Why Swine Flu and What we should be doing in India?

 Everybody in the medical sector please read this thought provoking article 

It is worrying to note that we are not upset and panicking to the same extend  as we do  in  Swine Flu, when several thousands or even lakhs  die here due to various communicable diseases like Leptospirosis, Malaria, Viral Hepatitis, Chickenpox, Mumps, Measles, Rabies, Typhoid, Pneumonias, and a host of other  infections and even due to pure malnutrition.

Swine Flu is just another infection like any other air born infection, in fact is much less serious than Chicken Pox, Mumps Measles and others with a similar mode of spread. How it is different form usual Flu-like illness is that since it is a new virus, there is a chance for more persons to be affected.

We must also remember that all infections are primarily due to poor immunity of the subjects, which is most importantly due to malnutrition, followed by other coexisting medical problems. Malnutrition is very common even among the rich in India due to lack of awareness about what constitutes a balanced diet and in others who do not have access to a balanced diet. How many of our people regularly take a combination of cereals, Pulses, Vegetables and fruits simultaneously all three times a day for 365 days a year  in the right proportions in the right way?.

How many people know that pulses, meat, egg  and fish all are primarily sources of protein and any one of them has be consumed regularly but should not  be consumed simultaneously and in excess quantities?. How many people know  that the vegetables are to be taken either raw or should not be overcooked, and fish and meat should not be fried, and the junk foods and fast foods should be avoided as also smoking and alcohol to prevent getting all diseases including communicable diseases?. Next important cause of infections is lack of personal and environmental hygiene. How many people follow simple hygienic  measures like holding towels while sneezing and coughing?

How many wash their hands regularly after visiting toilet and before eating, may be one can see this practice among the people traveling by air or in the AC coaches of trains. This is all what our elite administrators and their all the more elite advisor -doctors see and they for sure are unaware of the real issues. Whoever they happen to see will always be doing all these, they see and interact only with such people who have access to all these facilities and having good habits. Even these elite people have malnutrition due to lack of awareness. How many are in the habit of disposing of the house hold wastes and plastics in the proper way? People feel that all wastes are to be thrown around  anywhere and every where, it is the duty of the municipality or the corporation to remove it. Do we provide waste baskets and waste collecting and processing facilities every where for proper disposal of all types of wastes? How many people get safe drinking water through the public water supply system here?.

It is only because all these basic issues are still in infancy that we get all infections including swine Flu. We still waste our resources in setting up Super specialty treatment centers ignoring all the basic issues and basic treatment facilities, and we also invest money in manufacturing mineral water and water filters.

Why Swine Flu got contained very fast or did not spread in developed countries is only common sense? Because their basic behavior and basic amenities are  different and that alone  limits the spread, and their body has better immunity since majority consume a near balanced diet and could stop the virus from multiplying inside their bodies. If we introduce the virus of H1N1 or HIV virus into 100 average Indians/ Africans and  another 100 persons from the developed countries simultaneously, we are sure to observe that almost all the Indians and Africans will get the disease and may be 10% or even less in the case of developed countries getting the infection. This is due to the malnutrition factor because our people do not get a balanced diet and even those who are rich do not know what all they should eat.

Why this Scare in the case of H1N1? People with tubular vision only are involved in monitoring, and advising the authorities, unfortunately common sense and social sense are rare qualities among many doctors of today. I have seen that only some specialist doctors in metropolitan cities or big corporate hospitals are being consulted for the control of Swine Flu, what is needed here is a consolidated opinion of good family doctors and  of good general physicians across the country who always maintain a common sense approach to all clinical issues, these are the people who exercise common sense more often than specialists.

What we should do now?
Even if there is an epidemic let us face it without much scare, since it is to be considered only as a natural calamity, and we must remember that uncertainty is the only certainty in life, one cannot make everything hundred percent sure and predict everything at the first contact itself, that urge to confirm the diagnosis in every case is unscientific; we are dealing with human life issues and natural issues having non- linear correlations.  When Calicut  Medical College alone has 60 to 70 deaths annually due to Leptospirosis(Rat fever) why this 8-10 deaths all over India due to swine flu giving such a big scare? The people who die with so called Swine Flu are having several other contributory factors other than the infection itself. The deaths in Swine Flu were not directly due to Swine Flu, they were either elderly, malnourished, or with other preexisting illness which had weakened their immunity; even if they are tested positive it does not always mean that the diagnosis is certain. Death occurs only when the body is weakened by low immunity and other illnesses.

We cannot blame one disease alone as the cause of mortality, it is just another Flu and death occurs only in those who are predisposed to die due to other reasons. We have to remember also that death is a natural phenomenon as birth is, and sometimes it is unavoidable and we doctors are not here to stop death altogether. We should therefore work for improving the quality of life. Even if the threat of Swine Flue is genuine we are unable to stop it by all that we do now and the scare that we have created,  the scare and commotion only helps in multiplying the risk, by exposing everyone who travel to get tested, people are tensed up and do not even take a balanced diet which they forget while awaiting the tests and due to paralysis of all the services and even scarcity of food due to the closure of all facilities. The meager resources that we have are wasted on procuring the medicines, the test kits, face masks and finally the vaccine. Let us use this money to develop universal protection by improving respiratory hygiene and the body immunity by consuming a balanced diet.

Who are benefited  out of the scare?
If at all it is the people who manufacture the test kits, the face masks, the antiviral drug TamiFlu, and the vaccine people who are waiting for a possible drug trial on the Indians

All that is happening in this country is due to fact that we do not have a National Health Policy which should have set the priorities and guidelines for utilization of resources, obviously  after good discussion. In Health Care and disease care, we conveniently forget their relation to all other fields like law, education, finance, police, agriculture, public works and what not. If we can ensure proper health  care and Education, all the rest will follow. All ministers must be health ministers anyway, they should know how their action or decision will affect the body, mind and environment of an individual or the state or nation or the world. All doctors and in fact all individuals should start thinking how his/her activity would influence the health and education of people around us.

