From SARS to Swine Flu: Who is Laughing All the Way to Their Banks?

The Epidemics Act is promulgated to fight swine flu situation in Maharashtra: news.

Even pigs should know how to respect the laws of the land...!

I WAS a dutiful parent, providing all the mandatory vaccinations to both my children as they were born: In the eighties when my children were born, these were primarily oral polio vaccines and the DPT injections against some scourges which used to take so many lives away and resulted in wastage of limbs.

Every parent I knew used to take all these precautions for the safety of their children, regardless of their background, their religion, etc. And the childbirth was mostly in hospitals and this helped the newborns to get the best possible medical attention and timely vaccinations which helped the eradication of these ailments.

But recent surveys seem to indicate that there is as resurgence of some of these ailments in some parts of Kerala, especially in Malabar. These reports were available for some time and it appears there is a regression in our vigilance against such childhood ailments which could cripple our kids for a life time. It is a dangerous tendency and needs to be curbed.

But why the slippage in our vigilance against such ailment? Some doctors say the media is primarily responsible as they highlight some stray incidents of extremely rare occurrence of side-effects of such vaccination, as a recent Malayala Manorama news report exemplified. They say these reports cause fear in the minds of people and cause them to keep away from vaccinations.

This diagnosis looks silly. As they say such side-effects take place extremely rarely and so reports of such side-effects also need to be extremely rare. And nobody in their right mind could claim that a rare report of a rare incident in one or two news media could have such a major impact on society.

Then what is the real problem?

To my mind, the problem is with our medical care system which has become completely commercialized and profit-oriented. They are looking for as money to make and even vaccinations have now become a good chance to mint money.

This had started in 80s itself when they started administering vaccinations for a large number of new ailments like Hepatitis B, for which I had to shell out a big amount of money. The vaccine was being promoted by a multinational pharmaceutical company and the pediatricians then recommended it strongly. Most parents accepted it, though the amount was often beyond their means. It is well known that a part of this money went directly to the doctors concerned.

Then a few years down the road, the vaccine became locally available and the prices came down drastically and now it seems there is no pressure on the parents to go for it. So what it means is that the medical profession was being a willing tool in the hands of the pharmaceutical industry and the losers were people who were forced to pay through their noses, but the ultimate result was the loss of trust between the medical professionals and their clients.

Of course there were other factors like religious fanatics, naturopaths and many others who kept up a campaign against vaccination for a variety of reasons. But I do feel that what proved to be the real tragedy was the loss of faith in the medical profession.

Now we see reports about a variety of epidemics from time to time from SARS to bird flu to swine flu, and naturally people are concerned. In Pune, where the first swine flu death took place the other day, it is more like panic.

But in spite of the seriousness of the situation, I do wonder whether some of these concerns are over-done, are we not being hoodwinked by a rapacious industry in cahoots with a profession which has lost its ethical moorings, looking for new ways to make a kill selling us cures for a flu which, as some reports say, is as harmful as a common cold in most cases?

Sister Alphonsa's Canonization and a Media Orgy in Superstition

YESTERDAY WE Malayalees and our Catholics got our first home grown saint after 2000 years. We do deserve this honour, being one of the first Christian communities in the world. The media played it up, in fact the media became so excited with the event that they went overboard in their coverage.

As I watched the live coverage of the events in various news channels, I could not but be concerned about the kind of message the media overkill might be sending to the world: The 24 hour channels had nothing much exciting to report for most of the time, as the holy mass is a long drawn, unexciting event and so the media got hold of anyone who had a story to tell; atKutamalur, Bharanangaanam and Rome. Yesterday being Sunday and sitting at home, I spent most of the time watching TV. Here are some examples of the coverage I witnessed:

1. A Malayali lady from Rome, on NDTV described about her relations with the saint; how she did a miraculous thing for some of her relatives. She said Sister Alphonsa was a close relative and one of the girls in the family had some disease and her aunt or grandmother or somebody came to Bhranangaanam, where the good sister is buried, and told Annakkutty: "Edi Annakkuty, this is our girl and you better do something to help her out, do it fast and I don't take no for an answer..."

No wonder, the terror-stricken Annakkutty, even as she was lying in her grave, lost no time to use her influence with higher ups and got it done.

2. Then at Bharanangaanam, where there was huge excitement, I saw on Manorama TV another young man, who said he too was related to Annakkutty. He too had a story of a miraculous cure:

His daughter had some problem and when medicine failed Annakkutty came to the rescue...

3. Then some channels showed the family of the boy who was miraculously saved by prayer because of Annakkutty's intervention, which led her to the sainthood.

There were so many such instances of sheer superstition put on air without even a question as to whether all these claims can be true, whether it was wise to keep peddling such superstitions in the name of faith. I realized that in this media-controlled world, God, as it used to be in the past, was not a distant one, so far away and talking in the voice of thunder and lightning any longer; but a real and tangible presence in our drawing rooms and He is available just as the veejays on TV, pick up the phone or send anSMS to Annakkutty or Mariyakkutty or whatever...

I am sure such indiscriminate claims of miracle cures could add a few more diseases to our society whether we like it or not. In fact I think the media excitement over the miracle cures done by the new saint may be of greater help to Pentecostals(who refuse medical treatment as they are sure prayer would do the trick), than to Catholics (who have set up some of the best super-speciality hospitals and run some of the medical colleges inKerala). Perhaps it might also help develop some new business avenues for those close to the saint as people were making such absurd claims as I cited above.

The point is that the Catholic Church used to be more prudent in the past making saints out of people only centuries after the death of the concerned ones. A faster canonization could throw up so many touts and small time enterprises in this world of influence-peddling and professional lobbying, I am afraid.

