever we tend to cure the fever and that in turn delay the treatment that we ought to have taken.

2. Practicing traditional medicine system : First of all I gotta admit I'm not an expert on this subject but I can proudly say the people who are now prescribing us to follow traditional practices themselves aren't experts unlike the earlier days where certain group of people devoted their time and energy to come up with the test and trial methods results.

So, what is to be used and to how much aren't well defined and that is what differentiates it from the today's drugs of allopathy. Say, for instance a person is suffering from constipation one person would ask him/her to take certain leaves, boil it or drink it (with no idea of what are the leaves composition, the consequences and the unintended consequences etc), sometimes it helps, sometimes it leads to further complication of other organs of the body.

3. Lack of transport and financial problem : Timely admission and treatment are sometimes delayed because of lack of transportation and financial problem. Despite knowing the urgency of the need of treatment if the nearest health centre is 50-60km away, you can't help it but see your near and dear one pass away right in front of your eyes despite knowing they could've been saved had they been admitted on time. In some families despite transportation being available they can't afford to pay for the cost of it and accept the fates of departing their dear ones as if it is Pithi's prediction.

4. Lack of medical facilities in Manipur : This include both doctors and medical facilities. I don't exactly know the statistics here, but based on my common experience in most cases, either we are told to wait for the doctor to come for ¾ hours or we are told to visit some private health care centres as the Government institution doesn't have the machinery required to diagnose the illness of the patient.

So, this is also one of the main causes that people prefer to depend on local sexpert and pseudo-doctors to have a fast accessible answer to their problems. It doesn't encourage them to visit hospital as it is costly and time consuming.

5. Lack of trust on Doctors and short OPD duration : The conduct of doctors also varies (I'm not generalizing here), in most cases they tend to blame the patient for reporting late for treatment, as stated above the reasons for their delay could be manifold but they've to bear the brunts as if its entirely their fault in the stars.

The doctor then would give them an appointment to meet him/her at a private hospital or his home if they want to be examined seriously. What is questionable here is why are some doctors practicing both in Government and private hospital ?

I one can afford to meet the doctor at private hospital one gets a better treatment but at a higher cost. So most of the poor people prefer not to visit the doctor or the hospital once and for all.

As stated above, as many villagers have to travel all the way to Imphal to get treatment, by the time they arrive, in most cases the OPD is either closed or the doctors have left to attend to some functions, so if the case is serious we have two option, either to visit the next day during OPD or go and visit the said doctors either at his home or the private institute where he serves.

It is also amusing to know the facts that other States for instance like Odisha, Bihar and UP despite having many more medical facilities their duration of the OPD is till 5 pm , whereas in Manipur, the duration of OPD is only till 1 pm and the arrival of the doctor is late for sure (I'm really sorry I don't enclose the doctor and patient ratio of these States here).

But in reality, Manipur is one the worst performing States in these criteria, and on top of it the duration is shortened again. It is like a slap on the face of the poor and the villagers. And this is one of the main factors why rural folks and poor people prefer to get treatment from local practitioners and pharmacists.

So the Government need to ensure that the medical needs of every person are attended to irrespective of their place of habitation or their income. This can be encouraged by increasing the duration of the OPD and opening of OPD on Saturday, Sunday and National holiday.

6. Role of pharmacists and self prescription practices: Before we further delve into the unintended consequences of this practice we need to know that, as cited above the unavailability of doctors and others systems prevailing in Manipur force the people to resort to this practices of depending on the pharmacists to prescribe them the medicine that they need/require (Think so).

It is a common that in Manipur one needn't show the pharmacist the prescribed prescription from doctors for medicine, one can just tell them either the name of the medicine or the illness one is suffering from and the rest is history. This practice needs to be stopped and stricters rules need to be made to ensure that such practices are not encouraged.

This in turn encourage the villagers themselves to self-prescribe and the unintended consequences are worse. Regarding the pharmacist sale of drugs also, as I've witnessed on various accounts, they prescribe and promote their own products in collaboration with some privates firms (unsure of whether the drug is certified for human use or not), and this in turn increase the use of steroids drugs in India.

India is the number one country that depended on steroids or the wonder drugs. As the villagers want fast result and the pharmacist provide them so, their relation strengthened but the consequence of it is yet to come.

What can be done to prevent unnecessary deaths in the village

1. Awareness campaign : This is easier said than done. I've been to many health camp awareness campaign and most people don't even take it seriously. Despite having attended the awareness program the next thing they would do is return to their own way of diagnosing their illness.

As mentioned above to make it a habit for them to take precautionary measures various steps can be taken like spreading it in pamphlets, posters etc in the village area where they would see on a daily basis and this would in turn shape their mind and thinking. This can further be emphasized by spreading awareness in various institution like Church, School and others.

I haven't seen any health awareness camp conducted in my village till today by any Government bodies, I have seen some NGOs and private firms promoting their "heal all" and "panacea" products though. I don't know whose incompetency is it ? Maybe our villagers, our villages leaders or Government's fault or all of the above. But it is the need of the hour that this be considered on a serious note.

2. Medical facilities increment : Availability of accessible medical facilities will definitely help improve the footfall of villagers to these facilities. As of today's present context in Manipur we have only two main hospital RIMS and JNIMs which are considered to be accessible to the villagers and rural folk both in terms of cost and accessibility.

3. OPD duration and unavailability of doctors: This will not only encourage the rural folks to visit medical institution and get treated but this will also help in improving the overall health of the State.

4. Imposition of stricter rules on pharmacist: Pharmacist drugs prescription need to be stopped immediately without proper prescription. This will encourage the rural folks to visit the health centre and get treated and they are also not prescribed any wonder drugs by the pharmacist at their fancy and whims.

Conclusion

This writing only wants to spread the message to the masses that, the Pithis and their prediction are myths and illogical, but, the recklessness on our part, the Government and the doctors that result in the death of many is a fact.

This article is dedicated to Rimson*.
Rimson Saiphu.
Born at RIMS
Treated for Typhoid at RIMS
Passed away at RIMS.

* Pithi: Pithi are some angelic/divine figures the Kharam tribe believes to visit the infant during their birth and they fix the events of his life cycle on that very day.

# Rimson's mom was having complication during his birth and was rushed to RIMS where he was delivered safely, His dad was so happy that he decided to name him after the Institution (RIMS).