We can predict what is going to happen- we somehow will contain the problem this time mostly by natural consequences and not because of our sophisticated interventions and after this we wait casually for the next year with the similar drama repeated in the same sequence.

The lack of concern and apathy towards the basic issues in health care is really appalling.  The medical profession is busy and happy treating diseases, confining to their own insulated and comfortable compartments. I happened to read with concern the comments made by some last year that we are not equipped to face the threat of Swine Flu, as if we are already well equipped to face the threat of all other communicable diseases;  they go on to assert that the problems that we face are all due to lack of dedicated Infectious Disease departments and dearth of WHO trained doctors in the medical Colleges in Kerala. It is true that we need  infectious disease units in each Medical College, like the ones we already have- but the only problem is that we do not have adequate number of doctors to spare for organized work to improve the services, to do  research and surveillance.

It is high time that we stop producing departments for anything and everything, Is it possible or is it necessary to have training of  doctors under WHO for solving all our Health problems which have several unique issues? Why not the existing system tackle the problem by reorienting and reorganizing than compartmentalizing. In Health Care (No Disease Care) we have now only doctor oriented planning and implementation and there is no community oriented planning or genuine Health Care as such. Properly trained MBBS doctor or even an educated person with common sense and some training is more than enough in managing the threat of any public Health issue. The General medicine department of any medical College can easily tackle all the clinical issues  if they have a few more doctors and isolation wards.

Those who are crying for infectious disease departments and virology institutes are not genuinely concerned about the overcrowding by patients in general hospitals and government medical colleges across the country. Why our wards are so overcrowded? We ignore health care and literally manufacture disease of all colour and shades, and finally we have a museum of all diseases. We have already become the Diabetic capital of the world, now we are trying to overtake Sub Saharan  Africa to win the first place in the number of AIDS cases and in malnutrition and other infections, which produce more morbidity and mortality than swine Flu. If that is the case,  then why are we worried only about this small drop in the ocean of diseases here?: that is Swine flu.

We are just being pompous trying to catch up with the western world in the H1N1 issue, or are influenced by vested interests. The developed countries are worried since they have controlled all infections by proper waste management, safe drinking water and good nutrition for all the citizens and press the panic button  the moment they come across any one of them.  They would have shown similar panic if Typhoid, Viral Hepatitis, Leptosirosis  or  TB has occurred even in much lesser numbers as we see in India. Why are  we not similarly worried about these diseases which kill several lakhs annually in our country?. Let us not equate with them and show panic to show that we are also developed and evolved. All communicable disease are flourishing here because of lack all basic health amenities and such people are now exposed to unchecked consumerist forces promoting lifestyle disorders with even greater impact on us.  Majority of our people are malnourished and we are number one in malnutrition especially in children below 5 years.

All infections occur primarily because of malnutrition, poor environmental hygiene and unsafe drinking water; One more world environment day had passed -we behaved like the developed world by planting some trees  here and there and having a talk on  Ozone  layer and global warming and Green house effect and that is it. We forget the staring environmental issues like poor waste management and unsafe drinking water every where.  Why are we like this? We always ignore basic issues and go for knee jerk reactions to make appear big in front of other developed countries of the world. We need to do some home work and introspect and bring well meaning leaders with vision for the people on top of every system and make the following changes to achieve health and prosperity to our country, and then only start panicking on problems like Swine Flu.

  1. Stop imitating  USA in disease care but may  imitate them on issues of public Health, we do not see what they have already achieved, they have achieved good environmental hygiene and safe drinking water for everyone
  2. Let us concentrate on economic and social reforms to reduce the impact of black money, We are drowning in black money when we are literally starving on one side, let us restore the money that we have in Swiss bank and other similar places is estimated to be 7.5 million crores of rupees-  sixty  times more than our annual budget
  3. Our annual defense spending may have to be reduced and more money earmarked on social development- 1.51lakh  crores for defence and only 1.3lakh crores for social development
  4. We need to set limits for immovable property and gold so that more money would be siphoned for social development
  5. All money transactions above 1000 or say 10,000 to be made through banks only,  to check black money, tube money and counterfeit notes which are de-stabilising our nation.
  6. Private sector  should not be allowed to dominate or even equalize in Health Care, ideally  it has to be a state subject  as in most developed countries- only in  USA it is entirely in the private sector
  7. All ministers should be Health Ministers by realizing the impact of their portfolio and their action on the Health of our people, we need to realize the relations between other issues and Health care.
  8. These measures will give us enough resources and then we must prioritize and spend on Health care firs and then only on disease care.
  9. Let us provide social security to our people by ensuring Health Care, Nutrition,    Education and shelter for every individual so that they will become more useful to the society rather than going after amassing wealth.

Doctors should not be apprehensive of becoming jobless by concentrating on prevention of disease and promotion of health. Health is a relative state and the problems with which the people approach doctors will change once they become healthier and therefore doctors have to work according to the changing and genuine health needs of the society. They should not be equipping themselves to meet the present trend of the artificially increased need for specialist doctors due to lack of a referral system and of Health Policy in this country, which is absolutely essential.  

Dr. PK Sasidharan
Prof, HOD, Department of Medicine. Medical College. Calicut. Kerala
Dean Faculty of Medicine, University of Calicut, Kerala
Email : sasidharanpk@gmail.com    

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