Kerala: Crisis in Public Health System

Kerala Witnesses Return of Epidemics


By N P Chekkutty


The outbreak of seasonal epidemics like dengue fever, chikun guniya and Weil’s disease in Kerala during the past few monsoons, affecting millions of people across the State, has raised serious concern about a crisis in public health. Politicians, policy-makers and public health workers are now unanimous in their view that the famous public healthcare system that helped Kerala achieve a developed-nation status in all major human development indices like life expectancy, infant mortality, etc, is now facing serious challenge.

With the monsoon season this year, which started early June, came the chikun guniya epidemic that practically immobilized the entire State with more than a million people being treated in various hospitals. According to newspapers, over a hundred deaths have taken place in the two months of June and July owing to chikun guniya, though official agencies like the special teams of experts deputed by the Union Health Ministry, have disputed claims that they were caused by the epidemic. But the Central experts as well as public health organizations like the Kerala Sastra Sahitya Parishad and the Indian Medical Association are united in their view that urgent steps are necessary to address the widespread occurrence of epidemics as a regular phenomenon in Kerala during the monsoon.

Two major reasons are attributed to the return of the epidemics to a State which had practically banished such scourges more than a quarter century ago. First, the decay of grassroots-level public healthcare system that thrived on the support of Government and the dysfunctional municipal systems with the result of accumulation of wastes, most of them non-degradable items like plastics almost everywhere. The national highways now resemble a public waste dumping ground and most of its rivers and other waterways are clogged with reeking bags full of chicken and other animal wastes thrown in. The situation became unbearable in Kochi, the fastest growing city in Kerala: Because of the huge accumulation of wastes in the streets as the municipal system broke down, schools in some areas had to declare holidays in July for a few days.

Dr T Jacob John, former head of virology division at the famous Vellore Medical College, in Tamil Nadu, who is an acknowledged authority in virology in south India, points out that epidemic is a phenomenon making a comeback in Kerala. He says that with easy access to modern medicine through an effective public healthcare system, the State had weeded out such occurrences by early seventies.

Experts point out that the return of the scourges became a major concern from the mid-eighties with regular outbreak of diseases like dengue fever and chikun guniya with the appearance of new and virulent species of carriers like Aedis Egypti mosquitoes. The large-scale rubber plantations which has now spread even to the mid-lands helped the appearance of these guests. Along with them came the widespread use of plastic and its indiscriminate disposal with no public action to put in place an effective recycling mechanism. Added to this was the breakdown of a once efficient public healthcare system with a decline in Government support to public health and the increasing tendency of privatization of healthcare taking it beyond the reach of the poorer sections of society.

At a seminar on the threat of epidemics to the State organized by Malayala Manorama, the State’s largest newspaper network at Kottayam this week, Dr Jacob John pointed out that dengue virus and Aedis Egypti mosquitoes were the primary sources behind the outbreak of various epidemics from mid-eighties. The Weil’s disease, a water –borne disease spread by affected rats, was reported from Kerala from 1987 and it has been one of the major causes of death ever since during the monsoon season. A decade later, by 1995-96, Kerala witnessed the return of cholera and malaria epidemics which had been almost non-existent in the earlier two decades. In this period, cholera epidemic was reported from Alapuzha, a coastal district, and malaria from Kasargode, a northern district. Added to this was the outbreak of Japan Encephalitis, another virulent disease caused by mosquitoes, in districts like Kottayam and Alapuzha.

It was this sudden and widespread outbreak of various epidemics that spurred the Government to set up the State Virology Institute in Alapuzha, a place that had emerged as the epicenter of such diseases. The institute had taken steps to identity the outbreak of any such disease in any part of the State, urging the doctors to use a post-card to give them warning.

That worked beautifully in the initial years: In Kottayam during the 1990 monsoon, an outbreak of cholera was noticed. What helped contain this outbreak was an early-warning system that worked and ensured efficient preventive steps, according to health workers who participated in the campaign. Doctors and health workers asserted that the Kottayam experience was an example that proved the efficiency of coordinated effort of grass-roots’ health-workers, the three-tier panchayat raj system and the administration.

But four years later, as hepatitis virus struck in the same district, the system failed as authorities took a negative line. They asserted that there was no serious threat. It was a massive faux paus, as the authorities denied any major outbreak, while dozens of patients were being admitted to the hospitals. The point of origin of the epidemic was the Medical College Hospital at Kottayam, but there was no step to tackle it at the initial stages. More than 170 doctors and para-medical staff were infected and two doctors succumbed to the disease. Dr Jacob John pointed out that when by January 2005, it was confirmed that the cause of deaths was Hepatitis A virus, it had reached epidemic proportions. He is of the view that if the authorities had taken preventive steps and cautioned the public about the possibility of an outbreak and ensured supply of clean water, such a calamity could have been averted.

Doctors and health workers feel that a public campaign and mass-based preventive methods are the best in fighting epidemics as in most cases the diseases are caused by poor health awareness, lack of proper water supply and sanitation. The media in the State had taken a leading role in such campaigns, but many health workers and activists feel that the media has been taking a largely negative role in recent years. According to Dr K P Aravindan, a senior doctor at the Kohikode Medical College and leader of the Kerala Sastra Sahitya Parishad, major newspapers had spread alarming reports about even minor issues. He also pointed out instances where media and some cultural leaders taking a negative stand against polio vaccination and the mass consumption of tablets against elephantiasis, a disease widespread in the coastal region. The sensational nature of media reports and the irresponsible attitude of a section of intellectuals against science and rationality is a mater of concern in the State. The recent chikun guniya season was a classic example of a media-created scare: The newspapers went to town with screaming headlines and the State came to a grinding halt for weeks together.

(Originally published at www.infochangeindia.org)