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.

  

052. Save Health From Shamans of Ayurveda And Shehanshas Of Allopathy

Save Health From Shamans of Ayurveda And Shehanshas Of Allopathy 

By P.S.Remesh Chandran
Editor-in-Chief
Kerala Health Research Online

Ayurveda, Siddha and Unani are the three Indian systems of medicine used widely in Kerala. Before two centuries, there were only these three systems in Kerala. There was no allopathy. The control of these three was put under the Director of Health Services and control of the drugs belonging to these three indigenous systems of treatment was put under the State Drug Control Administration. The variety of plants and herbs relating to these systems were to be cultivated and promoted by the Medicinal Plant Board OF Kerala. In short, under the British and under the post-British governments in Kerala, ayurveda, siddha and unani had no identity. For government, health meant, and still means allopathy. Kerala’s Chief Minister, Health Minister and Health Secretary, if and when they become sick, will only go to an allopathic hospital, that too a large private one, only. 

Doctors, staff and the treatment technology of native systems suffered much and had to compromise much under the allopathic strong hands who controlled them in the health services department of Kerala. They were considered pariahs by those in the department and in the government and allopathic personnel were considered like Brahmins! Hospitals, beds, staff, medicines, equipments and vehicles would only be provided for the allopathic system. Leave, increment, higher grade, promotion and pension applied for by native systems’ staff would be ignored by the staff of the DHS, or kept pending or go missing altogether in the health directorate and the various district medical offices. These systems with more than 2000 years’ tradition were condemned, laughed at, ignored and disparaged by arrogant medical and clerical officers in the health services department, while they catered everyway to the whims of the proponents of a system which was only 200 years old. This neglect and hatred of officers towards these three time-tested and cheap systems of medicine gradually created such a fury and uproar among people who could not afford costly allopathic treatment and medicines, reflected well in the popularity of the few remaining ayurveda, siddha and unani physicians in the state reached a stage where unless these native systems were not separated from the state health services, people will see to it that the allopathic drug industry in the state collapse. At last bifurcation came, against the wishes of the health department. A separate Department of Indigenous Systems of Medicine (Ayurveda) was created, under a new director and staff. Still the question and state of siddha and unani systems remained the same. Like ayurveda suffered under the allopathic directorate, they continued to suffer under the control of the new Ayurveda Directorate. No separate departments and directorates for them were ever created, bi-furcating them from Ayurveda Department. 

The Government of India and people in the health sector of India had by then come to believe that only the creation of an exclusive Ayush Department for catering to the needs of native systems of medicine in India would hold them and save them from the immensely rich and strong allopathic industry. India turned this line and several states including Maharashtra, Madhya Pradesh and Bihar began to bifurcate them from the mainstream of allopathic health services and create separate Ayush Departments for their protection and rescue. Many states in India which are long being ruled and exploited by the allopathic industry, due to politicians and bureaucrats on the payroll of this behemoth industry, still oppose formation of separate Ayush Departments. These states include Kerala which is thought to be one of the most progressive states in India, literally and culturally. The fact is, the State Health Services Department, Directorate and Ministry is heavily bribed by the allopathic industry to make creation of Ayush Department impossible. 

Will creating a separate new department for Ayush solve the problems of indigenous systems of medicine in Kerala and save them is another question. Did the attempts of the health services department save allopathy in Kerala? More hospitals, staff, medicines and equipments came to be built, employed and procured but more number of people became sick and sought treatment each year. Population did not increase much but number of sick people increased unbelievably. Without thousands and thousands of large private hospitals coming into commissioning, the health department could not have contained this situation. Like traitors and cowards, they permitted opening up and privatization of everything in medicine and treatment. 

The problem, when viewed from the people’s side, is enough government hospitals to give free treatment in indigenous systems not being there. Sick people wreck the economy. When they become sick they cannot work; unless they are treated back to well being, they will perish, economy will collapse and country will ruin. That is why state has to provide free treatment. That is the concept of free hospitals system. We may ask, cannot the sick person pay for the treatment? Learn that we become sick only when the last rupee has left our purse. Diseases will not come to us when we are ready with money. Remember that a sick person is a person without money, almost always. So the problem, as far as people are concerned, is setting up new training centres for indigenous systems, creating more doctors and staff, teaching them new techniques, making available new hospitals, staff, medicines and equipments and provide infrastructure. But, for the Ayurveda doctors in Kerala, representing the Ayurveda Medical Association of India, it is only a problem of setting up a new Ayush Department in line with what the central government did in New Delhi and creating a few posts of Joint Directors for them in the Government Secretariate, which was just what they requested to the health minister of Kerala in February 2013. There is a standard phrase in government dealings which every desperate post-seeker uses: ‘this would make no additional financial commitment for the government’, and they used it. In a country where MLAs sit in state assemblies and vote unanimously for their own pay rise instead of conducting public referendum, what else can we expect from ambitious doctors? 

