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Oct-Dec2003-11(4)
LETTER FROM
BONGAIGAON
A silent epidemic
Sunil
Kaul
Every third person I know in Assam has either got
his or her appendix removed or is in the process of getting it done. Every other
person I know is either on injections or on tonics for a 'spoilt liver'. The
textbooks make no mention of these entities but we find doctors diagnosing
something called 'chronic appendicitis' that needs to be operated upon at the
earliest, and 'chronic hepatitis' that needs tonics. A silent epidemic is taking
its toll on the community. It is an epidemic of irrational medical practice.
Those most affected are the poorest in the villages.
We help LOCOST, the Gujarat-based charitable trust
that manufactures essential and generic medicines, run their Guwahati depot.
After having entered the tea industry hospitals, we decided to target the bigger
hospitals of Guwahati, a city that acts as a gateway to the northeast. All the
medical directors we meet have heard of LOCOST and, yes, they are sure of their
quality as well. But they are also sure that LOCOST medicines cannot be made
available in their hospitals. 'You know the margins from sales of medicines
subsidise a lot of our running costs, so how can we buy your medicines?'
The director of a charitable hospital outside the
southern city of Silchar recounted his experience with a drug supplier the year
before. 'We wanted a few hundred of an antibiotic injection. The drug supplier
was not ready to give more than a 33% discount though I got a much better rate
last time. So I decided to go to another supplier. Immediately, the first
supplier drove down and offered me a Maruti car if I got the purchase okayed for
Rs 50 instead of the Rs 25 that I was insisting on. It was then that I came to
know of the margins and the stakes involved,' he said. Another chief executive
officer-an administrator, not a doctor-of one of the leading hospitals in
Guwahati recounted the spat that he had with his board of directors to stop the
19% commission they were offering doctors who referred their patients for
laboratory diagnosis, or for admission. 'They would have none of it; they
thought I was mad.'
Five years ago, when I used to work in Majuli, the
largest inhabited river island in the world, I managed to get a total of five
disposable syringes from the three pharmacies in its head village. Doctors would
drive through muddy village roads to reach their patients. Their prescriptions
may have been far from perfect but they would not charge more than Rs 100 for
the entire effort of travel, diagnosis, prescription and a two-to-three-day
course of medicine.
Today, I meet villagers who are ready to sell their
land to take their patient straight to Vellore without even consulting an MBBS
doctor in the nearby town. 'The doctors here are no good' for the many patients
who travel every day to Vellore, Chennai or Hyderabad. The going is good for
Apollo Hospitals; reportedly, they have an Assamese interpreter at the
reception. They had all but set up a hospital in Guwahati, until their plans
were thwarted-reportedly by the lethal combination of local doctors and
militants.
The epidemic has moved swiftly and silently and
although everyone is aware of it, it has shocked and awed the mild-mannered
Assamese and tribal populations into numbness. Couple it with the age-old
problem of poor governance and the round-the-clock imposition of Section 144
under the Armed Forces Special Powers Act, and one understands why no
non-governmental organisation voices its concerns.
We in the northeast are good importers. We import
vegetables, fruit and mustard oil. Until two years ago, even our rice was
imported. The UK can afford only a limited number of computerised tomography
scans, but we have started importing them freely. The rotten ethics is the
newest import that has entered the personal and social life of the traditional
society. My friend Sabu insists that the increasing import of ultrasonograms is
for sex-selective abortion, even if people like me feel that traditional
societies, such as those in the northeast, treat their women much better. But
one ceases to be shocked any longer. Liberation armies are here in plenty. Can
we hope that one of them will take a stand to call off these imports? Or must
the epidemic be allowed to spread unchecked?
SUNIL KAUL, The Action Northeast Trust, Ward 10, BOC Gate, Bongaigaon (N), Assam 783380, India. e-mail:scowl@satyam.net.in