10/24/2006, 00.00
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India's health care system in crisis following dengue fever outbreak

Since September the virus has claimed 125 lives across the country. Many deaths would have been prevented if adequate steps had been taken in time and public awareness campaigns started earlier. The government's faults and the disastrous situation of the country's public hospitals are there for all to see.

New Delhi (AsiaNews) – An outbreak of mosquito-borne dengue fever has killed at least 125 people in India, the health ministry reported. This has in turn raised serious questions about the country's public health care system.

"A total number of 7,100 cases and 125 deaths have been reported from India as a whole," a ministry said in a press release last Sunday. With 2,051 cases, New Delhi and neighbouring states have been the worst hit. The rate of contagion has been slowing down though.

Dengue is transmitted to humans through bites of the female Aedes aegypti mosquitoes that proliferate in standing water both inside and outside buildings. It feeds primarily during the day. It causes fever, fatigue and, in the last phase internal, bleeding. If it is not treated in time, it can be lead to death.

A Health care system in crisis

According to a feature article by Hong Kong's South China Morning Post newspaper on Delhi's main public hospital, the All India Institute of Medical Sciences (AIMS), most of the dengue-related death (44 just last week-end) were preventable if patients had been diagnosed sooner and received the right treatment in time. Lack of medical and health care staff is the main cause.

Last week, the hospital had to put up temporary tents on the institute campus to cope with the stream of patients. And although the AIMS Hospital is at the centre of the dengue outbreak, it has failed to observe basic prevention rules such as removing pools of stagnant water.

If big city hospitals suffer from shortages and overcrowding, the few facilities in rural areas are even shorter of funds and staff. Of those that do exist many often lack beds, functioning equipment, drugs and trained staff.

World Health Organisation estimates there are six doctors for every 10,000 Indians compared to an estimated 15 in China. In some backward states such as Bihar, hospitals can even lack running water or electricity; only 20 per cent have phones.

Spending in India's public health care system is among the lowest in the world—about US$ 4 per person per year, less than 1 per cent of GDP. In the US, it's US$ 2,000 per person, almost 6 per cent of GDP.

A belated prevention campaign

The government started a prevention campaign with public interest announcements and instructions to the population only when the rate of contagion and the number of dengue-related deaths started to mount.

The Health Ministry began warning people to make sure their homes were free of stagnant water and telling patents to dress their children with long clothes to avoid mosquito bites. It also began fumigating high-risk areas. But in many cases it was already too late.

In Delhi residents initiated a public petition accusing the Delhi municipal government of failing to take preventive steps against the outbreak. However, the failure was general.

Middle-class Indians should have known that once the summer heat had abated and they had stopped using air coolers—a popular alternative to expensive air conditioners—the water had to be dried out.

Only when the headlines began screaming dengue deaths and Manmohan Singh's grandsons were admitted to hospital with the disease, did middle-class families begin checking for water collection.

In 1996 a dengue outbreak in Delhi claimed more than 400 lives when 10,000 people contracted the virus.

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