The arguments of the Ayurveda Medical Association of India can be read here: http://www.pharmabiz.com/NewsDetails.aspx?aid=73654&sid=1


Tags: Health, Kerala Health, Indian Health, Health Research, Health News, Health Service, Indian Systems Of Medicine, Indigenous Systems Of Medicine, Allopathy, Ayurveda, Siddha, Unani, Ayush Department,

046. When Did Kerala Health Qualify For Central Grant For Total Automation?

When Did Kerala Health Qualify For Central Grant For Total Automation?

By Special Correspondent

The Department of Health, Kerala, in their Face Book page dated 24th January 2013, announced that they won a grant for total automation of the department. There was no mention of the amount involved or what specific uses the amount of this grant was ordered to be put into, as if it is their private pleasure and right to hide specific information from people and use this grant at their will. First we shall read here their own article from their Face Book. Do not mind the language and grammar, for it represents only the person going to benefit most from this ‘grant’. 

Then we shall look into the Face Book Set Up of this department to see how current, updated and sophisticated they are to receive such India Government grants for total automation. To tell the truth, they do not qualify for it. A screen shot of their page on April 05, 2014 denotes that they are 8 months back in digital updatedness and that they are not skilled and resourceful enough to control such elaborate e-health governance for an entire state, unless they outsource everything which is what they really wish to do. If they outsource it as is evidenced from this article, it is illegal and against the interests of the people. It seems this is going to become a sequel to the ill famous solar scam, involving perhaps the same kind of people. The government is quite unwilling to disclose the names of the people who ‘expressed their interest’ to participate in the various projects likely to come up in connection with the implementation of e-health in Kerala. Even then they ‘won’ a Union Government grant for total automation. How did this happen and which powers were behind it?

Their article which is reproduced here is just a blabbering of the uninformed and the uncaring in the health field of Kerala, knowing nothing about e-governance or electronic health informatics, interested only in the securing of funds from all possible sources and spending it at their will. They care nothing about people’s health or the privacy and confidentiality of people’s health data or government servants’ accountability. If what they say on doing things in the name of e-health is to be believed to be going to happen actually, they either intend to ignore the legalities of accessibility to health data, protection of health data, citizens’ rights to privacy and confidentiality of their sensitive health data and international guide lines for sharing patient data, or they think they can simply bypass these by sheer criminality. Certainly the health minister of Kerala, a politician who proclaims to know everything under the sun, the political parties of Kerala who assume the role of keeping suspicious views of everything, the various scientific, civil and human rights organizations who pretend to know about every law in the world and interfere in almost everything and the news media in Kerala who report every involvement above five lakhs rupees as scams, did not speak a word against this involvement which is sure to affect the life of every man, woman and child in Kerala. They all will have their piece of the pie, or their relatives or favourites will have it. Violating international chapters on safeguarding sensitive patient data, the people involved in e-health finance and administration in Kerala, are going to enlist private parties and outsource sensitive works to them, at the risk of data loss, theft and manipulation. If there are investigating agencies in Kerala, it is time they begin. 

Note that when it was assured that a considerable amount of money would be allotted by the Union Government, there were a rush of activities. Pages were opened in DHS and NRHM websites, news released to news papers and television channels and articles were posted in Face Book. When the money actually came to Trivandrum, it all stopped; there were no more updating or information release, ever. From then onwards, everything became secret and silent, till the alert and vigilant Treasuries Officers began to turn down e-health bills for enormous amounts.

Department of Health, Government of Kerala. Face Book Article On 24 January 2013. 

Health department Kerala was won a project grant from the Department of IT (DeITY) Government of India for total automation of the department. This will have three arms: automation of demographic data indexed on UID, State Data Centre (where all individual data would be stored) linked to all health institutions and accessed by field workers through a 3G enbled tablets and hospital automation. The field workers will digitise the family health register where each individual will be identified by UID. This data would be sent to the state data centre (SDC) through the Kerala State Wide Area Network (KSWAN). The field worker will be able to down load the demographic data she needs for her planned work for the data and be able to update the individual data at the SDC with new data generated (immunisation, Blood Pressure data) during her work for the day.

When the person visits any government health institution this data would be downloaded to the local server of the institution. This would be available at the OP, Consultation room, pharmacy, lab etc. It will contain alerts for the physician, pharmacist and other staff such as pre-existing condition, specific allergies etc. The communication between different parts of the hospital (e.g: Cinician and laboratory or Ward Nurse and Pharmacy) will be through the system. At the time of discharge an abstract will go back to update the data at the SDC.

Our aim to develop an Electronic Health Record for every citizen of the state. Once it is stablised the private sector may also be invited to participate. The project aims to make data available for planning, research and for individuals to manage their own health. Government of India sees this as a pilot project to apply IT to ensuring Universal Health Coverage in the country. 

The challenge is to develop good Functional Requirement Specifications. Our teams are on this task now.

Screen Shot of Department of Health, Kerala’s Face Book page. See how current they are: