[Reader-list] Current Dengue epidemic in Calcutta

[Amit Basu]

This is indeed good Ramaswamy. Can't you give us some more like this?
amit basu

hpp at vsnl.com wrote:
A few days ago, the West Bengal govt declared that there was a dengue epidemic in Calcutta. Subsequently this was denied by the Mayor of Calcutta Municipal Corporation, who said it was only an 'outbreak' and not an 'epidemic'.

I was reminded of the outbreak of malaria in 1995, which saw the city completely unable to cope.

I am giving below a transcript of a discussion in May 1996 with the Principal Secretary, Dept of Health, Govt of West Bengal. Its never too late to learn!

V Ramaswamy, Calcutta

.....

Secretary: ... through (the West Bengal Health System Development Programme, supported by the World Bank) we are trying to start at least a health MIS for Calcutta. Doctors are also not very sure about the present need with respect to environmental aspects. The planning is ad hoc. There is no planning worth the name in the Health Dept now. We are not sure what we want to do. If we are asked what is the trend in bronchial problems - we will be found to be shallow; there is no data; no exercise has been undertaken on this. What is the effect of air pollution, and where? Doctors can only say this is on the rise. There is an increasing trend in malaria, and Calcutta is especially at risk in this regard. Last year, suddenly, there was a crisis. Some ad hoc spraying was taken up? But where should the spraying be done? 

Gastro-enteritis is on the rise. Noise pollution is also a problem. There is an increase in the incidence of deafness and voice-related problems. Psychiatric cases are also believed to have a link with noise pollution - but nothing has been researched in detail and no link has been established.

Community Medicine Specialist: We have found that among pavement dwellers, the number of cases of bronchial asthma is on the rise. TB incidence is also high. Primary data is needed, the existing secondary data is highly inadequate. Doctors are only treating symptoms, there is no etiologic approach.

Secretary: All this is also ultimately leading to overcrowding of hospitals in Calcutta. If the basic cause of such ailments were known, then perhaps these people need not be admitted to the hospitals.


 Detailed analysis of disease profile and morbidity pattern for Calcutta city cannot be taken up through this (World Bank project).


 In Calcutta, disease pattern is changing very fast - malaria, gastro-enteritis, respiratory distress etc. There is also another factor regarding Calcutta. In the municipalities, they are supposed to do some health work, but in practice, they are totally dependent on the Dept of Health. So there is a unified chain of command for these areas, under the Health Dept. In Calcutta, we have the Calcutta Municipal Corporation (CMC), which has its own health-related activities. So here, we do not have a strong, unified command system.

(Regarding achieving greater health planning and coordination, about what can be done) - we have not worked out anything. We try to do something when a calamity arises. When the malaria crisis occurred (in 1995), CMC wanted to be in full control. We felt that they would not be able to do the needful, given the nature and dimension of the problem, and the lack of information about the exact spatial dimension.

Thus, lacking a unified chain of command, we ended up with an unhappy situation. There was pressure from the GoI. So we had to step in and take over. Our efforts included :

daily monitoring of the situation

we did not depend on the CMUHO only; a control room was opened

sent doctors to CMC areas, together with Borough Medical Officers / CMO

technology : collection of information on options - though this was quite late. There was a difference of opinion between CMC doctors and ours - e.g. on what to spray, how to spray.

procurement of medicines from Delhi

Through this, at least treatment was taken care of. But even here, in regard to the falciparum malaria, there were difficulties. Frankly, we did not succeed in addressing the crisis. Luckily, the outbreak subsided.

The role of health education is critical. This is a long-term preventive initiative. It is not meaningful when malaria actually breaks out. It should continue throughout the year, in areas where awareness is low and in specifically relevant areas - such as in South Calcutta, where construction activity is higher.

Question: Why should 3 million people in Calcutta be left to the vagaries of lack of institutional arrangements? And given the limitations of the CMC, can we think of take-over of some of the functions in Calcutta and Howrah by the DoH and leave only some rudimentary matters to the Corporations?

Secretary: This can be done. We don’t have much problems with other municipalities. They do not have health officers, nor the culture of addressing such problems. They have accepted our role. Besides malaria, on other counts too, Calcutta is in a bad situation. West Bengal is very high in TB. Under the Revised TB Control Programme supported by he World Bank, 6 cities and 5 states are being taken up. Calcutta and West Bengal have been chosen. In fact this is the only case of choice of state and its capital city. CMC does not have the expertise and manpower to handle this. This is an in-depth, community-based approach. In leprosy too, West Bengal is very high. On this too there is a gap between the DoH and the CMC. And now we also have the threat of AIDS. How can CMC alone take preventive steps on all this? They don’t have the orientation, or expertise; their priorities are different and yet they will not give up their responsibilities.

What the CMC can do is run good maternity clinics.

The IPP 8 programme, in slum areas (like the CUDP 3 Health component) is going well in the non-CMC areas.

Question: If a political decision can be reached, can DoH take up planning and related functions for the CMC or would DoH itself need strengthening first?

Secretary: Some basic infrastructure, like an office, some equipment will be needed. Personnel already exists. There also needs to be an arrangement between the Dept of Urban Development (DoUD), Dept of Municipal Affairs (DoMA) and the DoH.

Question: Another important issue is that of convergence of programmes. You have just mentioned the IPP 8. This is, as you mentioned, something involving community participation. Even though this programme has its own agenda, by virtue of the fact that it involves community participation, this opportunity of community outreach and interface could conceivably be useful in initiating other concerns as well. For these concerns, the IPP 8 can be seen as providing an entry point. So this would give rise to a body of work to be done - how to operationalise the convergence? This is something that will involve a lot of detailing and close collaboration with Dept officials.

Secretary: Yes, very much so. There is an educational component in this programme (for education on health), and scope for a pilot project on environmental sanitation; similarly, there is some scope for education and self-employment of women. In the CMC, 2 other projects are on: CUDP 3 Health component and CSIP. We are now also posing another project to the GoI for assistance through World Bank; this would focus on the large municipalities outside CMA. But it is unlikely that GoI would approve of so many World Bank supported health programmes in one state.

I would also like to raise the issue of training of doctors to deal with cases of arsenic poisoning. We need to have adequately equipped laboratories for diagnosing this. While there is a lot of controversy on the exact scale of the problem, we can take it that ultimately, Calcutta must be affected. There is a possibility of obtaining funds to deal with this issue - if the will to do so is there. There needs to be a co-ordinated effort involving the DoUD, PHED and DoH.

There also needs to be some empowerment of the DoH to implement what requires to be done. CMC can do certain things, but they should conform to guidelines and report to the monitoring system which has to be evolved. 

If I were to ask “what is the actual situation on arsenic”, we find that govt does not know. People have a right to know such things.


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