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E-Pao! Opinions - Sick State Health care system

Sick State Health care system
By: Abe Irengbam*



A terminal illness seems to afflict the health services of our state. To get a grasp of the reality of the situation we need to know some hard facts.

First, the Jawaharlal Nehru Hospital that should be the premier hospital of the state is in a dismal state. Dark, primeval cave like corridors and wards, defunct CT scan, X-rays, non-operational operation theatres and a labour room that can hardly conduct even normal deliveries. Nonchalant doctors, nurses and hospital staff and non-availability of even lifesaving essential drugs add to this atmosphere of utter neglect.

Secondly, ever wondered if JN hospital were in such a dismal state how would be the state of affairs in the remote and not so remote peripheral areas. Non-existent doctors and staff in the Primary Health centers and Community health centers and vice versa, doctors and staff posted in non existent PHCs and sub-centers in the middle of nowhere seems to be the norm of the day. Need I add that here too, X-rays and essential drugs are conspicuous by their absence.

Thirdly, why do we always have to wait for a catastrophe to occur and then take some remedial measures? The National Malaria Eradication Programme (NMEP) to control malaria is in a mess in our state. For years we have not seen the regular spray of DDT even in the most endemic regions of our state like Jiribam, Moreh, Tamenglong district etc. This year, like every year, news of malarial outbreaks that may even be fit to be termed epidemics was reported from places like Moreh and Tamenglong with a number of deaths.

But what has the authorities done? Maybe theyíve sent a medical team, collect a few blood slides, distribute the mandatory chloroquine Tablets, sprayed a few houses with DDT and finally make a report for their own convenience. One question worth asking here is, has the state malaria officer or the NMEP in-charge visited these places and made a spot inquiry? Isnít it time that we do something worthwhile instead of celebrating countless malaria weeks in the air conditioned comforts of their offices and wasting precious govt. funds?

Fourthly, regarding the recent Bishenpur outbreak, why has it taken so long for the state govt. to give a definite reason for the deaths of so many people? If the deaths were due to Japanese Encephalitis as the honbíle minister stated on the floor of the on-going assembly, what steps has been taken to fight this fatal disease? Has there been definite confirmation of Japanese Encephalitis? If yes, then, is there a plan for vaccination? What about testing and elimination of the natural amplifiers of the disease, the pigs of the locality, not so long ago thousands of pigs were slaughtered and incinerated in south east Asia to control the spread of this disease.

Fifth, HIV and AIDS have truly put our state on the world map. Million of rupees and dollars have been pumped into this state to fight this disease. The reality is there has been only lip service; we have long past passed the stage of shouting about how HIV and AIDS spreads. Donít you think we need to do something more than sponsoring some relativeís music concert/ beauty contest? MACS must do something concrete like providing at least a part of the medication or provide a subsidy on such medication and investigations like CD4 count, viral load etc. to the real sufferers that, People living with HIV and AIDS (PLWHAs).

Sixth, RIMS; oh that hallowed institution! This is a super-speciality hospital in name only, where we donít even have a cardiologist or where even a bump of the head is labeled as head injury and referred to the lone neurosurgeon in the state at JN hospital. Even though RIMS is outside the purview of the state health services the govt. can at least put it in a certain semblance of order.

It is shuddering to think that next time you visit this super speciality hospital (sic) you could be operated on by a novice MBBS with no previous experience in surgery, or your labour could be conducted by a novice posing as a obstetrician or worse still by one of the many trainee nurses. The less said about the emergency services the better, no traumatologist, no emergency OT, specialist on call usually simple MBBS elevated to registrars, no resuscitation apparatus even the basic Ambu bag and laryngoscope, no cardio version apparatus, the list goes on.

This can happen only at RIMS as the authorities there has flouted all MCI rules in trying to accommodate their kith and kin or simply to increase their bulging bank balances or acquire more real estate. No wonder cases of gross negligence, malpractice or simple pure incompetence will rise and lead to huge lawsuits under COPRA.

Seventh, everybody knows that Imphal and the other main towns are thriving with private medical clinics and diagnostic centers. It is no secret that most of the doctors practicing in such clinics are all govt. employed. Some time ago the health minister gave a threat of taking action against such errant doctors, this threat seems rather hollow as the state is not giving the rightful Non practicing allowance (NPA) and they probably are legally on the right side. Why not give them what is rightfully theirs and then contemplate action again the errant doctors?

Eighth, the recent fiasco about the MBBS entrance could have been avoided if the govt. had some foresight. It has presented the govt. in poor light, as it seemed to be weak kneed by buckling down to some vested organisationís threats. The govt. should also look to increase the number of this stateís nominees for MD/MS in RIMS proportionate to the number of nominees in the first year. Why should we get the same number of seats as Nagaland which sends about 14-15 students compared to our 30-35 students? If this happens then we can at least fill in the glut of specialists at the peripheral areas, which I am coming to later.

Ninth, Medical specialists, in neighbouring Mizoram there are specialist posted at least in all the district headquarters and routine/emergency operations like appendicectomy and caesarean section are performed at such places. Compare this scenario with our state, the number of specialists must be no less but seemed to be concentrated in the few square kilometers of the Imphal valley. The govt. should formulate a transfer policy for sending specialist to at least the district headquarters and also provide facilities for them accordingly as for example, what would be the use of a surgeon at Chandel if we could not provide him a basic operation theatre?

Tenth, why do we have to spend precious money and drain this already cash starved state by going for treatment outside the state to even a run down clinic in Gauhati, forget about the Apolloís and AIIMS. This is due to the lack of earnest will of the health care providers inclusive of the policy makers, true there is a dearth of facilities but blaming everything on it is just a lame excuse. Ever wondered what the Downtown clinic at Gauhati has that RIMS does not; itís the will albeit at a price!

I could go on and on, but with this few hard fact and some suggestions. I would like to draw the attention of the people of Manipur to the problems afflicting our state in every sphere and goad our leaders to do something for this beleaguered state.

Thanks,

Abe Irengbam
Imphal


* The writer can be reached at abe_123@rediffmail.com


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