It is a pity that one is forced to make the same points again and again.
I can see the Pediatric Surgery ward in my mind’s eye. Not that long ago, JIPMER, Pondicherry. A leg with an abcess full of pus- drained. But too late. The blood infection is sure to claim this five-year-old’s life. You tell the parents that the child could die. You expect tears and despair. Wailing and even beating of breasts. Instead. There is panic.
“We will take him home, sir. Please. We will sign any paper you require.”
“Um…we cant do that. He is too sick. There is still chance. A small one, but….”
“No- we have to go, sir.”
An empty bed- and a note pinned to the case sheet- ‘LAMA’- Left Against Medical Advice.
A scene played out every day, often many cases a day.
A simple dynamic is at work here. They are coming from rural hamlets, often 100s of kilometres away. The money has already run out. Once the child dies, the public transport wont allow a dead body in. They will have to hire a vehicle, and that will ruin them.
You know what- I do think that the death of these children in Muzaffarpur could have happened at similar places in India under any government. I don’t think any single political party or group is particularly worse than the other. I dare say similar tragedies are being played out every day in various areas of India. Maybe not in this exact scale.
Maybe yes- occasionally in comparable magnitude, and nobody finds out.
The so called, “Acute Encephalitis Syndrome’, is very likely to be a case of metabolic encephalopathy, due to a toxin that can only affect chronically starved children, and that too, when they haven’t had a decent supper when they go to sleep!
This scourge has taken the lives of more than 1000 children over the past 10 years.
It was investigated by Dr. Jacob John and Dr. Arun Shah of Vellore, in 2014.
The disease affects children from poorer communities during the Litchi harvest season. Most are the children of workers that camp in orchards and harvest the fruit.
In the day, Children eat the fallen Litchi fruit. It has a compound called Methyl Iso propyl Glycine.
They go to sleep without having supper. In the night, their blood sugar levels fall. Usually, this is not a problem, as most healthy children have stored glycogen in their livers, which can easily be converted to Glucose. The Brain needs glucose.
But chronically starving children, do not have glycogen. The stores are all dry.
Again, this is not a problem, but for the Litchi. Body transforms proteins and other body components into Glucose- gluco neogenesis. But the MCPG in the fruit blocks this process. A host of abnormal amino acids are produced, and the blood glucose drops. Both of which affects the brain.
The entire pathway was elucidated by our Doctors mentioned, and the offending amino acids isolated from the blood by the centre for disease control in the US. The results were published by Lancet.
It can easily be prevented:
It doesn’t happen to well-nourished children.
It won’t happen if the children get a good supper every day.
We know the dynamics, and health education should be easy.
Even after the disease sets in, a simple infusion of 10 percent glucose can easily reverse the process, if given within four hours.
It is not only the fault of Doctors struggling in makeshift ICUs that don’t have even 10 percent glucose.
Let us face it. In spite of our economic might and massive chest thumping, we are a desperately poor country. We may be the third largest Economy.by PPP, but do you know our ranking according to per person GDP?
It is like; 190th.
All over the developed countries, most basic problems are solved! Food- there is plenty of food. Everyone can have a roof over their heads.
But not healthcare. UK spends close to 16 percent of its entire income on it. They have a model of exclusively free medical care, sponsored by the government. A majority of its population pays fifty percent income tax on their earnings. And it is a rich country.
The system there is struggling to survive, due to money issues.
The US spends 20 percent of its income on healthcare, and half of it is public sector. The rest is the private sector, and the private sector is almost exclusively controlled, and kept in a vice-like grip, by insurance companies. Insurance monitors spending of hospitals and the treatment. Without insurance, the cost would have shot up through the roof. And no one seems happy with the present system.
To cut through the crap, ideal cutting edge medicine, as per the standards set by western countries, is enormously expensive.
India spends three percent of its GDP on health, as compared to the 15 to 20 percent of developed countries. Out of which only one percent of it is by the government. The 2 percent private health spending is paid by individuals on small clinics, private practitioners and quacks.
Remember that per capita GDP of the US is thirty times that of India. And our people are expected to get care at ‘world standards.’!
World class care is given by a miniscule number of pure private ‘for-profit’ players.
These centres are not monitored by insurance (mostly) and the government oscillates between populist obstructionism and corrupt lassiez faire.
Increasingly, we are demanding medical care on par with the standards of the west. Our doctors try to do that, and the courts want doctors to do that.
And we expect the exclusive profit driven system to take out-of-pocket money from our impoverished population and give that care? What the hell are we smoking?
There is no point in revelling in fantasies of past glory. What we need is pragmatic appraisal, coming out from denial (hunger! Poverty! – oh no, we don’t have that!), and policies based on rational judgement.
Is that too much to ask? Yes. I guess so. (Jimmy Mathew)