053. What Does This Minister Harsh Vardhan Know About Horrible Kerala Health?

What Does This Minister Harsh Vardhan Know About Horrible Kerala Health?

By Special Correspondent,

Kerala Health Research Online

Can Government of India’s Union Health Minister be this much ignorant about a state? Can he repeat what his speech-writer scribbles this much blindly? What does this Mr. Harsh Vardhan actually know about Kerala’s health?

From India Today News 21 September 2014:

‘The Union Health Minister was full of praise for the Kerala Health Sector who maintained that the achievements of Kerala in the health sector are a model for the country and the state has been maintaining quality right from the primary health sector to the medical college sector. The minister was inaugurating the 13th Annual Conference of the Association of Otolaryngologists of India, Kerala branch. He admitted it was quite alarming that India occupied the top spot globally in suicide of youths' in the 15 to 35 age group, and it was most unfortunate that 75,455 persons committed suicide in Kerala in the 10 years between 2003 and 2013. Kerala health minister V. S. Sivakumar said Kerala was aiming for comprehensive health protection by including modern scientific technologies in the medical treatment.’ (Reported by PTI)

Note From Editor, Kerala Health Research Online:

The Union Minister's observations cannot be based on statistics collected in their Kerala Health Survey because the Director of Health Services Dr. P. K. Jameela pointed out that these union statistics is erring and differs much from Kerala health department statistics. Mr. Harsh Vardhan’s and Mr. V. S. Siva Kumar’s yelping do not deserve comments. But these two ministers need read some good articles evaluating Kerala’s health. Kerala Health Research Online would like to quote here for their use an article written in February 2007 by Dr. C. R. Soman, Former Professor and Head of the Department at Medical College, Trivandrum, Kerala’s Health Activist and noted Nutritionist. We regret this learned doctor is no more with us; he left us in 2009. Had he lived, he would not have hesitated to make reply to these two ignorant politicians. 

Kerala's Crisis in Public Health. By Dr. C. R. Soman.

Kerala is on the brink of a public health crisis. The state, which set an example for the rest of India and third world countries in providing primary health care, now gropes in the dark and is fast losing the edge. The great achievements in the fields of mortality and fertility have reached a plateau, and the near-universal immunization coverage achieved in the nineties has fallen. 

The state is regularly visited by emerging outbreaks of leptospirosis, dengue fever and other insect-borne viral fevers; the latest entrant is chickungunya. Natural ecology has been tampered with and the once-famous backwaters of the state are polluted and weed-infested. Waste disposal in the municipalities and corporations still remains a formidable challenge. Conventional methods like land-fill evoke furious protests from local inhabitants. Critics have re-christened 'God's Own Country' as 'God's Own Junkyard'. 

The state health department is no longer the prime mover of health development. With less than a third of physicians, beds and institutions under the government, the state health services department is a mute spectator to the rapid decay of health services, particularly primary healthcare. Many primary health centers are unmanned. Drug procurement and distribution systems are outmoded and complaints of drug unavailability appear frequently in the media. The state-run medical colleges have no longer bright young academics to work for. They opt for more lucrative placement in the burgeoning private sector instead. Many super-specialty departments face the threat of closure in the absence of new recruitments. 

There are worse problems. Recent studies suggest that Kerala has the highest burden of coronary heart disease, stroke, hypertension, diabetes and over-nutrition. Conservative estimates put the number of people with diabetes at three million; people with hypertension at 4.5 million and those with overweight and obesity at 10 million. 

Every year in Kerala, between 45,000 and 50,000 people die of heart attacks, while stroke kills over 20,000. In comparison, the annual death toll from HIV/AIDS is just over 200. But the government perceives HIV control as a greater priority. 

It is the healthcare industry that benefits from this sordid state of affairs in Kerala. Private hospitals offering sophisticated tertiary care are mushrooming, even in villages. By-pass surgery and coronary artery stenting are buzzwords familiar even to the children. One would be lucky if an MRI scan is not ordered if you reach a physician with a headache. The doctors prescribe laboratory tests even for minor ailments. 

They may argue that a variety of investigation is necessary for complete profiling of the disease in modern medical practice. According to the Indian Medical Association, the doctor would be in trouble if the diagnosis goes wrong. It argues that they practice defensive medicine. But defensive against whom? Implied in this approach is the assumption that people, individually and collectively, are enemies of the medical profession. The IMA cites stories of attacks against doctors and increasing trend towards litigation against hospitals to buttress their arguments. 

These are convincing arguments for the naive. The sad truth is such arguments are alibis offered to mislead and misinform. The over-use of technology and drugs is driven by greed - a greed that is fuelled and perpetuated by an unholy nexus between doctors, the drug industry and the diagnostic sector. Huge rewards are offered to the physicians for prescribing expensive investigations. Anywhere between Rs.2000 and 2500 is offered as commission for an MRI scan; 40 percent of the fee levied from laboratory investigations reach the doctor as commission. 

Private hospitals make more money through over-investigating patients in their own laboratories than from providing care to the patient. Profit at any cost is the watchword. Doctors in the government sector also gain through the nexus between the industry and the profession. The government has made no attempt to regulate the healthcare industry, and often goes out of the way to provide them with more concessions and soaps. 

Naturally, the victims are common men. Falling sick has become a reason for one to be pushed into debts. The Kerala Sasthra Sahithya Parishad's (KSSP's) studies revealed that at least 15 percent families spend over 30 percent of their income on healthcare alone. While private healthcare costs exceed Rs.55 billion per annum, the government expenditure is falling steadily. The government's failure in providing affordable healthcare is likely to fuel public anger. Hospitals and doctors are likely to be targets of public attacks. Facilities for medical education are being auctioned off to the highest bidders. 

To complete undergraduate course in a private medical college requires Rs. 3-5 million. Naturally, they would expect quick returns for the investment. Fleecing the people would be the only choice! Those who get state-funded medical education are only too eager to fly abroad. And those who choose to stay home prefer to work in cities and towns, leaving primary health centers unattended. 

Medical care in the state has become dehumanized and privatized. Commodifying healthcare- increasingly driven by profit- will demolish all that the state had achieved in the health sector during the last decades of the 20th century. The future looks bleak for Kerala.

Tribute to Late Dr. C. R. Soman.